Football is hard on the body. Across 23 elite European clubs, players picked up 8 injuries for every 1,000 hours of football, and the rate in matches was almost seven times the rate in training. A squad of 25 can expect around 50 injuries a season [1].
Most of the research comes from professional men’s football, but the same injuries turn up in Bangkok’s weekend leagues and five-a-side games. Here are the common ones, what reduces the risk and what good rehab looks like.
- Hamstring strains are now about a quarter of all injuries in elite men’s football.
- The Nordic hamstring exercise roughly halves the rate of hamstring injuries.
- Balance training after an ankle sprain cuts the chance of spraining it again.
- ACL prevention programmes reduce ACL injuries by about half.
- The FIFA 11+ warm-up cut injuries by 39% in recreational and sub-elite players.
- Suspected concussion means off the pitch, and no return that day.
Hamstring strains
The single most common injury in the UEFA study was a thigh strain, at 17% of all injuries [1]. Hamstrings lead the way. Over 21 seasons, hamstring injuries made up 19% of all injuries, and their share rose from 12% in the first season to 24% in the most recent [2].
They also come back. About 18% of hamstring injuries in that study were recurrences, and more than two thirds of those happened within 2 months of the player returning [2]. That points to players going back before the muscle is ready for sprinting.
The best-supported prevention is the Nordic hamstring exercise. You kneel with your ankles held, then lower your body forward as slowly as you can. A meta-analysis of 15 studies and 8,459 athletes found that programmes including it reduced hamstring injuries by up to 51% [3]. Those studies covered several sports, with football well represented.
Ankle sprains
Ankle sprains are common in any sport with cutting and tackling, and they often come back. In a trial of 522 athletes who had recently sprained an ankle, an 8-week home programme of balance exercises, done on top of usual care, cut repeat sprains from 33% to 22% over a year. That is a 35% reduction, and 9 people needed to do the programme to prevent one repeat sprain [4].
An overview of systematic reviews found strong evidence that bracing, and moderate evidence that neuromuscular training, prevents ankle sprains from coming back [5]. If you have sprained an ankle more than once, treat the rehab as seriously as you would a muscle injury.
ACL injuries
A torn anterior cruciate ligament (ACL) is the injury most players fear, and many ACL injuries happen without contact, when landing, cutting or stopping suddenly. Prevention programmes that train landing, cutting and strength reduced ACL injuries by about 50% overall, and non-contact ACL injuries in female athletes by 67%. There was not enough data to draw conclusions for male athletes alone [6].
After ACL reconstruction, the return to football matters as much as the surgery. In a Norwegian and US cohort, people who returned to jumping, cutting and pivoting sports had more than four times the reinjury rate of those who didn’t, and the risk of reinjury fell by 51% for each month that return was delayed, up to 9 months after surgery [7]. In 158 male professional athletes, those who returned without meeting six discharge criteria had four times the risk of rupturing their new ligament [8].
Our ACL rehab page sets out the stages of rehab and the criteria for returning to sport.
Concussion
Concussion is managed by doctors, but everyone on the pitch should know the rule. The FA’s guidance is that a player suspected of concussion must be removed immediately, in training or a match, and must not return to activity that day. Its slogan is “If in doubt, sit them out”. Under the FA’s graduated return for grassroots football, the earliest return to play is day 21 [9].
If you are worried about a head injury, get medical help straight away. In Thailand, call 1669 for emergency medical help.
The FIFA 11+ warm-up
The FIFA 11+ is a structured warm-up for football that combines running, strength, jumping and balance exercises, including the Nordic hamstring exercise. A meta-analysis of trials in recreational and sub-elite players found it reduced football injuries by 39%. The earlier FIFA 11 programme showed no clear effect [10].
For a weekend team, this is the easiest win available. Swap the usual jog and stretch for the FIFA 11+ before every training session and match.
Rehab that gets you back on the pitch
Good football rehab follows the same pattern whatever the injury. Settle the pain and swelling, rebuild strength and control, then load the injured area with the things football demands: sprinting, cutting, jumping, landing and kicking. Return is based on tests the player passes, not just time since injury.
At Aspire Physio Bangkok, rehab moves from the treatment room to our gym floor in the same building. See sports injury rehab, knee pain and hip pain, or book a free first consultation through our contact page. You can also call 082-281-8009.
Common questions
What is the most common football injury?
In elite men’s football, thigh muscle strains are the single most common injury, and hamstring strains alone made up 19% of all injuries across 21 seasons of the UEFA Elite Club Injury Study. Ankle sprains and knee ligament injuries are also common.
How do I stop spraining the same ankle?
Balance and coordination training works. In a trial of 522 athletes, an 8-week home programme of balance exercises cut repeat sprains from 33% to 22% over a year. Wearing a brace also helps prevent recurrence.
How long after ACL surgery can I play football again?
Base it on tests rather than the calendar, and don’t rush it. In one study, the risk of reinjury fell by about half for each month that return to sport was delayed, up to 9 months after surgery. Professional players who did not pass six return-to-sport criteria had four times the risk of rupturing the new ligament.
What is the FIFA 11+?
It is a structured warm-up programme for football that combines running, strength, jumping and balance exercises, including the Nordic hamstring exercise. In a meta-analysis of trials in recreational and sub-elite players, it reduced injuries by 39%.
References
- Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011;45(7):553-558. doi.org/10.1136/bjsm.2009.060582
- Ekstrand J, Bengtsson H, Waldén M, et al. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br J Sports Med. 2023;57(5):292-298. doi.org/10.1136/bjsports-2021-105407
- van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. 2019;53(21):1362-1370. doi.org/10.1136/bjsports-2018-100045
- Hupperets MDW, Verhagen EALM, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009;339:b2684. doi.org/10.1136/bmj.b2684
- Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113-125. doi.org/10.1136/bjsports-2016-096178
- Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J Orthop Res. 2018;36(10):2696-2708. doi.org/10.1002/jor.24043
- Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808. doi.org/10.1136/bjsports-2016-096031
- Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50(15):946-951. doi.org/10.1136/bjsports-2015-095908
- The Football Association. The FA concussion guidelines. Updated August 2023. www.thefa.com/-/media/cfa/global/files/2023/the-fa-concussion-guidelines.ashx
- Thorborg K, Krommes KK, Esteve E, et al. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 2017;51(7):562-571. doi.org/10.1136/bjsports-2016-097066
