The Treatment Room
What Gives You Cramp?
Cramp is another common injury for athletes at all levels and affects hard working muscles such as the calves in runners and the arm in tennis players.
But despite being able to cure all kinds of killer diseases, scientists still don't know what causes it!
WHAT IS CRAMP?
It is when a muscle goes into spasm and refuses to relax.
The pain in the affected muscle can range from a slight spasm to agonising pain. It can last a few seconds through to 15 minutes and can recur.
WHY DO WE GET CRAMP?
There are three major factors:
- Fatigue: Cramp sets in when our muscles are tired
- Hydration: We get cramp when we have not drunk enough water
- Conditioning: The less fit we are, the more likely we are to suffer from cramp
WHO DOES IT AFFECT?
Cramp is common in most athletes, especially long distance runners and tennis and football players.
HOW DOES IT HAPPEN?
It can set in during long bouts of exercise, particularly when the weather is hot and a player is dehydrating.
TREATMENT?
The immediate treatment for muscle cramp is to stretch and gently massage the muscle. Use ice packs for severe cases and drink water or a sports drink.
Grasp the muscle with one hand and pull back on the toes with the other. Point toes upward to help relieve the spasm.
You can continue exercising after massage but if the pain is too acute then 24 hours rest is advised.
HOW CAN YOU AVOID CRAMP?
A proper warm-up (especially stretching) is essential, good fitness, plenty of fluid and a nutritious diet. Top of Page
Hamstring Injury Explained
- a first degree strain is damage to a few muscle fibres,
- a second degree strain is damage to a more extensive number of muscle fibres,
- a third degree strain is a complete rupture of the muscle itself.
- Adductor Brevis
- Adductor Longus
- Adductor Magnus
- Gracilis
- Pectineus
- a first degree strain is damage to a few muscle fibres
- a second degree strain is damage to a more extensive number of muscle fibres
- a third degree strain is a complete rupture of the muscle itself
- Warm up prior to matches and training is thought to decrease muscle stretch injuries because the muscle is more extensible when the tissue temperature has been increased by one or two degrees. Warm Pants (Compression Shorts) are extremely effective at maintaining muscle temperature, even in cold conditions. They provide warmth and support and are extremely effective at preventing muscle injuries.
- Recovery after training sessions and matches can be enhanced by performing a cool down. Ideally the cool down session should take place the day after the activity. This is thought to help muscles get rid of waste products. This is also the ideal time to do stretching exercises. ( Professional Cool Down Guide )
- Maintaining good muscle strength and flexibility may help prevent muscle strains. Muscle strength allows a player to carry out match activities in a controlled manner and decreases the uncoordinated movements which can lead to injury. Core strength exercises using a Swiss Ball are ideal. Tight muscles are associated with strains and stretching on a mat should also be practiced to maintain muscle length and prevent injury. (Guide to Core Strengthening Exercises )
- Diet can have an effect on muscle injuries. If a player's diet is high in carbohydrate in the 48 hours before a match there will be an adequate supply of the energy that is necessary for muscle contractions. However, if the muscles become short of fuel, fatigue can set in during training or matches. This fatigue can predispose a player to injury. Carbohydrate and fluids can be replenished during training and matches by taking an Energy Drink or Energy Gel periodically during activity. Top of Page
The Hamstring muscle group comprises three muscles - biceps femoris, semitendonosus and semimembranosus. The action of these muscles is to bend the knee and extend the hip.
Hamstring Injury Signs & Symptoms
With a grade one Hamstring strain the signs may not be present until after the activity is over. There may be a sensation of Hamstring cramp or Hamstring tightness and a slight feeling of pain when the muscles are stretched or contracted.
With a grade two Hamstring strain there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain on stretch and contraction of the muscle. A grade two Hamstring strain is usually sore to touch.
A grade three Hamstring strain is a very serious injury. There is an immediate burning or stabbing pain and the athlete is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is. After a few days with grade two and three injuries a large bruise will appear below the injury site caused by the bleeding within the tissues.
Hamstring injuries can be a real irritant because they can occur again and again.
But with careful prevention and rehabilitation, there is no reason that they cannot be cured.
WHO??
Newcastle striker Michael Owen has had problems with injuries to his hamstring, and Manchester United winger Ryan Giggs has also suffered.
Quite often fast players are affected by this type of injury. Sprinters are also prone to hamstring pulls and tears.
HOW?
They occur when you over-extend the muscle in the back of the leg.
Warming up properly is the best way to prevent this injury.
WHAT?
Sudden onset of pain or a pop in the thigh.
TREATMENT?
Rest, ice, elevation of leg and a proper recovery program.
RETURN?
Within 2-4 weeks depending on severity.
BBC Cruciate Ligament Injury Video Clip
http://news.bbc.co.uk/sport1/hi/northern_ireland/gaelic_games/14250867.stm
What is a cruciate ligament?
Many footballers have suffered recently from cruciate knee injuries.
It results in a lengthy period on the sidelines, but why is it so serious?
WHAT IS A CRUCIATE LIGAMENT?
There are four main ligaments in the knee - one on either side and two across the middle.
· Medial collateral ligament (MCL)
· Lateral collateral ligament (LCL)
· Anterior cruciate ligament (ACL)
· Posterior cruciate ligament (PCL)
The ACL is behind the kneecap (patella) and is in front of the PCL.
It's the second strongest ligament in the knee and stabilises the joint, connecting the thigh bone (femur) and the leg bone (tibia).
The ACL and PCL limit the over straightening, over bending and rotation of the knee.
The average length of the ACL is around 35mm, weighing around 20g.
The medial ligament is one the inside of the knee, with the lateral on the outside.
OPERATE OR NOT?
Surgery is not always essential when the ACL is ruptured.
But in the case of a young sportsman looking to return to sport as soon as possible, it will be.
A middle aged or older person could recover without going under the surgeon's knife.
However, it is believed that repairing the ligament can reduce the risk of getting arthritis in the joint later in life.
Surgeon's will usually graft tissue from either the patella or hamstring tendons to repair the ACL.
Basically the new tendon replaces the ACL and is usually attached to the bones above and below the knee by screws.
The success rate for such operations is high and while the injured person can soon be up and walking, running and twisting are some months further down the line.
ROAD TO RECOVERY
Medical expert Bevan Ellis says: "Many top athletes will go through an accelerated rehabilitation programme to get them back in action within six months.
