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

A Scoping Review on the Influence of Contextual Factors on Training Load in Adolescent Soccer Players: What Do We Know?

This scoping review aimed to systematically explore the breadth and extent of the literature regarding the relationship between contextual factors (CFs) and training load (TL) in adolescent soccer players. Further aims included comprehending potential underlying mechanisms and identifying knowledge gaps. CFs were defined as factors not part of the main training process, such as the coach-athlete relationship and educational responsibilities. PubMed, EBSCO APA PsycINFO, Web of Science, ProQuest Dissertations & Theses A&I, and SportRxiv were searched. Studies involving adolescent soccer players that investigated the CF-TL relationship and measured TL indicators were deemed eligible. Seventeen studies were included, reflecting the limited number of articles published regarding the CF-TL relationship. CFs were mostly related to match-play (N = 13) and phase of the season (N = 7). Moreover, these factors appeared to affect TL. CF related to players' personal environment (N = 3) were underrepresented in the reviewed studies. Overall, the CF-TL relationship appears to be rarely scrutinized. A likely cause for this lack of research is the segregation of the physiological and psychological research domains, where the CF-TL relationship is often speculated upon but not measured. Therefore, a holistic approach is warranted which also investigates the effect of personal environment, such as stressful life stress events, on TL.

Economic impact of muscle injury rate and hamstring strain injuries in professional football clubs. Evidence from LaLiga

The aims of this study were: 1) to describe the total muscular injuries, and specifically HSIs, and their corresponding missed matches; 2) to analyse their economic impact; and 3) to estimate the loss of incomes due to TV rights, in first division clubs from LaLigaTM depending on the expected and actual ranking position during the 2018/2019 season. To do that, a cross-sectional study for season 18/19 and for all players of the 20 Spanish professional football clubs was performed. The economic impact of injuries was estimated considering the missed matches and salary cost of all players and the audio-visual income loss was estimated considering the Spanish Royal Decree of Law (RDL 5/2015). The high number of muscular (270) and hamstring injuries (57) implies a high cost for professional first division football clubs, specifically € 365,811 per month for the former and € 47,388 per month for the latter. In addition, reaching a worse than expected position in LaLigaTM ranking involved a loss of 45,2 million € in TV rights incomes. The high cost of muscle injuries in first division teams justifies the need for multidisciplinary teams that are capable of reducing the number of injuries as well as recovery times.

Health status of university football athletes through multidimensional screening

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Athlete Identity, Resilience, Satisfaction with Life and Well-Being of Para Badminton Players: A Multinational Survey

Objective

To explore regional differences (i.e. Europe, Asia and others) in the well-being of para-athletes and its potential psychosocial determinants, including the Athletic Identity Measure Scale (AIMS), the Brief Resilience Scale (BRS) and the Satisfaction with Life Scale (SWLS).

Methods

The study was a cross-sectional survey using data from multinational badminton federations. The study participants were athletes registered in the Para Badminton Classification Master List of the Badminton World Federation (BWF). The main study outcome is the WHO Quality of Life-Disability Questionnaire (WHOQOL-DIS).

Results

There were 1,385 (aged 36 years old, IQR 18 years old) registrants on the master list. Respondents totaled 170. Only 137 (65% were males) were included in the analysis after excluding those with missing data (Europe 40%, Asia 30%, others 30%). Following the results of factor analysis, the original Athletic Identity Measure Scale (AIMS) was separated into self-identity (SI) and AIMS-modified. SI, AIMS-modified, the BRS and the Satisfaction with Life Scale (SWLS) were all scored above average. The AIMS-modified scores of Europeans were significantly lower than those of other non-Asians (U = 757.000, P < 0.05). BRS was statistically higher among those with acquired disabilities (median: 3.33) compared to those with congenital disabilities (median: 3.0) (U = 1,717.000, Z = -2.711, P < 0.05) and among Europeans (median: 3.3) compared to Asians (median: 3.0) (U = 704.500, P < 0.05). The regression model explained 32% of the variability in quality of life (QOL) with five significant predictors. The SWLS (β = 0.307, P = 0.01), BRS (β = 0.269, P = 0.01), full-time employment (β = 0.191, P = 0.05) and being female (β = 0.162, P = 0.05) all had a positive effect on QOL, but not the AIMS (-0.228, P = 0.05).

