An examination of injuries in major league soccer. The inaugural season

A Rehabilitation Algorithm After Lateral Ankle Sprains in Professional Football (Soccer): An Approach Based on Clinical Practice Guidelines

Lateral ankle sprain (LAS) is one of the most common types of injury in professional football (soccer) players with high risk of recurrence. The rehabilitation after LAS in professional football players is often still time-based and relies on anecdotal experience of clinicans. There is still a lack of utilization of criteria-based rehabilitation concepts after LAS in professional football. The aims of this clinical commentary are (1) to critically discuss the need for criteria-based rehabilitation concepts after LAS in professional football players, (2) to highlight the current lack of these approaches and (3) to present a novel clinical guideline-based rehabilitation algorithm. Short time-loss (15 days) and high recurrence rate (17%) raise the question of trivialization of LAS in professional football. Despite consequences for many stakeholders involved (players, teams, clubs, insurers), there is still a lack of of criteria-based, step-by-step approaches. The use of a criteria-based rehabilitation approach might reduce the high recurrence rate after LAS in professional football players and will lead, in turn, to increased long-term player availability. Practical experiences of he authors demonstrate the feasibility of such an approach. The effectiveness of this novel rehabilitation algorithm remains to be evaluated in future studies. Level of Evidence: 5.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Arthroscopic debridement and microfracture for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint: A case report

RATIONALE

Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few reports. Additionally, bilateral cases are extremely rare. Therefore, the clinical outcomes of the surgical treatment for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint have not been fully elucidated.

PATIENT CONCERNS

A 16-year-old boy who played soccer presented to our hospital with bilateral hindfoot pain. The symptoms persisted even after 3 months of conservative treatment. The patient and family requested surgical treatment to relieve the symptoms.

DIAGNOSES

The patient was diagnosed with bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint based on computed tomography and magnetic resonance imaging findings.

INTERVENTIONS

Arthroscopic debridement and microfracture were performed bilaterally.

OUTCOMES

Postoperative computed tomography and magnetic resonance imaging of both feet revealed remodeling of the subchondral bone. The patient returned to play at the pre-injury level with no pain.

LESSONS

This report describes a case of bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint. Arthroscopic debridement and microfracture were effective in relieving symptoms and the subchondral bone remodeling. To the best of our knowledge, this is the first report of arthroscopic treatment of osteochondral lesions of the lateral process of the talus involving the subtalar joint.

A Thirteen-Year Analysis of Facial Fractures among Professional Soccer Players

This study aims to identify the epidemiology and effects of facial fractures on return to play (RTP) in Major League Soccer (MLS) and the English Premier League (EPL). A total of 39 MLS players and 40 EPL players who sustained facial fractures from 2007 to 2019 were identified. Data on player demographics, the injury, and the impact of their injury on RTP were collected. Elbow-to-head was the most common mechanism of injury (20.3%). The most common fracture involved the nasal bone (48.3%). Most players (90%) RTP the same season. Players who sustained nasal fractures missed significantly fewer games (p < 0.001) than those who suffered other craniofacial fractures. Players treated surgically missed significantly more games (3.21 vs. 0.71, p = 0.006) and days (30.1 vs. 8.70, p = 0.002) than those managed nonoperatively. Significantly more EPL players who sustained facial fractures wore headgear upon RTP compared to MLS players (82% vs. 56%, p <0 .01). Most professional soccer players who sustain a facial fracture RTP the same season, but their recovery time can vary depending on the type of fracture, injury management, or injury severity. Our findings can help inform future craniofacial injury management as well as guidelines on player safety and fracture prevention.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Patterns of ankle injury in soccer: MRI clues to traumatic mechanism

Understanding the traumatic mechanisms of ankle injuries in soccer is crucial for an accurate and complete MRI diagnosis. Many ankle injuries share universal mechanisms seen in other athletic activities, but certain patterns are found to be more specific and relatively unique to soccer. Ankle impingement syndromes encountered in soccer encompass a spectrum of disorders that include anterior and posterior impingement categories, with anterior impingement representing pathology relatively specific to soccer. Lateral ligamentous sprains are one of the most common injuries; however, there is a higher rate of injuries to the medial structures in soccer as compared to other sports. Ankle fractures are uncommon in soccer while bone contusions and chondral and osteochondral injuries frequently accompany ligamentous sprains. Tendon abnormalities in soccer most commonly result from overuse injuries and typically affect peroneal tendons, posterior and anterior tibialis tendons, and Achilles tendon. Acute Achilles tendon ruptures occur in both recreational players and elite soccer athletes. Tibialis anterior friction syndrome may mimic tibial stress fractures. Long-term sequelae of acute traumatic and chronic overuse ankle injuries in professional soccer players manifest as ankle osteoarthritis that is more prevalent compared to not only the general population, but also to former elite athletes from other sports. This article examines the most common and specific injuries in soccer in order of their frequency.

Epidemiology of Injuries in Professional and Amateur Football Men (Part II)

Background (1): Men's football is a physically demanding contact sport that involves intermittent bouts of sprinting, jogging, walking, jumping and changes of direction. The physical demands of the game vary by level of play (amateur club, sub-elite and open club or international), but injury rates at all levels of the men's football game remain the highest of all sports. Objective: The aim of this study is to conduct a systematic review of data from the epidemiological literature regarding the profile, severity and mechanisms of injuries and the frequency of recurrent injuries in professional and amateur football players. Methods (2): A systematic review, according to PRISMA guidelines, was performed up to June 2023 in the databases of PubMed, Web of Science, Google academic, Google scholar and the Diva portal. Twenty-seven studies that reported data on the type, severity, recurrence and mechanisms of injury in professional and amateur men's football were selected and analyzed. Two reviewers independently audited data and assessed the study quality using the additional and adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): In professional male football players, the mean prevalence of muscle/tendon injuries was 39.78%, followed by joint and ligament injuries-21.13%, contusions-17.86%, and fractures-3.27%, and for amateur football players, the prevalence's were 44.56% (muscle/tendon injuries), 27.62% (joint and ligament injuries), 15.0% (contusions) and 3.05% (fracture), respectively. The frequency of traumatic injuries was higher in amateur football players (76.88%) compared to professional football players (64.16%), the situation being reversed in the case of overuse injuries: 27.62% in professional football players and 21.13% in amateur football players. Most contact injuries were found in professional footballers (50.70%), with non-contact injuries predominating in amateur footballers (54.04%). The analysis of the severity of injuries showed that moderate injuries dominated in the two categories of footballers; the severe injuries in amateur footballers exceeded the severe injuries recorded in professional footballers by 9.60%. Recurrence proportions showed an inverse relationship with the level of play, being higher in amateur footballers (16.66%) compared to professional footballers (15.25%). Conclusions (4): Football-related injuries have a significant impact on professional and amateur football players and their short- and long-term health status. Knowing the frequency of severe diagnoses, such as strains, tears and cramps of the thigh muscles, ankle ligament sprains and hip/groin muscle strain requires the establishment of adequate programs to prevent them, especially in amateur football players, who are more prone to serious injuries.

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

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

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

OBJECTIVE

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

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

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

ELIGIBILITY CRITERIA

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

METHOD

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

RESULTS

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

CRD42020200022.

