Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention

Plyometric Jump Training Effects on Maximal Strength in Soccer Players: A Systematic Review with Meta-analysis of Randomized-Controlled Studies

BACKGROUND

Maximal strength may contribute to soccer players' performance. Several resistance training modalities offer the potential to improve maximal strength. During recent years, a large number of plyometric jump training (PJT) studies showed evidence for maximal strength improvements in soccer players. However, a comprehensive summary of the available data is lacking.

OBJECTIVE

To examine the effects of PJT compared with active, passive or intervention controls on the maximal strength of soccer players, irrespective of age, sex or competitive level.

METHODS

To perform a systematic review with meta-analysis following PRISMA 2020. Three electronic databases (PubMed, Web of Science, and SCOPUS) were systematically searched. Studies published from inception until March 2023 were included. A PICOS approach was used to rate studies for eligibility. The PEDro scale was used to assess risk of bias. Meta-analyses were performed using the DerSimonian and Laird random-effects model if ≥ 3 studies were available. Moderator and sensitivity analyses were performed, and meta-regression was conducted when ≥ 10 studies were available for a given comparison. We rated the certainty of evidence using GRADE.

RESULTS

The search identified 13,029 documents, and from these 30 studies were eligible for the systematic review, and 27 for the meta-analyses. Overall, 1,274 soccer players aged 10.7-25.0 years participated in the included studies. Only one study recruited females. The PJT interventions lasted between 5 and 40 weeks (median = 8 weeks), with 1-3 weekly sessions. Compared to controls, PJT improved maximal dynamic strength (18 studies, 632 participants [7 females], aged 12.7-24.5 y; effect size [ES] = 0.43, 95% confidence interval [CI] = 0.08-0.78, p = 0.017, impact of statistical heterogeneity [I2] = 77.9%), isometric strength (7 studies; 245 participants, males, aged 11.1-22.5 y; ES = 0.58, 95% CI = 0.28-0.87, p < 0.001, I2 = 17.7%), and isokinetic peak torque (5 studies; 183 participants, males, aged 12.6-25.0 y; ES = 0.51, 95% CI = 0.22-0.80, p = 0.001, I2 = 0.0%). The PJT-induced maximal dynamic strength changes were independent of participants' age (median = 18.0 y), weeks of intervention (median = 8 weeks), and total number of training sessions (median = 16 sessions). The certainty of evidence was considered low to very low for the main analyses.

CONCLUSIONS

Interventions involving PJT are more effective to improve maximal strength in soccer players compared to control conditions involving traditional sport-specific training. Trial Registration The trial registration protocol was published on the Open Science Framework (OSF) platform in December 2022, with the following links to the project ( https://osf.io/rpxjk ) and to the registration ( https://osf.io/3ruyj ).

Interpersonal Coordination between Female Soccer Players: Leader-Follower Roles within a Collision-Avoidance Task

Background/Purpose

Return to sport decision-making may be improved by assessing an athlete's ability to coordinate movement with opponents in sport. The purpose was to investigate whether previous injuries associated with female soccer players' interpersonal coordination during a collision avoidance task. The authors hypothesized that external perturbations would disrupt the strength and stability of coordinated movement, and that individuals with a history of injury would be less likely to recover coordinated movement.

Study Design

Cross-Sectional.

Methods

Nine female athletes with a history of lower extremity injuries and nine without injuries were paired into dyads. Each dyad completed twenty trials of an externally paced collision-avoidance agility task with an unanticipated perturbation. Participant trajectories were digitized and analyzed using cross-recurrence quantification analysis (CRQA) to determine the strength and stability of interpersonal coordination dynamics. Trials in which participants with injury history assumed leader or follower roles within each dyad were then used to study how dyadic coordination varied across task stages (early, perturbation, and late) using linear mixed effect models. Cohen's d effect sizes were calculated to demonstrate magnitude of differences. In exploratory analysis, psychological readiness (i.e., self-reported knee functioning, fear of injury, and risk-taking propensity) was evaluated for their association with leader-follower status.

Results

Perturbation disrupted the strength (R2=0.65, p<0.001, early=49.7±1.7, perturbation=41.1±1.7, d=0.39) and stability (R2=0.71, p < 0.001, early=65.0±1.6, perturbation=58.0±1.7, d=0.38) of interpersonal coordination regardless of leader-follower status. Individuals with injury history failed to restore coordination after the perturbation compared to control participants (injury=44.2.0±2.1, control=50.8±2.6, d=0.39). Neither demographic nor psychological measures were associated with leader-follower roles (B=0.039, p=0.224).

Conclusion

Individuals with a history of lower extremity injury may have a diminished ability to adapt interpersonal coordination to perturbations, possibly contributing to a higher risk of re-injury.

Level of Evidence

3.

The Effects of Strength, Plyometric and Combined Training on Strength, Power and Speed Characteristics in High-Level, Highly Trained Male Youth Soccer Players: A Systematic Review and Meta-Analysis

BACKGROUND

Male youth soccer players competing at a high level will typically engage in large volumes of soccer training from a young age. However, it is not known whether the high levels of habitual training that these high-performing players are exposed to limit their ability to respond to strength, plyometric or combined training interventions.

OBJECTIVE

The primary aim of our systematic review and meta-analysis was to compare the specific effects of strength, plyometric and combined training with active controls (standard soccer training) on the strength, power and speed characteristics of high-level, highly trained young male soccer players.

METHODS

We performed a literature search across PubMed, Scopus, CINAHL, Web of Science and SPORTDiscus to identify controlled studies that implemented strength, plyometric or combined training in high-level male youth soccer players. Participants were defined as high level or highly trained based on established guidelines related to either competition level or age-related weekly hours spent in soccer training. Studies needed to report at least one outcome of lower body strength, squat jump, countermovement jump, horizontal power, acceleration (0-10 m), speed (15-40 m) or change of direction speed. A meta-analysis was then performed using a random-effects model to determine the magnitude (Hedge's g) of training responses and whether effects differed across modes of training.

