Injuries in female football players in top-level international tournaments

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

OBJECTIVES

To determine the incidence and characteristics of injury and illness in English men's and women's senior and youth international football.

METHODS

Time-loss injuries and illnesses, alongside match and training exposure, were collected across 8 seasons (2012-2020) in youth (U15, U16, U17, U18, U19) and senior (U20, U21, U23, senior) English men's and women's international teams. Analysis of incidence, burden, and severity of injury and illness was completed. Sex-specific comparisons were made between the senior and youth groups, and across the 8 seasons of data collection.

RESULTS

In men's international football, 535 injuries were recorded (216 senior; 319 youth) during 73,326 h of exposure. Overall, match injury incidence (31.1 ± 10.8 injuries/1000 h) and burden (454.0 ± 195.9 d absent/1000 h) were greater than training injury incidence (4.0 ± 1.0 injuries/1000 h) and burden (51.0 ± 21.8 d absent/1000 h) (both P < 0.001). In women's international football, 503 injuries were recorded (senior: 177; youth: 326) during 80,766 h of exposure and match injury incidence (27.6 ± 11.3 injuries/1000 h) and burden (506.7 ± 350.2 days absent/1000 h) were greater than training injury incidence (5.1 ± 1.8 injuries/1000 h) and burden (87.6 ± 32.8 days absent/1000 h) (both P < 0.001). In women's international football, a group × season interaction was observed for training injury incidence (P = 0.021), with the senior group recording a greater training injury incidence during the 2015-2016 season compared to the youth group (14.4 vs 5.7 injuries/1000 h; P = 0.022). There was no difference in injury severity between match and training for men's (P = 0.965) and women's (P = 0.064) international football.

CONCLUSIONS

The findings provide a comprehensive examination of injury and illness in English men's and women's senior and youth international football. Practitioners will be able to benchmark their team's injury and illness incidence and characteristics to the match-play and training information provided in the present study.

Injury, illness, and medication use surveillance during the 2020 COSAFA Women's championship: a prospective cohort study of football players from Southern Africa

BACKGROUND

Systematic analyses of injuries, illnesses or medication use and their risk factors among female African athletes are scarce, which has implications for management of these athletes.

AIM

This prospective cohort study analysed the incidence and characteristics of injuries, illnesses and medication use during the 2020 COSAFA Women's Championship.

METHODS

The medical personnel of all participating teams reported all new injuries, illnesses and medication used by players daily.

RESULTS

Sixty-three injuries were reported: 45 match and 18 training injuries; 45.5 (95% CI: 32.2 to 58.8) injuries/1000 match-hours and 21.7 (95% CI: 11.7 to 31.7) injuries/1000 training-hours, respectively. Most (n = 55, 87%) were caused by contact with another player and involved the lower extremity (n = 43; 68%). Fifty-eight illnesses were reported: 44.4 (95% CI: 33.0 to 58.8) illnesses/1000 player-days, mostly diarrhoea (n = 25; 43.1%) and dysmenorrhoea (n = 18; 31%). No cases of COVID-19 were reported. In total, 175 medications were prescribed: 168.8 (95% CI: 143.8 to 193.8) medications/1000 player-days. Non-steroidal anti-inflammatory drugs (NSAIDs) (n = 60; 34.3%) and analgesics (n = 33; 18.9%) were the most commonly prescribed drugs.

CONCLUSION

Incidences of injury and illnesses were high but time loss was low, likely due to high NSAIDs use. Further studies should be conducted in order to inform appropriate prevention or management protocols in this population.

Effects of a Football Simulated Exercise on Injury Risk Factors for Anterior Cruciate Ligament (ACL) Injury in Amateur Female Players

Females are more at risk of Anterior Cruciate Ligament (ACL) injuries than males; however, there is limited literature on neuromuscular risk factors such as angle-specific hamstring/quadriceps functional strength ratios (H_ecc/Q_con) and rate of torque development (RTD) in female footballers. The aim of this study was to investigate the effects of fatigue on these neuromuscular risk factors. Thirty-three amateur players (20.3 ± 2.0 years old, 1.67 ± 9.31 m, 63.4 ±8.1 kg, 23.6 ± 5.7% body fat) performed strength assessments of the quadriceps (concentrically, Q_con) and hamstrings (eccentrically, H_ecc) on both legs on an isokinetic dynamometer, before and immediately after a football-specific exercise. Results showed significantly lower peak H_ecc (-15.1 to -15.5%), peak H_ecc/Q_con (-8.8 to -12.9%) and RTD (-14.0 to -17.0%) for hamstring eccentric contractions after fatigue in the dominant and non-dominant legs. Furthermore, significant decreases in H_ecc/Q_con were observed at 10° only in the dominant leg (-15.5%), and at 10°, 20° and 30° in the non-dominant leg (-15.1 to -21.8%). These results suggest a reduced capacity of the hamstrings to stabilise the knee joint with fatigue. Unlike results previously shown on men, the non-dominant leg seemed more affected, highlighting the need to consider specific prevention measures in females.

The prevalence and effect of the sites of pain in female soccer players with medial shin pain

BACKGROUND

Female soccer players are often diagnosed with medial shin pain, which includes tibial stress fracture, medial tibial stress syndrome, and chronic exertional compartment syndrome. As the possibility of varied sites of pain affecting sports activities has not been fully researched, an urgent discussion and evidence is required. This study investigates the prevalence and effect of sites of pain on the sports activities of female soccer players with medial shin pain.

METHODS

A questionnaire survey was conducted for 196 female soccer players with medial shin pain to assess symptom duration, the effect of practice and performance, and sites of pain. The players were classified into three conditions (tibial stress fracture, medial tibial stress syndrome, or medial shin pain with neurological symptoms) and compared based on sites of pain.

RESULTS

We observed that medial tibial stress syndrome had a lower impact on performance compared to that of tibial stress fracture and medial shin pain with neurological symptoms. While participants with tibial stress fracture had to suspend practice sessions more frequently, the difference in symptom duration between the classified groups was not statistically significant. The effect of sites of pain on sports activities was not significantly different in participants with medial tibial stress syndrome.

CONCLUSIONS

Medial shin pain should be evaluated carefully to differentiate between medial tibial stress syndrome and medial shin pain with neurological symptoms. Restriction of sports activities may help improve the patient's condition early, regardless of the presentation.

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

OBJECTIVE

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

DESIGN

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

DATA SOURCES

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

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

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

RESULTS

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

CRD42020162895.

