Injuries in team sport tournaments during the 2004 Olympic Games

A soccer-specific balance training program for hamstring muscle and patellar and achilles tendon injuries: an intervention study in premier league female soccer

BACKGROUND

A soccer-specific balance training has been shown to decrease injury incidence of the anterior cruciate ligament and ankle sprains in randomized controlled trials. However, hamstring injuries and tendinopathy remain significant issues in soccer.

HYPOTHESIS

Proprioceptive training can reduce the incidence of hamstring muscle injuries and tendinopathy in elite soccer. There is a dose-effect relationship between balance training duration and injury incidence.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Twenty-four elite female soccer players (body mass index, 21.7 +/- 1.2; age, 21 +/- 4 years) of a German premier league soccer team were prospectively included. Starting in January 2004, an additional soccer-specific proprioceptive multistation training was initiated over 3 years. Injury data/1000 hours of exposure with documentation of all occurred injuries, detailed training, and match exposure data as well as time loss data were 100% complete.

RESULTS

At the end of the 3-year proprioceptive balance training intervention, noncontact hamstring injury rates were reduced from 22.4 to 8.2/1000 hours (P = .021), patellar tendinopathy from 3.0 to 1.0/1000 hours (P = .022), and Achilles tendinopathy from 1.5 to 0.0/1000 hours (P = .035). There was no effect of balance training on contact injuries. Mean time loss of all assessed injuries significantly decreased from 14.4 days during the control period to 1.5 days during intervention periods (P = .003). The more minutes of balance training performed, the lower the rate of overall injuries (r = -0.185, P = .001), hamstring injuries (r = -0.267, P = .003), patellar tendinopathy (r = -0.398, P = .02), and gastrocnemius strains (r = -0.342, P = .002).

CONCLUSION

Soccer-specific balance training (protective balancing) can reduce noncontact hamstring injuries and patellar and Achilles tendinopathy. A dose-effect relationship between duration of balance training and injury incidence is evident. A proprioceptive training program reduced the rehabilitation time in noncontact injuries, which warrants further investigation.

Low risk of injuries among children playing organized soccer: a prospective cohort study

BACKGROUND

The injury rate in soccer is high, and studies have shown that the injury rate among players aged 16 years or older approaches that of adult players. However, little is known about the injury risk among the youngest players, that is, players between 6 and 12 years.

PURPOSE

To examine the risk of injuries in children 6 to 16 years old playing organized soccer.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

Injuries were recorded prospectively throughout 1 season among 121 soccer teams (1879 players, aged 6-16 years) from 2 communities in the southeastern part of Norway.

RESULTS

A total of 159 players sustained 200 injuries, corresponding to an overall injury incidence of 2.2 per 1000 playing hours (95% confidence interval, 1.8-2.6) among boys and 2.0 injuries per 1000 hours (95% confidence interval, 1.4-2.5) among girls. The overall injury incidence was significantly higher (relative risk, 1.7; 95% confidence interval, 1.3-2.2) among older players (13-16 years; 2.6 injuries per 1000 hours, 95% confidence interval, 2.2-3.0) than among younger players (6-12 years; 1.6 injuries per 1000 hours, 95% confidence interval, 1.2-1.9). The injuries recorded in the youngest group were few and mainly mild.

CONCLUSION

The injury risk among young players (6-12 years) playing organized 5- or 7-a-side soccer is low, lower than that of adolescents and much lower than at the elite level. Soccer is a safe sport for children.

Foot and ankle injuries during the Athens 2004 Olympic Games

Background

Major, rare and complex incidents can occur at any mass-gathering sporting event and team medical staff should be appropriately prepared for these. One such event, the Athens Olympic Games in 2004, presented a significant sporting and medical challenge. This study concerns an epidemiological analysis of foot and ankle injuries during the Games.

Methods

An observational, epidemiological survey was used to analyse injuries in all sport tournaments (men's and women's) over the period of the Games.

Results

A total of 624 injuries (525 soft tissue injuries and 99 bony injuries) were reported. The most frequent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (58%) versus female athletes (42%) were recorded. The incidence, diagnosis and cause of injuries differed substantially between the team sports.

Conclusion

Our experience from the Athens Olympic Games will inform the development of public health surveillance systems for future Olympic Games, as well as other similar mass events.

Shoulder pain in water polo: A systematic review of the literature

The main aim of this systematic review is to synthesize and critically evaluate literature on the incidence and clinical presentation of shoulder pain in water polo. A secondary aim is to examine the contributing factors to shoulder pain in water polo. Medline, Cinahl, Embase, Ausport, Ovid, Sports Discus, Pubmed and Google Scholar data bases were electronically searched. Data were extracted regarding research design, injuries, pain, incidence, interventions and therapy outcomes. Of an initial yield of 23 papers, 11 fulfilled the inclusion criteria and were categorized into studies on incidence, shoulder pain, shoulder mobility, strength and throwing injuries. Methodological limitations included sampling and measurement biases, inadequate internal validity of measurement tools, poor specification of testing protocols and limitations in statistical analysis. The review found a high incidence of shoulder pain in water polo. Although there was limited evidence regarding causation, the repeated action of throwing was identified as a contributing factor to shoulder pain. Future studies need to explore the relative contributions of hyper-mobility and muscle strength imbalance to shoulder pain in water polo.