"It requires intensive physiotherapy which needs to be monitored very closely at every stage.
"For a typical person, an ACL injury would normally take between 8-12 months to get back to full fitness."
Phase one (0-2 weeks after surgery)
The knee will be swollen after the operation, so the first job is to reduce the swelling.
After that, the physio will make the patient do a few light exercises like isometric contractions - keeping the leg still but moving the muscles around the knee.
Phase two (2-6 weeks after surgery)
The swelling should have disappeared, but the graft usually weakens around this time.
The physio may have to back off from the rehabilitation programme until the ligament is up to more exercises.
The patient should be walking normally by then.
Phase three (6-12 weeks after surgery)
By this stage, the knee should be getting stronger and able to take more strain.
The patient should be able to go swimming and use a road bike to get the knee back on track, as well as doing more strength exercises.
Phase three (3-6 months)
The patient will have their full range of movement and strength back, so they can start running properly once more.
They should be able to get back to specific drills and training.
Phase four (6-12 months)
The patient should be able to return to playing sport with their surgeon's approval.
The lowdown on an Achilles injury
A rupture to the Achilles tendon is a very common injury in male athletes .
WHO?
Most common for footballers, basketball, tennis and badminton players.
HOW?
Usually due to heavy landing on the fall and through wear and tear.
A tendon is a band or cord of dense fibrous tissue at the end of a muscle which attaches it to a bone.
The Achilles tendon is what attaches your calf muscles to your heel.
WHAT KIND OF PAIN?
Intense pain just above the heel. People often think they have been hit from behind. Swelling and bruising in leg and foot.
TREATMENT?
Doctor will either put you in cast for 4-10 weeks or operate and provide walking boot.
RETURN?
Around three to four months.
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Did you know? |
Healing ligament damage
Ligament injuries in athletes are common especially around the knee and ankle.
WHAT IS A LIGAMENT?
A ligament is a short band of tough, flexible tissue, made up of lots of individual fibres, which connect the bones of the body together. They can be found connecting most of the bones in the body.
HOW?
Twisting, or landing on a knee or ankle that is over-extended.
A heavy landing or awkward turn when the ligaments around a particular joint are at full-stretch can cause it to tear away from the bone.
Or even tear apart.
The four different grades of injury are:
· Partial ligament tear
· Complete ligament tear
· Partial bone tear
· Complete bone tear
WHAT KIND OF PAIN?
Sudden onset of pain and severe swelling.
TREATMENT?
Rest, ice and steady recovery program.
RETURN?
Between 4 and 12 weeks
What are shin splints?
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Shin splints are a common problem in the lower leg for athletes who change from one playing surface to another between seasons.
WHO?
Common in young players who play a lot of sport.
Cricketer James Kirtley has suffered, and many footballers such as Andy Cole have been temporarily laid off by it.
HOW?
It is an injury that can be caused in several ways.
The muscles at the front of the leg get injured or inflamed.
This can stem from playing too much sport on hard surfaces.
Or because of a weakness in the leg muscles, your running technique or even whether you have flat feet or high arches.
WHAT?
Tenderness in tibia (shin) area.
The affected muscles in the tibia also help maintain the arch of the foot which means there may also be pain when the toes or ankle is bent.
The pain stops when resting, but the injury will often remain unless the above causes are treated.
TREATMENT?
Rest will help to relieve the injury, but does not necessarily cure it.
Physiotherapists may ensure you are wearing proper footwear, tape your shins or even recommend a leg brace.
Cooling the injury in acute stages and then applying heat may also help.
Building up your muscles around your ankles will help to support those leg muscles causing the pain.
And getting yourself some proper cushioned footwear will help to soften the impact when your feet hit the ground when running.
Changing the way you run may also need to be considered. Having a smoother stride will again mean that the impact is spread more evenly throughout your feet and legs.
RETURN?
Can vary hugely but usually between two to four months. Do not start training until pain and tenderness in tibia has gone.
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Because these muscles are contained and sealed within a tough membrane it only takes a small amount of swelling before pain occurs since the muscles can't expand 
What are metatarsal injuries?
The dreaded metatarsal curse has struck some of the Premiership's top footballers in recent years.
Manchester United's Wayne Rooney fractured the base of his fourth metatarsal before his miraculous recovery for the 2006 World Cup.
So what exactly are metatarsals, and how long do they take to heal?
WHAT?
Metatarsals are the five long bones in the forefoot which connect the ankle bones to those of the toes.
The first is linked to the big toe and the fifth, on the outer foot, links to the little toe.
The five metatarsals act as a unit to help share the load of the body, and they move position to cope with uneven ground.
Injuries usually occur as a result of a direct blow onto the foot, a twisting injury or over-use.
WHO?
Rooney has broken his metatarsal two times but there are many players who have suffered.
Others include Steven Gerrard, David Beckham, Gary Neville, Roy Keane, Ashley Cole, Ledley King, David Nugent and Michael Owen.
But damage and recovery time depends on the extent of damage and which of the five metatarsals is affected.
HOW?
The middle metatarsals - which are the longest and narrowest - are usually injured as a result of wear and tear (stress fractures).
In other words, it is caused by an ongoing process - and not one single occurrence. This is common with athletes, ballet dancers and soldiers.
Impact (eg: someone stamping on your foot) and twisting can also result in fractures.
The first, second and fifth metatarsals are the most commonly injured in sport.
The first links to the big toe and is shorter and wider than the others. It is estimated this bears up to one third of the body weight.
Pain in the bone during exercise, bruising, swelling and tenderness in the foot when weight-bearing.
TREATMENT
Rest. The immediate response is a big "no" to all exercise and sport for 4-8 weeks.
The patient may be asked to wear walking boots or stiff-soled shoes to protect the injury while it heals.
If the cause is over-use, then treatment can vary hugely. Training habits, equipment used and athletic technique should all be investigated. With a bone fracture, the bone can often have a pin or screw inserted to speed up the recovery.
RECOVERY
It all depends on the damage and which metatarsal bone is involved. It is impossible to put a timescale on recovery from a stress injury.
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RECOVERY TIMES |
After initial rest, the training techniques or body mechanics may need minor tweaking or a major haul to avoid a repeat injury.
With an impact fracture, after the plaster and protective boot is not needed (usually after 4-6 weeks), it will be a case of exercise and increasing weight-bearing activities.
