Exploring Injury Prevention Strategies for Futsal Players: A Systematic Review

Futsal carries a high risk of injury for players. This systematic review aimed to assess the existing literature on injury prevention strategies for futsal players. The literature was searched using PubMed, Web of Science, and Scopus databases from inception to 20 March 2024. Relevant articles were searched using the terms "futsal" AND "injury" AND "prevention". Fourteen studies were included in the review. The review identified several injury prevention strategies with potential benefits for futsal players. Structured warm-up routines were shown to improve balance and eccentric strength and to reduce total, acute, and lower limb injuries. Proprioceptive training methods were suggested to improve joint stability and landing mechanics, which may reduce the risk of injury. Furthermore, multicomponent methods that include components such as core stability and flexibility have shown potential for reducing injury rates in futsal players. Finally, by reducing fatigue and improving movement control, strength training procedures designed to correct muscular imbalances may improve performance, which may ultimately minimize the risk of injury. This systematic review demonstrates the potential benefits of different injury prevention strategies for futsal players. The combination of several strategies, such as proprioceptive training, multicomponent programs, warm-up routines, and strength training specifically designed to address muscular imbalances, appears promising.

The effects of jump training on measures of physical performance, lower extremities injury incidence and burden in highly trained male soccer players

This study aimed to analyse the effects of a 16-week jump training program on the physical performance and lower extremities injury profile in semi-professional male soccer players. Participants were randomly assigned to the control group (CG; n = 13; age = 21.7 ± 3.6 years) or the experimental group (EG; n = 10; age = 22.3 ± 3.5 years). Countermovement jump (CMJ) height (cm), 30 m linear sprint time (s) with split times at 10 m and 20 m distances, and change of direction speed (CODS; 10 + 10 m with 90° turn) time (s) with turns using the dominant or non-dominant leg, were assessed before and after the intervention. Lower extremity injuries sustained throughout the intervention period were collected. Significant within-group improvements were found in EG in CMJ (p = 0.01; effect size [ES] = 1.03; large). Additionally, between-group difference after intervention was found in CMJ (F = 4.42; p = 0.013) in favour of EG. Injury burden was 194.86 (CG) vs 71.37 (EG) days of absence/1,000 h (RR = 2.73; 95% CI 2.10-3.54; p < 0.001). No other significant within-group or between-group differences were found. In conclusion, compared to regular soccer training, jump training was effective to improve jumping ability and burden in soccer players.

Quo Vadis Nordic Hamstring Exercise-Related Research?-A Scoping Review Revealing the Need for Improved Methodology and Reporting

The objective of this scoping review is to assess Nordic Hamstring Exercise quality (ANHEQ) of assessments and interventions according to the ANHEQ rating scales and to present practical recommendations for the expedient design and reporting of future studies. A total of 71 Nordic Hamstring Exercise (NHE) assessments and 83 NHE interventions were selected from the data sources PubMed, Scopus, and SPORTDiscus. Research studies which were presented in peer-reviewed academic journals and implemented the NHE during laboratory-based assessments or multi-week interventions met the eligibility criteria. NHE assessments analyzed force (51%), muscle activation (41%), knee angle kinematics (38%), and bilateral symmetry (37%). NHE interventions lasted 4-8 weeks (56%) and implied an exercise volume of two sessions per week (66%) with two sets per session (41%) and ≥8 repetitions per set (39%). The total ANHEQ scores of the included NHE assessments and interventions were 5.0 ± 2.0 and 2.0 ± 2.0 (median ± interquartile range), respectively. The largest deficits became apparent for consequences of impaired technique (87% 0-point-scores for assessments) and kneeling height (94% 0-point-scores for interventions). The 0-point-scores were generally higher for interventions compared to assessments for rigid fixation (87% vs. 34%), knee position (83% vs. 48%), kneeling height (94% vs. 63%), and separate familiarization (75% vs. 61%). The single ANHEQ criteria, which received the highest score most frequently, were rigid fixation (66% of assessments) and compliance (33% of interventions). The quality of NHE assessments and interventions was generally 'below average' or rather 'poor'. Both NHE assessments and interventions suffered from imprecise reporting or lacking information regarding NHE execution modalities and subsequent analyses. Based on the findings, this scoping review aggregates practical guidelines how to improve the design and reporting of future NHE-related research.

