A retrospective survey on injuries in Croatian football/soccer referees

Injury prevention in ladies Gaelic football referees: Understanding the barriers, facilitators, and preferences of referees

OBJECTIVES

The injury prevalence in Gaelic games refereeing is high, however few are adopting injury prevention programmes. This study aims to identify the barriers and facilitators to injury prevention strategy success and determine Ladies Gaelic Football referees' preferences for injury prevention strategies and education.

DESIGN

Semi-structured interviews were conducted with 11 Ladies Gaelic Football referees (10 men, 1 woman). Two were club level, two were provincial level and 7 were national level referees. Interviews were audio-recorded, transcribed verbatim, and reflexive thematic analysis was completed. This analysis involved examining the data repeatedly and gradually developing sub-themes, themes, and categories related to each core concept.

RESULTS

The barriers to injury prevention success included negative attitudes, accessibility issues, lack of education, the state of refereeing and undesirable injury prevention strategy characteristics. Injury prevention promotion, suitable strategy characteristics and open communication were believed to facilitate success. Referees gave their preferences for injury prevention programmes, strategy logistics, and stakeholder roles along with their preferred topics, delivery, educators, characteristics, rollout, and timing for injury prevention education.

CONCLUSIONS

Reducing referee injury is critical to the success of Ladies Gaelic Football and other community sports. Governing bodies must develop and support injury prevention programmes and education for referees. These should be designed according to referees' preferences and consider the barriers and facilitators referees have identified to maximise adoption.

Injury Occurrence in Amateur Rugby: Prospective Analysis of Specific Predictors over One Half-Season

Background and objectives: The incidence of injuries in rugby is extremely high, but studies have rarely examined the predictors of injury in amateur players. This study aimed to systematically analyse sports and injury factors as potential predictors of musculoskeletal injuries in senior-level amateur rugby players. Methods: The participants in this study were 101 senior-level rugby players from Croatia (average of 24.64 years old). At baseline, all participants were tested on sociodemographic and anthropometric parameters (age, body height and mass), consumption of dietary supplements, preseason injury status and training volume, and sport factors (position in game). Data on injury occurrence (dependent variable), prevalence of pain, training status, and characteristics of the played match were surveyed prospectively once a week during the three-month period (one half-season). Results: The logistic regression revealed a higher injury occurrence in forward players of the 1st row, 2nd row (OR = 5.07; 95% CI: 1.64–15.69), and center (OR = 4.72; 95% CI: 1.28–14.31), with reference to outside back players. When observed univariately, higher body mass, higher level of competition, more weekly training sessions, self-perceived pain, and playing with pain were significant injury risk factors. The multivariate logistic regression identified pre-season injury (OR = 1.30, 95% CI: 1.09–1.52), higher level of the game/match (OR = 1.44, 95% CI: 1.13–1.76), higher body mass (OR = 1.03, 95% CI: 1.01–1.05), and pain prevalence (OR = 5.71, 95% CI: 3.22-7.70) as multivariate predictors of injury occurrence over the season. Conclusion: The results of this study showed that among sport factors, the playing position, level of competition, and training exposure represent major injury risk factors. Therefore, in order to reduce the number of injuries, special emphasis should be placed on the specific tackling technique of forward players, which could both increase their situational efficiency and protect them from injuries. Additionally, perceived pain, injury history, and playing with injury were noted among injury factors as the ones that can be predictors of future injuries. In that manner, it is important that coaching and medical staff monitor players with previous injuries and with pain symptoms in order to act preventively against injury occurrence.

Injuries to Ice Hockey Referees and Linesmen: A Survey of International Ice Hockey Federation Officials

Background

Ice hockey referees and linesmen are at risk for musculoskeletal injuries because of the lack of protective equipment and contact with players, sticks, pucks, the ice surface and boards.

Purpose

To quantify and analyze injuries reported by officials of the International Ice Hockey Federation (IIHF).

Study Design

Descriptive epidemiology study.

Methods

A 61-question survey tool was designed by an interdisciplinary team to evaluate musculoskeletal injuries experienced by ice hockey officials. This survey was administered to 600 active IIHF referees and linesmen. Only completed survey responses were included in the statistical analysis. Continuous variables were analyzed using unpaired t-tests, while categorical data were assessed utilizing chi-square tests.

