Self-reported psychological characteristics as risk factors for injuries in female youth football

Health status of university football athletes through multidimensional screening

OBJECTIVE

Adequate conditioning results from various physical, environmental, and psychological factors in sports activities. In this study, we aimed to clarify the concurrence and relevance of injuries, psychological problems, and sleep disturbance in university football (soccer) players. Biomechanical characteristics and risk factors for those injuries were also investigated.

METHODS

Overall, 1,084 university football players participated in this cross-sectional study using a web-based health history questionnaire. Assessments were made via the presence of injuries for physical problems, the Athlete Psychological Strain Questionnaire (APSQ) for psychological problems, and the Athlete Sleep Screening Questionnaire (ASSQ) for sleep difficulties.

RESULTS

There were 200 (19%) athletes with injuries; 413 (38%) of these were APSQ-positive, 246 (23%) were ASSQ-positive, and 468 (43%) athletes had no physical, psychological, or sleep problems. APSQ-positive respondents were significantly more likely to have a current injury than those who were APSQ-negative. No significant difference was observed between the number of ASSQ-positive and -negative respondents and current injuries. Those with sleep problems were significantly more likely to have psychological problems.

CONCLUSION

More than 60% of university football players had one or more physical, psychological, or sleep problems. Players may have co-occurring problems, and it is important to address them for these athletes to reach peak performance.

Identification of potential risk factors for lower limb injuries in female team-sport athletes: a prospective cohort study

OBJECTIVES

The purpose of this prospective cohort study was to assess the associations between lower limb injuries in female team-sport athletes and a number of factors. The potential risk factors explored included (1) lower limb strength, (2) history of life-event stress, (3) family history of ACL injuries, (4) menstrual history, and (5) history of oral contraception use.

METHODS

One hundred and thirty-five female athletes aged between 14 and 31 years (mean: 18.8 ± 3.6 years) from rugby union (n = 47), soccer (n = 72), and netball (n = 16) volunteered to participate in this study. Demographics, history of life-event stress, injury history and baseline data were obtained prior to the competitive season. The following strength measures were collected: isometric hip adductor and abductor strength, eccentric knee flexor strength and single leg jumping kinetics. Athletes were then followed for 12 months, and all lower limb injuries sustained were recorded.

RESULTS

One hundred and nine athletes provided one-year follow-up injury data, of whom, 44 suffered at least one lower limb injury. All athletes who reported high scores for negative life-event stress sustained lower limb injuries. Non-contact lower limb injury was positively associated with weak hip adductor strength (OR: 0.88; 95%CI: 0.78-0.98; p = 0.017), and between-limb adductor (OR: 5.65; 95%CI: 1.61-19.7.; p = 0.007) and abductor (OR: 1.95; 95%CI: 1.03-3.71; p = 0.039) strength asymmetries.

CONCLUSION

History of life event stress, hip adductor strength, and between-limb adductor and abductor strength asymmetries offer potential novel avenues for investigating injury risk factors in female athletes.

Analysis of football research trends using text network analysis

This study was aimed to identify football research trends in various periods. A total of 30,946 football papers were collected from a representative academic database and search engine, the 'Web of Science'. Keyword refinement included filtering nouns, establishing synonyms and thesaurus, and excluding conjunctions, and the Cyram's Netminer 4.0 software was used for network analysis. A centrality analysis was conducted by extracting the words corresponding to the top 2% of the main research topics to obtain the degree and eigenvector centralities. The most frequently mentioned research keywords were injury, performance, and club. Keyword performance showed the highest degree centrality (0.294) and keyword world and cup showed the highest eigenvector centrality (0.710). The keyword with the highest eigenvector degree changed from injury in the 1990s and world in the 2000s to cup since the 2010s. Although various studies on football injuries have been conducted, research on the sport itself has recently been conducted. This study provides fundamental information on football trends from research published over the past 30 years.