Physical exercises for preventing injuries among adult male football players: A systematic review

BACKGROUND

Football is the most practised sport in the world and is associated with the risk of injuries in the players. Some studies have been published that identify injury prevention programs, but there is no review of the full body of evidence on injury prevention programs for use by football coaches. The aim of this article was to carry out a systematic review of published studies on injury prevention programs for adult male footballers, identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies.

METHODS

PubMed and EMBASE databases were used to identify relevant published articles using the following keywords: "soccer" AND "injury" AND "prevention".

RESULTS

A total of 2512 studies were identified initially, but only 11 studies met the inclusion criteria, and their outcomes are presented. Results revealed that injury prevention programs in football have focused on strength training, proprioceptive training, multicomponent programs (balance, core stability, and functional strength and mobility), and warm-up programs.

CONCLUSION

Based on results from the studies analyzed, football players can lower the incidence of match and training injuries by participating in dynamic warm-up programs that include preventive exercises before games or during training sessions, and by adding strength, balance, and mobility training to the training sessions.

The ANHEQ Evaluation Criteria: Introducing Reliable Rating Scales for Assessing Nordic Hamstring Exercise Quality

BACKGROUND

The Nordic Hamstring Exercise (NHE) is very popular for selective eccentric hamstring strengthening. However, NHE-related research is hindered by insufficient details about implementation and reporting. Available tools to assess study quality (e.g., PEDro or TESTEX scale) are too unspecific to account for the specific demands of NHE. Therefore, this study aimed to introduce two rating scales for Assessing Nordic Hamstring Exercise Quality (ANHEQ) of assessment and intervention studies.

METHODS

Eighteen graduated sports scientists, sports physiotherapists and elite coaches with scientific experience independently evaluated the quality of published NHE studies via ANHEQ scales, each comprising eight items and a maximal 13-point score. Inter-rater agreement was analyzed by using criterion-based reference values, while Krippendorff´s alpha determined inter-rater reliability. Systematic differences of the summated ANHEQ scores were determined using Friedman tests.

RESULTS

Inter-rater agreement was 87 ± 5% for NHE assessments and 88 ± 6% for interventions with single items ranging from 71 to 100%. Alpha values for inter-rater reliability ranged from fair (.250) to perfect (1.00) depending on the item. Total ANHEQ scores revealed coefficients of .829 (almost perfect) and .772 (substantial) without significant inter-rater differences (p = .292).

CONCLUSIONS

The ANHEQ scales are suitable tools to rate NHE execution quality and data presentation. They facilitate a comprehensive review of NHE-related evidence and potentially improve the design and reporting of future NHE studies.

Comparison of player-dependent and independent high-speed running thresholds to model injury risk in football

High-speed running (HSR) loads have been linked with non-contact injury risks in team-sports. This study investigated whether player-specific speed zones, reflecting individual fitness characteristics, impact the associations between non-contact injury and acute and chronic HSR loads. Semi-professional soccer players from two clubs (n = 47) were tracked over two seasons using 10 Hz GPS (5552 observations). HSR distances were calculated arbitrarily (≥5.5 m·s^-1), and in an individualised fashion based on the final speed of the 30-15 intermittent fitness test. Cumulative running loads were represented by exponentially weighted moving averages with 7-(acute) and 28-day (chronic) decay parameters. Physiotherapists collected non-contact, lower-limb, time-loss injury data (n = 101). Injury models using session type (training vs matches), coach, as well as arbitrary or individualised running loads were constructed via mixed-effect logistic regression. Session type had the largest effect on injury (training vs match OR = 0.28; 95%CI:0.17-0.44). Variations in individualised or arbitrary acute and chronic HSR loads within the mid-range of the observed data had negligible effects on predicted injury risk. However, the uncertainty of estimated effects at extreme values of acute and chronic HSR loads prevented any conclusive findings. Therefore, the efficacy of using customised speed thresholds in quantifying load for injury risk mitigation purposes remains unclear.