Conclusion

The results show that the athletes' resilience, satisfaction with life and identity vary across regions. Furthermore, satisfaction with life, employment and gender were found to be significant predictors of athletes' QOL.

Relationship Between Athletes' History of Stressors and Sport Injury: A Systematic Review and Meta-Analysis

A history of stressors in athletes represents psychosocial factors that may lead to sport injury. However, empirical studies have provided varying results for the relationship between stress history and sport injury. We examined prior literature on the stress history - sport injury relationship within a systematic review and, by meta-analysis, we offered a pooled estimate of the strength of this relationship. We searched seven major academic databases (Sportdiscus, Psyinfo, Academic Search Premier, Ovid, Scopus, Web of Science, and PubMed) from January 2000 to September 2023 and identified 19 empirical studies that examined injuries in sports contexts for meta-analysis. In 19 empirical studies of moderate to high publication quality, we found moderate heterogeneity (Q(17) = 98.61; p < .001), low sensitivity (I2 77.82-83.77), and low publication bias (Z-value = 7.74; p < .001). Further, using a random effect estimate-r, we found a low but significant correlation between stress history and sport injury, yielding a small overall effect size (ES) of r = .12. Furthermore, moderation analyses found adolescents (r = .14), contact-sport athletes (r = .09), non-elite athletes (r = .13), and non-European athletes (America r = .16; Asia r = .14; Oceania r = .14) to have a relatively higher ES than their counterparts in this stress history/sport injury relationship. We concluded that inevitable life stressors may lead to many negative consequences for athletes, such that sports professionals should provide stress management educational programs to enhance athletes' health and well-being.

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

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

[Combined influence of psychological and biomechanical factors in muscular loads in soccer : A new approach for the prevention of muscle injuries]

When mental stress and musculoskeletal loading interact, the risk for injury increases due to altered body kinematics and increased muscle tension. These changes can be detected with musculoskeletal models, and mental loading and stress must be analyzed at emotional, cognitive, and behavioral levels. To investigate these kinematic and loading changes under stress, competitive athletes were subjected to mental stress during highly dynamic movements, and musculoskeletal models were used to analyze the biomechanical loading. It was shown that under mental stress, independent of the subjective perception, a strong change in muscle forces can occur. Accordingly, competitive athletes should undergo screenings to assess individual movement patterns and promote general stress resilience.

Clinical Commentary: Depression and Anxiety in Adolescent and Young Adult Athletes

Mental health (MH) symptoms and disorders are common in adolescents and young adults, and athletes may be at risk due to sport-specific triggers such as injury or illness as well as stressors related to performance, transition, or retirement from sport. Anxiety and depression are reported frequently in this age group, and early recognition and treatment can improve outcomes. The medical team (eg, athletic trainers or therapists, team physicians) should be familiar with the symptoms of depression and anxiety, recognize "red flags" for these symptoms and disorders, and seek to provide screening assessments and develop MH plans and MH emergency action plans. As a part of their scope of practice, team physicians should have the initial assessment and management of patients with these MH conditions and appreciate the importance of referrals to other MH providers with expertise caring for athletes. Athletic trainers are often the first point of contact for athletes who may be experiencing MH symptoms and therefore play a key role in early recognition and referrals to team physicians for early diagnosis and treatment. Additional resources that provide more in-depth information regarding the treatment and management of anxiety and depression are provided herein.

Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs

Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research that has included psychological factors and mental health variables when investigating the effect of LEA, dieting/restrictive eating and Relative Energy Deficiency in Sport (REDs), since the 2018 IOC consensus statement on REDs. Based on currently available data, early psychological indicators associated with problematic LEA are mood changes, fatigue and psychological conflict. More severe mental health outcomes associated with REDs are reduced well-being, elevated anxiety, depressive symptoms and eating disorders. We propose a psychological model that helps structure how possible risk factors (eg, body dissatisfaction, environmental demands or increased training load) and moderating (eg, gender, sport) and/or potential mediating (eg, social climate, self-esteem) factors are associated with LEA and ultimately REDs. The current scientific literature underscores the importance of including mental health factors when screening for REDs and for developing a clinical approach to address the psychological sequelae of REDs once diagnosed. An interdisciplinary perspective is recommended. Lastly, and importantly, the athlete perspective urges clinicians to not underestimate the drive for success and denial of health consequences that athletes demonstrate when pursuing their sport goals.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Do you have a good all-around view? Evaluation of a decision-making skills diagnostic tool using 360° videos and head-mounted displays in elite youth soccer

Elite youth players' decision-making skills are considered important predictors of adult performance in soccer. The presentation of 360° videos in head-mounted displays offers new potential for the diagnostic of these skills in talent development programs. This study evaluated a new diagnostic tool using soccer-specific 360° videos for assessing decision-making skills in youth academy (YA) players. The evaluation consisted of players' subjective feedback as well as the analysis of diagnostic and prognostic validity. It was hypothesized that high-level YA players achieve better diagnostic results than regional-level players, and U19 outperform U17 players. Moreover, YA players' diagnostic results should be positively associated with future adult performance level. During the 2018/19 season, N = 48 youth players participated in the diagnostic procedures (split-half reliability r = .78). Participants were shown 54 videos which terminated when the central midfielder received a teammate's pass. Participants were then asked how to best continue playing. The subjective evaluation explored YA players' experiences with the diagnostic tool via quantitative ratings (e.g., "How exciting was the task?", "How involved did you feel in the game situation?") and additional interviews. Diagnostic validity was examined in a balanced cross-sectional 2 × 2-design (performance level x age group) and prognostic validity in a 3-year prospective design. Sensitivity and case-by-case analyses completed the evaluation. The YA players provided positive quantitative ratings regarding their experienced immersion into the environment. Players' qualitative feedback indicated general acceptance of the diagnostic tool as well as it offered recommendations for improvements. Confirming the diagnostic validity, ANOVA revealed significant main effects for performance level (p < .001, η² = .29) and age group (p < .01, η² = .14). Contributing to the prognostic validity, the diagnostic results discriminated between YA players achieving a higher and a lower adult performance level ("League 1-4" vs. "League 5 or below") in adulthood (p < .05; d = 0.80). A ROC curve and the AUC showed that the correct assignment to the adult performance levels is possible with a 71% probability. YA players with a high decision-making accuracy had a six times higher chance of playing in "League 1-4". The results demonstrated empirical evidence for the new diagnostic tool in terms of YA players' acceptance and validity coefficients exceeding effect sizes of former studies. The technology provides opportunities to test soccer-specific situations demanding an all-around view that were not testable in former experimental settings. Further technological advancements will enable the realization of improvements recommended by the players. Nonetheless, case-by-case analyses suggest caution in using such a diagnostic as a selection tool in talent development programs.

Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach

BACKGROUND

Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure.

METHODS

This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition.

RESULTS

Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants' gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers.

CONCLUSION

The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure.

Predicting Severity of Head Collision Events in Elite Soccer Using Preinjury Data: A Machine Learning Approach

OBJECTIVE

To develop machine learning (ML) models that predict severity of head collision events (HCEs) based on preinjury variables and to investigate which variables are important to predicting severity.

DESIGN

Data on HCEs were collected with respect to severity and 23 preinjury variables to create 2 datasets, a male dataset using men's tournaments and mixed dataset using men's and women's tournaments, to perform ML analysis. Machine learning analysis used a random forest classifier based on preinjury variables to predict HCE severity.

SETTING

Four elite international soccer tournaments.

PARTICIPANTS

Elite athletes participating in analyzed tournaments.

INDEPENDENT VARIABLES

The 23 preinjury variables collected for each HCE.

