Will Wayne Rooney’s latest injury set-back affect his chances of making the Euros in the summer?

February 19, 2016

It emerged this week that Wayne Rooney had suffered knee ligament damage in the 2-1 defeat to Sunderland and would be unavailable for up to 8 weeks. With the first game of the European Championships in France starting on the 10^th June England manager Roy Hodgson will be concerned about how this injury may affect his captain in the run up to the tournament.

What are knee ligament injuries?

• Ligaments are tough structures made from collegen that link bones to bones. In the knee joint the prime function is to link the thigh bone (Femur) to the shin bone (Tibia)
• There are 4 main ligaments within the knee – 2 collateral ligaments that run on the inside and outside of the knee and 2 cruciate ligaments which cross each other deep within the knee joint.
• Injuries to the anterior cruciate ligament commonly referred to as the ACL are the most feared sporting injury as they often require reconstructive surgery and up to 9 months of rehabilitation.
• It appears that Wayne Rooney has injured one of his collateral ligaments. The most commonly injured collateral ligament injured during football is the medial collateral ligament (MCL) as this ligament is put under tension when receiving a tackle from the opposition or when block tackling.
• When injured the ligament stretches and some tears of the ligament fibres occurs.

What are the symptoms?

• Pain is often immediate and often leads to the player coming off the field. In this case however Manchester United coach Louis Van Gaal revealed that Rooney carried on playing despite being aware of the injury.
• Swelling is common after such injuries and heat is often felt around the joint.
• The knee may feel unstable and weak as the ligament support will have been reduced.

Does the severity of ligament injury affect recovery?

Ligament injuries are graded 1-3

• Grade 1 injuries – There is damage to a few collagen fibres, producing a local inflammatory response. This is characterised by pain over the affected ligament. Grade 1 injuries typically take 6-8 weeks before a return to play is possible.

• Grade 2 injuries – There is damage to a more extensive number of collagen fibres. This produces a more marked inflammatory response characterised by intense pain and joint effusion (swelling). Grade 2 injuries typically take 3-4 months before a return to play is possible.

• Grade 3 injuries – The damage to collagen fibres is such that there is a complete rupture of the ligament. This produces intense pain, joint effusion and marked joint instability. Surgery may be necessary to restore joint stability. Grade 3 injuries may take 6 months before a return to play is possible.

How will the ligament repair itself?

The ligament undergoes three stages of repair.

• Inflammatory stage

This stage lasts for 3-5 days, depending on the severity of the injury and involves the release of chemicals which produce pain, and there is bleeding in the tissues. This, together with fluid from damaged cells, produces swelling within the joint, putting pressure on nerve endings and causing more pain.

• Repair phase

The repair phase is assisted by blood clotting over the damaged tissue. A mesh is formed from blood platelets to initiate healing. Fibroblast cells, which gradually increase in number begin to lay down Type 3 (immature) collagen tissue, between 3-21 days after the injury.

• Remodelling stage

The repair phase  can last for up to a year and  involves maturation of collagen tissue from Type 3 to Type 1 which is stronger.. The ligament gradually becomes stronger through being subjected to controlled strain in a functional pattern.

What treatment can be offered?

Initial treatment can help reduce the overall length of recovery and is comprised of the P.R.I.C.E regime. This consists of protecting the injured part from further damage (e.g. the use of crutches), rest from activity involving the injured part, ice (never apply ice directly to the skin), compression, elevation.

After the first 2-3 days physiotherapy, in the form of controlled exercises progressing to functional activity, aid the process of ligament remodelling.

Because the remodelling phase lasts for up to a year, there is a potential weakness in the ligament and a risk of re-injury. This risk is reduced by providing additional stability with a strapping, increasing the strength of muscles which also provide support to the joint, and by doing proprioceptive exercises to increase the patient’s sense of joint positioning.

Before a return to training is allowed the player will be subject to progressively difficulty functional exercises which would mimic actions in a game. This includes, jumping, running with twists and turns and football specific exercises such as kicking a ball.
Nick Livadas, Clinical Specialist at Physiotherapy Matters commented that.

“It appears that Rooney has suffered a grade 1 ligament injury and may be back in full training within 6-8 weeks. It may take him a further 4 weeks to get his match sharpness and during this phase he may be more prone to further muscle or tendon type injuries if the body has de-conditioned during his lay off. Rooney has gone into previous international tournaments on the back of injuries and it has shown in his performances. His medical team will be working hard to ensure his fitness does not dip too much during his lay off and the nation hopes he will quickly rediscover his goal scoring form ahead of the tournament.”

Physiotherapy Matters physiotherapist all hold extensive experience in treating sports injuries and if you have suffered a traumatic sports injury or an overuse type injury a consultation with one of the team will be the first step in getting you back to your sport or exercise.