RESULTS

From an initial return of 5464 papers, n = 34 studies met the inclusion criteria and provided a total sample of n = 1396 high-level male youth soccer players. Strength, plyometric and combined training resulted in improvements in strength, squat and countermovement jump, horizontal power, acceleration, change of direction speed (all p < 0.05; g = 0.73-1.08, moderate) and speed (p < 0.05; g = 0.40-0.59, small). Lower body strength was the only outcome where training mode had a significant effect (p < 0.05), with plyometric training producing small effects (g = 0.27, p < 0.05) compared with moderate effects for strength (g = 1.07, p < 0.05) and combined (g = 0.75, p < 0.05) training. Prediction intervals for overall effects (all training modes combined) showed that the greatest confidence that future training will lead to positive effects was in the squat and countermovement jump, horizontal power and acceleration (prediction intervals = 0.03-1.81).

CONCLUSIONS

High-level, highly trained male youth soccer players can experience positive gains in indices of strength, power and speed from strength, plyometric and combined training, and the magnitude of gains are mostly similar across modes of training. Based on prediction intervals, there is a good level of certainty that future strength, plyometric and combined training in this population would lead to positive improvements in vertical and horizontal power and sprint acceleration.

Apophyseal injuries in soccer players

Soccer is the most popular sport worldwide, and it is associated with high injury rates, with most of these injuries occurring in the lower extremities. Particularly, in youth soccer players with immature skeleton, the physeal plate is two to five times weaker than the surrounding fibrous structures, and therefore more vulnerable to injury. The physeal plate consists of epiphyses and apophyses, with the former serving as tendon attachment sites and being subject to traction forces. There are two types of apophyseal injury: (i) apophyseal avulsion, which consists of an acute separation across the physeal plate; and (ii) apophysitis, an injury caused by chronic and repetitive contraction of musculotendon unit, leading to inflammation of the growth plate cartilage. Apophyses of the hip and pelvis are the most commonly injured in youth soccer players, due to vigorous contractions during sports activities and the fact that they tend to fuse later compared to other epiphyseal centers, making them more susceptible to injury. In this review, we will discuss the anatomy of lower limb apophyses and clinical and imaging findings of apophyseal injuries in youth soccer players, as well as briefly review treatment options and complications.

Evaluation of the Value of the Y-Balance Test to Predict Lower Limb Injuries in Professional Male Footballers

CONTEXT

The aim of this prospective cohort study was to identify whether Y-Balance Test (YBT) performance and asymmetry are associated with lower limb injury in elite adult football athletes.

DESIGN

A prospective cohort study.

METHODS

Preseason YBT measures were obtained from 121 male footballers participating in National League One across the 2021-2022 season. Lower limb injuries were tracked across the season to determine the relationship between YBT variables and injury incidence using logistic regression analysis. The statistical significance level was .05.

RESULTS

The average YBT score was 111.0 (5.8) cm on the left limb and 112.0 (5.5) cm on the right limb, with an average asymmetry of 2.3 (1.4) cm. Athletes with lower YBT scores on both the left (odds ratio = 2.9; 95% confidence interval, 1.7 to 4.8: P ≤ .001) and right (odds ratio = 2.3; 95% confidence interval, 1.6 to 3.2: P ≤ .001) limbs were at a greater risk of injury. Similarly, athletes with greater amounts of asymmetry were also more likely to get injured (odds ratio = 2.1; 95% confidence interval, 1.3 to 3.3: P = .002).

CONCLUSIONS

Results indicate that lower and asymmetrical YBT scores have a significant relationship with future lower limb injuries in professional male footballers. The YBT offers a simple, reliable, and effective screening tool that can be used by practitioners in football to help identify players at a greater risk of injury before the season commences.

Knowledge of traumatic dental injuries and mouthguard behavior among Croatian soccer players

OBJECTIVES/AIM

Sports-related dental injuries occur frequently among athletes due to inadequate knowledge and prevention measures. The aim of the study was to assess knowledge, attitudes, and practices of active soccer players from all leagues in Croatia regarding traumatic dental injuries and the use of mouthguards.

MATERIAL AND METHODS

393 respondents completed a questionnaire-based online survey from March 2022 to April 2022. The questionnaire consisted of 37 questions divided in four sections: demographic characteristics, experience with orofacial injuries, knowledge of emergency therapeutic procedures for dental injuries, and behaviors related to the use of a mouthguard.

RESULTS

Insufficient knowledge was confirmed by a total score of 2.8 ± 2.8 points, with a possible maximum of 11. Respondents' better knowledge can be associated with educational level (p = .002), playing position (p = .046), and personally experienced injuries to the face and jaw (p ≤ .001) and teeth (p = .022). Less than 40% of respondents suffered facial and jaw injuries while playing football and 18.6% suffered dental injuries. Although most respondents (93.9%) were familiar with mouthguards and 68.9% believed that they help prevent injuries while playing football, only 16% used them.

CONCLUSION

The study revealed significant gaps in knowledge regarding dental injuries and the practice of mouthguard usage among Croatian soccer players. Therefore, it is evident that additional education is needed to prevent dental injuries and take proper procedures when taking care of them among the examined population.

The use of sand as an alternative surface for training, injury prevention and rehabilitation in English professional football and barriers to implementation: a cross-sectional survey of medical staff

PURPOSE

The purpose of the present study was to investigate the use of sand as an alternative surface for training, injury prevention and rehabilitation interventions in English professional football. A Secondary aim was to explore the potential barriers to implementation.

MATERIALS AND METHODS

All 92 teams from the male English professional football pyramid during the 2021-22 season were eligible to take part. A cross-sectional survey of the medical personnel (one per club) was conducted between June 2021 and December 2021 based on the RE-AIM framework. A total of 58 respondents (63% of all clubs) completed the survey.

RESULTS AND CONCLUSIONS

Only 18 (31%) of the clubs surveyed used sand-based interventions across the last 3 seasons. Respondents felt sand-based interventions would be effective at improving physiological gains (median 4, interquartile range [IQR] 4-5) and as part of injury prevention and rehabilitation strategies (4, IQR 3-4) but were indifferent in relation to its potential to improve sporting performance (3, IQR 3-4). Barriers to implementation of sand-based interventions within wider football were a lack of facilities, lack of awareness of its potential benefits, lack of high-quality evidence and the surface not being specific to the sport. Medical staff also did not perceive that coaches' positively viewed sand interventions as a training or injury management strategy.

