Soccer Injuries in Players Aged 7 to 12 Years: A Descriptive Epidemiological Study Over 2 Seasons

FIFA 11+ KIDS in the prevention of soccer injuries in children: a systematic review

BACKGROUND

The "FIFA 11+" is an injury prevention program conceived for soccer athletes aged over 14. The use of FIFA 11+ Kids in soccer was associated with a reduction of the overall risk of injuries in children by 48%, and of 74% for serious injuries. However, to the best of our knowledge, a systematic review of the literature on the effects of FIFA 11+ Kids is still missing. Therefore, a systematic review was conducted to ascertain the benefits of the "FIFA 11+ KIDS" program in children who practice soccer.

METHODS

This systematic review was conducted according to the PRISMA recommendations and prospectively registered in PROSPERO. The electronic search was conducted in the following databases: Web of Science, PubMed, Medline via Ovid, EMBASE and SportDiscuss via EBSCO. Database searches were performed in January 2024. This review included studies that evaluated the effects of the "FIFA 11+ KIDS" program. Eligible studies had to describe program implementation and the mean age of the children.

RESULTS

A total of 11 articles were included in this systematic review from a pool of 8513 articles screened across various databases. These articles involved over 10,000 young participants from 8 countries, primarily aged 7-14 years, with the majority being soccer athletes. Study quality varied, with four categorized as high, four as good, and three as fair quality. Objectives varied across studies, with four focusing on FIFA 11+ Kids' efficacy in injury prevention, five examining its impact on performance and physical abilities, and two assessing its effects on children's focus and attention skills. Notably, injury prevention studies reported around a 50% reduction in overall injuries and nearly 60% in severe injuries, with a dose-response relationship observed with increased weekly sessions. Significant improvements were noted in physical and functional tests such as the Y balance, jump tests, and various soccer skills, along with positive effects on children's focus and attention, as indicated by 13-18% improvements in Attention Scale for Elementary School Children (ASESC) scores.

CONCLUSION

The FIFA 11+ KIDS injury prevention program appears to be effective in reducing injuries in young football players. This can positively influence player and team overall performance and might support the long-term athlete development of these young athletes. These findings highlight the importance and necessity of injury prevention in young athletes.

Epidemiology of football-related injuries in young male football players. An additional analysis of data from a cluster-randomised controlled trial

Football carries a high risk of injury for youth players. The aim of this study was to investigate the epidemiology of football-related injuries in young male players. The data stems from a previously conducted cluster-randomised controlled trial that investigated the efficacy of 'FUNBALL', a new injury prevention programme. This study contains the data of the 503 players of the control arm. The players belonged to 22 football teams of the Under-(U)15, U17 and U19 age groups. The time-loss injuries were recorded during the season 2021-2022 according to the Football Consensus Statement. An analysis on the injury incidence (IR, calculated per 1000 hours of exposure), location, severity, category, and type was performed. Incidence rate ratios (IRRs) were used to compare the variables between the specific age groups. 187 injuries (96 in training and 91 in matches) occurred during 52 938 hours of exposure. The overall IR was 3.53 injuries/1000 h (95% confidence intervals (CI) 3.06 to 4.07). The training IR was 2.16 injuries/1000 h (95% CI 1.17 to 2.64). The match IR was 10.50 injuries/1000 h (95% CI 8.55 to 12.89). In the U19s, the overall IRR was higher compared to the U17s (IRR 1.57, CI 1.12 to 2.19; p = 0.008) and compared to the U15s (IRR 1.82, 95% CI 1.25 to 2.62; p = 0.001). The thigh was the most commonly affected body region (IR 0.92/1000 h, 95% CI 0.69 to 1.22). Muscle injuries were the most common injury type (IR 1.05/1000 h, 95% CI 0.81 to 1.37). Injury burden was 74 lost days/1000 h. The findings of this study indicate a lower injury incidence in youth players than in adult ones. We observed a higher injury incidence towards the older age groups.

Longitudinal analysis of the incidence rate of injury in elite youth football: Trends over six years including the COVID-19 pandemic period

OBJECTIVES

We aimed to analyze injury trends and the possible effects of the coronavirus disease (COVID-19) pandemic on the incidence rates of injury in young elite football players.

DESIGN

A prospective cohort study design was adopted.

PARTICIPANTS

Our study included 832 male football players who suffered an injury during any of the six competitive seasons.

SETTING

An elite youth football academy.

MAIN OUTCOME MEASURE

Descriptive data and the incidence of injury were calculated. A generalized linear mixed model was used to assess differences in the occurrence of injury among the various age groups. Joinpoint regression was used to analyze injury trends.

RESULTS

Joinpoint regression models showed a statistically significant decrease in the incidence of injury in all age groups with an average annual percent change (AAPC) of 13.9 (95 %Confidence Interval [CI]:-23.2 - 3.4) and -13.5 (95 %CI:-24.5 to -0.9) for models with zero and one joinpoint, respectively. Football players in older age groups sustain a higher number of injuries, probably due to a higher number of matches and greater training intensity.

CONCLUSION

This study showed a downward trend in injuries in the participants prior to the pandemic, with an evident increase in the incidence rate of injury during the COVID-19 pandemic.

The Characteristics of Badminton-Related Pain in Pre-Adolescent and Adolescent Badminton Players

Body pain, often considered as an early sign of injury in young players, warrants thorough study. This study aimed to examine the distribution of badminton-related pain and prevalence in pre-adolescent and adolescent badminton players. Profiles of badminton-related pain were surveyed using a questionnaire among 366 pre-adolescent and adolescent badminton players aged 7-12 years. The distribution of badminton-related pain was described, and the pain incidence was calculated. Proportions of pain per 1000-training-hour exposures were the main outcome measures. The analysis considered various age groups (7-8, 9-10, and 11-12 years) and years of badminton experience (≤2, 2-3, and > 3 years). In total, 554 cases of badminton-related pain were reported. The ankle was the most common site, followed by knee, plantar, shoulder, and lower back. The overall pain rate per 1000-training-hour exposure was 3.06. The 11-12-year-old group showed the highest pain rate, significantly greater than the 7-8-year-old group and the 9-10-year-old group. Additionally, the prevalence of pain exhibited an increasing trend with age. Finally, regardless of the age groups, participants with 2-3 years of badminton experience had the highest pain rate. These findings might help inform targeted interventions to reduce the high prevalence of pain in various body regions across pre-adolescent and adolescent badminton players.

