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Barreira P, Vaz JR, Ferreira R, Araújo JP, Tavares F. External Training Loads and Soft-Tissue Injury Occurrence During Congested Versus Noncongested Periods in Football. Int J Sports Physiol Perform 2024; 19:1068-1075. [PMID: 39142646 DOI: 10.1123/ijspp.2024-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To analyze the influence of congested and noncongested fixture periods during 2 seasons in a professional male football team on soft-tissue injury incidence and external load. METHODS Thirty-three professional football players from a Portuguese Liga I team participated in this study. Weekly external load and soft-tissue injury rate and burden of 2 consecutive seasons (2021-22 and 2022-23) were analyzed. RESULTS Total soft-tissue injury rate and burden for the 2 seasons were 3.9 and 3.2 injuries per 1000 hours and 71.8 and 60.5 days per 1000 hours for congested and noncongested periods, respectively. No significant differences were observed between congested and noncongested periods. Total high-speed running, sprint distance, distance above 80% and 90% of maximal velocity, and meters accelerating and decelerating above 2 m/s2 were significantly higher for noncongested weeks. Match accelerations and decelerations above 3 m/s2 were higher during congested periods and training during noncongested periods. No differences between the 2 periods were observed for the total number of accelerations and decelerations above 3 m/s2. Overall, physical outputs per week were higher for training during noncongested weeks, whereas matches during congested periods registered higher external load. CONCLUSIONS No effect of a congested schedule was observed on soft-tissue injury rates and injury burden. Higher match exposure during congested periods increased external load performed per week, and during noncongested periods, training load was superior to congested weeks.
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Affiliation(s)
- Paulo Barreira
- Medical and Performance Department, Sporting Clube Portugal SAD, Lisbon, Portugal
| | - João R Vaz
- Egas Moniz Interdisciplinary Research Center, Egas Moniz School of Health and Science, Monte de Caparica, Portugal
| | - Ruben Ferreira
- Medical and Performance Department, Sporting Clube Portugal SAD, Lisbon, Portugal
| | - João Pedro Araújo
- Medical and Performance Department, Sporting Clube Portugal SAD, Lisbon, Portugal
| | - Francisco Tavares
- Medical and Performance Department, Sporting Clube Portugal SAD, Lisbon, Portugal
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2
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Wilke CF, Serner A, Massey A, McCall A, Fulcher M, Rosenbloom C, Carmody S, Patterson SD, Okholm Kryger K. Knowledge, attitude and behaviour around concussion at the FIFA Women's World Cup 2023: part 2 - coaches, performance staff and players. SCI MED FOOTBALL 2024:1-13. [PMID: 39166422 DOI: 10.1080/24733938.2024.2385339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/17/2024] [Accepted: 07/21/2024] [Indexed: 08/22/2024]
Abstract
The objective of this observational cross-sectional study was to assess the knowledge, attitude and behaviour of coaches and performance staff (i.e. 'coaching staff'), and players from the 32 teams qualified for the FIFA Women's World Cup 2023 regarding assessment and management of concussion in football. Two online surveys were developed: 1) coaching staff, and 2) players. The results were analysed descriptively. Eighty-four coaching staff and 229 players completed the survey. Concussion knowledge: 39% of coaching staff and 33% of players were aware of concussion protocol(s). Knowledge: concussion symptom onset time was correctly reported by 18% of coaching staff and 11% of players. Knowledge about risks related to sustaining a concussion or returning to play too soon varied in both groups. Attitude: 26% of coaching staff and 31% of players reported being very confident or confident in recognizing a suspected concussion. Half of the players (52%) reported to always report symptoms of concussion if feeling any. One (1%) member of the coaching staff and 24 (10%) players reported feeling that a player can return to play with mild symptoms after a concussion. Behaviour: Most coaching staff reported they would have supportive behaviour if faced with a suspected concussion on the pitch. Among players, 64% stated that they would leave the assessment to their team's medical staff, and 4% would encourage their teammates to keep playing. In conclusion, coaching staff and players showed limited knowledge about concussion. Most coaching staff reported attitudes and intended behaviour towards protecting players' health; whilst players' responses varied.
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Affiliation(s)
- Carolina Franco Wilke
- Faculty of Sport, Technology and Health Sciences, St Mary's University Twickenham, London, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Andrew Massey
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Alan McCall
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, Australia
- School of Sport and Exercise Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Mark Fulcher
- Axis Sports Medicine Specialists, Auckland, New Zealand
| | - Craig Rosenbloom
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
| | - Sean Carmody
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen D Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University Twickenham, London, UK
| | - Katrine Okholm Kryger
- Faculty of Sport, Technology and Health Sciences, St Mary's University Twickenham, London, UK
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
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3
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Wang J, Qian Y, Wang D, Liu N, Yang Q. A prospective epidemiologic study of injuries and illnesses in the football matches of the 14th National Student Games of China. SCI MED FOOTBALL 2024:1-7. [PMID: 39120555 DOI: 10.1080/24733938.2024.2388824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
The aim of this study is to determine the incidence and characteristics of football player injuries and illnesses during the 14th National Student Games of China. The results indicate that 32 illnesses were reported, with 17 (53%) involving the gastrointestinal system, primarily caused by environmental factors (24, 69%). The illness incidence rate was 4.3 cases per 100 players or 10.2 cases per 1,000 player-days. Regarding injuries, 122 cases were reported, yielding an overall injury incidence rate was 38.9 per 1,000 game hours, or 1.14 per game. Most injuries resulted from collisions with other players, occurring predominantly 15 minutes before the end of the first half, and 30 minutes before the end of the game. Most of the injuries were in the ankle, thigh, knee joint, and groin. In conclusion, the injury incidence of football players in the 14th National Student Games of China is high, occurring from a variety of mechanisms. Physical contact should be emphasized during training, core strength, and stability training should be enhanced alongside comprehensive injury management and prevention strategies.
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Affiliation(s)
- Jibing Wang
- International College of Football, Tongji University, Shanghai, China
| | - Yaqi Qian
- International College of Football, Tongji University, Shanghai, China
| | - Duona Wang
- International College of Football, Tongji University, Shanghai, China
| | - Nannan Liu
- International College of Football, Tongji University, Shanghai, China
| | - Qin Yang
- International College of Football, Tongji University, Shanghai, China
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4
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den Hollander S, Kerkhoffs G, Gouttebarge V. The Impact of Match Workload and International Travel on Injuries in Professional Men's Football. Sports (Basel) 2024; 12:212. [PMID: 39195588 PMCID: PMC11360389 DOI: 10.3390/sports12080212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
There are concerns over the impact of the congested international match calendar on professional footballers' physical and mental well-being, and injury susceptibility. This study aimed to determine whether there were differences in match workload and international travel between injured and non-injured male football players over two elite competition seasons. An observational, retrospective, case-control study was conducted using data from the 2021/2022 and 2022/2023 seasons of five top-tier European men's football leagues. Student t-tests were used to compare cumulative match workload and international travel data over a 28-day period preceding 1270 injuries and 2540 controls. There were significant differences in match workload and international travel variables between the injured groups (all injuries and hamstring injuries) and the control group. Match workload variables were higher (p < 0.01), recovery variables lower (p < 0.01), and international travel variables higher (p < 0.01). An overload of match workload and international travel contribute to increased injury susceptibility in professional men's football. This emphasizes the need to address international match calendar concerns, including the number of games per season, the frequency of back-to-back games, and international travel requirements. Additionally, the findings highlight the importance of monitoring player match workloads, and implementing squad rotations and tailored training programs to mitigate injury risks.