A Systematic Review with a Meta-Analysis of the Motivational Climate and Hedonic Well-Being Constructs: The Importance of the Athlete Level

Motivational climate is known to relate to individual behaviors, emotions, and thoughts. Hedonic or subjective well-being includes self-assessed positive affect (i.e., pleasant affect, moods, and emotions), negative affect (i.e., unpleasant affect, moods, and emotions), and life or domain-specific satisfaction. The aim of this review was to quantify the relationships between task and ego motivational climate scales and measures representing hedonic well-being with sports participants. Potential moderators of the motivational climate and hedonic well-being were examined. This review followed the PRISMA guidelines (PROSPERO ID CRD42023470462, registered 28 October 2023). From five relevant databases, one relevant review, and hand searching, 82 articles totaling 26,378 participants (46.3% female) met the inclusion criteria. The articles spanned publication dates from 1993 to 2023, representing 18 countries, various team and individual sports, and athletes competing in elite (e.g., Olympic) to grassroot (e.g., club sport) competitions. To meta-analyze the motivational climate and hedonic well-being relationships, the random-effects model was used. For the moderation analyses, the mixed-effects model was used. The task or mastery climate relationships were medium in magnitude with positive affect and satisfaction and small with negative affect. The ego or performance climate relationships were small in magnitude for positive affect, negative affect, and satisfaction. Evidence of bias existed in the motivational climate and hedonic well-being relationships. For moderation analyses, athlete level (i.e., elite vs. non-elite) moderated (p < 0.05) the task (elite, r = 0.23; non-elite, r = 0.34) and ego motivational climate (elite, r = -0.02; non-elite, r = -0.13) and positive affect and satisfaction combined relationships. In conclusion, the motivational climate and hedonic well-being relationships were stronger for the task climate than for the ego climate. The finding that elite athlete correlations appeared dampened is important for future research. Even with the damped relationships, practitioners, from the Olympics to local clubs, should ensure the promotion of the task climate to maximize positive affect and satisfactions in and around the sport experience.

How Mental Health Affects Injury Risk and Outcomes in Athletes

CONTEXT

The importance of mental health among athletes is becoming more recognized and valued. Athletes experience symptoms of depression, anxiety, and related mental health disorders at rates similar to those of the general population, but because athletes face unique cultural and environmental pressures, such disorders are exacerbated in the context of an injury. Furthermore, we review the less well-known evidence that mental health disorders in athletes are associated with an increased risk of injury. We discuss the increasing awareness of the deficiencies in mental health support for athletes, which has been especially highlighted during the COVID-19 pandemic as well as in prominent professional and Olympic athletes, and describe both internal and external barriers to appropriate care.

EVIDENCE ACQUISITION

We searched PubMed for pertinent peer-reviewed studies.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

There is a known psychological response to injury that can prolong recovery from musculoskeletal injury; conversely, mental health disorders in athletes are not only associated with an increased injury risk but also portend poorer outcomes subsequently, including prolonged recovery times, increased rates of injury recurrence, decreased rates of return to sport, and reduced performance upon return. Because of inherent barriers to appropriate care of athletes, including identification, stigma, and resource availability, there are currently various ongoing efforts nationally to create and implement initiatives regarding athlete mental health screening, support systems, and directed interventions to address the inextricably linked physical and mental health of athletes.

CONCLUSION

Athletic injury negatively impacts the mental health of athletes. Likewise, mental health can and does influence athletic performance and is also intimately tied to the risk of athletic injury, thus creating a complex cycle with inability to separate physical and mental health.

Preoperative psychological competitive ability has little relationship with subjective knee function and return to sports at 6 months postoperatively in patients with anterior cruciate ligament reconstruction

Objective

This prospective study aimed to investigate the relationship between preoperative psychological competitive ability and preoperative and 6 months postoperative subjective knee function in patients undergoing anterior cruciate ligament (ACL) reconstruction.

Methods

Eighty-four patients who underwent ACL reconstruction and had a Tegner Activity Scale score of 6 or more were included in this study. Preoperatively, all patients were administered the Diagnostic Inventory of Psychological Competitive Ability for Athletes (DIPCA.3) for psychological competitive ability assessment and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form for subjective knee function assessment. The IKDC subjective score was re-evaluated 6 months postoperatively. We evaluated the associations of volition for competition, mental stability and concentration, confidence, strategic ability, and cooperation (DIPCA.3 factors) with the IKDC subjective score preoperatively and 6 months postoperatively. Furthermore, patients were classified into two groups according to whether they could return to participate in the entire practice and compared the DIPCA.3 total score and IKDC subjective score.

Results

The DIPCA.3 confidence score negatively correlated with the preoperative IKDC subjective score (β = -0.34, p = 0.04). However, there was no association between the DIPCA.3 score for all variables and IKDC subjective score at 6 months after ACL reconstruction. Moreover, the DIPCA.3 total score was not related to return to participate in the entire practice 6 months after ACL reconstruction.

