The Football Association Injury and Illness Surveillance Study: The Incidence, Burden and Severity of Injuries and Illness in Men's and Women's International Football

Injury incidence and characteristics in adolescent female football players: A systematic review with meta-analysis of prospective studies

To observe overall, training, and match injury incidence in female youth football. We also aimed to quantify the incidence of injuries by affected tissue and body location. The following databases were examined: PubMed, Web of Science, Scopus, SPORTDiscus, Cochrane and PEDro. Papers that reported overall injury incidence, training or match injury incidence were included. Additionally, studies had to be performed in adolescent female football players (13-19 years of age). The Newcastle-Ottawa Scale and the checklist of items that must be included in epidemiological football reports were used to assess methodological quality of the included articles. For the meta-analyses, a random effect model was used. A total of 13 studies were included. There were 2,333 injuries; incidence was higher during games (12.7/1000 h) compared to training sessions (2.3/1000 h). The injury match-to-training ratio was 5.8. The lower limbs were the region in which the greatest number of injuries occurred, with the ankle (1.2/1000 h) and knee (0.8/1000 h) having the most injuries. In relation to injured tissue, ligament injuries represented an incidence of 1.3/1000 h, followed by muscle injuries (0.9/1000 h). This study represents the first step towards the creation and implementation of preventative measures in female youth football. The results suggest that attention should be focused on ankle and knee injuries, since they are the most frequent and can lead to sport retirement in some cases depending on the severity.

Injury and illness surveillance monitoring in team sports: a framework for all

BACKGROUND

Sport-related injuries and illnesses can negatively impact athlete welfare at all standards of participation in team sports. Injury and illness surveillance (IIS), and the development of monitoring systems, initiates the sequence of injury and illness prevention. Operational IIS monitoring systems help to appraise epidemiological estimates of injury and illness incidence and burden in various athlete populations. However, the methodological underpinnings of various monitoring systems are not harmonized or widely documented, with the presence of efficient and successful programmes rarely showcased at non-elite levels. The aim is to provide a framework that guides the development of IIS, which will enhance overall surveillance, to indirectly inform injury prevention strategies.

METHODS

The process involved all members of the research group initially discussing the research gaps, scope of the project, and the aims of the article. Unique experiences were shared, and specific and global challenges and barriers to IIS at all standards of team sport participation were identified. A tiered system of data collection with corresponding content were produced, with experiences and guidance provided throughout the article.

RESULTS

The literature has been reviewed and using first-hand experience in conducting IIS programmes in complex and diverse sport settings, the authors have identified key enablers and barriers for best practise as time, technological and human resources, reporter/practitioner training, and medical expertise. Areas of greatest importance regarding the conducting of IIS have been outlined, providing guidance and recommendations across all levels of team sport participation. These areas include definitions, data context, collection procedures, handling, security, ethics, storage, dissemination, quality, compliance, and analysis. Given the barriers to IIS, 3-tiered levels of data collection and content have been proposed. The levels indicate data collection variables, with a focus on sufficiency and achievability, aiming to support the successful conducting of IIS in team sports across all standards of participation. Future opportunities in IIS have been discussed, with several predictive measures and analytical techniques expanded upon.

CONCLUSIONS

The framework provides universal guidance for implementing IIS monitoring systems, facilitating athletes, coaches, parents/guardians, governing bodies and practitioners to implement IIS processes, identify challenges, complete analysis, and interpret outcomes at all standards of participation.

Injury Profile in Youth Female Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

An increasing number of epidemiological studies assessing the incidence, prevalence and severity of injury in youth female sport are available. However, no study has sought to synthesise the current evidence base across all youth female sport. As such, a systematic review and meta-analysis of injury in this cohort is necessary to understand the diversity of injury and its associated burden between sports in addition to identifying the density of research available.

OBJECTIVE

To conduct a systematic review and meta-analysis of epidemiological data of injuries in youth female athletes with particular attention to injury incidence, mean days lost and injury burden.