Soccer's AI transformation: deep learning's analysis of soccer's pandemic research evolution

Introduction

This paper aims to identify and compare changes in trends and research interests in soccer articles from before and during the COVID-19 pandemic.

Methods

We compared research interests and trends in soccer-related journal articles published before COVID-19 (2018-2020) and during the COVID-19 pandemic (2021-2022) using Bidirectional Encoder Representations from Transformers (BERT) topic modeling.

Results

In both periods, we categorized the social sciences into psychology, sociology, business, and technology, with some interdisciplinary research topics identified, and we identified changes during the COVID-19 pandemic period, including a new approach to home advantage. Furthermore, Sports science and sports medicine had a vast array of subject areas and topics, but some similar themes emerged in both periods and found changes before and during COVID-19. These changes can be broadly categorized into (a) Social Sciences and Technology; (b) Performance training approaches; (c) injury part of body. With training topics being more prominent than match performance during the pandemic; and changes within injuries, with the lower limbs becoming more prominent than the head during the pandemic.

Conclusion

Now that the pandemic has ended, soccer environments and routines have returned to pre-pandemic levels, but the environment that have changed during the pandemic provide an opportunity for researchers and practitioners in the field of soccer to detect post-pandemic changes and identify trends and future directions for research.

A cross-sectional study examining Nigerian footballers' knowledge and attitudes towards sport-related concussion and associated contextual factors

OBJECTIVE

To examine Nigerian footballers' knowledge and attitudes towards sport-related concussion (SRC) and associated contextual factors.

METHODS

A cross-sectional study design was used with an online questionnaire distributed to Nigerian footballers affiliated with a registered team. The questionnaire included demographic information and the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS-ST). The concussion knowledge index (CKI, 0-25) and attitude index (CAI, 15-75) were calculated. The association between various contextual factors with "high" knowledge and attitude were determined.

RESULTS

A total of 331 participants completed the questionnaire from 10 football clubs. Mean CKI and CAI scores were 14.0 ± 3.0 (56.2 ± 13.2%) and 54.5 ± 9.4 (72.6 ± 12.5%), respectively, and the association between scores was considered large (r = 0.530; 28%). A small proportion (n = 25; 7.6%) of participants reported a previous diagnosis of an SRC, with a further 40 (12.1%) suspecting they have suffered SRC. Thirty-five participants (10.6%) reported sustaining a SRC but did not seek medical help. Results indicated that men were at 4.8 times greater odds of having a "high[er]" CKI than women, and that those with 5-10 years playing experience had lower odds of a "high" CKI than those with >10 years' experience. Men had 7 times greater odds of having a "high" CAI than women.

CONCLUSION

The results of this study suggest that Nigerian footballers have a moderate level of SRC knowledge, satisfactory symptom recognition, and high SRC attitudes. Those working with Nigerian football may consider these findings when seeking strategies to improve concussion knowledge, potentially by improving attitudes and considering sex and playing experience.

Mixed-methods process evaluation of the injury prevention Warming-up Hockey programme and its implementation

Warming-up Hockey (WUP) is an effective injury prevention programme to reduce acute field hockey injuries among youth. This paper describes the process evaluation of the nationwide scaling-up. We conducted a mixed-methods process evaluation from September 2019 to December 2020 according to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, focusing on the intervention and its implementation. We collected data through questionnaires, interviews and web/app analytics. Participants were trainers/coaches, technical/board members of hockey clubs (TBMs) and employees of the Royal Dutch Hockey Federation (KNHB). In total, 226 trainers/coaches (61 via WUP and 165 via training courses) and 14 TBMs filled in questionnaires. Ten individuals (four trainers/coaches, four TBMs and two KNHB employees) participated in semistructured interviews. The study showed the following results according to the RE-AIM framework. Reach: According to web/app analytics, 1492 new accounts were registered. Effectiveness: Overall, users were satisfied with WUP and the implementation strategies, and believed WUP could reduce field hockey injuries. Adoption: 63% of the trainers/coaches (enrolled via WUP) indicated they used WUP. Implementation: Most trainers/coaches did not use WUP during every training session or match. Most TBMs promoted WUP in their club. Implementation barriers included lack of integration with other training programmes, 'know-it-all' trainers, lack of supervision on WUP use and delayed start of implementation. Facilitators included perceived added value, information need on injury prevention in small clubs and tailored communication. Maintenance: Users planned to use WUP occasionally. The KNHB intended to integrate WUP in their newly developed Knowledge Platform. To conclude, WUP was evaluated as a useful programme, but adherence to WUP was challenging. Timely preparation and creating an implementation plan based on stakeholder input, including communication at key moments during the sports season and tailored communication, were found to be important during implementation. Findings can be useful for others planning to implement evidence-based injury prevention programmes on a larger scale.

Injury Types and Training Habits among Soccer (Football) Athletes

Background

For soccer athletes, injuries are frequent and pose a considerable health and financial burden for individuals and families. While studies have previously assessed the incidence of soccer injuries and preventive strategies male athletes use to reduce these occurrences, few have included women and players of varying skill levels.

Objective

To report the frequency of injuries in a cohort of male and female soccer athletes and describe the training habits that have helped prevent injury.

Methods

Two hundred (n=200) United States participants completed a questionnaire on soccer practicing frequency, habits, injuries, and treatments. A screening question ensured all respondents had played soccer for at least one year and determined eligibility for the study. Participant information related to age, sex, education, income, and race was also collected. JMP statistical software was used to analyze collected data and build multivariate regressions, mosaic plots, and histograms.

Results

The mean number of practice sessions per week was 3.60 +/- 1.64, and the median experience playing soccer was 2-4 years. Older participants were more likely to practice once (p = 0.0001) or twice (p= 0.0008) per week. Women were less likely to include warmups before playing soccer (p = 0.022). This was problematic as participants who did not include a proper warmup routine were more likely to have been absent from play for longer amounts of time following injury (p = 0.032). The four most common injury sites were knees (n = 35, 17.5%), ankles (n = 31, 15.5%), shoulders (n = 25, 12.5%), and head/neck (n = 24, 12%). 140 (47.62%) patients used pain medication as their main remedy, 128 (43.54%) went to physical therapy, and 26 (10.78%) underwent surgery.