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Affiliation(s)
- Steve den Hollander
- Football Players Worldwide (FIFPRO), 2132LR Hoofddorp, The Netherlands
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, Rondebosch 7701, South Africa
| | - Gino Kerkhoffs
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105AZ Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105AZ Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Football Players Worldwide (FIFPRO), 2132LR Hoofddorp, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105AZ Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105AZ Amsterdam, The Netherlands
- Section Sports Medicine, Faculty of Health, University of Pretoria, Pretoria 0028, South Africa
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5
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Orchard JW, Rio E, Crossley KM, Orchard JJ, Mountjoy M. Orchard Sports Injury and Illness Classification System (OSIICS) Version 15. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:599-604. [PMID: 38494156 PMCID: PMC11184301 DOI: 10.1016/j.jshs.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Sports medicine (injury and illnesses) requires distinct coding systems because the International Classification of Diseases is insufficient for sports medicine coding. The Orchard Sports Injury and Illness Classification System (OSIICS) is one of two sports medicine coding systems recommended by the International Olympic Committee. Regular updates of coding systems are required. METHODS For Version 15, updates for mental health conditions in athletes, sports cardiology, concussion sub-types, infectious diseases, and skin and eye conditions were considered particularly important. RESULTS Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes. Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes. Rugby union protocols on head injury assessment were used to create additional concussion codes. CONCLUSION It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility. The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3083, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3083, Australia
| | - Jessica J Orchard
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton L8S 4L8, Canada
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Quintana-Cepedal M, López-Aguado I, Fernández-Somoano A, Rodríguez MÁ, del Valle M, Olmedillas H. Injury incidence and characteristics in adolescent female football players: A systematic review with meta-analysis of prospective studies. Biol Sport 2024; 41:137-151. [PMID: 38952921 PMCID: PMC11167467 DOI: 10.5114/biolsport.2024.132996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/25/2023] [Accepted: 11/11/2023] [Indexed: 07/03/2024] Open
Abstract
To observe overall, training, and match injury incidence in female youth football. We also aimed to quantify the incidence of injuries by affected tissue and body location. The following databases were examined: PubMed, Web of Science, Scopus, SPORTDiscus, Cochrane and PEDro. Papers that reported overall injury incidence, training or match injury incidence were included. Additionally, studies had to be performed in adolescent female football players (13-19 years of age). The Newcastle-Ottawa Scale and the checklist of items that must be included in epidemiological football reports were used to assess methodological quality of the included articles. For the meta-analyses, a random effect model was used. A total of 13 studies were included. There were 2,333 injuries; incidence was higher during games (12.7/1000 h) compared to training sessions (2.3/1000 h). The injury match-to-training ratio was 5.8. The lower limbs were the region in which the greatest number of injuries occurred, with the ankle (1.2/1000 h) and knee (0.8/1000 h) having the most injuries. In relation to injured tissue, ligament injuries represented an incidence of 1.3/1000 h, followed by muscle injuries (0.9/1000 h). This study represents the first step towards the creation and implementation of preventative measures in female youth football. The results suggest that attention should be focused on ankle and knee injuries, since they are the most frequent and can lead to sport retirement in some cases depending on the severity.
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Affiliation(s)
- Marcos Quintana-Cepedal
- Department of Functional Biology, University of Oviedo, Oviedo, Spain
- Asturian Research Group in Performance, Readaptation, Training and Health (ASTURES), University of Oviedo, Oviedo, Spain
| | | | - Ana Fernández-Somoano
- Unidad de Epidemiología Molecular del Cáncer, Instituto Universitario de Oncología del Principado de Asturias-Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERSP), Madrid, Spain
| | | | - Miguel del Valle
- Asturian Research Group in Performance, Readaptation, Training and Health (ASTURES), University of Oviedo, Oviedo, Spain
- Department of Cellular Morphology and Biology, University of Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, University of Oviedo, Oviedo, Spain
- Asturian Research Group in Performance, Readaptation, Training and Health (ASTURES), University of Oviedo, Oviedo, Spain
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7
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Aiello F, Avery L, Gardner T, Rutherford H, McCall A, Impellizzeri FM, Peek K, Della Villa F, Massey A, Serner A. Broadening our understanding of injury mechanisms to include at-risk situations: an overview of potential injuries at the FIFA men's World Cup Qatar 2022 TM. SCI MED FOOTBALL 2024:1-10. [PMID: 38935553 DOI: 10.1080/24733938.2024.2372304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
This study aims to examine and describe the characteristics of potential injury situations during a men's professional international tournament quantified using the FIFA Football Language Medical Coding. A prospective study was conducted during the 64 matches of the FIFA World Cup Qatar 2022™, during which five analysts recorded potential injury situations from video analysis. "Potential injuries" were recorded when players stayed down > 5 s and/or requested medical attention. Characteristics were further recorded for variables such as opponent's action and body location. In total, 720 potential injury situations were recorded of which 139 required medical assessment. The actions which resulted in most potential injuries were running while receiving a pass (74; 10%), while passing the ball (59; 8%), and while progressing with the ball (48; 7%). Duels and ball progression led to a potential injury in 3.0% and 2.1% of all similar actions in total. Both aerial duels and ball progression led to an potential injury that required medical assessment on 0.4% of occasions. Most potential injuries involved the head (149; 21%), foot (120; 17%), or lower leg (110; 15%) with most medical assessments of the head (35; 25%), lower leg (17; 12%), and knee (15; 11%) with a median duration of 47 seconds (IQR 28-61). This study provides a detailed overview of match circumstances that may have a higher injury risk. Although some variables within the coding system need improvement to increase reliability, its use will allow a more detailed comparison of differences between high-risk player actions leading to injury and those that do not, which can improve future prevention strategies.