Short and Long-Term Effects of a Simple-Strength-Training Program on Injuries Among Elite U-19 Soccer Players

Purpose: The aim of this study was to examine the short and long-term effects of a simple strength training program on muscle injury prevention in soccer players. Methods: Twenty-seven U-19 elite male soccer players participated in the study. The investigation was conducted over two consecutive and similar seasons (e.g., the same staff, players, weekly training schedule), the first being the control and the second the experimental season. The strength program was carried out 2 times per week, for 10 weeks, during part of the preseason and in-season. Injury incidence and absence days were compared between both seasons, according to the injury rate ratio (IRR), with 95% CI and the Z test. Results: A lower number of total and hamstring injuries were recorded during the experimental (9 and 2, respectively) compared to the control (15 and 7, respectively) period. During the 10 weeks intervention period, the injury rate ratio (IRR) was lower in the experimental season than in the control season (IRR = 8.12; 95% CI: 1.00-66.03; effect size (ES) = 3.30, large). In addition, there was a decline in absence days per injury and in the number of absence days/1000 h (IRR = 2.44; 95% CI: 1.90-3.14; ES = 1.12) during the experimental season. Conclusion: The results of this study suggest that this simple strength-training program could reduce the muscle injury incidence during its application period in young soccer players.

[Employees in professional European football: comparison of the personnel structure in sports medicine, sports sciences and physiotherapy between Bundesliga, La Liga, Serie A and Premier League]

INTRODUCTION

Regional and league-specific differences in injury risk and time loss have been observed in professional European football. Besides time of play or different pre-season preparations, possible reasons may also include medical and sport-scientific support. A survey of what UEFA deems to be the best four football clubs has therefore been conducted to investigate the personnel status in the fields of medicine, physiotherapy, massage, sports science and athletic and "strength and conditioning" coaching in order to compare the Erste Bundesliga with the first leagues of the other countries.

METHODS

The study is based on a survey of all 78 teams in the highest football leagues of Germany (Bundesliga), Spain (La Liga), Italy (Serie A) and England (Premier League). The teams were contacted directly and a questionnaire concerning their personnel deployment in the different fields was handed out.

RESULTS

The Bundesliga was found to have a significantly lower total number of employees compared with the other European leagues (6.9 vs. 11.02; p < 0.0001). The number of physicians in the Bundesliga is significantly higher (2.2 vs. 1.76; p = 0.0259), but the number of physicians dedicating more than 80 % of their total medical practice to the team was significantly lower in the Bundesliga (0.2 vs. 1.45; < 0.0001). In the group of physiotherapists (1.8 vs. 3.6; p < 0.001), massage therapists (2.1 vs. 2.69; p = 0.0094), sports scientists (0.3 vs. 1.12; p < 0.0001) and athletic and "strength and conditioning" coaches (0.5 vs. 1.83; p < 0.0001), there were also significant differences between the staff structure in the Bundesliga compared with the grouped results of the other leagues.

CONCLUSION

The personnel structure and the personnel employment in the Bundesliga in sports medicine and sports sciences differs significantly from La Liga, Serie A and the Premier League with the latter three leagues having more personnel and the personnel having closer ties to their teams. Further investigation is necessary to find out if this may be a reason for the differences in injury rates observed between these leagues. A special focus should be placed on country-specific differences in the professions including education and scope of work.