Conclusion

Psychological competitive ability is not associated with a return to participate in the entire practice, and a low preoperative IKDC subjective score should not be viewed too negatively.

Not All Injuries Are the Same: Different Patterns in Sports Injuries and Their Psychosocial Correlates

Sports injuries are ubiquitous and can have far-reaching consequences for athletes (e.g., health, performance). Previous studies have examined various psychosocial influencing factors (e.g., stress), but have mostly focused on only one or two injury characteristics (e.g., frequency), neglecting the broader injury pattern. Thus, the present study aimed to obtain a more differentiated picture of potentially different injury patterns and related profiles of psychosocial factors. We investigated a sample of 213 athletes from a cross-sectional online study. Current injury status, frequency, severity, chronicity, medical treatment, and rehabilitation measures were subjected to cluster analysis indicating a 3-cluster solution with predominantly chronically injured athletes (n = 54), athletes not seeking treatment (n = 62), and athletes utilizing medical treatment and rehabilitation (n = 97). Building on the Model of Stress and Athletic Injury, we subsequently conducted three multivariate analyses of variance (MANOVAs) to examine whether the obtained clusters differed in terms of personality factors (e.g., athletic identity), history of stressors (e.g., life events), and coping resources (e.g., self-compassion). We observed significant differences in all three categories of psychosocial variables implying different intervention possibilities for different injury patterns in the future.

Lifestyle characteristics in adolescent female football players: data from the Karolinska football Injury Cohort

BACKGROUND

Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year.

METHODS

We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years).

RESULTS

12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up.

CONCLUSION

Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.

Study protocol for a prospective cohort study identifying risk factors for sport injury in adolescent female football players: the Karolinska football Injury Cohort (KIC)

INTRODUCTION

Football is a popular sport among young females worldwide, but studies concerning injuries in female players are scarce compared with male players. The aim of this study is to identify risk factors for injury in adolescent female football players.

METHODS AND ANALYSIS

The Karolinska football Injury Cohort (KIC) is an ongoing longitudinal study that will include approximately 400 female football academy players 12-19 years old in Sweden. A detailed questionnaire regarding demographics, health status, lifestyle, stress, socioeconomic factors, psychosocial factors and various football-related factors are completed at baseline and after 1 year. Clinical tests measuring strength, mobility, neuromuscular control of the lower extremity, trunk and neck are carried out at baseline. Players are followed prospectively with weekly emails regarding exposure to football and other physical activity, health issues (such as stress, recovery, etc), pain, performance and injuries via the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O). Players who report a substantial injury in the OSTRC-O, that is, not being able to participate in football activities, or have reduced their training volume performance to a moderate or major degree, are contacted for full injury documentation. In addition to player data, academy coaches also complete a baseline questionnaire regarding coach experience and education.

ETHICS AND DISSEMINATION

The study was approved by the Regional Ethical Review Authority at Karolinska Institutet, Stockholm, Sweden (2016/1251-31/4). All participating players and their legal guardians give their written informed consent. The study will be reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology. The results will be published in peer-reviewed academic journals and disseminated to the Swedish football movement through stakeholders and media.

The Role of the Results of Functional Tests and Psychological Factors on Prediction of Injuries in Adolescent Female Football Players

Football is a popular sport among adolescent females. Given the rate of injuries in female footballers, identifying factors that can predict injuries are important. These injuries are often caused by complex reasons. The aim of this study was to investigate if the combination of demographic (age, number of training and match play hours/week), psychosocial (perceived stress, adaptive coping strategies) and physiological factors (functional performance) can predict a traumatic injury in adolescent female footballers. A cohort consisting of 419 female football players aged 13-16 years was established. Baseline questionnaires covered potential risk factors for sport injuries, and measurements included football-related functional performance tests. Data were collected prospectively with a weekly online questionnaire for 52 weeks covering, e.g., injuries, training, and match play hours/week. A total of 62% of the players reported at least one traumatic injury during the 52 weeks. The coping strategy "positive reframing" had the strongest association with the risk of traumatic injuries. The combination of more frequent use of the coping strategy, positive reframing, and high levels of physical performance capacity may prevent a traumatic injury in adolescent female footballers. Coaches are encouraged to adopt both physiological and psychological factors when preventing injuries in young female footballers.