Results

Of the 600 surveys administered, 264 surveys were completed by officials from 45 countries (44% response rate). Of the respondents, 72% were male, and 28% were female, with a mean age of 31.1 ± 5.8 years. Officiating experience averaged 11.4 ± 6.0 years (6.3 ± 4.5 years with the IIHF). A total of 295 injuries were reported by 55% of the officials. Injuries occurred more frequently during games compared with training, and officials who worked year-round had more total injuries than those who took time off (P = .03). The most common injuries involved the wrist and hand (n = 64 [22%]), head and face (n = 58 [20%]), and the knee (n = 47 [16%]). Wrist and hand trauma included 23 fractures. Knee and shoulder injuries were most likely to require surgery compared with other body areas (P < .001); 30 officials underwent surgery because of an acute knee injury (10%). Injury prevention activities were effective at reducing injuries (P = .04).

Conclusion

Most ice hockey officials experienced musculoskeletal injuries during their career. The risk of trauma to the wrist and hand can possibly be reduced via equipment modifications including protective gloves. A greater emphasis should be placed on injury prevention programs and time away from officiating competitions.

Prevalence and burden of health problems in top-level football referees

BACKGROUND

Top-level football referees take decisions during strenuous physical activity, and often under great mental pressure. Despite their central role in a football match, little is known about referees' health problems, particularly in female referees.

AIM

To investigate the prevalence and burden of health problems in female and male top-level referees.

STUDY DESIGN

Prospective cohort study.

METHOD

Fifty-five Norwegian male and female top-level referees reported health problems (injuries and illnesses) in pre-season and during the 2020 competitive season, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2).

RESULTS

We recorded data for 49 weeks with a compliance of 98%. On average, 34% (95% CI 31-36%) of referees reported at least one health problem each week, and 20% (95% CI 19-22%) reported substantial health problems. Female referees reported more health problems than male referees, and on-field referees reported more health problems than assistant referees. Gradual-onset injuries were most prevalent and caused the greatest absence from training and matches, whereas illnesses represented only a small portion to the overall burden of health problems. The injury incidence was three injuries per athlete-year (95% CI 2.5-3.5) and 11 injuries per 1000 match hours (95% CI 7-18). The illness incidence was 1.4 illnesses per athlete-year (95% CI 1.1-1.8). Injuries to the lower legs and feet represented the highest burden of health problems.

CONCLUSION

Top-level referees, especially females, reported a high prevalence of health problems. Gradual-onset injuries to the lower leg and foot represented the highest injury burden.

Influence of Football Match-Play on Isometric Knee Flexion Strength and Passive Hip Flexion Range of Motion in Football Referees and Assistant Referees

The aim of this study was to examine the acute effect of officiating a football (soccer) match on isometric knee flexion strength and passive hip flexion range-of-motion (ROM) in referees and assistant football referees. Twelve referees (25.3 ± 3.3 years) and twenty-three assistant referees (25.1 ± 4.8 years) underwent measurements on isometric knee flexion strength and passive hip flexion ROM before and after officiating an official football match. Referees’ and assistant referees’ running patterns were monitored during the match using GPS technology. In comparison to pre-match values, referees reduced their isometric knee flexion strength (−12.36%, p = 0.046, Effect size [ES] = −0.36) in the non-dominant limb, while no significant differences were reported in the dominant limb (−0.75%, p = 0.833, ES = −0.02). No effect of the match was found in hip flexion ROM values in dominant (−4.78%, p = 0.102, ES = −0.15) and non-dominant limb (5.54%, p = 0.544, ES = 0.19). In assistant referees, the pre-to-post-match changes in isometric knee flexion strength (dominant limb −3.10%, p = 0.323, ES = −0.13; non-dominant limb −2.18%, p = 0.980, ES= 0.00) and hip flexion ROM (dominant limb 1.90% p = −0.816, ES = 0.13; non-dominant limb 3.22% p = 0.051, ES = 0.23) did not reach statistical significance. Officiating a match provoked a reduction in isometric knee flexion strength in the non-dominant limb of football referees, while no differences were reported in assistant referees.