Understanding the Relationship between Sport Courage and Female Soccer Performance Variables

The purpose of this study was to examine the relationships between female soccer players’ courage and key performance variables (level of participation, injury past, being selected or non-selected by a national team, being starter or substitute). Methods: The Sport Courage Scale-31, by Konter and Ng (2012) and key performance variables were collected from 210 female soccer players aged 12 to 27 (M = 17.97 ± 3.34 years old). Spearman correlations and Mann−Whitney U tests were used to analyse the collected data. Results: The correlations between mastery (r = 0.196), determination (p = 0.239), assertiveness (r = 0.325), sacrifice behaviour (r = 0.182), total sport courage (r = 0.265) and age of female soccer players were found to be significant (p < 0.05). Female soccer players who have sustained an injury in the past scored significantly higher on the venturesome scale (p = 0.006) than those who have not sustained an injury in the past. In comparison, female soccer players who have not sustained an injury in the past or who have not been substituted had significantly more mastery than female soccer players who have sustained an injury in the past or who have been substituted (p = 0.017, p = 0.002, respectively). Conclusions: This study indicates that sport courage is related to key performance variables among female soccer players. Mastery and age seem to be related to courageous behaviour, whereas increasing venturesomeness might cause injuries in female soccer. Some relevant implications for practitioners can be drawn from the present findings.

Epidemiology of injuries in elite male and female futsal: a systematic review and meta-analysis

The main purpose of this study was to conduct a systematic review and meta-analysis quantifying the incidence of injuries in futsal players. A systematic search was conducted using MEDLINE, PubMed, Web of Science and Scopus databases and subsequently, six studies (14 cohorts) were selected. Separate meta-analyses for male and female players were conducted using a Poisson random-effect regression model approach. The overall and match incidence rates in elite male futsal players were 6.8 (95% CI = 0.0-15.2) and 44.9 (95% CI = 17.2-72.6) injuries/1000 hours of exposure. Pooled training injury rate in male players was not calculated due to the lack of studies reporting training injuries in this cohort. For females, an overall, training and match incidence rates of 5.3 (95% CI = 3.5-7), 5.1 (95% CI = 2.7-7.6) and 10.3 (95% CI = 0.6-20.1) injuries/1000 hours of exposure were reported. In males, match incidence rate in International tournaments was 8.5 times higher than in national leagues (77.2 [95% CI = 60.0-94.5] vs 9.1 [95% CI = 0.0-19.3] for international tournaments and national leagues, respectively). Elite male and female futsal players are exposed to a substantial risk of sustaining injuries, especially during matches.

Incidence of injury in adult elite women's football: a systematic review and meta-analysis

AIM

To estimate the incidence of injury in adult elite women's football and to characterise the nature and anatomical location of injuries.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Combinations of the key terms were entered into the following electronic databases (PubMed, SPORTDiscus, Science Direct and Discover) from inception to May 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

(1) Used a prospective cohort design; (2) captured data on elite adult women players; (3) reported injury incidence by anatomical site; (4) captured data of at least one season or national team tournament; (5) included a definition of injury; and (6) written in English.

RESULTS

The search identified 1378 records. Twelve studies published between 1991 and 2018 were included in our review and sampled 129 teams. In domestic club football, injury incidence rate was estimated to be 5.7/1000 hours (total), 19.5/1000 hours (match) and 3.1/1000 hours (training). In tournament, football match incidence was estimated to be 55.7/1000 hours. The knee (22.8%; 368/1822) was the most common site of injury in domestic club football. The ankle (23.7%, 105/443) was the most common site of injury in tournament football. Ligament sprains were the most common type of injury (27.8%), followed by muscle strains (19.1%). Severn studies (58%) had a high risk of bias associated with exposure definition and measurement and considerable heterogeneity exists between the included studies (I2=49.7%-95%).

SUMMARY/CONCLUSION

Ligament sprains occur more frequently in adult elite women football players. We advise caution in interpretating point estimates of the incidence of injury due to high statistical heterogeneity. Standardising injury reporting and the accurate recording of match and training exposure will overcome such limitations.

PROSPERO REGISTRATION NUMBER

CRD42019130407.su.

Injury prevention knowledge, beliefs and strategies in elite female footballers at the FIFA Women's World Cup France 2019

OBJECTIVES

This study assessed knowledge, beliefs and practices of elite female footballers regarding injury prevention.

METHODS

A survey was sent to players participating in the FIFA Women's World Cup France 2019. Questions covered three injury prevention domains: (1) knowledge; (2) attitudes and beliefs; (3) prevention practices in domestic clubs. Additionally, ACL injury history was assessed.

RESULTS

Out of 552 players, 196 women responded (35.5%). More than 80% of these considered injury risk to be moderate or high. Players listed knee, ankle, thigh, head and groin as the most important injuries in women's football. The most important risk factors identified were low muscle strength, followed by poor pitch quality, playing on artificial turf, too much training, reduced recovery and hard tackles. In these elite players, 15% did not have any permanent medical staff in their domestic clubs, yet more than 75% had received injury prevention advice and more than 80% performed injury prevention exercises in their clubs. Players identified the two most important implementation barriers as player motivation and coach attitude. Two-thirds of players used the FIFA 11+ programme in their clubs.

CONCLUSIONS

This diverse group of elite players demonstrated good knowledge of risk level and injury types in women's football. Of the risk factors emphasised by players, there was only one intrinsic risk factor (strength), but several factors out of their control (pitch quality and type, training volume and hard tackles). Still players had positive attitudes and beliefs regarding injury prevention exercises and indicated a high level of implementation, despite a lack of medical support.

Athlete health and safety at large sporting events: the development of consensus-driven guidelines

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

Does an Optimal Relationship Between Injury Risk and Workload Represented by the "Sweet Spot" Really Exist? An Example From Elite French Soccer Players and Pentathletes

Objective

To examine the relationships between the occurrence and severity of injuries using three workload ratios (ACWR, EWMA, REDI) in elite female soccer players and international male and female pentathletes.

Materials and Methods

Female soccer players in the U16 to U18 national French teams (n = 24) and international athletes (n = 12, 4 women and 8 men) in the French modern pentathlon team were monitored throughout an entire season. The Acute Chronic Workload Ratio (ACWR), the Exponentially Weighted Moving Averages (EWMA), and the Robust Exponential Decreasing Index (REDI) were calculated for internal load by the ROE method in soccer and external load in pentathlon. The occurrence and severity of injuries (determined according to time-loss) were quantified in the sweet spot zone [0.8; 1.3] and compared to the other zones of load variation: [0; 0.8], [1.3; 1.5], [1.5; +8], using the three ratios.