Beyond athletic development: The effects of parkour-based versus conventional neuromuscular exercises in pre-adolescent basketball players

The purpose of this study was to compare the effects of a parkour-based warm-up to a conventional neuromuscular training (NMT) warm-up on the athletic capabilities of youth basketball players. This was examined through two arms: In Investigation 1, the aims were to measure the effects of the two warm-ups on physical measures of athletic performance in prepubescent basketball players. Using post-intervention semi-structured interviews, Investigation 2 aimed to gain insights from the players in relation to the perceived benefits of the two warm-ups. Pre-adolescent children were recruited from two youth level basketball teams. Participants from one club were randomly assigned to either a conventional NMT warm-up group or a parkour warm-up group, while a control group was formed of participants from the second club. Participants of both experimental groups were required to complete a 15-minute warm-up once per week before their regular basketball practice across 8-weeks. For both groups, the coach adopted the same pedagogical approach, utilising a guided discovery strategy. Pre-post test measures of overhead squat performance, countermovement jump, and 10-metre sprint speed were recorded in all three groups. Additionally, pre-post measures were recorded for a timed parkour-based obstacle course for the two experimental groups. No significant between-group differences were found between pre- and post-test measures. However, analysis using Cohen's d effect sizes revealed improvements in both intervention groups versus the control. Moreover, between group effect size differences were observed between the two experimental groups. Following the intervention, participants from both experimental groups were also invited to take part in a post-intervention semi-structured interview to discuss their experiences. The thematic analysis of these semi-structured interviews revealed three higher order themes: Enjoyment; Physical literacy; and Docility; of which the two former themes appear to align to constructs relating to the wider concept of physical literacy. In summary, warm-ups designed to improve athleticism can include less structured and more diverse movement skills than are typical of conventional NMT warm-ups. Specifically, we provide evidence that advocates for warm ups that include parkour-related activities alongside conventional NMT exercises to preserve physical fitness qualities and to simultaneously evoke a sense of enjoyment, fun, and purpose. The benefit of such activities may extend beyond athletic development and, more broadly, contribute to the development of physical literacy.

Age related changes in the Q angle of non-professional football players

Background

Football practice involves a great muscular demand, leading to the development of the lower limbs that, on occasions, can cause deviations from the normal anthropometric values. The quadriceps angle (Q angle) is a value often taken as a reference for the alignment of the lower limbs.

Objective

To observe the changes of the Q angle in young football players, because of muscular effort, analyzing the differences between four groups of different ages and to determine whether the playing position might influence these variations.

Methods

A cross sectional study was carried out with 104 male subjects divided into four groups according to age: under 8 years-old, 8-17 years-old, 17-21 years-old and over 21 years-old. A photograph was taken in standing position and the Q angle was plotted with KINOVEA® software. As for the reliability of the measurements, intraclass intra and interobserver coefficient were 0.958 and 0.860 respectively. The study was conducted in mid-season.

Results

Q angle value is greater in those under 8 years of age and decreases gradually and significantly (p < 0.005) until 17-21 years of age, where it stabilizes at values of 5.73° ± 2.78 for right Q angle and 5.88° ± 2.55 for left Q angle. Two way ANOVA demonstrated a significant group*position interaction for goalkeepers with a medium effect size in both angles (p < 0.001) with a medium effect (η² Right Q angle = 0.31; η² Left Q angle = 0.37). The values remain unchanged in subjects over 21 years of age (p > 0.005), except for goalkeepers, who suffered a difference in the evolution of the angle within their age category (p < 0.005) and with a high effect size with the other positions (value > 0.8) except forward (value < 0.5).

Conclusion

This study determines that the Q angle in football players decreases with growth, reaching values below 15° at the end of development. Playing positions only influence players over the age of 21, and the Q-angle of goalkeepers is greater than that of other players.

What is needed to reduce the risk of anterior cruciate ligament injuries in children? - Hearing from experts

OBJECTIVE

Anterior cruciate ligament (ACL) injuries are an emerging health problem in children. Acknowledging considerable gaps in knowledge, the aim of this study was to examine the current knowledge on childhood ACL injury, and to explore risk assessment and reduction strategies, with experts in the research community.

DESIGN

Qualitative study; semi-structured expert interviews.

METHODS

Interviews with seven international, multidisciplinary academic experts were conducted from February until June 2022. A thematic analysis approach organized verbatim quotes into themes using Nvivo Software.

RESULTS

Gaps in knowledge on the actual injury mechanism, and influence of physical activity behaviours, constrain targeted risk assessment and reduction strategies in childhood ACL injuries. Strategies to examine and reduce the risk of ACL injury included: examining an athletes' whole-body performance, moving from constraint (e.g., squat) to less constraint (e.g., single-leg) tasks, making assessments into children's context, building a movement repertoire at young age, performing risk reduction programs, multiple sports, and prioritising rest.

CONCLUSION

Research is urgently warranted on the actual injury mechanism, reasons for ACL injuries in children, and potential risk factors to update risk assessment and reduction strategies. Further, educating stakeholders on risk reduction strategies could be essential to address the increasing occurrence of childhood ACL injuries.

Knee pain in young sports players aged 6-15 years: a cross-sectional study in Japan

BACKGROUND

Knee is the most commonly injured part of the body in young athletes. Knee pain in several studies have been seen to be more prevalent in active adolescents compared to inactive, although common in both groups. Nevertheless, few studies with large sample size have been published reporting the difference of the prevalence of knee pain for each sport among young sports players. This study investigated the point prevalence of knee pain among young sports players aged 6-15 years old according to age, sex, and sports discipline. Furthermore, this study investigated the association between knee pain and sports discipline among young sports players.

METHODS

A cross-sectional study was conducted using a self-reported questionnaire on young sports players aged 6-15 years from the Miyagi Amateur Sports Association. Multivariable logistic regression models were used to examine the association between knee pain and sports discipline and were adjusted for age, sex, body mass index (BMI), training days per week, and training hours per weekday and weekend.

RESULTS

A total of 7234 young sports players were included. The point prevalence of knee pain was 10.9%. Females (13.3%) had more knee pain than males (9.8%). Young, 13-year-old sports players had the highest prevalence of knee pain (19.1%). The multivariable analysis showed that the highest odds ratio [95% confidence interval] was observed for handball players (2.42 [1.01-5.81]). In addition, hand ball, mini-basketball (odds ratio 1.85; 95% CI 1.38-2.47), and basketball (odds ratio 1.66; 95% CI 1.23-2.26) were significantly associated with knee pain, compared with football. The lowest odds ratio was observed for swimming (0.34 [0.05-2.54]), followed by karate (odds ratio 0.38; 95% CI 0.16-0.89) and baseball (odds ratio 0.47; 95% CI 0.35-0.64).

CONCLUSION

The prevalence of knee pain among young athletes differed according to age, sex, and sports discipline. Their parents and clinicians should recognize this information to manage knee pain among young sports players.

The incidence and burden of injuries in elite English youth female soccer players

This study aimed to investigate the incidence, severity and burden of injury in English elite youth female soccer players. Qualified therapists at six English girls' academies prospectively recorded all injuries that required medical attention or caused time loss for matches and training in 375 elite youth female soccer players (under-10 [U10], U12, U14 and U16) during the 2019/2020 season. One hundred- and eleven time-loss injuries (52 from training, 59 from matches) were sustained, resulting in 1,946 days absent (779 days from training injuries, 1,167 days from match injuries) from soccer activities. The injury incidence for matches (9.3/1000 hours, 95% CIs: 7.2-11.9) was significantly greater than training (1.1/1000 hours, 95% CIs: 0.9-1.5, p < 0.001). Additionally, the injury burden for matches (183 days lost/1000 hours, 95% CIs: 142-237) was significantly greater than training (17 days lost/1000 hours, 95% CIs: 13-22, p < 0.001). Injury incidence and burden were greatest in the U16 age group and were found to increase with age. Whilst injury incidence and burden are greater in matches than training, a large proportion of preventable injuries, soft-tissue and non-contact in nature, were sustained in training. Findings provide comparative data for elite youth female soccer players.