Exercise-Based Strategies to Prevent Muscle Injury in Elite Footballers: A Systematic Review and Best Evidence Synthesis

BACKGROUND

Exercise-based strategies are used to prevent muscle injuries in football and studies on different competitive-level populations may provide different results.

OBJECTIVES

To evaluate the effectiveness of exercise-based muscle injury prevention strategies in adult elite football.

METHODS

A systematic search was conducted in PubMed (MEDLINE), Web of Science, Cochrane Library, and SPORTDiscuss (EBSCO). We considered only elite adult (> 16 year-old) football players with no distinction for gender; the intervention to be any exercise/s performed with the target to prevent lower-limb muscle injuries; the comparison to be no injury prevention exercise undertaken; the outcome to be the number of injuries, injury incidence, and severity. We searched systematic reviews, randomized-controlled trials (RCTs), and non-randomized-controlled trials (NRCTs), limited for English language. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, the Cochrane Collaboration's Tool for assessing risk of bias in RCTs, and the Risk of Bias in NRCTs of Interventions tool.

RESULTS

15 studies were included. Three systematic reviews showed inconsistent results, with one supporting (high risk of bias) and two showing insufficient evidence (low risk of bias) to support exercise-based strategies to prevent muscle injuries in elite players. Five RCTs and seven NRCTs support eccentric exercise, proprioception exercises, and a multi-dimensional component to an injury prevention program; however, all were deemed to be at high/critical risk of bias. Only one RCT was found at low risk of bias and supported eccentric exercise for preventing groin problems.

CONCLUSION

We found limited scientific evidence to support exercise-based strategies to prevent muscle injury in elite footballers.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42017077705.

Injury prevention of hamstring injuries through exercise interventions

INTRODUCTION

Hamstring injuries are the most prevalent time-loss injuries in sport, mainly in those modalities characterized by high-intensity and short-term actions, especially accelerations and decelerations during high-speed running. Expanding the knowledge about this type of injury and its preventive programs could be a key strategy to reduce the hamstring injury incidence. Thus, this review aimed to study the effectiveness of different preventive programs based on exercise interventions on reducing the hamstring injury incidence in athletes.

EVIDENCE ACQUISITION

An umbrella review was conducted through of PubMed/MEDLINE, Scopus, SPORTDiscus, Web of Science, Cochrane Library and Physiotherapy Evidence Database databases. The methodological quality of the included systematic reviews was assessed through the Assessing the Methodological Quality of Systematic Reviews 2 and the quality of the evidence was evaluated using the modified Grading of Recommendations Assessment, Development and Evaluation principles.

EVIDENCE SYNTHESIS

Eight systematic reviews and meta-analysis (40 primary studies) met the inclusion criteria, which included interventions based on eccentric strength, Nordic hamstring, proprioceptive training, stretching, FIFA11 and combined programs. From the qualitative synthesizes, three studies showed that eccentric-based training programs were effective; seventeen studies reported that Nordic hamstring-based programs were effective; three studies observed that stability training-based interventions were effective; two studies indicated that flexibility were effective; three studies claimed that FIFA11+based programs were effective; and two studies reported that combined programs were effective.

CONCLUSIONS

Exercise is a key strategy to reduce the hamstring injury incidence, being programs based on eccentric strength mainly by means of Nordic hamstring exercise, and on stability training, those programs which reported greater effectiveness.

Effects of two exercise programmes on joint position sense, dynamic balance and countermovement jump in male amateur football players. A randomised controlled trial