Results

Over the study period, a total of sixty-six injuries (2.75 per athlete) were reported in the soccer players and twelve in pentathletes (1 per athlete). The cumulative severity of all injuries was 788 days lost in soccer and 36 in pentathlon: respectively, 11.9 days lost per injury in soccer player and 3.0 per pentathlete. The mean values across the three methods in soccer showed a higher number of injuries detected in the [0; 0.8] workload ratio zone: 22.3 ± 6.4. They were 17.3 ± 3.5 in the sweet spot ([0.8-1.3] zone) and 17.6 ± 5.5 in the [1.5; +8] zone. In comparison to the [1.5; +8] zone, soccer players reported a higher number of days lost to injuries in the presumed sweet spot and in the [0-0.8] zone: 204.7 ± 28.7 and 275.0 ± 120.7 days, respectively. In pentathletes, ten of the twelve injuries (83.3%) occurred in the presumed sweet spot. REDI was the only method capable of tracking workloads over all-time series.

Conclusion

In the present cohort of elite soccer players and pentathletes, acute chronic workload calculations showed an association with injury occurrence and severity but did not provide evidence supporting existence of a sweet spot diminishing injury risk.

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes

OBJECTIVE

To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.

DESIGN

Longitudinal prospective surveillance study.

SETTING

Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.

PARTICIPANTS

Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.

INTERVENTIONS

Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.

MAIN OUTCOME MEASURES

The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.

RESULTS

Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.

CONCLUSIONS

The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

Sports injury and illness incidence in the PyeongChang 2018 Olympic Winter Games: a prospective study of 2914 athletes from 92 countries

Objective

To describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.

Methods

We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.

Results

In total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1 day and >7 days of absence from sport, respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.

Conclusion

Overall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.

UEFA model in identification of types, severity and mechanism of injuries among footballers in the Nigerian Women's Premier League

Objective

To prospectively investigate the injury profile and the incidence rate per 1000 hours exposure during training and actual league matches in the Nigerian Women’s Premier League (NWPL) and to develop an adequate information pool, using the UEFA injury study model in order to develop appropriate injury prevention strategies.

Methods

241 women footballers from the eight football clubs that participated in the 2015/2016 Nigerian Women Premier league (NWPL) season were selected for the study and prospectively followed for a period of 6 months. The UEFA injury report forms and Competitive Aggressiveness and Anger Scale were sent to the various clubs, and the forms administered on them as at when due. The forms were analysed using descriptive statistics.

Results

There was a high incidence rate per 1000 hours of exposure during training sessions (10.98 injuries/1000 hours) and matches (55.56 injuries/1000 hours); the predominant injury type was muscle rupture/strain injuries (35.49%), while moderate severity injuries were the most frequent. The predominant injury mechanism was traumatic injuries caused by contact with other players as a result of a tackle by other players (14.5%). No statistical association was established between the level of aggression and the prevalent types of injury (p=0.63).

Conclusions

The organisers of the league and indeed the referees should ensure that the rules of the game are upheld, and foul or overly aggressive play is penalised. Medical staff and coaches should consider evidence-based injury prevention strategies to reduce the risk of the common injuries sustained in the NWPL.

Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York

There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.

Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review

BACKGROUND

Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries.

OBJECTIVE

The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football.

METHODS

Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary.

RESULTS

The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men's football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players.

CONCLUSION

Future research should focus on concussion in women's contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided.

The FIFA 11+ injury prevention program for soccer players: a systematic review

Background

Soccer is one of the most widely played sports in the world. However, soccer players have an increased risk of lower limb injury. These injuries may be caused by both modifiable and non-modifiable factors, justifying the adoption of an injury prevention program such as the Fédération Internationale de Football Association (FIFA) 11+. The purpose of this study was to evaluate the efficacy of the FIFA 11+ injury prevention program for soccer players.

Methodology

This meta-analysis was based on the PRISMA 2015 protocol. A search using the keywords “FIFA,” “injury prevention,” and “football” found 183 articles in the PubMed, MEDLINE, LILACS, SciELO, and ScienceDirect databases. Of these, 6 studies were selected, all of which were randomized clinical trials.

Results

The sample consisted of 6,344 players, comprising 3,307 (52%) in the intervention group and 3,037 (48%) in the control group. The FIFA 11+ program reduced injuries in soccer players by 30%, with an estimated relative risk of 0.70 (95% confidence interval, 0.52–0.93, p = 0.01). In the intervention group, 779 (24%) players had injuries, while in the control group, 1,219 (40%) players had injuries. However, this pattern was not homogeneous throughout the studies because of clinical and methodological differences in the samples. This study showed no publication bias.

Conclusion

The FIFA 11+ warm-up program reduced the risk of injury in soccer players by 30%.

Injuries in male and female semi-professional football (soccer) players in Nigeria: prospective study of a National Tournament

Background

Research on the epidemiology of football injuries in Africa is very sparse despite its importance for injury prevention planning in a continent with limited sports medicine resources. The vast majority of studies available in literature were conducted in Europe and only a very few studies have prospectively reported the pattern of football injury in Africa. The purpose of this study was to evaluate the incidence and pattern of injuries in a cohort of male and female semi-professional football players in Nigeria.

Methods

A prospective cohort design was conducted, in which a total of 756 players with an age range of 18–32 years (356 males and 300 females) from 22 different teams (12 male and 10 female teams), were prospectively followed in a National Football Tournament. Physiotherapists recorded team exposure and injuries. Injuries were documented using the consensus protocol for data collection in studies relating to football injury surveillance.

Results

An overall incidence of 113.4 injuries/1000 h (95% CI 93.7–136.0) equivalent to 3.7 injuries/match and time-loss incidence of 15.6 injuries/1000 h were recorded for male players and 65.9 injuries/1000 h (95% CI 48.9–86.8) equivalent to 2.2 injuries/match and time-loss incidence of 7.9 injuries/1000 h were recorded for female players. Male players had a significantly higher risk of injuries [IRR = 1.72 (95% CI 1.23–2.45)]. Injuries mostly affected the lower extremity for both genders (n = 81, 70% and n = 31, 62% for males and females respectively). Lower leg contusion (n = 22, 19%) and knee sprain (n = 9, 18%) were the most common specific injury types for male and female players respectively. Most of the injuries were as a result of contact with another player (n = 102, 88%—males; n = 48, 96%—females). Time-loss injuries were mostly estimated as minimal (n = 11, 69%) for male players and severe (n = 4, 66%) for female players.