Effects of the "FIFA11+ Kids" Program on Injury Prevention in Children: A Systematic Review and Meta-Analysis

FIFA11+ Kids is a warm-up program specially designed to prevent football injuries in children. This systematic review and meta-analysis aimed to summarize the effects of FIFA11+ Kids on injury prevention in young football players. PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure were searched from 1 January 2016 to 24 August 2022. The primary outcome was overall injuries, and the secondary outcomes were severe, ankle, knee, and lower extremity injuries. Risk ratios (RRs) were calculated for each outcome. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 230 articles were screened, 6 of which were finally included in the meta-analysis. Compared with normal warm-up training, FIFA11+ Kids significantly reduced overall injury risk (RR = 0.52 [95% CI, 0.44-0.62]; p < 0.00001), severe injury risk (RR = 0.33 [95% CI, 0.18-0.61]; p = 0.0004), lower extremity injury risk (RR = 0.51 [95% CI, 0.41-0.65]; p < 0.00001), knee injury risk (RR = 0.45 [95% CI, 0.29-0.72]; p = 0.0009), and ankle injury risk (RR = 0.56 [95% CI, 0.35-0.89]; p = 0.01) in young football players. FIFA11+ Kids was found to be an effective approach to decrease the injury risk among young football players, which is worth generalizing extensively.

The FIFA 11+ Kids Injury Prevention Program Reduces Injury Rates Among Male Children Soccer Players: A Clustered Randomized Controlled Trial

BACKGROUND

The Fédération Internationale de Football Association (FIFA) 11+ Kids is an exercise-based injury prevention program developed by an international group of experts to prevent injuries among child soccer players.

HYPOTHESIS

It was hypothesized that the FIFA 11+ Kids program would be more effective than performing a typical warm-up regimen in reducing overall injuries among soccer players aged 7 to 13 years.

STUDY DESIGN

A clustered randomized controlled trial.

LEVEL OF EVIDENCE

Level 1.

METHODS

A total of 94 boys' soccer teams, including 780 players, were randomly allocated into an experimental or control group. Complete datasets were collected from 45 teams (377 players) and 43 teams (363 players) in the experimental and control groups, respectively. The experimental group underwent the FIFA 11+ Kids program as a warm-up during training sessions and matches at least twice a week, and the control group continued performing their usual warm-ups. Participants were prospectively followed during 1 season (6 months). The primary outcomes included the incidence of overall and recurrent injuries and their mechanism and severity. The secondary outcome was the rate of compliance with the intervention program.

RESULTS

A total of 43 injuries were reported in the experimental group in 50,120 hours of exposure (0.85 injuries/1000 exposure hours). A total of 86 injuries were reported in the control group in 42,616 hours of exposure (2.01 injuries/1000 exposure hours). The injury risk ratio was 0.43 (0.29-0.61), suggesting that the experimental group experienced 57% fewer injuries than those in the control group.

CONCLUSION

The FIFA 11+ Kids program reduced overall injury rates in children playing soccer more than the usual warm-ups.

CLINICAL RELEVANCE

The results of this study provide evidence for children's coaches to consider including the FIFA 11+ Kids program in their warm-up regimen. Such a program may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Players with high physical fitness are at greater risk of injury in youth football

The aim of this study was to investigate physical fitness, football-specific skills, and their association with injury risk in youth football. Altogether 447 male and female players aged 9-14 years (median 12 years) participated in performance tests and prospective follow-up. The physical fitness tests included five-jump test for distance, 30-m sprint, football-specific figure of eight agility, countermovement jump, and Yo-Yo intermittent endurance test level 1. The football-specific skill tests included dribbling and passing tests. Injuries and exposure were registered during the 20-week follow-up. Our candidate risk factors were low/high level of physical fitness measured with a composite score of physical fitness tests and low/high level of football-specific skills measured with a composite score of dribbling and passing tests. Secondarily, we investigated performance in individual tests and their association with injury risk. During the follow-up, players reported 565 injuries (264 acute and 301 overuse injuries). High level of physical fitness was associated with increased rate of all injuries (age-, sex-, and mean team exposure-adjusted IRR: 1.28, 95% CI: 1.04-1.58). The level of football-specific skills had no influence on the overall injury rate. Burden of overuse injuries, but not acute injuries was significantly higher in most fit players compared with the players in the reference group (IRR: 2.09, 95% CI: 1.04-4.24). In conclusion, most fit players were at greater risk of sustaining injuries in youth competitive football.

Influence of Ankle Injury on Subsequent Ankle, Knee, and Shoulder Injuries in Competitive Badminton Players Younger Than 13 Years

Background:

In recent years, there has been a trend in badminton toward more specialized training at an earlier age. Accompanying this trend is the increased frequency of injuries in young players. Ankle injury is the most common injury in pediatric sports; however, its influence on subsequent injuries is rarely considered.

Purposes:

To evaluate the incidence of ankle, knee, and shoulder injuries in youth badminton and to investigate the influence of ankle injuries on subsequent ankle, knee, and shoulder injuries.

Study Design:

Descriptive epidemiology study; Level of evidence, 3.

Methods:

A custom-designed questionnaire was used to survey Japanese players 7 to 12 years of age who attended national elementary school–level badminton tournaments between May and September 2019. Information including the players’ characteristics, training history, injuries in the previous 12 months, and ankle injury histories were collected. Logistic regression was used for analysis.

Results:

A total of 478 players were included in the study, with 71 ankle injuries, 74 knee injuries, and 48 shoulder injuries reported. The injury incidence rates (per 1000 hours of play) were 0.23 (95% CI, 0.18-0.29) for the ankle, 0.24 (95% CI, 0.19-0.30) for the knee, and 0.16 (95% CI, 0.11-0.20) for the shoulder; 90.1% of ankle injuries, 25.7% of knee injuries, and 33.3% of shoulder injuries were acute. Previous ankle injury was significantly associated with subsequent ankle injury (adjusted Odds Ratio (OR), 3.05; 95% CI, 1.54-6.07; P < .05), knee injury (adjusted OR, 2.03; 95% CI, 1.12-3.69; P < .05), and shoulder injury (adjusted OR, 2.46; 95% CI, 1.26-4.83; P < .05).

Conclusion:

The study results indicated that previous injury to the ankle significantly increased the occurrence of subsequent ankle, knee, and shoulder injuries. Emphasizing protection and prevention of ankle injuries may help lower future injury risk in young badminton players.

Epidemiology of Campus Football Injuries in Ningxia, China: Occurrence, Causes, and Management

Objective

By 2022, the Chinese government intends to have more than 30 million primary-, middle- and high-school children and adolescents regularly participate in campus football. In contrast, epidemiology of campus football injuries is completely missing. The goal of this descriptive epidemiological study was to determine the current state of campus football injuries and then to recommend appropriate prevention and management strategies.

Methods

This retrospective epidemiological study conducted a survey of students, physical education and football teachers in primary, middle and high schools in the Ningxia Autonomous Region to determine the campus football injuries that occurred throughout the preceding 12-month period. The survey comprised questions on demographic characteristics, the occurrence, causes, and management of campus football injuries.