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Affiliation(s)
- Francesco Aiello
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lewis Avery
- FIFA Football Performance Insights, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Tom Gardner
- FIFA Football Performance Insights, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Harvey Rutherford
- FIFA Football Performance Insights, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Alan McCall
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
- School of Sport, Exercise and Rehabilitation, Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Franco M Impellizzeri
- School of Sport, Exercise and Rehabilitation, Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kerry Peek
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Francesco Della Villa
- Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Andrew Massey
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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Magistrali M, Stefanini L, Abate M, Biancalana G, Stegagno A, Cugia P, Candoli P, Anania G, Lucchese PL, Gaddi D, Volpi P, Mariani F, Boldrini L, Filippi N, Cerrone A, Sirtori C, Battaglino P, Bravin G, Del Fabro E, Berti M, Vecchini E, Minetto MA. Epidemiology of Non-Contact Muscle Injuries in the Italian Male Elite Under-19 Football (Soccer) Championship. SPORTS MEDICINE - OPEN 2024; 10:75. [PMID: 38902551 PMCID: PMC11190129 DOI: 10.1186/s40798-024-00738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND While extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship ("Primavera 1"). RESULTS Conducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p < 0.0001). CONCLUSIONS The study highlighted a peculiar distribution of non-contact muscle injuries among elite young football players. While hamstring injuries were confirmed as the most burdensome, incidence and burden of adductors and calf injuries were found to be similar. A significant incidence and burden of iliopsoas injuries were observed. These findings suggest potential implementations for targeted injury prevention strategies in the Italian male elite Under-19 football Championship.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Diego Gaddi
- FC Internazionale Milano SpA, Milano, Italy
- Department of Orthopedics and Traumatology, Policlinico San Pietro, Ponte San Pietro, Bergamo, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Piero Volpi
- Istituto Clinico Humanitas IRCCS Rozzano, Milano, Italy
- FC Internazionale Milano SpA, Milano, Italy
| | | | | | | | | | | | | | - Guido Bravin
- SOC Ortopedia e Traumatologia ASUFC, Udine, Italy
- Udinese Calcio, Udine, Italy
| | | | - Mattia Berti
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, Italy
- Hellas Verona Calcio, Verona, Italy
| | - Eugenio Vecchini
- Hellas Verona Calcio, Verona, Italy
- Clinica Ortopedica, University of Verona, Verona, Italy
| | - Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Torino, Italy
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Achenbach L, Bloch H, Klein C, Damm T, Obinger M, Rudert M, Krutsch W, Szymski D. Four distinct patterns of anterior cruciate ligament injury in women's professional football (soccer): a systematic video analysis of 37 match injuries. Br J Sports Med 2024; 58:709-716. [PMID: 38684328 PMCID: PMC11228206 DOI: 10.1136/bjsports-2023-107113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND To identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women's professional football by means of video match analysis. METHODS ACL match injuries sustained in Germany's first women's league during the 2016-2017 to 2022-2023 seasons were prospectively analysed by three expert raters using a standardised observation form. Epidemiological and injury data, as well as the medical history of ACL tears, were obtained from media reports and the statutory accident insurance for professional athletes. RESULTS Thirty-seven ACL injuries sustained in official football matches were included in the video analysis, of which 24 (65%) had associated knee injuries, mainly meniscus and collateral ligament injuries. According to the categorised contact mechanisms, 17 (46%) were non-contact injuries, 14 indirect contact injuries (38%) and six direct contact injuries (16%). Of the 17 non-contact injuries, seven (41%) occurred during the first 15 min of the match. Contact mechanisms did not differ between primary and secondary ACL injuries to the same or the contralateral side. Most injuries (80%) of field players occurred during horizontal movements such as sprinting (n=9, 26%), change-of-direction manoeuvres (n=7, 19%), stopping (n=5, 14%) and lunging (n=5, 14%). Four distinct repetitive patterns of ACL match injuries were identified: (1) non-contact 'pressing ACL injury' (n=9), (2) indirect contact 'parallel sprinting and tackling ACL injury' (n=7), (3) direct contact 'knee-to-knee ACL injury' (n=6) and (4) non-contact 'landing ACL injury' (n=4). CONCLUSION Most of the identified patterns of ACL injuries in women's professional football have great potential for prevention.
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Affiliation(s)
- Leonard Achenbach
- Department of Orthopedics, Julius Maximilians University Würzburg, Wurzburg, Germany
| | - Hendrik Bloch
- Department of Sports Injury Prevention, VBG, German Statutory Accident Insurance for the Administrative Sector, Bielefeld, Germany
| | - Christian Klein
- Department of Sports Injury Prevention, VBG, German Statutory Accident Insurance for the Administrative Sector, Bielefeld, Germany
| | - Theresa Damm
- Faculty of Medicine, University Würzburg, Würzburg, Germany
| | - Matthias Obinger
- University of Cooperative Education for Sports and Health, Baunatal, Germany
| | - Maximilian Rudert
- Department of Orthopedics, Julius Maximilians University Würzburg, Wurzburg, Germany
| | - Werner Krutsch
- Department of Traumatology, University Clinic Regensburg, Regensburg, Germany
- SportDocsFranken, Nuremberg, Germany
| | - Dominik Szymski
- Department of Traumatology, University Clinic Regensburg, Regensburg, Germany
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10
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Materne O, Bennett F, Sweeney A, Ramsden J, Milne C, Waller M, Chamari K, Drust B. Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies. Res Sports Med 2024:1-19. [PMID: 38898686 DOI: 10.1080/15438627.2024.2367199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women's Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club's international players' lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player's injury resilience in professional women footballers.
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Affiliation(s)
- Olivier Materne
- Sports Medicine Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
| | - Faye Bennett
- Football Performance Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
- Sports Exercise and Rehabilitation Sciences Department, University of Birmingham, Birmingham, UK
| | - Ashley Sweeney
- Football Performance Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
| | - Jamie Ramsden
- Football Performance Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
| | - Chris Milne
- Sports Medicine Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
- Hampden Sports Clinic, Glasgow, UK
| | - Mark Waller
- Sports Medicine Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
| | - Karim Chamari
- Biological Science Department, Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Manouba, Tunisia
- Research Department, Naufar, Wellness and Recovery Centre, Doha, Qatar
| | - Barry Drust
- Football Performance Department, The Glasgow Rangers Football Club Ltd, Glasgow, UK
- Sports Exercise and Rehabilitation Sciences Department, University of Birmingham, Birmingham, UK
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Buoite Stella A, Dragonetti AM, Fontanot S, Sabot R, Martini M, Galmonte A, Canton G, Deodato M, Murena L. The Acute Effects of Cold Water Immersion and Percussive Massage Therapy on Neuromuscular Properties and Muscle Soreness after Exercise in Young Male Soccer Players. Sports (Basel) 2024; 12:167. [PMID: 38921861 PMCID: PMC11207944 DOI: 10.3390/sports12060167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
Cold water immersion (CWI) and percussive massage therapy (PMT) are commonly used recovery techniques in team sports. In particular, despite its wide use, PMT has been scarcely investigated in the literature, especially regarding neuromuscular measures and in comparison with other techniques. This study aimed to evaluate and compare the acute and short-term effects (24 h) of CWI and PMT on muscle strength, contractile properties, and soreness after exercise. A randomized crossover study was performed on sixteen male soccer players (22 years, 20-27) who participated in three experimental sessions involving a fatiguing protocol consisting of a Yo-Yo Intermittent Endurance Test followed by 3 × 10 squat jumps and a wall sit for 30 s, and 12 min of recovery including CWI (10 °C water), bilateral PMT on the anterior and posterior thigh, or passive resting. Outcomes were assessed immediately after the exercise protocol, after the recovery intervention, and at 24 h. Isometric knee extension (IKE) and flexion (IKF) and tensiomyography (TMG) were assessed. Muscle soreness and fatigue were scored from 0 to 10. PMT increased strength after the treatment (p = 0.004) and at 24 h (p = 0.007), whereas no significant differences were found for the other two recovery modalities. At post-recovery, compared to CON, CWI resulted in a longer TMG contraction time (p = 0.027). No significant differences were found at 24 h. Finally, PMT and CWI enhanced muscle soreness recovery compared to passive rest (F4,60 = 3.095, p = 0.022, pη2 = 0.171). Preliminary results from this study suggest that PMT might improve isometric strength after strenuous exercise, and both PMT and CWI reduce muscle soreness perception, while the effects on TMG parameters remain controversial.
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Affiliation(s)
- Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
| | - Angelo Michele Dragonetti
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
| | - Simone Fontanot
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
| | - Raffaele Sabot
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
- PhD Program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Alessandra Galmonte
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
| | - Gianluca Canton
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
- Orthopedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (A.B.S.); (M.M.); (A.G.); (G.C.); (M.D.); (L.M.)