Introduction: The injury prevention and warm-up exercises programmes improve physical performance and injury ratio, but it is poorly investigated in amateur football. Objectives: To assess the effects of two warm-up multi-station programmes (IAI-Programme and FIFA11+) through JPS, LSDT and CMJ. Study design: Randomised controlled trial. Methods: 36 football players were randomised into 2 groups: IAI-Programme (n = 18) and FIFA11+ (n = 18) and performed the intervention protocol for 6 weeks. JPS, LSDT and CMJ were measured at baseline, after 6, 10 and 18 weeks (from baseline). The inter-group and intra-group differences were assessed by repeated-measures analysis of variance test (ANOVA). Results: Significant differences between groups were found after 18 weeks in the absolute angular error (-2.18[-4.33,-0.047], d = 0.69, p < 0.05) of the JPS and in the CMJ (p = 0.001, ŋ²p=,0.298) in favour of IAI-Programme when compared to FIFA11 +. No significant differences between groups were found in the LSDT. There were also intra-group differences observed in the LSDT in both groups. Conclusions: IAI-Programme can provide sensitive benefits with respect to the proprioceptive ability of knee flexion and CMJ than FIFA11 +. Both IAI-Programme and FIFA11+ present improvements in the dynamic postural control measured by the LSDT.

An Injury Prevention Program for Professional Ballet: A Randomized Controlled Investigation

BACKGROUND

Few investigations have examined dance-specific injury prevention programs (IPPs), and no published randomized controlled trials are available that evaluate IPPs for dance.

HYPOTHESIS

The implementation of an IPP will significantly reduce the risk of injury in professional ballet dancers.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 2.

METHODS

A randomized controlled trial was designed that entailed a superiority model for the intervention group. All professional dancers from a single ballet company were eligible to participate. Randomization and allocation were performed before the start of the season. The control group practiced and performed without change to preexisting standard operating practice. The IPP group was instructed to perform a 30-minute exercise program 3 times per week over the 52-week study period. Injuries were recorded. Standard continuous and categorical data comparisons and correlations were used. Cox proportional hazards regression models for recurrent failures were used wherein the hazard ratio indicates the relative likelihood of injury in the control versus intervention groups.

RESULTS

Of the 52 eligible dancers, 75% (n = 39) participated. Of these 39 dancers, 19 (9 males, 10 females; mean age, 26.6 ± 4.0 years) were randomized to the control group and 20 (11 males, 9 females; mean age, 25.1 ± 5.1 years) to the IPP group. No significant (P > .05) difference was found in baseline demographics between groups. A total of 116 injuries were recorded for the entire study population (49 IPP; 67 control). Traumatic and chronic injuries accounted for 54% and 46% of injuries, respectively. The injury rate was 82% less (IPP hazard ratio, 0.18; z = -2.29; P = .022) in the IPP group after adjustment for confounding variables, and time between injuries was 45% longer (IPP hazard ratio, 0.55; z = -2.20; P = .028) than for controls.

CONCLUSION

The present study is the first prospective randomized controlled investigation of an IPP for professional ballet. The results showed an 82% decrease in injury rate for the intervention group and an extended period from previous injury to subsequent injury.

REGISTRATION

NCT04110002 (ClinicalTrials.gov identifier).

Comparison of 10 vs. 20 min neuromuscular training for the prevention of lower extremity injuries in male youth football: A cluster randomised controlled trial

The aim of this study was to compare the effects of 20 min neuromuscular training with a programme of 10 min in youth football players. 342 (15.4 ± 1.7 years) male football players from 18 teams were included, and cluster-randomized by team into two intervention groups. Both groups performed an injury prevention programme twice a week over five months using the same exercises but a different duration. The first intervention group (INT10, n = 175) performed the programme for 10 min, the second intervention group (INT20, n = 167) for 20 min. Primary outcomes were lower extremity (LE) injuries. Secondary outcomes were injury type, severity, mechanism and compliance to the intervention. 13 teams with 185 players were included for final analysis. No significant group difference was found between INT10 (6.37 per 1000 h) and INT20 (7.20 per 1000 h) for the incidence rate ratio of the lower extremities (IRR = 1.03, 95% confidence interval 0.59, 1.79), nor for the distribution of injury location, type, severity or mechanism. The results show that performing preventive exercises for 10 min is no less effective than 20 min in youth football players. Shorter training sessions can, therefore, be effectively used for injury prevention.