Youth sport injury research: a narrative review and the potential of interdisciplinarity

To prevent sports injuries, researchers have aimed to understand injury aetiology from both the natural and social sciences and through applying different methodologies. This research has produced strong disciplinary knowledge and a number of injury prevention programmes. Yet, the injury rate continues to be high, especially in youth sport and youth football. A key reason for the continued high injury rate is the development of injury prevention programmes based on monodisciplinary knowledge that does not account for the complex nature of sport injury aetiology. The purpose of this paper is to consider and outline an interdisciplinary research process to research the complex nature of sport injury aetiology. To support our proposition, we first present a narrative review of existing youth football and youth sport injury research demonstrating an absence of paradigmatic integration across the research areas’ main disciplines of biomedicine, psychology and sociology. We then demonstrate how interdisciplinary research can address the complexity of youth sport injury aetiology. Finally, we introduce the interdisciplinary process we have recently followed in a youth football injury research project. While further research is necessary, particularly regarding the integration of qualitative and quantitative sport injury data, we propose that the pragmatic interdisciplinary research process can be useful for researchers who aim to work across disciplines and paradigms and aim to employ methodological pluralism in their research.

Adolescent physical activity-related injuries in school physical education and leisure-time sports

Objective

The aims of this study were to investigate the prevalence of sports injuries in school physical education (PE) and leisure-time sports among 1011 15- to 16-year-old adolescents in relation to physical activity, and to examine goal orientation.

Methods

A survey was used with additional narrative descriptions.

Results

There was a higher prevalence of injuries in leisure time (645/993 = 65%) than in PE (519/998 = 52%). Two groups with high PE injury rates were identified: a) highly active (258/998 = 26%) in both school PE and leisure-time sports and b) highly inactive (180/998 = 18%) in both contexts. There were no differences between girls and boys. Task-oriented adolescents were more prone to injury.

Conclusions

The high prevalence of injuries in PE appears to have two mechanisms: renewed inadequately recovered leisure-time injuries among highly active adolescents, and injuries among fragile inactive adolescents unfamiliar with exercise. PE educators of these two groups with different injury patterns have a considerable didactic challenge. Knowledge of inadequately recovered injuries and consideration of the high volume and intensity of early sport-specific training in children and adolescents are important parameters in the design of lesson plans for PE.

The Relationship Between Personality Traits and Muscle Injuries in Swedish Elite Male Football Players

CONTEXT

The physical and mental demands of an elite football player are complex, which may explain why injuries are common in football. At elite level, muscle injuries of the lower-extremity are the most common among male football players, and the research hitherto is limited.

OBJECTIVE

To investigate whether personality traits affect the incidence of muscle injuries among male football players from the first league in Sweden.

DESIGN

Prospective cohort study.

PARTICIPANTS

A male football team from the first league in Sweden was prospectively followed, in terms of muscle injuries of the lower-extremity during 8 seasons, between 2007 and 2015.

INTERVENTION

All muscle injuries included in this study were evaluated and diagnosed with ultrasonography. Players from the team filled out the Swedish Universities Scales of Personality questionnaire. Swedish Universities Scales of Personality questionnaire consists of 91 items and is divided into 13 categories.

MAIN OUTCOME MEASURES

The raw values of each scale were linearly transformed to T scores, having a mean (SD) of 50 (10). All variables were summarized with standard descriptive statistics, such as frequency, mean, and SD. As data were of interval scale and no variable distribution was severely skewed, differences between noninjured players, rarely injured players, and frequently injured players were analyzed with 1-way analysis of variance with post hoc tests by Tukey honestly significant difference test.

RESULTS

No significant difference in personality traits were observed between noninjured players, rarely injured players, and frequently injured players regarding number of muscle injuries (P > .05). However, a trend (P = .07) was seen, where frequently injured players scored higher on stress susceptibility than rarely injured players.

CONCLUSION

A player's stress susceptibility should be taken into consideration by the player, coaches, and medical staff when assessing the risk of a muscle injury. Also, preventive measures available for these players may need to be considered.

Relationship between pulmonary function, throw distance, and psychological competitive ability of elite highly trained Japanese boccia players via correlation analysis

Background

Boccia players have severe quadriplegia; nonetheless, detailed aspects of the physical function of individual players have not been evaluated.

Aims

This study aimed to detetmine the relationship between pulmonary function, pitching distance, and psychological competitive ability of Japanese boccia players.

Methods

Participants were athletes from the Japan Boccia Association (10 males, 3 females; average age, 32.9 ± 12.0 years) who could independently perform pitching motions. We measured pulmonary function, respiratory muscle force, and diaphragm movement using ultrasonography, pitching distance, and psychological competitive ability.

