Exercise-Based Strategies to Prevent Muscle Injury in Male Elite Footballers: An Expert-Led Delphi Survey of 21 Practitioners Belonging to 18 Teams from the Big-5 European Leagues

Maximum speed exposures in Australian rules football: do methods matter?

This study compared weekly near-to-maximum speed exposure data when determined via different methods and criteria. Forty-seven professional Australian rules football (AF) players undertook pre-season sprint assessments (PSSA) via 3 × 50 m maximal efforts using 10 Hz GPS over two consecutive seasons. The same technology was used continually during the in-season to identify maximum speeds attained in training and matches. Weekly near-to-maximal speed (MS) exposure counts were aggregated for speeds ≥80%, ≥85%, ≥90% and ≥95% of their individual maximum for both determination approaches. Weekly near-to-MS exposures was lower (p < 0.0001) when determined from in-season monitoring for ≥80% (-1.26; CI: -1.58 to -0.93), ≥85% (-0.78; CI: -0.97 to -0.59), ≥90% (-0.42; CI: -0.53 to -0.32), and ≥95% (-0.09; CI: -0.12 to -0.06) versus PSSA, with no effect of playing position (P ≥ 0.161). Although ≥80% and ≥85% near-to-maximum speed exposure data was meaningfully influenced by the determination method, the effect was somewhat trivial at higher speed criteria (≥90% and ≥95%) often considered important for performance gains and injury risk reduction purposes. Maximum speed determination methods therefore may be used interchangeably, and discrete sprint assessments may not be necessary for this purpose.

Frequency and intensity of maximal and submaximal demanding scenarios in U19 professional soccer players

This study examined the frequency of the most demanding scenarios (MDS) during official soccer matches using rolling averages over 1, 5, and 10 min. Forty-two Under-19 players from different positions (central defenders, full-backs, central midfielders, wide midfielders, offensive midfielders, and forwards) were monitored across 27 matches using GPS to track distance covered, high-speed running, sprint distance, accelerations, and decelerations. Intensity thresholds were established based on percentiles (0-25, 25-50, 50-75, 75-100, and ≥100). The main findings suggest that: (i) Peak Demands occur in less than 1% of all time windows and variables for all positions; (ii) Most efforts occur below peak demands, with around 95% for high-speed running and sprint distance, and 85% for accelerations, decelerations, and total distance; (iii) Significant differences in intensity distributions were found between positions, particularly at medium-low and high intensities. Regarding training prescription, relying solely on MDS may be limited, highlighting the need to supplement MDS with other metrics for a comprehensive understanding of match demands. This approach ensures better-informed training programs for soccer players.

Hamstring Strain Injury Prevention: Current Beliefs and Practices of Practitioners Working in Major League Baseball

CONTEXT

Hamstring strain injury (HSI) is the most frequently sustained injury in Major League Baseball (MLB). However, the beliefs and practices of practitioners working in MLB regarding HSI risk factors and prevention strategies in baseball athletes have not been documented.

OBJECTIVE

To document the current beliefs and practices of practitioners working in MLB regarding HSI prevention.

DESIGN

Cross-sectional study.

SETTING

Major League Baseball via an online survey.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers, physical therapists, and strength and conditioning coaches working in MLB during the 2021 season.

DATA COLLECTION AND ANALYSIS

An online survey was conducted, with participants completing the survey once. Questions pertained to risk factor identification, the use and perceived effectiveness of prevention strategies, and barriers to implementation. Descriptive statistics were calculated for each question.

RESULTS

A total of 91 responses were received featuring respondents from 28 of 30 MLB organizations. The perceived most important intrinsic risk factors were tolerance to high-speed running for first-time HSI and previous HSI for recurrent injury. The perceived most important extrinsic risk factor for both first-time and recurrent HSI was internal communication between staff. The perceived most effective prevention strategies were managing overall workload, regular exposure to high-speed running, and periodization. The most used prevention strategies were core or lumbopelvic strengthening, traditional resistance-training exercises, and managing overall workload. Approximately half (53%) of respondents reported barriers to effective implementation of HSI prevention strategies, including player and coach buy-in, compliance, workload management, and scheduling.

CONCLUSIONS

This was the first survey to investigate MLB practitioner beliefs and practices regarding HSI prevention. Responses from practitioners regarding their beliefs about risk factors and appropriate prevention strategies varied, and discrepancies existed between the perceived most effective strategies and those most frequently used.

If You Want to Prevent Hamstring Injuries in Soccer, Run Fast: A Narrative Review about Practical Considerations of Sprint Training

Hamstring strain injuries (HSIs) are one of the most common injuries in sprint-based sports. In soccer, the ability to sprint is key, not only because of its relation to performance but also due to its possible protective effect against HSIs. Although many authors have focused on the "how", "when", and "what" training load should be implemented, there is a lack of practical proposals for sprint training in a high-level professional environment. The objective of this narrative review is, after a deep review of the scientific literature, to present a practical approach for sprint training, trying to answer some of the questions that most strength and conditioning coaches ask themselves when including it in soccer. Once the literature published on this topic was reviewed and combined with the practical experience of the authors, it was concluded that sprint training in soccer, although it presents an obvious need, is not something about which there is methodological unanimity. However, following the practical recommendations from this narrative review, strength and conditioning coaches can have a reference model that serves as a starting point for optimal management of the internal and external training load when they wish to introduce sprint training in the competitive microcycle in professional soccer players, with the aim of reducing HSIs.

Epidemiology of injuries in elite female rink hockey players: A two season observational study

OBJECTIVES

To record the time-loss injuries of female rink hockey players and describe the affected region, tissue, and onset of injury.

DESIGN

Cross-sectional survey study.

SETTING

First (Ok Liga) and Second (Plata) division clubs.

PARTICIPANTS

280 player-seasons.

MAIN OUTCOME MEASURES

Incidence of overall, training, and match injuries (number of injuries per 1000 h) from two seasons.

RESULTS

A total of 229 injuries occurred in 56,438 h of exposure. The overall incidence was 4 injuries per 1000 h (4/1000 h), with a significantly higher rate of injuries during matches (15.2/1000 h) compared to training sessions (2.6/1000 h) (p < 0.001). Injuries affecting the lower limb were the most common (2.3/1000 h), followed by upper limb (1.2/1000 h), and head/trunk (0.6/1000 h). The tissue with the highest incidence of injury was the muscle/tendon (1.3/1000 h), followed by the ligament (0.8/1000 h). Around one in every three injuries (31%) affected either the thigh or hip/groin (73 injuries).

CONCLUSIONS

The injury incidence in elite female rink hockey is moderate and occurs mainly during match sessions. Preventative measurements should be implemented in rink hockey with a special concern for injuries affecting the thigh, and hip/groin.

Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence

Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.