Conclusion

The overall incidence of injuries among Nigerian semi-professional football players is high but most of the injuries do not result in time-loss. Pattern of injuries is mostly consistent with previous studies. More prospective studies are needed to establish injury prevention initiatives among African players.

Injury and illness epidemiology in soccer - effects of global geographical differences - a call for standardized and consistent research studies

Soccer is the most popular sport in the world. While injuries and illnesses can affect the players’ health and performance, they can also have a major economic impact on teams. Moreover, several studies have shown the favourable association between higher player availability and team success. Therefore, injury prevention could directly impact clubs’ financial balance and teams’ performance via increased player availability. To be able to develop effective methods of injury prevention, it is vital to first determine the scope and the degree of the problem: the mechanisms and types of injuries, their frequency and severity, etc. According to the most widely known prevention model, systematic injury surveillance is the first and most fundamental step towards injury prevention. Since epidemiological studies have shown that injuries and illnesses in soccer players differ from region to region, it is important to establish a specific injuries and illness database in order to guide specific preventive actions. Since Asia is the largest continent, with the highest number of soccer players, and in the light of the long-term research on injuries performed in UEFA clubs, the authors of the present article present the AFC surveillance. Some methodological issues related to this prospective design study are discussed. The definition of injury and illness and the methods to track players’ exposure are described along with the potential challenges related to such a vast scale study. This article is also a call for action to have consistent and standardized epidemiological studies on soccer injuries and illnesses, with the aim to improve their prevention.

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.

The incidence of injury in a Caribbean amateur women's football league

This prospective study looked at the incidence of injury (IN) sustained by players during a season in an amateur women's football league in Trinidad and Tobago where games were played on grass (GR) and on a new generation artificial turf (AT). The overall incidence of time loss injuries was 27.6/1000 player hours (95% CI: 17.0, 38.2). Most injuries were mild and players returned to play within one week of sustaining an injury. Players who trained predominately on, and played their home games on AT (PAT) sustained significantly fewer injuries when playing games on GR than those sustained while playing on AT (p=0.006). There were no differences in injury rates between games played on AT versus games played on GR (p=0.68). Most injuries were of a non-contact nature and so an injury prevention program should be implemented to reduce the injury rate in this amateur league.

The relationships between the center of mass position and the trunk, hip, and knee kinematics in the sagittal plane: a pilot study on field-based video analysis for female soccer players

Athletes with non-contact anterior cruciate ligament tears have common features in the sagittal plane; namely, the body’s center of mass (COM) is located posterior to the base of support, the trunk and knee joints are extended, and the hip angle is flexed. However, the relationships among these variables have not been assessed in field-based movements. This study sought to determine relationships between distances from the COM to the base of support and the trunk, hip, and knee positions in women while playing soccer. Sixty events (29 single-leg landing and 31 single-leg stopping events) were analyzed using two-dimensional video analysis. The relationships among the measurement variables were determined using the Pearson’s product-moment correlation coefficient, and stepwise multiple linear regression models were used to explore the relationships between the COM position and the kinematic variables. The distance from the COM to the base of support displayed a moderate negative relationship with the trunk angle (r = −0.623, p < .0001, r² = 0.388) and a strong positive relationship with the limb angle (r = 0.869, p < .0001, r² = 0.755). The limb, knee, and trunk angles were selected in the best regression model (adjusted r² = 0.953, p < .0001, f² = 20.277). These findings suggest that an increased trunk angle and a decreased limb angle at initial contact are associated with a safer COM position. Neuromuscular training may be useful for controlling the trunk and lower limb positions during dynamic activities.

Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games

BACKGROUND

Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport.

AIM

To analyse the injuries and illnesses that occurred during the XXII Olympic Winter Games, held in Sochi in 2014.

METHODS

We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Sochi 2014 medical staff.

RESULTS

NOC and Sochi 2014 medical staff reported 391 injuries and 249 illnesses among 2780 athletes from 88 NOCs, equalling incidences of 14 injuries and 8.9 illnesses per 100 athletes over an 18-day period of time. Altogether, 12% and 8% of the athletes incurred at least one injury or illness, respectively. The percentage of athletes injured was highest in aerial skiing, snowboard slopestyle, snowboard cross, slopestyle skiing, halfpipe skiing, moguls skiing, alpine skiing, and snowboard halfpipe. Thirty-nine per cent of the injuries were expected to prevent the athlete from participating in competition or training. Women suffered 50% more illnesses than men. The rate of illness was highest in skeleton, short track, curling, cross-country skiing, figure skating, bobsleigh and aerial skiing. A total of 159 illnesses (64%) affected the respiratory system, and the most common cause of illness was infection (n=145, 58%).

CONCLUSIONS

Overall, 12% of the athletes incurred at least one injury during the games, and 8% an illness, which is similar to prior Olympic Games. The incidence of injuries and illnesses varied substantially between sports.

Injuries in iran futsal national teams: a comparative study of incidence and characteristics

Background:

Futsal is a growing sport with lots of fans in many countries including Iran, but there are few papers in the literature which report injuries in top level futsal.

Objectives:

The aim of this study is to record and analyze the incidence and characteristics of injuries in Iran futsal national teams from March 2011 to September 2012.

Patients and Methods:

55 Iranian national futsal players participated in this prospective cohort study. Before entering the study, all players took part in Pre-Competition Medical Assessment (PCMA) in accordance with FIFA protocol. Team physicians recorded the injuries throughout the match and trainings in a special form which was designed for this purpose. Finally, data analysis was done with the SPSS software.

Results:

The total exposure time for all players was 24326 hours (21138 hours during training and 3188 hours during matches). During the study period, 32 of the 55 national players (58.2%) incurred 54 injuries (incidence rate = 2.22 injuries per 1000 players-hours). The incidence rate of injury in female players was significantly higher than male players (P = 0.001). The majority of injuries (85.2%) were located on the lower extremities. The ankle was the most frequent injury location (40.7%) and sprain was the most frequent type of injury.

