Soccer injuries in adolescents

Combined effects of estrogen and progesterone on the anterior cruciate ligament

Previous studies from the authors' laboratory have established the presence of estrogen and progesterone receptors in the human anterior cruciate ligament. The purpose of the current study was to investigate the combined effects of 1beta-estradiol and progesterone on cell proliferation and procollagen synthesis of the human anterior cruciate ligament fibroblasts. Fibroblast proliferation and procollagen synthesis in response to logarithmic concentrations of 17beta-estradiol (0.0025 ng/mL, 0.025 ng/mL, 0.25 ng/mL) and progesterone (1 ng/mL, 10 ng/mL, 100 ng/mL) were assessed with the measurement of 3H-thymidine incorporation and Types I and III procollagen specific equilibrium radioimmunoassays. On Days 1, 3, and 5 there was a dose dependent decrease in the fibroblast proliferation and procollagen Type I synthesis with increasing estradiol concentrations. The effect was attenuated with increasing progesterone concentrations. Controlling for estrogen levels, a dose dependent increase in fibroblast proliferation and procollagen Type I synthesis was observed with increasing progesterone concentrations. The effect was more pronounced at lower concentrations of estrogen, suggesting estrogen levels were the dominant factor. The effects of estrogen and progesterone became less apparent by Day 7. No significant differences in Type III procollagen synthesis were seen with varying estradiol concentrations at any of the designated times. These early physiologic changes in fibroblast proliferation and Type I procollagen synthesis may provide a biologic explanation for the increased anterior cruciate ligament injury rate observed in female athletes, suggesting the acute cyclical hormonal variations in the female athlete during menstruation predispose her to ligamentous injury.

Avoidance of soccer injuries with preseason conditioning

The effect of a preseason conditioning program was studied to evaluate its influence on the occurrence and severity of soccer injuries. Three hundred female soccer players (ages 14 to 18 years) were studied over a 1-year period. Forty-two of these players participated in a 7-week training program before the start of the season. The type, mechanism, and severity of the injury, when the injury occurred, the number of games or practices missed, and type of shoe worn were recorded. All injuries occurred in the lower extremities, with 61.2% occurring at the knee and ankle. Student's t-test evaluations revealed that the trained group experienced a significantly lower incidence of injury than the untrained group (P = 0.0085). Although not statistically significant, the trained group also had a lower percentage (2.4%) of anterior cruciate ligament injuries compared with the untrained group (3.1%). These results suggest that this type of conditioning has a significant influence on lowering the incidence of injury in female adolescent soccer players.

Effect of estrogen on cellular metabolism of the human anterior cruciate ligament

Previous studies from this laboratory have established the presence of estrogen receptors in the human anterior cruciate ligament. The purpose of this study was to investigate the effects of 17 beta-estradiol on cell proliferation and procollagen levels, as an indicator of collagen synthesis, in the human anterior cruciate ligament fibroblasts. Fibroblast proliferation and procollagen synthesis in response to near log concentrations of 17 beta-estradiol (at 0.0029 ng/mL, 0.025 ng/mL, 0.25 ng/mL, 2.5 ng/mL, and 25 ng/mL) were assessed with the measurement of 3H-thymidine incorporation and Types 1 and 3 procollagen specific equilibrium radioimmunoassays. On Days 1 and 3, there was a dose dependent decrease in the proliferation of anterior cruciate ligament fibroblasts with increasing estradiol concentrations. This dose dependent effect of decreased fibroblast proliferation with increasing estradiol concentrations became less apparent at 7, 10, and 14 days. On Days 1 and 3, procollagen synthesis decreased in a dose dependent manner with increasing estradiol concentrations. On Days 7, 10, and 14, this dose dependent effect was attenuated. No significant differences in Type 3 procollagen synthesis by anterior cruciate ligament fibroblasts were observed with varying estradiol concentrations at any of the designated points. These early physiologic changes in fibroblast proliferation and Type I procollagen synthesis may provide a biologic explanation for the increased anterior cruciate ligament injury rate observed in female athletes, suggesting that it is the acute cyclic variations in the female athlete who is menstruating that predisposes her to ligamentous injury.

Youth soccer: an epidemiologic perspective

The youth soccer movement in the United States is developing at a tremendous rate. This article explores the epidemiology of youth soccer including trends in participation, injury data, and injury categories that are of specific concern to the young athlete. Finally, recommendations are made regarding possible future areas of study and research on youth soccer.