The Ratio between Weekly Training and Match External Physical Loads in U17 Elite Youth Soccer Players: Implications for the Training Process

Research on the external physical load on elite youth soccer players during the weekly training microcycle in competitive periods and official matches is limited. The aims of this study were twofold: a) investigate possible differences in external physical load (PL) across player positions in U17 elite youth soccer players during official matches; b) determine the weekly training to match physical load ratio (WTMLr) across player positions. The sample included 20 outfield players from an elite soccer academy (mean age 15.94 ± 0.25 years) playing in four positions: central defender (CD), full-back (FB), central midfielder (CM) and Striker (S). Data were collected during the spring in-season period for 17 official matches played in a 4-3-3 game format. Indicators of external physical load monitored were: total distance (TD); total distance in high-speed running (HSR; > 16.1 km.h-1); total distance in sprint running (SPR; > 21.6 km.h-1); and relative physical load intensity (%HSR). The WTMLr was calculated for TD, HSR, SPR and %HSR as the ratio of the average weekly sum of training PL to the average sum of PL in an official match for a given players' position. Collectively, the training intensity during a one-week microcycle (%HSR in WTMLr) achieved only 76 % of match demands. CD performed significantly lower in all measured indicators of external PL during the official match than all other positions (p < 0.05; g > 0.80) except for TD in S. S achieved significantly higher SPR during official matches compared to CD (p < 0.05; g > 0.80), CM, and FB (g > 0.80). In contrast, CD reported higher WTMLr (medium-large effect size) in HSR and SPR indicators than all other positions. CM performed significantly higher %HSR in WTMLr than S and FB (p < 0.05; g > 0.80). Results revealed insufficient training intensity relative to match demands and, at the same time, weekly training PL did not meet match demands (especially in HSR and SPR) for players across the different positions. Therefore, practitioners should select appropriate training methods (drills and games) to ensure sufficient training intensity (HSR and SR metrics) and consider using the WTMLr, which can be used to help optimise and individualise training PL for different player positions.

Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study

BACKGROUND

Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited.

PURPOSE

To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints.

STUDY DESIGN

An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed.

METHODS

In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario.

RESULTS

Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain.

CONCLUSIONS

This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).

Application of arbitrary and individualized load quantification strategies over the weekly microcycle in professional soccer players

The aims of this study were to: (a) determine the differences in external load quantification between arbitrary and individual speed thresholds over the weekly microcycle in professional soccer players, and (b) analyse the association between internal load and different external load quantification strategies (ELQSs). Ten professional outfield players were monitored during training sessions and official matches using 10 Hz GPS devices over a 6-week in-season period. The absolute and relative ("R" before the distance category) distances covered were calculated for the following external load variables: medium-intensity running distance (MIR), high-intensity running (HIR), sprint distance (SD), and very high-intensity running (VHIR). Individualized thresholds were determined based on maximal sprinting speed (MSS) and the last speed achieved during the 30-15 Intermittent Fitness Test (VIFT) of each player. In terms of match-day workload, significant differences (p < 0.05) were observed between arbitrary and individualized strategies (i.e., MSS and VIFT) for the distance covered in MIR, HIR, SD, VHIR, RHIR, RSD, and RVHIR. The MSS strategy compared to arbitrary thresholds revealed significant differences (p < 0.05) for distance covered in HIR, RHIR, and VHIR during all training sessions. The present results showed that arbitrary thresholds lead to underestimation of external load absolute and relative metrics compared to the MSS strategy throughout the microcycle. The VIFT strategy mainly revealed differences in external load quantification regarding MD compared to arbitrary thresholds. Individualized speed threshold strategies did not achieve better associations with internal load measures in comparison with arbitrary thresholds in professional soccer players.

Top-class women's soccer performance: peak demands and distribution of the match activities relative to maximal intensities during official matches

The aims of the current study were to determine the most demanding passages of match play (MDP) and the distribution of match activities relative to maximum intensities during official matches in top-class women soccer players. Twenty-eight women players competing in European championship and international UEFA competitions were monitored during 38 official matches (277 individual samples). Maximum relative (m · min-1) total distance (TD), high-speed running (HSRD), very high-speed running (VHSRD), sprint, acceleration and deceleration distances were calculated across different durations (1-5, 10, 15, 90 min) using a rolling average analysis. Maximum intensities (1-minpeak) were used as the reference value to determine the distribution of relative intensity across the whole-match demands (90-minavg). Time and distance higher than 90-minavg (> 90-minavg) were also calculated. MDP showed moderate to very large [effect size (ES): 0.63/5.20] differences between 1-minpeak vs all durations for each parameter. The relative (m · min-1) 1-minpeak was greater than 90-minavg of about +63% for TD, +358% for HSRD, +969% for VHSRD, +2785% for sprint, +1216% for acceleration, and +768% for deceleration. The total distance covered > 90-minavg was ~66.6% of the total distance covered during the 90-minavg for TD, ~84.8% for HSRD, ~97.4% for VHSRD, ~100% for sprint, ~99.1% for acceleration and ~98.2% for deceleration. The relative distance > 90-minavg was higher (P < 0.05) than the 90-minavg for each metric (ES: 2.22 to 7.58; very large). The present results may help coaches and sport scientists to replicate the peak demands during training routine in top-class women soccer players.

Do small-sided games prepare players for the worst-case scenarios of match play in elite young soccer players?

The aim of the study was to determine whether the physical performance of young soccer player during various small sided games (SSGs) underloads, replicates or overloads the requirements of the worst-case scenarios (WCS) during match play. A total of 521 SSGs' individual observations and 15 different formats of SSGs with different areas per player (ApP) (ApP100: < 100; ApP200: ranged from 101 to 200; ApP300: > 201, all in m2 · player-1) were taken into consideration. Whole (90-min average; OM) and 15-, 5- and 1-min worst-case scenarios (WCS15, WCS5 and WCS1, respectively) were analysed. Total distance covered relative (m · min-1) (TDCR), high-speed distance relative (m · min-1) (HSDR), very high-speed distance relative (m · min-1) (VHSDR) and sprint distance relative (m · min-1) (SDR), player load relative (PLR) and both total (ACCR) and high intensity relative accelerations (n · min-1) (ACCHR) were collected. All external load measures analysed were significantly higher in WCS1 compared to WCS of longer duration and SSGs with different ApP (p < 0.001). The analysis demonstrated interactions between game type and player positions (p < 0.001) for TDCR, VHSDR, PLR and ACCHR. The SSG formats did not sufficiently stimulate the WCS for locomotor demands (VHSDR and SDR). SSGs played on an ApP100 overestimated the mechanical values compared to WCS15 and WCS5. The analysed SSG formats did not sufficiently stimulate players to cope with all external load demands that occurred during WCS1. This study provides useful information for practitioners on the heightened impact of different SSG formats on external load in relation to the WCS of competitive match play.

Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies

Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.

Interchangeability of optical tracking technologies: potential overestimation of the sprint running load demands in the English Premier League

PURPOSE

The purpose of this study was to assess the agreement between match-derived running load outputs; total distance (TD), high-speed running (HSR) and sprint distance (SPR) obtained by two optical tracking systems.

METHODS

Data were collected from 31 elite footballers from the first team and under-21 squads of an English Premier League (EPL) football club across three competitive matches. One EPL game (game 2) and one under-21 Premier League game (game 3) were played at the team's home stadium and one EPL game (game 1) at an away venue. All matches were tracked concomitantly using eight colour cameras sampling at 10 Hz (PROZONE®) and six high-definition motion cameras sampling at 25 Hz (TRACAB®).

RESULTS

TD displayed a perfect (r = 0.99) correlation while HSR and SPR displayed very large (r = 0.81 and r = 0.73) correlations between TRACAB® and PROZONE®. Mean biases were 5% for TD, -3% for HSR and 61% for SPR. Between games, mean biases for TD were 6% for game 1, and 5% for game 2 and game 3. For HSR, 9% for game 1, -5% for game 2 and 6% for game 3 and for SPR, 31% for game 1, 71% for game 2 and 84% for game 3.

