Treatment and prevention of soccer injuries - part I

The symptoms and emergency treatment of a number of common injuries are described below. Suggestions are also given for avoiding such injuries. A number of serious, but less common, injuries are also described.

Nosebleed

A nosebleed involves bleeding in one or both nostrils. There are many possible causes. The most usual cause is a nose injury. A nosebleed should be treated by pinching the player’s nostrils and keeping them closed for one minute. The head should be inclined slightly forward. The nostrils can then be slowly and carefully allowed to open again. If bleeding resumes, there is a good chance that clotted blood is holding the edges of the wound apart. These clots of blood must be removed from the nose before another attempt is made to stop the flow of blood. This can be done by firmly blowing the nose into a handkerchief. The nostrils should then be pinched together again as described above. If there is still no success, one more attempt can be made. If this fails to help, it is advisable to consult a doctor to go to a hospital first-aid department. The shape and condition of the nose must also be looked at. The nose might be broken. If there is any suspicion of this, the player must be taken to hospital as soon as possible for examination.

Scrapes

Soccer players frequently carry out sliding tackles, in the course of which they may scrape their hips or, to a lesser extent, their knees. The main danger associated with scrapes is that infections may occur through the open wound. This must therefore be immediately and carefully cleaned, removing as much dirt as possible. This can best be done with running water and disinfectant soap. Do not run water directly onto the wound. If necessary, use a clean, soft brush. When this has been done, apply iodine to the wound and the adjacent skin. The blood and pale yellow fluid subsequently dry and form a crust. The wound should never be dried with powders, because this would hinder the healing process. A scrape heals fastest by being exposed to the air. If clothing is worn over a wound, the wound must be covered with a bandaid or sterile gauze to prevent infections. If a wound is very badly soiled, a doctor should be consulted. Players are less likely to sustain scrapes if they wear protective clothing or other material. Coating the most vulnerable areas with a layer of Vaseline also has a preventive effect.

Blisters

Blisters are caused by excessive friction and pressure, especially on the heels, toes and ball of the foot. The surface skin is displaced with regard to the underlying layer, and moisture is therefore formed between the two layers. Friction between the skin and clothing can also cause blisters. This can happen when new boots are worn. An area of inflamed skin appears before a blister forms. It is advisable not to burst a blister. If this is unavoidable, the following procedure must be followed:

1. Apply iodine to the blister and the surrounding skin.
2. Sterilize a needle by, for example, holding it in a frame.
3. Prick the edge of the blister, then prick the opposite edge.
4. Use sterile gauze or absorbent cotton to press the moisture out of the blister, from the center outward.
5. If you have a pipette, drip a little iodine into the blister.
6. Squeeze the blister again until no more fluid emerges.
7. Apply iodine to the blister and the surrounding skin again.
8. Cover the blister with sterile gauze or a bandaid.
9. If necessary, spray a “second skin” over the blister.

If a blister is not a hindrance during a training session or match, it is better to cover it with layers of bandaid, arranged like tiles on a roof. The blister will dry out within a few hours or days, and will then present no more problems. If a blister is formed under a thick layer of horny skin on the foot, it is advisable to consult a doctor or chiropodist. Wearing comfortably fitting boots can prevent the formation of blisters. When new boots are worn, they should be “run in” properly before they are worn during a complete training session or match. Soap or Vaseline can be applied to the inside of the heel to reduce friction. Wetting the socks and smearing them with soap is another good method.

Cuts

A superficial cut only affects the skin. Deeper cuts may damage the underlying structures. The cuts sustained by soccer players are often caused by studs with a ragged edge. Hygiene is a very important aspect of the treatment of cuts. Any infection must be prevented. A small wound must be sterilized with iodine and then covered with gauze or sticking bandaid. Longer and deeper cuts must be treated by a doctor. There are two reasons for this. Firstly, they need to be inspected to determine whether underlying blood vessels, nerves and muscle tendons have been damaged. Secondly, such cuts, and especially facial cuts, have to be stitched carefully.

Bruises

A bruise is an extravasation of blood into the skin or underlying tissues due to tissue damage. Such damage is caused by the violent impact of an object against the body. Examples of such impacts are a knee against the thigh, or a kick against the shin. The symptoms of a superficial bruise are:

• in most cases, brief localized pain;
• loss of function, which, depending on the positon and strength of the violent impact, can range from mild to considerable;
• swelling as a result of extravasation of blood;
• a subsequent black and blue discoloration.

The swelling and the discoloration are only visible if the deeper-lying muscles are bruised. Bruises must be given the RICE treatment. A minor swelling begins to recede after 48 hours. Recovery must then be stimulated with a hot shower, light massage, or gentle exercise below the pain limit. Extensive massage is out of the question during the first 24 to 36 hours, because this would damage the recovering tissues again. A doctor or a physiotherapist is the most suitable person to determine the severity of the bruising of a muscle, and to determine how to handle it. Inexpert treatment of a bruised muscle can result in the deposition of calcium in the muscle tissue, causing permanent functional impairment. Bruises can be avoided in the same way as broken bones, by protecting the vulnerable parts of the body with specific equipment such as shinguards and padding.