Injury prevention programs including balance exercises with compliance and follow-up reduce the incidence of knee injuries in athletes: A systematic review and meta-analysis

BACKGROUND: The knee is one of the most common injuries in sports. However, the incidence of knee injuries can be decreased by enhancing balance and neuromuscular control. OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate how injury prevention programs (IPPs) that include balance training influence knee injury rates in athletes. METHODS: Data were obtained from different databases (1985–2021). Only randomised controlled trials that used IPPs that include balance training, were considered. Two investigators extracted data from the qualifying documents. The critical outcome data elements derived from the included studies were the number of ACL/knee injuries, ACL/knee injury rates, exposure hours, compliance rate, and follow-up duration. RESULTS: Compared to the control groups, those who participated in the IPP had a 54% lower risk of knee injuries per 1000 hours of exposure (IRR 0.457 (95% CI 0.346–0.603), P= 0.001) and a 60% lower risk of ACL injuries per 1000 hours of exposure (IRR 0.401 (95% CI 0.215–0.750), P= 0.004). CONCLUSIONS: IPPs that include balance training may reduce the risk of knee injuries.

Time-loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta-analysis

A literature search was conducted to systematically review and meta-analyze time-loss and recurrence rate of lateral ankle sprains (LAS) in male professional football players. Six electronic databases (PubMed, Scopus, Web of Science, PEDRO, CINAHL, and Cochrane) were searched independently, separately both for time-loss and recurrence from inception until April 30, 2021. In addition, reference lists were screened manually to find additional literature. Cohort studies, case reports, case-control studies and RCT in English language of male professional football players (aged more than 16 years) for which data on time-loss or recurrence rates of LAS were available were included. A total of 13 (recurrence) and 12 (time-loss) studies met the inclusion criteria. The total sample size of the recurrence studies was 36,201 participants (44,404 overall initial injuries; 7944 initial ankle sprain [AS] injuries, 1193 recurrent AS injuries). 16,442 professional football players (4893 initial AS injuries; 748 recurrent AS injuries) were meta-analyzed. A recurrence rate of 17.11% (95% CI: 13.31-20.92%; df = 12; Q = 19.53; I² = 38.57%) based on the random-effects model was determined. A total of 7736 participants were part of the time-loss studies (35,888 total injuries; 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time-loss was 15 days (weighted mean: 15.92; median: 14.95; min: 9.55; max: 52.9). We determined a priori considerable heterogeneity (CI: 18.15-22.08; df = 11; Q = 158; I² = 93%), so that the data on time-loss are only presented descriptively. There is an average time-loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with higher recurrence rates than ACL injuries (9%-12%) in professional football players. Nevertheless, the focus of research in recent years has been mostly on ACL injuries. However, the high recurrence rates and long-term consequences show the necessity for research in the field of LAS in elite football. Yet, heterogeneous data lead to difficulties concerning the aspect of comparability.

Player Sex and Playing Surface Are Individual Predictors of Injuries in Professional Soccer Players

Background: The factors contributing to soccer injuries and their influence on the occurrence of injury are controversial and inconclusive. This study aimed to determine the association between player characteristics and playing factors with injuries in professional soccer players. Methods: One hundred and fifty-two professional soccer players completed a self-administered questionnaire that asked about demographic information and injury profile, the type of playing surface on which they sustained their injury, medical treatment, and the time lost due to soccer injury at the end of the soccer season. Results: The injury rate was 44.74% (n = 68; males: 61.50% (n = 56), females: 19.70% (n = 12)). Players’ age (OR: 1.15, 95%CI: 1.05−1.25, p < 0.002) and BMI (OR: 1.21, 95%CI: 1.06−1.38, p < 0.003) were significantly associated with soccer injuries. After adjusting for age and BMI, players’ sex (OR: 5.39, 95%CI: 2.11−13.75, p < 0.001), previous soccer injury (OR: 3.308, 95%CI: 2.307−29.920, p < 0.001), and playing surfaces (OR: 11.07, 95%CI: 4.53−27.03, p < 0.001) were the significant predictors of soccer injuries. Conclusion: Players’ age, BMI, sex, previous soccer injury, and playing surface were associated with injuries among professional soccer players. Old male athletes with high BMI, previous soccer injuries, and playing on natural grass were more likely to sustain soccer injuries than young female players with low BMI who had no previous injuries and played on synthetic surfaces.

Match activity profile of professional female soccer players during a season

It is necessary to understand movement characteristics of elite female soccer players during a match to develop effective training program. The purpose of this study is to analyze the physical demands of Korean female professional soccer players during a competitive season. Twenty-four female professional players (age: 27.8±3.9 years; height: 165.7± 5.1 cm) from a team, belonging to the women's professional soccer league in South Korea participated in the study. The players participated in 11 home matches and 10 away matches from April 26 to November 9 of the 2011 season. Body weight and body mass index decreased during the first half-season compared to the preseason (P<0.05), and the decreased values were maintained until the second half-season. Total distance covered by the players was more than 9.5 km per match. No difference was found in the total distance, movement distance by exercise intensities, number of sprints and accelerations, and maximum speed between the first half- and second half-seasons. Midfielders covered the most distance during a match compared to other positions (P<0.05). Wing forward covered the most distance of high-intensity exercise. Maximum speed during the match was higher among wing forward and forward than in other positions (P<0.05). There were no significant differences between home and away matches in all variables (P>0.05). In conclusion, in order to improve the performance of female soccer players and prevent injuries, a training program should be constructed that considers the characteristics of each player and playing position rather than uniform training in a team.

Analysis of Injury Patterns in Men's Football between the English League and the Spanish League

BACKGROUND

Injuries in professional football lead to reduced team performance and large financial losses. The aim of this study was to analyse injuries in the two best team competitions in the world (LaLiga and Premier League), establishing similarities and differences, as well as determining injury causation patterns.

METHODS

A total of 277 on-field injuries requiring a substitution were analysed (142 in the Spanish league and 135 in the English league). The analysis was performed using traditional statistical tests (frequency analysis, chi-square test) with SPSS 25 and a T-Patterns sequence analysis with THEME 5.0.

RESULTS

In the Spanish league, there were a similar number of injuries in the first part of the season as in the second part of the season, while in the English league, they are more frequent in the first part of the season. In the Spanish league, injuries are more frequent in the first half of the match, while in the English league, they are more frequent in the second half. The type of player most frequently injured was the defender. Most of the injuries occurred without the presence of an opponent. The accumulated minutes during the season affect injuries of the muscular type.

CONCLUSIONS

The most common type of injury in both leagues was a strain, followed by a sprain and a contusion. Although common injury patterns can be established between the two leagues, there are notable differences. One of the factors is determined by the English league calendar (many matches at Christmas). In Spain, there were more muscular injuries that were not caused by the opponent, while in England there were more tackling injuries. Age is a risk factor in the Spanish league. In this league, there is a moderately significant relationship between the number of injuries and the points won.

Incidence of Injury for Professional Soccer Players in the United States: A 6-Year Prospective Study of Major League Soccer

Background:

Despite an abundance of injury research focusing on European professional soccer athletes, there are limited injury data on professional soccer players in the United States.

Purpose:

To describe the epidemiology of injury across multiple years in Major League Soccer (MLS) players.

Study Design:

Descriptive epidemiology study.

Methods:

A web-based health management platform was used to prospectively collect injury data from all MLS teams between 2014 and 2019. An injury was defined as an incident that required medical attention and was recorded into the health management platform anytime over the course of the 2014-2019 seasons. Injuries and exposure data were recorded in training and match settings to calculate injury incidence.