CONCLUSION

TD and HSR can be interchanged between PROZONE® and TRACAB®, to allow accurate interpretation between the two optical systems. PROZONE® overestimated SPR compared to the TRACAB®, with the magnitude of difference considered meaningful, altering interpretation of historical match outputs, sprint volume trends in the EPL and forecasts of the modern game.

Neuromuscular electrical stimulation during maximal voluntary contraction: a Delphi survey with expert consensus

PURPOSE

The use of electrical stimulation to assess voluntary activation of muscle/s is a popular method employed in numerous exercise science and health research settings. This Delphi study aimed to collate expert opinion and provide recommendations for best practice when using electrical stimulation during maximal voluntary contractions.

METHODS

A two-round Delphi study was undertaken with 30 experts who completed a 62-item questionnaire (Round 1) comprising of open- and closed-ended questions. Consensus was assumed if ≥ 70% of experts selected the same response; such questions were removed from the subsequent Round 2 questionnaire. Responses were also removed if they failed to meet a 15% threshold. Open-ended questions were analysed and converted into closed-ended questions for Round 2. It was assumed there was no clear consensus if a question failed to achieve a ≥ 70% response in Round 2.

RESULTS

A total of 16 out of 62 (25.8%) items reached consensus. Experts agreed that electrical stimulation provides a valid assessment of voluntary activation in specific circumstances, such as during maximal contraction, and this stimulation can be applied at either the muscle or the nerve. Experts recommended using doublet stimuli, self-adhesive electrodes, a familiarisation session, real-time visual or verbal feedback during the contraction, a minimum current increase of + 20% to ensure supramaximal stimulation, and manually triggering stimuli.

CONCLUSION

The results of this Delphi consensus study can help researchers make informed decisions when considering technical parameters when designing studies involving electrical stimulation for the assessment of voluntary activation.

Integrating Deloading into Strength and Physique Sports Training Programmes: An International Delphi Consensus Approach

BACKGROUND

Deloading is a ubiquitous yet under-researched strategy within strength and physique training. How deloading should be integrated into the training programme to elicit optimal training outcomes is unknown. To aid its potential integration, this study established consensus around design principles for integrating deloading in strength and physique training programmes using expert opinion and practical experience.

METHODS

Expert strength and physique coaches were invited to an online Delphi consisting of 3 rounds. Thirty-four coaches completed the first round, 29 completed the second round, and 21 completed the third round of a Delphi questionnaire. In the first round, coaches answered 15 open-ended questions from four categories: 1: General Perceptions of Deloading; 2: Potential Applications of Deloading; 3: Designing and Implementing Deloading; and 4: Creating an Inclusive Deloading Training Environment. First-round responses were analyzed using reflexive thematic analysis, resulting in 138 statements organized into four domains. In the second and third rounds, coaches rated each statement using a four-point Likert scale, and collective agreement or disagreement was calculated.

RESULTS

Stability of consensus was achieved across specific aspects of the four categories. Findings from the final round were used to develop the design principles, which reflect the consensus achieved.

CONCLUSIONS

This study develops consensus on design principles for integrating deloading into strength and physique sports training programmes. A consensus definition is proposed: "Deloading is a period of reduced training stress designed to mitigate physiological and psychological fatigue, promote recovery, and enhance preparedness for subsequent training." These findings contribute novel knowledge that might advance the current understanding of deloading in strength and physique sports.

Development of a Standardised System to Classify Injury-Inciting Circumstances in Football: the Football Injury Inciting Circumstances Classification System (FIICCS)

BACKGROUND

A comprehensive examination of the sport-specific activities and circumstances being performed at the time of injury is important to hypothesise mechanisms, develop prevention strategies and inform future investigations. Results reported in the literature are inconsistent because inciting activities are reported using different classifications. Hence the aim was to develop a standardised system for the reporting of inciting circumstances.

METHODS

The system was developed using a modified Nominal Group Technique. The initial panel included 12 sports practitioners and researchers from four continents with respectively ≥ 5 years of experience working in professional football and/or conducting injury research. The process consisted of six phases: idea generation, two surveys, one online meeting and two confirmations. For answers to the closed questions, consensus was deemed achieved if ≥ 70% of respondents agreed. Open-ended answers were qualitatively analysed and then introduced in subsequent phases.

RESULTS

Ten panellists completed the study. The risk of attrition bias was low. The developed system includes a comprehensive range of inciting circumstances across five domains: contact type, ball situation, physical activity, session details, contextual information. The system also distinguishes between a core set (essential reporting) and an optional set. The panel deemed all the domains to be important and easy to use both in football and in research environments.

CONCLUSION

A system to classify inciting circumstances in football was developed. Given the extent of reporting inconsistency of inciting circumstances in the available literature, this can be used while further studies evaluate its reliability.

Do non-contact injuries occur during high-speed running in elite football? Preliminary results from a novel GPS and video-based method

OBJECTIVES

Understanding how injuries occur (inciting circumstances) is useful for developing etiological hypotheses and prevention strategies. The aims of this study were 1) to evaluate the feasibility of a method combining video and Global Positioning System data to estimate the speed and acceleration of activities leading to injuries and 2) to use this method to analyse the inciting circumstances leading to non-contact injuries.

DESIGN

Retrospective descriptive study.

METHODS

Injury inciting circumstances from 46 elite players over three seasons were analysed from video recordings and from external load measures collected through Catapult Vector S7 Global Positioning System.

RESULTS

In total 34 non-contact injuries were analysed. Sixteen out of the seventeen hamstring injuries occurred when players were running for (median and interquartile range) 16.75 m (8.42-26.65 m) and achieved a peak speed of 29.28 km·h-1 (26.61-31.13 km·h-1) which corresponded to 87.55 % of players' maximal speed (78.5 %-89.75 %). Of the three adductor injuries, one occurred whilst the player was decelerating without the ball, one occurred whilst the player was accelerating and controlling the ball at knee level, and one occurred whilst the player was performing an instep kick. Two quadriceps injuries occurred whilst the players were kicking either whilst walking or running.

CONCLUSIONS

From the preliminary results reported in this study most hamstring injuries occurred when players ran >25 km·h-1 and above 80 % of their maximal speed. This study suggests that this novel approach can allow a detailed and standardised analysis of injury inciting circumstances.

Players', Head Coaches', And Medical Personnels' Knowledge, Understandings and Perceptions of Injuries and Injury Prevention in Elite-Level Women's Football in Ireland

BACKGROUND

To manage injuries effectively, players, head coaches, and medical personnel need to have excellent knowledge, attitudes, and behaviours in relation to the identification of risk factors for injuries, the implementation of injury prevention initiatives, as well as the implementation of effective injury management strategies. Understanding the injury context, whereby specific personal, environmental, and societal factors can influence the implementation of injury prevention initiatives and injury management strategies is critical to player welfare. To date, no qualitative research investigating the context of injuries, has been undertaken in elite-level women's football. The aim of our study was to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish Women's National League (WNL) to injury prevention and injury management.

METHODS

We used qualitative research methods to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish WNL to injury prevention and injury management. Semi-structured interviews were undertaken with 17 players, 8 medical personnel, and 7 head coaches in the Irish WNL. The data were analysed using thematic analysis. Our study is located within an interpretivist, constructivist research paradigm.