How can injuries be prevented in the World Cup soccer athlete?

In order to prevent soccer injuries, different risk factors have to be identified as intrinsic (e.g., joint stability or muscle imbalance) and extrinsic (e.g., equipment, turf, and rules risk factors). Some preventive measures are discussed in this article, such as shin guards, prophylactic braces and taping (or both), and proprioceptive training.

Concussion history in elite male and female soccer players

A unique feature of soccer is the purposeful use of the head for controlling, passing, and shooting a soccer ball. Some concern has been expressed in the literature on the cumulative effects of heading on soccer players. Certain neurophysiologic and neuropsychologic changes have been reported in current or retired players, with heading being blamed. A major factor that could influence some of the findings is a player's history of concussive episodes, which are known to influence brain function. These episodes can occur during aspects of the game other than heading. We interviewed all male and female soccer players (N = 137, average age = 20.5 years) who competed at the U.S. Olympic Sports Festival in 1993. The mechanisms of injuries, frequency, and sequelae were determined. There were 74 concussions in 39 male players (grade I = 50) and 28 concussions in 23 female players (grade I = 19). For the men, 48 of the 74 episodes were from collisions with another player. For the women, 20 of 28 were from such collisions. Headaches, being "dazed," and dizziness were the most common symptoms reported. Based on concussion history, the odds are 50% that a man, and 22% that a woman, will sustain a concussion within a 10-year period. The data indicate that concussions from player-to-player contact are a frequent hazard in soccer. Head injuries incurred this way may be more of an influence for published findings of physiologic and psychologic deficiencies than routine heading of the soccer ball.

Primary immunolocalization of androgen target cells in the human anterior cruciate ligament

To identify androgen target cells in the human anterior cruciate ligament, immunohistochemical localization of the androgen receptor was performed in 31 specimens of the ligament. All of the specimens were obtained at surgery. Seventeen specimens were from women, and 14 were from men: the average age of the patients was 45.2 years (range: 18-78 years). An immunoperoxidase method using monoclonal antibodies to the androgen receptor was employed to identify androgen target cells in the ligament. Consistent staining of the androgen receptor was demonstrable in six specimens obtained from young men 18-24 years old, and equivocal positive staining was seen in two other specimens from young men. No receptors were demonstrated by this method in any of the specimens from women or older men. Androgen receptors were localized to synoviocytes in the synovium and under the synovial lining, fibroblasts in the ligament stroma, and cells lining the blood-vessel walls of the anterior cruciate ligament. The demonstration of androgen receptors in the cells of the anterior cruciate ligament strongly suggests that male sex hormones may have an effect on the structure and composition of this ligament in young men.

Estrogen affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury

Investigations from this laboratory have established the presence of estrogen receptors in the human anterior cruciate ligament. This study further investigates the effects of 17 beta-estradiol on the cellular proliferation and collagen synthesis of fibroblasts derived from the rabbit anterior cruciate ligament. Fibroblast proliferation and collagen synthesis in response to near log concentrations of 17 beta-estradiol (at 0.0029, 0.025, 0.25, 2.5, and 25 ng/ml) were assessed by measuring [3H]thymidine and [14C]hydroxyproline incorporation, respectively. Collagen synthesis was significantly reduced with increasing local estradiol concentration (P < 0.001). Declining collagen synthesis was first noted at a 17 beta-estradiol concentration of 0.025 ng/ml. Within normal physiologic levels of estrogen (0.025 to 0.25 ng/ml), collagen synthesis was reduced by more than 40% of control, and at pharmacologic levels of 2.5 and 25 ng/ml, by more than 50% of control. A significant reduction of fibroblast proliferation was also observed with increasing estradiol concentrations (P = 0.023). Clinically, alterations in anterior cruciate ligament cellular metabolism caused by estrogen fluctuations may change the composition of the ligament, rendering it more susceptible to injury.