Conclusion

In any sample of soccer athletes involving variations in sex, race, and competitive play, injuries are highly common. Few studies before this one have included female athletes, and our findings highlight an important discrepancy in training habits between sexes. Women are less likely to follow a warmup regimen and are thus injured for longer. Incorporating dynamic stretching and plyometrics are particularly helpful to stay healthy.

High-intensity Actions in Elite Soccer: Current Status and Future Perspectives

Over the years, soccer has become more physically demanding; the number and frequency of high-intensity actions have increased, and these activities are decisive in determining the match outcome. Importantly, the reductionist approach commonly used to analyze high-intensity actions does not contemplate a more contextualized perspective on soccer performance. Traditionally, most investigations have only provided quantitative data regarding sprints (i. e. time, distances, frequency) without examining "how" (e. g. type of trajectory or starting position) and "why" (e. g. tactical role) soccer players sprint. In fact, other high-intensity actions, apart from running, are not even mentioned (i. e. curve sprints, change of direction, and specific-jump tasks). This has led to the use of tests and interventions that do not accurately reflect real game actions. Given the true technical-tactical-physical demands of each playing position, this narrative review collected a wide-spectrum of current soccer-related articles and provided a discussion regarding high-intensity actions, with a positional-based approach. In this narrative review, practitioners are encouraged to contemplate and consider the different elements that characterize high-intensity actions in soccer, in order to assess and train soccer players under a more sport-specific and integrative perspective.

Suggested improvements to the 11+ as identified by coaches, players, strength and conditioning staff and medical staff in New Zealand Football

The aim of this study was to investigate the experience with the 11+, attitudes towards injury prevention, and potential improvements to the 11+ and the delivery of injury prevention strategies within football. A qualitative study design was used to investigate the views of four stakeholder groups (players, coaches, strength and conditioning staff and clinicians). Twenty-two adults participated (nine women; median age 35.5 years). Participants were purposively recruited and were based in New Zealand. They represented various levels of football, including different genders, ages and levels of play. Focus group interviews were conducted, which were recorded, transcribed and subject to thematic analysis. Four key themes were identified: understanding of the 11+ injury prevention warm-up, content of an ideal injury prevention programme, structure of the programme and education, adherence and dissemination. The study found that while participants appeared to have good awareness of the existing 11+ programme and an interest in injury prevention, adherence and enthusiasm towards the programme was limited. Participants highlighted a number of elements that may help shape the development of a new injury prevention strategy, including a desire to retain many of the elements of the 11+ and to have a proven programme. Participants wanted greater variety, more football-specific elements and to implement a new strategy throughout a session, rather than being seen as a stand-alone warm-up. Whether the intervention should also include strength-based exercises, or whether this should be promoted outside of a football training session, was less certain.

Nutritional Strategies in the Rehabilitation of Musculoskeletal Injuries in Athletes: A Systematic Integrative Review

It is estimated that three to five million sports injuries occur worldwide each year. The highest incidence is reported during competition periods with mainly affectation of the musculoskeletal tissue. For appropriate nutritional management and correct use of nutritional supplements, it is important to individualize based on clinical effects and know the adaptive response during the rehabilitation phase after a sports injury in athletes. Therefore, the aim of this PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science PERSiST-based systematic integrative review was to perform an update on nutritional strategies during the rehabilitation phase of musculoskeletal injuries in elite athletes. After searching the following databases: PubMed/Medline, Scopus, PEDro, and Google Scholar, a total of 18 studies met the inclusion criteria (Price Index: 66.6%). The risk of bias assessment for randomized controlled trials was performed using the RoB 2.0 tool while review articles were evaluated using the AMSTAR 2.0 items. Based on the main findings of the selected studies, nutritional strategies that benefit the rehabilitation process in injured athletes include balanced energy intake, and a high-protein and carbohydrate-rich diet. Supportive supervision should be provided to avoid low energy availability. The potential of supplementation with collagen, creatine monohydrate, omega-3 (fish oils), and vitamin D requires further research although the effects are quite promising. It is worth noting the lack of clinical research in injured athletes and the higher number of reviews in the last 10 years. After analyzing the current quantitative and non-quantitative evidence, we encourage researchers to conduct further clinical research studies evaluating doses of the discussed nutrients during the rehabilitation process to confirm findings, but also follow international guidelines at the time to review scientific literature.

FUNCTIONAL TRAINING ON ANKLE SPRAIN REHABILITATION IN SOCCER PLAYERS

ABSTRACT Introduction An ankle sprain is a common soccer injury. Functional training is used to rehabilitate muscle strength with undiscovered benefits on soccer players’ recovery. Objective Explore the functional training effects on ankle injury recovery in soccer players. Methods 29 amateur soccer players were randomly assigned to control (n=15) and experimental (n=14) groups with no statistical difference in age or sex (P>0.05). The experimental group used functional rehabilitation training, while the control group was treated with traditional rehabilitation methods. Both groups practiced 30 to 40 minutes of rehabilitation, three times a week, for two months. Mathematical statistics were used to analyze the effects of different injury rehabilitation on the two groups, estimating the ankle joint continuous motion angle by the tibialis anterior muscle electromyogram responses. Results The ankle instability assessment questionnaires were statistically different between the two groups of patients after rehabilitation training (P<0.05). There was a statistical difference in the agility test after the intervention. The ankle capacity score and agility test score were better in the experimental group (P<0.05). Conclusion Functional rehabilitation training can improve ankle performance after a sprain. This training can also help athletes avoid future sprains and is recommended as preventive training. Evidence Level II; Therapeutic Studies - Investigating the result.

Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review

Background

High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature.

Methods

A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis.

Results

Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load–injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies.

Conclusions

There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load–injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load–injury relationships.

Trial Registration PRISMA ID - CRD42020203622.

