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Why Do Our Sports Medicine Experts Focus on Football?

Football is a very popular youth sport, with over two million children and adolescents participating yearly across the city of Cincinnati and the entire country. Around half of these football players will suffer some degree of injury during the season. Our team of physicians, athletic trainers and physical therapists understand the rigors and demands of the sport and are equipped to treat these injuries. Cincinnati Children’s Sports Medicine physicians strive to provide the best and most updated care to football athletes and return them to competition as quickly and as safely as possible.

What is the impact on the body?

Injuries caused by overuse are common in football due to repetitive running, drills and conditioning. Broken bones, sprained or torn ligaments, and concussions are also common given high-speed collisions and the contact nature of the sport.

Tackling, especially with improper form or illegal tackling, can lead to head and neck injuries. Overall, these injuries are less common than injuries to other parts of the body but tend to be more severe. Our Sports Medicine physicians are here for you to answer questions and provide evidence-based care on these conditions to promote injury prevention and safe sport participation.

Common Football Injuries

Fractures

Fractures or breaks in the arms and legs are among the most common injuries seen in football. These can occur from falls or collisions. Younger children are more likely to sustain arm injuries than to leg injuries compared to adolescents due to differences in motor skills. If the athlete has an obvious deformity, significant swelling or can’t move their extremity, they should be seen urgently for evaluation. The time table for returning to the field and treatment options will vary depending on the location and severity of the injury.

Concussion

A concussion is a mild brain injury that occur from a direct hit to the head or whip-like motion to the head or neck injury from hitting another player or the ground. Unfortunately, helmets do not prevent or protect against concussions. Concussions are seen the most in tight ends and defensive lineman but occur in any player on the field. Common symptoms of concussions include headache, dizziness, nausea, light or sound sensitivity, change in mood and trouble concentrating. Concussions are common in football given the high speed collisions and tackling involved in the sport. Athletes with a concussion should be removed from play immediately and be cleared by a medical professional before returning to any contact.

Visit the Brain Health and Wellness Center to learn more about concussion recovery.

Heat Illness

Football players are at risk for heat-related illness such as heat cramps, heat exhaustion or heat stroke as they often start play in hot and humid months and wear several pieces of equipment. Athletes should gradually increase how long and how much activity they are doing in the heat, ideally over a two-week period. Adequate hydration with frequent water breaks and rest are key to prevention. Signs of heat illness can include headache, vomiting, acting differently, dizziness, weakness, fatigue or high body temperatures. Quick recognition and treatment with rapid cooling are imperative.

Lower Extremity Injuries

Knee injuries

Knee injuries are common in football, especially injuries to the medial collateral ligament (MCL), the anterior cruciate ligament (ACL) and the meniscus.

The MCL is a ligament on the inner portion of your knee and can be injured when the outer side of the knee is hit while blocking or tackling. Treatment includes rest, bracing and physical therapy.

The ACL is a ligament inside your knee and helps stabilize the knee joint. The ACL can be injured during a tackle or when athletes are cutting while running. Full ACL tears are typically treated with surgery.

The menisci are cartilage and can be torn when the knee is twisted while bent. Meniscal tears are managed based on the severity but often require surgery. These injuries in children are best treated with the help of a pediatric sports medicine or pediatric orthopedic surgeon as their growth plates are still open and require expert care and attention.

Hamstrings

The hamstrings are one of the most commonly injured muscle groups in football. The hamstring is a large muscle group in the back of the thigh and can be injured when an athlete suddenly starts or stops sprinting. This can be a recurrent injury due to returning to sport too early or inappropriate treatment. Repetitive injuries to these muscles can increase time away from sport. Risk factors include poor flexibility of the hamstring musculature, prior injury, improper conditioning or weak core muscles. Proper rehab with an athletic trainer or physical therapy is key to returning to pre-injury function and capacity.