Epidemiology of anterior cruciate ligament injuries in soccer

We did a retrospective study of all anterior cruciate ligament injuries (972) verified by arthroscopic evaluation at hospitals in the Hordaland region of Norway from 1982 to 1991. Our final study group comprised 176 patients who had participated in organized soccer and answered a questionnaire. The overall incidence rate was 0.063 injuries per 1000 game hours. Men incurred 75.6% (133) of the injuries. Women had an incidence rate of 0.10 injuries per 1000 game hours, significantly higher than that for men (0.057). The incidence rate was higher (0.41) for men in the top three divisions. Most of the injuries (124) occurred during games. Contact injuries from tackling was the injury mechanism in 46.0% of the cases. Players on the offensive team incurred 122 (69.3%) of the injuries. Reconstructive surgery was performed on 131 (74.4%) of the injured players and was found necessary for return to a high level of play. Half of the players (87) returned to soccer; men at high levels of play had the highest return rate (88.9%), and men over age 34 had the poorest return rate (22.9%). Nearly one-third of the injured athletes gave up soccer because of poor knee function or fear of new injury.

Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament

To identify estrogen and progesterone target cells in the human anterior cruciate ligament immunohistochemical localization of both estrogen and progesterone receptors was performed in 17 specimens of human anterior cruciate ligament. All ligament specimens were obtained at surgery. Thirteen specimens were from women, and four were from men: the average age was 57 years (range, 18-78 years). Eleven specimens (from nine women and two men) came from total knee replacements for osteoarthritis of the knee: three (from two women and one man), from reconstructions of the anterior cruciate ligament: two (both from women), from medial meniscectomies; and one (from a man), from an amputation secondary to chondrosarcoma of the pelvis. An immunoperoxidase method using monoclonal antibodies to the estrogen and progesterone receptors was employed to identify estrogen and progesterone target cells in the anterior cruciate ligament. Staining of both receptors was demonstrable in 14 specimens and in the remaining three specimens less than 15% of the cells were stained. Both estrogen and progesterone receptors were localized to synoviocytes in the synovial lining, fibroblasts in the anterior cruciate ligament stroma and cells in the blood vessel walls of the ligament. This demonstration of receptors for estrogen and progesterone in the cells of anterior cruciate ligament suggests that female sex hormones may have an effect on its structure and composition.

Epidemiology and traumatology of injuries in elite soccer: a prospective study in Finland

A prospective study of male soccer injuries among 12 teams playing at the highest competition level was carried out in Finland in 1993. Overall, two out of three players were injured during the whole season. The injury incidence per 1000 playing hours among injured players and all players during games was higher than during practice, 14.2 vs. 11.3 and 2.3 vs. 1.8, respectively. The lower extremity was involved in 76% of the injuries. Thigh injuries were most frequent (22%), whereas overuse injuries were scarce (6%). Eighteen per cent of the injured players needed surgery and in most cases (58%) the reason for surgery was a knee injury. Sixteen per cent of all injured players were absent from soccer for more than 1 month after the injury. The mean absence time was 17 days for all and 84 days for operatively treated players.

Injuries in indoor soccer. The Lake Placid Dawn to Dark Soccer Tournament

We conducted a prospective study of soccer injuries during the Soccer America Dawn to Dark Indoor Soccer Tournament, which was organized by the Lake Placid Soccer Center, Lake Placid, New York, 1993. Eight hundred twenty-four players competed in open men's, open women's, over-30 men's, and mixed divisions. The overall rate of injury per 100 player hours was 4.44, with a rate of 5.79 in the open men's, 4.74 in the open women's, 2.73 in the over-30 men's, and 1.54 for the mixed divisions. The differences in injury rates for men versus women and men versus older men were not statistically significant. Twenty-five of the 38 injuries (65.8%) were mild, with 27 injuries (71.4%) occurring in the lower extremities. Ankle sprains were the most common injuries and combined ligamentous injuries to the knee were the most common severe injuries. As the injuries increased in severity, they were more likely to be noncontact injuries. The data demonstrate the low incidence of injury in male and female indoor soccer participants. The data also show the similarity in the types of injuries sustained by indoor and outdoor soccer players.

Soccer injuries in Iceland

We investigated the frequency, cause and location of injuries in Icelandic elite soccer in 1991. The incidence of injuries for the individual player was 34.8 +/- 5.7 per 1000 game-hours and 5.9 +/- 1.1 per 1000 practice-hours. The most common types of injuries were muscle strains (29%), ligament sprains (22%), contusions (20%), and other injuries (29%). The frequency of reinjury was markedly high, where 44% of the strains and 58% of the sprains were registered as reinjuries. Strains occurred mainly during sprinting, sprains by tackling, and contusion during other contact. Significantly more injuries occurred on artificial turf than on grass or gravel in correlation to number of hours in games and practices. Teams who had the longest pre-season preparation period obtained significantly fewer injuries during the season.

Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data

OBJECTIVE

To determine the acute injury profile in each of six sports and compare the injury rates between the sports.

DESIGN

Analysis of national sports injury insurance registry data.

SETTING

Finland during 1987-91.

SUBJECTS

621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate.

MAIN OUTCOME MEASURES

Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors.

RESULTS

54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability.

CONCLUSIONS

Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.

Managing Groin Pain

In brief The cause of groin pain, common in kicking sports, is obvious when a patient suffers an acute muscle strain. However, a case study involving a 16-year-old male high school athlete demonstrates how gradual-onset groin pain can open up a multitude of orthopedic and nonorthopedic diagnostic possibilities including avulsion fracture, osteitis pubis, and inguinal hernia. Muscle strains usually resolve with RICE therapy and a focused rehabilitation program. Conservative treatment is also appropriate in the initial workup of inguinal canal weakness. Surgery may be needed to repair severely torn muscles or to correct an inguinal canal defect.

Incidence of injury in indoor soccer

All injuries occurring over a 7-week period at a local indoor soccer arena were documented for analysis of incidence rates. All injury rates were calculated per 100 player-hours. The overall injury rates for male and female players were similar, 5.04 and 5.03, respectively. The lowest injury rate was found among the 19- to 24-year-old athletes and the highest injury rate was found among the oldest age group (> or = 25 years). Collision with another player was the most common activity at the time of injury, accounting for 31% of all injuries. The most common injury types were sprains and muscle contusions, both occurring at a rate of 1.1 injuries per 100 player-hours. Male players suffered a significantly higher rate of ankle ligament injuries compared with female players (1.24 versus 0.43, P < 0.05), while female players suffered a significantly higher rate of knee ligament injuries (0.87 versus 0.29, P < 0.01). Goalkeepers had injury rates (4.2) similar to players in nongoalkeeper positions (4.5).

Incidence and nature of sports injuries in Ireland. Analysis of four types of sport

The objectives of this study were to investigate the incidence of sports injuries in Ireland and to analyze various ways of quantifying the seriousness of these injuries. A 12-month, prospective study was carried out on 324 Irish athletes involved at a high level of sports participation in one of the following categories: endurance, contact, noncontact, or explosive sports. Results were expressed in four ways: 1) number of injuries per year; 2) days injured per year; 3) number of injuries per 10,000 hours of participation; and 4) duration of injury per 1000 hours of participation. The average athlete sustained 1.17 acute and 0.93 overuse injuries per year and suffered the effects of sports injury for 52 days. More time was lost through overuse injuries than acute injuries. The incidence of acute injuries per 10,000 hours of participation was lowest in the noncontact sports and highest in the contact sports, but there was no difference in the incidence of overuse injuries between any of the four categories of sport. The injury rate per 10,000 hours of participation was lowest in noncontact and explosive sports and highest in contact sports. However, when expressed in terms of days lost per 1000 hours of participation, endurance sports had the lowest incidence of time loss and explosive sports the highest.

Head and neck injuries in soccer. Impact of minor trauma

Head injuries have been shown to account for between 4 and 22% of soccer injuries. Clinical and neuropsychological investigations of patients with minor head trauma have revealed organic brain damage. 69 active football (soccer) players and 37 former players of the Norwegian national team were included in a neurological and electroencephalographic (EEG) study to investigate the incidence of head injuries mainly caused by heading the ball. 3% of the active and 30% of the former players complained of permanent problems such as headache, dizziness, irritability, impaired memory and neck pain. 35% of the active and 32% of former players had from slightly abnormal to abnormal EEG compared with 13 and 11% of matched controls, respectively. There were fewer definitely abnormal EEG changes among typical 'headers' (10%) than among 'nonheaders' (27%). The former players were also subjected to cerebral computed tomography (CT), a neuropsychological examination and a radiological examination of the cervical spine. One-third of the players were found to have central cerebral atrophy and 81% to have from mild to severe (mostly mild to moderate) neuropsychological impairment. The radiological examination of the cervical spine revealed a significantly higher incidence and degree of degenerative changes than in a matched control group.