MAIN OUTCOME MEASURES

Predictive ability of the ML models and association of important variables.

RESULTS

The ML models had an average area under the receiver operating characteristic curve for predicting HCE severity of 0.73 and 0.70 for the male and mixed datasets, respectively. The most important variables for prediction were the mechanism of injury and the event before injury. In the male dataset, the mechanisms "head-to-head" and "knee-to-head" were together significantly associated ( P = 0.0244) with severity; they were not significant in the mixed dataset ( P = 0.1113). In both datasets, the events "corner kicks" and "throw-ins" were together significantly associated with severity (male, P = 0.0001; mixed, P = 0.0004).

CONCLUSIONS

ML models accurately predicted the severity of HCE. The mechanism and event preceding injury were most important for predicting severity of HCEs. These findings support the use of ML to inform preventative measures that will mitigate the impact of these preinjury factors on player health.

Associations between health problems and athlete burnout: a cohort study in 210 adolescent elite athletes

Objectives

We studied associations between the burden of health problems and athlete burnout in a population of athletes from Norwegian Sport Academy High Schools.

Methods

This is a mixed prospective/retrospective cohort study. We included 210 athletes, 135 boys and 75 girls, from endurance, technical and team sports. We used the Oslo Sports Trauma Centres Questionnaire for Health Problems to collect 124 weeks of health data. During the first 26 weeks, athletes reported the health data prospectively using a smartphone app. For the following 98 weeks, we collected health data by interviewing athletes at the end of their third year in Sport Academy High School. At the time of the interview, the athletes also completed a web-based questionnaire, including the Athlete Burnout Questionnaire and covering social relations in sports and school, coach relations and living conditions.

Results

A greater burden of health problems was associated with a higher score for athlete burnout (B: 0.16, 95% CI 0.09 to 0.22, p<0.001). In a multivariable model, this was true for both illnesses (B: 0.21, 95% CI 0.10 to 0.32, p<0.001), acute injuries (B: 0.16, 95% CI 0.04 to 0.27, p=0.007) and overuse injuries (B: 0.10, 95% CI 0.002 to 0.18, p=0.011). This was also true in gender and sports category subgroups. The coach having a high influence on training week was associated with a lower score for athlete burnout.

Conclusion

A greater burden of health problems was associated with greater symptoms of athlete burnout in athletes attending Sport Academy High Schools.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

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

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

Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A Mixed-Studies Systematic Review

Background

While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries.

Objective

The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes.

Design

Systematic review.

Data Sources

MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists.

Eligibility Criteria for Selecting Studies

Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies.

Results

Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries.

Conclusions

There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01597-5.

4BR: Educational Training Programme for the Prevention of Sports Injuries in Young Athletes

This article provides a vision of the importance of the recovery process for the prevention of injuries in young athletes. From a sports psychology perspective, it presents a proposal for an optimisation programme to reduce the negative impact of exertion and subsequent risk of injury. The 4BR programme consists of three sub-programmes (technician advice, vulnerability detection, and the implementation of four recovery habit blocks). An interdisciplinary approach is taken to configure the four healthy blocks: nutrition-hydration, relaxation-rest, social life and personal moments. It demonstrates the importance of personalised adaptation to the sports context and moment in order to achieve maximum effectiveness of the proposed 4BR programme, which comprises workshops, exercises, evaluation systems and information feedback. The presented programme facilitates recovery, optimizes the return to training and reduces the risk of intrinsic injuries in young people. The conclusion drawn from the study is that there is a need to conduct further research to find empirical evidence of the positive effects of applying the 4BR programme to different sports.