Results:

A total of 9713 injuries were recorded between 2014 and 2019. A mean 1.1 injuries per year per player were identified, with midfielders sustaining the largest number of injuries. The most common injuries were hamstring strains (12.3%), ankle sprains (8.5%), and adductor strains (7.6%). The mean time missed per injury was 15.8 days, with 44.2% of injuries resulting in no days missed. Overall injury incidence was 8.7 per 1000 hours of exposure, declining over the course of the investigation, with a 4.1-times greater mean incidence during matches (14.0/1000 h) than training (3.4/1000 h).

Conclusion:

Between 2014 and 2019, the most commonly reported injuries in MLS players were hamstring strains, ankle sprains, and adductor strains. Injury incidence during matches was 4.1 times greater when compared with training, while overall injury incidence was found to decline during the course of the study period.

The Uptake of Nordic Hamstring Exercise Program for Injury Prevention in Major League Soccer and Its Barriers to Implementation in Practice

CONTEXT

It is well demonstrated that Nordic hamstring (NH) program has poor compliance across European soccer clubs, but little is known about its implementation in Major League Soccer (MLS). The authors aimed to investigate MLS hamstring prevention practices and compliance with the NH program and understand the reasons for its inclusion or exclusion.

DESIGN

A cross-sectional electronic survey was completed by 24 of the 26 (92%) MLS top-division soccer clubs.

METHODS

The survey, based on the Reach, Efficacy, Adoption, Implementation, and Maintenance framework, was sent to team medical staff. Medical staff were also asked for opinions on barriers to implementation.

RESULTS

Eighteen clubs (75%) reported a formal hamstring injury prevention program, with eccentric exercises (94%; 95% CI [confidence interval], 74%-99%), high-speed running (94%; 95% CI, 74%-99%), and NH exercises (89%; 95% CI, 67%-97%) the most common strategies adopted. Fifteen clubs partially implemented the NH program, but only 5 (21%; 95% CI, 9%-40%) completed the full program and were classed as compliant. A total of 20 respondents reported that player perception and muscle soreness (83%; 95% CI, 64%-93%) were barriers to the implementation of the NH program. On a 5-point Likert scale, respondents "partially agreed" (4.13 [0.80]) that the NH exercise could substantially reduce injuries and would be "effective" at their own club (3.88 [0.61]).

CONCLUSIONS

The NH exercise was valued, but negative player perception and muscular soreness were identified as barriers to implementing the full program. Manipulation of volume and frequency should inform future "effectiveness" research to prospectively assess such modifications in the context of MLS.

Patterns of Injury in the Spanish Football League Players

BACKGROUND

The study of football injuries is a subject that concerns the scientific community. The problem of most of the available research is that it is mainly descriptive. The objective of this study is to discover and analyse the patterns of injury in the Spanish Football League (2016-2017 season).

METHODS

The sample data consisted of 136 given injuries identified by the official physicians of the football clubs. The analysis was performed by using traditional statistic tests, T-pattern detection and polar coordinate analysis.

RESULTS

The analysis revealed several patterns of injury: (a) The defender suffered a rupture of the hamstring muscles after a sprint, (b) knee sprains happened due to a received tackle, (c) fibrillar adductor rupture appeared mostly among defenders and (d) fibrillar ruptures took place mostly throughout the first part.

CONCLUSIONS

There is a marked shift in the tendency regarding the player who gets more injured, from the midfielder to the defender. The most common injury was fibrillar rupture. The most common scenario in which this injury occurred was that in which the player injured himself after a sprint (24%). A week without competing seems to be insufficient as a prevention mechanism for injuries.

PROSPECTIVE STUDY OF INJURIES OCCURRED DURING BRAZILIAN FOOTBALL CHAMPIONSHIP IN 2019

Objective:

To determine the incidence and risk factors for injuries that occurred during the matches of the Brazilian Football Championship.

Methods:

A prospective study was carried out with the collection of data referring to injuries that occurred during the 2019 Brazilian Football Championship. The injuries were recorded by the responsible physician of each team, through an online injury mapping system.

Results:

Among the 645 athletes who were included in the study, 214 (33.2%) of the players had at least one injury during the tournament. In total, 257 injuries were recorded during the Brazilian Championship, with an average of 0.68 injuries per game. 59.1% of the injured athletes were over 26 years old. The most common type of injury was muscle strain (37.7%) and forwards were the most affected (33.6%).

Conclusion:

Muscle injuries were the most frequent in the tournament, with the thigh muscles being the most affected. Most of the affected players were over 26 years old, there were 20.5 injuries for every 1000 hours of play and the incidence of injuries was approximately 33%, with attackers being the most affected (33.6%). Level of Evidence III, Study of nonconsecutive patients; without consistently applied reference “gold” standard.

INCIDENCE OF INJURIES IN SOCCER PLAYERS – MAPPINGFOOT: A PROSPECTIVE COHORT STUDY

ABSTRACT Introduction: Although the positive effects of physical activity on global health are well documented, sports practice is associated with a greater risk of injury; in professional soccer in particular, the risk is substantial. Objective: The primary objective of this study was to investigate the incidence of injuries among male athletes competing in the regional soccer championship. The secondary objective was to determine the prevalence of injuries. Methods: In this prospective cohort study, level of evidence II, the incidence and prevalence of injuries were assessed using an adapted version of the UEFA Champions League Study questionnaire. Results: This study included 310 male athletes from ten teams, aged 26.53±4.75 years, height 180.93±6.49 cm, and weight 79.32±8.29 kg, with a 4-month follow-up. Ninety-two injuries were recorded, representing a prevalence of 29.68% injuries. The body part most frequently injured was the lower limbs (86.9%). The main types of injuries were muscle tear/strain (37.0%), sprain/ligament (19.6%), and other injuries (14.1%). The injuries were mainly caused during run/sprint (33.7%), kick (12.0%) and jumping/landing (6.5%). The incidences of injuries were 15.88±8.57, 2.04±1.09, and 3.65±1.50 injuries/1000h of exposure during matches, training, and matches/training, respectively. Time-loss over the season was between 1 and 50 days, and the severity of the injuries was as follows: light (25%), minor (22.8%), moderate (43.5%) and severe (8.7%). Conclusion: This study suggests that there is a higher incidence of injuries during matches compared to training, among male regional soccer championship players. The lower limbs are the body part most affected, with a higher prevalence of rupture/strain in the thigh region, during running/sprinting. Level of evidence II; Prospective Cohort Study .

Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Hamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

Meniscal Injuries in the Olympic and Elite Athletes

INTRODUCTION

Elite and Olympian athletes are often stretching the upper limits of normal physiology and biomechanics of the musculoskeletal system in their efforts to excel in their sport. For them to get back to their sport at the same level after injury, the management, repair techniques, and rehabilitation protocols should be robust to permit healing of tissues to allow supra-normal loading and performance. The knee and the meniscus are commonly injured in these sports. Yet, the incidence, mechanisms, types of injuries to the meniscus, and their management are not known across different sports in the Olympics.

METHODS

We set out to look into the incidence and the trends of publications on meniscal injuries of the knee in Olympic games. A search of the PubMed and Scopus for these injuries using a search strategy gave 79 and 116 articles, respectively.

RESULTS

There were very few publications giving the incidence of meniscal injuries in the Olympics. Football is the sport with the highest rate of meniscal injuries. Different sports are popular in different countries, and depending on the popularity and the country reporting these injuries, incidences differed. There was data available from India and Brazil for Elite athlete from diverse sports, whereas most data from other countries were for football and soccer. Knee was found to be the second most commonly injured part of the body in both Winter and Summer Olympics as well as the Youth Winter Olympics. Data were not available from the Youth Summer Olympics to make any conclusions. The number of publications on this topic is low. We presented the timeline of publications and citations of articles on this topic. The top country, language, journal, university, and author were USA, English, American Journal of Sports Medicine, Hospital of Special Surgery in New York and Brophy RH, respectively. The data on the risk factors for meniscal injuries were analyzed, discussed, and presented for football, as this was the most extensively studied sport.