Conclusions:

Injuries are common among futsal players and female players are more prone to injuries than male players. The ankle is the most frequent site and sprain is the most frequent type of injury among futsal players.

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.

Incidence and risk factors of lower leg fractures in Belgian soccer players

INTRODUCTION

Soccer is the world's most popular sport and one that is physically demanding and highly competitive. Consequently, the rate of injuries resulting from this sport is only increasing. It is estimated that 2-20% of all such injuries are fractures, one-third of which are located in the lower extremities. The aim of this epidemiological study was to investigate the incidence of lower-leg fractures (LLFs) in Belgian soccer players and determine the possible risk factors that lead to them.

METHODS

All injuries of players associated with the Royal Belgium Football Association (RBFA) were reported and collected in a nationwide registry. We retrospectively compared the incidence rate of and risk factors for LLFs in Belgian soccer players during two seasons, 1999-2000 and 2009-2010.

RESULTS

In total, 1600 fractures (3%) were located in the lower leg. After a decade, the number of LLFs remained unchanged. Ankle fractures were the most common (37%), followed by foot and tibia fractures (33% and 22%, respectively). The least common were fibula fractures, which accounted for just 9%. A higher incidence of every type of LLF was observed in older and amateur-level soccer players, when compared with their younger and professional counterparts. Male players experienced more tibia and foot fractures, whereas the incidences of ankle and fibula fractures were comparable with those in female soccer players. The vast majority of fractures occurred during soccer games.

CONCLUSION

Ankle fractures and foot fractures represented two-thirds of all fractures noted in this analysis. Male gender, recreational level and adult age were important risk factors for LLFs. After 10 years, the incidence of LLFs did not decrease. Given the socioeconomic impact of these injuries, improved prevention techniques are required to reduce their incidence, particularly with regard to the frequently occurring ankle and foot fractures in this population.

Injury surveillance during a 2-day national female youth football tournament in Kenya

OBJECTIVE

To analyse the incidence, characteristics and circumstances of injuries during a female youth amateur football tournament in Kenya.

DESIGN

14 injury recorders prospectively registered and classified all injuries during all matches. Four physiotherapists and two doctors supported the injury recorders.

SETTING

A 2-day Mathare Youth Sports Association (MYSA) inter-provincial football tournament for female players in Nairobi, Kenya. The tournament is organised by a non-governmental organisation (NGO).

PARTICIPANTS

938 females divided into three age groups (under 13 years (U13), under 16 years (U16) and over 16 years (O16)).

MAIN OUTCOME MEASUREMENTS

Overall injury incidence.

RESULTS

123 injuries occurred in 106 matches. The incidence of all injuries was 93.3 injuries/1000 h. Players in the U13 (relative risk (RR)=2.16, 95% CI 1.3 to 3.5; p=0.002) and U16 (RR=2.17, 95% CI 1.3 to 3.5; p=0.002) age groups had an increased risk of injury compared to the O16 group. Most injuries allowed the players to continue to play (n=98 of 121; 81%). For 15 (12%) of the injuries the player did not continue to play but was expected to fully participate in the following match, and eight of the injuries (6.1 injuries/1000 h) were expected to result in the player's absence from play for 1-7 days. The injuries most commonly affected the lower limb (n=100; 82%); contusions to the ankle (n=15; 12%) and foot/toe (n=15; 12%) were the most common specific injury types. Most acute injuries (89 of 113, 79%) were caused by player contact.

CONCLUSIONS

The incidence of injuries among female youth football players in a national tournament in Kenya was high, but time-loss injuries were rare. Playing football in a tournament organised by an NGO at the inter-provincial level was safe.

Cardiovascular health profile of elite female football players compared to untrained controls before and after short-term football training

This study examined the intermittent exercise performance and cardiovascular health profile in elite female football players in comparison to untrained young women, as well as a subgroup subjected to football training 2x1 h · week(-1) for 16 weeks. Twenty-seven Danish national team players (elite trained, ET) and 28 untrained women (UT) underwent dual-energy X-ray absorptiometry-scanning (DXA), comprehensive transthoracic echocardiography, treadmill and Yo-Yo Intermittent Endurance level 2 (IE2) testing. Eight women in UT were also tested after the football training period. Maximal oxygen uptake rate (VO2max), peak ventilation and peak lactate were 40, 18 and 51% higher (P< 0.01) in ET than UT, respectively. Cardiac dimensions and function were greater in ET than UT, with left ventricular diastolic diameter, right ventricular diastolic diameter, tricuspid annular plane systolic excursion (TAPSE) and peak transmitral flow in early diastole divided by peak transmitral flow velocity in late diastole during atrial contraction (E/A-ratio) being 13, 19, 27 and 41%, respectively, greater in ET than UT (P< 0.001 to< 0.05). Yo-Yo IE2 performance was 7-fold higher in ET than UT (1772 ± 508 vs. 234 ± 66 m, P< 0.001), fat mass was 51% lower (P< 0.001) and high density lipoprotein (HDL) cholesterol levels were 20% higher (P< 0.01). Sixteen weeks of football elevated VO2max and Yo-Yo IE2 performance by 16 and 40%, respectively, and lowered fat mass by 6%. Cardiac function was markedly improved by 16 weeks of football training with 26 and 46% increases in TAPSE and E/A ratio, respectively, reaching levels comparable to ET. In summary, elite female football players have a superior cardiovascular health profile and intermittent exercise performance compared to untrained controls, but short-term football training can markedly improve the cardiovascular health status.

Differences in soccer players' dynamic balance across levels of competition

CONTEXT

Balance ability has been associated with performance and injury prevention in athletes. Few published reports have investigated the differences in dynamic balance abilities among male high school, collegiate, and professional soccer players.

OBJECTIVE

To examine the differences on the Lower Quarter Y-Balance Test in male high school, collegiate, and professional soccer players.

DESIGN

Descriptive laboratory study.

SETTING

Field testing. Patients or Other Participants: Dynamic balance data were collected for male high school (HS; n = 38), collegiate (n = 37), and professional (n = 44) soccer players during preparticipation physical examinations using the Lower Quarter Y Balance Test standardized protocol. Main Outcome Measure(s): For the Lower Quarter Y Balance Test, the participant reaches with 1 foot in the anterior, posteromedial, and posterolateral directions while standing on a centralized stance platform with the other foot. The test is performed for both left and right limbs. Differences in reach distances between competition levels were analyzed using a 1-way analysis of variance with significance set at P < .05. The HS group had a greater anterior reach distance than the other 2 groups. In contrast, the HS group had less reach distance in the posteromedial and posterolateral directions than the other groups. Also, HS players tended to exhibit a lower composite reach score than the other groups, but this difference was not significant (P = .08). No differences were observed among groups for bilateral symmetry in any of the reach directions.