Injuries to the head and face in women's collegiate field hockey

OBJECTIVE

To investigate the incidence and severity of head and facial injuries in female collegiate field hockey players.

DESIGN

Prospective, survey-based study.

SETTING AND PARTICIPANTS

Certified athletic trainers and athletes at 6 Division I institutions. INTERVENTIONS/ASSESSMENT OF RISK FACTORS: Head and facial injuries were documented during practices and games during 2 women's field hockey seasons.

MAIN OUTCOME MEASUREMENTS

The total number of incidents that resulted in a head or facial injury, the total number of head and facial injuries, the injury type, location, and source, and the amount of time the injured athlete lost from play. When the injury occurred, either in a game or practice, was documented in year 2.

RESULTS

A total of 253 student-athlete seasons (each season that a player competed was considered 1 student-athlete season) were completed. A total of 57 incidents occurred with 62 head and facial injuries reported (5 incidents yielded 2 injuries each). Most injuries were due to contact with the ball (56%); the majority of injuries were lacerations (32%). A relatively high number of facial fractures were reported (13%). Sixty-five percent of the injuries resulted in less than 1-day time loss and would not have been reportable in many traditional injury surveillance systems.

CONCLUSIONS

The high number and rate of serious or potentially serious injuries occurring to the head and face in female collegiate field hockey players is a concern. Prevention measures, including better protective equipment for the head and face, may help reduce future head and facial injuries in these athletes.

Validity of the Foot and Ankle Ability Measure in athletes with chronic ankle instability

CONTEXT

The Foot and Ankle Ability Measure (FAAM) is a region-specific, non-disease-specific outcome instrument that possesses many of the clinimetric qualities recommended for an outcome instrument. Evidence of validity to support the use of the FAAM is available in individuals with a wide array of ankle and foot disorders. However, additional evidence to support the use of the FAAM for those with chronic ankle instability (CAI) is needed.

OBJECTIVE

To provide evidence of construct validity for the FAAM based on hypothesis testing in athletes with CAI.

DESIGN

Between-groups comparison.

SETTING

Athletic training room.

PATIENTS OR OTHER PARTICIPANTS

Thirty National Collegiate Athletic Association Division II athletes (16 men, 14 women) from one university.

MAIN OUTCOME MEASURE(S)

The FAAM including activities of daily living (ADL) and sports subscales and the global and categorical ratings of function.

RESULTS

For both the ADL and sports subscales, FAAM scores were greater in healthy participants (100 +/- 0.0 and 99 +/- 3.5, respectively) than in subjects with CAI (88 +/- 7.7 and 76 +/- 12.7, respectively; P < .001). Similarly, for both ADL and sports subscales, FAAM scores were greater in athletes who indicated that their ankles were normal (98 +/- 6.3 and 96 +/- 6.9, respectively) than in those who classified their ankles as either nearly normal or abnormal (87 +/- 6.6 and 71 +/- 11.1, respectively; P < .001). We found relationships between FAAM scores and self-reported global ratings of function for both ADL and sports subscales. Relationships were stronger when all athletes, rather than just those with CAI, were included in the analyses.

CONCLUSIONS

The FAAM may be used to detect self-reported functional deficits related to CAI.

Football injuries during European Championships 2004-2005

The risk of injury in football is high, but few studies have compared men's and women's football injuries. The purpose of this prospective study was to analyse the exposure and injury characteristics of European Championships in football and to compare data for men, women and male youth players. The national teams of all 32 countries (672 players) that qualified to the men's European Championship 2004, the women's European Championship 2005 and the men's Under-19 European Championship 2005 were studied. Individual training and match exposure was documented during the tournaments as well as time loss injuries. The overall injury incidence was 14 times higher during match play than during training (34.6 vs. 2.4 injuries per 1000 h, P < 0.0001). There were no differences in match and training injury incidences between the championships. Teams eliminated in the women's championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 h, P = 0.02). Non-contact mechanisms were ascribed for 41% of the match injuries. One-fifth of all injuries were severe with absence from play longer than 4 weeks. In conclusion, injury incidences during the European Championships studied were very similar and it seems thus that the risk of injury in international football is at least not higher in women than in men. The teams eliminated in the women's championship had a significantly higher match injury incidence than the teams going to the final stage. Finally, the high frequency of non-contact injury is worrying from a prevention perspective and should be addressed in future studies.

Injuries in female football players in top-level international tournaments

BACKGROUND

Despite the growing popularity of women's football and the increasing number of female players, there has been little research on injuries sustained by female football players.