European soccer injuries. A prospective epidemiologic and socioeconomic study

In 1 year, 715 patients with soccer injuries were registered and treated in the emergency department of Randers City Hospital. We did a prospective study of these patients using a questionnaire to determine the most common locations, types, mechanisms, and treatments of injury. Financial costs for society and the individual were also examined. Forty-nine percent of the injuries were to the joints; sprains and contusions were the most common types of injury, accounting for 46% and 25%, respectively. The majority of patients (64% of the men and 58% of the women) were injured during physical contact with another player. Most (63%) of the patients were treated in the emergency department and then released. Thirty-one percent had to be absent from work, but only 8% of the patients had a loss of income because of their injury. The average amount of work time lost was 5 days.

Injuries in high-skilled and low-skilled soccer: a prospective study

Fifty-five male soccer players organized in three teams, one high and two lower ranking, were followed prospectively during 1 year to register the rate, type and severity of injuries in highly skilled and low-skilled players. The injury rate of the low-skilled players was significantly higher than that of the better players. The reason for this is that low-skilled players play in more competitions. and this is where injuries tend to occur. When we stratified on game/practice, the low-skilled players' excess risk disappeared and no difference was found in the severity of injuries. Different ways of collecting data in epidemiological studies of soccer are discussed and it is concluded that the most precise and accurate collection of data can only be obtained by direct supervision and examination of soccer players in the field.

Soccer injuries among elite female players

Injuries occurring in two female elite soccer teams were recorded during 1 year. Of 41 players, 33 (80%) sustained 78 injuries. The incidence of injury during games was 24/1000 hours, while the incidence during training was 7/1000 hours. The majority (88%) of injuries were localized to the lower extremities, with equal occurrence in the left and right legs. Forty-nine percent of the injuries occurred in the knee or ankle. Most of the injuries were minor (49%), while 36% were moderate and 15% were major. Of the major injuries (N = 12), 10 were due to trauma and 7 (58%) were knee ligament or meniscal tears. Overuse injuries constituted 28% of all injuries and occurred mainly during preseason training and at the beginning and end of the competitive season. Traumatic injuries (72%) occurred mainly during games with a predominance at the beginning of the competitive season. Almost 80% of the traumatic injuries occurred during physical contact with an opponent. Extrinsic factors such as weather, playing surface, temperature, or the position of the player within the team did not influence the injury rate. We conclude that female elite soccer players sustain a high incidence of injury. Few injuries were major, but 17% of the players sustained a major knee injury during the year.

Injuries among young soccer players

We registered all new injuries among 496 male youth soccer players, aged 12 to 18 years, during the course of one year. The incidence of injury was 3.7 injuries per 1000 hours of soccer per player. The incidence increased with age, and at the higher ages within the youth players, approached the incidence rate of senior players (age greater than or equal to 18 years). Seventy percent of the injuries were located in the lower extremities, particularly the knee (26%) and ankle (23%). Back pain occurred in 14% of players. Fractures, which accounted for 4% of injuries, were most often in the upper extremities. We conclude that youth soccer is a relatively low-risk sport with an injury pattern that differs slightly from that of senior players.

The incidence of ankle sprains in soccer

This study investigated the relationship between exposure time and ankle sprains in soccer. Forty-one teams (639 players) from four male senior soccer divisions at different levels of skill (divisions I-VI) were followed prospectively for 1 year. The exposure to soccer and the number of injuries per player were higher in higher divisions, but the injury incidence, percentage of ankle injuries and incidence of ankle injuries were the same at different levels of skill. Of all injuries 17 to 20% were ankle sprains and the incidence varied between 1.7 to 2.0 ankle injuries per 1,000 hours of exposure. Since players with previous ankle problems run an increased risk of reinjury we suggest that these players receive preventive advice.

Normal course of events amongst Swedish soccer players: an 8-year follow-up study

In this study 180 male soccer players entered into a prospective study of injuries in 1980. They were examined again in 1988. The aim of the present study was to evaluate the course of events during their active period. The study was carried out using a questionnaire. The importance of major injuries was evaluated. Hospital records were scrutinized and 179 of 180 (99 per cent) were included in the evaluation.

Sports injuries in adolescents' ball games: soccer, handball and basketball

In a prospective study of 302 adolescent players in three ball games (soccer, handball and basketball), 119 incurred injuries. The injury incidence (number of injuries per 1000 playing hours) was 5.6 in soccer, 4.1 in handball and 3.0 in basketball. Ankle sprains accounted for 25 per cent of the injuries, finger sprains 32 per cent, strains in the thigh and leg 10 per cent, and tendinitis/apophysitis 12 per cent. The most serious injuries were four fractures, one anterior cruciate ligament rupture, and two meniscus lesions. The most serious injuries, with the longest rehabilitation period, occurred in soccer. In soccer, many injuries occurred during tackling and contact with an opposing player, while the injuries in handball and basketball were often caused by ball contact and running.