Results

A total of 1,285 students and 200 teachers returned eligible surveys. 25.7% of students had encountered injury accidents while participating in campus football activities. 31.3% of high school students, 23.8% of middle school students, and 19.2% of primary school students have sustained injuries. Football competition, accounting for 45.4% of all injuries, is the leading cause of injury. Football class teaching, which accounted for 3.0% of all injuries, had the lowest injury rate of any campus football activity. Students and teachers reported that a lack of safety awareness and injury prevention education were the primary causes of injuries. Only 18.7% and 11.4% of students are familiar with first aid basics and cardiopulmonary resuscitation, respectively. 10.6% and 7.5% of students lack any first aid basics and skills, respectively. 43.9% of students lack insurance coverage for athletic injuries. 62.5% and 38.5% of teachers reported that schools lack first aid training and an emergency plan for injuries, respectively.

Conclusion

Students in Ningxia's campus football programs have a high injury risk. Injury prevention and management strategies lag significantly behind the mainstream nationwide promotion of campus football in China.

In-Season Quantification and Relationship of External and Internal Intensity, Sleep Quality, and Psychological or Physical Stressors of Semi-Professional Soccer Players

The purpose of this study was two-fold: (a) to describe and analyse the relationship of the in-season variations of external and internal intensity metrics as well as well-being measures across different periods of a semi-professional soccer season (early-, mid- and end-season); and (b) to describe training monotony (TM) and training strain (TS) for 20 weeks in a semi-professional soccer season. Eighteen semi-professional players (age: 29 ± 4.1) from the Asian First League team participated in this study. The players were monitored for 20 consecutive weeks during in-season for external training intensity, internal training intensity and well-being parameters. The in-season was organized into three periods: early-season (weeks 1−7); mid-season (weeks 8−13); and end-season (weeks 14−20). Total distance (TD), high-speed running distance (HSRD), sprint distance, rate of perceived exertion (RPE), session-RPE (s-RPE), TM, TS, heart rate average and maximum, as well as sleep quality, stress and muscle soreness were collected. Results revealed that TD, HSRD and sprint distance (total values) were meaningfully greater during end-season than in the early-season. RPE showed a significantly highest value during the end-season (4.27 AU) than in early- (3.68 AU) and mid-season (3.65 AU), p < 0.01. TS showed significant differences between early-season with mid-season (p = 0.011) and end-season (p < 0.01), and the highest value occurred in week 17 during end-season (6656.51 AU), while the lowest value occurred in week 4 during early-season (797.17 AU). The average TD periods showed a moderate to large correlation with RPE, sleep and s-RPE at early-, mid- and end-season. Increasing the training intensity without considering the well-being of the players affects the performance of the team. Examining processes of the relationship between training intensity and other psychological indicators among players will probably be effective in training planning. Sports coaches and fitness professionals should be wary of changes in TM and TS that affect players performance. Therefore, to better control the training, more consideration should be given by the coaches.

Youth sport specialization associated with poorer lower extremity function & pain as young adults

OBJECTIVE

Examine the link between youth sports specialization and long-term lower extremity joint health after sports by comparing lower extremity function, pain, and history of sport-related injuries between young adults that were highly, moderately, and low specialized in youth sports.

METHODS

We used a cross-sectional design, and all data was collected using an electronic survey. Our sample included N = 356 young adults who participated in a primary sport during youth and high school sports but were no longer participating in that sport as a young adult. Participants were stratified into high (n = 111), moderate (n = 119), and low (n = 126) specialization groups using a 3-criteria sport specialization questionnaire based on youth sports participation prior to high school. We compared participants current Lower Extremity Functional Scale (LEFS) score (0-80), the proportion of participants with clinically important deficits in LEFS score (≤71/80), current lower extremity (foot/ankle, knee, hip) pain scores (0-10), and history of lower extremity (foot/ankle, knee, hip) injuries between the high, moderate, and low specialization groups.

RESULTS

The high specialization group reported significantly lower overall LEFS scores, and a greater proportion (40%) reported clinically important deficits in LEFS scores compared to the low specialization group (20%). The high specialization group also reported greater foot/ankle and knee pain and a greater proportion of sport-related knee injuries than the low specialization group (49% vs 25%).

CONCLUSIONS

Our findings suggest that even after discontinuing sports, young adults who were highly specialized in youth sports before high school reported clinically important deficits in lower extremity function, greater foot/ankle and knee pain, and a greater history of knee injuries than young adults who were not specialized in youth sports, suggesting a possible link between youth sports specialization and long-term lower extremity health after sports.

Heading incidence in boys' football over three seasons

Purpose: To quantify the incidence and characteristics of purposeful headers and unintentional head impacts in football (soccer) in boys' football over three seasons.Methods: This retrospective longitudinal study analysed purposeful headers and unintentional head impacts collected over three seasons (under-10 to under-12) using match video analysis from boys' team in Australia. Total headers and head impacts, as well as incidence rate (IR) per 1000 match-hours for different match characteristics, were calculated.Results: Total number of headers and heading IR increased significantly (r = 0.99) with age from under-10 (n = 29; IR: 483) to under-12 (n = 149; IR: 1515). All but three players (87%) were observed to head the ball at least once during a season (mean: 10, range 0-25) with the accumulative number of headers performed by out-field players over three seasons ranging from 6 to 40. Players in defensive positions (n = 121) headed the ball more frequently than midfielders (n = 83) or attackers (n = 53). Five (IR: 22) unintentional head impacts were observed, of which four required medical attention.Conclusion: Although the number of headers performed by young players in under-10 to under-12 age groups was low, the range of headers performed by individuals varied greatly. These results could be used to guide age-specific heading coaching practices.

Apophysitis Among Male Youth Soccer Players at an Elite Soccer Academy Over 7 Seasons

Background:

Apophyseal injuries are common in children and adolescent athletes. These injuries are believed to be caused by repetitive overloading, which can create inflammatory and degenerative conditions in growing bone prominences. However, their prevalence, diagnosis, and treatment in young soccer players have been understudied.

Purpose:

To evaluate characteristics of apophyseal injuries in adolescent athletes at an elite soccer academy.

Study Design:

Case series; Level of evidence, 4.

Methods:

All apophyseal injuries between July 2008 and June 2015 were evaluated. For each injury, the authors recorded the type and location, age of the player, injury date, imaging modalities, and time absent from training/competition.

Results:

Over the 7 seasons of this study, 210 apophyseal injuries were documented, including 172 simple apophyseal injuries and 38 apophyseal avulsion fractures. The rate of apophyseal injuries was 0.35 per 1000 hours of training exposure. A total of 196 (93.3%) cases were primary injuries, and the rest (6.7%) were reinjuries. Ultrasonography was the most commonly used imaging modality for diagnosis (172 cases; 81.9%). The most common location of apophyseal injuries was the anterior inferior iliac spine (AIIS). Return to sport was faster in athletes with apophyseal injury at the ischiopubic ramus, those with simple apophyseal injuries, and younger athletes.

Conclusion:

The most common location for apophyseal injury among soccer players was the AIIS. Return to training and competition differed according to injury location, type of apophyseal injury, and age.

Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study

INTRODUCTION

Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy.

METHODS

In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad).

RESULTS

There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12-30) days; II: 10 (95% CI: 7.3.1-13.4)]. Apophyseal injuries of the hip-pelvis resulted in the greatest burden [median: 13 (95% CI: 10-17); II: 2.5 (95% CI: 2.1-3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot-ankle (II: 2.4; 95% CI: 1.0-4.9), U-14 for knee (II: 4.5; 95% CI: 2.7-7.1), and U-17 for hip-pelvis (II: 6.4; 95% CI: 4.2-9.3).

CONCLUSION

Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip-pelvic apophyseal injuries accounted for the largest injury burden.

The Effect of Navigation Demand on Decision Making in a Dynamic, Sport-Inspired Virtual Environment

Athletes commonly make decisions about the passability of closing gaps when navigating sport environments. This study examined whether increased temporal pressure to arrive at a desired location modifies these decisions. Thirty participants navigated toward a waypoint in a virtual, sport-inspired environment. To do so, they had to decide whether they could pass through closing gaps of virtual humans (and take the shortest route) or steer around them (and take a longer route). The decision boundary of participants who were time pressured to arrive at a waypoint was biased toward end gaps of smaller sizes and was less reliably defined, resulting in a higher number of collisions. Effects of temporal pressure were minimized with experience in the experimental task. Results indicate that temporal pressure affects perceptual-motor processes supporting information pickup and shapes the information-action coupling that drives compliance with navigation demands. Theoretical and practical implications are discussed.

Acceleration profile of high-impact movements during young football games: a cross-sectional study involving healthy children

Repetitive high-impact movements cause growth-related injuries in children. This study aimed to identify which movements during junior football games require >6 G and >8 G acceleration and the frequency at which they occur. Additionally, we compared the components of acceleration among movements with >8 G resultant acceleration. Eleven young male footballers (10.7 ± 0.4 years) played 8-a-side games while wearing a tri-axial accelerometer on their upper back. The number and frequency of the movements that generated >6 G and >8 G were calculated, and each directive acceleration of the top five items was compared using two-way ANOVA to examine the effect of movements. The frequency of movements that generated >6 G and >8 G acceleration during junior football games was 8.70 case/min and 2.62 case/min, respectively. The top five >8 G movements were braking and pre-braking in shuffle, slowdown, stop, and run/jog items. The vertical acceleration was significantly greater during braking in shuffle than during slowdown, stop, and run/jog and also greater during stop and pre-braking in shuffle than during run/jog movement. This pilot study suggests that decelerated movements mainly provoked high-impact situations and may be key actions for preventing overuse injury in young footballers.

Neuromuscular Training and Motor Control in Youth Athletes: A Meta-Analysis

Our purpose in this review was to determine the effects of bodyweight-only neuromuscular training (NMT) programs on motor control of movement among youth athletes. We searched three electronic databases (CrossRef, Google Scholar, and PubMed), using the following inclusion criteria for selecting research studies: (a) healthy male and female participants aged 8-18 years who were engaged in organized sports; (b) interventions up to 16-weeks duration; (c) incorporation of a control group; and (d) interventions that utilized only exercises using participants' body mass. We calculated pooled estimates of effect sizes (standardized mean difference) for changes in motor control across nine studies (12 comparisons) using the inverse-variance random effects model for meta-analyses and 95% confidence intervals. Among the nine studies included in our meta-analysis, there was a moderate, significant effect in favor of neuromuscular training programs (0.79 [95% CI: 0.38, 1.20], Z = 3.76 [p = 0.0002]) on motor control. Heterogeneity was high and significant (I²= 77% [p = 0.00001]). Moderator analyses for age and stature revealed NMT programs to be more effective in younger, shorter, and lighter individuals. We found larger effect sizes in males, and for programs >8 weeks in duration. We concluded that the older and heavier an individual is, the less effective bodyweight-only NMT programs became, particularly for female participants. These results reinforce the notion that exercise to enhance motor control should be emphasized during pre-adolescence.

M. Biceps Femoris Long Head Architecture and Sprint Ability in Youth Soccer Players

PURPOSE

Hamstring muscle architecture may be associated with sprint performance and the risk of sustaining a muscle injury, both of which increase during puberty. In this study, we investigated the m. biceps femoris long head (BFlh) cross-sectional area (ACSA), fascicle length (FL) and pennation angle (PA), and sprint performance as well as their relationship in under 13 to 15 youth soccer players.

METHODS

We measured 85 players in under-13 (n = 29, age = 12.5 [0.1] y, height = 155.3 [6.2] cm, weight = 43.9 [7.6] kg), under-14 (n = 25, age = 13.5 [0.3] y, height = 160.6 [7.7] cm, weight = 47.0 [6.8] kg), and under-15 (n = 31, age = 14.4 [0.3] y, height = 170.0 [7.7] cm, weight = 58.1 [8.8] kg) teams. We used ultrasound to measure BFlh ACSA, FL and PA, and sprint tests to assess 10- and 30-m sprint time, maximal velocity  (vmax), and maximal acceleration (αmax). We calculated Pearson r to assess the relationship between sprint ability and architectural parameters.

RESULTS

All muscle architectural parameters increased from the under-13 to the under-15 age group (BFlh ACSA = 37%, BFlh FL = 11%, BFlh PA = 8%). All sprint performance parameters improved from the under-13 to under-15 age categories (30-m time = 7%, 10-m time = 4%, vmax = 9%, αmax = 7%). The BFlh ACSA was correlated with 30-m sprint time (r = -.61 (95% compatibility interval [CI] [-.73, -.45]) and vmax (r = .61, 95% CI [.45, .72]). A combination of BFlh ACSA and age best predicted 30-m time (R² = .47 [.33, .62]) and 10-m time (R² = .23 [.08, .38]).

CONCLUSIONS

Muscle architectural as well as sprint performance parameters increase from the under-13 to under-15 age groups. Even though we found correlations for all assessed architectural parameters, BFlh ACSA was best related to the assessed sprint parameters.

Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children's Soccer: A Cluster Randomized Controlled Trial

Background:

Prevention of sports injuries is essential in youth, as injuries are associated with less future physical activity and thus greater all-cause morbidity.

Purpose:

To investigate whether a neuromuscular training warm-up operated by team coaches is effective in preventing acute lower extremity (LE) injuries in competitive U11-U14 soccer players.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Twenty top-level U11 to U14 soccer clubs in Finland were randomized into intervention and control groups and assessed for 20 weeks. Participants included 1403 players (280 female, 1123 male; age range, 9-14 years): 673 players (44 teams) in the intervention group and 730 players (48 teams) in the control group. The intervention group team coaches were introduced to a neuromuscular training warm-up to replace the standard warm-up 2 to 3 times per week. The control teams were asked to perform their standard warm-up. Injury data collection was done via weekly text messages. The primary outcome measure was a soccer-related acute LE injury, and the secondary outcome measure was an acute noncontact LE injury.