- PhD Program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
- Orthopedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
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Serner A, Chamari K, Hassanmirzaei B, Moreira F, Bahr R, Massey A, Grimm K, Clarsen B, Tabben M. Time-loss injuries and illnesses at the FIFA world cup Qatar 2022. SCI MED FOOTBALL 2024:1-8. [PMID: 38860817 DOI: 10.1080/24733938.2024.2357568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/12/2024] [Indexed: 06/12/2024]
Abstract
The study aimed to analyse incidence and characteristics of time-loss injuries and illnesses during the FIFA World Cup Qatar 2022. Of 838 male football players, 705 consented to participate. Team medical staff reported 82 time-loss injuries, corresponding to an injury event incidence of 5.6 injuries/1000 h of total exposure (95%CI 4.5 to 7.0 injuries/1000 h), with a median of 2 time-loss injury events per team (IQR, 1 to 4.5, range 0-7). The total injury burden was 103 (95% CI 61 to 152) days per 1000 h. Muscle/tendon injuries had the highest incidence of tissue types (48 cases, 3.3/1000 h (95% CI 2.5 to 4.4), and hamstring muscle injuries were the most frequent diagnosis (16 cases, incidence 1.1/1000 h, 95% CI 0.6 to 1.8). Match injury event incidence was 20.6/1000 h (15.0 to 27.7) and training injury event incidence was 2.1/1000 h (1.4 to 3.1). The majority (52%) of sudden-onset injuries were non-contact injuries, 40% direct contact and 8% indirect contact. We recorded 15 time-loss illnesses, corresponding to an illness event incidence of 1.1 per 1000 competition days, (95% CI: 0.6 to 1.8), and illness burden of 2.1 (1.0 to 3.4) days lost per 1000 competition days. The most common illness was respiratory infection (12 cases, 80%). Match injury event incidence was the lowest in any FIFA World Cup since injuries have been monitored.
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Affiliation(s)
- Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Karim Chamari
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Manouba, Tunisia
| | - Bahar Hassanmirzaei
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Francisco Moreira
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Andrew Massey
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Katharina Grimm
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Ben Clarsen
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Montassar Tabben
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
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Sprouse B, Chandran A, Rao N, Boltz AJ, Johnson M, Hennis P, Varley I. Injury and illness surveillance monitoring in team sports: a framework for all. Inj Epidemiol 2024; 11:23. [PMID: 38858694 PMCID: PMC11163858 DOI: 10.1186/s40621-024-00504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Sport-related injuries and illnesses can negatively impact athlete welfare at all standards of participation in team sports. Injury and illness surveillance (IIS), and the development of monitoring systems, initiates the sequence of injury and illness prevention. Operational IIS monitoring systems help to appraise epidemiological estimates of injury and illness incidence and burden in various athlete populations. However, the methodological underpinnings of various monitoring systems are not harmonized or widely documented, with the presence of efficient and successful programmes rarely showcased at non-elite levels. The aim is to provide a framework that guides the development of IIS, which will enhance overall surveillance, to indirectly inform injury prevention strategies. METHODS The process involved all members of the research group initially discussing the research gaps, scope of the project, and the aims of the article. Unique experiences were shared, and specific and global challenges and barriers to IIS at all standards of team sport participation were identified. A tiered system of data collection with corresponding content were produced, with experiences and guidance provided throughout the article. RESULTS The literature has been reviewed and using first-hand experience in conducting IIS programmes in complex and diverse sport settings, the authors have identified key enablers and barriers for best practise as time, technological and human resources, reporter/practitioner training, and medical expertise. Areas of greatest importance regarding the conducting of IIS have been outlined, providing guidance and recommendations across all levels of team sport participation. These areas include definitions, data context, collection procedures, handling, security, ethics, storage, dissemination, quality, compliance, and analysis. Given the barriers to IIS, 3-tiered levels of data collection and content have been proposed. The levels indicate data collection variables, with a focus on sufficiency and achievability, aiming to support the successful conducting of IIS in team sports across all standards of participation. Future opportunities in IIS have been discussed, with several predictive measures and analytical techniques expanded upon. CONCLUSIONS The framework provides universal guidance for implementing IIS monitoring systems, facilitating athletes, coaches, parents/guardians, governing bodies and practitioners to implement IIS processes, identify challenges, complete analysis, and interpret outcomes at all standards of participation.
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Affiliation(s)
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Neel Rao
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Ian Varley
- Nottingham Trent University, Nottingham, UK
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Barlow A, Blodgett JM, Williams S, Pedlar CR, Bruinvels G. Injury Incidence, Severity, and Type Across the Menstrual Cycle in Female Footballers: A Prospective Three Season Cohort Study. Med Sci Sports Exerc 2024; 56:1151-1158. [PMID: 38227488 DOI: 10.1249/mss.0000000000003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE The aim of the study was to assess the influence of menstrual cycle phase on injury incidence, severity, and type in elite female professional footballers over three seasons. METHODS Time-loss injuries and menstrual cycle data were prospectively recorded for 26 elite female football players across three seasons. The menstrual cycle was categorized into four phases using a standardized model: menstruation (phase 1; P1), remainder of follicular phase (phase 2; P2), early luteal (phase 3; P3), and premenstrual phase (phase 4; P4). Injury incidence rates (IIR) and ratios (IIRR) were calculated for overall injuries, injury severity, type, contact vs noncontact, and game/training. RESULTS A total of 593 cycles across 13,390 d were tracked during the study, and 74 injuries from 26 players were eligible for analysis. When comparing IIR between phases (reference: P1), overall injury rates were highest in P4 (IIRR, 2.30 (95% confidence interval, 0.99-5.34; P = 0.05)). When examining rates by injury severity and type, IIR values were also highest in P4 for ≤7 d' time-loss (4.40 (0.93-20.76; P = 0.06)), muscle-specific (6.07 (1.34-27.43; P = 0.02)), and noncontact (3.05 (1.10-8.50; P = 0.03)) injuries. Muscle-specific (IIRR P3/P1, 5.07 (1.16-22.07; P = 0.03)) and ≤7 d' time-loss (4.47 (1.01-19.68; P = 0.05)) injury risk was also significantly higher in P3. Muscle injuries were the most prevalent subtype ( n = 41). No anterior cruciate ligament injuries were recorded across the monitoring period. CONCLUSIONS Injury risk was significantly elevated during the luteal phase of the menstrual cycle (P3 and P4) among elite female professional footballers. Further research is urgently needed to better understand the influence of the menstrual cycle on injury risk and to develop interventions to mitigate risk.
