How many athletes have ended their football career from a catastrophic knee injury?
Upwards of 54% of football players have a reported knee injuries (1). Wow!
As any player knows, if you ruin your knee, it is very difficulty. to come back from.
This is why it is crucial that if you do injury your knee, you get the best health care providers on your team, so you can get back into the game faster. Those who do, typically do quite well.
Those that don’t…well, we wont’t talk about them.
Why Do Players Get Knees Injuries In Football?
Any sport that requires sprinting, quick cuts and physical trauma …let's face it, football is trauma…increases the potential risk of knee injury. And the game we all know and love has these three items in spades.
This article will discuss the different types of knee injuries that commonly happen in the fooball player, and ways that you can make your knee’s more resilient, so they don’t happen to you!
First We Need To Understand Basic Knee Anatomy
The knee joint is a complex and pivotal joint in the human body. Many people think the movement of the knee is strictly bending forward and back, but there is actually a small amount of rotation that occurs as well.
Your knee provides stability, and allows you to move your body into various directions. While you don’t need to understand its anatomy in order to play football, it is crucial in comprehending how knee injuries can occur. Here's an overview of the key components of the knee joint:
- Femur (Thigh Bone): The upper bone of the knee joint, which forms the rounded end known as the femoral condyles.
- Tibia (Shin Bone): The lower bone of the knee joint, which joins with the femur. The tibia has a flat, upper surface known as the tibial plateau.
- Patella (Kneecap): A small, triangular bone that covers the front of the knee joint. It helps improve the mechanics of knee movement.
These are crucial in providing the knee joint its stability. Imagine the ligaments as the guide wires on a bridge. They help stabilize the bridge, just as your ligaments stabilize your knee.
- Anterior Cruciate Ligament (ACL): This ligament runs diagonally inside the knee joint, connecting the femur to the tibia. It helps prevent forward movement of the tibia and rotational instability.
- Posterior Cruciate Ligament (PCL): Behind the ACL, the PCL connects the femur to the tibia. It primarily prevents backward movement of the tibia.
- Medial Collateral Ligament (MCL): Found on the inner side of the knee, it connects the femur to the tibia and provides stability against forces pushing from the outer side.
- Lateral Collateral Ligament (LCL): Located on the outer side of the knee, the LCL connects the femur to the fibula (a bone in the lower leg) and helps resist forces from the inner side.
- There are two menisci in the knee joint, the medial meniscus (inner) and the lateral meniscus (outer). They are C-shaped pieces of cartilage that act as shock absorbers between the femur and tibia. The menisci also help with load distribution and stability within the joint, and allow for smooth movement.
- Articular Cartilage: This is a smooth, slippery tissue that covers the ends of the femur, tibia, and patella. It allows for frictionless movement of the joint.
- Patellar Cartilage: Found on the underside of the patella and the front of the femur, this cartilage enables the patella to glide smoothly in the femoral groove during knee flexion and extension.
- Synovial Membrane and Synovial Fluid:
- The synovial membrane lines the inner surface of the joint capsule and produces synovial fluid. This fluid lubricates the joint, reducing friction between moving parts.
- Bursae are small, fluid-filled sacs located around the knee joint. They act as cushions and reduce friction between tendons, ligaments, and bones.
- Various muscles surround and support the knee joint, including the quadriceps (front thigh muscles), hamstrings (back thigh muscles), and calf muscles. These muscles play a vital role in knee stability and function.
- Nerves and Blood Vessels:
- Numerous nerves and blood vessels supply the knee joint, and cross the knee into the lower leg. Nerves and blood vessels are obviously important for proper sensory and motor function.
This is the basic anatomy of the knee. If you understand these areas, you have a heads up in helping diagnosing and treating the various knee injuries and conditions that commonly occur. It will also help you understanding on the importance of maintaining your knee health through injury prevention, exercise and proper therapeutic care.
Common Causes of Knee Injuries - And What Gets Injured
Knee injuries in football and field sports often occur due to specific scenarios and movements.