CONCLUSIONS

Dynamic balance performance varied with competition level. This may indicate that athletes' movement strategies may be different depending on the competition level and that normative values may need to be established for each competition level.

Psychosensorial assessment of skin damage caused by a sliding on artificial turf: the development and validation of a skin damage area and severity index

OBJECTIVES

Injury prevention is an important reason for the development of performance standards in football. Currently, there is no objective method available to classify sliding induced skin injuries, which includes the perceived sliding friendliness of football pitches. The purpose of this study was to develop a non-invasive method for quantification of the observed sliding induced skin damage and evaluate whether there is a correlation between the subjective perceived skin irritation and sliding friendliness.

STUDY DESIGN

Randomized controlled trial.

METHODS

Previously obtained clinical images of sliding induced skin lesions where rated by a dermatologist on the degree of abrasion, erythema and type of exudation. To test the practical feasibility of a proposed Skin Damage and Severity Index (SDASI) to characterize sliding induced skin lesions, a randomized user trial with nine amateur football players was performed. The sliding friendliness of three different grades of infill materials was tested.

RESULTS

The Skin Damage and Severity Index correlates both with the perceived skin irritation (r=-0.53, P=0.02) and sliding friendliness (r=-0.58, P=0.01). Statistical analysis of the individual clinical scores showed that perception of skin irritation and sliding friendliness correlate very well with the degree of erythema and abrasion. However, these scores are independent of the size of the lesion and type of exudation. There was no statistical significant difference found between the three evaluated types of infill and their sliding performance.

CONCLUSIONS

This study demonstrated that the Skin Damage and Severity Index, which is a tool for quantification of a sliding induced skin lesion, correlates very well with the perceived skin irritation and the sliding friendliness.

Injury surveillance in the World Football Tournaments 1998-2012

BACKGROUND

International sports bodies should protect the health of their athletes, and injury surveillance is an important pre-requisite for injury prevention. The Fédération International de Football Association (FIFA) has systematically surveyed all football injuries in their tournaments since 1998.

AIMS

Analysis of the incidence, characteristics and changes of football injury during international top-level tournaments 1998-2012.

METHODS

All newly incurred football injuries during the FIFA tournaments and the Olympic Games were reported by the team physicians on a standardised injury report form after each match. The average response rate was 92%.

RESULTS

A total of 3944 injuries were reported from 1546 matches, equivalent to 2.6 injuries per match. The majority of injuries (80%) was caused by contact with another player, compared with 47% of contact injuries by foul play. The most frequently injured body parts were the ankle (19%), lower leg (16%) and head/neck (15%). Contusions (55%) were the most common type of injury, followed by sprains (17%) and strains (10%). On average, 1.1 injuries per match were expected to result in absence from a match or training. The incidence of time-loss injuries was highest in the FIFA World Cups and lowest in the FIFA U17 Women's World Cups. The injury rates in the various types of FIFA World Cups had different trends over the past 14 years.

CONCLUSIONS

Changes in the incidence of injuries in top-level tournaments might be influenced by the playing style, refereeing, extent and intensity of match play. Strict application of the Laws of the Games is an important means of injury prevention.

Functional ankle instability and health-related quality of life

CONTEXT

To our knowledge, no authors have assessed health-related quality of life (HR-QOL) in participants with functional ankle instability (FAI). Furthermore, the relationships between measures of ankle functional limitation and HR-QOL are unknown.

OBJECTIVE

To use the Short Form-36v2 Health Survey (SF-36) to compare HR-QOL in participants with or without FAI and to determine whether HR-QOL was related to functional limitation.

DESIGN

Cross-sectional study.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Sixty-eight participants with FAI (defined as at least 1 lateral ankle sprain and 1 episode of giveway per month) or without FAI were recruited (FAI group: n = 34, age = 25 ± 5 years, height = 1.71 ± 0.08 m, mass = 74.39 ± 12.78 kg, Cumberland Ankle Instability Tool score = 19.3 ± 4; uninjured [UI] group: n = 34, age = 23 ± 4 years, height = 1.69 ± 0.08 m, mass = 67.94 ± 11.27 kg, Cumberland Ankle Instability Tool score = 29.4 ± 1).

MAIN OUTCOME MEASURE(S)

All participants completed the SF-36 as a measure of HR-QOL and the Foot and Ankle Ability Measure (FAAM) and the FAAM Sport version (FAAMS) as assessments of functional limitation. To compare the FAI and UI groups, we calculated multiple analyses of variance followed by univariate tests. Additionally, we correlated the SF-36 summary component scale and domain scales with the FAAM and FAAMS scores.

RESULTS

Participants with FAI had lower scores on the SF-36 physical component summary (FAI = 54.4 ± 5.1, UI = 57.8 ± 3.7, P = .005), physical function domain scale (FAI = 54.5 ± 3.8, UI = 56.6 ± 1.2, P = .004), and bodily pain domain scale (FAI = 52.0 ± 6.7, UI = 58.5 ± 5.3, P < .005). Similarly, participants with FAI had lower scores on the FAAM (FAI = 93.7 ± 8.4, UI = 99.5 ± 1.4, P < .005) and FAAMS (FAI = 84.5 ± 8.4, UI = 99.8 ± 0.72, P < .005) than did the UI group. The FAAM score was correlated with the physical component summary scale (r = 0.42, P = .001) and the physical function domain scale (r = 0.61, P < .005). The FAAMS score was correlated with the physical function domain scale (r = 0.47, P < .005) and the vitality domain scale (r = 0.36, P = .002).

CONCLUSIONS

Compared with UI participants, those with FAI had less HR-QOL and more functional limitations. Furthermore, positive correlations were found between HR-QOL and functional limitation measures. This suggests that ankle impairment may reduce overall HR-QOL.