Muscle Asymmetries in the Lower Limbs of Male Soccer Players: Preliminary Findings on the Association between Countermovement Jump and Tensiomyography

Strength and power asymmetries have been observed in different sports, including soccer. Such asymmetries, as well as the bilateral deficit (BLD), can be assessed during different tasks, static or dynamic, and with different methods and devices, in order to detect the possible different aspects, as well as the association with physical performance and injuries. The aim of this study was to investigate the association between muscle asymmetries and BLD during a countermovement jump (CMJ), and tensiomyography (TMG) parameters and asymmetries, in the lower limbs of male soccer players. A total of 23 male soccer players (18 ± 4 years) were recruited. Bilateral and unilateral CMJs were performed, and peak power (W) and height (cm) were obtained. TMG was performed on different muscles of the lower limbs, and lateral and functional symmetries were obtained. Playing position and history of injuries were collected. CMJ inter-limb symmetry was found to significantly correlate with biceps femoris (r = 0.574, p = 0.004) and soleus (r = 0.437, p = 0.037) lateral symmetry. Players in central roles presented significantly worse functional symmetry scores of the knee than defense players (-17.5%, 95% CI -31.2--3.9; p = 0.10). Participants reporting a history of injury at the ankle were characterized by significantly lower functional symmetry in both the dominant (43%, 39.5-48.0 vs. 74.5%, 46.5-89.3, p = 0.019) and non-dominant (45%, 42.5-46.0 vs. 81.0%, 45.8-90.3, p = 0.024) ankle. Findings from this preliminary study suggest an association between lower-limb muscle asymmetries during a dynamic task, such as jumping, and muscle contractile properties evaluated with TMG; moreover, functional asymmetries may be present after ankle injuries. Future studies in larger samples should evaluate the presence of such asymmetries as predictors or characteristics of different muscular and joint injuries.

Barriers and facilitators to the adoption and implementation of evidence-based injury prevention training programmes: a narrative review

While there is a multitude of evidence supporting the efficacy of injury prevention training programmes, the literature investigating the implementation of these programmes is, in contrast, rather limited. This narrative review sought to describe the commonly reported barriers and facilitators of the implementation of injury prevention training programmes among athletes in organised sport. We also aimed to identify necessary steps to promote the uptake and sustainable use of these programmes in non-elite athletic communities. We identified 24 publications that discussed implementing evidence-based injury prevention training programmes. Frequently reported barriers to implementation include the perceived time and financial cost of the programme, coaches lacking confidence in their ability to implement it, and the programme including exercises that were difficult or confusing to follow. Frequently reported facilitators to implementation include the coach being aware of programme efficacy, shared motivation to complete the programme from both coaches and athletes, and the ability to easily integrate the programme into practice schedules. The current literature is focused on high-income, high-resource settings. We recommend that future studies focus on understanding the best practices of programme dissemination in culturally and economically diverse regions. Programmes ought to be of no financial burden to the user, be simply adaptable to different sports and individual athletes and be available for use in easily accessible forms, such as in a mobile smartphone application.

Elit genç futbol akademisi sporcularında yaralanma insidansı: 3 yıllık geriye dönük takip

Aim: The aim of this study was to investigate the incidence and characteristics of injuries suffered by elite soccer academy athletes. Materials and Methods: A retrospective analysis was made of the health records between 2016 and 2019 of athletes in the elite male soccer academy of an elite football club. The cause, type, location, recurrence, and severity of the injuries, where the injuries occured and time lost due to the injuries were recorded. The injury incidence and prevalence were calculated. Results: Overall, total injuries and seasonal incidence rate were 1.49 (1.33-1.68) and 8.06 (7.16-0.04) per 1000 hours, respectively. The injury burden ranged between 11.83 (10.53-13.29) days and 51.43 (49.11-53.85) days. The injury characteristics were not statistically different according to age groups (p˃0.05). Conclusion: Youth soccer players in the U19 and U21 age groups had more injuries than other junior age groups in a typical soccer season. It was concluded that there were more match injuries, the thigh was the most injured area, muscle injuries were more common, and the hamstring was the most frequently injured muscle.

Preventive Training Program Feedback Complexity, Movement Control, and Performance in Youth Athletes

CONTEXT

Preventive training programs (PTPs) reduce injury risk by improving movement control. Corrective feedback is important; however, many cues at once may be too complicated for athletes.

OBJECTIVE

To compare movement control and long-jump (LJ) changes in youth athletes participating in a season-long PTP, with simplified feedback, traditional feedback, or a warmup of the coaches' choosing.

DESIGN

Cluster-randomized controlled trial.

SETTING

Soccer fields.

PATIENTS OR OTHER PARTICIPANTS

A total of 420 athletes (simplified feedback = 173, traditional feedback = 118, and control = 129; age = 11 ± 3 years).

INTERVENTION(S)

Teams were randomized into the simplified PTP, traditional PTP, or control group. Simplified and traditional PTPs lasted 10 to 12 minutes and used the same exercises. The simplified PTP provided only sagittal-plane feedback (eg, "get low"), and the traditional PTP provided feedback targeting all motion planes (eg, "don't let your knees cave inward"). Research assistants administered the PTP warmups 2 to 3 times/week for the season. Control team coaches chose and ran their own warmup strategies.

MAIN OUTCOME MEASURE(S)

Participants completed 4 sessions (preseason [PRE], postseason [POST] at approximately 8 weeks after PRE, retention 1 [R1] at 6 weeks postseason, and retention 2 [R2] at 12 weeks postseason). They performed 3 trials of a jump-landing task, which was evaluated using the Landing Error Scoring System (LESS) and 2 recorded standing LJ trials at each test session. A time series panel was used to evaluate group differences across time points for the LESS and LJ.

RESULTS

Change score analyses revealed improvements in the LESS score from PRE to POST for all groups. Improvements from PRE were retained at R1 and R2 for the intervention groups (simplified and traditional). The traditional group demonstrated better LJ performance at POST (P < .001) and R1 (P = .049) than the simplified or control group.

CONCLUSIONS

Simplified cues were as effective as traditional cues in improving LESS scores from PRE to POST season. Participating in PTPs, regardless of their complexity, likely provides movement benefits.

Risk factors and prevention strategies for shoulder injuries in overhead sports: an updated systematic review

PURPOSE

The aim of this systematic review was to update the knowledge on risk factors and prevention strategies for shoulder injuries in overhead sports with special emphasis on methodological quality.