CONCLUSIONS

Even though the knee is one of the commonly injured anatomical locations in elite athletes, there is a lack of literature on meniscal injuries in this subset of population. We looked at possible reasons and made recommendations to improve data collection on these injuries.

Ten-Year Epidemiology of Ankle Injuries in Men's and Women's Collegiate Soccer Players

CONTEXT

Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players.

OBJECTIVE

To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance.

MAIN OUTCOME MEASURE(S)

The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics.

RESULTS

When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98).

CONCLUSIONS

Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

Biceps femoris long head muscle fascicle length does not differ between sexes

Hamstring strain injury (HSI) rates are higher for males vs. females. This cross-sectional study investigated if inherent differences in biceps femoris long head (BF_LH) fascicle length (Lf) exist between recreationally active males and females (i.e., individuals without specific training practice history). Twenty-four young healthy participants (12 males; 12 females) had their BF_LH muscle architecture (Lf, pennation angle [θp], and muscle thickness [MT]) measured using B-mode ultrasonography. Eccentric and isometric knee flexion strength were also assessed. BF_LH Lf did not differ between sexes when expressed in absolute terms (males, 81.5 ± 14.7 mm; females, 73.6 ± 15.9 mm, P = 0.220, effect size (ES) = 0.52) or relative to femur length (0.140 ≤ P ≤ 0.220, ES = 0.63). Similarly, BF_LH θp did not differ between sexes (P = 0.650) but BF_LH MT was 18.9% larger for males vs. females (P = 0.024, ES = 0.99). Isometric and eccentric knee flexion strength was greater for males vs. females in absolute terms ([both] P < 0.001, 2.00 ≤ ES ≤ 2.27) and relative to body mass ([both] P < 0.001, 1.93 ≤ ES ≤ 2.13). In conclusion, factors other than BF_LH Lf seem likely to be implicated in higher male vs. female HSI rates.

The Effects of Cupping on Hamstring Flexibility in College Soccer Players

Context: College soccer players suffer from hamstring injuries due to inflexibility and repetitive motions involving intense hamstring lengthening and contraction during sport. Although it is a popular intervention for muscular injury, there exists limited evidence of the effects of therapeutic cupping on hamstring flexibility. Objective: To determine the effect of cupping therapy on hamstring flexibility in college soccer players. Design: Cohort design. Setting: Athletic training clinic. Patients: A total of 25, asymptomatic, National Collegiate Athletic Association Division III soccer players (10 males and 15 females; age = 19.4 [1.30] y, height = 175.1 [8.2] cm, and mass = 69.5 [6.6] kg). Intervention(s): A 7-minute therapeutic cupping treatment was delivered to the treatment group. Four 2-in cups were fixed atop trigger point locations within the hamstring muscle bellies of participants' dominant legs. Control group participants received no intervention between pretest and posttest measurements. Main Outcome Measures: Pretest and posttest measurements of hamstring flexibility, using a passive straight leg raise, were performed on both groups. Passive straight leg raise measurements were conducted by blinded examiners using a digital inclinometer. An independent samples t test was used to analyze changes in hamstring flexibility from pretreatment to posttreatment with P values set a priori at .05. Results: An independent samples t test demonstrated no significant difference in change in hamstring flexibility between participants in the treatment group and those in the control group (t₂₃ = -.961, P = .35). Conclusions: The findings of this study demonstrated no statistically significant changes in hamstring flexibility following a cupping treatment.

Sport injuries in international masters rowers: a cross-sectional study

Methods

A cross-sectional study was conducted among 743 masters rowers who participated in the 34th International Federation of Rowing Associations (Fédération Internationale des Sociétés d’Aviron, FISA) World Rowing Masters Regatta held in Zagreb, September 2-9, 2007. A rowing-specific questionnaire was used, followed by an interview about the injuries sustained during the 12-month period before the competition.

Results

The mean injury rate per year was 0.48 injuries/masters rower (2.25 injuries/1000 training sessions/rower). The majority of injuries were chronic injuries (the ratio of acute to chronic injuries was 1:1.7), and did not lead to the loss of training/competition time. Of all acute injuries, 49.6% were acquired during rowing-specific training, 43.7% during cross-training, and 6.7% in the gym. The most commonly affected region was the low back (32.6%), followed by the knee (14.2%), shoulder/upper arm, and elbow (10.6% each).

Conclusion

International masters rowers sustained predominantly chronic injuries of low severity, and the most commonly injured region was the low back. The mean injury rate per rower per year was lower than the rates previously reported for juniors and seniors.

The lack of standardized outcome measures following lower extremity injury in elite soccer: a systematic review

PURPOSE

Sport-specific, performance-based outcomes are increasingly used to improve evaluation of treatment efficacy in elite athletes; however, its usage in elite soccer may be limited. The purpose of this investigation is to (1) assess current outcome reporting in elite soccer; (2) identify any variability in reporting of outcomes; and (3) determine how sport-specific performance-based outcomes are utilized to assess treatment efficacy in elite soccer.

METHODS

A systematic review of the Pubmed, MEDLINE, and Embase, Scopus, SportDiscus, CINAHL and HealthSource: Nursing databases was performed without limitation on publication year. Inclusion criteria were (1) reporting of outcomes after a (2) lower extremity injury in (3) elite soccer players. The study's population, type of injury, return to play, as well as functional, objective, and sport-specific performance-based outcomes were extracted from each article. The methodological index for nonrandomized studies was used for quality assessment.

RESULTS

Twenty-one studies were selected after application of the inclusion and exclusion criteria. Objective outcomes were reported by 6 (29%) studies, and 6 (29%) employed patient-reported outcomes. The visual analog scale, Lysholm, and Tegner scores were the most common patient-reported outcomes (PROs). Return to play was reported by 18 (86%) studies, and only 2 (10%) utilized sport-specific performance-based outcomes. Despite the majority of studies reporting return to play, variation was seen in the definitions, and 15 (71%) studies reported the activity level of the players at final follow-up.

CONCLUSION

Assessment of treatment efficacy is limited in elite athletes, and PROs lack the sensitivity to identify residual performance deficits after an injury. Although performance-based measures are available at the elite level, these outcomes were seldom used for evaluation of treatment efficacy.

CLINICAL RELEVANCE

When treating elite soccer players, patient-reported outcome measures lack the sensitivity to detect changes in patient function, thus performance-based metrics may be more efficacious in assessing return from injury in these patients.

LEVEL OF EVIDENCE

IV.