TRIAL REGISTRATION

DRKS00015282.

Perceptions of the technical staff of professional teams regarding injury prevention in Spanish national futsal leagues: a cross-sectional study

Futsal is a sport with increasing popularity and level of performance, both in male and female categories. Also, there are several injuries along a season, so it is needed to know how to reduce this burden. The purpose of this study was to describe the perceptions of technical staff on injury risk factors, risk testing and preventive measures, and the strategies used by them within professional male and female futsal teams. A cross-sectional study was designed during the 2017–2018 season. A total of 32 futsal teams involved in male and female Spanish national futsal leagues completed, through an online survey platform, a questionnaire about injury risk factors, risk testing and preventive measures. Findings showed that: (a) most teams reported enough human resources, but insufficient material and time resources, (b) the main risk factors detected were previous injuries, strength deficits and dehydration, (c) functional movement patterns, flexibility tests and self-report questionnaires were the most applied tests for detecting injury risks in their players and (d) most of the main preventive measures used by technical staff matched with the best valued by them. Technical staff defined properly the main risk factors in futsal performance, as well as they applied preventive strategies with scientific support. The information provided in this research could be of interest for sport scientists and technical staff when designing more accurate and efficient injury prevention programs in futsal.

Quantifying Functional Ankle Rehabilitation Progression Criteria Using GPS: A Preliminary Study

Context: Contemporary developments in Global Positioning System (GPS) technology present a means of quantifying mechanical loading in a clinical environment with high ecological validity. However, applications to date have typically focused on performance rather than rehabilitation. Objective: To examine the efficacy of GPS microtechnology in quantifying the progression of loading during functional rehabilitation from ankle sprain injury, given the prevalence of reinjury and need for quantifiable monitoring. Furthermore, to examine the influence of unit placement on the clinical interpretation of loading during specific functional rehabilitation drills. Design: Repeated measures. Setting: University athletic facilities. Participants: Twenty-two female intermittent team sports players. Intervention: All players completed a battery of 5 drills (anterior hop, inversion hop, eversion hop, diagonal hop, and diagonal hurdle hop) designed to reflect the mechanism of ankle sprain injury, and progress functional challenge and loading. Main Outcome Measures: GPS-mounted accelerometers quantified uniaxial PlayerLoad for each drill, with units placed at C7 and the tibia. Main effects for drill type and GPS location were investigated. Results: There was a significant main effect for drill type (P < .001) in the mediolateral (η2 = .436), anteroposterior (η2 = .480), and vertical planes (η2 = .516). The diagonal hurdle hop elicited significantly greater load than all other drills, highlighting a nonlinear progression of load. Only the mediolateral load showed evidence of progressive increase in loading. PlayerLoad was significantly greater at the tibia than at C7 for all drills, and in all planes (P < .001, η2 ≥ .662). Furthermore, the tibia placement was more sensitive to between-drill changes in mediolateral load than the C7 placement. Conclusions: The placement of the GPS unit is imperative to clinical interpretation, with both magnitude and sensitivity influenced by the unit location. GPS does provide efficacy in quantifying multiplanar loading during (p)rehabilitation, in a field or clinical setting, with potential in extending GPS analyses (beyond performance metrics) to functional injury rehabilitation and prevention.

The effects of detraining and retraining periods on fat-mass and fat-free mass in elite male soccer players