High injury rates and weak injury prevention strategies in football referees at all levels of play

Football referees need other physiological requirements on field than football players and are affected by different types of injury. The absence of referees may result in canceled matches, so special focus should be placed on injury prevention through specific training programs for referees. This study retrospectively analyzed injury occurrence and prevention strategies for German football referees at the different levels of play over one season. Data were collected by means of seasonal injury reports based on the consensus statement of injury definition and data collection. Of the 923 participating referees, 91 (9.9%) played at the professional level, 151 (16.3%) at the semi-professional, and 681 (73.8%) at the amateur level. 86.2% (n = 796) were men and 13.8% (n = 127) women. Referees at the amateur level showed the highest injury incidence (3.14/1000 h football) compared to referees at the semi-professional (1.92/1000 h; p < 0.001) and professional level (1.01/1000 h; p < 0.001). Most referees at the amateur (n = 372; 56.4%) and semi-professional level (n = 46; 31.3%) conducted warm-up programs of <10 min, whereas the mean warm-up duration of professional referees was >11 min (n = 75; 82.4%). Although running and stretching exercises were common among referees during warm-up, preventive exercises focusing on coordination and trunk muscles were less frequent, especially among amateur referees (jumping: 15.9%; strengthening: 9.7%; balance exercises: 7.9%). Injury incidence was highest at lower amateur levels, which thus has specific need for injury prevention. Appropriate training exercises to prevent injuries of referees were weak at all levels of play, especially the lack of strength, plyometric, and balance exercises in training and warm-up programs.

Eccentric Hamstring Muscle Strength during Home Confinement Due to the COVID-19 Pandemic, and Football Competition Resumption in Professional Football Referees: A Prospective Observational Study

The COVID-19 pandemic has produced a major disruption for professional football leagues that has affected the physical preparation of both football players and referees. In Spain, health authorities decreed home confinement for eight weeks, supressing the normal training routines of professional referees. After home confinement, referees had four weeks to retrain as the national football league was set to resume matches to complete the 11 games remaining. The aim of the present investigation was to assess changes in eccentric hamstring muscle strength during football competition suspension/resumption due to the COVID-19 pandemic in 21 professional football referees (mean ± SD, age: 33.4 ± 5.1 years; height: 182.4 ± 5.0 cm; body mass: 75.1 ± 4.4 kg). Eccentric hamstring muscle strength was measured with the Nordic hamstring exercise at four time points. During home confinement, referees presented the lowest value of bilateral eccentric muscle strength (300 ± 14 N). Eccentric muscle strength increased by 13.2 ± 3.7% one week after the end of home confinement (339 ± 16 N; p = 0.001, effect size (ES) = 2.8) and remained stable before the first match (343 ± 17 N; p = 0.001, ES = 3.1) and after the end of the national league (328 ± 13 N; p = 0.001, ES = 2.0). In summary, home confinement produced detraining effects in professional football referees associated with hamstring muscle weakness. In this regard, strength-based activities with body loads may be insufficient to avoid muscle weakness and other means (e.g., weights) may be necessary to maintain muscle strength. However, the 4-weeks retraining period was sufficient to resolve hamstring muscle weakness induced by the restrictions of home confinement. This information may be helpful in the case of future sport competition suspension or home quarantine due to new waves of COVID-19 pandemic.

Musculoskeletal pain in lacrosse officials impacts function on the field

This study determined the prevalence of joint pain among lacrosse officials and described the impact of pain thereof on current officiating duties on the field. Members of the US Lacrosse Officials Development Programme were provided with an electronic survey (a 15.7% response rate resulted in N = 1,441 of completed surveys). Pain sites and severity, previous injuries and current impact of musculoskeletal pain on officiating duties were captured. Pain was present in 18.1-40.1% of respondents at the foot, shoulder, back and knee. A total of 437 officials reported diagnoses of osteoarthritis ([OA]; knee 48.7%, hip 10.5%, spine 10.1%, shoulder 8.0%) and 247 reported OA in more than one joint (p < .05). Officials with OA or previous lacrosse-related injuries reported frequent difficulty with running the entire field distance (p < 0.0001), starting and stopping on the field (p < 0.0001), keeping pace (p < 0.0001), focusing on multiple actions of players at once (p < 0.0001), and enjoyment (all p < 0.0001). Musculoskeletal pain is a common, unrecognized issue in this population that interferes with sport officiating functions. Additional study is needed to objectively determine the impact of OA pain and musculoskeletal injuries on measurable performance outcomes on the field and subjective measures of focus, attention and enjoyment.

