Football is the most famous sport in the world. It is played in every country and at all ages, both at amateur and professional levels. It is a contact sport that requires high-speed actions such as running, dodging obstacles, dribbling, kicking, jumping… the risk of sports injury is high.
In general, more injuries occur during matches than during training sessions. Midfielders and goalkeepers also tend to get injured more often, especially if they have had previous injuries or if the preseason was very intense. Skeletal immaturity is a factor that increases the risk of injury in younger players.
65% of injuries suffered by football players occur in the hamstrings (back of the thigh) and the knee. Spinal injuries occur rarely and are divided into two types: traumatic or overuse injuries.
Acute injuries occur during falls, when fighting for the ball, or due to impacts against another player or the goalpost.
Overuse injuries are related to the overload received by the back, which constantly performs repeated flexions, extensions, and rotations.
A higher incidence of spinal injuries has been observed in adolescent females, perhaps related to the fact that they have greater joint laxity and weaker cervical musculature.
The most frequent injuries in the thoracolumbar spine of both types, their treatment, and when it is recommended to return to play are discussed below:
- – Muscle fiber tears and ligament sprains are benign injuries that are resolved with physiotherapy and core work. They are usually diagnoses of exclusion once more serious causes of back pain have been ruled out, and they do not typically limit the return to play within a few weeks.
- – When a lumbar disc herniation occurs, sciatic pain usually appears suddenly. Once diagnosed with an MRI, the first treatment is usually non-surgical rehabilitation. Microdiscectomy or endoscopy can accelerate the rehabilitation process and the return to the field, especially in professional patients.
- – Lumbar discopathy or disc wear manifests in players who have dedicated many years to the sport. In most cases, treatment is conservative, but if instability in the segment is demonstrated in highly symptomatic patients, minimally invasive arthrodesis can be a good option. No study has evaluated the appropriate time to return to the field after surgery, so in general, playing is permitted once the pain has disappeared, strength, flexibility, and endurance have been recovered, and the X-ray shows stability of the implants.
- – Spondylolysis or a fracture of the pars interarticularis is caused by repetitive flexion and extension movements when kicking the ball, as well as trunk rotations; when the vertebra shifts, it is called spondylolisthesis. Children and adolescents are at higher risk for this injury due to skeletal immaturity. Initial treatment involves a brace for 2-3 months followed by rehabilitation. If treatment fails and pain persists, minimally invasive repair of the pars interarticularis is indicated. This is a significant injury that usually requires 6 to 12 months before returning to play.
- – Vertebral fractures occur mainly due to bad falls, but it is rare for them to be accompanied by spinal cord or nerve injuries. When fractures are unstable, percutaneous fixation allows healing with an internal fixation device and without a brace; once the screws are removed, the spine will regain its mobility after the injury. In the case of a fracture, returning to play is usually not permitted until 6 months after the injury.
To avoid injuries, it is essential for players to have strength, endurance, and good neuromuscular control to ensure coordinated motor responses and prevent repetitive damage to joints, including those of the spine. To prevent some lumbar spine injuries, correct lumbopelvic control through core work during training is essential.
Spine injuries in soccer. Blais N, Salzmann N, Shue J, Diez C, Urraza F, Girardi F. Current Sports Medicine Reports ( 2019)
