Football Season: The Injuries We See

Football season has a rhythm in Manitoba. The Blue Bombers are back under the lights, high school and community tackle programs are running two-a-days in the August heat, and by early fall the first wave of bumps, sprains, and strains starts showing up. Football is a collision sport played at high speed, so a certain amount of injury is part of the game. The useful thing is that most football injuries follow recognizable patterns. Knowing what they are, and which ones need a closer look, helps players and parents respond sensibly rather than anxiously.

Shoulder: AC Joint Sprains

The acromioclavicular (AC) joint sits at the top of the shoulder, where the collarbone meets the shoulder blade. A direct fall onto the shoulder or a hard hit, exactly the kind of contact football produces, can sprain or separate this joint. Players often describe pain right at the top of the shoulder, sometimes with a visible bump in more significant separations.¹

Most lower-grade AC sprains are managed conservatively: a short period of relative rest and pain control, then a progressive return of range and strength. The bump from a separation may not fully disappear, but function usually returns well. The rehab priority is restoring pain-free overhead and pressing strength and rebuilding confidence in the shoulder before contact resumes.

Hamstring Strains

Hamstring strains are among the most common injuries in any running-and-sprinting sport, and football is full of accelerations, sudden stops, and full-speed sprints. The typical mechanism is high-speed running, where the hamstring is loaded eccentrically as the leg swings forward, or an overstretch, such as reaching for a tackle.²

The evidence here is encouraging: progressive, strength-based rehabilitation with an emphasis on eccentric loading reduces re-injury and builds a more durable hamstring. Programs featuring exercises like the Nordic hamstring curl have repeatedly lowered hamstring injury rates in footballers.³ The temptation is to rush back once pain settles, but the hamstring needs to prove it can produce force at speed first. We go deeper on that recovery arc in our article on hamstring strain recovery.

Ankle Sprains

Ankle sprains are the workhorse injury of field sports. Getting stepped on, planting awkwardly, or rolling the ankle on a cut most often injures the ligaments on the outside of the ankle. They are common, they are usually manageable, and, importantly, they are frequently under-rehabilitated.

The old instinct to simply rest an ankle until it stops hurting leaves many people with lingering instability and repeat sprains. Better outcomes come from early protected movement followed by a progressive program targeting range, strength, and especially balance and proprioception, the sense of where the joint is in space.⁴ This is the same modern, movement-first thinking captured in the PEACE & LOVE framework we describe in our piece on managing soft-tissue injuries.

A Word on Head Contact: Concussion Awareness

No honest discussion of football injuries can skip head contact. Concussion is a brain injury, and it deserves to be treated seriously and separately from the musculoskeletal injuries above. The single most important message is simple: any player suspected of a concussion should be removed from play and evaluated, and should not return the same day.⁵

Warning signs include headache, confusion or feeling "foggy," dizziness, nausea, sensitivity to light or noise, balance problems, and any brief loss of consciousness. Symptoms can also appear or worsen over the hours after the hit. Concussion management is a medical matter that should be directed by an appropriately trained healthcare provider following a recognized return-to-sport protocol, and it is outside what we manage here. If a concussion is suspected, our role is to recognize it and refer to the right care, not to clear an athlete back to contact. When in doubt, sit them out.

Load, Contact, and Staying Available

Away from the acute, contact-driven injuries, a lot of early-season football soreness comes from a familiar culprit: the sudden spike in training load when camp opens. Athletes go from an off-season lull to full-intensity practices in a matter of days, and the body has not built the capacity to absorb it yet. This is where a principle we come back to often applies directly: there are no bad exercises, only too much too soon.⁶ Progressive conditioning in the weeks before contact, rather than a sudden jump into full volume, is one of the more reliable ways to reduce soft-tissue injuries early in the season.

It also helps to remember that the body works as a chain. A hamstring that keeps straining, an ankle that keeps rolling, or a shoulder that keeps flaring may be signalling a demand it is not yet strong enough to meet, often influenced by the joints and muscles above and below it. Looking at the whole kinetic chain, and building capacity through loading rather than relying on passive treatments, is central to how we approach return-to-sport rehab at Boreal Spine & Sport.

The Takeaway

Football will always carry some injury risk, but most of what we see is predictable and responds well to a structured, active plan. Build conditioning gradually before contact, rehabilitate strains and sprains with real loading rather than rest alone, and treat any suspected head injury as the medical priority it is. Do those three things and most players stay available for the season that matters to them.

References

1. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316-329.
2. Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39(6):1226-1232.
3. van der Horst N, Smits DW, Petersen J, Goedhart EA, Backx FJ. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med. 2015;43(6):1316-1323.
4. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113-125.
5. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711.
6. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.