Matt Rawlins is a Physiotherapist and Clinical Mentor based in the Midlands. He has a keen interest in football and a wealth of experience providing pitch side and rehab physiotherapy up to a professional level, most recently working for Birmingham City FC Academy.
I have always been a football fan, so being able to help people fulfil their potential on the pitch is something that I’m passionate about.
Hamstring tears and ankle sprains are the most common injuries that I see, but football is very leg focused so you are liable to strain or damage many different areas.
Unfortunately, some people can be predisposed to this, particularly if you have been playing for many years, have overtrained the muscles or have an underlying weakness.
Injuries can be unavoidable if it’s due to a bad tackle or unexpected move, but there are a number of ways you can protect yourself and stay on top of your game.
Matt's top ten physio tips for footballers
1. Wear the right footwear
You’re using your feet a lot, twisting and turning, so footwear is important. It doesn’t have to be expensive or the latest gear, but your shoes should fit you properly and be changed if you notice wear and tear, or roughly every 12-18 months if you play regularly.
Use the right footwear at the right time. You want to be using old style metal studs for a grass pitch or an area that might be boggy, blades on a harder pitch and moulds on a plastic or AstroTurf pitch.
2. Warm up properly
In football you’re going to be performing a lot of agile movements quickly, so you must prepare your body by warming up key areas like the hamstring effectively.
You should spend a good 15-20 minutes gently warming up. This is about getting the blood flowing to the area, preparing the body for harder exercise and improving the elasticity of the muscle.
If you haven’t warmed up then your range of movement is reduced and you increase your risk of injury. A good warm up should include:
- Low intensity high repetition range of movement exercises that move through all of the positions you might get into during the game, including jogging.
- Sport specific drills – including ball skills, dribbling and jumping.
- Moderate intensity dynamic drills such as shuttle runs or agility runs.
3. Mix up your training
Building core strength and stability in the lower limbs through other forms of training can be hugely beneficial.
A lot of premier league footballers do Pilates and Yoga for this reason as it’s great for balance and stability. Leg training in the gym can also be beneficial as can exercises like swimming and cycling.
People come into clinic and say that their hamstrings feel tight, but often this is due to overuse or an underlying weakness that can be resolved with strength building.
4. Warm down
You’re often training outside in a variety of weather conditions and for a number of hours, so it’s essential that you don’t just stop straight away or go home without warming down. It can be a shock for your muscles and lead to unnecessary aggravation.
Foam rollers are great for reducing the feeling of tightness in the soft-tissue and many professionals opt for ice bath to reduce lactic acid, but leg stretches can be just as effective.
Lactic acid is removed by the body through blood flow to the area and so a warm down helps prevent what we call DOMS (Delayed Onset Muscle Soreness), which is essentially the aching the next day after exercising intensely.
5. Deal with an injury correctly when it first happens
Leave the pitch as soon as you have an injury. If it’s a sprain, strain or injury to the soft-tissue then sit down and follow the principles of PEACE and LOVE:
During the first 3 days of an injury, your body enters what we call the ‘inflammatory stage’. This stage is often the most painful and needs the correct management, known as PEACE:
P Protection - avoid activities and movements that increase pain for the first few days.
E Elevation - elevate the injured limb higher than the heart as often as possible.
A Avoid taking anti-inflammatory medication as they can reduce tissue healing. Avoid icing for more than 5 minutes.
C Compression - use a compression bandage or taping to reduce swelling.
E Education - your body knows best. Avoid unnecessary treatments and medical investigations and let nature play its role.
What else should I avoid?
During the first 3 days after injury you should remember the ‘NO HARM’ protocol.
This means no:
- Running / exercise
These activities may prevent or slow down the healing process.
What should I do after the first 3 days?
After this time, and for the next 7-14 days the injury needs LOVE:
L Load - let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load.
O Optimism - condition your brain for optimal recovery by being confident and positive
V Vascularisation - choose pain-free cardio-vascular/aerobic activities to increase blood flow to repairing tissues
E Exercise - restore mobility, strength and balance by adopting an active approach to recovery.
Here’s some more information about some of these stages:
Avoid any activities that increase pain and protect the area from further damage. However complete rest should be minimised as this can also delay repair. Move your injured part little and often into directions that do not cause sharp pain when you are sitting down or when there is no weight going through the area. Do not move into any positions that caused the injury in the first instance. For example, if you twisted your knee, don’t twist it into the same direction or position again. The use of a brace or splint may be helpful depending on the severity of the injury.