Ice packs, strapping and even the use of oxygen tents can be used to assist recovery.
Full return to action can be anything from another four weeks and upwards - depending on the extent of initial damage. Young bones heal quicker.
One factor that also helps is if the broken bone is one of the three inner metatarsals. As was the case with Rooney.
This means that the fourth metatarsal is aided by the 'splint effect' of the bones on either side.
Preston's David Nugent broke his fifth metatarsal in March 2006 and returned to action after being sidelined for just six weeks.
His remedy? Drink plenty of milk.
WHY SO MANY INJURIES?
The breaking of a metatarsal seems to be increasingly common among England's top stars.
There are many theories being put forward to explain why so many players have fallen foul over the last few years.
Some believe it is the number of games played at the top level, some say training is more intensive, and others argue that training on artifical surfaces has a higher impact the body.
Evolving designs of boots have also come into question.
Many boots are now much lighter and more flexible, with a variety of new studs and blades available.
Some suggest that players' feet are less protected and supported than a few years ago.
What is a dead leg?
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A dead leg can be extremely painful and is a frequent injury in contact sports.
WHO?
Rugby players and any other people involved in contact sports.
HOW?
Heavy impact to the quadriceps causing the muscle to be crushed against the bone.
This causes a tearing of the muscle within the sheath that surrounds it.
WHAT KIND OF PAIN?
Hurts at point of impact and usually tingling in leg. Also swelling, bruising and sometimes restricted movement.
TREATMENT?
Rest, ice, compress and elevate. Use a compression bandage until pain ceases.
RETURN?
Can take days or weeks to recover.
Top of Page
What is a sprained ankle?
Sprained ankles are one of the most common injuries in sport. They can be extremely painful and often involve ligament damage.
WHO?
Common for anyone involved in sport or outdoor activities particularly in sports where you turn quickly like basketball or tennis.
HOW?
Going over on your ankle - sometimes a "snap" or "tear" is felt or heard.
WHAT KIND OF PAIN?
· Grade 1: Pain turning foot in or out
· Grade 2: Swelling
· Grade 3: Huge swelling and problems walking
TREATMENT?
Rest, ice, compression and elevation. Do not remove the shoe until ice has reduced the swelling.
RETURN?
Between one week and three months depending on grade of injury. Usually two weeks.
A guide to back injuries
Back injuries are quite common in sport, with most athletes suffering from them at some stage in their career.
WHO?
Duncan Ferguson, Andrew Flintoff and Pat Rafter have all had back problems throughout their careers.
And Tim Henman is having to deal with back problems in the twilight of his career.
HOW?
Too much strain on the spine and back muscles.
Since the back is a major part of the body, different areas get injured playing sport.
You can also get back injuries from doing day to day activities like lifting heavy objects.
Athletes who play contact sports are more likely to suffer from back problems.
They are, however, also common in tennis, golf and cricket.
CAN BACK INJURIES END SPORTING CAREERS?
It depends on the injury.
If it is a spinal injury, then it can be very dangerous.
In the most severe cases, it can lead to paralysis - the loss of use of the legs.
Because the back is very complex, one injury can often affect another part of the spine.
Doctors and physiotherapists use X-rays to see whether the spine has been affected.
But they also use a series of questions and short tests to find out whether the problem is muscular.
Back injuries are often very painful and prevent athletes from training.
WHAT ARE THE MAIN PARTS OF THE BACK?
The main bone in the back is the spine.
The spine is made up of little bones called vertebrates sitting on top of each other.
There are 24 vertebrates in the back. They are:
· Seven cervical (neck) vertebrae
· 12 thoracic (chest) vertebrae
· Five lumbar (lower back) vertebrae
Ligaments and muscles are attached to each vertebrae to allow the back to move around without causing any damage.
In between each vertebrae are disks of fibro cartilage - the back's version of shock absorbers.
These disks contain a jelly-like fluid which help the back move around freely.
TREATMENT
Certain back injuries, like vertebrae fractures, may require surgery because they can cause damage to the rest of the spinal cord.
But other injuries, like muscle tears, aren't as serious.
Massages, physiotherapy and rest are the best ways to get back to full fitness.
RETURN?
Again, it depends on how serious the injury is.
Muscle strains and tears can take anywhere between two to eight weeks to heal.
But more serious injuries, for example a slipped back disk, can take a lot longer to recover from.
Athletes must avoid doing any activities which can harm their recovery.
So for a fast bowler, physiotherapists would advise them not to bowl until their injury has cleared up.
TREATMENT
Certain back injuries, like vertebrae fractures, may require surgery because they can cause damage to the rest of the spinal cord.
But other injuries, like muscle tears, aren't as serious.
Massages, physiotherapy and rest are the best ways to get back to full fitness.
A guide to broken bones
Bone fractures are potentially serious injuries.
As well as damaging the bone they often injure the tissues around the bone such as tendons, ligaments, muscles and even the skin.
WHO?
Anyone involved in contact sports.
There are four different types of fracture:
· Transverse: Straight across bone
· Oblique: Diagonal break across bone
· Spiral: Around the bone
· Comminuted: Bone is shattered
HOW?
Impact to the arm, leg or bone or indirect blow.
WHAT?
Swelling and progressive bruising, pain during movement.
You may also be able to see that the affected limb look awkward and that the bone isn't in the right place.
TREATMENT?
Cover and elevate the injured limb and keep it completely still. Go to hospital for treatment.
They will probably put your limb in a cast to keep it completely still while the bone heals.
These can be made of plaster, which can be quite heavy, but doctors are increasingly using lightweight plastic casts.
RETURN?
Between 5-12 weeks.
What is concussion?
Head injuries can occur in all sports and must be treated seriously. Check out our guide below.
WHO?
Anyone in contact sports. Concussion is most common in boxing, skiing, rugby and football.
HOW?
It is caused by a hard blow to the head or by striking the head against a stationary object.
WHY?
An injury to the head causes the brain to bounce against the rigid bone of the skull.
This may cause a tearing or twisting of the structures and blood vessels of the brain, which results in a breakdown of the normal flow of messages within the brain.
SYMPTOMS?
Headache, nausea, dizziness, sickness, increased pupil size, and confusion.
TREATMENT?
Light concussion: can return to playing within fifteen minutes after medical check.