That is why defensive players must get good at avoiding a cut block. And why horse collar tackles are illegal…certain movements can really cause serious damage!
By understanding these common scenarios you can bring more awareness to injury prevention and awareness. Here are some of the typical situations and movements that can lead to knee injuries, and the typical injury that occurs
1. Cutting and Directional Changes:
- Scenario: You are making a rush on the QB, and make abrupt cut, then spin move to the outside to evade that left tackle, get in the backfield and make the tackle.
- Movement: Quick pivoting and cutting movements can place excessive stress on the knee ligaments, particularly the ACL and MCL. These rotational or lateral movements are typically what can cause an injury to the ACL, MCL, and medial meniscus.
2. Tackling and Collisions:
- Scenario: You make it past the tackle, and lay down the thunder, bringing to QB to the turf. BOOM!
- Movement: When the quarterback is tackled or you are involved in a in a collision, there is a risk of direct impact on the knee, potentially causing ligament sprains, meniscus tears, or patellar injuries.
- Scenario: Players often jump to catch passes, block kicks, or in celebration after a big tackle or touchdown.
- Movement: Poor landing mechanics or awkward landings can lead to knee injuries, including ACL tears or patellar tendon injuries.
4. Overextension Knee Injuries:
- Scenario: Stretching to reach for a ball or overstriding during a sprint, or getting cut blocked, or hit in the front of the knee.
- Movement: Overextending the knee beyond its normal range of motion can strain the ligaments and lead to injuries like hyperextension or ligament sprains.
5. Running on Grass Turf (Uneven Surfaces):
- Scenario: Playing on natural grass fields can have divots in the turf.
- Movement: Uneven surfaces can cause players to twist or stumble, increasing the risk of twisting or torque-related knee injuries, such as meniscus tears or ligament sprains.
6. Insufficient Warm-up:
Scenario: Not warming up adequately before practice or game
Movement: Skipping warm-up routines can increase the risk of injury. You need to ensure your muscles, joint, and nervous system are ready for the field. Skipping your warm up is not recommended!
Awareness of these common scenarios and movements is essential to implement effective injury prevention strategies. For example, your your strength and conditioning program, technique training, and warm-up protocols. Additionally, recognizing when to seek medical evaluation and treatment for knee injuries is crucial for a timely and successful recovery.
Typically most aches and pains can be self managed. However, if you are having swelling, locking, giving way weakness, or persistent and re occurring issues, I strongly recommend you get evaluated by a professional experienced in these areas.
The last thing you want is a knee injury - that could have been avoided - to set you on the sidelines for the season!
Types of Common Knee Injuries
ACL & Medial Meniscus & MCL injuries
The terrible triad. This is a nasty injury. Often this occurs as a ‘non-contact’ injury. But there of course can also be direct contact that can cause this.
The MCL experiences stress when there is a force that is pushing your knee in. This is known as valgus stress. So if you get tackled from the side of the leg, and it pushes your knee inward, and your foot is planted, it could very easily injure. Your MCL.
The Meniscus can become injured from a rotational, or twisting movement that occurs in the knee, such as from cutting, spinning, or changing directions. This is often times why this is one of the most common non-contact injuries.
Often a meniscus injury will cause swelling in your knee. It may also lead to giving out at the knee, or even locking.
The Anterior Cruciate Ligament (ACL) is one of the most well known, and painful, season ending injuries you can have. Some ruin careers.
ACL tears can often coincide with an injury to the meniscus and MCL. These can range from sprains, to a pull, al the way to a full thickness tear.
An injury to the ACL is often a non-contact injury that happens when the player is pivoting, cutting, twisting, or making some type of rotational movement around the knee. It may also happen during contact, obviously. If the players leg is stuck, or caught on the ground for example, and another player is driven from the side through the knee, the ACL may tear.
An example includes:
A wide receiver is sprinting downfield, trying to outrun the defender on a post. As he approach the defender, he makes a sudden cut to the left to create separation and catch the pass.
