Prevention & Management of Injuries

Introduction

The role of the football coach covers a vast range of responsibilities. One of the most important roles of the coach is to provide an environment that does not predispose the player to any unnecessary injury.

An effective coach must be concerned with the prevention, immediate care and rehabilitation of injuries.

Coaches must be aware of warm-up routines, and methods used to prepare the body for competition. They should also ensure that all players have the appropriate gear, such as mouthguards, available to avoid injury.

Players must be taught the correct way to perform the body contact skills of the game, and how to protect themselves from serious injury.

Any player who is injured during a game must have their injury dealt with immediately and in a professional manner. It is important that experts make a diagnosis, and if there is any doubt about the seriousness of a players injury then he should be kept off the ground.

A coach must ensure that a player undergoes the correct rehabilitation from injury before he returns. It is important that communication occurs between player, coach and a medical expert before a decision is made regarding a player's return.

Injury Prevention

One of the most frustrating aspects of football for the player is being injured. The problem is that with good training and good coaching, injuries still occur. The 'Golden Rule' for all injuries is 'prevention is better than cure'.

Be Prepared

1. Warm-Up, Stretching and Cool Downs

Warm-Up
Warm-Up is a vital part of any competition or strenuous exercise session. It results in improved flexibility as well as preparing the mind, the heart, the muscles and the joints for participation, thus reducing the likelihood of injury. The warm-up should involve 5-10 minutes of general activity before the stretching session. A good indication of a sound warm-up is a light sweat.

Stretching
Stretching is another vital factor in the prevention of injury. Without stretching, muscles lose their flexibility and may fail to respond when being used, and injury could be the result. Stretching rules:

1. Warm-up prior to stretching
2. Stretch before and after exercise
3. Stretch alternative muscle groups
4. Stretch gently and slowly
5. Never bounce or stretch rapidly
6. Stretch to the point of tension or discomfort, never pain. Hold for at least 15-20 seconds.
7. Do not hold your breath when stretching - breathing should be slow and easy

Cool Downs
Cool-downs are also important, because they prevent pooling of the blood in the limbs, which could lead to fainting or dizziness, and improves the recovery of the heart, muscles and other tissues after exercise. An effective cool-down consists of a gradual reduction in activity levels for 5-10 minutes followed by a comprehensive stretching program.

2. Fitness

Injuries can occur at any time during a game or training session. However, studies have shown that they are more common when a player is fatigued. This means that an adequate level of fitness is of the utmost importance in preventing injuries.

3. Obey the Rules

Many of the rules of sport are specifically designed to create a safe playing environment. All players should be encouraged to learn and observe both the written and unwritten rules of the game. Players should be continuously reminded of the importance of good sportsmanship and fair play.

4. Playing Areas and Facilities

Padding of goal posts, maintenance and condition of the playing surface and an adequate distance between the boundary line and fences and spectators are important injury reducing measures which should be undertaken at club level.

5. Protective Devices

Unlike many other contact sports, football has evolved as a game played with a minimum of protective equipment.

A mouthguard, however, is essential for all players. Mouthguards are a must for both training and games. In addition to protecting the teeth and the gums, mouthguards reduce the incidence and severity of concussion, lessen the risk of a fracture of the jaw and protect the lips and cheeks from lacerations.

6. Environmental Conditions

Fluid Replacement
Players who are unfit or overweight are more susceptible to heat illness. Coaches should be familiar with the symptoms of heat stress such as cramps, headaches, dizziness and uncharacteristic lack of coordination. Regular intake of fluid reduces the risk of heat illness and enables better maintenance of physical and mental performance. Fluid replacement is very important and coaches should be aware of the following points.

Thirst is a poor indicator of fluid replacement
Therefore drink before you are thirsty
Plain water is the best fluid replacement
The following quantities of water are advisable:
45 minutes before event: one or two glasses of water
During event: one glass of water every 15 minutes
After event: water should be consumed regularly to replace fluid loss (Amounts will depend on the weather conditions)

Cold
Cold weather can have life-threatening consequences. However, it commonly causes injuries by cooling warm muscles.

Long breaks will cause the body to cool down, thus players should be encouraged to wear adequate warm clothing such as tracksuits. Coaches should plan training sessions to avoid long breaks. Another warm-up period may need to be considered if long rest periods cannot be avoided.

7. Manage Existing Injuries Properly

Returning to play too early after injury can make the player susceptible to further injury. The coach should ensure that the risk of recurrence of injury is reduced. Protective strapping and the concentration on muscle stretching and a strengthening exercise routine before play will assist in preventing a recurrence of the injury.

8. Illness

During times of illness the player's body is particularly vulnerable, with the risk of damage to tissues or organs being very high. Thus, when ill or feverish, the player should not participate.

9. Balanced Competitions

It is important to keep the competitions balanced in order to reduce injuries. Consideration should be given to age, size, sex, strength and skill of the players when organising competitions.

10. Common Sense

Common sense tells us that it is far better to prevent injuries than it is to treat them.