Sport accidents in childhood

Injuries among children during sporting activities are common. This study is a one year study including children between five and fourteen years of age who sustained their injuries during sporting activities and were treated at Trondheim Regional and University Hospital. Sport accidents account for 27 per cent of all childhood accidents in this age group. Fifty-three per cent of the injured were boys, and 47 per cent were girls. The boys sustained more severe injuries than the girls. Soccer caused the greatest number of injuries. Horse riding and alpine skiing were the cause of the most severe injuries. A more widespread use of protective guards, better technique and body control, better coaching and not allowing the younger children to take part in technically advanced sporting activities might reduce the number and the severity of the sport injuries in children.

Groin Strain and Other Possible Causes of Groin Pain

In brief: Groin strains (and injuries assumed to be groin strains) have been treated with a simple, straightforward approach. However, complications too often arise from inadequate diagnosis or improper management of these injuries. A pelvic stress fracture, an avulsion injury, and even a tumor can be confused with a groin strain. This article discusses the importance of differential diagnosis, which can help prevent serious complications. The authors also present a case report of a football player who was diagnosed with myositis following a groin strain he had sustained a year earlier.

A physiological profile of the elite soccer athlete

From the Cincinnati Sportsmedicine and Orthopaedic Center and The Deaconess Hospital, Cincinnati, OH. Research Funded by the Cincinnati Sportsmedicine Research and Education Foundation and the United States Olympic Committee. The purpose of this study was to develop a physiological profile of the elite soccer athlete. Protocols were developed to assess flexibility, knee ligament translation, body composition, anaerobic power, lower extremity functional performance, and muscle strength. Eighty-three male U.S. National Team players provided data for this study. Different protocols were used over the years the data was gathered. Each area was tested, using a subset of the total group. The physiological profile of the elite soccer player was compiled from results in each area tested. The players were flexible, on the whole, although 17% of the players demonstrated hamstring tightness. All but one player tested had less than 2.5 mm anterior/posterior (A/P) knee ligament translation. The average body fat was 9.5%, and all athletes performed normally on the function tests. The mean power output on Wingate testing was 8.1 Watts per kilogram body weight. The average hamstring-to-quadricep torque ratio (H/Q) at 60 degrees /sec was 56% (right) and 56.6% (left), and at 450 degrees /sec, was 67.1% and 70.1 %. Identification and measurement of these key physiological qualities for the elite soccer athlete will provide standards and a baseline for trainers, coaches, players, and future investigators. J Orthop Sports Phys Ther 1990;12(4):147-152.

Epidemiology and traumatology of injuries in soccer

A prospective investigation of soccer injuries among 123 players participating at various competition levels was undertaken in a Danish soccer club. The injury incidence during games was highest at division level (18.5/1000 hours) and lowest at series level (11.9/1000 hours), whereas the distribution of the incidences during practice was reversed. The youth section (16 to 18 years) had incidences that could be compared to the highest senior level. The lower extremity was involved in 84% of the injuries, including 34% of overuse injuries. Ankle sprains were most common (36%) and equally found at all levels, whereas half of all overuse injuries were seen among division players. Contact injuries during tackling occurred most often in lower series and youths (45%). Players participating at high levels had only 30% of the injuries during tackling and 54% during running. More than half of 20 knee injuries were caused by tackling. Thirty-five percent of injured players were absent from soccer for more than 1 month; 28% had complaints 12 months after the end of the season with knee injuries the most serious. The study shows that the injury incidence, the pattern of injury, and the traumatology varied between players participating at different levels of soccer competition.

Soccer injuries to the brain. A neurologic and electroencephalographic study of active football players

Sixty-nine football players from six Norwegian First Division League Clubs underwent a neurologic and EEG examination to investigate the incidence of head injuries. A significantly increased incidence of EEG disturbances were found in the football players compared to matched controls. The disturbances were most pronounced among the youngest players. The higher incidence of EEG disturbances found in the football players is most likely due to neuronal damage caused by repeated minor head traumas.