PURPOSE

Analysis of the incidence, characteristics and circumstances of injury in elite female football players in top-level international tournaments.

STUDY DESIGN

Prospective survey.

METHODS

Injuries incurred in seven international football tournaments were analysed using an established injury report system. Doctors of all participating teams reported all injuries after each match on a standardised injury reporting form. The mean response rate was 95%.

RESULTS

387 injuries were reported from 174 matches, equivalent to an incidence of 67.4 injuries/1000 player hours (95% CI 60.7 to 74.1) or 2.2 injuries/match (95% CI 2.0 to 2.4). Most injuries (84%; 317/378) were caused by contact with another player. The injuries most commonly involved the lower extremity (n = 248; 65%), followed by injuries of the head and neck (n = 67, 18%), trunk (n = 33, 9%) and upper extremity (n = 32, 8%). Contusions (n = 166; 45%) were the most frequent type of injury, followed by sprains or ligament rupture (n = 96; 26%) and strains or muscle fibre ruptures (n = 31; 8%). The most common diagnosis was an ankle sprain. There were 7 ligament ruptures and 15 sprains of the knee. On average 1 injury/match (95% CI 0.8 to 1.2) was expected to result in absence from a match or training.

CONCLUSION

The injury rate in women's top-level tournaments was within the range reported previously for match injuries in elite male and female players. However, the diagnoses and mechanisms of injury among the female players differed substantially from those previously reported in male football players.

Stress fracture risk factors in female football players and their clinical implications

A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading, which results in structural fatigue, and resultant signs and symptoms of localised pain and tenderness. Reports of stress fractures in female football players are not prevalent; however, they are probably under-reported and their importance lies in the morbidity that they cause in terms of time lost from participation. By considering risk factors for stress fractures in female football players it may be possible to reduce the impact of these troublesome injuries. Risk factors for stress fractures in female football players include intrinsic risk factors such as gender, endocrine, nutritional, physical fitness and neuromusculoskeletal factors, as well as extrinsic risk factors such as training programme, equipment and environmental factors. This paper discusses these risk factors and their implications in terms of developing prevention and management strategies for stress fractures in female football players.

Medical report from the 2006 FIFA World Cup Germany

OBJECTIVE

To continue the injury surveillance of FIFA-sponsored football tournaments and report on other medical aspects of the 2006 FIFA World Cup.

DESIGN

Prospective epidemiological injury surveillance and descriptive summary of additional medical aspects.

SETTING

Major international football tournament.

PARTICIPANTS

National team players, doctors and referees at the 2006 FIFA World Cup Germany.

MAIN OUTCOME MEASURES

Injury type, location and rate.

RESULTS

145 injuries were reported for the 64 matches of the 2006 FIFA World Cup Germany-an overall injury rate of 68.7 per 1000 match hours (95% CI 57.5 to 79.9) or 2.3 injuries per match, in comparison with 2.7 injuries per match in the 2002 FIFA World Cup (p = NS). Physical examinations before participation uncovered no hidden cardiovascular problems. Once the tournament started, no referees were unable to complete their duties. There were no positive doping tests.

CONCLUSIONS

The injury rate for this World Cup was below that of 2002, but consistent with the overall injury rate per match since data collection began in 1998. There continues to be no evidence of systematic doping in international football.

Handball injuries during major international tournaments

BACKGROUND

Several authors have analyzed the incidence of handball injuries in amateur players but information of handball injury in top-level players is very limited. The aim of the study was to analyze the incidence, circumstances and characteristics of handball injuries during major international tournaments.

METHODS

Injuries during six international handball tournaments were analyzed, using an established injury report system. The physicians of all participating teams were asked to report all injuries after each match on a standardized injury report form. The response rate was on average 87%.

RESULTS

The incidence of injury was on average 108 injuries/1000 player hours (95% confidence interval (CI): 98-117) or 1.5 injuries/match (95% CI: 1.4-1.6). The injuries affected most frequently the lower extremity (42%), followed by injuries of the head (23%), upper extremity (18%) and trunk (14%). The most frequent diagnosis was contusion of head (14%) or ankle sprain (8%). The majority of injuries were caused by contact with another player. The incidence of time loss injuries was on average 27/1000 player hours (95% CI: 22-32), and significantly higher in men than in women.

CONCLUSION

Preventive program proven effective should be implemented. Fair Play is an essential aspect of injury prevention. Therefore, close cooperation with the referees is also necessary to make handball a safer sport.

Strategies for the prevention of volleyball related injuries

Although the overall injury rate in volleyball and beach volleyball is relatively low compared with other team sports, injuries do occur in a discipline specific pattern. Epidemiological research has revealed that volleyball athletes are, in general, at greatest risk of acute ankle injuries and overuse conditions of the knee and shoulder. This structured review discusses both the known and suspected risk factors and potential strategies for preventing the most common volleyball related injuries: ankle sprains, patellar tendinopathy, and shoulder overuse.