Severe concussion: if unconscious, then check air passage is free and call trained first aid person to the scene. A brain scan in hospital may be advisable.
RETURN?
Usually within 15 minutes after passing medical check.
In more serious cases it can be over a week before full recovery.
Professional rugby players are not allowed play for three weeks after sustaining concussion.
Post-concussion syndrome can kick in after weeks and months if proper treatment was not given at the time of the original injury.
What happens when you get winded?
Nearly everyone has been winded at some point in their sporting career - it's never a nice experience - but how does it happen?
WHO CAN IT HAPPEN TO?
Anyone involved in contact or ball sports.
HOW DOES IT HAPPEN?
Usually by a blow to the abdomen. Think a football being blasted into you, but sometimes it can happen when you fall to the ground heavily.
WHAT HAPPENS TO MY BODY?
The technical name for being winded is to receive "a blunt trauma to the solar plexus".
These are the nerves behind the stomach.
The impact causes the pressure to change in the diaphragm, which is the large muscle which divides your stomach and abdomen from your heart and lungs.
The diaphragm goes into spasm and contracts painfully, making it hard for your lungs to breathe in and out.
Once the muscle stops cramping, you're able to catch your breath again.
TREATMENT?
Encourage the affected person to assume a crouching position so muscles can relax.
RETURN?
Within fifteen minutes unless there is a more serious problem with the abdominal and respiratory muscles.
Sprained Thumb Injury Explained
A Sprained Thumb is often referred to as Skier's Thumb, due to the prevalence of this injury during skiing. It is a common cause of thumb pain and swelling. Skier's Thumb refers to damage to the Ulnar Collateral Ligament at the base of the thumb. It is important to note that this injury is not exclusive to skiers and can occur to anyone where there is sufficient force applied to the thumb that takes it in a direction furthest away from the hand (described as thumb abduction and extension) In days gone by it afflicted gamekeepers and was known as 'Gamekeeper's thumb' due to it being an occupational hazard of the gamekeeper.
As well as skiers, football (soccer) goalkeepers and rugby players are also susceptible to this injury.
Skier's Thumb is an apt description of this injury since the mechanism of injury commonly occurs during skiing, if the skier holds on to the ski pole during a fall.
The pole gets fixed in the snow and acts as a lever and forces the thumb into an extended position, resulting in high stress forces through the Ulnar Collateral Ligament. If these forces are sufficiently high then the Ulnar Collateral Ligament will either be sprained or ruptured.
Sprained Thumb Signs & Symptoms
There is pain and tenderness over the Ulnar Collateral Ligament of the thumb. The ligament is located at the 'web space' between base of the thumb and the base of the index finger.
In severe Sprained Thumb injuries there is often immediate thumb swelling and bruising may develop in a few days. In more chronic cases of Sprained Thumb that have not been diagnosed early, then there may be a persistent thickening of the joint with chronic thumb swelling.
The joint between the Metacarpal and thumb bone (Meta-Carpo-Phalangeal or MCP joint) will feel lax and unstable.
The ability to pinch grip small objects between the thumb and the index finger is often severely impaired because of the resultant instability in the MCP joint (see anatomy image above).
Diagnosis is made by physical examination. Stressing the Ulnar Collateral Ligament reveals instability in the joint. This can be confirmed by taking an x-ray while stressing the joint, although x-ray evidence is not always helpful in isolation.
Sprained Thumb TreatmentIn the immediate period following damage to the Ulnar Collateral Ligament of the thumb, Ice Packs and compression are the best treatments. Non Steroidal Anti Inflammatory Drugs ( NSAIDs ) can be prescribed by a doctor to help relieve inflammation and pain. Anti inflammatory gel can also help to relieve pain.
Sprains tend to resolve in around four to six weeks and can be aided by physiotherapy treatment. Ultrasound can be effective in the early stages, then massage and mobilisation can aid ligament repair and help restore function. Thumb strength and dexterity can be improved by using Hand Therapy Balls and Therapeutic Putty. Grip and thumb strengthening devices can also be useful to restore normal hand and thumb strength.
Ligament Sprain Healing ExplainedWhere there is a total rupture of the Ulnar Collateral Ligament, then surgical repair may be considered. In some cases the ruptured ligament becomes entangled in the soft tissue at the base of the thumb. This is known as a 'Stener lesion' and it usually indicates that surgery would be appropriate as ligament healing is impaired otherwise.
Ulnar Collateral Ligament injuries may sometimes be accompanied by an 'avulsion' fracture, where one end of the ligament is pulled so forcefully that is pulls a small piece of bone off the Metacarpal of the thumb. If the fragment of bone is closely aligned to its original position, then it usually heals without surgery. If there is a complication with the fragment, then surgery may be necessary.
Ruptured Ulnar Collateral Ligaments, without Stener lesions, have a good capacity to heal without the need for surgery. For this reason, many doctors simply immobilise the thumb in a plaster cast called a 'Thumb Spica', for six weeks. A removable Wrist Support with Thumb Spica is more comfortable and may be used, depending on the preference of the treating doctor. Following successful rehabilitation, a return to sporting activities is possible at around 10 to 12 weeks.
If there is residual instability or a lack of pinch grip strength in those cases that have been managed conservatively, then surgical repair is appropriate. There are several surgical methods, but basically the surgeon fixes the damaged ligament back in place using wire or sutures. Following surgery, the thumb is usually immobilised in a Thumb Spica for six weeks. Once the thumb spica is removed, then physiotherapy treatment is very important to regain range of thumb motion, rebuild thumb muscle strength and to resolve stiffness. Exercises using Hand Therapy Balls and Therapeutic Putty can be very helpful to regain mobility. Grip and thumb strengthening devices can also be useful to restore normal hand and thumb strength.
Sprained Thumb Prevention
For football (soccer) goalkeepers, rugby players and American football players, preventative Taping can be very effective in improving thumb joint stability and preventing Ulnar Collateral Ligament injuries. In skiers who don't have to catch balls, then a Thumb Brace can do an even more effective job of improving stability.
Skier's Thumb accounts for 10% of all skiing injuries. Unless you are in deep powder snow and fear losing your ski poles, its best not to put your hands inside the ski pole loop when skiing. This greatly increases the risk of sustaining a Skier's Thumb sprain in the event of a fall. In addition, the wearing of a Thumb Stabiliser helps to protect the Ulnar Collateral Ligament, without limiting hand movement and function.