Movement: To execute the cut, the wide receiver plants their right foot forcefully into the ground, pivoting their body to change direction quickly. At the same time, they extend their left leg to push off in the opposite direction. This sudden deceleration, change of direction, and forceful pivoting put immense stress on the knee joint, especially the ACL.
Injury Occurrence: As the wide receiver plants their right foot and pivots, the ACL may tear due to the following factors:
- The forceful change in direction places an extreme load on the ACL.
- The player's body weight and momentum combined with the pivoting motion create a twisting force on the knee.
- The ACL can become overstretched or torn when trying to stabilize the knee during this rapid and forceful movement.
The Injury: When an ACL tears, it is often accompanied by a sudden and sharp pain in the knee, and a very loud SNAP! Within even a few minutes, there will be immense swelling and instability. A full tear is certainly season ending.
The good news is that it may not be career ending! If this injury happened to you even 30 years ago, you were done. But in today’s age, that is not the case.
Surgery MIGHT be required. But, many times it isn’t. Thankfully players these days can get back to a high level of sport without an intact ACL…just ask Hines Ward, Joe Namath, John Elway, Tyjae Spears, to name a few.
Prevention: To reduce the risk of ACL tears during cutting and pivoting movements, athletes must focus on proper strength and conditioning, balance training, and agility drills. Additionally, using appropriate footwear and maintaining good overall ankle, knee, hip and back health can help mitigate the risk of such injuries.
This scenario highlights the importance of ACL injury prevention strategies and the need for athletes to develop proper cutting and pivoting techniques to minimize the risk of serious knee injuries in football.
Patellar Tendons and Tendonitis
A familiar scenario in football players is plain the front of the knee. It may not be from any one particular movement, or strain. But after practice, maybe. A few weeks or months into the season your knees start to ache.
Sometimes it can be sharp, even cause swelling. This may be patellar tendonitis (aka. Jumper’s Knee) or patellofemoral pain syndrome. It may also be tendonitis from another tendon.
These typically happen during repetitive movements, such as running and cutting like in football.
Imagine you are the running back. Your playing a challenging opponent, and their D-line and Linebackers are not slackers. Its the 4th quarter, 1:10 left on the clock. Your down by 4, and your 3rd and 3 on the 7-yard line.
Your in the huddle and you get the call. Off tackle run
Movement: As you receive the handoff, you start sprinting forward, making quick cuts changes in direction to evade defenders.
These dynamic movements place a substantial load on the knee joint, particularly the patellofemoral joint, which is the area where the kneecap (patella) joins with the thigh bone (femur).
Oh, and knowing you, you clearly pushed through the pain and got drove the ball into the end zone, carrying 2 defenders on your back. Good job! Now if only your defence can hold the other team off for the remaining 57 seconds!
Injury Occurrence: The repetitive nature of these running and cutting movements can lead to patellofemoral pain syndrome. Over time, the constant pounding on the knee joint can cause irritation and inflammation of the patellar tendon, as well as softening or damage to the cartilage on the underside of the patella. This results in pain, discomfort, and aching around the front of the knee, especially during and after physical activity.
Consequences:If you get this, you may experience persistent pain and discomfort that affects your game. The pain can worsen with prolonged activity, running, or climbing stairs. It can also limit your ability to make quick cuts or change direction effectively, impacting their agility and acceleration.
While most players can play through. This if it is mild to moderate, sometimes it can put you on the bench for a few weeks if you let it get severe.
Treatment and Prevention: Treatment for patellofemoral pain syndrome often involves rest, ice, and manual therapies to address muscle imbalances and improve knee stability.
Football players with patellar tendinitis (runners and jumpers knee) may also benefit from modifications in training routines and wearing supportive footwear. It's crucial to address any underlying biomechanical issues that are contributing to the condition.
Prevention: To reduce the risk of developing runner's knee, football players can focus on proper conditioning and strengthening exercises for the quadriceps, hamstrings, and hip muscles. Ensuring that the cleats provide proper support and cushioning is essential. Athletes should also pay attention to running mechanics and technique to minimize excessive stress on the patello femoral joint.