Rule Modifications

Modification of rules has been highly effective in preventing injuries.

Changes to normal playing rules have been introduced for beginners in football programs to promote skill development, increase participation rates and to provide a safer playing environment. Some of these modifications include:

Smaller playing field
Fewer players
No tackling
The use of smaller footballs
No ruck, ruck-rover or rover, thus easing the congestion in general play
No kicking the ball off the ground
When ball is kicked out of bounds a kick is awarded to the nearest opponent

First Aid for Injuries

In managing an injury the main aim is to do no further damage.

When an injury occurs there are many decisions to be made. The most important of these for the coach is whether the player should continue to play or not. Coaches should always err on the side of caution as resuming play may cause further damage to an injury.

Unconscious Player

If the player is unconscious it is a life threatening situation and the DRABC of first aid should be used by an accredited sports trainer.

DANGER
Check for danger to:

You
The injured player
Others

RESPONSE
Ask the injured player:

Can you hear me?
Open your eyes
What is your name?

AIRWAY

Make sure the airway is clear

BREATHING

Check if the player is breathing by observing chest movements and/or air passing in or out of the mouth
If not, an accredited sports trainer or a trained first aider should begin Expired Air Resuscitation (EAR)

CIRCULATION

Check the pulse beside the Adam's apple. If the pulse is absent, an accredited sports trainer or trained first aider should commence Cardio Pulmonary Resuscitation (CPR)
EAR and CPR should be maintained until respiration and circulation are normal and/or until professional help arrives
Stop any bleeding by placing firm pressure over the injury site

Conscious Player

With all injuries it is important to have a set procedure to follow. The following S.T.O.P. procedure allows the coach to assess the severity of the injury and determine whether the player should continue or not.

STOP
Stop the player from participating or moving.
Stop the game if necessary.

Don't Panic...Stay Cool

TALK
Talk to the injured player.
What happened?
How did it happen?
What did you feel?
Where does it hurt?
Does it hurt anywhere else?
Have you injured this part before?

Provide a few words of encouragement

OBSERVE
Observe whilst talking to the player.
General
Is the player distressed?
Is the player lying in an unusual position / posture?
Injury Site
Is there any swelling?
Is there any deformity?
Is there any difference when compared to the other side/limb?
Is there tenderness when touched?
Does it hurt to move the injured part?

If the answer to any of the above questions is yes, seek an accredited sports trainer or qualified first aid support

PREVENT
Prevent further injury (3 options)

1. SEVERE INJURY
Suspected head, facial, spinal, chest, abdomen injuries, fractures or major bleeding.

GET HELP
Get professional help...don't move the player

Keep onlookers away
Comfort the player until professional help arrives
Immobilise and support

2. LESS SEVERE
Soft tissue injuries such as sprains, strains and muscle bruises.

RICER REGIME
The first 48 hours are vital in the effective management of soft tissue injuries

Rest
Ice
Compression
Elevation
Referral

3. MINOR INJURY
Bumps and bruises which do not impair performance

PLAY ON
A few words of encouragement will help

Monitor any such injuries
Minor injuries should also be managed using the RICER regime

Soft Tissue Injury Management

A large majority of injuries in football are soft tissue injuries. The first 48 hours are vital in the effective management of any soft tissue injury. Injuries managed effectively during this period will reduce the time spent on the sidelines.

The immediate management should follow the R.I.C.E.R. regime. This regime should be used for all ligament sprains, muscle strains and muscle bruises (corks, etc) in fact in any bumps or bruises which occur in football.

RICER with no HARM

REST
Place the player in a comfortable position, preferably lying down. The injured part should be immobilised and supported.
Activity will promote bleeding by increasing blood flow.

ICE
The conventional methods are:

Crushed ice in a wet towel / plastic bag
Immersion in icy water
Commercial cold packs wrapped in wet towel
Cold water from the tap is better than nothing

Apply for 20 minutes every 2 hours for the first 48 hours.

CAUTION

Do not apply ice directly to skin as ice burns can occur
Do not apply ice to people who are sensitive to cold or who have circulatory problems
Children have a low tolerance to ice
Ice Reduces:
Swelling
Pain
Muscle spasm
Secondary damage to the injured area

COMPRESSION
Apply a firm wide elastic bandage over a large area covering the injured part, as well as above and below the injured part.
Compression:

Reduces bleeding and swelling
Provides support for the injured part

ELEVATION
Raise injured area above the level of the heart at all possible times.
Elevation:

Reduces bleeding and swelling

REFERRAL
Refer to a suitable qualified professional such as a Doctor or Physiotherapist for diagnosis and ongoing care.
Early referral for a definitive diagnosis to ascertain the exact nature of the injury and to gain expert advice on the rehabilitation program required.

Avoid Harm

Remember, with injuries of this kind, you should avoid the HARM factors:

H	Harm	Increases bleeding
A	Alcohol	Increases swelling
R	Running	or exercising too soon can make the injury worse
M	Massage	in the first 48-72 hours increases swelling and bleeding