Investigating the Prevalence and Predictors of Injury Occurrence in Competitive Hip Hop Dancers: Prospective Analysis

Hip hop is a popular form of competitive and recreational sport worldwide, but studies rarely investigate injury prevalence and factors associated with injury occurrence in this sport. This study aimed to prospectively examine injury occurrence in hip hop dancers in a three-month period and to evaluate potential predictors of injury occurrence in hip hop dancers. The participants were 129 competitive hip hop dancers (114 females, 17.95 ± 4.15 years of age). Study predictors were obtained at study baseline and included sociodemographic factors, sport-related factors, previous injury status, anthropometric and body build indices (body height, mass, body mass index, and body composition variables), and dynamic balance performance (obtained by the Star Excursion Balance Test—SEBT). The outcome was injury occurrence, which was prospectively observed once a week by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC). During the course of the study, 101 injuries occurred, equating to an annual injury incidence of 312%. On average, each dancer suffered 0.78 injuries (95% Confidence Interval (95% CI): 0.61–0.97) across a study period of three months (0.76 (95% CI: 0.60–0.95) and 0.93 (95% CI: 0.75–1.13), in females and males, respectively; Mann Whitney Z-value: 0.68, p = 0.52). Seventeen percent of dancers suffered multiple injuries, and 49% of all injuries were time-loss injuries. The knee was the most frequently injured body location (42% of all reported injuries), followed by the back region (32%) and the ankle (15%). Previous injury was a strong predictor of injury occurrence (Odds Ratio: 3.76, 95% CI: 1.87–4.59). Lower injury risk was evidenced among those participants who achieved better scores on several SEBT variables, irrespective of gender and previous injury status; with no significant influence of anthropometric and body build variables on injury occurrence. This study highlighted a high injury rate in hip hop dancers. Dancers and coaches should be informed about the certain protective effects of dynamic balance on the prevention of musculoskeletal injury in hip hop in order to assure safe and effective practices. The usage of SEBT as a convenient and cheap testing procedure is encouraged in other dance disciplines.

INCIDENCE OF MUSCULOSKELETAL INJURIES IN SOCCER REFEREES: A THREE-YEAR STUDY

ABSTRACT Objectives To determine the incidence and intensity of pain and the areas most affected by injuries with musculoskeletal pain, and the incidence and severity of “injuries defined by time of leave” in games and training of soccer referees in a triennium. Methods An interview was conducted with 257 referees using a web application. With this tool, a monthly evaluation form was sent to the referees with questions that measured the incidence, location, and pain intensity of injuries with complaints of pain and time of leave, severity in games and training in the years 2012, 2013, and 2014. The numerical pain scale was used to classify the pain intensity of the lesions with pain complaint. Results There was no difference between the years studied in relation to injuries with pain complaints, both in games and in training. Mean values were 37.8/1,000 hours in games and 39.9/1,000 hours in training, with a mean incidence of “ injuries defined by time of leave” of 3.7/1,000 hours in games. The difference was significantly higher in 2013 compared to 2012 and 2014, and in training, the average incidence was 3.5/1,000 hours, with a significantly higher difference in 2012 compared to 2013 and 2014. Conclusion Lesions with pain complaints did not present a significant difference in games compared to training; in the lesions by time of leave, the incidence in games was higher than in training, and the most frequent type of injury was low-degree muscle pain, predominantly in the thigh and triceps surae. Level of Evidence II; Prognostic Study - Investigating the Effect of Patient Characteristics on Disease Outcome.