Outcomes and results

In all participants, pulmonary function, respiratory muscle force, and diaphragm displacement were low, whereas respiratory function was very low compared to the normal range (i.e., the value calculated from the subjects’ height, weight, and age). However, boccia players with high level of competitive ability performed well.

Conclusions and implications

The results raise the question as to whether focusing on the development of boccia players’ competitive ability and physical function will improve their overall performance. This question warrants future investigation.

Soccer Injuries in Children and Adolescents

Participation in youth soccer in the United States continues to increase steadily, with a greater percentage of preadolescent participants than perhaps any other youth sport. Despite the wide-ranging health benefits of participation in organized sports, injuries occur and represent a threat to the health and performance of young athletes. Youth soccer has a greater reported injury rate than many other contact sports, and recent studies suggest that injury rates are increasing. Large increases in the incidence of concussions in youth soccer have been reported, and anterior cruciate ligament injuries remain a significant problem in this sport, particularly among female athletes. Considerable new research has identified a number of modifiable risk factors for lower-extremity injuries and concussion, and several prevention programs have been identified to reduce the risk of injury. Rule enforcement and fair play also serve an important role in reducing the risk of injury among youth soccer participants. This report provides an updated review of the relevant literature as well as recommendations to promote the safe participation of children and adolescents in soccer.

Unique Predictors of Sleep Quality in Junior Athletes: The Protective Function of Mental Resilience, and the Detrimental Impact of Sex, Worry and Perceived Stress

Since athletic development and functioning are heavily dependent on sufficient recuperation, sleep in athletes is becoming a topic of increasing interest. Still, existing scientific evidence points to inadequate sleep in athletes, especially in females. This may be due to the fact that sleep is vulnerable to disturbances caused by stress and cognitive and emotional reactions to stress, such as worry and negative affect, which may exacerbate and prolong the stress response. Such disturbing factors are frequently experienced by junior athletes aiming for performance development and rise in the rankings, but may be damaging to athletic progression. Based on limited research in non-athletic samples, mental resilience may protect individuals against the detrimental effects of stress on sleep. Therefore, the present study aimed to investigate the extent to which sex, mental resilience, emotional (negative affect) and cognitive (worry) reactions to stress, and perceived stress, uniquely contributed to sleep quality in a cross-sectional study including 632 junior athletes. A multiple hierarchical linear regression showed that females had poorer sleep quality than males, while the mental resilience sub-components Social Resources and Structured Style were positively associated with sleep quality, providing a protective function and thus preventing sleep quality from deteriorating. Simultaneously, worry, as well as perceived stress, were negatively associated with sleep quality. Together, the independent variables explained 28% of the variance in sleep quality. A dominance analysis showed that perceived stress had the largest relative relationship with sleep quality. Based on these results, close attention should be paid to athletes' abilities to manage worry and perceived stress, and the potential of mental resilience as a protective factor that could prevent sleep from deteriorating. The latter might be especially relevant for female athletes. Since performance margins are progressively becoming smaller and smaller, every improvement that adequate sleep can provide will be beneficial in terms of improved functioning and athletic performance.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Effects of a multifactorial injuries prevention program in young Spanish football players

BACKGROUND

The high injury rate in football has highlighted the need to research strategies that allow the modification of the dynamic risk factors. Most of the preventive proposals have focused on standardized protocols. However, the aim of this study was to evaluate the effect of a multifactorial injuries prevention program (MC-7) in Spanish football players.

METHODS

A total of 219 Spanish football male players aged 16-23 were enrolled. The study was conducted over two consecutive seasons (2012-2013, 2013-2014). The first season was the control season (SC) and the second one was the experimental season (ES). Injuries were recorded prospectively during the two seasons in accordance with the criteria established by the consensus statement. During CS the injuries were just observed, while during ES, the players participated in the MC-7: training methodology, specific warm-up protocol (FIFA 11+), basic injury recovery strategies, continuous training of coaches, conferences for parents/family and education sessions for players.

RESULTS

The frequency of injuries was significantly reduced by 63.8% in the ES. Muscle-tendon and joint injuries were reduced by 65% and 56.7% respectively, with a significant decrease in the lower-limbs injuries. The incidence of injuries was reduced by 71.4%, with significant differences in the typology, location and severity of injuries.