Psychological risk profile for overuse injuries in sport: An exploratory study

Overuse injuries account for a substantial part of sport injury incidence among athletes of various sports and levels. Despite the gradual onset of symptoms, athletes often persevere in training and competing. The present exploratory study aimed to identify a psychological risk profile for overuse injury. One hundred and forty-nine athletes competing in various sports responded to a range of questionnaires measuring the following psychological variables: negative life stress, perfectionistic concerns, perfectionistic strivings, athletic identity, and the coach-athlete relationship. Participants subsequently answered the OSTRC Overuse Injury Questionnaire on a weekly basis during a 10-week period. Using a latent profile analysis, athletes were classified into three latent profiles regarding their psychological characteristics. Athletes in the second profile, characterized by a combination of high athletic identity, perfectionistic concerns and negative life stress and poor coach-athlete relationship, were found to be significantly more often affected by overuse injuries (74% of the time) than individuals in the two other profiles (52% and 48% of the time, respectively). In conclusion, psychological factors may contribute to the risk of overuse injuries through complex interactions (i.e. accounting for interdependencies within a specific configuration of variables) rather than through their independent influences.

Injury Profile in Women's Football: A Systematic Review and Meta-Analysis

BACKGROUND

Football is the most popular sport among women; however, little is known about the injury profile in this population. This information would help design tailored injury risk mitigation strategies that may make football safer for women.

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis of epidemiological data of injuries in women´s football.

METHODS

A systematic review following PRISMA guidelines was performed up to January 2020 in PubMed, Web of Science, Sportdiscus and the Cochrane Library databases. Twenty-two studies reporting the incidence of injuries in women football were analysed. Two reviewers independently extracted data (intraclass correlation coefficient [ICC] for inter-reviewer reliability = 0.87) and assessed study quality using the STROBE statement, GRADE approach, Newcastle Ottawa Scale and Downs and Black assessment tools. Studies were combined in pooled analyses (injury incidence and injury proportion) using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in female football players was 6.1 injuries/1000 h of exposure. Match injury incidence (19.2 injuries/1000 h of exposure) was almost six times higher than training injury incidence rate (3.5 injuries/1000 h of exposure). Lower extremity injuries had the highest incidence rates (4.8 injuries/1000 h of exposure). The most common types of injuries were muscle/tendon (1.8 injuries/1000 h of exposure) and joint (non-bone) and ligament (1.5 injuries/1000 h of exposure), which were frequently associated with traumatic incidents. Slight/minimal injuries (1-3 days of time loss) were the most common. The incidence rate of injuries during matches in the top five world ranking leagues was higher than the rest of the leagues (19.3 vs 10.7 injuries/1000 h of exposure, respectively). The weighted injury proportion was 1.1 (95% confidence interval = 0.6-1.7) whereby on average players sustained more than one injury per season.

CONCLUSIONS

Female football players are exposed to a substantial risk of sustaining injuries, especially during matches that require the highest level of performance. To markedly reduce overall injury burden, efforts should focus on introducing and evaluating preventative measures that target match specific dynamics to make football players more capable of responding to the challenges that they have to deal with during match play.

REGISTRATION

This systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42019118152).

Player Wellness (Soreness and Stress) and Injury in Elite Junior Australian Football Players Over 1 Season

Purpose: To investigate the association between player wellness and injury in elite junior Australian football players over 1 competitive season. Methods: Prospective cohort study. Elite junior Australian football players (N = 196, average age = 17.7 y, range = 16–18 y) were recruited in the under-18 state league competition in Victoria, Australia. They recorded their wellness (sleep, fatigue, soreness, stress, and mood) according to a 5-point Likert scale 3 times weekly, with injuries (missed match/training session) entered into an online sport-injury surveillance system. A logistic generalized estimating equation was used to examine the association (expressed as odds ratio [OR]) between wellness and injury (yes/no). Results: Soreness was associated with injury at each time point across the week, with the strongest association evident for soreness reported 6 d postmatch (OR = 1.30; 95% confidence interval [CI], 1.17–1.44; P < .001). Stress and injury were associated with injury for average stress values across the week, as well as specifically on day 1 postmatch (OR = 1.10; 95% CI, 1.01–1.21; P = .038). Mood reported in the middle of the week (3 d postmatch) was associated with injury (OR = 0.87; 95% CI, 0.78–0.97; P = .014), as was fatigue (OR = 1.10; 95% CI, 1.00–1.22; P = .044). Conclusions: This study demonstrates key associations between wellness and injury in elite junior Australian football, specifically soreness, stress, fatigue, and mood. Monitoring strategies help identify injury-risk profiles, which can help decision makers (coaches or medical staff) intervene when relevant to reduce injury risk.