Brain damage in former association football players. An evaluation by cerebral computed tomography

Thirty-three former football players from the National Football Team of Norway were examined by cerebral computer tomography (CT). The CT studies, evaluated for brain atrophy, visually and by linear measurements compared two different normal materials. One third of the players were found to have central cerebral atrophy. It is concluded that the atrophy probably was caused by repeated small head injuries during the football play, mainly in connection with heading the ball.

Head Injuries in Soccer

In brief: Although soccer is considered a safe sport, fatal head injuries have occurred on rare occasion. Mechanisms of injury include heading the ball improperly and making head-to-head contact; injury may also occur when a forcefully kicked ball strikes a player's head. Goalkeepers most commonly sustain collision injuries when the head strikes the goalpost, the playing field, or another player's elbow, foot, or head. The author reviews the medical literature on soccer injuries and contends that rule changes and other measures may be more appropriate than the use of helmets to prevent head injuries.

The medical aspects of soccer injury epidemiology

In this article, the six major studies of soccer injury epidemiology are reviewed. Strengths and weaknesses of each epidemiologic design are critiqued and the crucial importance of the definition of injury is emphasized. The effect of age, sex, and intensity of play on injury rates is discussed. Our present knowledge of injury rate by anatomical site, player position, and the type of playing surface are reviewed. We examined the importance of player factors such as flexibility, joint laxity, weakness, and incomplete rehabilitation from other injuries. In addition, we reviewed the role played by inadequate equipment, field conditions, and rule violations. A successful program for soccer injury prevention is described, and guidelines for future soccer injury epidemiology research are proposed.

The medical aspects of soccer injury epidemiology

In this article, the six major studies of soccer injury epidemiology are reviewed. Strengths and weaknesses of each epidemiologic design are critiqued and the crucial importance of the definition of injury is emphasized. The effect of age, sex, and intensity of play on injury rates is discussed. Our present knowledge of injury rate by anatomical site, player position, and the type of playing surface are reviewed. We examined the importance of player factors such as flexibility, joint laxity, weakness, and incomplete rehabilitation from other injuries. In addition, we reviewed the role played by inadequate equipment, field conditions, and rule violations. A successful program for soccer injury prevention is described, and guidelines for future soccer injury epidemiology research are proposed.

Frequency of Injuries in a Youth Soccer Tournament

In brief: This study documents the types and frequency of injuries sustained in the 1984 Norway Cup-the largest soccer tournament in the world. During a total of 35,154 player-hours, 411 injuries and hyperventilatory conditions were recorded for the 1,016 boys' teams and 332 girls' teams participating. The injury rate was 8.9 and 17.6 per 1,000 player-hours for boys and girls, respectively. The overall injury rate for both sexes was 11.7 per 1,000 player-hours. Of total injuries 47% were contusions, 22% sprains, 18% lacerations, and 6% fractures. More than 60% of the injuries involved the lower extremities, 17% the head and neck, and 14% the upper extremities. The authors conclude that youth soccer, even on this highly competitive level, is a sport with few and mainly minor injuries.

Outdoor and indoor soccer: injuries among youth players

The incidence of injuries among youth soccer players (under age 16) participating in indoor soccer was 4.5 times that of youth players in outdoor soccer when calculated per 100 hours of team play, and 6.1 times greater when calculated per 100 hours of player game participation. Injuries were few among players under age 10 in either game, and the number of injuries increased with age in the older players. Medical assistance was required for 6.5% of the injuries among outdoor players and for 24.3% among indoor players. Overall, 66.6% of the injuries were the result of physical contact between players. No relationship was observed between the risk of injury and playing position, conduct of warm-up exercises, or the team having a licensed coach.

Soccer accidents in the French Rhône-Alpes Soccer Association

The analysis of 6153 accidents reported to the insurance company of the French Rhône-Alpes Soccer Association, for the 1980-81 season was undertaken, providing a survey of acute pathology in French soccer accidents and an estimation of the cost of this pathology to French society. Findings from this study include: injuries--ankle sprain is the most common; fractures prevail in the young players pathology; exposure--the average risk is one accident for 20 matches; the highest risk is for the senior category; collisions with opponents is the main cause of accidents; the first 5 minutes of the second half have a peak of accidents; the players exposure is roughly the same whatever their position on the ground; risk--winter should not increase the risk if the matches are played under good conditions; the risk is unevenly distributed according to the level of practice; cost--the cost for France over 1 year was estimated at US$20,000,000 and the total number of sick leave days at 2000 years; games with several accidents are very common in January and for the adult category. Consequently, tightening up the safety measures would be a very good investment.