Results:

A total of 656 acute LE injuries occurred: 310 in the intervention group and 346 in the control group. The overall acute LE injury incidence was 4.4 per 1000 hours of exposure in the intervention group and 5.5 per 1000 hours of exposure in the control group, with no significant difference between groups (incidence rate ratio [IRR], 0.82 [95% CI, 0.64-1.04]). There were 302 acute noncontact LE injuries: 129 in the intervention group (incidence, 1.8 per 1000 hours) and 173 in the control group (2.7 per 1000 hours). A significant reduction in acute noncontact LE injuries of 32% (IRR, 0.68 [95% CI, 0.51-0.93]) was observed in the intervention group compared with the control group. Furthermore, significant reductions in injury incidence in favor of the intervention group were seen in the subanalyses of acute noncontact LE injuries, leading to ≤7 days of time loss and fewer ankle and joint/ligament injuries.

Conclusion:

A neuromuscular training warm-up operated by team coaches was found to be effective in preventing acute noncontact LE injuries in children’s soccer, but this was not seen in all acute LE injuries.

Clinical Relevance:

We encourage children’s soccer coaches and health care professionals to implement neuromuscular training warm-up in youth sports.

Registration:

ISRCTN14046021 (ISRCTN registry).

Epidemiology and pain in elementary school-aged players: a survey of Japanese badminton players participating in the national tournament

Pain is common in athletes which should be well managed. To identify risk factors for shoulder pain, and the association between shoulder pain, lower back pain and knee pain among elementary school-aged badminton players, we conducted a cross-sectional study to collect data of the past year among 611 elementary school age (7-12 years old) badminton players belonging to the Japan Schoolchildren Badminton Federation using a questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by multivariate logistic regression analysis. The overall incidence rate of shoulder injuries, lower back injuries and knee injuries was 0.38 injuries per 1000 h of badminton training. Players with training time per day > 2.5 h were 2.64 times (95% CI 1.03-6.78, p = 0.043) more likely to sustain shoulder pain than those with training time per day ≤ 2.5 h. A significant association was revealed between shoulder pain and knee pain as well as between lower back pain and knee pain as training hours per day > 2.5 h. Moreover, lower back pain was significantly associated with shoulder pain independent of training hours per day (≤ 2.5 h: p = 0.001; > 2.5 h: p < 0.001). These findings indicate that training time per day is risk factor, and shoulder pain, lower back pain and knee pain were associated with each other in elementary school-aged badminton players.

Influence of Size and Maturity on Injury in Young Elite Soccer Players

The involvement of pre-adolescents in soccer is becoming more and more frequent, and this growing participation generates some concerns about the potential factors for sports injuries. The purpose of this study was to investigate sports injuries in younger (U9–U11) and older (U12–U13) children playing soccer at an elite level, analyzing potential anthropometric and maturity risk factors. A total of 88 elite soccer players aged 9–13 years were investigated. Weight, stature, and sitting height were measured at the start and at the end of the competitive season, computing the relative growth velocities. Additional body composition parameters were taken during a second survey. Maturity offset was calculated using predictive equations based on anthropometric traits such as years from age at peak height velocity (YPHV). Injuries suffered during the competitive season were recorded. Maturity and some anthropometric characteristics were significantly different according to the presence or absence of injuries among the players. Multiple logistic regression revealed that YPHV, body mass index (BMI), and calf muscle area were the factors most significantly correlated with injuries. Players with increased BMI, with decreased calf muscle area, and who were closer to their peak height velocity, were at a higher risk of injury. Findings showed that a monitoring program of anthropometric characteristics taking into account the maturational stage needs to be developed to prevent injuries.

Abdominal Organ Injuries in Youth Soccer: A Case Series and Review of Literature

ABSTRACT

We describe 13 children who presented to the Penn State Health Milton S. Hershey Medical Center (HMC) with pediatric soccer-related abdominal organ injuries. A review of the Pennsylvania Trauma System Foundation's Trauma Registry was performed between 2001 and 2015 for children with soccer injuries hospitalized at trauma centers across Pennsylvania. Out of 52 children at Hershey Medical Center, 13 suffered abdominal organ injuries. Injuries included the spleen [5], kidney [4], liver [2], and combined organ involvement [2]. All patients presented with abdominal and/or flank pain. All patients with kidney injuries presented with hematuria. All patients presented after a player-to-player (P2P) contact. Nearly all patients (12/13) were treated nonsurgically. Our findings showed that abdominal organ injuries constitute a substantial portion of pediatric soccer injuries requiring hospitalization, with spleen being the organ injured most frequently. Soccer-related abdominal organ injuries should be suspected in players who suffer abdominal and/or flank pain, and/or hematuria after a P2P contact.

Relationship Between Training Factors and Injuries in Stand-Up Paddleboarding Athletes

Stand-up paddleboarding (SUP) is an increasingly popular sport but, as in other sports, there is an injury ratio associated with practicing it. In other types of sport, some factors have been linked to the likelihood of suffering an injury, among which stretching, core training and resistance training may be considered the most significant. Therefore, the main aim of this study was to identify the training factors that could influence injuries suffered by participants in international SUP competitions. Ninety-seven questionnaires were collected from paddlers who participated in an international SUP circuit, with epidemiological data being gathered about injuries and different questions related to the training undertaken. A multi-factor ANOVA test was used to identify the factors which influence the state of injury. Results showed that almost 60% of injuries occurred in the arms or in the upper thoracic region, around 65% of which were in tendons or muscles and, in almost half of cases, were related to overuse. Likewise, the results showed that athletes with injury performed fewer resistance training sessions per week (p = 0.028), over fewer months per year (p = 0.001), more weekly training sessions (p = 0.004) and, lastly, a greater volume of weekly training (p = 0.003) than athletes without injury. Moreover, the most important training factors that reduce the likelihood of suffering an injury were taken into account-in. particular, resistance training alone (p = 0.011) or together with CORE training (p = 0.006) or stretching (p = 0.012), and the dominant side of paddling (p = 0.032). In conclusion, resistance training would seem to reduce the likelihood of injury among SUP practitioners, and such benefits could be obtained by resistance training alone or in combination with CORE training or stretching.

Employing Standardised Methods to Compare Injury Risk Across Seven Youth Team Sports

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61-120) than all sports except female rugby union (54/1000 h; 95% CI 37-76). Concussion was the most common injury (incidence range 0.0-26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies.

Future Directions in Sports-Related Concussion Management

This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.

Structure, Intensity and Player Duels in Under-13 Football Training in Switzerland

We evaluated the structure (i.e., the different training parts), contents (i.e., the various activities used), intensity and occurrence of contact situations and headers during training sessions in under-13 football in Switzerland. A total of 242 players from 20 different teams on average aged 11.4 (SD 0.7) years participated. The participants were filmed during a typical training session while they were equipped with a heart rate sensor. The sessions were systematically recorded to allow for detailed analyses. Furthermore, a preliminary and explorative analysis of the influence of the level of play on these results was conducted. The overall findings indicated that training included 33.4% playing forms, 29.5% training forms, 28.4% inactivity time and 8.7% athletics. The highest heart rates were achieved in the playing forms (166 min⁻¹, 83% HR_max) compared to the other two activities (training forms 154 min⁻¹, 77% HR_max; athletics 150 min⁻¹, 75% HR_max). Each player had 12.8 duels and 0.6 headers per training. Overall, most duels were conducted from the anterior direction. Playing forms induce higher cardio-circulatory load as well as a better learning environment. Potentially dangerous situations like contact with other players or headers occurred in a single player on average every six min during a training session.