Limited Coping Skills, Young Age, and High BMI Are Risk Factors for Injuries in Contemporary Dance: A 1-Year Prospective Study

This study investigated potential risk factors (coping, perfectionism, and self-regulation) for substantial injuries in contemporary dance students using a prospective cohort design, as high-quality studies focusing on mental risk factors for dance injuries are lacking. Student characteristics (age, sex, BMI, educational program, and history of injury) and psychological constructs (coping, perfectionism, and self-regulation) were assessed using the Performing artist and Athlete Health Monitor (PAHM), a web-based system. Substantial injuries were measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems and recorded on a monthly basis as part of the PAHM system. Univariate and multivariate logistic regression analyses were conducted to test the associations between potential risk factors (i.e., student characteristics and psychological constructs) and substantial injuries. Ninety-nine students were included in the analyses. During the academic year 2016/2017, 48 students (48.5%) reported at least one substantial injury. Of all factors included, coping skills (OR: 0.91; 95% CI: 0.84-0.98), age (OR: 0.67; 95% CI: 0.46-0.98), and BMI (OR: 1.38; 95% CI: 1.05-1.80) were identified as significant risk factors in the multivariate analysis. The model explained 24% of the variance in the substantial injury group. Further prospective research into mental risk factors for dance injuries with larger sample sizes is needed to develop preventive strategies. Yet, dance schools could consider including coping skills training as part of injury prevention programs and, perhaps, providing special attention to younger dancers and those with a higher BMI through transitional programs to assist them in managing the stress they experience throughout their (academic) career.

Overuse Injury: The Result of Pathologically Altered Myofascial Force Transmission?

Overuse injuries are suggested to result from repetitive microdamage eliciting pain in the affected tissue. Therapy commonly focuses on the area of symptom localization; however, such approach may oversimplify the true etiopathology. This review hypothesizes that the development of some sports-related soft tissue disorders, such as plantar fasciitis or lumbago, is promoted by pathologically altered force transmission from anatomically connected structures.

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

Current Approaches to the Use of Artificial Intelligence for Injury Risk Assessment and Performance Prediction in Team Sports: a Systematic Review

Background

The application of artificial intelligence (AI) opens an interesting perspective for predicting injury risk and performance in team sports. A better understanding of the techniques of AI employed and of the sports that are using AI is clearly warranted. The purpose of this study is to identify which AI approaches have been applied to investigate sport performance and injury risk and to find out which AI techniques each sport has been using.

Methods

Systematic searches through the PubMed, Scopus, and Web of Science online databases were conducted for articles reporting AI techniques or methods applied to team sports athletes.

Results

Fifty-eight studies were included in the review with 11 AI techniques or methods being applied in 12 team sports. Pooled sample consisted of 6456 participants (97% male, 25 ± 8 years old; 3% female, 21 ± 10 years old) with 76% of them being professional athletes. The AI techniques or methods most frequently used were artificial neural networks, decision tree classifier, support vector machine, and Markov process with good performance metrics for all of them. Soccer, basketball, handball, and volleyball were the team sports with more applications of AI.

Conclusions

The results of this review suggest a prevalent application of AI methods in team sports based on the number of published studies. The current state of development in the area proposes a promising future with regard to AI use in team sports. Further evaluation research based on prospective methods is warranted to establish the predictive performance of specific AI techniques and methods.

Electronic supplementary material

The online version of this article (10.1186/s40798-019-0202-3) contains supplementary material, which is available to authorized users.