Top of PageBroken Collar Bone Explained
A broken Collar bone (broken Clavicle) is a very common shoulder injury. A broken collar bone frequently occurs when someone falls onto an out stretched hand. The Collar bone (Clavicle) is attached centrally to the sternum (breast bone) and at its outer side to the shoulder complex. This arrangement means that when a person falls onto an outstretched hand, the force is transmitted up the arm resulting in a collar bone fracture. Sometimes a direct blow to the clavicle can also result in a broken Collar bone.
With broken Collar bones in children, there is usually little displacement of the two fracture fragments and subsequent healing occurs quickly over a period of 2 to 3 weeks. In older individuals, where more force is applied to produce a broken Collar bone, the two fragments often become displaced and are prominent through the skin. Once the fractured bone has been reduced back into place by the treating doctor it will usually heal in about 6 weeks.
Occasionally there are complications with this type of fracture, including a fragment of bone causing damage to blood vessels in the chest, or imperfect union of the two fracture fragments which leads to a prominent notch once healing has taken place.
Broken Collar Bone Signs & Symptoms Because the Collar bone is so close to the surface of the skin, the fracture is usually characterised by the protruding fracture fragments. As with any fracture there is considerable pain, and bruising may be visible. The patient will hold the arm immobile in an attempt to relieve the pain.Broken Collar Bone Treatment
Treatment of a broken Collar bone is dependent upon the degree of displacement of the fracture fragments. If the two pieces of bone are reasonably well aligned, it will usually be sufficient to immobilise the affected arm in a sling or a figure-of-eight harness.
Where there is excessive displacement that prevents fracture union and healing, the orthopaedic consultant may choose to repair the fracture surgically using screws. However, this situation is rare as the Clavicle has a very good capacity to heal.
What you can do| Consult a sports injury expert |
| Practice exercises to maintain range of movement |
| Maintain forearm & grip strength with hand therapy exercises |
| Use resistance bands for shoulder strengthening exercises |
| Wear a shoulder support for reassurance |
Throughout the healing process the patient should follow a series of exercises to maintain the range of movement in the elbow, wrist and hand of the affected limb. Hand Therapy Balls and Therapeutic Putty are particularly helpful to maintain forearm and grip strength.
After a few weeks shoulder range of movement exercises can be progressed to gradually increase available shoulder movement. These exercises may be a little uncomfortable, but with some encouragement from a Chartered Physiotherapist this discomfort should quickly resolve as normal movement returns. Shoulder strengthening should then begin using Resistance Bands to regain full function.
Once full range of movement and shoulder strength has been achieved, unrestricted shoulder motion is permitted. A return to sport should be granted by the orthopaedic consultant, based on functional ability and x-ray evidence. Many people find that a Neoprene Shoulder Support is helpful following a Collar bone fracture.
Broken Collar Bone PreventionBecause of the traumatic nature of a broken Collar bone, prevention strategies are limited. Care should be taken to avoid falls onto an outstretched arm, especially where weather conditions make the surface extra slippery.
Top of PageBroken Wrist Injury
A broken wrist commonly occurs following a fall on an outstretched hand. A Capitate fracture accounts for around 2% of all wrist fractures. The Capitate is one of the eight small Carpal bones that make up the wrist complex. It is positioned in the centre of the Carpal region and is therefore quite well protected. Isolated Capitate fractures can occur but, more often, Capitate fractures occur together with fractures of another Carpal bone - the Scaphoid. These injuries usually occur following a fall onto an outstretched hand.
Signs & SymptomsThere is a good deal of wrist pain and tenderness at the back of the wrist. Moving the hand back (wrist extension) will exacerbate the pain.
In the first 48 hours following injury, a Capitate fracture is difficult to detect on x-ray and a cautious approach should therefore be taken. Supporting the wrist in a protective race can be helpful to relieve pain. If the wrist is still painful after two weeks the wrist should be x-rayed again. At this stage the fracture is more easily visible on the x-ray.
Because the Capitate has a poor blood supply there are sometimes complications with the healing process. This may manifest itself as a diffuse ache in the wrist upon activity, and can persist for many months. This is due to a breakdown of the Capitate caused by the lack of blood supply and healing (Avascular Necrosis). If these symptoms persist for more than six weeks it is likely that the bone hasn't healed and the patient should return to the treating doctor.
In the case of an acute Capitate fracture where there is x-ray evidence of excellent alignment of the fracture fragments, the attending doctor will immobilise the wrist in a plaster or lightweight Wrist Brace. This will be worn for a period of 6 weeks to allow healing of the bone to take place. Once the cast has been removed the patient begins physiotherapy treatment to regain range of movement of the wrist joint and strength in the muscles that work over the wrist.
Rehabilitation begins immediately by maintaining the range of movement in the shoulder, fingers and thumb, on the side of the affected wrist. This prevents secondary stiffness in these areas and helps to resolve swelling in the wrist. Assuming that there are no complications with healing, the plaster can usually be removed after 6 weeks, if the doctor is satisfied that the bone has united and healed itself. At this stage more active rehabilitation can be undertaken.
Exercises in warm water are helpful to improve the hydration of the skin if it was previously encased in a plaster cast. These also encourage the patient to gently begin moving the wrist in all directions, relieving stiffness. Exercises using Therapeutic Putty, Hand Therapy Balls and Finger & Grip Strengtheners can add strength to the muscles around the wrist and resolve wrist swelling. In the period following the removal of the plaster it may be helpful to wear a Supportive Splint when not doing the exercises.
If x-rays show that the Capitate fracture fragments are out of alignment by more than 1mm, or that the break is not healing, it may be necessary to treat the problem with surgery. The surgeon uses small screws to unite the two pieces of bone. Often. the ligament between the Capitate and the Scaphoid bone is also injured and this will be repaired at the same time.
Following surgery, a Removable Plastic Cast can provide the same degree of protection as a conventional plaster, but is much lighter and therefore more comfortable to wear. The fact that they can be removed allows washing of the wrist region, making it much more hygienic than a conventional plaster, which allows the user to keep the skin in good condition. Once the treating doctor indicates that the cast is no longer required, physiotherapy treatment can help to restore hand and wrist function. Exercises using Therapeutic Putty, Hand Therapy Balls and Finger & Grip Strengtheners can add strength to the muscles around the wrist and resolve wrist swelling.