Keep the affected area supported and higher than the joint above it.
For example, if the injured area is your ankle then sit with your leg out straight supported on a pillow to raise it higher than your knee. This will prevent excessive swelling.
This should be done as much as possible in the first 3 days if swelling is a problem.
Avoid anti-inflammatories and icing for long periods
Icing the area can help with any pain relief, but it may also interfere with healing tissues if applied for long periods. If you’d like to use ice for pain relief, follow the steps below during the first 3 days, after this time you can use ice for up to 20 minutes.
- Rub some barrier oil or moisturiser on the area you are going to ice. This can be olive oil, vegetable oil, almond oil or whatever you have. This helps to avoid any sticking.
- Wrap crushed ice, frozen peas or a chill pack from the freezer in a clean and damp tea-towel.
- Place over the area and secure with another towel.
- Never place your calf or thigh on top of the ice, always place ice on the body part as the extra compression can increase the risk of an ice burn.
- Leave for 5 mins and remove if it gets painfully cold (after 3 days this can be left for up to 20 minutes).
- Repeat every 2 hours for acute or severe injuries or 3-4 times a day for less serious injuries or complaints.
- The skin will look pink when you remove the ice but this is normal.
Do not apply ice if you have any loss of sensation or numbness in the area, extreme sensitivity to cold, poor circulation in your hands or feet, Raynaud’s disease or broken skin.
Some people find a compression bandage or support helpful in the early stages of a soft-tissue injury. This is optional, not essential, and should not be used if you are also elevating the area.
Then after 3 days…
This is a technical way of saying keep the area moving as much as you are able to and within your comfort zone. You can still do this with the use of a brace or splint to support the area.
During this period, the injured area will still feel quite sore, weak, swollen and difficult to move.
This is the time when small, controlled movements can really help the healing tissues form in the right direction and pattern to ensure the newly healed area becomes flexible and strong like the original tissue was.
Frequent movements in all of the directions that the area will move into will help. This should not be against any weight or pressure, just gentle repeated movements every few hours.
If you are unable to weight bear and pain does not improve after 1-2 hours then you should seek additional medical attention by calling 111, attending a walk in clinic or A&E.
Even if you play for a small team then I would strongly recommend clubbing together and buying an emergency first aid kit/equipment.
6. Don’t train through pain or injuries!
If you continue to play football with an injury, pain or when you experience a flare up of an old problem, then you are putting your long term health and performance at risk.
If you have an injury or complaint that hasn’t started to settled down within 4-5 days then stop training and seek help from a physiotherapist or a healthcare professional.
As an example, with an ankle injury if it’s rehabilitated well you can be back to normal and playing within a month, whereas if you leave it, it can become a long term chronic problem.
7. Think about your lifestyle off the pitch
Football and drinking often go hand in hand, but living a healthy lifestyle and eating a balanced diet is important if you are serious about your performance.
Studies have shown that smoking can weaken tendons and it’s really important that if you train regularly, you provide your body with the nourishment that it needs.
8. Give your body a rest
Chances are that you have a day job and other activities that you have to do alongside your training, so don’t be afraid to pair things back if you feel over tired or stretched one week.
Sometimes the pressure and buzz of an impending match can lead you to train more, but it’s important that you leave a day for rest 24 hours before and 24 hours afterwards if you have exerted yourself heavily.
Getting a good quality of sleep is also really important as it allows your muscles and body to repair itself properly.
9. Use manual therapies to stay in top condition
People often wait until they are in a lot of pain before they see a physiotherapist, but it can be hugely beneficial to seek help before a small problem escalates.
If you are serious about your football then you may want to consider proactive physiotherapy every 4-6 weeks even if you are not injured. This physio should include what we call ‘manual therapies’ such as soft-tissue massage and joint mobilisation, alongside a general review of your strength and function.
Professionals have regular treatment and preventative soft-tissue massage as it has been proven to improve the quality of the tissue and the condition of the body.
10. Check your function
Sometimes it can be really frustrating when you feel that you are unable to progress your training or keep getting held back.
Physiotherapy can provide you with a functional body assessment. This is when we look at the biomechanics of how your body functions as a whole, which may reveal areas of underlying weakness that you didn’t know about, for example tight groins or hip flexors.
Together we can work on a plan that will help you to reach your goals and stay in top condition, which may include simple adjustments to your routine or more intensive manual therapies.