Soccer injuries of youth

During a soccer tournament with participation of 6,600 boys and girls (9-19 years) all injuries were evaluated, 5.2% of the players were injured; out of these 51% had "slight injuries", 42% "moderate injuries" and 7% "severe injuries". For the individual player the incidence of injury was 19.1/1,000 playing hours including all degrees of injuries; if "slight injuries" were excluded the incidence was 9.4/1,000 playing hours. The incidence rose with increasing age, girls were injured more often than boys. There were 81% of all injuries localised to the lower extremity, especially the ankle and foot. Contusion was the most frequent diagnosis, amounting to a third of all injuries. Blisters and exoriations amounted to nearly a fifth, 4% of the injuries were fractures, especially in the upper extremity; overuse injuries were seen only in 5.2% of the cases. Based on examination of the injury pattern in these children, injuries of youth seem to be relatively rare and mostly of a non-severe character.

Complications that may occur in those with spinal cord injuries who participate in sport

The purpose of this study was to determine the risk of developing complications in paraplegics taking part in sport. It is a retrospective study of patients with complete spinal cord injury at the spinal level of C7--cauda equina/conus injury, and consists of 61 patients admitted to the Beitostølen Healthsportcenter, Norway. All of them had achieved satisfactory bladder/bowel function. The wheelchair dependents were all skilled in the use of the wheelchair. They participated in a training programme with an average duration of 25 days. Different activities were tried, such as weight-lifting, pulking, swimming, volleyball, calisthenics in a group, horseback-riding, archery, tabletennis, canoeing, totalling 11 955 training hours. During the training period the following complications were observed: urinary tract infections, pressure sores, and sprains and strains. There were 30 complications, most of them only of minor type. The incidence of complications, expressed as number of complications/1000 training-hours was, for urinary tract infections--0,50, pressure sores 0,42, sprains/strains 1,33, others 0,25: in all 2,51. Sprains and strains were the most common complications, accounting for about 55 per cent of the total, all of which were successfully treated before discharge. Sport activities are an important part of the rehabilitation of the spinal cord injured and the risk of serious complications appears to be low.

Football injuries in Oslo: a one-year study

All football injuries treated at the Emergency Department, Oslo City Hospital, 1329 patients, 1167 males and 162 females, were recorded for one year, accounting for 28.4% of all sports injuries. Most injuries seen were in the 15-19 years age group in females and 20-24 years age group in males; 68% of the females and 42% of the males (p less than 0.001) were below 20 years of age, and 87% of the injuries occurred in competitive football. During matches, 695 players were injured giving an incidence of 34.5 injuries/10,000 player matches. The injuries occurred all year with a peak in June. Sprains accounted for 41% of the injuries, 23% were contusions and 19% fractures. Most injuries (59%) affected the legs. Hospital admission was required for three females and 57 males. The football injuries required 1966 consultations and necessitated that 349 patients had to stay away from work for a total of 6137 days.

Sports injuries during one academic year in 6799 Irish school children

Details of the sports injuries occurring in 6799 children between the ages of 10 and 18 were recorded during the course of one academic year (September to June). One hundred sixteen injuries were noted: 29 sprains, 20 fractures, 18 strains, 14 contusions, 10 wounds, 7 dislocations, and 18 other injuries. On average these injuries resulted in 0.47 days of hospitalization, 18 days of incapacity, and 28 days before full recovery. The activities at which the injuries occurred were: football, 24; athletics, 15; rugby and gymnastics, 11 each; hockey, 10; basketball, 9; hurling and soccer, 8 each; indoor soccer, 5; camogie, 4; swimming, 3; tennis, 1; and others, 7. The rugby and indoor soccer injuries tended to be of above average seriousness. Eighty-eight injuries occurred in males and 28 in females. Males over 14 were three and half times as likely to be injured as younger boys. In girls the incidence of injury dropped after the age of 15. In both sexes the likelihood of injury increased with the physical standing of the individual. In outstanding males over the age of 15 the incidence of injury was one in six. The factors which contributed most frequently to injury were recklessness on the part of the injured party and foul or illegal play by another player. Lack of fitness and defects in sports gear, playing area, and equipment were other common causes.