RESULTS

The participants had incomplete knowledge of common injuries in elite-level football, and many held beliefs about risk factors for injuries, such as menstrual cycle stage, which lacked evidence to support them. Jumping and landing exercises were commonly used to reduce the risk of injuries but evidence-based injury prevention exercises and programmes such as the Nordic hamstring curl, Copenhagen adduction exercise, and the FIFA 11+ were rarely mentioned. Overall, there was dissatisfaction amongst players with their medical care and strength and conditioning (S & C) support, with resultant inadequate communication between players, head coaches, and medical personnel.

CONCLUSION

Poor quality and availability of medical care and S & C support were considered to be a major obstacle in the effective implementation of injury risk reduction strategies and successful return-to-sport practices. More original research is required in elite-level women's football to explore injury risk factors, injury prevention initiatives, and contextual return-to-sport strategies, so that players, head coaches, and medical personnel can use evidence that is both up-to-date and specific to their environment.

Speed Matters in Nordic Hamstring Exercise: Higher Peak Knee Flexor Force during Fast Stretch-Shortening Variant Compared to Standard Slow Eccentric Execution in Elite Athletes

Hamstring strain injuries are prevalent in many sports. Research has demonstrated that the Nordic hamstring exercise (NHE), a knee-dominant exercise addressing the posterior chain muscles, can aid in reducing the risk of hamstring injuries in athletes. However, most research on hamstring injury prevention has focused on performing the eccentric version of the NHE (NHE_ECC). In contrast, in sports, it is quite frequent for athletes to use an eccentric-concentric version of the NHE. Additionally, eccentric NHE is typically performed using a slow, controlled tempo. The effect of a fast stretch-shortening cycle NHE (NHE_SSC) compared to standard slow NHE_ECC on peak knee flexor force has not been investigated. The aim of the study was therefore to investigate fast NHE_SSC vs. standard slow NHE_ECC. Our hypothesis posited that peak knee flexor force would be greater for fast NHE_SSC compared with standard slow NHE_ECC. The study involved 22 elite athletes (actively competing in both national and international events) consisting of female (n = 10) and male (n = 7) track and field athletes and male football players (n = 5), aged 17-31 years. The participants performed maximum trials of slow NHE_ECC and fast NHE_SSC repetitions in which measurement of bilateral peak knee flexor force was conducted at the ankle with the use of a load cell. During the NHEs, a linear encoder was used to measure both the position where the peak knee flexor force was recorded and the average eccentric velocity. SSC contributed to an enhanced NHE performance, where bilateral absolute peak knee flexor force was 13% higher for fast NHE_SSC vs. standard slow NHE_ECC (822 vs. 726 N, p < 0.01, ES = 0.54). Participants achieved a 32% greater forward distance at the breakpoint stage during NHE_ECC compared to the coupling phase for NHE_SSC (54 vs. 41 cm, p < 0.001, ES = 1.37). Eccentric average velocity was more than three times higher for NHE_SSC compared with NHE_ECC (0.38 vs. 0.12 m/s, p < 0.001, ES = 3.25). The key findings of this study were that SSC contributed to an enhanced NHE performance, where absolute peak knee flexor force was 13% greater for fast NHE_SSC compared to standard slow NHE_ECC. The fast NHE_SSC could therefore be an interesting alternative to the standard slow NHE_ECC execution, as it may offer potential advantages for sprint performance, as well as hamstring injury prevention and rehabilitation.

Anterior Cruciate Ligament Rehabilitation for the 10- to 18-Year-Old Adolescent Athlete: Practice Guidelines Based on International Delphi Consensus

Background

There are 2 treatment options for adolescent athletes with anterior cruciate ligament (ACL) injuries-rehabilitation alone (nonsurgical treatment) or ACL reconstruction plus rehabilitation. However, there is no clear consensus on how to include strength and neuromuscular training during each phase of rehabilitation.

Purpose

To develop a practical consensus for adolescent ACL rehabilitation to help provide care to this age group using an international Delphi panel.

Study Design

Consensus statement.

Methods

A 3-round online international Delphi consensus study was conducted. A mix of open and closed literature-based statements were formulated and sent out to an international panel of 20 ACL rehabilitation experts. Statements were divided into 3 domains as follows: (1) nonsurgical rehabilitation; (2) prehabilitation; and (3) postoperative rehabilitation. Consensus was defined as 70% agreement between panel members.

Results

Panel members agreed that rehabilitation should consist of 3 criterion-based phases, with continued injury prevention serving as a fourth phase. They also reached a consensus on rehabilitation being different for 10- to 16-year-olds compared with 17- and 18-year-olds, with a need to distinguish between prepubertal (Tanner stage 1) and mid- to postpubertal (Tanner stages 2-5) athletes. The panel members reached a consensus on the following topics: educational topics during rehabilitation; psychological interventions during rehabilitation; additional consultation of the orthopaedic surgeon; duration of postoperative rehabilitation; exercises during phase 1 of nonsurgical and postoperative rehabilitation; criteria for progression from phase 1 to phase 2; resistance training during phase 2; jumping exercises during phase 2; criteria for progression from phase 2 to phase 3; and criteria for return to sports (RTS). The most notable differences in recommendations for prepubertal compared with mid- to postpubertal athletes were described for resistance training and RTS criteria.

Conclusion

Together with available evidence, this international Delphi statement provides a framework based on expert consensus and describes a practice guideline for adolescent ACL rehabilitation, which can be used in day-to-day practice. This is an important step toward reducing practice inconsistencies, improving the quality of rehabilitation after adolescent ACL injuries, and closing the evidence-practice gap while waiting for further studies to provide clarity.

Connective Adaptive Resistance Exercise (CARE) Machines for Accentuated Eccentric and Eccentric-Only Exercise: Introduction to an Emerging Concept

Eccentric resistance exercise emphasizes active muscle lengthening against resistance. In the past 15 years, researchers and practitioners have expressed considerable interest in accentuated eccentric (i.e., eccentric overload) and eccentric-only resistance exercise as strategies for enhancing performance and preventing and rehabilitating injuries. However, delivery of eccentric resistance exercise has been challenging because of equipment limitations. Previously, we briefly introduced the concept of connected adaptive resistance exercise (CARE)-the integration of software and hardware to provide a resistance that adjusts in real time and in response to the individual's volitional force within and between repetitions. The aim of the current paper is to expand this discussion and explain the potential for CARE technology to improve the delivery of eccentric resistance exercise in various settings. First, we overview existing resistance exercise equipment and highlight its limitations for delivering eccentric resistance exercise. Second, we describe CARE and explain how it can accomplish accentuated eccentric and eccentric-only resistance exercise in a new way. We supplement this discussion with preliminary data collected with CARE technology in laboratory and non-laboratory environments. Finally, we discuss the potential for CARE technology to deliver eccentric resistance exercise for various purposes, e.g., research studies, rehabilitation programs, and home-based or telehealth interventions. Overall, CARE technology appears to permit completion of eccentric resistance exercise feasibly in both laboratory and non-laboratory environments and thus has implications for researchers and practitioners in the fields of sports medicine, physiotherapy, exercise physiology, and strength and conditioning. Nevertheless, formal investigations into the impact of CARE technology on participation in eccentric resistance exercise and clinical outcomes are still required.

London International Consensus and Delphi study on hamstring injuries part 1: classification

Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.

London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport

Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.