METHODS

Searches were performed in PubMed, EBSCO (SPORTDiscus with Full Text MEDLINE, APA PsycINFO, CINAHL, Academic Search Complete) and Cochrane databases. Studies were considered if they reported time-loss injury incidence or prevalence in youth female (≤ 19 years old) athletes. Study quality and risk of bias were assessed using STROBE-SIIS extension, Newcastle-Ottawa Scale, and funnel plots, respectively. Injury incidence and burden rate data were modelled using a mixed-effect Poisson regression model. Days lost data were modelled using a generalised linear mixed model.

RESULTS

Thirty-two studies were included. The overall incidence rate, mean days lost per injury, and burden rate were 4.4 injuries per 1000 h (95% CI 3.3-5.9), 10 days (95% CI 6-15), and 46 days per 1000 h (95% CI 23-92), respectively. Forty percent of athletes sustained at least one time-loss injury. Competitive level was a significant moderator of match and training injury incidence, with elite youth athletes presenting greater pooled injury incidence estimates than non-elite athletes (p = 0.0315 and p = 0.0047, respectively). The influence of moderators on days lost and injury burden could not be determined due to an insufficient number of studies for analysis.

CONCLUSION

Despite a broad inclusion criterion, there is limited injury surveillance research available across youth female sport. Outside of soccer, little research density is evidenced with single studies available in popular team sports such as Australian football and rugby union. Insufficient study numbers reporting mean days lost and injury burden data were available for analysis, and pooled days lost data could only be estimated for soccer. This highlights a need for future research to report days lost data alongside injury number and exposure so burden can be calculated and the full risk of injury to youth female athletes can be identified.

The impact of a mid-season FIFA World Cup™ on injury occurrence and patterns in French professional soccer clubs

This study retrospectively compared the effect of holding the 2022 FIFA World Cup™ (WC) mid-season (season 2022/23) on injury rates and patterns in French Ligue 1 soccer clubs. Epidemiological data in 17 clubs were prospectively recorded by their physicians. Time-loss injuries (injuries leading to a player being unable to fully participate in play over the following 72-hour period) were compared with those reported during a regular season (2021-22). In the WC season, an increase of approximately 23% (training + match-play) was observed for both the total number of injuries and knee, ankle and muscle injuries combined. Incidences for match-play injury overall and for the knee, ankle and muscle regions combined and the hamstrings and calf regions specifically also rose significantly (range: p < 0.05-p < 0.01). These results suggest that injury occurrence and patterns in French L1 soccer clubs were substantially affected during the 2022/23 season when a mid-season WC was held.

Injury data collection and utilisation practices in university sports teams: A cross-sectional study

OBJECTIVES

This study aimed to examine injury surveillance practices in a variety of university sports teams and barriers and facilitators for injury data collection and utilisation.

DESIGN

Cross-sectional study.

SETTING

University sports teams in Japan.

PARTICIPANTS

Medical, coaching, and other staff (non-medical/-coaching staff) of the university sports teams in Japan.

MAIN OUTCOME MEASURES

The survey included 31 questions that examined the barriers and facilitators for injury data collection, and the type of data on injury and exposure collected.

RESULTS

Injury data were collected during matches for 69 teams (48.3%) and training for 61 teams (42.7%). Injuries were primarily captured by athletic trainers in teams with medical staff, coaching staff and athletes in teams without medical staff. Common barriers in collecting and utilising injury data included limited funding for trained personnel and lack of time for medical staff to record data. Facilitating factors included clarification of the methods employed in recording and utilising injury data for teams with medical staff and the deployment of trained personnel to record injuries for teams without medical staff.

CONCLUSIONS

Approximately half of the Japanese university teams collected injury data. Considering barriers and facilitators is crucial to facilitate the collection and utilisation of injury data.