Pre-season Fitness Level and Injury Rate in Professional Soccer - A Prospective Study

The aim of the present study was to assess prospectively the effect of pre-season fitness on injury rate during the competitive season among professional soccer players. Thirty-one players participated in the study during two consecutive competitive seasons (2015-16 and 2016-17; a squad of 22 players in each season). During the 6-week pre-season training period (8 training sessions and a friendly match every week, 14-18 training hours/week) there was a significant improvement in VO ₂ max, a significant increase in ideal and total sprint time and no change in vertical jump, flexibility and repeated sprint-test performance decrement. During the two consecutive seasons, 28 injuries were recorded. Ten injuries were classified as mild (missing 3-7 days of practice/match), 8 as moderate (missing 8-28 days) and 10 as severe (missing >28 days). The rate of match injuries was higher (9.4 per 1000 match hours) compared to practice injuries (4.7 per 1000 training hours). Most injuries were overuse injuries (72%) of the lower limbs (71%). Most of match injuries occurred during the last 15 min of each half. There were no differences in fitness characteristics in the beginning of pre-season training between injured and non-injured players. However, improvements in VO ₂ max during the pre-season training period were significantly lower among injured players (0.9±5.5%) compared to non-injured players (10.4±6.5%, p<0.05). Our results emphasize the importance of pre-season training in professional soccer players not only for improvement in fitness but also for injury prevention during the following competitive season.

The Epidemiology of Ankle Injuries Identified at the National Football League Combine, 2009-2015

Background:

American football is a leading cause of sports-related injuries, with the knee, ankle, and shoulder most commonly involved.

Purpose/Hypothesis:

The purpose of this study was to describe the epidemiology, characteristics, and imaging findings of ankle injuries in football players at the National Football League (NFL) Combine and determine the relationship to player position. We hypothesized that there would be a high relative incidence of ankle injuries in these players compared with other sports and that there would be a direct correlation between the incidence of ankle injuries and player position.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A retrospective chart review of data collected from NFL Combine participants between 2009 and 2015 was performed. Patient demographics, history, physical examination results, and imaging findings were reviewed.

Results:

Of 2285 players, 1216 (53.2%) had a history of ankle injuries; of these, 987 (81.2%) had unilateral injuries, while 229 (18.8%) had bilateral injuries (total of 1445 ankles injured). This included 1242 ankle sprains (86.0% of ankle injuries): 417 (33.6% of sprains) high and 930 (74.9%) low. The most common soft tissue injuries were to the anterior talofibular ligament (n = 158, 12.7% of sprains) and syndesmosis (n = 137, 11.0%). Of all players at the NFL Combine with radiographs, 131 (10.9%) had evidence of an ankle fracture, all of which had healed. Magnetic resonance imaging (MRI) identified 66 players (28.9% of players at the combine who underwent MRI) with articular cartilage injuries: 62 involving the talus and 16 involving the tibia. Furthermore, 85 players (37.3% of players with MRI) with tendon injuries were identified: 26 Achilles, 55 peroneal, 3 flexor hallucis longus, and 19 posterior tibial. A total of 611 players (50.6% of players with radiographs) had signs of arthrosis on radiography. Running backs (61.9%), offensive linemen (60.3%), and tight ends (59.4%) had the highest rates of ankle injuries by position, while kickers/punters (23.3%) and long snappers (37.5%) had the lowest.

Conclusion:

Prior ankle injuries were present in more than 50% of elite college football players attending the NFL Combine. The rate of these ankle injuries varied by player position: offensive linemen, running backs, and tight ends had the highest overall rates, while special teams players had the lowest. Additional prospective work is needed to determine the impact of prior injuries on future playing career.

A review advocating caution with Major League Soccer expansion and investment in more rehabilitation professionals

BACKGROUND AND PURPOSE

Major League Soccer (MLS) has aggressively expanded from 10 teams to 23 teams. With the addition of more teams, the league will have to dictate a schedule that maximizes the league's popularity, while also maintaining the health of the players. A longer season and congested game schedule could increase the risk of injury for players. The purpose of this commentary is to make recommendations for the prevention of injuries among MLS players with respect to proposed league expansion.

DESCRIPTION OF TOPIC

MLS has lengthened the regular season with each expansion in teams. An increase in season length was seen in conjunction with the MLS expansion from 14 to 19 teams during the 2008 through 2013 seasons. Data from the inaugural MLS season found injury rates were higher in games compared to practices and more injuries occurred later in the season. With the expansion of MLS, anterior cruciate ligament tears appeared to have increased each year.

DISCUSSION

Current evidence suggests the implementation of a proper preseason in addition to the once-per-week game frequency would best promote player health and well-being. Players may benefit from in-season injury prevention training and weekly load monitoring.

Characteristics of goalkeeping injuries: a retrospective, self-reported study in adolescent soccer players

BACKGROUND

Characteristic types of actions and training/matches loads of soccer goalkeepers show that goalkeeper's performance differs from other soccer's formations. Such situation may predispose to the occurrence of other kinds of injuries in this position. The aim of this study was to analyze epidemiology of injuries in young soccer goalkeepers.

METHODS

Forty-eight soccer goalkeepers (aged:15.2±1.9 years) filled the questionnaire aimed at collecting information about all injuries sustained within 12 months before the data collection. The anthropometric data, soccer experience and information regarding the injury types and occurrence were analyzed. The injury rate proportion for acute and overuse injuries and values of injuries including the burden of the match game and training were evaluated. The level of significance was set at P<0.05.

RESULTS

Thirty-three (68.8%) questionnaires were given back. Twenty-four (72.7%) goalkeepers reported the history of soccer related injury within a year before the survey. 52 injuries were reported. Significantly higher number of acute (76.9%) vs. overuse (23.1%) injuries was described (P=0.0012). Acute injuries involved fractures/subluxations of the fingers and thigh muscle strain/tears. The group of overuse injuries was dominated by trauma of the knee and pelvic girdle muscles. Majority of injuries occurred during training (88.5% of all injuries), and there was significant higher number of injuries sustained on artificial vs. natural grass for all, acute and overuse types of injuries (P<0.0001).

CONCLUSIONS

Young soccer goalkeepers suffer mostly acute injuries (within the fingers of hands and muscles of thighs). It might be associated with specific characteristic of performance related to goalkeeper's position.

PROSPECTIVE EVALUATION OF INJURIES OCURRED DURING A PROFESSIONAL SOCCER CHAMPIONSHIP IN 2016 IN SÃO PAULO, BRAZIL

OBJECTIVE

To identify the incidence of injuries, their main characteristics, and the way they were managed throughout 2016 in two major series of a professional soccer championship in São Paulo, Brazil.

METHODS

This prospective study used an electronic questionnaire previously developed by the Medical Committee of the Paulista Soccer Federation which was sent to the team doctors after each match.

RESULTS

Two hundred and fifty-nine injuries occurred during 361 matches, and the incidence of injury per 1000 hours of game play was 21.32. Strikers were the most affected by injury; the most frequent diagnosis was muscle injury and the legs were predominantly affected. Most of the injuries occurred in the last 15 minutes of the first half and only 7.7% required surgical treatment.

CONCLUSIONS

Muscle injuries were the most frequent, with most occurring in forwards and in the legs. Approximately half of the injuries occurred after contact and the vast majority was treated without surgery. MRI was the most requested exam and most injuries were classified as moderate (8 to 28 lost play days). Level of Evidence III, Study of Non Consecutive Patients; Without Consistently Applied Reference "Gold" Standard.

Orthopaedics injuries in male professional football players in Brazil: a prospective comparison between two divisions

BACKGROUND

Football is a high-speed contact sport and the risk of injury is high. The objective of this study was to compare the two main divisions (A1 and A2) of the São Paulo Football Championship and to perform a correlation analysis of the variables studied.

METHODS

A prospective study was conducted using an electronic questionnaire previously developed by the Medical Committee of the São Paulo Football Federation. The questionnaire was sent to the doctors of the teams playing in the A1 and A2 divisions of the São Paulo Football Championship after each round. Setting: 2016 São Paulo Football Championship.