CONCLUSIONS

The rate of injury in football is reduced when multifactorial strategies are applied. Reducing the frequency and severity of injuries allowed players to greatly increase their available for sports practice.

Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention

BACKGROUND

Several studies have suggested that psychosocial variables can increase the risk of becoming injured during sport participation.

OBJECTIVES

The main objectives of these meta-analyses were to examine (i) the effect sizes of relationships between the psychosocial variables (suggested as injury predictors in the model of stress and athletic injury) and injury rates, and (ii) the effects of psychological interventions aimed at reducing injury occurrence (prevention).

METHODS

Electronic databases as well as specific sport and exercise psychology journals were searched. The literature review resulted in 48 published studies containing 161 effect sizes for injury prediction and seven effect sizes for injury prevention.

RESULTS

The results showed that stress responses (r = 0.27, 80 % CI [0.20, 0.33]) and history of stressors (r = 0.13, 80 % CI [0.11, 0.15]) had the strongest associations with injury rates. Also, the results from the path analysis showed that the stress response mediated the relationship between history of stressors and injury rates. For injury prevention studies, all studies included (N = 7) showed decreased injury rates in the treatment groups compared to control groups.

CONCLUSION

The results support the model's suggestion that psychosocial variables, as well as psychologically, based interventions, can influence injury risk among athletes.

The relationship of gross upper and lower limb motor competence to measures of health and fitness in adolescents aged 13-14 years

Introduction

Motor competence (MC) is an important factor in the development of health and fitness in adolescence.

Aims

This cross-sectional study aims to explore the distribution of MC across school students aged 13–14 years old and the extent of the relationship of MC to measures of health and fitness across genders.

Methods

A total of 718 participants were tested from three different schools in the UK, 311 girls and 407 boys (aged 13–14 years), pairwise deletion for correlation variables reduced this to 555 (245 girls, 310 boys). Assessments consisted of body mass index, aerobic capacity, anaerobic power, and upper limb and lower limb MC. The distribution of MC and the strength of the relationships between MC and health/fitness measures were explored.

Results

Girls performed lower for MC and health/fitness measures compared with boys. Both measures of MC showed a normal distribution and a significant linear relationship of MC to all health and fitness measures for boys, girls and combined genders. A stronger relationship was reported for upper limb MC and aerobic capacity when compared with lower limb MC and aerobic capacity in boys (t=−2.21, degrees of freedom=307, P=0.03, 95% CI −0.253 to –0.011).

Conclusion

Normally distributed measures of upper and lower limb MC are linearly related to health and fitness measures in adolescents in a UK sample.

Trial registration number

NCT02517333.

Psychosocial stress factors, including the relationship with the coach, and their influence on acute and overuse injury risk in elite female football players

Background

The relationship between specific types of stressors (eg, teammates, coach) and acute versus overuse injuries is not well understood.

Objective

To examine the roles of different types of stressors as well as the effect of motivational climate on the occurrence of acute and overuse injuries.

Methods

Players in the Norwegian elite female football league (n=193 players from 12 teams) participated in baseline screening tests prior to the 2009 competitive football season. As part of the screening, we included the Life Event Survey for Collegiate Athletes and the Perceived Motivational Climate in Sport Questionnaire (Norwegian short version). Acute and overuse time-loss injuries and exposure to training and matches were recorded prospectively in the football season using weekly text messaging. Data were analysed with Bayesian logistic regression analyses.

Results

Using Bayesian logistic regression analyses, we showed that perceived negative life event stress from teammates was associated with an increased risk of acute injuries (OR=1.23, 95% credibility interval (1.01 to 1.48)). There was a credible positive association between perceived negative life event stress from the coach and the risk of overuse injuries (OR=1.21, 95% credibility interval (1.01 to 1.45)).

Conclusions

Players who report teammates as a source of stress have a greater risk of sustaining an acute injury, while players reporting the coach as a source of stress are at greater risk of sustaining an overuse injury. Motivational climate did not relate to increased injury occurrence.

Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness

OBJECTIVE

To systematically review studies examining the role of psychological interventions in injury prevention. The primary research question was: What is the real-world effectiveness of psychological intervention in preventing sports injuries?

DESIGN

Mixed methods systematic review with best evidence synthesis.

DATA SOURCES

CINAHL, MEDLINE, PsycARTICLES, PsycINFO, SPORTDiscus, Science Direct and PubMed.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCT), non-RCTs that included a comparison group, before and after study designs and qualitative methods. Studies were required to outline specific unimodal or multimodal psychological interventions used in relation to injury prevention in the real-world setting.

