The Doctors Surgery – Part 3

The Doctors Surgery – Part 1

The Doctors Surgery – Part 2

Qualified Doctor, Has 5 years experience in Musculoskeletal injury and disease working in Liverpool at the Royal Liverpool Hospital with a strong research background. Now working at St Mary’s Hospital in Manchester in a research related position for the Medical Research Council (because theres no money or interest in musculoskeletal injuries now from the Government).

Tendons & Ligaments

If muscles are everywhere in the body, tendons are to.

You’ll find them at the ends of muscles and work to anchor the muscle to the underlying bone to allow a base to work on. Without them, the force the muscle attempts to produce comes to nothing.

Ligaments work to connect the bones to one another to allow the joints to maintain their shape and form.

Unlike muscles, you often cannot change the size of tendons or ligaments and they are quite resistant to changes with age.

Tendons and ligaments however do share a similar structure and arrangement to the muscles in that they resemble the wire below.


Image result for tendon structure

Despite sharing a similar structure, not all tendons are the same. Some are used for delicate movements such as moving fingers and toes whereas others are like springs ready to maximise a muscles force output (Achilles tendon).

These tissues are really quite robust. Next time you have a chicken in front of you take a look at the “knee” or “elbow” joint.  You can twist and turn and pull at those two bones but it takes quite some force to tear the ligament holding them together.

It shouldnt come as a shock to see that bad ligament damage (usually ACL damage) is quite rare compared to the muscle injuries that occur.

In a study of 1,367 players from 28 European teams, there were 43 ACL injuries in 738,608 hours of football (training and game time).

Thats one ACL injury per 17,176 hours of football or one injury in 32 players. So you would expect one ACL injury per team roughly every 2 seasons.

This study did throw up the fact, these injures are far more likely during the match situation.

Image result for liverpool acl injury

Despite the higher chance of these injuries occuring during matches, 58% were due to non-contact.

Image result for liverpool acl injury

The major cause seems to be  through turning the upper body on a planted foot, thus causing a twist in the knee. These forces are unnatural to the knee ligaments and so tearing occurs.

Image result for acl injury

Image result for acl injury

The return to football after an ACL injury is long and complicated but players can and will recover. Previous ACL injuries however do cause weak spots and so the potential for repeat injuries are high.

What are the stats though?



Most but not all players returned to training within 12 months with the average lay off being just over 200 days.

Why though?

Well think of an elastic band that has snapped. Its extremely difficult to fix the two ends back together and even if you do, any force on the band would lead to it snapping again very easily.

In the joints this is more complicated because when the ligament breaks, the entire joint becomes unstable and that can lead to even further damage. This is why when a ligament or tendon injury is suspected, the player is strapped up straight away. The only real treatment is to use a graft of usually tendons from elsewhere to cover the gap and hopefully act as a scaffold for healing although this isnt perfect.

It does appear that for now, our two current sufferers are fully fit and performing. Lets hope to avoid any new ones for the remainder of the season!

Image result for ings gomez 2017


Up the Reds!


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