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Affiliation(s)
- Ally Barlow
- Centre for Health, and Injury & Illness Prevention in Sport, Department for Health, University of Bath, Bath, UNITED KINGDOM
| | - Joanna M Blodgett
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, University College London, UNITED KINGDOM
| | - Sean Williams
- Centre for Health, and Injury & Illness Prevention in Sport, Department for Health, University of Bath, Bath, UNITED KINGDOM
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Alashram AR, D'Onofrio R, Sannicandro I, Manzi V, Padua E, Youssef T, Annino G. Return to training in soccer players after anterior cruciate ligament reconstruction: reflections and considerations. J Sports Med Phys Fitness 2024; 64:578-587. [PMID: 38324269 DOI: 10.23736/s0022-4707.23.15448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
This clinical and rehabilitative overview focuses on the return to unrestricted sporting activity, aiming to consolidate the scientific evidence surrounding the structural progression of athletes, particularly footballers, undergoing anterior cruciate ligament reconstruction (ACLR). A multidisciplinary approach necessitates a shared language and standardized methodologies. Unfortunately, significant disparities persist in the structural strategies guiding the decision-making process for returning to on-field activities, the latter stages of rehabilitation, and subsequent restoration of technical and tactical football abilities. Divergences in definitions, terminologies, and rehabilitation protocols can substantially influence final outcomes. Presently, scientific consensus studies regarding the decision-making process during the final stages of on-field rehabilitation are lacking. Nevertheless, this overview outlines and defines pivotal language parameters crucial for effective communication and the seamless integration of clinical and rehabilitative data among the diverse professionals involved in facilitating the athlete's return to peak performance. In conclusion, the successful resumption of competitive sporting activities for footballer's post ACLR demands a collaborative decision-making approach encompassing various professionals. Additionally, it necessitates a cohesive transition from rehabilitation to on-field work, aiming at reinstating athleticism, technical prowess, and tactical acumen.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan -
- Applied Science Research Center, Applied Science Private University, Amman, Jordan -
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy -
| | - Rosario D'Onofrio
- Medical-Scientific Multidisciplinary Commission, Italian Football Doctors Association, L.A.M.I.CA., Rome, Italy
| | - Italo Sannicandro
- Experimental and Clinical Department, University of Foggia, Foggia, Italy
| | - Vincenzo Manzi
- Department of Humanities Science, Pegaso Open University, Naples, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Tarek Youssef
- Department of Physiotherapy, Middle East University, Amman, Jordan
| | - Giuseppe Annino
- Center of Space Bio-Medicine, Department of Medicine Systems, Tor Vergata University, Rome, Italy
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Hardin S, Silverman R, Brophy R, Putukian M, Silvers-Granelli H. Epidemiology of Injury and Illness in North American Professional Men's Soccer: Comparing COVID-19 Lockdown With Previous Seasons. Sports Health 2024:19417381241253227. [PMID: 38761004 DOI: 10.1177/19417381241253227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND After COVID-19 lockdown, studies across Europe and Asia examined its effect on professional soccer injury rates and severity; however, COVID-19 lockdown influence on injuries in United States men's professional soccer has not been evaluated. HYPOTHESIS Injury and illness rates during the 2020 season were higher than the previous 2 seasons. STUDY DESIGN Retrospective observational cohort study. LEVEL OF EVIDENCE Level 3. METHODS Medical staff from participating Major League Soccer (MLS) clubs entered injuries and athletic exposures during the study period into a league-wide electronic medical record system. Injury rate and severity were analyzed to examine differentials between the 2020 COVID season and historical controls. RESULTS The injury incidence rate per 1000 hours in 2020 was 10.8, ie, higher than 2018 (5.4) and 2019 (5.0) (P < 0.05). Training injury incidence rate increased in 2020 (8.9) compared with 2018 (2.5) and 2019 (2.6) (P < 0.05), whereas match injury incidence decreased in 2020 (18.3) compared with 2018 (24.0) and 2019 (22.7) (P < 0.05). Incidence rates of lower extremity muscle injuries (6.04), anterior cruciate ligament (ACL) injuries (0.17), and concussions (0.49) were also higher in 2020 compared with 2018 (2.5, 0.07, 0.27) and 2019 (2.36, 0.05, 0.22) (P < 0.05). More injured players in 2020 missed >90 days (17.7%) than in 2018 (10.2%) and 2019 (10.1%) (P < 0.05). Incidence of all non-COVID-19 illness was higher in 2020 (3.93) than 2018 (1.53) and 2019 (1.32) (P < 0.05). CONCLUSIONS During 2020, there were significant increases in incidence rates of overall injuries, training injuries, lower extremity muscular injuries, ACL injuries, concussions, and non-COVID illness, along with a higher percentage of players missing >90 days compared with the 2 previous seasons. CLINICAL RELEVANCE These results may help clarify the effects of future MLS inseason work stoppages and periods of restricted training.
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Affiliation(s)
- Stacey Hardin
- Major League Soccer, Research, New York, New York
- Bay Football Club, National Women's Soccer League, San Francisco, California
| | - Richard Silverman
- Washington University in St Louis School of Medicine, S Orthopaedic Surgery, Chesterfield, Missouri
| | - Robert Brophy
- Washington University in St Louis School of Medicine, S Orthopaedic Surgery, Chesterfield, Missouri
| | | | - Holly Silvers-Granelli
- Major League Soccer, Research, New York, New York
- Velocity Physical Therapy, Santa Monica, California
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Quintana-Cepedal M, Roces-Vila I, Del Valle M, Olmedillas H. Epidemiology of injuries in elite female rink hockey players: A two season observational study. Phys Ther Sport 2024; 67:7-12. [PMID: 38394829 DOI: 10.1016/j.ptsp.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To record the time-loss injuries of female rink hockey players and describe the affected region, tissue, and onset of injury. DESIGN Cross-sectional survey study. SETTING First (Ok Liga) and Second (Plata) division clubs. PARTICIPANTS 280 player-seasons. MAIN OUTCOME MEASURES Incidence of overall, training, and match injuries (number of injuries per 1000 h) from two seasons. RESULTS A total of 229 injuries occurred in 56,438 h of exposure. The overall incidence was 4 injuries per 1000 h (4/1000 h), with a significantly higher rate of injuries during matches (15.2/1000 h) compared to training sessions (2.6/1000 h) (p < 0.001). Injuries affecting the lower limb were the most common (2.3/1000 h), followed by upper limb (1.2/1000 h), and head/trunk (0.6/1000 h). The tissue with the highest incidence of injury was the muscle/tendon (1.3/1000 h), followed by the ligament (0.8/1000 h). Around one in every three injuries (31%) affected either the thigh or hip/groin (73 injuries). CONCLUSIONS The injury incidence in elite female rink hockey is moderate and occurs mainly during match sessions. Preventative measurements should be implemented in rink hockey with a special concern for injuries affecting the thigh, and hip/groin.
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Affiliation(s)
- Marcos Quintana-Cepedal
- Department of Functional Biology, University of Oviedo, Oviedo, Spain; Asturian Research Group in Performance, Readaptation, Training, and Health (ASTUres), Oviedo, Spain
| | - Isaac Roces-Vila
- Department of Functional Biology, University of Oviedo, Oviedo, Spain
| | - Miguel Del Valle
- Asturian Research Group in Performance, Readaptation, Training, and Health (ASTUres), Oviedo, Spain; Department of Cellular Morphology and Biology, University of Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, University of Oviedo, Oviedo, Spain; Asturian Research Group in Performance, Readaptation, Training, and Health (ASTUres), Oviedo, Spain.
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Thorarinsdottir S, Amundsen R, Larmo A, Pedersen R, Andersen TE, Bahr R, Møller M. Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics. Scand J Med Sci Sports 2024; 34:e14611. [PMID: 38534061 DOI: 10.1111/sms.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. METHODS During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). RESULTS On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). CONCLUSION The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.
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Affiliation(s)
- Solveig Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Roar Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | | | | | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian FA Medical Centre (Idrettens helsesenter), Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Gasparin GB, Ribas LO, Flores HN, Bueno GBDB, Vrkoslaw L, Bittencourt NFN, Baroni BM. Uncovering injuries in Brazilian elite women's football: A prospective cohort study. J Sci Med Sport 2024; 27:228-233. [PMID: 38336547 DOI: 10.1016/j.jsams.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To elucidate the injury profile in Brazilian elite women's football. DESIGN Prospective cohort study. METHODS Time-loss injuries, along with match and training exposure, were monitored throughout a full season in four Brazilian elite clubs. RESULTS Sixty-three out of 133 players (47 %) sustained 112 time-loss injuries along the season, leading to 0.8 injuries per player on average. The overall injury incidence rate was 5.0 injuries per 1000 h of exposure. Sudden onset injuries occurred at a rate of 4.2/1000 h of overall exposure, with rates of 15.9/1000 h during matches and 2.9/1000 h during training sessions. Forty-eight percent of the time-loss injuries were attributed to non-contact events. Gradual onset injuries accounted for 16 % of the injuries, resulting in a rate of 0.8/1000 h of overall exposure. The most affected locations were knee and thigh (29 % of all injuries for each), followed by ankle (17 %) and hip/groin (13 %). Muscle/tendon was the most affected tissue (47 % of all injuries), followed by ligament/joint capsule (33 %), bone (10 %), and cartilage/synovium/bursa (7 %). Ankle sprains, hamstring strains, and anterior cruciate ligament injuries accounted for over one-third of the injuries. Mild, moderate, and severe injuries account for 40 %, 43 %, and 17 % of cases, respectively. Overall, 18 % of cases were categorized as re-injuries, and 40 % of those occurred within 2 months of the index injury. CONCLUSIONS This study provides the initial understanding into the injury profile of Brazilian elite women's football. This information should serve as a guiding resource for injury prevention programs.
