How to Manage Injuries in Football

In this article, Matt Rogers explains the impact of player unavailability in football and factors that can contribute to an increased risk of injury at both an academy and elite level. Matt has worked across a range of participation levels, most recently working as First Team Sports Therapist at League One football club Peterborough United. Alongside a range of experiences in elite football, Matt also holds a Masters Degree in Sports Therapy.

In my (so far relatively short) career working in football, I have worked at both academy level and in a first team environment. Managers have come and gone in both settings, replaced by people with differing opinions on how best to get excellence from their players. Training sessions, opinions on gym sessions, tactics, everything is different from one manager to another – but one thing is consistent: regardless of who is in charge and at what level you work – players get injured.

Credit: Joe Dent / Peterborough United FC

Injuries are common in professional football and are the most common for player unavailability in training and matches. Injuries during a season or a tournament could therefore have a considerable impact on a team’s performance. It can be difficult to pinpoint cases in football where a player’s unavailability has had a direct impact on results, but would FC Barcelona be the same team without Lionel Messi? Would Manchester City be closer to the top of the table with a fully fit Sergio Aguero? The impact of injury loads on team success has been heavily researched, with one study by Drew et al. (2017) finding that low player availability is associated with a failure to achieve key performance indicators. From their research it was found that a strong negative relationship was evident between player availability and team success, therefore the widespread implication of this finding is that training and match availability is imperative to team success across a range of sports (e.g. basketball, football) and individual success in track and field.

More specifically to football, Hägglund et al. (2013) concluded that injury burden and match availability affected all three of their studied performance measures (the UEFA Season Club Coefficient, final league ranking, and points per league match), while injury incidence was associated only with points per league match. This means that a team that had both decreased injury rates and injury severity compared with the preceding season had a statistically better chance of improved team performance.

Credit: Joe Dent / Peterborough United FC

Injuries are multifactorial, so it is never possible to completely stop them from happening. What is possible, however, is gaining an understanding of what can contribute to an increased risk of injury, and putting interventions in place to counteract this. Ekstrand et al. (2018) conducted a study that aimed to investigate the transformational leadership styles of head coaches in elite men’s football and to evaluate the correlation between leadership styles, injury rates and players’ availability. Coaching styles were determined using The Global Transformational Leadership scale, which has been shown to be a reliable and appropriate tool for assessing transformational leadership. Their study found that there was a correlation between a head coach’s leadership style and the incidence of severe injuries and players’ availability. For example, teams whose coaches tended to employ a transformational or democratic leadership style had a lower incidence of severe injuries in their teams. The correlation between the two explains 6% of total variation in the incidence of severe injuries. They also found the incidence of severe injuries was 29%–40% lower in teams where coaches communicated a clear and positive vision of the future, supported staff members, and gave staff encouragement and recognition.

Credit: Joe Dent / Peterborough United FC

Another finding of this study was that attendance at training was higher in teams where coaches gave encouragement and recognised staff members, encouraged innovative thinking, fostered trust and cooperation among team members and acted as role models. Further to this, Ekstrand et al. (2019) investigated whether the quality of communication between medical teams and their head coach is associated with injury burden and player availability in elite football clubs. They found that both injury rates and player availability were significantly different across the high, moderate and low groups of internal communication between the head coach or manager and the medical staff. Teams with low communication quality had significantly higher injury burden and higher incidence of severe injury compared with teams with moderate or high communication quality. Teams with low communication quality also had lower attendance at training and lower availability at matches compared with teams with moderate communication quality.

Additionally, the quality of communication within the medical team between doctors and physiotherapists was generally very good in the studied elite football teams; however, in rare cases of poor communication, player availability at training was affected negatively. This was also the case for teams with low communication quality between the medical team and the fitness coaches. The improved injury rates in both studies may be due to the manager valuing the opinion of their staff, and listening to advice regarding extra recovery days for players who may require them. Similarly, if a manager does not value these opinions, or is not easy to communicate with, the players and teams could end up suffering as their needs are not being catered for.

Credit: Joe Dent / Peterborough United FC

COVID-19 Impact

Injuries are a major concern for football teams at the best of times. The first 8 gameweeks in the Premier League proved pivotal to the incidence of injury. Injury data website Premier Injuries reported 237 injuries, the joint highest since 2016-17, however a greater significance has been attributed to injuries during the current campaign - keeping players out for longer. The most high-profile of these have been muscle injuries sustained by Nathan Ake, Naby Keita, Luke Shaw, Callum Wilson, Danny Ings, Michail Antonio and Toby Alderweireld for their respective clubs, some still yet to return to match-day squads. Moreover, the same database reported 133 muscle injuries after the ninth match day, which was a 23% increase compared to the same period in the previous campaign. Whilst the EFL board moved quickly to continue with the use of five substitutes for the rest of the season, the Premier League have instead scrapped the rule, much to the disappointment of managers like Jürgen Klopp, who is currently without 7 of his key players - including Virgil Van Dijk, Thiago Alcantara, Diogo Jota and Joe Gomez. After 9 games however, it was only Arsenal, Newcastle, Spurs, West Brom and Manchester United that had used all three available subs in each of their games.

Several key factors play true to the rise in injury rates, mainly the lack of a normal pre-season and a congested fixture schedule - only seven weeks between the conclusion of the 2019-20 Premier League campaign and the start of the 2020-21 season. 12 weeks were originally planned, therefore, resulting in a five-week cut to the traditional length of a season. Surprisingly, no real compromise has been made to domestic cup competitions either (Carabao Cup, FA Cup), with top teams still expected to play in European competition and players fulfilling international duty. Most recently, international teams crammed three fixtures in eight days, a period that would normally utilise only two. A shorter window for recovery means the increased likelihood of fatigue - and if you begin to load under fatigue, that's when you'll see players breaking down with soft-tissue, muscle injuries.

Take Home Messages

From available research, it is clear that injuries and illnesses have the potential to increase the chance of failure in athletic populations. Injuries detrimentally affect the final ranking position of a team, with higher availability rates associated with better outcomes. Research has shown that injuries and illnesses sustained during competition affect the outcome of success and failure in team and individual sports. Research has also shown that managers can have an impact on injury rates in their teams via their management style, and also the way they communicate with their medical staff – so it is certainly worth liaising with other coaches, parents and the players themselves to identify any potential injury risks.

About the Author: Matt Rogers is a qualified sports therapist, specialising in football. He has worked across a range of participation levels since 2014, undertaking a number of roles within both academy and first team football. He is currently First Team Sports Therapist at Peterborough United Football Club.

Twitter: @mattrogers91

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