Soccer: No Pain, No Gain?

Created by Wyatt Kahn for The Art of the Game, photographed by Megan Maloy for ARTS 14C.

Created by Wyatt Kahn for The Art of the Game, photographed by Megan Maloy for ARTS 14C // Each of my stories includes an original artwork. Clicking on them will take you to their websites. I am grateful for all the collaborators, sharing their work.

@Created by: Wyatt Kahn | Photo: Megan Maloy for ARTS 14C

Nothing sells the game like a World Cup. One team, 11 players, four positions—and the knockout rounds are roaring.

I talked about position dynamics and their related injuries with Dr. Zafar Iqbal, who until recently led sports medicine at Arsenal with a 21-year record consulting in sports and exercise medicine.

The Goalkeeper’s Hands

The keeper is the only player allowed to use their hands, and pays for it up top. “Goalkeepers face a significantly higher risk of upper limb injuries than outfield players because of the repeated high force impacts involved in blocking, catching, and punching the ball,” says Iqbal. “These actions place substantial stress on the fingers, wrists, elbows, and shoulders.” The usual casualties are sprained, dislocated and broken fingers, and “it’s rare to meet a professional goalkeeper who hasn’t experienced at least one such injury,” he admits. His advice for the weekend warrior: “Protecting your hands as a recreational goalkeeper starts with using appropriate, well-fitted gloves that provide adequate padding and grip.” A finger that swells, weakens or stops bending is one to get checked, not to tape up.

The Back Line: Ankles And Heads

Defenders live in contact. They are particularly prone to lower‑limb injuries, which may occur through side tackles or overuse. One of their signature injuries is the ankle sprain. “This usually happens when the ankle rolls inward (inversion), overstretching the ligaments on the lateral side of the ankle,” Iqbal explains. “Less commonly, the ankle may roll outward (eversion), affecting the medial ligaments, or rotate in a way that stresses structures higher up in the ankle.” The temptation is to charge back the moment it stops hurting, and that is the trap. “Players often feel ready to return because pain has subsided, but pain relief alone does not mean the ankle has fully recovered,” he warns. “If strength, range of motion, or proprioception remain impaired, the risk of re-injury is significantly higher.” Does taping help? “Taping can sometimes provide additional support to healing ligaments and improve proprioception—the body’s ability to maintain balance and joint position—which helps reduce the likelihood of recurrent sprains.”

Heading and collisions pose a risk that warrants real caution. Defenders and midfielders suffer the highest number of concussions. “Concerns around head injuries have grown significantly in recent years, driven by emerging evidence of their long-term consequences, particularly when impacts are repeated or when individuals are not managed appropriately after an initial injury,” he reflects. “A concussion is a brain injury that should always be taken seriously. It occurs when a blow to the head—or an impact to another part of the body that causes the head to move rapidly—disrupts normal brain function. This disturbance can affect how a person thinks, feels, behaves, and remembers. Common symptoms include headache, dizziness, memory problems, and balance difficulties. These symptoms often appear immediately or within minutes of the injury, but in some cases they may not emerge until 24 to 48 hours later.” The detail that should end every touchline argument: “Importantly, loss of consciousness occurs in fewer than 10% of concussions, and is not required for diagnosis.”

The Midfield Engine

Midfielders cover more grass than anyone, and it catches up late. Do injuries really spike as players tire? “Research suggests that injury rates in football increase during the latter stages of each half, with fatigue considered a major contributing factor,” says Iqbal. Fatigue bites twice, dulling the brain and weakening the muscle: “As fatigue develops, slower reaction times and reduced coordination may increase the likelihood of contact injuries. In addition, fatigued muscles are less able to absorb and generate force effectively, making them more susceptible to strains and tears, particularly during high-speed running, sprinting, or rapid changes of direction.” For recreational or weekend footballers, the good news is that this is the most trainable risk of all: “Regular conditioning, appropriate training, and sufficient recovery between sessions and matches can improve fitness, delay the onset of fatigue, and help reduce the risk of injury.”

The Forwards: Hamstrings And Knees

In the photo: Dr. Zafar Iqbal with Luis Suárez, 2013.

@Photo: John Powell, an LFC Club Photographer.

Up front, the forwards live at top speed with rapid accelerations and sudden direction changes. These take their toll on the lower limbs. “While almost any muscle or joint can be affected, the injuries we see most frequently involve the ligaments of the knee and ankle, as well as the hamstrings, adductors (groin), quadriceps and calf muscles. Among these, hamstring injuries often attract the most attention, particularly in professional sport, where they can sideline players for weeks or even months and have a frustratingly high rate of recurrence.”

No pain, however, does not indicate complete recovery. “If an athlete returns too soon, the injured area may be unable to tolerate the required loads, increasing the risk of another tear. Recurrent injuries can lead to further scar tissue formation, making the cycle increasingly difficult to break.”

We can’t talk about soccer injuries without mentioning the knee, particularly injuries to the anterior cruciate ligament. The ACL often tears with no contact at all—a player plants a foot to stop or cuts sharply to change direction, and the knee gives way under the twist. “Although ACL tears are not the most common knee injury, they receive considerable media attention because of their potentially devastating impact on an athlete’s career,” says Iqbal. “In most cases, treatment requires surgical reconstruction followed by an extensive rehabilitation program.”

Heat and Warmup: Everyone’s Game

Created by Taína H. Cruz for The Art of the Game, photographed by Megan Maloy for ARTS 14C // Each of my stories includes an original artwork. Clicking on them will take you to their websites. I am grateful for all the collaborators, sharing their work.

@Creted by: Taína H. Cruz | Photo: Megan Maloy for ARTS 14C

And then the opponent that ignores position: the heat, the backstory of this tournament. “Research has shown that losing as little as a couple of liters of fluid during a football match in hot conditions can reduce physical performance by up to 20%, while also increasing the risk of fatigue-related injuries,” says Iqbal.

And it all starts before the kickoff: “insufficient preparation for match play, either through suboptimal prematch nutrition, poorly timed food intake, or the absence of an appropriate warm-up.” It bites hardest when you are rusty: “This is particularly important for individuals returning to play after a prolonged break, as their neuromuscular and cognitive systems may require additional activation to perform safely and effectively.”

“The principles of staying safe and performing well in the heat are the same for everyone. Maintaining good hydration before, during, and after exercise, gradually exposing the body to warmer conditions through training, and allowing time to acclimatize can all help improve performance while reducing the risk of heat-related illness and injury, regardless of whether you’re playing in a World Cup stadium or a local weekend league.”

None of this is a reason to stay home. It is a reason to prepare. Warm up, hydrate, and stop when a finger, an ankle or a foggy head tells you to. Play your position—and plan on playing for years.

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Dr. Tal Patalon, MD, LLB, MBA

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