Epidemiology of International Match Injuries in Scottish Rugby: A Prospective Cohort Study

Fifteen-a-side rugby union ("rugby") is a full-contact sport played separately by men and women, with large injury incidences reported previously. Context specific injury surveillance fulfils governing bodies' duty of care to understand risks to player welfare, yet no contemporary match injury epidemiology studies exist for international players in Scotland. The current study therefore aimed to describe the incidence, severity, burden and nature of match injuries sustained by Scotland's men's and women's national teams. A prospective cohort study of injuries recorded in matches across the 2017/18 and 2018/19 seasons was undertaken, with injury and exposure definitions in line with the international consensus for injury surveillance in rugby. Injury incidence was 120.0 (men) and 166.7/1,000 player match hours (women), injury severity was 12.0 (median) and 31.2 days (mean) for men, and 11.0 (median) and 30.2 days (mean) for women. Injury burden was 3,745 (men) and 5,040 days absence/1,000 player match hours (women). Concussion was the most common specific injury for men (22.5/1,000 hours) and women (26.7/1,000 hours). No statistical differences were found for incidence or severity measures between sexes. Injury incidence was greater than recent Rugby World Cup studies. High incidences of concussion reinforces the need for prevention strategies targeting this injury.

Growth-related sports injuries among young male professional football players in the Netherlands: a prospective cohort study concerning injury incidence, severity and burden

OBJECTIVES

To investigate the incidence, type and location of growth-related sports injuries (GRSI) in youth professional football in the Netherlands. Secondary, to gain more knowledge on the injury severity and burden of GRSI.

METHODS

In this prospective, longitudinal cohort study, 813 players aged 10-18 are included. Data collection is performed by instructing the medical staff of six professional football club academies to register GRSI by means of standardized forms. Training and match exposure are registered individually on a weekly basis. Injury incidence was calculated as number of GRSI per 1000 hours, injury severity as the median number of days lost in categories and injury burden as the number of days lost per 1000 hours.

RESULTS

A total of 62 GRSI were documented in the football season 2021-2022. The total incidence of GRSI was 0.62/1000 hours football exposure. Morbus Osgood Schlatter and Morbus Sever were most common types of GRSI, both with incidence rates of 0.22/1000 hours exposure. About 58.3% of the documented GRSI were classified as major (>28 days lost). Within this group, the mean severity was 55 days time-loss to football.

CONCLUSIONS

GRSI are relatively common in youth professional football. The most common types are Morbus Sever and Morbus Osgood Schlatter. Morbus Osgood Schlatter has the highest injury severity and burden compared to other types of GRSI.

Epidemiology of Injuries in Men's Professional and Amateur Football (Part I)

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men's football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players.

The effect of progressive and individualised sport-specific training on the prevalence of injury in football and handball student athletes: a randomised controlled trial

Objective

To evaluate the effectiveness of communication and coordination combined with designing a progressive and individualised sport-specific training program for reducing injury prevalence in youth female and male football and handball players transitioning to a sports academy high school. An additional aim was to investigate the characteristics of the reported injuries.

Methods

Forty-two Norwegian athletes were randomised into an intervention or control group. Mean age, height, weight and BMI was 15.5 ± 0.5 years, 178.6 cm ± 6.3 cm, 71.3 ± 9.8 kg, 22.3 ± 2.7 BMI for the intervention group (IG) (n = 23), and 15.4 ± 0.5 years, 175.6 cm ± 6.6 cm, 67.1 ± 9.8 kg, 21.7 ± 2.4 BMI for the control group (CG) (n = 19). During the summer holiday, the intervention group received weekly progressive, individualised sport-specific training programs and weekly follow-up telephone calls from the researchers. All athletes completed a baseline questionnaire and a physical test battery. Training data and injuries were recorded prospectively for 22 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). A two-way chi-square (χ²) test of independence was conducted to examine the relationship between groups and injury.

Results

Average weekly prevalence of all injuries was 11% (95% CI: 8%-14%) in IG and 19% (95% CI: 13%-26%) in CG. Average weekly prevalence of substantial injuries was 7% (95% CI: 3%-10%) in IG and 10% (95% CI: 6%-13%) in CG. The between-group difference in injuries was significant: χ² (1, N = 375) = 4.865, p = .031, φ = .114, with 1.8 times higher injury risk in CG vs. IG during the first 12 weeks after enrolment.

