Football Injuries: The Five We See Most in Liverpool

Every August the pitches across Merseyside start filling up again. Pre-season friendlies, Sunday league squads reassembling, teenagers back at training after six weeks of doing very little. And every August my diary fills with more or less the same five injuries.

Football is unusually demanding on a body. It asks for repeated near-maximal sprinting, hard deceleration, cutting and turning, kicking with force, and doing all of that while somebody else is trying to take the ball off you. Most of what I treat is not freak contact. It is a body being asked to do something it has not been prepared for.

Why the start of the season is the danger zone

Injury rates in football are highest in pre-season and the opening weeks of the campaign. That is not bad luck. Research consistently shows that risk climbs when training load increases faster than tissue can adapt to it, and a summer off followed by three sessions a week is exactly that kind of jump.

Fitness and tissue tolerance also move at different speeds. Your lungs will feel noticeably better after a fortnight. Tendon and muscle take considerably longer to remodel. That mismatch, where you feel ready before you are robust, is where most August injuries live.

1. Hamstring strain

The hamstring is the most commonly strained muscle in football, and the mechanism is nearly always the same: the late swing phase of a sprint, when the hamstring is long and working hard to slow the lower leg before the foot lands. It is a lengthening contraction at speed, and that is where the tissue is most vulnerable.

The typical story is a sudden grab at the back of the thigh mid-sprint, sometimes with a pop. Walking is usually still possible. Sprinting is not.

What reduces the risk is not stretching before kick-off. It is eccentric strength work and sprint exposure. Nordic hamstring curls have a strong evidence base in football specifically, because they load the muscle in the position it tends to fail. Equally important, and often ignored: if you never sprint in training, your first competitive sprint of the season is an untrained maximal effort.

Early management is a few days of relative rest followed by progressive loading. Resting completely until it stops hurting and then going straight back to matches is the most reliable way to strain it again a month later.

2. Lateral ankle sprain

Rolling the ankle inwards damages the ligaments on the outer side. Almost every footballer has done it. The problem is rarely the first sprain, it is what happens afterwards. A significant number of people go on to develop ongoing ankle instability, with repeated giving way, grumbling swelling and no confidence on uneven ground.

That usually happens because the first sprain was treated as a few days off rather than a rehabilitation problem. Every sprain blunts proprioception, your ability to sense where the joint is without looking, and that does not simply return on its own. Balance work, single-leg control and hop training restore it. Skipping that step is the single most common reason someone ends up in front of me with their fifth sprain. Structured sports injury rehabilitation after the first one is genuinely preventative.

3. Groin and adductor pain

Kicking, lunging into a tackle and cutting all load the adductors hard. Groin pain in footballers is often insidious rather than dramatic: stiffness first thing, a niggle when striking a ball with the inside of the foot, gradually creeping worse. Because it builds slowly, players train through it, which is exactly why it becomes one of the more stubborn problems I see.

The Copenhagen adductor exercise is the mainstay for both prevention and rehabilitation. It is uncomfortable and unglamorous, and it works. Worth knowing too that not all groin pain is muscular. Hip joint problems and pubic-related pain present similarly, so groin pain that has not settled in three or four weeks deserves a proper assessment rather than another fortnight of guesswork.

4. Knee ligament and cartilage injuries

Anterior cruciate ligament injuries are the ones everybody fears. The classic mechanism is non-contact: decelerating or pivoting with the knee collapsing inwards over the foot. Marked swelling within a few hours, a sense that the knee gave way, and real apprehension about turning are all features that need prompt assessment. Medial ligament injuries tend to follow a blow to the outside of the knee, and meniscal tears often involve twisting with the foot planted.

Neuromuscular training programmes that coach landing and cutting mechanics, alongside hip and hamstring strength, have good evidence for reducing serious knee injuries, particularly in younger players. If you already have a grumbling knee, the assessment matters more than the label, and I have written more about that on my knee pain page.

5. Calf and Achilles problems

These climb steadily with age, and they dominate my over-thirty-fives. Calf strains announce themselves as a sharp pain mid-calf during push-off. Achilles tendinopathy is the opposite: gradual onset, stiff and sore for the first few minutes of activity, warms up, then aches afterwards.

Tendons dislike sudden change and respond well to progressive loading. Calf raises, done properly and heavy enough to be hard, are the backbone of both treatment and prevention.

Red flags: when it is not a physio problem first

Get urgent medical assessment, usually A&E or an urgent treatment centre, if you have:

• sudden severe pain at the back of the ankle with a feeling of being kicked, and difficulty rising onto your toes, which can indicate an Achilles rupture
• inability to take four steps on the injured leg
• an obviously deformed joint, or a knee that locks and will not straighten
• numbness, pins and needles or a cold, pale foot
• significant swelling within an hour of a knee injury

Getting it seen properly

Most football injuries do not need a scan. They need an accurate assessment, a clear plan and someone honest about return-to-play timelines. I offer home visits across Liverpool and Merseyside at £90 a session, so you can be assessed on your own stairs and floor rather than in a clinic cubicle, and online video consultations at £60 if you mainly need a plan and progression advice. No GP referral is needed, and I work evenings Monday to Friday, plus Saturday and Sunday daytimes, which suits people who train in the evenings. There is more detail on how I work with players on my sports injury physiotherapy in Liverpool page.

If you have picked up a niggle in pre-season, get it looked at before it becomes a season-long problem. You can book at /portal/book or call me on +44 7443 357020.