London International Consensus and Delphi study on hamstring injuries part 2: operative management

The key indications for surgical repair of hamstring injuries (HSIs) remain unclear in the literature due to a lack of high-level evidence and expert knowledge. The 2020 London International Hamstring Consensus meeting aimed to highlight clear surgical indications and to create a foundation for future research. A literature review was conducted followed by a modified Delphi process, with an international expert panel. Purposive sampling was used with two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering (round 1) questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15) comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion of each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. The consensus threshold was set a priori at 70% agreement. Rounds 1 and 2 survey respondents were 35/46 (76%) and 99/112 (88.4%), respectively. The consensus group agreed that the indications for operative intervention included: gapping at the zone of tendinous injury (87.2% agreement) and loss of tension (70.7%); symptomatic displaced bony avulsions (72.8%); and proximal free tendon injuries with functional compromise refractory to non-operative treatment (72.2%). Other important considerations for operative intervention included: the demands of the athlete/patient and the expected functional outcome (87.1%) based on the anatomy of the injury; the risk of functional loss/performance deficit with non-operative management (72.2%); and the capacity to restore anatomy and function (87.1%). Further research is needed to determine whether surgery can reduce the risk of reinjury as consensus was not reached within the whole group (48.2%) but was agreed by surgeons (70%) in the cohort. The consensus group did not support the use of corticosteroids or endoscopic surgery without further evidence. These guidelines will help standardise treatment of HSIs, specifically the indications and decision-making for surgical intervention.

International orienteering experts' consensus on the definition, development, cause, impact and methods to reduce mental fatigue in orienteering: A Delphi study

Orienteering is an outdoor activity wherein participants use a map and compass to locate control points and choose the quickest path to the next control point in a natural environment. Attentional focus, rapid decision-making, and high aerobic fitness may influence orienteering performance. Therefore, this research aimed to seek international orienteering expert consensus regarding the definition, development, causes, influences and methods to reduce mental fatigue (MF) in orienteering based on practical experience. Following ethical approval, a three-round Delphi survey was conducted online with twenty-four orienteering coaches and athletes (or former athletes) from 10 different countries with international orienteering competition experience. The threshold of consensus was ≥ 70% agreement among respondents. The experts agreed that MF exists in daily life and orienteering with a substantial negative effect on their conscious decision-making performance and psychological responses. The experts disagreed that the form of MF that athletes experienced in orienteering training are similar to the competition. However, there was no agreement that MF would impact endurance and high-speed running performance during orienteering. This research refines the definition of MF and summarises the distinctions in what causes MF in orienteering training and competition, implying that MF should be addressed separately.

Differences in Peak Knee Flexor Force between Eccentric-Only and Combined Eccentric-Concentric Nordic Hamstring Exercise

In many sports, the hamstring strain injury is a common injury. There is evidence that the Nordic hamstring exercise (NHE), a knee flexor exercise, can reduce hamstring injury risk in athletes. In research on hamstring injury prevention, eccentric-only NHE is typically performed, whereas in sports, it is relatively common for athletes to perform NHE eccentrically-concentrically. Further, NHE strength is generally assessed by measuring knee flexor force through an ankle brace, attached atop of a load cell. An alternative method might be to assess knee flexor force about the knee joint using a force plate. The aim of the study was to investigate differences in peak knee flexor force between eccentric-only and combined eccentric-concentric NHE. The purpose was also to determine the correlation between hamstring force measured at the ankle using a load cell (current gold standard) and force assessed about the knee joint using a force plate during NHE. Fifteen junior and senior elite soccer and track and field athletes (3 women and 12 men aged 17-27 years) performed eccentric NHE (ENHE) in which they leaned forward as far as possible until breakpoint and eccentric-concentric NHE (ECNHE) where they returned to the starting position. A linear encoder measured the position at which peak force occurred during the NHEs. Force assessed at the ankle differed significantly (678 vs. 600 N, p < 0.05), whereas force about the knee joint did not (640 vs. 607 N, p > 0.05) between ENHE and ECNHE (12 and 5% difference, respectively). The forward distance achieved by the participants in cm at breakpoint for ENHE was 37% higher than at the coupling phase for ECNHE (74 vs. 54 cm, p < 0.001). Very strong significant (p < 0.01) correlations were noted between peak force assessed at the ankle and about the knee joint for ENHE and ECNHE, r = 0.96 and r = 0.99, respectively. Our results suggest that ECNHE, where peak knee flexor force was reached with 37% less forward movement, may complement ENHE, i.e., during hamstring injury rehabilitation, where a position of great knee extension may not be well tolerated by the athlete. Further, assessing knee flexor force about the knee joint using a force plate may provide an alternative to measuring force at the ankle using a load cell when testing NHE strength.

Injury-Inciting Activities in Male and Female Football Players: A Systematic Review

BACKGROUND

A comprehensive examination of the sport-specific activities performed around the time of injury is important to hypothesise injury mechanisms, develop prevention strategies, improve management, and inform future investigations. The aim of this systematic review is to summarise the current literature describing the activities performed around the time of injury in football (soccer).

METHODS

A systematic search was carried out in PubMed, Web of Science, SPORTDiscus, and OpenGrey. Studies were included if participants were football players aged > 13 years old and the activities performed at the time of injury were reported together with the total number of injuries. Risk of bias was assessed using an adapted version of checklists developed for prevalence studies. The activities reported by the studies were grouped to account for inconsistent reporting, and the proportion of each injury activity was calculated. Data were not meta-analysed due to high heterogeneity of methods and classification criteria.

RESULTS

We included 64 studies reporting on 56,740 injuries in total. ACL injures were analysed by 12 studies, ankle/foot and knee injuries were analysed by five studies, thigh injuries were analysed by four studies, hip/groin injuries were analysed by three studies, and hamstring injuries were analysed by two studies. Five studies analysed more than one type of injury and 38 studies did not specify the type of injuries analysed. Running and kicking were the predominant activities leading to thigh and hamstring injuries. Changing direction and kicking were the predominant activities leading to hip and groin injuries and duels were the predominant activities leading to ankle injuries. Duels and pressing seem the predominant activities leading to ACL injuries, while results for other knee and general injuries were inconsistent.

CONCLUSIONS

A qualitative summary of the activities performed at the time of injury has been reported. The results need to be interpreted carefully due to the risk of bias observed in the included studies. If we are to meaningfully progress our knowledge in this area, it is paramount that future research uses consistent methods to record and classify injuries and activities leading up to and performed at the time of injury.

REGISTRATION

The protocol of this systematic review was registered at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/U96KV ).

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

Background

Groin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain.

Methods

Thirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus.

Results

High participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section.

Conclusion

Experts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00400-z.

A survey of organizational structure and operational practices of elite youth football academies and national federations from around the world: A performance and medical perspective

Aim

Medical and performance units are integral components of player development programmes in elite football academies. Nevertheless, the nature of the operational processes implemented by practitioners within clubs and national federations remains unexplored. The aim of the present study, therefore, was to survey elite youth professional football academies from around the world regarding the operational processes adopted by their medical and performance units.

Methods

Of the 50 organizations invited, 10 national federations and 25 clubs took part in the survey resulting in a response rate of 70% (95% confidence interval, 56%-81%). The respondents represented three groups: senior club and academy management, performance, and medical staff.