Conclusions

For student athletes transitioning to a sports academy high school, progressive individualised, sport-specific training programs reduced the prevalence of all-complaint injuries following enrolment. Clubs and schools should prioritise time and resources to implement similar interventions in periods where student athletes have less supervision, such as the summer holidays, to facilitate an optimal transition to a sports academy high school.

Many Pieces to the Puzzle: A New Holistic Workload Approach to Designing Practice in Sports

Representative learning design (RLD) in sport is a well-established concept in both theory and practice. The goal of RLD is to faithfully replicate competition environments in training settings to benefit improvement in athletic performance. There is currently little research that considers how representative an activity needs to be to facilitate learning transfer, and how that level of representativeness might fluctuate between activities or sessions, and across competitive cycles. Similarly, there is no existing research that specifically considers the elevated workload (in cognitive and physical load) of highly representative training, and the potential impacts of chronic overuse of these highly demanding activities. This paper addresses these limitations, making a case for the application of RLD that considers the level of representativeness (fidelity) and the demands placed on athletes (load) from both a cognitive and physical perspective. This paper also suggests several categorisations of training activities that are based on their relative representativeness, level of imposed demands, and the intended outcomes of the activity with reference to the perception-action cycle. The two core concepts of fidelity and load are combined for a new approach to representative training that allows practitioners to balance the benefits of representative training with the risks of imposing excessive load on athletes.

Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The "Italian Injury Study" during the Serie a Championship

INTRODUCTION

Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury.

METHODS

A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database.

RESULTS

Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI_95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI_95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI_95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI_95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19.

CONCLUSIONS

This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.

Epidemiology of Football Injuries of the German Bundesliga: A Media-Based, Prospective Analysis over 7 Consecutive Seasons

BACKGROUND

This study describes the implementation of a standardised, prospective injury database covering the entire 1st male German football league ("Bundesliga") based on publicly available media data. For the first time, various media sources were used simultaneously as the external validity of media-generated data was low in the past compared to data obtained by way of the "gold standard", i.e. by the teams' medical staffs.

METHODS

The study covers 7 consecutive seasons (2014/15-2020/21). The primary data source was the online version of the sport-specific journal "kicker Sportmagazin™" complemented by further publicly available media data. Injury data collection followed the Fuller consensus statement on football injury studies.

RESULTS

During the 7 seasons, 6653 injuries occurred, thereof 3821 in training and 2832 in matches. The injury incidence rates (IRs) per 1000 football hours were 5.5 [95% CI 5.3-5.6], 25.9 [25.0-26.9] per 1000 match, and 3.4 [3.3-3.6] per 1000 training hours. Twenty-four per cent of the injuries (n = 1569, IR 1.3 [1.2-1.4]) affected the thigh, 15% (n = 1023, IR 0.8 [0.8-0.9]) the knee, and 13% (n = 856, IR 0.7 [0.7-0.8]) the ankle. Muscle/tendon injuries contributed 49% (n = 3288, IR 2.7 [2.6-2.8]), joint/ligament injuries 17% (n = 1152, IR 0.9 [0.9-1.0]), and contusions 13% (n = 855, IR 0.7 [0.7-0.8]). Compared to studies using injury reports from the clubs' medical staff, media data revealed similar proportional distributions of the injuries, but the IRs tended towards the lower end. Obtaining specific locations or diagnosis especially with regard to minor injuries is difficult.

CONCLUSIONS

Media data are convenient for investigating the quantity of injuries of an entire league, for identifying injuries for further subanalysis, and for analysing complex injuries. Future studies will focus on the identification of inter- and intraseasonal trends, players' individual injury histories, and risk factors for subsequent injuries. Furthermore, these data will be used in a complex system approach for developing a clinical decision support system, e.g. for return to play decisions.