Injury Occurrence and Return to Dance in Professional Ballet: Prospective Analysis of Specific Correlates

Professional ballet is a highly challenging art, but studies have rarely examined factors associated with injury status in ballet professionals. This study aimed to prospectively examine gender-specific correlates of injury occurrence and time-off from injury in professional ballet dancers over a one-year period. The participants were 99 professional ballet dancers (41 males and 58 females). Variables included: (i) predictors: sociodemographic data (age, educational status), ballet-related factors (i.e., experience in ballet, ballet status), cigarette smoking, alcohol drinking, and consumption of illicit drugs; and (ii) outcomes: injury occurrence and time-off from injury. Participants were questioned on predictors at the beginning of the season, while data on outcomes were collected continuously once per month over the study period. Dancers reported total of 196 injuries (1.9 injuries (95% CI: 1.6–2.3) per dancer in average), corresponding to 1.4 injuries per 1000 dance-hours (95% CI: 1.1–1.7). In females, cigarette smoking was a predictor of injury occurrence in females (OR: 4.33, 95% CI: 1.05–17.85). Alcohol drinking was a risk factor for absence from dance in females (OR: 1.29, 95% CI: 1.01–4.21) and males (OR: 1.21, 95% CI: 1.05–3.41). Less experienced dancers were more absent from dance as a result of injury than their more experienced peers (Mann-Whitney Z: 2.02, p < 0.04). Ballet dancers and their managers should be aware of the findings of this study to make informed decisions on their behavior (dancers) or to initiate specific programs aimed at the prevention of substance use and misuse in this profession (managers).

Epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees

BACKGROUND

The purpose of this study was to determine the epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees in Iran.

METHODS

This was a descriptive study. 59 Football Premier League professional referees participated in the study. The knee injury related information such as injury history and mechanism was recorded. Injury related symptoms and their impacts on the activity limitation, ability to perform activities of daily living as well participation in sports and recreational activities was obtained through the Knee Outcome Survey (KOS).

RESULTS

The results indicated that 31 out of 59 participants reported the history of knee injury. In addition, 18.6%, 22.4% and 81% of the referees reported that they had been injured during the last 6 months of the last year, and at some point in their refereeing careers, respectively. Results further indicated that 48.8% of the injuries occurred in the non-dominant leg and they occurred more frequently during training sessions (52%). Furthermore, the value of KOS was 85 ± 13 for Activities of Daily Living subscale and 90 ± 9 for Sports and Recreational Activities subscale of the KOS.

CONCLUSIONS

Knee injury was quite common among the Football Premier League professional referees. It was also indicated that the injuries occurred mainly due to insufficient physical fitness. Therefore, it is suggested that football referees undergo the proper warm-up program to avoid knee injury.

Gender- and Sport-Specific Associations Between Religiousness and Doping Behavior in High-Level Team Sports

Religiousness is known to be specifically associated with substance abuse, but there is an evident lack of studies investigating the association between religiousness and doping behavior as a specific type of substance abuse in athletes. This study aimed to provide evidence for possible gender- and sport-specific associations between religiousness and doping behavior among team-sport athletes of both genders. The participants were 886 athletes (21.9 ± 3.8 years of age; 352 females) involved in four sports: volleyball (n = 154; 78 females), handball (n = 206; 68 females), soccer (n = 316; 110 females) and basketball (n = 230; 96 females) from Croatia and Slovenia (all traditionally Roman Catholics). The data were collected using a previously validated structured questionnaire that examined sociodemographic, sport- and doping-related factors. In addition, religiousness was captured by the Santa Clara Strength of Religious Faith questionnaire (SCSRF). Gender-stratified simple logistic regressions were applied to determine associations between covariates and doping behavior (criterion). There was no significant difference in potential doping behavior between males and females (OR 1.06, 95 % CI 0.76-1.46), while females reported higher religiousness (SCSRF: 23.11 ± 3.23 and 25.46 ± 7.2 for males and females, respectively; t test = 1.82, p < 0.05). Younger female athletes and those with higher SCSRF score are found to be less prone to doping behavior. When models were adjusted for personal opinion about doping presence in sport and age, the SCSRF remained a significant predictor of potential doping behavior (OR 0.95, 95 % CI 0.91-0.99). For males, the belief that doping was present in sport was strongly associated with a higher likelihood of doping. Our results suggest that highly religious females involved in three of the studies sports (i.e., volleyball, handball and basketball) show a weaker tendency toward doping. Meanwhile, there is no evidence that religiousness influences doping behavior among male team-sport athletes. Therefore, sport-specific and gender-specific approach in studying possible relationships that exist between religiousness and different types of misusing substances in sport is warranted.