OUTCOME MEASURE

Studies were independently appraised with the Mixed Methods Appraisal Tool.

RESULTS

Thirteen papers (incorporating 14 studies) met the eligibility criteria, of which 93% (13/14) reported a decrease in injury rates (effect size range=0.2-1.21). There was an overall moderate risk of bias in reporting (52%). There is a dominance of stress management-based interventions in literature due to the prominence of the model of stress and athletic injury within the area.

SUMMARY/CONCLUSIONS

Psychological interventions demonstrate small (0.2) to large (1.21) effects on sports injury rates. The research area demonstrates a cumulative moderate risk in reporting bias (52%).

PROSPERO REGISTRATION NUMBER

CRD42016035879.

Is there a correlation between coaches' leadership styles and injuries in elite football teams? A study of 36 elite teams in 17 countries

Background

Do coaches’ leadership styles affect injury rates and the availability of players in professional football? Certain types of leadership behaviour may cause stress and have a negative impact on players’ health and well-being.

Aim

To investigate the transformational leadership styles of head coaches in elite men’s football and to evaluate the correlation between leadership styles, injury rates and players’ availability.

Methods

Medical staff from 36 elite football clubs in 17 European countries produced 77 reports at four postseason meetings with a view to assessing their perception of the type of leadership exhibited by the head coaches of their respective teams using the Global Transformational Leadership scale. At the same time, they also recorded details of individual players’ exposure to football and time-loss injuries.

Results

There was a negative correlation between the overall level of transformational leadership and the incidence of severe injuries (rho=−0.248; n=77; p=0.030); high levels of transformational leadership were associated with smaller numbers of severe injuries. Global Transformational Leadership only explained 6% of variation in the incidence of severe injuries (r²=0.062). The incidence of severe injuries was lower at clubs where coaches communicated a clear and positive vision, supported staff members and gave players encouragement and recognition. Players’ attendance rates at training were higher in teams where coaches gave encouragement and recognition to staff members, encouraged innovative thinking, fostered trust and cooperation and acted as role models.

Conclusions

There is an association between injury rates and players’ availability and the leadership style of the head coach.

Hip Strength as an Intrinsic Risk Factor for Lateral Ankle Sprains in Youth Soccer Players: A 3-Season Prospective Study

BACKGROUND

Numerous epidemiological studies have emphasized the burden of lateral ankle sprains in youth soccer players. However, no prospective study has identified intrinsic physical and modifiable risk factors for these injuries in this particular population. Although injury prevention programs in soccer incorporate proximal hip and core stability exercises, it is striking that the relationship between impaired proximal hip function and ankle sprains has not yet been prospectively investigated in youth soccer players.

HYPOTHESIS

This prospective study aimed to examine whether hip muscle strength is a risk factor for sustaining a lateral ankle sprain in youth soccer players. We hypothesized that decreased hip muscle strength would predispose youth soccer players to an increased risk of lateral ankle sprains.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This study included a total of 133 male youth soccer players (age divisions U11-U17) for analysis. At the beginning of the season, anthropometric characteristics were collected and hip muscle strength was assessed using a handheld dynamometer. Injury registration was performed by the team medical staff during 3 consecutive seasons. A principal-component, multivariate Cox regression analysis was performed to identify potential risk factors for sustaining a lateral ankle sprain.

RESULTS

Twelve participants (18% of all reported injuries) sustained a lateral ankle sprain (0.36 per 1000 athletic-exposure hours). After adjustment for body size dependencies and other hip muscle forces, an increase in hip muscle extension force was associated with a significant decrease in the hazard of the injury (hazard ratio, 0.3; 95% confidence interval, 0.1-0.9; P = .028). No other study variable could be identified as a risk factor for lateral ankle sprains.

CONCLUSION

Reduced hip extension muscle strength is an independent risk factor for lateral ankle sprains in male youth soccer players. Other hip muscle strength outcomes were not identified as risk factors. Replication in larger samples with more injured cases is warranted to further ascertain the importance of this risk factor.