Incidence of injuries in young soccer players: epidemiological study in an Italian elite club

BACKGROUND

Football is the most popular sport in the world, increasingly played by the youngsters. However, little epidemiological data exists regarding injuries in young players. The aim of this study was to describe the most common types and sites of injury among the different classes of a single professional football club.

METHODS

The present perspective study covered a three-season period, including 679 children divided in 9 age classes. All the athletes were managed by the same staff and for each injury, onset date, date of return to training, anatomic site and type of injury were recorded.

RESULTS

The mean age of the population was 12.7 years old (Range 7.4-16.9). A total 975 injuries were recorded without significant differences among seasons (P=0.682). The most affected classes were U17 and U16, while the lowest rate of injury was in U11. The most common injury in U9 and U10 affected foot and ankle, while in all the other classes thigh was the most frequently site involved. Focusing on the type of injury, the most common cause was traumatic (40.9%), followed by muscular diseases. The mean value of absence from soccer was 19.7 days (±1.2). The highest rate of injuries occurred in September and August. In January and February, injuries were more frequent during competitions, whereas in the other months the rate was inverted.

CONCLUSIONS

This study highlights that preseason and the final phase of the season are more at risk of injury and the type of injury differs between classes.

Females Sustain more Ankle Injuries than Males in Youth Football

This prospective study evaluated the incidence and pattern of acute injuries in youth (9- to 14-year- old) football players. Ten football clubs [n=730 players (567 males, 163 females)] participated in the 20-week follow-up study (January-June 2015). Data was collected by sending a standardized weekly SMS to players' parents/guardians with follow-up interviews for injured players. During the study period, 278 players (38%) sustained 410 acute injuries. The overall injury incidence for males and females was 6.47 (95% CI, 5.84-7.09) injuries per 1000 h of football exposure. Most injuries (40%) caused minimal absence from sports. Eighty-four percent of the injuries affected the lower extremities, with the ankle (30%), knee (17%), and thigh (16%) being the most commonly injured body sites. Females had significantly higher ankle injury rate (IRR) 1.85 (95% CI, 1.18-2.91, p=0.007) and non-contact ankle injury rate IRR 2.78 (95% CI, 1.91-4.02, p<0.001) than males. In conclusion, our results showed that the acute injury incidence among youth football is moderately high, and females are at higher risk for ankle injuries. Injury prevention programs aimed at preventing ankle injuries should be considered in the future.

The UEFA Heading Study: Heading incidence in children's and youth' football (soccer) in eight European countries

To assess the real-life magnitude of the heading incidence in children's and youth' football in eight European countries with different "football cultures," a cross-sectional observational design, in which one match per team in 480 different teams from eight European countries (2017/18-2018/19), was recorded by video. One training session was recorded in 312 teams. Clubs with Under-10, Under-12 (female/male/mixed), and Under-16 female and male teams were eligible to participate. Heading frequencies and types were analyzed. Results are presented as headers per match/training and per team. Incidence rates (IR) per 1000 match/training hours were calculated. Under-10 teams carried out the lowest average number of headers per match (8.8), followed by Under-16 female (17.7), Under-12 (18.4), and Under-16 male (35.5). Total number of headers per match and team varied between countries. 80% of the total number of headers were single intentional headers, 12% heading duels, 3% unintentional headers by getting hit, and 5% others (trends apparent in all age groups). Three head injuries occurred during match play corresponding to an IR of 0.70 (95% CI, 0.23-2.16). The lowest number of headers per training and team was found in Under-10 (21.3), followed by Under-16 females (34.1), Under-12 (35.8), and Under-16 males (45.0). In conclusion, this large-scale study presents novel data about the number and type of headers in youth' football throughout Europe. A more precise understanding of the heading incidence, specifically in young players, is mandatory for the debate of restrictions on heading in youth football.

'Soccer toe': Chronic physeal injury of the great toe metatarsal in a skeletally immature child - A case report

Chronic physeal stress injuries in children can result from ongoing, repetitive compression, distraction and/or shear forces during sports-related activity, and manifest as physeal widening on imaging. We present an 11-year-old soccer athlete with focal physeal widening of her great toe metatarsal and postulate that ongoing or repetitive stress from soccer play may manifest as this imaging appearance. We suggest that recognition of this entity in growing children might explain pain, if present, and guide conservative treatment.

The 11+ Kids warm-up programme to prevent injuries in young Iranian male high-level football (soccer) players: A cluster-randomised controlled trial

OBJECTIVE

To assess the effectiveness of the 11+ Kids warm-up programme regarding injury reduction in male high-level children's football players.

DESIGN

Cluster-randomised controlled trial.

METHOD

Male youth football teams of Iran's high-level football schools were invited to participate. Inclusion criteria were: teams are competing in the highest league of their province; players are between 7 and 14 years old; regular training takes place at least twice per week. Teams were excluded if they used an injury prevention measure. Participating clubs were randomised to an intervention (INT, N = 20 teams) and a control group (CON, N = 22 teams), stratified by the number of teams and the age group. The groups were blinded against each other. The follow-up period was one season (9 months). INT replaced their warm-up by 11+ Kids. CON performed a standard warm-up programme. The primary outcome was the injury incidence density (injuries per 1000 h of football exposure), compared between groups by incidence rate ratios (RR).

RESULTS

In total, 64,047 h of football exposure of 962 players (INT = 443 players, 31,934 h of football, CON = 519 players, 32,113 h of football) were recorded. During the study, 90 (INT = 30; CON = 60) injuries occurred. The overall injury incidence density in INT was reduced by 50% compared to CON (RR 0.50; 95%-CI 0.32, 0.78). No injuries occurred during the execution of the intervention exercises.

CONCLUSIONS

The 11+ Kids reduces injuries in high-level children's football players, thus supporting player health and potentially performance and player development.

Factors Associated With Knee Pain and Heel Pain in Youth Soccer Players Aged 8 to 12 Years

Background:

Soccer is played by many children younger than 12 years. Despite its health benefits, soccer has also been linked to a high number of sport-related injuries.

Purpose:

To investigate the relationship between clinical factors and knee or heel pain in youth soccer players.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Study participants included 602 soccer players aged 8 to 12 years who were asked whether they had experienced episodes of knee or heel pain. Data were collected on age, body mass index, years of playing soccer, playing position, and training hours per week. Associations of clinical factors with the prevalence of knee or heel pain were examined by univariate and multivariate logistic regression analyses.

Results:

Episodes of knee and heel pain were reported by 29.4% and 31.1% of players, respectively. Multivariate analyses revealed that older age and more years of playing soccer were significantly and positively associated with the prevalence of knee pain (P = .037 and P = .015 for trend, respectively) but did not identify any significant associations for heel pain.

Conclusion:

In this study of youth soccer players, knee pain was associated with older age and more years of play, but heel pain was not significantly associated with any factor.

Soccer Injuries in Children and Adolescents

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

Sports Specialization Is Not Associated With Greater Odds of Previous Injury in Elite Male Youth Soccer Players

OBJECTIVE

To determine the relationship between sport specialization and previous injury in elite male youth soccer players.