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Affiliation(s)
- Gabriela Bissani Gasparin
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | | | - Luana Vrkoslaw
- Associação Ferroviária de Esportes, Araraquara, SP, Brazil
| | | | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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20
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Aiello F. Development of a standardised method for the analysis of mechanisms and circumstances of injury in football (PhD Academy Award). Br J Sports Med 2024; 58:289-290. [PMID: 38050031 DOI: 10.1136/bjsports-2023-107644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Francesco Aiello
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
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21
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Lima Y, Gouttebarge V, Bayraktar B. What do we know about beach soccer injuries? Systematic video analysis of four consecutive years with 580 match injuries. Res Sports Med 2024:1-11. [PMID: 38414221 DOI: 10.1080/15438627.2024.2324257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact (p < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) (p < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.
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Affiliation(s)
- Yavuz Lima
- Cerrahpasa Faculty of Medicine, Sports Medicine Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vincent Gouttebarge
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Section Sports Medicine, University of Pretoria, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, Netherlands
| | - Bülent Bayraktar
- Sports Medicine Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
- Turkish Football Federation, Medical Board, Istanbul, Turkey
- Acıbadem Sports/FIFA Medical Centre of Excellence Consultant, Istanbul, Turkey
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22
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Hallén A, Tomás R, Ekstrand J, Bengtsson H, Van den Steen E, Hägglund M, Waldén M. UEFA Women's Elite Club Injury Study: a prospective study on 1527 injuries over four consecutive seasons 2018/2019 to 2021/2022 reveals thigh muscle injuries to be most common and ACL injuries most burdensome. Br J Sports Med 2024; 58:128-135. [PMID: 38182274 PMCID: PMC10894819 DOI: 10.1136/bjsports-2023-107133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Injuries in women's football (soccer) have scarcely been investigated, and no study has been conducted in the highest competitive level involving club teams from different countries. Our aim was to investigate the time-loss injury epidemiology and characteristics among women's elite football players over four seasons. METHODS 596 players from 15 elite women's teams in Europe were studied prospectively during the 2018/2019 to 2021/2022 seasons (44 team seasons). Medical staff recorded individual player exposure and time-loss injuries. Injury incidence was calculated as the number of injuries per 1000 playing hours and injury burden as the number of days lost per 1000 hours. RESULTS 1527 injuries were recorded in 463 players with an injury incidence of 6.7 (95% CI 6.4 to 7.0) injuries per 1000 hours and a nearly fourfold higher incidence during match play compared with training (18.4, 95% CI 16.9 to 19.9 vs 4.8, 95% CI 4.5 to 5.1; rate ratio 3.8, 95% CI 3.5 to 4.2). Thigh muscle injuries (hamstrings 12%, 188/1527, and quadriceps 11%, 171/1527) were the most frequent injury, while anterior cruciate ligament (ACL) injury had the highest burden (38.0 days lost per 1000 hours, IQR 29.2-52.1) with median days lost of 292 (IQR 246-334) days. Concussions constituted 3% (47/1527) of all injuries, with more than half of them (55%, 26/47) due to ball-related impact. CONCLUSION An elite women's football team can expect approximately 35 time-loss injuries per season. Thigh muscle injury was the most common injury and ACL injury had the highest injury burden.
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Affiliation(s)
- Anna Hallén
- Football Research Group, Linköping, Sweden
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Rita Tomás
- Federação Portuguesa de Futebol, Portugal Football School, Cruz Quebrada, Portugal
- PM&R Unit, Hospital CUF Descobertas, Lisboa, Portugal
| | - Jan Ekstrand
- Football Research Group, Linköping, Sweden
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Håkan Bengtsson
- Football Research Group, Linköping, Sweden
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elke Van den Steen
- Department of Physical and Rehabilitation Medicine, AZ St Jan, Brugge, Belgium
| | - Martin Hägglund
- Football Research Group, Linköping, Sweden
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Football Research Group, Linköping, Sweden
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Amundsen R, Thorarinsdottir S, Larmo A, Pedersen R, Andersen TE, Møller M, Bahr R. #ReadyToplay: hamstring injuries in women's football - a two-season prospective cohort study in the Norwegian women's premier league. SCI MED FOOTBALL 2024:1-9. [PMID: 38243669 DOI: 10.1080/24733938.2024.2305389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
In this two-season prospective cohort study (2020-2021), we aimed to describe the characteristics, clinical findings and magnetic resonance imaging (MRI) findings of hamstring injuries in the Norwegian women's premier league. Hamstring injuries were examined by team physiotherapists using a standardised clinical examination and injury form. Injury location and severity (modified Peetrons classification) were graded based on MRI by two independent radiologists. Fifty-three hamstring injuries were clinically examined, 31 of these with MRI. Hamstring injuries caused 8 days (median) lost from football (interquartile range: 3-15 days, range: 0-188 days), most were non-contact and occurred during sprinting. Gradual-onset (53%) and sudden-onset injuries (47%) were evenly distributed. The injuries examined with MRI were classified as grade 0 (52%), grade 1 (16%) or grade 2 (29%). One proximal tendinopathy case was not graded. Grade 2 injuries caused more time loss than grade 0 (19 ± 8 vs. 7 ± 7 days, p = 0.002). Of injuries with MRI changes, 60% were in the m. biceps femoris, mainly the muscle-tendon junction, and 40% in the m. semimembranosus, most in the proximal tendon. Compared to previous findings from men's football, a higher proportion of hamstring injuries in women's football had a gradual onset and involved the m. semimembranosus, particularly its proximal tendon.
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Affiliation(s)
- R Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - S Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - A Larmo
- Radiology Department, Evidia Norge AS, Oslo, Norway
| | - R Pedersen
- Radiology Department, Unilabs Norge AS, Oslo, Norway
| | - T E Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian Football Association Medical Centre (Idrettens helsesenter), The Norwegian Football Association, Oslo, Norway
| | - M Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - R Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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24
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Pietsch S, Green B, Schache AG, Pizzari T. Epidemiology of quadriceps muscle strain injuries in elite male Australian football players. Scand J Med Sci Sports 2024; 34:e14542. [PMID: 37994173 DOI: 10.1111/sms.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To describe the epidemiology of quadriceps muscle strain injury (QMSI) in elite Australian Football League (AFL) players, explore recovery milestones and determine whether recovery is impacted by factors such as injury type (index vs. re-injury), the primary muscle injured and the mechanism of injury. MEASURES All QMSI data reported to the Soft Tissue Injury Registry of the AFL from the 2014 to 2020 seasons were evaluated. Player demographic data, circumstances of injury, MRI reports and recovery outcomes following injury were extracted. Descriptive statistics and frequency distributions are presented. Recovery outcomes for injury type, primary muscle injured and the mechanism of injury were compared using univariate analyses. RESULTS There were 164 QMSIs from 122 players reported (134 index; 30 re-injuries). Almost all (91.3%) QMSIs involved the rectus femoris. Half (48.4%) of the QMSIs occurred during kicking and most commonly affected the dominant kicking leg (72%). The majority occurred at training (64.6%). All re-injuries involved the rectus femoris, most occurred from kicking (63.0%) and within 6 months of the preceding injury (70%). The mean return to play (RTP) time was 25.4 days (95%CI = 22.6-28.2) and rectus femoris injuries took around 14 days longer to RTP than vastii injuries (p = 0.001). QMSIs with a kicking mechanism took the longest to RTP of all injury mechanisms. CONCLUSION In AFL players, QMSIs occur mostly in the dominant leg from a kicking mechanism. Rectus femoris injuries are more prevalent and result in longer RTP time frames. Re-injuries exclusively involved the rectus femoris, primarily from kicking.