Incidence and prevalence of hamstring injuries in field-based team sports: a systematic review and meta-analysis of 5952 injuries from over 7 million exposure hours

OBJECTIVE

This study aimed to systematically review and meta-analyse the incidence and prevalence of hamstring injuries in field-based team sports. A secondary aim was to determine the impact of other potential effect moderators (match vs training; sport; playing surface; cohort age, mass and stature; and year when data was collected) on the incidence of hamstring injury in field-based team sports.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

CINAHL, Cochrane Library, MEDLINE Complete (EBSCO), Embase, Web of Science and SPORTDiscus databases were searched from database inception to 5 August 2020.

ELIGIBILITY CRITERIA

Prospective cohort studies that assessed the incidence of hamstring injuries in field-based team sports.

METHOD

Following database search, article retrieval and title and abstract screening, articles were assessed for eligibility against predefined criteria then assessed for methodological quality using the Critical Appraisal Tool for prevalence studies. Meta-analysis was used to pool data across studies, with meta-regression used where possible.

RESULTS

Sixty-three articles were included in the meta-analysis, encompassing 5952 injuries and 7 262 168 hours of exposure across six field-based team sports (soccer, rugby union, field hockey, Gaelic football, hurling and Australian football). Hamstring injury incidence was 0.81 per 1000 hours, representing 10% of all injuries. Prevalence for a 9-month period was 13%, increasing 1.13-fold for every additional month of observation (p=0.004). Hamstring injury incidence increased 6.4% for every 1 year of increased average cohort age, was 9.4-fold higher in match compared with training scenarios (p=0.003) and was 1.5-fold higher on grass compared with artificial turf surfaces (p<0.001). Hamstring injury incidence was not significantly moderated by average cohort mass (p=0.542) or stature (p=0.593), was not significantly different between sports (p=0.150) and has not significantly changed over the last 30 years (p=0.269).

CONCLUSION

Hamstring injury represents 10% of all injuries in field-based team sports, with 13% of the athletes experiencing a hamstring injury over a 9-month period most commonly during matches. More work is needed to reduce the incidence of hamstring injury in field-based team sports.

PROSPERO REGISTRATION NUMBER

CRD42020200022.

Epidemiology of Upper Limb Injuries in two major Brazilian Soccer Championships from 2016 to 2019

PURPOSE

To evaluate epidemiological data of upper limb injuries in professional athletes who participated in two major Brazilian soccer championships between 2016 and 2019.

METHODS

A prospective cohort study was conducted to evaluate the teams of two divisions over four seasons within the Brazilian Soccer Championship and the Paulista Soccer Championship. Clubs and their doctors were contacted to participate in the study and guided on the correct way to enter data via online platforms: Transfermarkt (Transfermarkt GmbH & Co. KG) and Survey Monkey (Momentive.AI). Demographic data, injury characteristics, and FIFA Incidence Formula were analyzed.

RESULTS

Overall, the study analyzed 3,828 matches and 126,357 hours of play. Upper limb injuries were registered 169 times, representing 6.8% of total injuries, with a FIFA incidence of 1.34. Most lesions occurred in forward players (21.3%), the shoulder exhibited the highest number of injuries (63.3%). The player's position was related to the location on the field where the injury occurred (p < 0.001); however, there was no relationship between the type of injury and the location on the body (p > 0.001). The average time to return to play was 19.1 days (range 0-200 days) and it was longer for goalkeepers. The necessity of surgical treatment was statistically associated with additional time to return to play (p < 0.001).

CONCLUSIONS

Shoulder injuries were the most frequent upper limb injury sustained during the two major Brazilian soccer championships. Forward players suffered the most upper limb injuries and goalkeepers experienced the longest time to return to play.

Growth, maturation and injuries in high-level youth football (soccer): A mini review