DESIGN

Retrospective survey.

SETTING

U.S. Soccer Development Academy.

PARTICIPANTS

Male youth soccer players (N = 2123).

ASSESSMENT OF RISK FACTORS

Sport specialization, weekly training volume, training ratio, and age.

MAIN OUTCOME MEASURES

Previous sports-related injury, injury type (traumatic vs overuse), injury severity, and injury location.

RESULTS

Of 2099 participants (average age 13.2 ± 1.8 years), 61.7% were specialized in soccer (played soccer >8 mo/yr and no other sports) and 38.3% were nonspecialized (played soccer >8 mo/yr and also played other organized sports). Specialized athletes were older than nonspecialized athletes (13.7 ± 1.9 vs 12.5 ± 1.4, P < 0.0001). Thirty-three percent (690/2099) of athletes reported at least one previous sports-related injury for a total of 765 traumatic injuries and 25 overuse injuries. Distribution of injury type was similar for specialized and nonspecialized athletes. Among athletes with overuse injuries, nonspecialized athletes were more likely to report upper-extremity and trunk overuse injuries than specialized athletes. After accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury compared with nonspecialized athletes [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.64-0.95], and similar odds of reporting a previous lower-extremity (LE) overuse injury as nonspecialized athletes (OR, 0.70; 95% CI, 0.56-1.1). However, specialized athletes missed more practices due to injury than nonspecialized players [median = 3, interquartile range (IQR) 2-4 vs median = 2, IQR 2-4, P = 0.0003].

CONCLUSIONS

In this national sample of elite, male youth soccer players, after accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury and similar odds of reporting a previous LE overuse injury as nonspecialized athletes. These data suggest the need for further research to determine whether injury risk related to sports specialization depends on sex, chosen sport, and skill/competitive level.

Injuries and concussions among young children, ages 5-11, playing sports in recreational leagues in Florida

Background

The specific research aims of this study included: 1) Conduct an epidemiologic analysis of recreational sports injuries among 1500 children, ages 5–11 in Florida: and 2) Utilize the computerized pediatric concussion tool from ImPACT Applications, Inc. for baseline and follow-up testing to better understand these injuries. This research followed a prospective surveillance design utilizing a large cohort of children, ages, 5–11, who play recreational football, soccer, and baseball/softball in Florida. The study venue was a large athletic facility in Hillsborough County, Florida. The sports observed were soccer (girls’ and boys’), baseball, softball, and football. Internal and external advisory boards were consulted throughout the study.

Methods

Certified Athletic Trainers (ATCs) were hired to use High School Reporting Information Online (RIO) for injuries and the Ipad-administered pediatric concussion tool developed by ImPACT Applications, Inc for baseline/follow-up concussion data.

Results

Over the course of the project, 26 RIO-reported injuries were reported. Football and soccer produced the greatest rate of injuries. There were 12 concussions which comprised nearly half of all the RIO injuries (46%). We conducted 882 baseline concussion tests and 13 follow-up tests over the 2 years.

Conclusions

To the best of our knowledge, this is the first time data have been collected and reported on sports injuries in the study population. Future studies built on these findings will allow for the development of targeted guidelines and interventions for coaches, players, and parents so sports injury-related morbidity and mortality decrease in our youngest athletes.

The Effect of a Previous Strain Injury on Regional Neuromuscular Activation Within the Rectus Femoris

The rectus femoris (RF) has a region-specific functional role; that is, the proximal region of the RF contributes more than the middle and distal regions during hip flexion. This study aimed to investigate whether RF strain injury affected the region-specific functional role of the muscle. We studied seven soccer players with a history of unilateral RF strain injury. Injury data were obtained from a questionnaire survey and magnetic resonance imaging (MRI). Multichannel surface electromyographic (SEMG) signals were recorded from the proximal to distal regions of the RF with 24 electrodes during isometric knee extension and hip flexion. The SEMG signals of each channel during hip flexion were normalised by those during knee extension for the injured and non-injured RF (HF/KE), and compared among the proximal, middle, and distal regions. Six RF strain injuries showed a low signal area in MRI. There was no significant difference in muscle strength between the injured and non-injured RF. While the HF/KE in the proximal region was significantly higher than those in the middle and distal regions in the non-injured RF, a difference in the HF/KE was seen only between the proximal and distal regions of the injured RF. Furthermore, the HF/KE of the most proximal channel in the injured RF was significantly lower than that in the non-injured RF. However, there was no significant difference between injured and non-injured areas in the HF/KE. Our findings suggest that the region-specific functional role of the RF muscle is partly affected by RF strain injury.

Community-level football injury epidemiology: traumatic injuries treated at Swedish emergency medical facilities

Background

Despite the popularity of the sport, few studies have investigated community-level football injury patterns. This study examines football injuries treated at emergency medical facilities using data from three Swedish counties.

Methods

An open-cohort design was used based on residents aged 0-59 years in three Swedish counties (pop. 645 520). Data were collected from emergency medical facilities in the study counties between 1 January 2007 and 31 December 2010. Injury frequencies and proportions for age groups stratified by sex were calculated with 95% confidence intervals (95% CIs) and displayed per diagnostic group and body location.

Results

Each year, more than 1/200 person aged 0-59 years sustained at least one injury during football play that required emergency medical care. The highest injury incidence was observed among adolescent boys [2009 injuries per 100 000 population years (95% CI 1914-2108)] and adolescent girls [1413 injuries per 100 000 population years (95% CI 1333-1498)]. For female adolescents and adults, knee joint/ligament injury was the outstanding injury type (20% in ages 13-17 years and 34% in ages 18-29 years). For children aged 7-12 years, more than half of the treated injuries involved the upper extremity; fractures constituted about one-third of these injuries.

Conclusions

One of every 200 residents aged 0-59 years in typical Swedish counties each year sustained a traumatic football injury that required treatment in emergency healthcare. Further research on community-level patterns of overuse syndromes sustained by participation in football play is warranted.

A Multinational Cluster Randomised Controlled Trial to Assess the Efficacy of '11+ Kids': A Warm-Up Programme to Prevent Injuries in Children's Football

Objective

The objective of this study was to assess the efficacy of a newly developed warm-up programme (‘11+ Kids’) regarding its potential to reduce injuries in children’s football.

Methods

Children’s football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by ‘11+ Kids’, while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis.

Results

In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32–0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10–0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24–0.84) were also reduced. Injury incidence decreased with increasing compliance.

Conclusion

‘11+ Kids’ is efficacious in reducing injuries in children’s football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit.

Trial Registration

ClinicalTrials.gov identifier: NCT02222025.

Electronic supplementary material

The online version of this article (10.1007/s40279-017-0834-8) contains supplementary material, which is available to authorized users.

Effects of the '11+ Kids' injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomised controlled trial

BACKGROUND

To assess the effects of the injury prevention programme '11+ Kids' on reducing severe injuries in 7 to 13 year old football (soccer) players.

METHODS

Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by '11+ Kids' two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models.

RESULTS

The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously.

CONCLUSIONS

'11+ Kids' has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the '11+ Kids' in children's football.

TRIAL REGISTRATION NUMBER

NCT02222025.