Results

The majority (60%-90%) of clubs and national federations reported strategic alignment between senior and academy medical and performance units as well as between academy medical and performance units. Survey responses indicated substantial heterogeneity in the composition and number of medical and performance professionals employed in academies. The majority of respondents agreed their medical and performance departments were effective in utilizing staff knowledge and external sources of knowledge to inform their practice (56%-80%). Performance staff (40%-50%) and physiotherapists (30%-32%) were deemed most influential in injury prevention programmes. During the return-to-play process, the influence of specific practitioners in the medical and performance units was dependent upon the phase of return-to-play. Shared decision-making was common practice amongst performance and medical staff in injury prevention and return-to-play processes. Medical and performance data were generally centralized across the first team and academy in majority (50%-72%) of clubs and national federations. Data were integrated within the same data management system to a higher degree in clubs (68%) vs. national federations (40%). Research and development activity were reported for most academies (50%-72%), and generally led by the head of performance (37%) or team doctor (21%). Research activities were largely undertaken via internal staff (~100%), academic collaborations (50%-88%) and/or external consultants and industry partnerships (77%-83%) in the national federation and clubs.

Conclusion

Collectively, these findings provide a detailed overview regarding key operational processes delivered by medical and performance practitioners working in elite football academies.

Injury incidence rates in women's football: a systematic review and meta-analysis of prospective injury surveillance studies

OBJECTIVE

To review the literature to establish overall, match and training injury incidence rates (IIRs) in senior (≥18 years of age) women's football (amateur club, elite club and international).

DESIGN

Systematic review and meta-analysis of overall, match and training IIRs in senior women's football, stratified by injury location, type and severity.

DATA SOURCES

MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO and Web of Science were searched from earliest record to July 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

(1) football players participating in a senior women's football league (amateur club or elite club) or a senior women's international football tournament; (2) the study had to report IIRs or provide sufficient data from which this outcome metric could be calculated through standardised equations; (3) a full-text article published in a peer-reviewed journal before July 2021; (4) a prospective injury surveillance study and (5) case reports on single teams were ineligible.

RESULTS

17 articles met the inclusion criteria; amateur club (n=2), elite club (n=10), international (n=5). Overall, match and training 'time-loss' IIRs are similar between senior women's elite club football and international football. 'Time-loss' training IIRs in senior women's elite club football and international football are approximately 6-7 times lower than their equivalent match IIRs. Overall 'time-loss' IIRs stratified by injury type in women's elite club football were 2.70/1000 hours (95% CI 1.12 to 6.50) for muscle and tendon, 2.62/1000 hours (95% CI 1.26 to 5.46) for joint and ligaments, and 0.76/1000 hours (95% CI 0.55 to 1.03) for contusions. Due to the differences in injury definitions, it was not possible to aggregate IIRs for amateur club football.

CONCLUSION

Lower limb injuries incurred during matches are a substantial problem in senior women's football. The prevention of lower limb joint, ligament, muscle and tendon injuries should be a central focus of injury prevention interventions in senior women's amateur club, elite club and international football.

PROSPERO REGISTRATION NUMBER

CRD42020162895.

The Physical Demands of Match-Play in Academy and Senior Soccer Players from the Scottish Premiership

The present study aimed to assess the physical match performance among senior and youth soccer players from an elite Scottish Premiership club during the 2021/2022 season. Twenty-two first team (25.9 ± 4.5 years, 78.3 ± 8.2 kg, 1.82 ± 0.07 cm) and 16 youth players (16.8 ± 0.9 years, 70.1 ± 6.8 kg, 177 ± 5.8 cm) were examined. A selection of physical match performance variables were measured using a global positioning system. Linear mixed-effect regressions revealed for all examined variables no significant differences between first team and U-18 players and no significant differences between playing level by position interaction. Across both teams, Centre Backs compared to Wing Backs, showed a 295 m (p < 0.01) lower high-intensity distance, and performed on average 36 fewer very-high intensity decelerations (p = 0.03). Comparing to Wide Midfielders, Centre Backs showed lower total (1297 m, p = 0.01), high-intensity (350 m, p = 0.01), and sprint (167 m, p < 0.01) distances. Sprint distance was also lower in Centre Backs vs. Strikers (118 m, p = 0.03), and in Central Midfielders vs. both Strikers (104 m, p = 0.03) and Wide Midfielders (154 m, p = 0.01). The present findings highlight the physical match performance of elite Scottish players and provide useful information within the context of understanding how methods of physical development of youth soccer are implemented in different countries.

Adductor Strengthening Programme is successfully adopted but frequently modified in Norwegian male professional football teams: a cross-sectional study

OBJECTIVES

Groin injuries represent a substantial problem in male football, with the Adductor Strengthening Programme (ASP) being the only exercise programme demonstrated to significantly reduce the risk of groin problems. We aimed first, to use the Reach Adoption Effectiveness Implementation Maintenance (RE-AIM) framework to investigate attitudes, beliefs and behaviour to the ASP among primary delivery agents of injury prevention exercises in Norwegian male professional football teams. Second, we aimed to identify a real-world application of the ASP protocol used in a professional team setting.

DESIGN

A descriptive cross-sectional survey, using a questionnaire designed to cover all five dimensions of the RE-AIM framework.

SETTING

The top two divisions of Norwegian male professional football.

PARTICIPANTS

32 primary injury prevention delivery agents.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primarily, the proportion of respondents being aware of the ASP and its effect; having adopted it; having implemented it as intended; and considering maintaining using it. Secondary, the most often used ASP modifications.

RESULTS

Twenty-nine (91%) participants responded. All (100%) respondents were aware of the ASP and its injury preventive effect. The two most stated reasons for using the ASP were its injury preventive effect and that it does not require equipment. The ASP was adopted by all (100%) delivery agents, but only 10% used it in accordance with the original protocol. The main modifications were that the players in 72% of the teams were instructed to perform a non-progressive number of repetitions during pre-season, and in 86% of the teams instructed to perform more sets, but fewer repetitions per set, during in season. In total, 97% of the delivery agents planned to continue using the ASP.

CONCLUSION

The delivery agents have positive attitudes and beliefs to the ASP, but they frequently modify it. We identified and reported a real-world application of the ASP protocol.

Within Session Exercise Sequencing During Programming for Complex Training: Historical Perspectives, Terminology, and Training Considerations

The primary aim of this narrative review was to outline the historical genesis of resistance training strategies that incorporate high-load, low-velocity exercises and low-load, high-velocity exercises in the same training session allowing for different "exercise sequences" to be simultaneously implemented. Discrepancies between scientific works and the terminology used within contemporary sport science publications are identified. Upon review of the literature, we propose "complex training" to be considered an umbrella term with 4 different implementations, generally used to indicate a method in which movement velocity or load is altered between sets and/or exercises within the same session with the aim of improving slow and fast force expression. We propose the following terminology for said implementations: contrast training-exercise sequence with alternating high-load and low-load (higher-velocity) exercises in a set-by-set fashion within the same session (corresponding with 'contrast pairs' and 'intra-contrast rest'); descending training-several sets of high-load (e.g., back squat) exercises completed before the execution of several sets of low-load, higher-velocity (e.g., vertical jump) exercises within the same session; ascending training-several sets of low-load, higher-velocity exercises completed before several sets of high-load exercises within the same session; and French contrast training-subset of contrast training in which a series of exercises are performed in sequence within a single session: heavy compound exercise, plyometric exercise, light-to-moderate load compound exercise that maximises movement speed (i.e., external power), and a plyometric exercise (often assisted). Finally, practical applications and training considerations are presented.