Understanding the challenges football (soccer) players face during adolescence is fundamental to avoid disruptions in their development due to injury. This mini review will describe basic concepts of somatic growth and biological maturity, examine data from 53 prospective epidemiological studies on high-level youth football players and discuss how age, growth and maturity may affect the injury patterns observed. Based on the existing evidence, at least every third player sustains an injury during a football season. The thigh (median for studies of boys: 25%, median for girls: 21%), ankle (b: 18%, g: 30%), knee (b: 17%, g: 18%) and hip/groin (b: 14%, g: 10%) are the body parts injured most often, while muscle strains (b: 31%, g: 25%), sprains (b: 20%, g: 27%) and contusions (b: 17%, g: 16%) are the most common injury types. Injury trends are, however, not consistent throughout adolescence, and players' age, maturity status and position relative to peak height velocity (PHV) have shown to influence the number, type and location of injuries sustained. Despite a high volume of observational injury studies published on high-level youth players, girls (7 studies) and settings outside of Europe (included in 23% of studies) are underrepresented and should receive extra attention in the future. Based on the available epidemiological data, tailored injury reduction programmes can be considered in youth football, alongside application of general training principles such as progression, variation and individualization which may be especially important during vulnerable phases such as the adolescent growth spurt.

Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis

BACKGROUND

To conduct a systematic review and meta-analysis of epidemiological data of injuries in male and female youth football players.

METHODS

Searches were performed in MEDLINE/PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases. Studies were considered if they reported injury incidence rate in male and female youth (≤19 years old) football players. Two reviewers (FJRP and ALV) extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation approach determined the quality of evidence. Studies were combined using a Poisson random effects regression model.

RESULTS

Forty-three studies were included. The overall incidence rate was 5.70 injuries/1000 h in males and 6.77 injuries/1000 h in females. Match injury incidence (14.43 injuries/1000 h in males and 14.97 injuries/1000 h in females) was significantly higher than training injury incidence (2.77 injuries/1000 h in males and 2.62 injuries/1000 h in females). The lower extremity had the highest incidence rate in both sexes. The most common type of injury was muscle/tendon for males and joint/ligament for females. Minimal injuries were the most common in both sexes. The incidence rate of injuries increased with advances in chronological age in males. Elite male players presented higher match injury incidence than sub-elite players. In females, there was a paucity of data for comparison across age groups and levels of play.

CONCLUSION

The high injury incidence rates and sex differences identified for the most common location and type of injury reinforce the need for implementing different targeted injury-risk mitigation strategies in male and female youth football players.

COVID-19 disease in professional football players: symptoms and impact on pulmonary function and metabolic power during matches

This study aimed at: (1) Reporting COVID-19 symptoms and duration in professional football players; (2) comparing players' pulmonary function before and after COVID-19; (3) comparing players' metabolic power (P_met ) before and after COVID-19. Thirteen male players (Age: 23.9 ± 4.0 years, V̇O_2peak : 49.7 ± 4.0 mL/kg/min) underwent a medical screening and performed a running incremental step test and a spirometry test after COVID-19. Spirometric data were compared with the ones collected at the beginning of the same season. Players' mean P_met of the 10 matches played before COVID-19 was compared with mean P_met of the 10 matches played after COVID-19. Players completed a questionnaire on COVID-19 symptoms and duration 6 months following the disease. COVID-19 positivity lasted on average 15 ± 5 days. "General fatigue" and "muscle fatigue" symptoms were reported by all players during COVID-19 and persisted for 77% (general fatigue) and 54% (muscle fatigue) of the players for 37 ± 28 and 38 ± 29 days after the disease, respectively. No significant changes in spirometric measurements were found after COVID-19, even though some impairments at the individual level were observed. Conversely, a linear mixed-effects model analysis showed a significant reduction of P_met (-4.1 ± 3.5%) following COVID-19 (t = -2.686, p < 0.05). "General fatigue" and "muscle fatigue" symptoms may persist for several weeks following COVID-19 in professional football players and should be considered for a safer return to sport. Players' capacity to compete at high intensities might be compromised after COVID-19.