PreventionThere is not a lot that can be done about a fall on an outstretched hand in most sports. However, in snowboarding the incidence of wrist fractures is so high that wrist guards should be worn. They significantly reduce the incidence of wrist injuries during falls and are available from all good ski shops.
Top of PageGilmore's Groin Injury
Gilmore's Groin Signs & Symptoms
The symptoms of Gilmore's Groin are characterised by pain during sports movements, particularly twisting and turning. This pain usually radiates to the Adductor muscle region and even the Testicles, although it is often difficult for the patient to pin-point.Following sporting activity the person with Gilmore's Groin will be stiff and sore. The day after sports activity, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.
Pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen and the genito-urinary system, so diagnosis of Gilmore's Groin requires skilful differentiation.
The diagnosis of Gilmore's Groin is based on the patient's history and clinical signs. The most notable clinical sign is widening of the superficial Inguinal ring on the affected side, which can be palpated during the physical examination when the scrotum is inverted with the doctor's finger. Typically, there is specific pain on coughing and sneezing, as well as sitting up and squeezing the legs together.
Gilmore's Groin Treatment
What you can do Conservative treatment with a Chartered Physiotherapist involves stabilising and strengthening the muscles of the pelvic region but this is a stop gap at best. In most cases it is usually possible to continue playing sports while wearing Warm Pants (Compression Shorts), until an opportune time can be arranged for surgery. Core strength and stability exercises can be helpful and allow the person to continue competing for a little while longer. However, there usually comes a time when the person can no longer continue because sports performance becomes so impaired. A surgical approach is required to cure the problem. Successful surgery is dependent upon accurate diagnosis, meticulous repair and adherence to a standard rehabilitation program. Between 1980 and 2000, of 4,500 patients referred to Jerry Gilmore's clinic in London, 2,700 were treated surgically. Of the professional soccer players treated surgically, Gilmore reported a success rate of 97%.A specific rehab program must be carefully adhered to. This prohibits sudden twisting and turning movements, with a gradual progression of pelvic muscle stability, flexibility and strength. Upright standing and walking is encouraged from day one. Straight line jogging can be initiated between 10 and 14 days post-op and straight line sprinting is usually started after 3 weeks. Thereafter, sports specific rehabilitation is graduated, with a return to competition usually possible after five weeks.
The Gilmore protocol warns that some stiffness and discomfort may occur the day after sporting activity and advocates some activity 7 days a week to remedy this.
Gilmore's Groin Prevention
What you can do Core Strength and Core Stability exercises can improve muscle function across the trunk and pelvis. Core strength exercises on a mat using a Swiss Ball and Resistance Bands are ideal, because the improved muscular strength and stability can help to counteract the large forces that are applied to the lower abdomen and pelvis. This can reduce the risk of developing Gilmore's Groin.Top of Page
Groin Strain Injury
Groin Strain Signs & Symptoms
In the case of a grade one Groin Strain the signs may not be present until after the activity is over. There may be a sensation of cramp or tightness and a slight feeling of pain when the muscles are stretched or contracted.A grade two Groin Strain causes immediate pain which is more severe than the pain of a grade one injury and produces pain on walking. It is confirmed by pain on stretch and contraction of the muscle. A grade two Groin Strain is usually sore to touch.
A grade three strain is quite rare in the adductor muscles. There is an immediate burning or stabbing pain and the athlete is unable to walk without pain. In the case of grade two and three injuries, a large bruise will appear below the injury site after a few days - this is caused by bleeding within the tissues.
Groin Strain Treatment
What you can do The immediate treatment for any muscle injury consists of rest, ice, and compression. Ice Packs can be applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin as it can cause an ice burn). The Ice Packs relieve pain and reduce bleeding in the damaged tissue. This can help to reduce the injury rehab time.Resting may be the common sense approach, but it is one that is often ignored by competitive athletes. This is unwise, since it does not take much to turn a grade one strain into a grade two, or a grade two strain into a grade three. As a general rule, grade one Groin Strains should be rested from sporting activity for about 3 weeks, and grade two injuries for about 4 to 6 weeks.
In the case of a complete rupture an opinion from an orthopaedic doctor is required. The torn muscle may have to be repaired surgically and the rehabilitation afterwards will take about 3 months.
Groin Strain Prevention
What you can do The following measures may have the effect of reducing the chances of sustaining a muscle strain:A good warm up should last at least 20 minutes - starting gently and finishing at full pace activity. Practicing sport specific activities helps tune coordination and prepare mentally for competition.( Professional Warm Up Guide )
Inguinal Hernia Injury
The Inguinal canal is the region between the abdomen and inner thigh, through which the testes (or the round ligament in females) descend during childhood. The Inguinal region is a weak point in the abdominal wall. The weak point results from the fact that the spermatic cord passes through this canal in men and the ligament of the uterus passes through it in women.
Prior to a true Inguinal Hernia, the abdominal muscle layers can become elastic as a reaction to extreme strains in this region due to work and sports activities. The resultant pressure on the nerves passing through that region – particularly the Genitofemoral nerve, can cause severe pain that can radiate to the upper thigh and the testes.
Inguinal Hernia Signs & Symptoms
Following sporting activity, someone with an Inguinal Hernia will be stiff and sore. Typically, the day after a football match for example, getting out of bed or a car will be uncomfortable. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport but the problem usually gets progressively worse.Pain in the groin and pelvis can be referred from a number of problems, including injuries to the lower back, the hip joint, the Sacro-Iliac joint, the abdomen and the genito-urinary system. Therefore, diagnosis of an Inguinal Hernia requires skilful differentiation.
Because it requires an expert to diagnose an Inguinal Hernia it is not unusual for many weeks or months to pass before the correct diagnosis is made. In those people who have typical Inguinal Hernia symptoms, an expert can confirm the diagnosis with physical tests and an Ultrasound scan.
Inguinal Hernia Treatment
What you can do Conservative treatment with a Chartered Physiotherapist involves stabilising and strengthening the muscles of the pelvic region, but this rarely cures the problem. In most cases it is usually possible to continue doing sports while wearing Warm Pants (Compression Shorts), until an opportune time can be arranged for surgery. Usually, there comes a time when the person can no longer continue because sports performance becomes so impaired. A surgical approach is usually required.The surgical treatment of Inguinal Hernias has been revolutionised over the past ten years. The world's top hernia surgeons now perform hernia surgery under local anaesthetic. Depending on the individual circumstances of the patient, considering their age, occupation, general health and the size and degree of the Inguinal Hernia, the surgical technique is chosen which is 'tailored' to the patient's situation.