These scenario’s highlight the common type of knee injuries that occur in football players. Obviously they can happen to any position on the field, but I think you get the point.
Knee Injury Prevention Strategies
Reducing the risk of knee injuries is crucial for football players, as the knees endure significant stress during the game. Here are some tips and strategies to help football players minimize the risk of knee injuries:
1. Proper Warm-Up and Stretching:
- Always begin with a thorough warm-up routine to increase blood flow and prepare the muscles and joints for physical activity.
- Include dynamic stretching exercises that target the lower body, focusing on the quadriceps, hamstrings, calves, and hip muscles.
- Incorporate sport-specific movements into your warm-up to simulate football actions.
2. Strength and Conditioning:
- Develop a comprehensive strength and conditioning program that focuses on strengthening the muscles around the knee joint, including the quadriceps, hamstrings, and calves.
- Include exercises that improve core strength and balance, as a stable core can help reduce the risk of lower limb injuries.
- Ensure that the strength program addresses any muscle imbalances that may contribute to knee instability.
3. Flexibility and Mobility:
- Maintain good flexibility in the hips, thighs, and lower legs to allow for a full range of motion.
- Incorporate regular static stretching after workouts to improve flexibility and mobility.
- Consider yoga or Pilates to enhance flexibility and balance.
4. Proper Technique:
- Focus on mastering proper techniques for tackling, cutting, pivoting, and changing direction to minimize the risk of awkward movements that can lead to knee injuries.
- Coaches should emphasize safe and effective tackling techniques to prevent collisions that may result in knee injuries.
5. Appropriate Footwear:
- Ensure that you wear football cleats that provide proper support and traction on the playing surface.
- Regularly check the condition of your cleats and replace them if they are worn out.
6. Field Evaluation:
- Be aware of field conditions, as uneven or poorly maintained playing surfaces can contribute to knee injuries.
- Inspect the field for divots, holes, or other hazards that could lead to slips or twists.
- Ensure you are wearing appropriate footwear for the type of field you are playing on.
7. Rest and Recovery:
- Adequate rest between practices and games is essential to allow your body to recover and prevent overuse injuries.
- Listen to your body and seek medical attention if you experience persistent pain or discomfort.
- Massage, epsom salt baths, ice baths are all great strategies to improve your recovery.
8. Hydration and Nutrition:
- Stay hydrated before, during, and after practices and games to prevent muscle cramps and fatigue that may lead to altered biomechanics and injury.
- Maintain a balanced diet to support overall health and muscle recovery.
Treatment and Rehabilitation For Knee Injuries
The first thing you should do if you sustain a knee injury (or any other injury for that a matter) is seek out a health care provider that can help you recover as quickly as possible.
Some people like to ‘suck it up’, ‘hope it gets better on its own’, etc. BUT, when you are serious about playing, yo uwnat every advantage you can get.
Hope isn’t a strategy.
A quality health care provider (orthopaedic chiropractic specialist like myself, sports physiotherapist, quality athletic therapist, etc) can be worth their weight in gold in helping you get back into the game. And I’m a fairly heavy guy, so that’s a lot of gold!
The first step is diagnosing your injury.
What is it?
How ‘BAD’ is it?
Expected time to full recovery?
Can you still keep playing with it?
When there is a full, or even partial tear suspected they may send you for imaging. They may need to refer you to a surgeon for a consultation.
There is a lot that goes into determining what needs to be done. THIS is why you need a professional in your corner!
If you would like my assistance, drop a line, and I’ll point you in the right direction.
Don’t just leave it to chance and ‘hope’ it goes away on its own. We all know that injuries have a way to persist, especially as the season grows longer.
And the last thing you need is a nagging injury that keeps you on the bench, especially when you get into playoffs at the end of the season where every second counts.
1. Bradley J, Honkamp NJ, Jost P, West R, Norwig J, Kaplan LD. Incidence and variance of knee injuries in elite college football players. Am J Orthop (Belle Mead NJ). 2008 Jun;37(6):310-4. PMID: 18716695.