A Multidisciplinary Approach to Game Day Preparation for Team Sports: A Delphi Study With Expert Consensus

ABSTRACT

Mason, BRJ, Pumpa, KL, McKune, AJ, Gill, ND, and Ball, NB. A multidisciplinary approach to game day preparation for team sports: A Delphi study with expert consensus. J Strength Cond Res 36(5): 1345-1352, 2022-The aim of this study was to identify game day preparation strategies used by performance staff to improve team sport performance and to determine consensus regarding the application and importance of these strategies. Twenty-five performance staff working in high performance or professional team sports participated in this Delphi study, which implemented 3 survey rounds. The first round sought responses to open-ended questions relating to the use of game day preparation strategies. These responses were developed into statements and recirculated (round-2 survey), with subjects asked to rate their level of agreement with each statement. The third and final survey presented revised versions of statements that did not reach a consensus in the previous round, along with new statements derived from subject responses. A thematic analysis of the open-ended responses in the first survey identified 5 key themes relating to game day preparation strategies: "exercise," "nutrition," "psychological," "technical and tactical," and "other." The round-2 survey included 38 statements across the 5 themes, with 22 reaching the consensus threshold (≥75%) for agreement. The remaining 16 statements did not reach consensus. The final survey included 18 statements (16 revised and 2 new) with 12 reaching the consensus threshold for agreement. Key preparation strategies identified in this study include structured and progressive warm-ups, strength and power-based priming sessions, individualized nutrition plans, and precooling in hot conditions. Performance staff working in similar environments should consider adopting these strategies to improve athlete or team performance.

Hamstrings injuries in football

Background

Hamstrings injuries are a major concern in football (soccer), affecting both recreational players and professional athletes. Although being a recognized issue within the football community, its incidence has been increasing over the last years and still poses a challenge to all practitioners involved.

Study objectives and rationale

The goal of this narrative review is to outline hamstrings injuries epidemiology and mechanisms of injury, identify and discuss its risk factors, provide an approach to a proper early diagnosis, evaluate the efficacy of current treatment options and return to sports, and present the best strategies for hamstrings injury prevention. These guidelines will help the sports medicine staff team on how to better manage their players with or at risk of hamstrings injuries.

Conclusion

Despite several breakthroughs in research of hamstrings injuries, there is still heterogeneity across studies and lack of consensus in regards to classification, diagnosis, treatment and prevention. Hamstrings injuries compromise the athlete's performance with time loss due to injury, shortens their highest-level career longevity with higher risk of reinjury rates, and is a defying problem for clubs to balance financial losses due to having their players off the pitch. Further research is warranted to keep moving forward with evidence on treating and preventing hamstrings injuries to mitigate its high incidence and keep the players safe.

Tracking Systems in Team Sports: A Narrative Review of Applications of the Data and Sport Specific Analysis

Seeking to obtain a competitive advantage and manage the risk of injury, team sport organisations are investing in tracking systems that can quantify training and competition characteristics. It is expected that such information can support objective decision-making for the prescription and manipulation of training load. This narrative review aims to summarise, and critically evaluate, different tracking systems and their use within team sports. The selection of systems should be dependent upon the context of the sport and needs careful consideration by practitioners. The selection of metrics requires a critical process to be able to describe, plan, monitor and evaluate training and competition characteristics of each sport. An emerging consideration for tracking systems data is the selection of suitable time analysis, such as temporal durations, peak demands or time series segmentation, whose best use depends on the temporal characteristics of the sport. Finally, examples of characteristics and the application of tracking data across seven popular team sports are presented. Practitioners working in specific team sports are advised to follow a critical thinking process, with a healthy dose of scepticism and awareness of appropriate theoretical frameworks, where possible, when creating new or selecting an existing metric to profile team sport athletes.

Training Management of the Elite Adolescent Soccer Player throughout Maturation

Professional soccer clubs invest significantly into the development of their academy prospects with the hopes of producing elite players. Talented youngsters in elite development systems are exposed to high amounts of sports-specific practise with the aims of developing the foundational skills underpinning the capabilities needed to excel in the game. Yet large disparities in maturation status, growth-related issues, and highly-specialised sport practise predisposes these elite youth soccer players to an increased injury risk. However, practitioners may scaffold a performance monitoring and injury surveillance framework over an academy to facilitate data-informed training decisions that may not only mitigate this inherent injury risk, but also enhance athletic performance. Constant communication between members of the multi-disciplinary team enables context to build around an individual's training status and risk profile, and ensures that a progressive, varied, and bespoke training programme is provided at all stages of development to maximise athletic potential.

Deceleration Training in Team Sports: Another Potential 'Vaccine' for Sports-Related Injury?

High-intensity horizontal decelerations occur frequently in team sports and are typically performed to facilitate a reduction in momentum preceding a change of direction manoeuvre or following a sprinting action. The mechanical underpinnings of horizontal deceleration are unique compared to other high-intensity locomotive patterns (e.g., acceleration, maximal sprinting speed), and are characterised by a ground reaction force profile of high impact peaks and loading rates. The high mechanical loading conditions observed when performing rapid horizontal decelerations can lead to tissue damage and neuromuscular fatigue, which may diminish co-ordinative proficiency and an individual’s ability to skilfully dissipate braking loads. Furthermore, repetitive long-term deceleration loading cycles if not managed appropriately may propagate damage accumulation and offer an explanation for chronic aetiological consequences of the ‘mechanical fatigue failure’ phenomenon. Training strategies should look to enhance an athlete’s ability to skilfully dissipate braking loads, develop mechanically robust musculoskeletal structures, and ensure frequent high-intensity horizontal deceleration exposure in order to accustom individuals to the potentially damaging effects of intense decelerations that athletes will frequently perform in competition. Given the apparent importance of horizontal decelerations, in this Current Opinion article we provide considerations for sport science and medicine practitioners around the assessment, training and monitoring of horizontal deceleration. We feel these considerations could lead to new developments in injury-mitigation and physical development strategies in team sports.

Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise

OBJECTIVES

The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury). To underline the importance and impact of adopting appropriate methodology for evidence synthesis, we revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis.

STUDY DESIGN AND SETTING

Only randomized control trials (RCT) using NHE as one of the prevention arms were selected. Summary effects for risk ratios (RR) for original studies included in the earlier meta-analysis, and new studies identified (update), were re-estimated under the random-effects model and presented with 95% confidence intervals (CI) and prediction intervals (PI). Tentative recommendations were provided according to the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Only five RCTs out of the 15 studies included in the earlier meta-analysis randomized to NHE. Our update revealed one additional RCT. The point estimate (RR) for the five RCTs previously considered RCTs was 0.56 (95% CI, 0.20-1.52; 95% PI, 0.06-5.14, parametric, and 0.13-1.80, nonparametric). After the update, the RR was 0.59 (95% CI, 0.27-1.29; 95% PI 0.10-3.29, parametric, and 0.17-1.52, nonparametric).

CONCLUSION

Contrary to the conclusions of a recent meta-analysis, as well as earlier meta-analyses, by using more appropriate methodology, the evidence underpinning the protective effect of NHE so far remains inconclusive and mostly derived from high risk of bias RCTs. At best, only conditional recommendation can be provided (for soccer) and future RCTs are warranted.

Moving Beyond One-Size-Fits-All Approaches to Injury Prevention: Evaluating How Tailored Injury Prevention Programs Are Developed and Implemented in Academy Soccer

OBJECTIVE

To evaluate the real-world development and implementation of tailored injury prevention exercise programs (IPEPs) in academy soccer players.