A Minimal Repair technique has been pioneered by Dr Ulrike Muschaweck, at the Hernia Center Munich. This sparing technique doesn't use a surgical 'mesh' to repair the hernia and only the affected tissues are repaired. This means that the person can resume strenuous exercise after just two days, making it the ideal repair for athletes.
'Mesh' techniques have been developed for patients who have large defects in the wall of the Inguinal canal or for older patients where the abdominal wall is weak. A square surgical mesh is stitched onto the muscle layers of the abdominal region in order to repair the hernia.
The Minimal Repair is a mesh free technique which is used for patients who have a big defect in the fascia of the Inguinal canal, while the muscle layers are still intact. Physical immobility is not required and the patient can begin physical work a few days after surgery. The principle of local anaesthesia is pain elimination by blocking the nerves in the groin region with a pain-free injection. This is different from spinal anaesthesia, such as an epidural injection. The advantages of a local anaesthetic are that the patient is able to get up on their feet straight after the operation and there is no need for an overnight stay in hospital. Patients can usually eat immediately after surgery, as they don't experience the side effects of a general anaesthetic like nausea and vomiting, headaches and urinary retention.
Because these side effects are eliminated and the surgical repair is so unobtrusive, the rehabilitation process can begin immediately. Patients are encouraged to return to everyday activities and work the day after surgery. The patient can resume gentle exercise such as jogging or cycling. Elite athletes can begin sprinting after three or four days. Within five or six days there are no physical restrictions. Premiership footballers typically return to action after 7 to 10 days following surgery with Dr Ulrike Muschaweck at the Hernia Center Munich.
Inguinal Hernia Prevention
What you can do Core Strength and Core Stability exercises can improve muscle function across the trunk and pelvis. Core strength exercises on a mat and using a Swiss Ball or Resistance Bands are ideal, because the improved muscular strength and stability can help to counteract the large forces that are applied to the lower abdomen and pelvis. This can reduce the risk of developing a hernia.Top of Page
Sacro Iliac Joint Injury
Sacro Iliac Joint Pain Injury Explained
The Sacro Iliac joint can be a common source of back pain. The Sacro Iliac joint is located at the back of the pelvis and several scenarios can produce back pain in this region of the spine, including a traumatic incident, biomechanical mal-alignment, hormonal changes during pregnancy, or inflammatory joint disease.
The Sacro Iliac joint helps to transmit forces during weight bearing activities. There is a lot of controversy between anatomists over movements at the Sacro Iliac joint, but it is generally agreed that there is forward and backward, as well as rotational movement, but only by a couple of millimetres.
At the beginning of the last century 'Sacro-Iliac joint sprain' was the most commonly diagnosed lower back problem, but as the medical professions began to understand referred pain from disc problems it was realised that Sacro Iliac joint sprain was not as common as first thought. However, the Sacro Iliac joint can produce pain, due to a number of causes. These causes may include a traumatic incident, biomechanical mal-alignment, hormonal changes or inflammatory joint disease.
Traumatic incidents, biomechanical mal-alignments and hormonal changes can all lead to Sacro Iliac joint dysfunction that can be described as 'mechanical' in nature. The 'self braced' (by ligaments) position of the Sacro Iliac joint can be altered by these factors and the joint can lose its stability. This changes the mechanics of the joint, putting abnormal pressures on the joint surfaces, ligaments and surrounding muscles.
It is easy to see how trauma can produce this problem; when a person lands on one buttock during a fall, for example. A similar process may occur gradually if there is altered alignment or a discrepancy of length in the legs. This can lead to Sacro Iliac joint dysfunction and pain due to repeated stresses on the Sacro Iliac joint during sporting activities.
Hormonal changes during pregnancy can cause generalised laxity of ligaments that can cause mechanical Sacro Iliac joint dysfunction. The ligaments helping to stabilise the Sacro Iliac joint can become lax and this, together with increased load on the spine due to the pregnancy, can cause altered Sacro Iliac joint mechanics and pain. For this reason, mechanical Sacro Iliac joint dysfunction tends to be more common in women.
Inflammatory disorders can also produce pain in the Sacro Iliac joint. These disorders are classified as 'spondyloarthropathies', which simply means a disease that affects the spine. Among these conditions are ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease and Reiter's syndrome. These conditions will be identified with blood tests. Once confirmed, a referral to a Consultant Rheumatologist is required
Sacro Iliac Joint Pain Signs & Symptoms
Mechanical Sacro Iliac joint dysfunction typically causes a dull ache that is located at he base of the spine on the affected side(s). The pain may become worse and 'sharp' in nature during activities such as sitting, bending, lifting, standing up from a seated position, or lifting the knee up to the chest during stair climbing. Sometimes the pain can refer to the groin, buttock or the back of the thigh although, unlike referred pain from a Disc Prolapse, Sacro Iliac joint pain rarely goes below the knee.Sacro Iliac Joint Pain Treatment
What you can do Rest from the aggravating activities is essential during an acute episode of pain. Once the person has found a position that relieves the pain, then this should be maintained as much as possible during the first 24 hours. Over the counter analgesic medication normally brings some relief of symptoms. In more chronic cases pain relief is possible with a TENS unit (a battery powered device that 'blocks' pain signals by introducing a direct current to the body).Mechanical Sacro Iliac joint dysfunction usually responds well to conservative treatment from a Chartered Physiotherapist. Successful treatment is largely dependent upon addressing any underlying factors that can predispose a person to Sacro Iliac joint dysfunction. In the case of a woman who is suffering from Sacro Iliac joint dysfunction during pregnancy, it may not be possible to eradicate the problem until after the birth. Then, once ligamentous laxity is no longer such an issue, steps can be taken to restore normal Sacro Iliac joint mechanics. Research has shown that a Pregnancy Belt that supports the Sacro Iliac joint may be helpful for women who experience Sacro Iliac joint pain during pregnancy. In those people who aren't pregnant, but suffer from Sacro Iliac joint pain, then a Sacro Iliac Joint Support can be extremely effective.