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Affiliation(s)
- Samuel Pietsch
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Brady Green
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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25
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Andersen TR, Drevsfeldt A, Möller S, Møller M. Injuries in male youth football: a one season prospective cohort study of 223 Danish elite players. Front Sports Act Living 2023; 5:1250223. [PMID: 38164442 PMCID: PMC10757927 DOI: 10.3389/fspor.2023.1250223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study prospectively investigated injury prevalence, incidence, and burden in male elite under-17 football players (N = 223) during a full season. Methods The players weekly completed a standardized web-based injury survey (OSTRC-H2) and a physical exposure report throughout the study. Results Average weekly response rate was 89.5%. Football exposure accounted for 52.4% of total physical exposure. On average (±SD), the players participated in individual football, strength, and rehabilitation practices for 1.2 ± 1.5, 3.0 ± .2.1, and 1.9 ± 3.4 h/week, respectively. In total, 742 health problems were reported. Mean weekly prevalence of health problems, injuries and illnesses were 20.1%, 16.5% and 3.8%, respectively. The injury incidence per 1,000 h of football exposure, match play and team practice were 8.28 (95% CI: 7.54-9.08), 16.77 (95% CI: 13.65-20.4), and 7.24 (95% CI: 6.5-8.04), respectively. Sudden-onset and gradual-onset injuries accounted for 36.7% and 43.4% of the total proportion of health problems. Hip/groin injuries had the highest incidence (1.58/1,000 h), whereas knee injuries had the highest burden (20.86 days lost/1,000 h). On average, the players experienced 3.33 health problems (average duration: 7.8 days). On average pr. player, 2.7 (95% CI: 2.2-3.3) wks of football exposure were lost. Conclusion Sudden and gradual-onset injuries influenced player availability during the season. Health problem prevalence fluctuated markedly, and injury incidence was higher during match play than training. The players had substantial volumes of training beyond football-specific training and matches. Our findings could assist medical and sports science practitioneers in enhancing training and recovery processes to maximize player availability.
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Affiliation(s)
- Thomas Rostgaard Andersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Football Association, Brondby, Denmark
| | - Andreas Drevsfeldt
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Merete Møller
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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26
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Vella S, Bolling C, Verhagen E, Moore IS. 'After they see what you have, they contact you': a qualitative study of national team football players', coaches' and clinicians' experiences in engaging with a context-specific injury surveillance system. SCI MED FOOTBALL 2023:1-12. [PMID: 38054439 DOI: 10.1080/24733938.2023.2290077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Sports injury surveillance systems aid injury prevention, but their development without considering end-users' perspectives has led to low adherence and honesty in self-reporting by players, compromising their effectiveness. Context-specific injury surveillance systems have been proposed to address these challenges, but there is a limited understanding of stakeholders' perceptions and experiences in using them. OBJECTIVE Following the implementation of a context-specific injury surveillance system with 100% player adherence over 60 weeks, the study aimed to investigate Under-21 Maltese national football team players', coaches' and clinicians' experiences of how and why they engaged with the system. METHOD Seventeen semi-structured interviews with Under-21 Maltese male national football team players (n = 12), their coaches (n = 3) and clinicians (n = 2) were conducted. Data were analysed using reflexive thematic analysis. RESULTS Participants highlighted questionnaire-related factors that motivated engagement with the context-specific injury surveillance system (theme 1) and factors influencing further engagement with the system based on stakeholders' actions (theme 2). Perceived outcomes experienced as a result of engaging with the injury surveillance system (theme 3), in turn, motivated players to continue reporting and engaging with the system. CONCLUSION To encourage players' sustained reporting, injury-related information collected from well-designed questionnaires should serve to stimulate communication and teamwork among stakeholders, to prevent injuries and enhance performance.
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Affiliation(s)
- Sandro Vella
- Malta Football Association, Millenium Stand, National Stadium, Ta' Qali, Malta
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van, The Netherlands
| | - Caroline Bolling
- Malta Football Association, Millenium Stand, National Stadium, Ta' Qali, Malta
| | - Evert Verhagen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van, The Netherlands
| | - Isabel Sarah Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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27
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Marques J, Chamari K. Performance Management in Elite Football: A Teamwork Modeling Approach. Int J Sports Physiol Perform 2023; 18:1371-1373. [PMID: 37917956 DOI: 10.1123/ijspp.2023-0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Joao Marques
- Aspetar, Orthopedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha, Qatar
| | - Karim Chamari
- Aspetar, Orthopedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha, Qatar
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28
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Amundsen R, Thorarinsdottir S, Clarsen B, Andersen TE, Møller M, Bahr R. #ReadyToPlay: health problems in women's football-a two-season prospective cohort study in the Norwegian premier league. Br J Sports Med 2023:bjsports-2023-107141. [PMID: 37968072 DOI: 10.1136/bjsports-2023-107141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league. METHODS During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported. RESULTS We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss. CONCLUSION One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe.
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Affiliation(s)
- Roar Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Solveig Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
- FIFA Medical, Federation Internationale de Football Association, Zurich, Switzerland
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian Football Association Medical Centre (Idrettens helsesenter), The Norwegian Football Association, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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29
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Mountjoy M, Junge A, Bindra A, Blauwet C, Budgett R, Currie A, Engebretsen L, Hainline B, McDuff D, Purcell R, Putukian M, Reardon CL, Soligard T, Gouttebarge V. Surveillance of athlete mental health symptoms and disorders: a supplement to the International Olympic Committee's consensus statement on injury and illness surveillance. Br J Sports Med 2023; 57:1351-1360. [PMID: 37468210 DOI: 10.1136/bjsports-2022-106687] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
In 2019, the International Olympic Committee (IOC) published a consensus statement outlining the principles for recording and reporting injury and illness in elite sport. The authors encouraged sport federations to adapt the framework to their sport-specific context. Since this publication, several sports have published extensions to the IOC consensus statement.In response to a paucity of epidemiological data on athlete mental health, the IOC mental health working group adapted the IOC consensus statement on injury and illness surveillance to improve the capturing of athlete mental health data. In addition to the members of the working group, other experts and athlete representatives joined the project team to address gaps in expertise, and to add stakeholder perspective, respectively. Following an in-person meeting, the authors worked remotely, applying the scientific literature on athlete mental health to the IOC injury and illness surveillance framework. A virtual meeting was held to reach consensus on final recommendations.Practical outcomes based on the analysis of the scientific literature are provided with respect to surveillance design, data collection and storage, data analysis and reporting of athlete mental health data. Mental health-specific report forms for athlete and health professional utilisation are included for both longitudinal and event-specific surveillance.Ultimately, this publication should encourage the standardisation of surveillance methodology for mental health symptoms and disorders among athletes, which will improve consistency in study designs, thus facilitating the pooling of data and comparison across studies. The goal is to encourage systematic surveillance of athlete mental health.