RESULTS

The comparison of divisions A1 and A2 showed few significant differences among the various variables analysed in this study. The only significant differences were for right-side involvement in division A1 (p=0.044) and morning matches in division A2 (p<0.001). The correlation analysis of the variables studied showed expected associations, including sprains with a higher rate of need for surgery, ultrasound with muscle strains and moderate severity (8-28 days lost) with muscle strains.

CONCLUSION

Despite the differences between the two divisions regarding budgets and team characteristics, there was a little difference in the variables analysed and there were associations such as sprains with a higher rate of need for surgery, ultrasound with muscle strains and moderate severity (8-28 days lost) with muscle strains.

LEVEL OF EVIDENCE

II b, individual cohort study.

Preseason Aerobic Capacity Is an Independent Predictor of In-Season Injury in Collegiate Soccer Players

PURPOSE

To determine whether preseason aerobic capacity is independently associated with in-season injury among collegiate soccer players.

DESIGN

Prospective cohort study.

SETTING

University athletic department.

PARTICIPANTS

Forty-three NCAA Division I soccer athletes (male = 23).

INDEPENDENT VARIABLES

Gender and preseason lean body mass (LBM), body fat percentage (BF%), and maximal aerobic capacity (V[Combining Dot Above]O2max).

MAIN OUTCOME MEASURES

In-season injuries were recorded during the season, and body composition and fitness variables were compared between injured and uninjured players. Multivariate regression models were developed to predict injury during the entire season and during the first 4 weeks of the season.

RESULTS

Thirty-five injuries among 25 players were recorded during the season. Players injured at any point during the season had lower V[Combining Dot Above]O2max (57.7 vs 63.4 mL·kg·min, P = 0.014) and Tmax (15.8 vs 17.2 minutes, P = 0.035), compared with uninjured players, but no differences were noted in age, gender, LBM, or BF%. Players injured during the first 4 weeks of the season had lower LBM (49.7 vs 56.0 kg, P = 0.038) and Tmax (15.1 vs 16.7 minutes, P = 0.043) than uninjured players. For injuries occurring throughout the entire season, V[Combining Dot Above]O2max was an independent predictor of injury (P = 0.043), whereas gender, LBM, and BF% were not. During the first 4 weeks of the season, V[Combining Dot Above]O2max (P = 0.035) and LBM (P = 0.049) were related to injury, whereas gender and BF% were not.

CONCLUSIONS

Aerobic fitness is an independent predictor of in-season injury. Early-season injuries are related to aerobic fitness and LBM.

CLINICAL RELEVANCE

Efforts to increase aerobic capacity and LBM among soccer players in the off-season may help reduce in-season injury.

A comparison of injuries in elite male and female football players: A five-season prospective study

The aim was to compare the epidemiology of injuries between elite male and female football players from the same club. Injuries and individual exposure time in a male team and a female team, both playing in the Spanish first division, were prospectively recorded by the club's medical staff for five seasons (2010-2015) following the FIFA consensus statement. Total, training, and match exposure hours per player-season were 20% higher for men compared to women (P<.01). Total, training, and match injury incidence were 30%-40% higher in men (P≤.04) mainly due to a 4.82 (95% confidence interval [CI] 2.30-10.08) times higher incidence of contusions, as there were no differences in the incidence of muscle and joint/ligament injuries (P≥.44). The total number of absence days was 21% larger in women owing to a 5.36 (95% CI 1.11-25.79) times higher incidence of severe knee and ankle ligament injuries. Hamstring strains and pubalgia cases were 1.93 (95% CI 1.16-3.20) and 11.10 (95% CI 1.48-83.44) times more frequent in men, respectively; whereas quadriceps strains, anterior cruciate ligament ruptures, and ankle syndesmosis injuries were 2.25 (95% CI 1.22-4.17), 4.59 (95% CI 0.93-22.76), and 5.36 (95% CI 1.11-25.79) times more common in women, respectively. In conclusion, prevention strategies should be tailored to the needs of male and female football players, with men more predisposed to hamstring strains and hip/groin injuries, and women to quadriceps strains and severe knee and ankle ligament injuries.

Sports injuries in soccer according to tactical position: a retrospective survey

Abstract Introduction: In soccer, the players’ positions have been associated with specific functional overload, which may cause sports injuries. Objective: To investigate the occurrence and characterize sport injuries according to soccer player position. Methods: 232 male soccer players (129 professionals and 103 amateurs) from different sport teams in Mato Grosso do Sul, Brazil, were distributed in groups according to their soccer player position. Besides anthropometric characteristics, sports injuries were registered by using a referred morbidity survey. The occurrence of injuries was analyzed by means of the Goodman Test. Logistic regression models were used to investigate the relationship between different risk factors and the occurrence/-recurrence of sports injuries. Results: Forwards showed higher occurrence rates of sport injuries than other soccer position groups. Joint injuries in lower limbs constituted the most frequent registered cases. Muscle injuries in the back region were the most registered sports injuries among midfielders, while muscle damages in lower limbs were the primary injuries registered for other line positions. In the etiologic context, contact was the main cause of sports injuries in all groups. Most athletes (195) reported recurrence of sports injuries. Conclusion: The occurrence of sports injuries was higher among forwards. Traumatic joint and muscle injuries were the most prevalent registers in all line positions.

Soccer Players' Muscular Imbalances: Restoration with an Isokinetic Strength Training Program

The aim of the study was to investigate the effect of a muscular training program on soccer players' performance which initially appeared imbalanced or bilaterally asymmetrical. During the preparation period, 35 soccer players performed an isokinetic measurement of knee flexors and extensors (60°.−1 and 180°sec.−1). 15 of these had muscular imbalances or deficits and followed a specific isokinetic training program for 2 mo., 3 times per week. After the completion of the isokinetic training program, the 35 players underwent the same isokinetic test. Significant differences were noted between the pre- and posttraining measures at both angular velocities in peak torque values, in differences from one limb to the other, and in peak torque ratios for flexors and extensors. Consequently, the application of this specific isokinetic training program can restore imbalances in knee muscle strength efficiently.

Years of Training and Hamstring-Quadriceps Ratio of Soccer Players

To investigate the effect of the years of training on the hamstring-quadriceps isokinetic strength and establish normative data for the cardiorespiratory fitness of first and second division Greek male professional soccer players ( M = 25.1, SD = 5.1 yr.) a representative sample of 72 soccer players was chosen randomly from six teams of these divisions. Hamstring-quadriceps ratios of the preferred and nonpreferred leg correlated with years of training weekly ( r = .51) in the preferred leg. In conclusion, data indicated that the training background of the players (years of training) might have a small effect on the strength balance of quadriceps and hamstrings of the preferred leg.

Injuries in professional male football players in Kosovo: a descriptive epidemiological study

BACKGROUND

The incidence and severity of football-related injuries has been found to differ strongly between professional leagues from different countries. The aims of this study were to record the incidence, type and severity of injuries in Kosovarian football players and investigate the relationship between injury incidence rates (IRs), players' age and playing positions.

METHODS

Players' age, anthropometric characteristics and playing positions, training and match exposure as well as injury occurrences were monitored in 11 teams (143 players) of Kosovo's top division during the 2013/14 season. The exact type, severity and duration of football-related injuries were documented following International Federation of Football Associations (FIFA) recommendations.

