Thigh injuries in soccer

Muscle ruptures

Musculotendinous injuries or strains are some of the most common injury types in soccer, but also some of the easiest to prevent. In a Swedish study in 1980, the incidence of musculotendinous injuries in male senior soccer players was found to be 18%. After introduction of preventive measures such as stretching, proper warm-up, and cool-down, the incidence was found to be lower than 5% in a similar study in 1990.

Most muscle injuries affect the lower extremity especially the quadriceps, hamstrings, adductors, and gastrocnemius. Muscle ruptures can be total or partial. Total ruptures can be palpated as a defect in the muscle under contraction. Surgery should be considered for total ruptures of thigh muscles. Partial ruptures are more common and they are as a rule treated conservatively. There are two major causes of muscle ruptures in soccer players: a) compression, as a result of direct impact; b) distraction, as a result of overstretching or overload.

Symptoms and diagnosis

The diagnosis is usually clinical with pain, tenderness, and spasm in the affected muscle. The clinical diagnosis of an acute muscle injury can however sometimes be unreliable. Real ruptures of muscle fibers and hematomas due to bleeding from connective tissue vessels can both create the same pain and tenderness, but the prognosis is quite different. While hematomas due to bleeding from connective tissue vessels disappear in a few days, real ruptures take 2-12 weeks to heal. Therefore it is valuable to complement the clinical diagnosis with other diagnostic measures such as sonography, computerized tomography(CT), or creatinine kinase(CK) measurements.

Treatment

The treatment of these muscles includes RICE therapy. The rehabilitation should be gradual. Re-injuries are known to be common. However, re-injuries could be minimized by exact diagnosis, intensive immediate treatment, guided rehabilitation, and prophylactic measures such as stretching.

Heterotopic bone(myositis ossificians)

Heterotopic bone formation may follow hematoma formation in an injured muscle as a result of a contusion or strain. The most common location in soccer players is the quadriceps femoris and lateral hamstrings muscles. By the use of stretching for prevention and RICE therapy for acute treatment of muscle injuries, the development of myositis ossificans is rarely seen. The size of the heterotopic bone formation may cause functional impairment.

Symptoms and diagnosis

The diagnosis is verified on X-ray examination. Osteogenic sarcoma should thought of in the differential diagnosis.

Treatment

Surgical excision of the ossification should be considered if there is functional impairment.

“Handbook of Sports Medicine and Science - Football(Soccer)”, Björn Eklbom