The elite young athlete: strategies to ensure physical and emotional health

This article presents a current review of the risk of physical and psychological injury associated with participation in elite youth sport, and suggests strategies to ensure the physical and emotional health of these young athletes. Although there is lack of epidemiological data, especially with regard to psychological injury, preliminary data suggest that the risk of injury is high in this population. While there is lack of incident and follow-up data, there is also concern regarding burnout, disordered eating, and the long-term consequences of injury. Modifiable injury risk factors identified include postural control, competition anxiety, life events, previous injury, and volume of training. There are presently no studies designed to determine the effectiveness of injury prevention measures in elite youth sports. However, there is adequate evidence arising from injury prevention studies of youth sports participants - including neuromuscular training, protective equipment, mental training to enhance self-esteem, and sport rules modification - to prevent injuries in elite youth sports settings. Although not tested, psychosocial prevention strategies such as adoption of task-oriented coping mechanisms, autonomous support from parents, and a proactive organizational approach also show promise in injury prevention.

How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

Psychological traits regarding competitiveness are related to the incidence of anterior cruciate ligament injury in high school female athletes

BACKGROUND

The purpose of this study was to investigate the relationship between psychological competitive ability and the incidence of noncontact ACL injuries among high school female athletes.

METHODS

A three-year prospective cohort study was conducted using 300 15-year-old high school female athletes with no previous injuries or symptoms in their lower limbs (106 handball players and 194 basketball players). At baseline, their psychological competitive abilities were assessed using a self-administered questionnaire-the Diagnostic Inventory of Psychological Competitive Ability (DIPCA.3). After the baseline examination was performed at high school entry, all players were prospectively followed for 36months to document any subsequent incidence of ACL injury, according to their coaches. An unpaired t-test with Welch's correction was performed to compare the differences in the psychological competitive abilities between the injured and uninjured players.

RESULTS

Of the 300 players, 25 (8.3%) experienced a noncontact ACL injury during the three-year observation period. The injured players had significantly higher total DIPCA.3 scores for psychological competitive ability than the uninjured players (169.9±18.8 vs. 159.2±21.6, P=.036). Additionally, the injured players had significantly higher scores than the uninjured players in the following categories: aggressiveness, volition for self-realization, volition for winning, judgment, and cooperation. However, no significant differences were observed in patience, self-control, ability to relax, concentration, confidence, decision, and predictive ability.

CONCLUSIONS

High psychological competitive ability was associated with the incidence of noncontact ACL injuries in high school female athletes.

LEVEL OF EVIDENCE

Level II (prospective cohort study).

Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football

Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P < 0.001]. Risk of time-loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self-reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time-loss knee injury in adolescent female football.

A multistate framework for the analysis of subsequent injury in sport (M-FASIS)

Physical activity is beneficial for many aspects of health but is associated with a risk of injury. Studies that assess causal risk factors of injury and reinjury provide valuable information to help develop and improve injury prevention programs. However, the underlying assumptions of analytical approaches often used to estimate causal factors in injury and subsequent injury research are often violated. This means that ineffective or even harmful interventions could be proposed because the underlying analyses produced unreliable or invalid causal effect estimates. We describe an adapted version of the multistate framework [multistate framework for the analysis of subsequent injury in sport (M-FASIS)] that makes investigator choices more transparent with respect to outcome and healing time. In addition, M-FASIS incorporates all previous sport injury analytical frameworks and accounts for injuries or conditions that heal or do not heal to 100%, acute and overuse injuries, illnesses, and competing event outcomes.

The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist.

OBJECTIVE

Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity.

METHODS

We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields.

RESULTS

One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain.

CONCLUSIONS

Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement

This consensus statement summarizes key contemporary research themes relevant to understanding the psychology and socioculture of sport injury. Special consideration is given toward high-intensity sport in which elite athlete training and performance efforts are characterized by explosive physical speed and strength, mental fortitude to push physical limits, and maximum effort and commitment to highly challenging goals associated with achieving exceptional performance. Sport injury occurrence in high-intensity sport is an adverse and stressful health event associated with a complex multitude of risks, consequences and outcomes. A biopsychosocial (Engel, 1980) view is advocated which contextualizes an understanding of the psychological aspects of sport injury in light of influential sociocultural, ethical, and biomedical issues. Outcomes related to athlete health and performance excellence are of equal importance in considering how psychological scholarship, expertise and services can be used to improve efforts focused on the prevention and management of sport injury among high-intensity athletes. The consensus view is that psychology and socioculture do affect sport injury risk, response and recovery in high-intensity athletes, and that continued efforts in psychological research and professional practice are needed to protect athlete physical and mental health and contribute toward performance excellence and career longevity.