RESULTS

A total of 272 injuries were observed, with traumatic injuries accounting for 71 %. The overall injury IR was 7.38 (CI: 7.14, 7.63) injuries per 1,000 exposure hours and ~11x lower during training as opposed to matches. Strains and ruptures of thigh muscles, ligamentous injuries of the knee as well as meniscus or other cartilage tears represented the most frequent differential diagnoses. While no statistical differences were found between players engaged in different playing positions, injury IR was found to be higher by 10-13 % in younger (IR = 7.63; CI: 7.39, 7.87) as compared to middle-aged (IR = 6.95; CI: 6.41, 7.54) and older players (IR = 6.76; CI: 5.71, 8.00).

CONCLUSIONS

The total injury IR in elite football in Kosovo is slightly lower than the international average, which may be related to lesser match exposure. Typical injury patterns agree well with previously reported data. Our finding that injury IR was greater in younger players is related to a higher rate of traumatic injuries and may indicate a more aggressive and risky style of play in this age group.

Increase in ACL and PCL injuries after implementation of a new professional football league

PURPOSE

In the season 2008-2009, a third professional football league was established in Germany. This study analysed the influence of increased training and playing intensity on severe knee injuries in football players.

METHODS

In a prospective controlled one-season trial, injury incidence and injury patterns of players of the newly established professional football league were analysed, particularly with regard to ruptures of the anterior (ACL) and posterior (PCL) cruciate ligaments. Players of the highest amateur level served as a control group.

RESULTS

Four hundred and eight players of 24 teams were allocated to two groups. The overall training exposure was significantly (p < 0.001) higher in the new professional league (335.3 h per player) than at the amateur level (286.6 h per player). Players at both levels showed similar overall injury rates and injury patterns. However, players in the professional league had a significantly higher (p = 0.04) incidence of ACL and PCL injuries, than players at the amateur level. More than 90 % of all ACL and PCL ruptures in both groups were sustained by players, who had played at least one level lower in the previous season. In addition, injuries of players who had sustained repeat injuries over the season were more severe.

CONCLUSION

The introduction of a new professional football league increased the training and playing intensity of players as well as the number of ACL and PCL ruptures. A specific injury prevention concept, particularly for players facing rapidly increasing training and playing intensity, seems to be mandatory.

LEVEL OF EVIDENCE

Prospective controlled cohort study, Level II.

Return to play after all-inside meniscal repair in competitive football players: a minimum 5-year follow-up

PURPOSE

The purpose of this study was to report the mid-to-long-term return to sports after all-inside meniscal repair in competitive football players.

METHODS

All football players undergoing all-inside meniscal repair with a minimum Tegner activity score of 9 and minimum follow-up of 5 years were eligible for inclusion. Patients were excluded if: (a) they had ipsilateral or contralateral: meniscectomy, posterior cruciate ligament tear, multi-ligament knee injuries, osteotomies, or meniscal transplant (b) they had meniscal tears in the anterior horn, and (c) they had bucket-handle tears. All patients included were contacted by phone and asked for current sport status or Tegner score. Preoperative Tegner scores were collected from the medical charts.

RESULTS

All patients (n = 29) were men with a median (range) age of 27 (18-37) years and a follow-up of 6 (5-8) years. All meniscal injuries were complete and longitudinal tears. The median preinjury Tegner activity score was 9 (range 9-10). Two patients required revision arthroscopy (6.7 %) with partial meniscectomy before being able to return to competitive football due to suture failure. Twenty-six patients (89.6 %) returned to the same level of competition after recovering from surgery. At the last follow-up, 13 patients (45 %) were able to continue playing football at any level, and 8 (28 %) of them were able to return to the same pre-injury competitive level. The main reasons for the decreased level of activity (from competitive to recreational) or to give up football were job-related or changes in their personal life situation, but were not related to knee or meniscal disorders. Fourteen patients underwent meniscal repair alone, whereas 15 patients had an associated ACL reconstruction procedure. There were no significant differences in the collected variables between both subgroups.

CONCLUSIONS

All-inside meniscal repair allows for excellent results with regard to return-to-play rates in competitive football. However, only half of the patients are still playing football in the mid-to-long-term follow-up, although reasons to give up football are not related to knee or meniscal disorders.

LEVEL OF EVIDENCE

Case series, Level-IV.

Foot and Ankle Injuries in Professional Soccer Players: Diagnosis, Treatment, and Expectations

Soccer is one of the most popular sports in the world. It has undergone many changes in recent years, mainly because of increased physical demands, and this has led to an increased injury risk. Direct contact accounts for half of all injuries in both indoor and outdoor soccer and ankle sprains are the most common foot and ankle injury. There is a spectrum of foot and ankle injuries and their treatment should be individualized in these high-demand patients. An injury prevention program is also important and should the players, the trainer, responsible physician, and physical therapists.

Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review

CONTEXT

The incidence of injury for elite youth and professional adult soccer players is an important concern, but the risk factors for these groups are different.

OBJECTIVE

To summarize and compare the injury incidences and injury characteristics of male professional adult and elite youth soccer players.

DATA SOURCES

We searched MEDLINE and Web of Science using the search terms elite, international, European, soccer, football, injury, injuries, epidemiology, incidence, prevalence, not female, not American football, and not rugby. We also used the search terms professional for studies on professional adult soccer players and high-level, soccer academy, youth, adolescent, and young for studies on elite youth soccer players.

STUDY SELECTION

Eligible studies were published in English, had a prospective cohort design, and had a minimum study period of 6 months. To ensure that injury data were assessed in relationship to the athlete's individual exposure, we included only studies that reported on injuries and documented exposure volume.

DATA EXTRACTION

Two independent reviewers applied the selection criteria and assessed the quality of the studies.

DATA SYNTHESIS

A total of 676 studies were retrieved from the literature search. Eighteen articles met the inclusion criteria: 6 for elite youth and 12 for professional adult soccer players.

CONCLUSIONS

Injury rates were higher for matches than for training for both youth and adult players. Youth players had a higher incidence of training injuries than professionals. Efforts must be made to reduce the overall injury rate in matches. Therefore, preventive interventions, such as adequately enforcing rules and focusing on fair play, must be analyzed and developed to reduce match-related injury incidences. Reducing training injuries should be a particular focus for youth soccer players.

Fracture epidemiology in male elite football players from 2001 to 2013: 'How long will this fracture keep me out?'

BACKGROUND

Determining fracture risk and rehabilitation periods after specific fractures in professional football is essential for team planning.

AIM

To identify fracture epidemiology and absences after different types of fractures in male professional football players.

METHODS

2439 players from 41 professional male teams in 10 countries were followed prospectively from 2001 to 2013. Team medical staff registered fractures, absences after fractures and player exposure.

RESULTS

364 fractures were recorded, with an incidence of 0.27/1000 h of exposure (95% CI 0.25 to 0.30). The incidence of traumatic fractures was 0.25 (0.22 to 0.27) and that of stress fractures was 0.03 (0.02 to 0.04). 45% of traumatic fractures and 86% of stress fractures affected the lower extremities. Absence after a fracture was 32 days (1-278) (median (range)), compared to that after a traumatic fracture of 30 days (1-278) and a stress fracture of 65 days (6-168) (p<0.001). Annual fracture incidence was stable during the study period (R(2)=0.051, b=-0.011 (95% CI -0.043 to 0.021)). Young players had a relative risk of 10.9 (3.3 to 35.6) of sustaining stress fractures compared to old players (p<0.01). The fracture incidence did not differ between individuals in different playing positions (p=0.10).

SUMMARY

A male professional football team can expect 1 to 2 fractures per season. There are more traumatic fractures than stress fractures; while most fractures affect the lower extremities, stress fractures yield longer absences than traumatic fractures and young players have more stress fractures than old players. There is no difference in risk among players at different playing positions.