Sports Injury Surveillance Systems and Guidelines in Japan: A Systematic Review

This systematic review aimed to identify sports injury surveillance systems (ISSs) and injury surveillance guidelines (ISGs) developed and currently used in Japan. Additionally, the extent to which ISSs and ISGs developed overseas are employed in Japan was also examined. A systematic search of electronic databases was performed in March 2021. Prospective studies that investigated sports injuries and targeted Japanese athletes or sports in Japan were included to identify the following: (1) details of the ISSs or ISGs developed among sports in Japan, and (2) characteristics of studies focusing on sports in Japan employing ISSs or ISGs developed overseas and the method of use. A total of five ISSs developed among sports in Japan were included, most of which were based on insurance benefits or condolence payment systems. In total, 23 studies used ISSs or ISGs developed overseas, more than half of which were used as a resource for the development of other data collection tools or methods, indicating that the definition of injury and/or classification of items are modified based on the needs among sports in Japan. This review highlights the necessity of establishing club-based or organisational ISSs and ISGs that are appropriate for sports in Japan.

Neighborhood risk factors for sports and recreational injuries: a systematic review of studies applying multilevel modeling techniques

Background

Sports and recreational activities are the most commonly reported cause of injury-related emergency department (ED) visits among children and young adults in developed countries, yet studies about the effect of neighborhood environment on sports and recreational injuries (SRI) are very limited. The aim of this study was to systematically review studies that apply multilevel modeling approach in examining the relationships between SRI and neighborhood-level risk factors.

Data sources

A systematic search of peer reviewed English language articles was conducted in four electronic databases including PubMed (1992–2020), CINAHL (2000–2020), Sports Medicine and Education Index (1996–2020), and Web of Science (1991–2020).

Study selection

Selected studies were observational or experimental studies of people of all ages across the world that assessed neighborhood risk factors for SRI (or all injuries including SRI) using multilevel regression analysis.

Data synthesis

Nine studies—five cross-sectional, two prospective cohort, and two incidence studies—were selected out of a potential 1510. Six studies used secondary data and three used primary data. Only three studies examined SRI as the main or one of the main outcomes. These studies showed that neighborhood-level factors, such as higher socioeconomic context, lower street connectivity, and living or attending schools in urban communities, were associated with increased risk of SRI. Most studies did not provide a justification for the use of multilevel regression and the multilevel analytical procedure employed and quantities reported varied. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (National Institutes of Health) was used to assess the quality or risk of bias of each study. Four quality assessment criteria out of 15 were met by all nine studies. The quality assessment ratings of the reviewed studies were not correlated with the quality of information reported for the multilevel models.

Conclusion

Findings from this review provide evidence that neighborhood-level factors, in addition to individual-level factors, should be taken into consideration when developing public health policies for injury prevention. Considering the limited numbers of studies that were identified by this systematic review, more multilevel studies are needed to strengthen this evidence in order to better inform SRI prevention policy decisions.

Functional and Anthropometrical Screening Test among High Performance Female Football Players: A Descriptive Study with Injury Incidence Analysis, the Basque Female Football Cohort (BFFC) Study

The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women's football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1-5; 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.

Football-related injuries are the major reason for the career end of professional male football players

PURPOSE

Little is known about the consequences of injuries on professional male football players' career and retirement period. The aim of this study is to investigate the impact of injuries that male professional football players endure during their career, reasons for the end of their career and the post-career phase of retirement.

METHODS

In a retrospective cross-sectional cohort study, retired male professional football players of the German Bundesliga were investigated by a standardised questionnaire to analyse the history of injuries sustained during their professional football career, the reasons for ending their career, their current health status and their suggestions for future prevention strategies.

RESULTS

Most of the 116 analysed players (n = 73 (62.9%)) stated an injury as the reason for ending their professional career. Relevant injuries were mainly located in the lower extremities (n = 587 (61.3%)) with a focus on the knee (p < 0.001) and ankle (p < 0.001). A significant majority of the participants who had retired due to injury described degenerative symptoms, such as pain or instability, and were diagnosed with osteoarthritis after retirement (p < 0.001). These players had also often been affected by symptoms of depression during their career, which had decreased significantly after retirement. Moreover, players who had not retired due to injury had significantly better overall health status and quality of life after retirement.

CONCLUSION

Football-related injuries have a significant impact on the career end of professional male football players and their health status after retirement. Future prevention strategies need to particularly address injuries to the knees and ankles and to implement measures for preventing osteoarthritis after retirement.

LEVEL OF EVIDENCE

Level III.