Sprains

A sprain involves damage to the tissues in and around a joint, usually the ligaments of the joint and their connections to the bone. Sometimes the surrounding muscles are also damaged and, in serious sprains, joint capsule. Depending on the severity of the sprain, the ligaments may be torn or ruptured. A sprain is a consequence of an abnormal movement. The joint that is most frequently sprained in soccer is the ankle. In addition, goalkeepers often sprain their wrists and fingers. The symptoms of a sprain can vary from:

• mild, short-lived pain;
• no or minimal swelling;
• no or slight impairment of function;
• slight tenderness to the touch;
• extreme, persistant pain;
• major swelling due to extravasation of blood in and around the joint immediately after the injury is sustained;
• complete loss of function;
• a cracking noise or sensation.

A mild sprain should be treated by cooling it and applying a pressure bandage. Sporting activity can then be resumed. Sport must not be carried out if:

• the joint becomes more painful;
• swelling occurs;
• the player’s movements clearly indicate a functional impairment.

A player who suffers a serious sprain must be immediately withdrawn from the training session or match. It is advisable to consult a doctor or visit a hospital within 24 hours. Knee and ankle sprains, which are very prevalent in soccer, can be avoided to some extent by providing the joints with more support. Research has shown that 75% of soccer ankle sprains are sustained by players who have previously had such a sprain. Soccer players who have “slack” ankle ligaments also have a higher risk of suffering sprains. This group of players should have their ankles taped during training sessions and games. It takes 6 to 9 months to recover completely from a serious sprain. During this period, it is advisable to tape the ankle. It is also good idea to strengthen the muscles. This must be done by means of specific exercises for the muscles that have a supporting function in the injured joint.

Dislocations

A dislocation is the most serious type of sprain. When a dislocation occurs, there is no longer any contact between the articulating bones that form the joint. This results in serious damage to the joint capsule and ligaments. Soccer players often dislocate a shoulder when they fall awkwardly. Goalkeepers regularly suffer longer dislocations when they catch the ball incorrectly. Ankle, knee and hip dislocations also occur. The symptoms of a dislocation are:

• extreme pain when at rest and in motion;
• swelling due to extravasation of blood;
• abnormal shape and position of the joint(this can be seen by comparing the right and left sides);
• loss of function due to complete inability to move the injured joint.

The joint must be returned to its correct position as soon as possible. A doctor should therefore be called in immediately. Unqualified persons should never try to put a dislocated joint back into place themselves. The only thing that an unqualified bystander can do is immobilize the joint. It is also advisable to cool the joint, so that the swelling will decrease. Under no circumstances should anyone with a dislocated joint continue playing. Dislocations are caused, in particular, by the considerable range of movement and the less efficient development of the ligament system and the corset of muscles around the joint. Good recuperation is vital after a dislocation. Incomplete recovery can result in reccurence of the dislocation. For this reason, players who suffer sprains must concentrate on strengthening and coordination exercises. If the muscles attached to the affected joint are strengthened, they can help to prevent a subsequent recurrence of the dislocation. Joints that have already been dislocated in the past should also be protected by a supporting brace, bandage or tape during training sessions and matches.

Bursal damage

Bursae can be compared to cushions filled with fluid. These small cushions are located between skin and bone and between tendon and bone. Bursae are found at sites where there is a lot of friction, or where a lot of pressure is exerted. The most familiar bursae are above the kneecap and behind the lowest part of the Achilles tendon or the knee tendon. Bursae have a protective function. They protect the underlying tissues against violent impacts, such as those that regularly occur when a goalkeeper lands on his hip or elbow. Acute bursal damage is associated with the presence of blood in the bursa. The blood can cause inflammation. Long-term irritation can also result in inflammation in and around a bursa. Acute damage is characterized by symptoms such as:

• rapid swelling;
• pain, together with reddening of, or damage to, the skin.

Persistent irritation is usually associated with the following symptoms:

• gradual swelling;
• local heat and reddening;
• painful movement, which becomes worse during sporting activity.

Bursal damage should initially be treated by rest, avoidance of any painful movements, keeping the site cool for 48 hours, and application of a pressure bandage. A doctor should then be consulted. A doctor can prick the bursa, remove blood and fluid and, if necessary, prescribe inflammation-inhibiting drugs. A physiotherapist can treat the bursal damage so that the inflammation process is brought to a stop more quickly. Sometimes the inflammation recurs, even if protective material is worn. The doctor in charge must decide whether an operation is necessary.

Muscle cramp

Every soccer player has suffered a muscle cramp at some time or other. When muscle cramp occurs, the muscle tenses and contracts of its own accord, which results in a very unpleasant feeling. Muscle cramp is usually experienced at the end of a very tiring match or training session. Soccer players suffer most from cramp in the calf muscles. It is treated by active stretching(pointing the toes towards the nose as far as possible, and stretching the calf muscles). Passive stretching by a teammate or a bystander must be carried out very carefully, to ensure that no tearing of the muscle fibers occurs. Another possibility is to grab hold of the muscle with one or both hands, and to stretch it diagonally while gently squeezing. Sporting activity must be resumed carefully, and must be stopped immediately if the cramp returns. Although this phenomenon is far from fully understood, there are a number of possible causes of muscle cramp:

• a slight muscle tear;
• excessive loss of fluid and salt;
• sudden cooling;
• disturbances of the blood circulation;
• lack of muscle fitness or general physical fitness.

Muscle cramp can best be treated by tensing the group of muscles whose action opposes that of the affected muscles. This causes a movement in the opposite direction(biceps/triceps, hamstring/quadriceps). Muscle cramp can be avoided by:

• maintaining a good level of physical fitness;
• wearing the correct(non-pinching) clothing;
• checking bandages, etc. during warming-up, to ensure that they do not pinch;
• drinking regularly if the weather is hot.