METHODS

All methodological procedures were performed in line with a previous systematic review by Asker et al. (2018). The literature search was conducted in the PubMed, Google Scholar, Cochrane, and SPORT-Discuss databases. Due to the risk of bias assessment, only studies with at least an acceptable methodological quality were included. A best-evidence synthesis was performed to clarify the evidence and direction of the risk factors and prevention strategies.

RESULTS

A total of nine studies were included in the data extraction process. One study had a high and eight studies had an acceptable methodological quality. Seven cohort studies investigated risk factors and two randomised controlled trails evaluated prevention strategies. Moderate evidence was found for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) that were associated with the shoulder injury risk. All further risk factors had moderate and no association with risk (shoulder rotational ROM, joint position sense) or limited (history of shoulder/elbow pain, age, training experience, training volume, school grade, playing level), and conflicting evidence (setting).

CONCLUSIONS

There is moderate evidence for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) being associated with the shoulder injury risk in overhead sports.

Knowing Your Accessory Foot Ossicles and Avoiding Misdiagnoses: A Case Report of Painful Os Vesalianum Pedis

Os vesalianum pedisis located proximal to the base of the fifth metatarsal. Rarely, this accessory ossicle can be the source of lateral foot pain. There are very few cases of symptomatic os vesalianum pedisdescribed in the literature, and most of them were surgically managed. We report a painful case of os vesalianum pedis managed conservatively. A 25-year-old professional soccer player presented with lateral left midfoot pain. There was no known acute sprain or trauma, and no history of injuries in the left lower limb. The athlete reported both mechanical and inflammatory pain findings and tenderness on the palpation of the fifth metatarsal base. We conducted a radiographic study of the left foot and found an image compatible with os vesalianum pedis​​​​​​​. A right foot X-ray was also performed, and similar findings were reported, although the athlete had no pain. The athlete was treated conservatively, and the return-to-play was seven days. 

Due to the unspecific symptoms of our athlete, many diagnoses could be considered such as peroneus brevistendinopathy, lateral plantar fasciitis, ligamentum plantare longumsprain. However, the X-ray findings led us to other possible pathologies, mainly affecting the bone. Integrating clinical and radiological findings is mandatory to achieve a proper diagnosis and avoid mistakenly diagnosing a fracture such as a Jones fracture or pseudo-Jones fracture. Even though os vesalianum pedis​​​​​​​ is usually asymptomatic, this condition can lead to chronic pain. Well-designed conservative management should always be pursued to treat this condition as it might prevent the need for surgery. 

Absence of Injury Is Not Absence of Pain: Prevalence of Preseason Musculoskeletal Pain and Associated Factors in Collegiate Soccer and Basketball Student Athletes

Unlike musculoskeletal (MSK) injuries, MSK pain is rarely studied in athletes. In this study, we examined the prevalence of preseason MSK pain in apparently healthy collegiate soccer and basketball players and its relationship with previous injuries (1-year history), among other factors. Ninety-seven eligible student athletes (mean age: 20.1 (SD: 1.6) years; 43% male; 53% soccer players) completed a baseline questionnaire comprising questions related to demographics, medical and 1-year injury history and any current MSK pain and the corresponding body location. The overall prevalence of preseason MSK pain was 26% (95% CI: 17–36%) and it did not differ by sex or sport. The back (6.2%) and knee (5.2%) regions were reported to be the most frequently affected body parts for preseason MSK pain. Athletes with a previous injury and with perception of incomplete healing had 3.5-fold higher odds (OR: 3.50; 95% CI: 1.28–9.36) of baseline MSK pain compared with those without a previous injury. One in four collegiate soccer and basketball players had preseason MSK pain. Collegiate sports medicine professionals should consider conducting routine preseason evaluations of MSK pain in their athletes and initiate appropriate interventions for the prevention of MSK pain and its potential consequences among athletes.

Sex Differences in Pre-Season Anthropometric, Balance and Range-of-Motion Characteristics in Elite Youth Soccer Players

In soccer, injury epidemiology differs between males and females. It is clinically useful to know whether there are between-sex differences in selected characteristics relevant to primary injury risk and injury prevention practices. The purpose of this study was to explore between-sex differences in anthropometric, balance, and range-of-motion characteristics in Spanish elite male and female youth soccer players. This was a pre-season cross-sectional study. Sixty-nine males (age 16.8 ± 0.9 yr; height 175.9 ± 6.8 cm; mass 67.9 ± 6.3 kg) and thirty-seven females (age 17.2 ± 1.7 yr; height 164.0 ± 6.3 cm; mass 59.0 ± 5.8 kg) participated. Anthropometrics (standing/sitting height, bodymass, right/left leg length) and right/left anterior reach test (ART), hip internal/external active range of motion, active knee extension (AKE), and weightbearing lunge test (WBLT) were measured. Between-sex differences were assessed with Bonferroni-corrected Mann−Whitney U tests and Cliff’s delta (d). Between-sex significant differences (p < 0.003, d ≥ 0.50) were observed for anthropometric data and for hip internal rotation. No between-sex significant differences were observed for ART/AKE/WBLT measures. Between-sex significant differences with large effect sizes were identified for anthropometric data and right/left hip internal rotation. The present study adds new data to the literature for young Spanish male and female soccer players. The present findings will help inform clinical reasoning processes and future injury prevention research for elite male and female youth soccer players.