If Sacro Iliac joint dysfunction is caused by biomechanical factors, such as a difference in the left and right leg length or altered lower limb alignment, then these causes must be addressed. Orthotics (specially made inserts that go in the sole of the shoes) can be helpful in some cases. Specific muscle strengthening or stretching exercises can also remedy postural mal-alignment which may be contributing to Sacro Iliac joint dysfunction. Often the Iliacus and Psoas muscles (which flex the hip) are over active and tight.
Passive mobilisations by a Chartered Physiotherapist can be very effective where normal Sacro Iliac joint movement is 'blocked'. This has the effect of gently facilitating normal Sacro Iliac joint movement, thus removing abnormal stresses on the ligaments which surround the joint. Once normal Sacro Iliac joint movement has been restored, more active rehabilitation can be undertaken. This involves specific muscle work for the 30 plus muscles whose activity can affect Sacro Iliac joint stability - the series of exercises is different in each individual. In a sporting individual these exercises should be progressed to functional activities which are specific to the particular sport. This helps to prevent a recurrence once the person resumes their sport. Many people find that pool exercises using a Buoyancy Belt can help to relieve pain and encourage normal Sacro Iliac function.
Sacro Iliac Joint Pain Prevention
What you can do
In the long term, good posture is maintained by increasing the muscular stability of the spine, but an effective aid to improve sitting posture is a Sitting Support that can be used when driving or when sitting in the office. These work by supporting the forward curve at the bottom of the back which facilitates good posture and improves the load bearing characteristics of the back.
Research has shown that specific exercises, known as core stability and strength exercises, can be effective in relieving back pain and restoring normal function. These exercises are most effective where the problem is caused by poor postural habits. The Stabiliser Pressure Biofeedback Device is very useful for learning these specific exercises. Once the correct technique has been mastered under the guidance of a Chartered Physiotherapist, these exercises are very easy to do. They are not too vigorous and they can be done by people of all ages. More advanced exercises using Swiss Balls can then be used to relieve and prevent back pain.
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Dislocated Shoulder Injury Explained
The shoulder is a ball-and-socket joint that has a large range of movement but not a lot of stability, which makes the shoulder joint prone to dislocation. The shoulder is particularly unstable when it is rotated outwards and the arm cocked back or 'abducted'. Any additional force in this position will cause the head of the Humerus (arm) bone to come out of the joint in a forward direction. This is referred to as an anterior dislocation.
The shoulder joint is enclosed by a fibrous capsule which is strengthened by ligaments that provide a reinforced thickening of the capsule. The joint also has a labrum - a fibrocartilage lip that increases the stability of the joint. In the case of a dislocation due to trauma (such as a fall or collision), the joint capsule and ligaments are usually torn, and the labrum may also be damaged.
Dislocated Shoulder Signs & Symptoms
It is important that a shoulder dislocation is seen quickly by a doctor who can put the joint back in place. This is because the position of the Humerus in a dislocated shoulder joint can cause damage to the Axillary nerve. This can lead to a loss of sensation and muscle strength in the affected arm. Pain relieving medication prescribed by a doctor can help to relieve the shoulder pain.
Ice Packs can be applied to the injured shoulder for 20 minutes every two hours (never apply ice directly to the skin). The Ice Packs relieve pain and reduce bleeding in the damaged tissue. The Aircast Cryo/Cuff is the most effective method of providing ice therapy and is the professional's choice for shoulder injuries. It can provide continuous ice cold water and compression for up to 8 hours and significantly reduce shoulder pain and swelling.
Once the shoulder has been put back in place it is immobilised using a sling. The sling is kept on for about 2 to 3 weeks, during which time it is important that the elbow, wrist and fingers are kept moving to prevent them stiffening up.
Active rehabilitation is started as soon as possible but overhead arm movement and sporting activity should be avoided for at least 6 weeks. Gentle range of movement exercises under the supervision of a Chartered Physiotherapist can be started once the sling is removed.
Strengthening exercises for the Rotator Cuff muscles should be started as soon as they can be done without pain. These can be done at home using Resistance Bands.
Because of the damage to the structures surrounding the shoulder, there is a high chance of recurrent dislocation. Surgery on an unstable shoulder is usually required after four dislocations.
Following a shoulder dislocation and shoulder surgery, many people find that a Neoprene Shoulder Support helps to provide added reassurance. They also assist with shoulder stability by providing sensory input that improves shoulder proprioception.
Dislocated Shoulder Prevention
Once there has been a dislocation of the shoulder, the joint will have a degree of instability and will be more likely to dislocate again, or become subluxed (where it moves slightly but not fully out of joint). This is because the ligaments, capsule and labrum are damaged and cannot restrain the humeral head and prevent dislocation. In order to prevent dislocation, the Rotator Cuff muscles that surround the humeral head should be strengthened. The Rotator Cuff muscles (Subscapularis, Supraspinatus, Infraspinatus and Teres minor) are small muscles situated around the shoulder joint. Although they have individual actions, their main role is to work together to stabilise the humeral head (ball) in the shoulder socket. Exercises using a Resistance Band can be very effective at strengthening the Rotator Cuff and maintaining shoulder stability.
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FIFA Injury Prevention
FIFA's "The 11"
Football, like most sports, is associated with a certain risk of injury for the players. However, scientific studies have shown that the incidence of football injuries can be reduced by prevention program.
The prevention program “The 11” was developed by FIFA’s medical research centre (F-MARC) in cooperation with a group of international experts. “The 11” is a simple, catchy and time-efficient preventive program that comprises ten evidence-based or best-practice exercises and the promotion of Fair Play. It requires no equipment other than a ball, and can be completed in 10-15 minutes (after a short period of familiarization). The exercises focus on core stabilization, eccentric training of thigh muscles, proprioceptive training, dynamic stabilization and plyometrics with straight leg alignment. The program is efficient as most of the exercises simultaneously train different aspects and can replace other exercises.
“The 11” should be performed in every training session after a warm-up and stretching of all the important muscle groups.
(Preceding paragraphs provided by FIFA 11 Booklet)
To download FIFA's "the 11" Poster for injury prevention click here.
To view FIFA's new website on injury prevent, click here.
Also, download "The 11+" Cards, a complete warm-up. click here.
FIFA has given NIGOALKEEPING.COM permission to use "The 11" on the website. The above poster is provided by FIFA. Original location of "the 11" is at www.fifa.com
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