Changes in muscle activity after performing the FIFA 11+ programme part 2 for 4 weeks

Changes in muscle activity were evaluated by positron emission tomography-computed tomography (PET-CT) after performing part 2 of the Fédération Internationale de Football Association's 11+ programme (11+) for 4 weeks. Eleven males performed part 2 of the 11+ for 20 min before and after 37 MBq of (18)F-fluorodeoxyglucose (FDG) was injected intravenously. PET-CT images were obtained 50 min after FDG injection. The participants were then instructed to perform part 2 of the 11+ 3 times per week for 4 consecutive weeks, after which another set of PET-CT images was obtained following the same procedure. Regions of interest were defined within 30 muscles. The standardised uptake value (SUV) of FDG by muscle tissue per unit volume was calculated, and FDG accumulation was compared between pre- and post-training PET-CT results. Performing part 2 of the 11+ for 4 weeks increased mean SUV in the sartorius, semimembranosus, biceps femoris, abductor hallucis, and flexor hallucis brevis muscles (P < 0.05). In conclusion, routinely performing part 2 of the 11+ for 4 weeks increased glucose uptake related to muscle activity in the hamstrings and hallux muscles. We speculate that there is some possibility of this change of muscle activity contributing to a decrease in sports-related injuries.

Finger injuries in a developing sport: cachibol (Newcomb Ball)

BACKGROUND

Cachibol (also known as Newcomb ball) is a team ball game with characteristics similar to volleyball. Cachibol is becoming increasingly popular, particularly among middle-age women, and is now the fastest growing female sport in our country. Despite its growing popularity, there is a lack of information about the epidemiology of injuries incurred from this activity. The purpose of this study is to describe the incidence and pattern of finger injuries among female cachibol players competing in a 3-day tournament.

METHODS

We conducted a cross-sectional survey and an observational cohort study of 612 amateur female cachibol players participating in a 3-day national tournament; 355 players completed questionnaires (58 % response rate). All injuries sustained during the tournament were reported.

RESULTS

Fingers were the most commonly injured part of the body; 148 of 355 respondents reported sustaining a finger injury. During the tournament, 26 players reported a total of 27 injuries, 15 to the fingers. Most finger injuries resulted from a direct hit by the ball. Finger injuries, though considered "mild," have long-term implications; over 50 % of injured players reported long-term discomfort.

CONCLUSIONS

Finger injuries are more prevalent in cachibol than volleyball due to the unique characteristics of the game. Cachibol-related injuries are a growing cause for concern due to the growing number of cachibol players. This study may be useful in developing effective treatment protocols and injury prevention programs for cachibol players.

Efficacy of the FIFA 11+ Injury Prevention Program in the Collegiate Male Soccer Player

BACKGROUND

The Fédération Internationale de Football Association (FIFA) 11+ program has been shown to be an effective injury prevention program in the female soccer cohort, but there is a paucity of research to demonstrate its efficacy in the male population.

HYPOTHESIS

To examine the efficacy of the FIFA 11+ program in men's collegiate United States National Collegiate Athletic Association (NCAA) Division I and Division II soccer.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

Before the commencement of the fall 2012 season, every NCAA Division I and Division II men's collegiate soccer team (N = 396) was solicited to participate in this research study. Human ethics review board approval was obtained through Quorum Review IRB. Sixty-five teams were randomized: 34 to the control group (CG; 850 players) and 31 to the intervention group (IG; 675 players). Four teams in the IG did not complete the study, reducing the number for analysis to 61. The FIFA 11+ injury prevention program served as the intervention and was utilized weekly. Athlete-exposures (AEs), compliance, and injury data were recorded using a secure Internet-based system.

RESULTS

In the CG, 665 injuries (mean ± SD, 19.56 ± 11.01) were reported for 34 teams, which corresponded to an incidence rate (IR) of 15.04 injuries per 1000 AEs. In the IG, 285 injuries (mean ± SD, 10.56 ± 3.64) were reported for 27 teams, which corresponded to an IR of 8.09 injuries per 1000 AEs. Total days missed because of injury were significantly higher for the CG (mean ± SD, 13.20 ± 26.6 days) than for the IG (mean ± SD, 10.08 ± 14.68 days) (P = .007). There was no difference for time loss due to injury based on field type (P = .341).

CONCLUSION

The FIFA 11+ significantly reduced injury rates by 46.1% and decreased time loss to injury by 28.6% in the competitive male collegiate soccer player (rate ratio, 0.54 [95% CI, 0.49-0.59]; P < .0001) (number needed to treat = 2.64).

Injury characteristics in the German professional male soccer leagues after a shortened winter break

CONTEXT

The winter break in the top 2 German professional soccer leagues was shortened from 6.5 to 3.5 weeks in the 2009-2010 season.

OBJECTIVE

To investigate whether this change affected injury characteristics by comparing the second half of the 2008-2009 (long winter break) with the equivalent period in the 2009-2010 season (short winter break).

DESIGN

Prospective cohort study.

SETTING

German male professional soccer leagues.

PATIENTS OR OTHER PARTICIPANTS

Seven professional German male soccer teams (184 players in the 2008-2009 season, 188 players in the 2009-2010 season).

MAIN OUTCOME MEASURE(S)

Injury incidences and injury characteristics (cause of injury, location, severity, type, diagnosis), including their monthly distribution, were recorded.

RESULTS

A total of 300 time-loss injuries (2008-2009 n = 151, 2009-2010 n = 149) occurred. The overall injury incidence per 1000 soccer hours was 5.90 (95% confidence interval = 5.03, 6.82) in 2008-2009 and 6.55 (5.58, 7.69) in 2009-2010. Match injuries per 1000 hours were 31.5 (25.0, 38.0) in the first season and 26.5 (20.2, 32.7) in the second season; the corresponding training values were 2.67 (2.08-3.44) and 3.98 (3.19-4.95), respectively. The training injury incidence (incidence rate ratio = 1.49 [95% confidence interval = 1.07, 2.08], P = .02) and the risk of sustaining a knee injury (incidence rate ratio = 1.66 [1.00, 2.76], P = .049) were higher in 2009-2010 after the short winter break; the incidence of moderate and severe injuries (time loss >7 days) trended higher (incidence rate ratio = 1.34 [0.96, 1.86], P = .09).

CONCLUSIONS

Shortening the winter break from 6.5 to 3.5 weeks did not change the overall injury incidence; however, a higher number of training, knee, and possibly more severe injuries (time loss >7 days) occurred.

Return to sport after muscle injury

Skeletal muscle injuries are among the most common sports-related injuries that result in time lost from practice and competition. The cellular response to muscle injury can often result in changes made to the muscle fibers as well as the surrounding extracellular matrix during repair. This can negatively affect the force and range of the injured muscle even after the patient's return to play. Diagnosis of skeletal muscle injury involves both history and physical examinations; imaging modalities including ultrasound and magnetic resonance imaging (MRI) can also be used to assess the extent of injury. Current research is investigating potential methods, including clinical factors and MRI, by which to predict a patient's return to sports. Overall, function of acutely injured muscles seems to improve with time. Current treatment methods for skeletal muscle injuries include injections of steroids, anesthetics, and platelet-rich plasma (PRP). Other proposed methods involve inhibitors of key players in fibrotic pathways, such as transforming growth factor (TGF)-ß and angiotensin II, as well as muscle-derived stem cells.