EFFECTS OF A PROPHYLACTIC KNEE SLEEVE ON THE ANTERIOR CRUCIATE LIGAMENT AND LOWER EXTREMITY BIOMECHANICS: AN EXAMINATION USING MUSCULOSKELETAL SIMULATION

The current study aimed using a two-experiment musculoskeletal simulation-based approach, measuring anterior cruciate ligament (ACL) biomechanics, knee joint kinematics, and lower extremity joint loading to examine the effects of both a prophylactic knee sleeve on (1) a sport-specific change of direction movement in female footballers and (2) a single leg landing in male footballers. Experiment 1 examined 12 female university first team level footballers (age [Formula: see text] years, height [Formula: see text][Formula: see text]m, body mass [Formula: see text][Formula: see text]kg) undertaking a [Formula: see text] cutting movement in sleeve and no-sleeve conditions. Experiment 2 examined 10 male university first team level footballers (age [Formula: see text] years, height [Formula: see text][Formula: see text]m, body mass [Formula: see text][Formula: see text]kg) undertaking a single leg drop jump landing in sleeve and no-sleeve conditions. In each experiment, data was collected in a biomechanics laboratory and three-dimensional (3D) motion capture and ground reaction force (GRF) information was collected. 3D kinematics, 3D knee kinetics, and ACL ligament forces/strains were measured using musculoskeletal simulation, and participants were also asked to subjectively rate the knee sleeve in terms of both comfort and stability. Experiment 1 showed that the sleeve condition was associated with greater ACL strain ([Formula: see text]% and no-[Formula: see text]%) and forces ([Formula: see text] BW and no-[Formula: see text] BW). In addition, the brace condition also enhanced lateral compressive tibiofemoral ([Formula: see text] BW and no-[Formula: see text] BW) and total compressive tibiofemoral force ([Formula: see text] BW and no-[Formula: see text] BW). Finally, for the subjective ratings, participants indicated that the knee sleeve significantly improved perceived comfort and stability. Experiment 2 did not reveal any statistical differences between knee sleeve and no-sleeve conditions nor any effects of the knee sleeve on subjective ratings of comfort or stability. Therefore, the findings from the current investigation suggest that the prophylactic knee sleeve examined in the current investigation does not appear to reduce the biomechanical parameters linked to the aetiology of knee pathologies in male/female footballers.

LaLiga Lockdown: Conditioning Strategy and Adaptation to In-Game Regulations during COVID-19 Pandemic Prevented an Increase in Injury Incidence

The first division of Spanish professional football (LaLiga) was suspended for 12 weeks as part of the policies enforced by health authorities during the first wave of COVID-19. During this period, players were confined to home for 8 weeks, followed by a club-based retraining period of 4 weeks. Afterwards, LaLiga’s teams completed 11 matches, with approximately 3 days of recovery between matches, to finish the competition. The aim of this investigation was to determine whether there is a difference in mean injury incidence in LaLiga players between the pre-lockdown period and post-lockdown period. A total of 277 players belonging to 11 teams competing in LaLiga were monitored during the 2019–2020 season. Injury incidence in the 27 matchdays completed before the lockdown was compared to the last 11 matchdays completed after the resumption of the competition. In comparison to the period before the suspension, the resumption of the championship did not significantly affect the injury incidence (4.2 vs. 5.4 injuries per 1000 h of exposure, p = 0.338). Injury incidence before suspension and after resumption of the competition was similar for muscle (2.6 vs. 3.4 injuries per 1000 h of exposure, p = 0.152) and ligament injuries (0.8 vs. 0.4 injuries per 1000 h of exposure, p = 0.062). The resumption of the competition also did not modify the distribution of injury according to body location (p = 0.948), injury type (p = 0.766), mode of onset (p = 0.614), severity (p = 0.065), or player position (p = 0.295). In summary, mean injury incidence in LaLiga players was similar before and after the lockdown. It is probable that the conditioning strategy adopted by clubs before the resumption of LaLiga and the adaptation of some in-game regulations helped to avoid an increased injury rate after the lockdown.

The Hamstring and ACL Injury Incidence during a Season Is Not Directly Related to Preseason Knee Strength Ratios in Elite Male Soccer Players

Background and Objectives: The aim of this study was to identify preseason isokinetic strength differences in the knee flexors and extensors and their ipsilateral/bilateral ratios and, furthermore, to compare the results among players who subsequently overcame a hamstring strain injury (HSI) or anterior cruciate ligament (ACL) rupture during the season and those who did not. Materials and Methods: A total of 134 professional soccer players underwent isokinetic strength assessment at a velocity of 60°·s−1 (knee flexors and extensors) for the dominant and non-dominant lower limb to determine preseason peak torque values and bilateral and ipsilateral strength ratios. Subsequently, the incidence of injuries during the season was recorded, and players were divided into groups according to ACL rupture injuries (n = 10), hamstring strains (n = 10), and a control group of non-injured players who were selected on a random basis (n = 20). A retrospective approach was used to analyze and compare the preseason strength characteristics and whether some variance among groups was relevant among the injured leg and non-injured leg groups. Results: The results of our study show that low-angular velocity preseason testing did not result in a player’s HSI or ACL injury during the season. The difference between the monitored groups ranged from 1.5% to 3%. The comparison showed low evidence for significant differences. Conclusions: An angular velocity of 60°·s−1 within concentric muscle contraction alone was not linked to subsequent injury of the hamstring or anterior cruciate ligament and acted as an insufficient factor of injury risk in adult professional soccer players.

Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold?

BACKGROUND

This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury.

METHODS

A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function.

RESULTS

We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes.

CONCLUSION

At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis.

LEVEL OF EVIDENCE

Level III, historical cohort study.

The "SHRed Injuries Basketball" Neuromuscular Training Warm-up Program Reduces Ankle and Knee Injury Rates by 36% in Youth Basketball

OBJECTIVE

To evaluate the effectiveness of a neuromuscular training warm-up prevention program, Surveillance in High school and community sport to Reduce (SHRed) Injuries Basketball, for reducing all-complaint ankle and knee injuries in youth basketball players.

DESIGN

Quasi-experimental study.

METHODS

High school/club basketball teams (male and female players aged 11-18 years) in Calgary, Canada participated in 2016-2017 (control; season 1) and 2017-2018 (intervention; season 2). The control season included a standard-of-practice warm-up. In season 2, a SHRed Injuries Basketball coach workshop was completed by participating team coaches. Teams were randomized by school/club to an unsupervised or a supervised (weekly supervision by study personnel) implementation of the coach-delivered SHRed Injuries Basketball program. The 10-minute SHRed Injuries Basketball program included 13 exercises (ie, aerobic, agility, strength, balance). All-complaint ankle and knee injuries were collected weekly using validated injury surveillance. Multilevel, multivariable Poisson regression analyses (considering important covariates, clustering by team and individual, and offset by exposure hours) estimated incidence rate ratios (IRRs) by intervention group (season 1 versus season 2) and secondarily considered the control versus completion of the SHRed Injuries Basketball program, unsupervised and supervised.