Prevalência de lesões em atletas do futsal feminino brasileiro: um estudo retrospectivo

INTRODUÇÃO: O futsal vem se destacando no cenário internacional como uma das modalidades em maior ascensão. Na literatura, são escassos os estudos que relatam as lesões no gênero feminino nesta modalidade. OBJETIVO: O objetivo deste estudo foi identificar a prevalência de lesões em atletas do futsal feminino brasileiro. MÉTODOS: A amostra correspondeu às atletas que participaram da Liga Nacional de Futsal 2011, totalizando 135 atletas. Investigou-se a prevalência de lesões apresentadas durante toda a temporada de 2010. RESULTADOS: Das 135 atletas, 73 (54,1%) apresentaram algum tipo de lesão, sendo identificados 104 traumas. As lesões nos membros inferiores corresponderam a 86,5% do total, com 28,9% (n = 30) no tornozelo, 24% (n = 25) na coxa e o joelho correspondeu a 23,1% (n = 24). Quanto à forma, 51,9% (n = 54) ocorreram sem contato e 46,1% (n = 48) por contato direto. Durante o treinamento técnico/tático ou treinamento físico ocorreram 59,6% das lesões (n = 62) e 40,4% (n = 42), durante os jogos. Das lesões, 58,6% ocorreram pela primeira vez e 40,4% são recidivas. Não foi encontrada associação entre acompanhamento fisioterapêutico em treinos e competições, com o número e a gravidade das lesões. Também não há relação com o membro dominante e o hemicorpo do trauma. CONCLUSÕES: As atletas do futsal feminino brasileiro apresentam grande prevalência de lesões, principalmente no tornozelo, coxa e joelho, sendo que a maioria delas ocorre nos treinamentos. Lesões que acontecem sem contato com outro adversário prevaleceram em relação aos traumas com contato, fato que se opõe aos demais achados da literatura. O número de primeiras lesões foi maior em relação às recidivas e, quanto à gravidade, prevaleceram as lesões moderadas. Para minimizar o número de lesões, são necessárias estratégias específicas de prevenção, enfatizando os segmentos do tornozelo, joelho e coxa.

Q-angle, Pelvic width, and Intercondylar notch width as predictors of knee injuries in women soccer players in South Africa

OBJECTIVE

To investigate the association between the three anatomical factors of Q-angle (QA), pelvic width (PW) and Intercondylar notch width (INW) and knee injuries among the U-23 female soccer players of South Africa

METHODS

The study is a case-control prospective study design. Twenty four U-23 women soccer players of the South African team were purposively chosen to participate in this study. Participants were divided into two groups: group 1 (Case) was those with knee injuries, while those without injuries were in group-2 (Control). PW and INW were measured after X-rays of the hip were taken while the QA was measured manually with the goniomenter. Association between anatomical factors and knee injuries were tested with ANOVA.

RESULTS

Q-angle ranged from 14° to 18° for both injured and non injured groups. PW was between 24 -29 cm for both injured and non injured groups. INW was between 1.3mm and 2.8mm for the right and between 1.4mm and 2.5mm for the left notch for the injured group, while INW for the right and left of the non injured group were between 1.7 mm to 2.1 mm and 1.8 mm to 2.1 mm, respectively No significant association between knee injuries and each of the anatomical factors was found QA (p= 0.74), PW (p=0.34), INW (right and left respectively) (p=0.142 & p=0.089).

CONCLUSION

The three anatomical factors of QA, PW and INW could not be used to predict knee injuries amongst the U-23 female players in South Africa.

Knee and ankle osteoarthritis in former elite soccer players: a systematic review of the recent literature

OBJECTIVES

To investigate the prevalence of knee and/or ankle osteoarthritis in former elite soccer player.

DESIGN

Systematic review.

METHODS

Medline, Embase and SPORTDiscus (2000 to January 2012) were used. To be included, studies were required to be a primary study, written in English, Dutch, French or German, former elite soccer players had to be the study population, and presenting knee or ankle OA had to be the outcome measure.

RESULTS

The search strategy resulted in four studies. Two studies, evaluated as having a high methodological quality, found a prevalence rate of knee OA between 60 and 80%. Both studies used radiographic examination as their measurement instrument to diagnose OA; the presence of ankle OA was not determined. The other two studies, evaluated as having a moderate methodological quality, found a prevalence rate of knee OA between 40 and 46% and a prevalence rate of ankle OA between 12 and 17%. These studies used a questionnaire as their measurement instrument wherein players were asked if they had ever been diagnosed with OA by a medical specialist.

CONCLUSIONS

The prevalence of knee and ankle OA in former elite soccer players can be considered high compared to the general population and to other occupations. To identify players at risk for OA, a health surveillance program should be implemented in elite soccer as a preventive measure. Further research should be conducted to determine if the risk of developing OA varies among different subgroups of elite soccer players and what the consequences of this high OA prevalence are.

A 15-year prospective epidemiological account of acute traumatic injuries during official professional soccer league matches in Japan

BACKGROUND

Few prospective epidemiological studies on soccer match injuries have collected continuous data using subjects from the same group.

PURPOSE

To investigate long-term injury-induced changes during official matches in the professional Japanese soccer league.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

Acute injuries during official matches among top-division Japanese professional soccer leaguers were prospectively collected from 1993 to 2007. Injuries preventing player participation for 7 days or more were defined as a reportable injury. Interseasonal variations of injury rate (IR: injuries/1000/player hours) and injury pattern (type, location, circumstances, severity, injury time, positional role, and relationship to weather) were analyzed.

RESULTS

Throughout the study period, 2947 injuries from 3984 matches occurred. Mean annual IR was 21.77/1000 player hours, and annual variance showed gradual decrement throughout the study period. The proportion of injury type and location were not significantly changed. Sprain and contusion as injury type and thigh and ankle joint as location were the most common in every season. Contact-related injuries comprised 73.3% on average and were observed to occur more frequently during the last 15 minutes and extra time of match play. The proportion of foul play-related injuries showed a clear declining trend. The proportion of severe injury showed a sporadic increase from 2001 to 2004. The second, fifth, and sixth 15-minute match segments showed a higher IR. Goalkeepers had a lower IR versus other field players. Matches on rainy days resulted in a lower IR than did those held under other weather conditions.

CONCLUSION

Long-term surveillance and statistical feedback of injury characteristics to organization members were considered effective in improving safer play awareness among players and for referees to reduce injury incidence, particularly foul play-related injuries.

