Acute muscle and tendon injuries

In football, you can sustain various injuries. Tissues such as muscles and tendons can be damaged. An injury can occur suddenly (acutely) or develop over a longer period. In this article, only acute injuries are discussed.

Acute muscle and tendon injuries can arise from external factors such as a blow, knock, or collision with another player. The cause can also lie within the body itself, such as with a muscle strain or tendon tear.

Different acute muscle and tendon injuries

Acute injuries that can occur in muscle or tendon tissue are:

• Muscle strain.
• Muscle contusion.
• Muscle cramp.
• Tendon tear (partial or complete).
• Acute compartment syndrome.

Below, we explain each of these acute muscle and tendon injuries. We then discuss how each injury is treated and what the risk factors are for acute muscle and tendon injuries.

Muscle strain
The most common acute muscle injury is a strain or tear. The terms muscle strain and muscle tear are often used interchangeably, while the same thing is meant.
A muscle strain has different grades, with the highest grade being a muscle tear. In every muscle strain, muscle fibres have torn; the amount and size of these determine the grade.

The muscles most sensitive to strain during football are the quadriceps, the hamstrings, and the calf muscles. An acute muscle injury usually occurs when initiating or braking a movement. That rapid change of movement imposes too great a load at that moment. The muscle cannot adapt quickly enough and sustains a strain. This is felt immediately as a sharp pain at that location.

Muscle contusion
A muscle contusion arises from a blow or knock to the body. This impact causes local muscle injury with bleeding. The best-known muscle contusion in footballers is the so-called dead leg. This is a contusion of the quadriceps muscle.

Muscle cramp
With muscle cramp, there are sudden painful involuntary muscle contractions. Muscle cramp occurs most often in the calf.
The exact cause of cramp is not entirely clear. It is probably due to excessive muscle activation. This also explains why footballers often do not get cramp in regular time, but do in extra time.

In addition, blood flow plays a role in the development of cramp. Blood flow provides the supply of oxygen and nutrients and the removal of waste products. (Nutrients, particularly salts, are important for a muscle to function properly).

Tendon tear
A tendon can tear partially or completely. The most common tendon tear in footballers is an Achilles tendon rupture, a tear in the tendon of the calf muscle. In addition, the tendons of the quadriceps or hamstrings can also tear. A torn shoulder tendon is rare. Goalkeepers have a somewhat higher risk of a tendon tear in the shoulder.

A tendon tear occurs without warning. The tear is usually in the part of the tendon where the blood supply is poorest. Older footballers are generally more sensitive to tendon tears, because as we age, blood flow decreases.

Acute compartment syndrome
A compartment is a group of one or more muscles that are held together by a fascia (connective tissue sheath). In a compartment syndrome, the pressure within a compartment increases.

A compartment syndrome usually develops over a longer period, but it can also arise acutely due to trauma. Due to a hard blow, knock, or major injury such as a fracture, the amount of fluid that develops can raise the pressure too high.

A compartment syndrome can have serious consequences for the blood supply. The blood vessels in the compartment can be compressed as a result.

It can happen that an acute compartment syndrome develops after a muscle contusion. In footballers, this can occur in the thigh or lower leg. Fortunately, this is very rare in footballers.

Treatment of acute muscle and tendon injuries

Muscle strain
For an acute muscle strain, the best treatment is immediate cooling and pressure (compression). Then a short period of rest (immobilisation) follows. This means that the muscle may not be loaded. The duration of this period depends on the severity of the strain.

Muscle contusion
After a muscle contusion, it is most important to limit bleeding and swelling. This can be done with ice and compression. At a later stage, stretching exercises and strengthening exercises follow. A muscle contusion should not be treated with heat or massage. This can increase the risk of myositis ossificans.

Muscle cramp
Stretch, stretch, stretch. By lengthening the muscles, you break the involuntary contraction of muscle fibres and relieve the cramp. After stretching, it is advisable to drink water or a sports drink with the right salts. If someone often suffers from cramp, drinking water or using the right minerals (including magnesium) can help to prevent cramp.

Tendon tear
After an acute tendon tear, loading is not allowed. If an Achilles tendon rupture or quadriceps tendon rupture is suspected, the player must go straight from the football pitch to the emergency department. Rapid treatment is important with a tendon tear. A physiotherapist can already examine on the pitch whether there is a tendon tear or a suspicion of one.

A complete tendon tear is operated on in most cases. The tendon ends are then sutured together. When the tendon is partially torn, a cast is more likely to be chosen to give the tendon rest. In this way, the tendon can grow back together fully.

Acute compartment syndrome
For an acute compartment syndrome in the thigh, rest is sufficient. For an acute compartment syndrome in the lower leg, surgery is the only correct treatment.

Risk factors for acute muscle and tendon injuries

Risk factors for sustaining an acute muscle or tendon injury are:

• Insufficient warm-up. Good blood flow is necessary for a muscle to function properly.
• Joint stiffness.
• Increased muscle tension.
• Fatigue.
• Ageing. As we get older, blood flow to tissues decreases, making, for example, a tendon more prone to tearing.

Advice

Acute muscle and tendon injuries can be different for every athlete. This means that it is important to have an injury properly examined by a physiotherapist. They will first assess what is going on and tell you what you can best do to prevent the complaints from getting worse.