Quadriceps Contusion

A quadriceps contusion is the most common soft tissue injury seen in football and occur from blunt trauma to the front portion of the thigh. The quadriceps is a muscle group that consists of 4 muscles that live on the front of the thigh.Treatment includes ice, anti-inflammatory medications, rest and rehabilitation. It is important to stretch the quadriceps during this injury to maintain range of motion and help prevent a complication such as myosistis ossificans -- calcific changes in the muscle that can occur in improperly treated contusions.

Turf toe

Turf Toe is sprain to the ligament on the underside of the toe, most often the big toe. It occurs due to repetitive extension of the big toe while the foot is planted on turf surfaces. Treatment is with rigid shoe inserts, padding or taping the big toe, ice and anti-inflammatory medications. Sports participation depends on the degree of pain and motion of the affected toe.

Upper Extremity Injuries

Shoulder injuries

AC (Acromioclavical) Sprain / Separated shoulders are routinely seen in football players and represent an injury to a ligament in the acromioclavicular joint, where the shoulder blade meets the collar bone. These often occur from falling directly on your shoulder or outstretched hand while being tackled or a direct hit to the shoulder during a tackle or block. AC joint Injuries can vary from minor sprains that improve with rest and therapy to more severe than can require surgery.

Shoulder Instability can occur due to repetitive hits to the shoulder or a sudden direct hit that dislocates the shoulder. Instability events can increase risk for labral tears. The labrum is the ring of cartilage that helps to hold your shoulder joint in place. Players should be seen in the clinic for a physical exam. Dislocations frequently require MRI’s and referral to an orthopedic surgeon due to the high likelihood of repeated dislocations.

Finger injuries

Mallet Finger is an injury to the distal joint (knuckle closest to the finger nail) where athletes can’t fully extend or straighten the tip of the finger. It is an injury to the tendon on the nail side of the finger or a fracture of the small bones of the finger called the "phalanges". Mallet finger generally occurs from a ball or object hitting the end of the finger. Early treatment is ideal and requires splinting the finger in full extension (fully straight) for at least 6 weeks.

Jersey Finger is an injury to the tendon that bends the tip of the finger, most commonly seen in the ring finger. It happens when a football player is reaching to grab the jersey while the opponent is running away, causing the finger to straighten forcefully. Prompt recognition and referral to an orthopedic hand specialist is necessary.

Spine injuries

Spondylolysis is a stress fracture in the vertebrae bones of the spine, often seen in offensive and defensive linemen from repetitive extension of the back. Athletes typically describe gradual onset of pain that is worse with leaning backwards. Treatment with rest and physical therapy is necessary. Return to sport can take 2-3 months.

Burners / Stingers (Brachial Plexus Neurapraxia) is the most common nerve injury in football players, normally seen in defensive players. It occurs when the neck is forcefully bent to the side while making a tackle or falling. It results in stretching or compressing the nerve complex that travels from the spine through the neck and down into the arm and hand called the Brachial Plexus. Symptoms include numbness or tingling down one arm with or without weakness that resolves within a few minutes. Once range of motion and strength return to normal, full football activities can resume. Repeated stingers, neck pain, symptoms down both arms or symptoms that do not resolve within a few minutes can suggest more serious injury. Athletes should be evaluated and cleared by a trained physician prior to return to any contact.

Tips for Parents and Coaches

Football players demonstrate heads-up tackling.

Parents: Make sure your child has the proper equipment and a well-fitted helmet. Educate yourself and your family on common signs and symptoms of concussion and how to treat them. Discuss with your child the importance of following the league rules on tackling. Ensure your child is well hydrated and eats a well-balanced diet. Remind your child to stay focused and involved in school in addition to sport.

Coaches: Coaches should be trained in common injuries and concussions and have a first aid kit available at practices and games. Tackling should be delayed until older ages to prevent more serious head and neck injuries in younger children. Proper tackling techniques should be taught and enforced in practices and in games. Additionally, hits to the head and neck area should be discouraged in practices and game play. Coaches should advocate for a skilled athletic trainer and or physician to be present on the sidelines of games. Players should have free access to water at all times.

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