Foot pressure and center of pressure in athletes with ankle instability during lateral shuffling and running gait

This study evaluates foot pressure and center of pressure (COP) patterns in individuals with ankle instability during running and lateral shuffling. Eleven participants with ankle instability (AI) and 11 normal subjects (Normal) performed running and lateral shuffling tasks. The outcome measures were foot progression angle, peak pressure, and displacement of COP during stance phase. During running, the foot progression angle, that is, the angle of foot abduction, was lower in the AI group (Normal: 13.46° ± 4.45°; AI: 8.78° ± 3.91°), and the 1st metatarsal contact pressure (Normal: 0.76 ± 0.47 N/cm(2)·kg; AI: 1.05 ± 0.70 N/cm(2)·kg) and the 3rd metatarsal peak pressure were higher in the AI (Normal: 0.96 ± 0.60 N/cm(2)·kg; AI: 1.54 ± 0.68 N/cm(2)·kg). The medial-lateral (M-L) COP in the late-stance phase of running for the AI group transferred faster from lateral to medial foot than the Normal group. For lateral shuffling, the AI group had greater peak pressure at the 1st (Normal: 0.76 ± 0.67 N/cm(2)·kg; AI: 1.49 ± 1.04 N/cm(2)·kg), 2nd (Normal: 0.57 ± 0.39 N/cm(2)·kg; AI: 0.87 ± 0.68 N/cm(2)·kg), 3rd (Normal: 0.70 ± 0.54 N/cm(2)·kg; AI: 1.42 ± 0.87 N/cm(2)·kg), and 4th (Normal: 0.52 ± 0.38 N/cm(2)·kg; AI: 1.12 ± 0.78 N/cm(2)·kg) metatarsal areas than the Normal group. The M-L COP located more laterally from the early to mid-stance phase in the AI compared with the Normal group. The findings suggest that COP displacement during lateral shuffle may be a factor in ankle instability while the foot progression angle during running may be a compensatory strategy.

Comparison of injuries sustained on artificial turf and grass by male and female elite football players

The objective of this study was to compare incidences and patterns of injury for female and male elite teams when playing football on artificial turf and grass. Twenty teams (15 male, 5 female) playing home matches on third-generation artificial turf were followed prospectively; their injury risk when playing on artificial turf pitches was compared with the risk when playing on grass. Individual exposure, injuries (time loss) and injury severity were recorded by the team medical staff. In total, 2105 injuries were recorded during 246,000 h of exposure to football. Seventy-one percent of the injuries were traumatic and 29% overuse injuries. There were no significant differences in the nature of overuse injuries recorded on artificial turf and grass for either men or women. The incidence (injuries/1000 player-hours) of acute (traumatic) injuries did not differ significantly between artificial turf and grass, for men (match 22.4 v 21.7; RR 1.0 (95% CI 0.9-1.2); training 3.5 v 3.5; RR 1.0 (0.8-1.2)) or women [match 14.9 v 12.5; RR 1.2 (0.8-1.8); training 2.9 v 2.8; RR 1.0 (0.6-1.7)]. During matches, men were less likely to sustain a quadriceps strain (P=0.031) and more likely to sustain an ankle sprain (P=0.040) on artificial turf.

Effective injury prevention in soccer

Sports participation is accompanied by risk of injury, and each specific sport has its own unique injury profile. One of the goals of a sports medicine professional is injury prevention, and the past decade has seen numerous reports on the outcomes of injury-prevention studies. Health care professionals have been particularly vigilant in attempting to reduce common injuries in soccer, beginning with work in the early 1980s to the rigorous randomized trials of today. The use of a structured, generalized warm-up program has been shown to be effective in preventing common soccer injuries, reducing overall injury rates by approximately 30%. Given the number of individuals who play soccer worldwide, any injury reductions will likely have an impact on public health. It is an important goal of the sports medicine community to inform physicians and other sports medicine professionals about the effectiveness of prevention programs to increase use and compliance.

Comparação da performance funcional do membro inferior entre jovens futebolistas e jovens não treinados

INTRODUÇÃO: Em atletas, a utilização de testes de performance funcional permite avaliar com maior validade ecológica possíveis alterações do membro inferior observadas na prática desportiva. OBJETIVO: O objetivo do presente estudo consistiu na comparação da performance funcional do membro inferior entre jovens futebolistas e jovens não treinados. METODOLOGIA: A amostra foi constituída por 39 jovens do sexo masculino, divididos em dois grupos: um grupo composto por 19 futebolistas (idade = 16,8 ± 0,83 anos; peso = 69,8 ± 6,2 kg; altura = 176,6 ± 0,5 cm) e outro composto por 20 sujeitos não treinados (idade = 16,6 ± 0,8 anos; peso = 66,3 ± 11,0 kg; altura = 172,0 ± 0,8 cm). Para avaliação da performance funcional do membro inferior foram utilizados três testes: o Single-Leg Hop Test, o Quadrant Jump Test e o Hexagon Test. RESULTADOS: Os jovens futebolistas obtiveram melhor performance do que os jovens não treinados em ambos os membros inferiores no Single-Leg Hop Test (membro inferior direito: 124 ± 62 cm, membro inferior esquerdo: 127 ± 68 cm versus membro inferior direito: 99 ± 10 cm, membro inferior esquerdo: 97 ± 12 cm; p < 0.001), em ambas as direções, na execução do Hexagon Test (sentido dos ponteiros do relógio: 5,1 ± 0,6 s, sentido inverso: 4,9 ± 0,5 s versus sentido dos ponteiros do relógio: 6,0 ± 0,4 s, sentido inverso: 5,7 ± 0,4 s; p < 0.001) e no Quadrant Jump Test (32,4 ± 2,5 pontos versus 28,2 ± 2,5 pontos, p < 0.001). Dentro de cada grupo não foi encontrada diferença entre os dois membros inferiores no Single-Leg Hop Test, nem entre as duas direções do Hexagon Test. CONCLUSÕES: Os resultados do presente estudo indicam que jovens futebolistas apresentam melhor performance funcional do membro inferior do que jovens não treinados.

Sports injuries during the Summer Olympic Games 2008

BACKGROUND

Standardized assessment of sports injuries provides important epidemiological information and also directions for injury prevention.

PURPOSE

To analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physicians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village.

RESULTS

Physicians and/or therapists of 92 national teams covering 88% of the 10,977 registered athletes took part in the study. In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all >or=15% of the athletes) and lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming.

CONCLUSION

The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports. The identification of these factors should stimulate future research and subsequent policy change to prevent injury in elite athletes.

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

BACKGROUND

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

HYPOTHESIS

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

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

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

RESULTS

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

CONCLUSION

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