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

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

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

Motivational Climate in Sport Is Associated with Life Stress Levels, Academic Performance and Physical Activity Engagement of Adolescents

The present study sought to define and contrast an explanatory model incorporating motivational climate towards sport, life stress, academic performance, and engagement in physical activity, and to analyze the existing relationships between these variables as a function of sex. A total of 2452 adolescents of both sexes (42.7% males and 57.3% females) participated in the present study, with self-reported ages between 13 and 16 years (M = 14.43; SD = 1.15). Participants were from Granada (Spain) and perceived motivational climate towards sport (PMCSQ-2), life stress (PSS), academic performance, and engagement in physical activity (PAQ-A) were analyzed. A multi-group structural equation model was constructed, which demonstrated excellent fit to the observed data (χ² = 309.402; DF = 40; p < 0.001; CFI = 0.973; NFI = 0.970; IFI = 0.973; and RMSEA = 0.052). A negative and direct association exists between ego climate and task climate. A positive association was found between motivational climate, task climate (males r = 0.336/females r = 0.238), and ego climate (males r = 0.198/ females r = 0.089) and engagement in physical activity. A task climate was associated with better academic performance and lower levels of life stress. The main conclusions of this study highlight that a task-involving climate and engagement in physical activity are both associated with lower levels of life stress and higher levels of academic performance.

Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs

OBJECTIVES

We investigated medical staff interpretations and descriptions of internal communication quality in elite football teams to determine whether internal communication was correlated with injuries and/or player availability at training and matches.

METHODS

Medical staff from 36 elite football clubs across 17 European countries produced 77 reports at four postseason meetings to provide their perceptions of internal communications in their teams. They also recorded data on individual players' exposure to football and time-loss injuries.

RESULTS

The injury burden and incidence of severe injuries were significantly higher in teams with low quality of communication between the head coach/manager and the medical team (scores of 1-2 on a 5-point Likert scale) compared with teams with moderate or high-quality scores (scores of 3-5; p=0.008 for both). Teams with low scores had 4%-5% lower training attendance (76% vs 83%, p=0.001) and less availability at matches (82% vs 88%, p=0.004) compared with teams with moderate or high communication quality scores.

CONCLUSIONS

The quality of internal communication within a team was correlated with injury rates, training attendance and match availability.

Monitoring Training Loads and Perceived Stress in Young Elite University Athletes

With increased professionalism in sport there has been a greater interest in the scientific approach to training and recovery of athletes. Applying appropriate training loads along with adequate recovery, is essential in gaining maximal adaptation in athletes, while minimizing harm such as overreaching, overtraining, injury and illness. Although appropriate physical stress is essential, stress for many athletes may come from areas other than training. Stress from may arise from social or environmental pressure, and for many athletes who combine elite athletic training with university study, academic workloads create significant stress which adds to the constant pressure to perform athletically. This research aimed to determine if subjective stressors were associated with counterproductive training adaptations in university athletes. Moreover, it aimed to elucidate if, and when, such stressors are most harmful (i.e., certain times of the academic year or sports training season). We monitored subjective (mood state, energy levels, academic stress, sleep quality/quantity, muscle soreness, training load) and objective (injury and illness) markers in 182 young (18–22 years) elite athletes over a 4-year period using a commercially available software package. Athletes combined full-time university study with elite sport and training obligations. Results suggest athletes were relatively un-stressed with high levels of energy at the beginning of each university semester, however, energy levels deteriorated along with sleep parameters toward the examination periods of the year. A logistical regression indicated decreased levels of perceived mood (0.89, 0.85–0.94, Odds Ratio and 95% confidence limits), sleep duration (0.94, 0.91–0.97) and increased academic stress (0.91, 0.88–0.94) and energy levels (1.07, 1.01–1.14) were able to predict injury in these athletes. Examination periods coincided with the highest stress levels and increased likelihood of illness. Additionally, a sudden and high increase in training workload during the preseason was associated with an elevated incidence of injury and illness (r = 0.63). In conclusion, young elite athletes undertaking full-time university study alongside their training and competition loads were vulnerable to increased levels of stress at certain periods of the year (pre-season and examination time). Monitoring and understanding these stressors may assist coaches and support staff in managing overall stress in these athletes.