RESULTS

Sixty-three teams (n = 502 players) participated in season 1 and 31 teams (n = 307 players: 143 unsupervised, 164 supervised) participated in season 2. The SHRed Injuries Basketball program was protective against all-complaint knee and ankle injuries (IRR = 0.64; 95% confidence interval [CI]: 0.51, 0.79). Unsupervised (IRR = 0.62; 95% CI: 0.47, 0.83) and supervised (IRR = 0.64; 95% CI: 0.49, 0.85) implementations of the SHRed Injuries Basketball program had similar protective effects.

CONCLUSION

The SHRed Injuries Basketball program was associated with a 36% lower rate of ankle and knee injuries. Neuromuscular training warm-ups are recommended as the minimal standard of practice for injury prevention in youth basketball. J Orthop Sports Phys Ther 2022;52(1):40-48. doi:10.2519/jospt.2022.10959.

Smart sensor tights: Movement tracking of the lower limbs in football

This article presents a novel smart sensor garment with integrated miniaturized inertial measurements units (IMUs) that can be used to monitor lower body kinematics during daily training activities, without the need of extensive technical assistance throughout the measurements. The smart sensor tights enclose five ultra-light sensor modules that measure linear accelerations, angular velocities, and the earth magnetic field in three directions. The modules are located at the pelvis, thighs, and shanks. The garment enables continuous measurement in the field at high sample rates (250 Hz) and the sensors have a large measurement range (32 g, 4,000°/s). They are read out by a central processing unit through an SPI bus, and connected to a centralized battery in the waistband. A fully functioning prototype was built to perform validation studies in a lab setting and in a field setting. In the lab validation study, the IMU data (converted to limb orientation data) were compared with the kinematic data of an optoelectronic measurement system and good validity (CMCs >0.8) was shown. In the field tests, participants experienced the tights as comfortable to wear and they did not feel restricted in their movements. These results show the potential of using the smart sensor tights on a regular base to derive lower limb kinematics in the field.

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.

Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise

OBJECTIVES

The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury). To underline the importance and impact of adopting appropriate methodology for evidence synthesis, we revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis.

STUDY DESIGN AND SETTING

Only randomized control trials (RCT) using NHE as one of the prevention arms were selected. Summary effects for risk ratios (RR) for original studies included in the earlier meta-analysis, and new studies identified (update), were re-estimated under the random-effects model and presented with 95% confidence intervals (CI) and prediction intervals (PI). Tentative recommendations were provided according to the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Only five RCTs out of the 15 studies included in the earlier meta-analysis randomized to NHE. Our update revealed one additional RCT. The point estimate (RR) for the five RCTs previously considered RCTs was 0.56 (95% CI, 0.20-1.52; 95% PI, 0.06-5.14, parametric, and 0.13-1.80, nonparametric). After the update, the RR was 0.59 (95% CI, 0.27-1.29; 95% PI 0.10-3.29, parametric, and 0.17-1.52, nonparametric).

CONCLUSION

Contrary to the conclusions of a recent meta-analysis, as well as earlier meta-analyses, by using more appropriate methodology, the evidence underpinning the protective effect of NHE so far remains inconclusive and mostly derived from high risk of bias RCTs. At best, only conditional recommendation can be provided (for soccer) and future RCTs are warranted.

The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study

This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11–18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7–22.7%), 23.2% (95% CI: 18.6–28.2%) in males and 12.5% (95% CI: 8.3–17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7–6.4%), 4.1% (95% CI: 2.2–7.0%) in males and 4.5% (95% CI: 2.1–8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10–4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58–16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.

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.

Assessment of External Load During Matches in Two Consecutive Seasons Using the Mediacoach® Video Analysis System in a Spanish Professional Soccer Team: Implications for Injury Prevention

(1) Background: Knowledge of competition loads is a relevant aspect of injury prevention. We aimed to describe the training and match injury incidence and physical demand variables observed during a competition using a multi-camera video analysis system (Mediacoach^®) (LaLiga^TM, Madrid, Spain) in a professional Spanish soccer team during two consecutive seasons. (2) Methods: 30 players (age: 26.07 ± 3.78 years) participated in the study. Physical variables of 74 matches were collected retrospectively. Injury characteristics of both seasons were also collected. Differences in these variables between the two seasons and by player position and correlations between variables were explored. (3) Results: There were statistically significant differences between the two seasons in the total distance traveled and the distance traveled at a high-intensity sprint (p < 0.05). During the two seasons, there was an average of 4.7 ± 2.2 injuries. The total distance traveled was different according to the playing position, and statistically significant correlations were found in the total distance and sprint at a high intensity for certain positions with different injury severity (4) Conclusions: The match performance data recorded by the Mediacoach^® system may provide relevant information by player position to technical and medical staff for injury prevention.

Dissemination and implementation research in sports and exercise medicine and sports physical therapy: translating evidence to practice and policy

Knowledge from research evidence is wasted unless it is applied. While the scientific evidence base for many sports and exercise medicine and sports physical therapy interventions is robust, real-world implementation and evolution to scale remains an ongoing challenge. Dissemination and implementation research is important to generate evidence-informed, cost-effective and context-specific strategies for implementation partners and stakeholders to effectively apply and sustain the best research evidence in public health and clinical practice. However, this field of inquiry remains underexplored in sports and exercise medicine and sports physical therapy. Most intervention studies in sports and exercise medicine and sports physical therapy are terminated at the efficacy trial stage without considerations for best practices for translation to community and clinical settings. Lack of context-specific dissemination and implementation strategies to drive the translation of evidence-based interventions results in poor execution of, and attrition from, interventions, and this is associated with suboptimal outcomes and increased healthcare costs. Theory-driven quality research informing the successful dissemination and implementation of evidence-based interventions is needed to address lingering evidence-to-practice gaps. Dissemination and implementation research completes the final stage in the research-to-practice pipeline. It seeks to close evidence-to-practice gaps, thereby ensuring speedy application of research evidence to achieve desired public health outcomes while making more efficient use of limited resources. This review introduces sports and exercise medicine and sports physical therapy researchers and stakeholders to key concepts and principles in dissemination and implementation research.