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Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Medical and Scientific Department-Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Astrid Junge
- Center for Health in Performing Arts, MSH Medical School Hamburg, Hamburg, Germany
| | - Abhinav Bindra
- Olympic Champion and IOC Athletes Commission Member, Deharadun, Punjab, India
| | - C Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Alan Currie
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Exercise, Sport and Rehabilitation Therapies, University of Sunderland, Sunderland, UK
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - David McDuff
- Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rosemary Purcell
- Elite Sport and Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Margot Putukian
- Chief Medical Officer, Major League Soccer, Princeton, New Jersey, USA
| | - Claudia L Reardon
- Department of Psychiatry, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Vincent Gouttebarge
- Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Section Sports Medicine, University of Pretoria, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
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30
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Veith S, Whalan M, Gibson N, Williams S, Sampson JA. Injury incidence and burden differ between season phases in male academy football (soccer) players. J Sports Sci 2023; 41:1753-1761. [PMID: 38179709 DOI: 10.1080/02640414.2023.2296719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/09/2023] [Indexed: 01/06/2024]
Abstract
Adolescent elite-level footballers are exposed to unique physical and psychological stressors which may increase injury risk, with fluctuating injury prevalence and burden. This study investigates the patterns of injury incidence and burden from 2017 to 2020 within combined pre-, start-of-, mid- and end-of-season and school-holiday phases in U13-U18 Australian male academy players. Injury incidence rate and burden were calculated for medical attention (MA), full and partial time-loss (TL) and non-time-loss (non-TL) injuries. Injury rate ratios (IRR) for injury incidences were assessed using Generalised Linear Mixed Models, and 99% confidence intervals for injury burden differences between phases. MA and non-TL injury incidence rates were higher during pre-season (IRR 1.65, p = 0.01; IRR 2.08, p = 0.02, respectively), and mid-season showed a higher non-TL incidence rate (IRR 2.15, p = 0.02) and burden (69 days with injury/1000 hrs, CI 47-103) compared to end-of-season (25 days with injury/1000 hrs, CI 15-45). MA injury rates and partial TL injury burden were higher during school compared to holiday periods (IRR 0.6, p = 0.04; 61 partial days lost/1000 hrs, CI 35-104; 13 partial days lost/1000 hrs, CI 8-23). Season phase and return-to-school may increase injury risks for elite academy footballers, and considering these phases may assist in developing injury prevention systems.
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Affiliation(s)
- Stella Veith
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, Australia
| | - Matthew Whalan
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, Australia
- Medical Department, Football Australia, Sydney, Australia
| | - Neil Gibson
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, Australia
| | - Sean Williams
- Department for Health, University of Bath, Bath, England, UK
| | - John A Sampson
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, Australia
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31
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Bordalo M, Serner A, Yamashiro E, Al-Musa E, Djadoun MA, Al-Khelaifi K, Schumacher YO, Al-Kuwari AJ, Massey A, D'Hooghe P, Cardinale M. Imaging-detected sports injuries and imaging-guided interventions in athletes during the 2022 FIFA football (soccer) World Cup. Skeletal Radiol 2023:10.1007/s00256-023-04451-z. [PMID: 37715819 DOI: 10.1007/s00256-023-04451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To describe imaging-detected musculoskeletal injuries and image-guided interventional procedures during the 2022 FIFA football (soccer) World Cup. MATERIALS AND METHODS Retrospective analysis of all radiologic examinations performed in a central medical facility for athletes was performed by two board certified musculoskeletal radiologists. Data on muscle, tendon, ligament, cartilage, and bone injuries were collected according to imaging modality and body part. RESULTS A total of 143 radiology examinations in 94 athletes were evaluated at the central medical facility. Magnetic resonance imaging (MRI) was the most utilized modality (67%), followed by radiography (12%), ultrasonography (9%), and computed tomography (4%). Image-guided interventions corresponded to 8% of all radiological examinations. There were 112 injuries described, affecting muscles and tendons (42%), ligaments (25%), cartilage (21%), and bone (12%). Most injured body parts were thigh (27%), foot and ankle (23%), knee (23%), and hip/groin (8%). Most injured players were within the age range of 24-35 years old (71%). CONCLUSION Imaging was utilized in 11% of players who participated in the 2022 FIFA World Cup in Qatar. MRI was the most utilized modality, and acute muscle tears were the most diagnosed type of injury. Diagnostic imaging played an important role in diagnosing sports-related injuries during the 2022 FIFA World Cup.
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Affiliation(s)
- Marcelo Bordalo
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.
| | - Andreas Serner
- Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
| | | | - Emad Al-Musa
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | | | | | - Andrew Massey
- Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Marco Cardinale
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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Pillay L, Janse van Rensburg DC, Ramkilawon G, Maas M, Orhant E, Rantanen J, Salo J, Kerkhoffs G, Gouttebarge V. Determination of the Prevalence of Knee and Hip Clinical Osteoarthritis in the Active Professional Male Footballer and Its Association with Pain, Function, Injury and Surgery. Sports (Basel) 2023; 11:136. [PMID: 37505623 PMCID: PMC10385669 DOI: 10.3390/sports11070136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To comment on and explore (1) the prevalence of clinical knee and hip osteoarthritis (OA); (2) the association between pain or function and clinical knee or hip OA; (3) the association between injury or surgery and clinical knee or hip OA. METHODS Participants were recruited from FIFPRO members. A total of 101 footballers consented to answer (1) a developed questionnaire, (2) patient-reported outcome measures, and (3) be evaluated by their team physician for clinical knee or hip OA. RESULTS Of the 53% evaluated for clinical knee and hip OA, a prevalence of 9.43% and 7.55% of knee and hip OA, respectively, was found. There was a significant and strong association between knee (p = 0.033; Cramers v Value = 0.523) and hip pain (p = 0.005; Cramers v Value = 0.602) and clinical OA. A significant association existed between Hip dysfunction and Osteoarthritis Outcome short form Scores and clinical OA of the hip (p = 0.036). The odds of clinical knee OA were 1.5 and 4.5 times more after one or more injuries or surgeries, respectively. There was no association between playing position and clinical OA. CONCLUSION There is a low prevalence of a clinical knee or hip OA in the active professional male footballer. Pain may be a valid symptom to predict or monitor knee or hip OA. Validated assessment tools should be utilised to identify a negative effect on function. The odds of developing clinical OA in the knee with the number of injuries or surgeries. The hip presents with earlier clinical signs of OA compared to the knee.
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Affiliation(s)
- Lervasen Pillay
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands; (L.P.)
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Dina C. Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Gopika Ramkilawon
- Department of Statistics, University of Pretoria, Pretoria 0028, South Africa
| | - Mario Maas
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105 Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105 Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105 Amsterdam, The Netherlands
| | - Emmanuel Orhant
- French Football Federation (FFF), Clairefontaine Medical Centre, FIFA Medical Center of Excellence, 93216 Clairefontaine, France
| | - Jussi Rantanen
- Orthopaedics and Sports Clinic, Mehilainen NEO Hospital, 20520 Turku, Finland
| | - Jari Salo
- Sports Hospital Mehilainen, 41400 Helsinki, Finland
| | - Gino Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands; (L.P.)
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105 Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105 Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105 Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, 1105 Amsterdam, The Netherlands; (L.P.)
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
- Academic Center for Evidence-Based Sports Medicine (ACES), 1105 Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, 1105 Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, 1105 Amsterdam, The Netherlands
- Football Players Worldwide (FIFPRO), 2132 Hoofddorp, The Netherlands
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Corsini A, Bisciotti A, Canonico R, Causarano A, Del Vescovo R, Gatto P, Gola P, Iera M, Mazzoni S, Minafra P, Nanni G, Pasta G, Pulcini I, Salvatori S, Scorcu M, Stefanini L, Tenore F, Palermi S, Casasco M, Calza S. Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The "Italian Injury Study" during the Serie a Championship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5182. [PMID: 36982090 PMCID: PMC10048896 DOI: 10.3390/ijerph20065182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury. METHODS A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database. RESULTS Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19. CONCLUSIONS This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stefano Mazzoni
- Sport Medicine Department—Milan Lab, Associazione Calcistica Milan, 20149 Milano, Italy
| | | | - Gianni Nanni
- Bologna Football Club 1909, 40132 Bologna, Italy
| | | | | | | | | | | | | | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | | | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy
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