New research undertaken with football teams in the Bundesliga has shown a trend between ankle injury recurrences and the speed of returning to play after rehabilitation, indicating that external pressures to recover too quickly are detrimental.
The research, published by the BMJ and carried out with elite footballers including those from 13 professional Bundesliga and Bundesliga 2 football clubs (from under 17 level through to professional level), analysed injury data for lateral ankle sprains (LAS) – one of the most common injuries in professional football players.
The average overall time away from competitive play (time-loss) for LAS in the football players assessed was 29.9 days, except for under-23 players, who experienced an average time-loss of 33.8 days. Time-loss tended to decrease with increasing age, with professionals having the shortest overall time-loss, averaging 15.5 days. The lead author on the research paper, Kent PhD student Zacharias Flore has suggested that a time-loss of 15 days is below the necessary physiological healing time for LAS and that this highlights the question of whether professionals could be returning from LAS injury too soon in elite football due to external pressures.
The overall recurrence rate of all ankle injuries was 23.52%, with LAS recurrence rate slightly higher at 25.95%. More specifically the highest LAS recurrence rates were found in under 19’s (32.8%) and professional players (20%), similar to Zacharias Flore’s findings in a previously published systematic review. This demonstrates that a shorter recovery period is associated with a significantly increased risk of recurrence. This finding provides football coaches with a strong argument that athletes are prematurely returning to competition. Zacharias Flore argues that only four more days of rehabilitation could reduce future recurrences of LAS.
The findings of this study will inform a future larger multiphase, multicentre study that aims to evaluate a newly developed criteria-based rehabilitation approach after LAS in professional football players which Zacharias Flore is leading with Bundesliga football clubs.
Zacharias Flore who has also worked as physiotherapist and head of rehabilitation service for Bundesliga clubs in his career prior to and alongside studying his PhD, said: ‘This research has highlighted interesting findings and trends that are incredibly useful to take forward in our rehabilitation study. In my career so far working with many athletes I have recognised the lack of criteria-based rehabilitation protocols in place which has inspired me to bring change. This initial research demonstrates that rehabilitation for LAS in professional football is often still time-based and based on the anecdotal experience of the practitioner (e.g. physiotherapist) without any guidelines/criteria of when and why to progress throughout the rehabilitation phase. I look forward to the next step of this research.’
The research paper ‘Time-loss and recurrence rate of lateral ankle sprains in male professional football players depending on the severity grade: do we trivialise LAS?’ is published by BMJ: https://bmjopensem.bmj.com/content/11/1/e002271