DESIGN

A mixed-methods process evaluation employing the Consolidated Framework for Implementation Research.

METHODS

The participants were 38 players and staff members (eg, coaches, physical therapists) from 4 male teams in 1 European soccer academy. The content and nature of the 4 teams' IPEPs and the degree of implementation across 1 playing season were evaluated. Additionally, participants took part in semi-structured interviews and focus groups, focusing on the development of tailored IPEPs and implementation barriers and facilitators.

RESULTS

Teams employed multiple IPEPs, developed by the team physical therapists and strength and conditioning coaches. A range of sources, including scientific literature, guidelines, individual player screening data, and previous experience, influenced IPEP development. Across all teams, 76% of IPEP sessions were completed as originally planned and a further 11% were completed in modified form. The key barriers to implementation during the season were related to scheduling changes and managing player workload. Thematic coding of interviews and focus groups identified 25 IPEP implementation barriers (eg, time and scheduling, player workload) and 41 facilitators (eg, program adaptability, facilities and equipment).

CONCLUSION

In a male soccer academy setting, physical therapists and strength and conditioning coaches played the key role in IPEP development. Teams employed a range of different, internally developed programs. The key implementation factors were related to time and scheduling and managing player workload. J Orthop Sports Phys Ther 2021;51(9):432-439. doi:10.2519/jospt.2021.10513.

Analysis of the worst-case scenarios in an elite football team: Towards a better understanding and application

This study investigated the variability in the worst-case scenario (WCS) and suggested a framework to improve the definition and guide further investigation. Optical tracking data from 26 male players across 38 matches were analysed to determine the WCS for total distance, high-speed running (>5.5 m.s-1) and sprinting (>7.0 m.s-1) using a 3-minute rolling window. Position, total output, previous epoch, match half, time of occurrence, classification of starter vs substitute, and minutes played were modelled as selected contextual factors hypothesized to have associations with the WCS. Linear mixed effects models were used to account for cross-sectional observations and repeated measures. Unexplained variance remained high (total distance R2 = 0.53, high-speed running R2 = 0.53 and sprinting R2 = 0.40). Intra-individual variability was also high (total distance CV = 4.6-8.2%; high-speed CV = 15.6-37.8% and Sprinting CV = 21.1-76.4%). The WCS defined as the maximal physical load in a given time-window, produces unstable metrics lacking context, with high variability. Furthermore, training drills targetting this metric concurrently across players may not have representative designs and may underprepare athletes for complete match demands and multifaceted WCS scenarios. Using WCS as benchmarks (reproducing similar physical activity for training purposes) is conceptually questionable.

Low Horizontal Force Production Capacity during Sprinting as a Potential Risk Factor of Hamstring Injury in Football

Clear decreases in horizontal force production capacity during sprint acceleration have been reported after hamstring injuries (HI) in football players. We hypothesized that lower F_H0 is associated with a higher HI occurrence in football players. We aimed to analyze the association between sprint running horizontal force production capacities at low (F_H0) and high (V₀) velocities, and HI occurrence in football. This prospective cohort study included 284 football players over one season. All players performed 30 m field sprints at the beginning and different times during the season. Sprint velocity data were used to compute sprint mechanical properties. Players' injury data were prospectively collected during the entire season. Cox regression analyses were performed using new HI as the outcome, and horizontal force production capacity (F_H0 and V₀) was used at the start of the season (model 1) and at each measurement time point within the season (model 2) as explanatory variables, adjusted for individual players' (model 2) age, geographical group of players, height, body mass, and previous HI, with cumulative hours of football practice as the time scale. A total of 47 new HI (20% of all injuries) were observed in 38 out of 284 players (13%). There were no associations between F_H0 and/or V₀ values at the start of the season and new HI occurrence during the season (model 1). During the season, a total of 801 measurements were performed, from one to six per player. Lower measured F_H0 values were significantly associated with a higher risk of sustaining HI within the weeks following sprint measurement (HR = 2.67 (95% CI: 1.51 to 4.73), p < 0.001) (model 2). In conclusion, low horizontal force production capacities at low velocity during early sprint acceleration (F_H0) may be considered as a potential additional factor associated with HI risk in a comprehensive, multifactorial, and individualized approach.

The Hamstrings: Anatomic and Physiologic Variations and Their Potential Relationships With Injury Risk

The incidence and recurrence of hamstrings injuries are very high in sports, posing elevated performance and financial-related costs. Attempts to identify the risk factors involved in predicting vulnerability to hamstrings injury is important for designing exercise-based programs that aim to mitigate the rate and severity of hamstrings injuries and improve rehabilitation strategies. However, research has shown that non-modifiable risk factors may play a greater role than modifiable risk factors. Recognizing non-modifiable risk factors and understanding their implications will afford the prescription of better suited exercise programs, i.e., that are more respectful of the individual characteristics. In a nutshell, non-modifiable risk factors can still be acted upon, even if indirectly. In this context, an underexplored topic is how intra and inter- individual anatomic and physiologic variations in hamstrings (e.g., muscle bellies, fiber types, tendon length, aponeurosis width, attachment sites, sex- and age-related differences) concur to alter hamstrings injuries risk. Some anatomic and physiologic variations may be modifiable through exercise interventions (e.g., cross-sectional area), while others may not (e.g., supernumerary muscle bellies). This apparent dichotomy may hide a greater complexity, i.e., there may be risk factors that are partially modifiable. Therefore, we explored the available information on the anatomic variations of the hamstrings, providing a deeper insight into the individual risk factors for hamstrings injuries and contributing with better knowledge and potential applications toward a more individualized exercise prescription.

Effect of Resisted Sprint and Plyometric Training on Lower Limb Functional Performance in Collegiate Male Football Players: A Randomised Control Trial

The main objectives of this study were to evaluate the short-term effects of resisted sprint and plyometric training on sprint performance together with lower limb physiological and functional performance in collegiate football players. Ninety collegiate football players participated in this three-arm, parallel group randomized controlled trial study. Participants were randomly divided into a control group and two experimental groups: resisted sprint training (RST) (n = 30), plyometric training (PT) (n = 30), and a control group (n = 30). Participants received their respective training program for six weeks on alternate days. The primary outcome measures were a knee extensor strength test (measured by an ISOMOVE dynamometer), a sprint test and a single leg triple hop test. Measurements were taken at baseline and after 6 weeks post-training. Participants, caregivers, and those assigning the outcomes were blinded to the group assignment. A mixed design analysis of variance was used to compare between groups, within-group and the interaction between time and group. A within-group analysis revealed a significant difference (p < 0.05) when compared to the baseline with the 6 weeks post-intervention scores for all the outcomes including STN (RST: d = 1.63; PT: d = 2.38; Control: d = 2.26), ST (RST: d = 1.21; PT: d = 1.36; Control: d = 0.38), and SLTHT (RST: d = 0.76; PT: d = 0.61; Control: d = 0.18). A sub-group analysis demonstrated an increase in strength in the plyometric training group (95% CI 14.73 to 15.09, p = 0.00), an increase in the single leg triple hop test in the resisted sprint training group (95% CI 516.41 to 538.4, p = 0.05), and the sprint test was also improved in both experimental groups (95% CI 8.54 to 8.82, p = 0.00). Our findings suggest that, during a short-term training period, RST or PT training are equally capable of enhancing the neuromechanical capacities of collegiate football players. No adverse events were reported by the participants.