The aim of the study was to examine the effects of a detraining period (DTP) (i.e., off-season) with an individually prescribed training program, and a retraining period (RTP) (i.e., pre-season) combining soccer and flywheel-based strength training on fat-free mass (FFM) and fat-mass (FM) in 10 elite professional male soccer players. The present study used a controlled repeated-measures research design to investigate the changes in FFM and FM using dual-energy X-ray absorptiometry. Whole body %FM increased (effect size (ES) = 0.87 ± 0.46) and FFM reduced after DTP (ES = −0.30 ± 0.19), returning to values comparable to the end of the previous season after RTP. At regional levels, arms, legs, and trunk %FM increased (ES = from 0.42 to 1.29) while trunk-FFM was reduced (ES = −0.40 ± 0.26) after DTP, returning to the values observed at the end of the previous season after RTP. Legs-FFM did not change after DTP, with a substantial increase after RTP in comparison with pre-season values (ES = 0.34 ± 0.29 and 0.53 ± 0.36 for the right and left leg, respectively). Despite the small sample size of the present study, the findings indicate that elite soccer players can be allowed 2 weeks of rest during a five-week DTP, since the changes in %FM and FFM were relatively small, and FM and FFM returned to the optimal initial values for competition after the proposed RTP during the pre-season.

Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes

Research question

Does the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention?

Design

Systematic review and meta-analysis.

Eligibility criteria for selecting studies

We considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries.

Analysis

The effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men.

Data sources

MEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey.

Results

There is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006).

Conclusions

Programmes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes.

Trial registration number

PROSPERO CRD42018106150.

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

In-season eccentric-overload training in elite soccer players: Effects on body composition, strength and sprint performance

The aim of this study was to describe the changes in body composition, strength and sprint performance in response to an entire competitive season of football training supplemented with 2 inertial eccentric-overload training sessions a week in young male professional soccer players. Whole body and regional composition (assessed using dual-energy X-ray absorptiometry), power output in half-squat and 40-m sprinting performance were evaluated in fourteen players. The eccentric-overload training consisted of training sessions a week of 1–2 sets of 10 exercises of upper-body and core (Day 1) and lower-body (Day 2), during the entire competitive season (27 weeks). Whole body fat mass decreased (-6.3 ± 3.6%, ES = -0.99 ± 0.54) substantially while lean mass increased (2.5 ± 0.8%, ES = 0.25 ± 0.09), with some regional differences. There was a substantial increase in half-squat power output (from 3% to 14%, ES from 0.45 to 1.73) and sprint performance (from 1.1% to 1.8%, ES from -0.33 to -0.44), however performance changes were not correlated with changes in body composition. A combined soccer and eccentric-overload training program was able to promote positive changes in body composition and physical factors relevant to both on-field performance and injury prevention in elite soccer players.

Multicomponent Musculoskeletal Movement Assessment Tools: A Systematic Review and Critical Appraisal of Their Development and Applicability to Professional Practice

Multicomponent movement assessment tools have become commonplace to measure movement quality, proposing to indicate injury risk and performance capabilities. Despite popular use, there has been no attempt to compare the components of each tool reported in the literature, the processes in which they were developed, or the underpinning rationale for their included content. As such, the objective of this systematic review was to provide a comprehensive summary of current movement assessment tools and appraise the evidence supporting their development. A systematic literature search was performed using PRISMA guidelines to identify multicomponent movement assessment tools. Commonalities between tools and the evidence provided to support the content of each tool was identified. Each tool underwent critical appraisal to identify the rigor in which it was developed, and its applicability to professional practice. Eleven tools were identified, of which 5 provided evidence to support their content as assessments of movement quality. One assessment tool (Soccer Injury Movement Screen [SIMS]) received an overall score of above 65% on critical appraisal, with a further 2 tools (Movement Competency Screen [MCS] and modified 4 movement screen [M4-MS]) scoring above 60%. Only the MCS provided clear justification for its developmental process. The remaining 8 tools scored between 40 and 60%. On appraisal, the MCS, M4-MS, and SIMS seem to provide the most practical value for assessing movement quality as they provide the strongest reports of developmental rigor and an identifiable evidence base. In addition, considering the evidence provided, these tools may have the strongest potential for identifying performance capabilities and guiding exercise prescription in athletic and sport-specific populations.

Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel

OBJECTIVES

To update the current injury prevention strategy evidence base for making recommendations to prevent physical training-related musculoskeletal injury.

DESIGN

We conducted a systematic review to update the evidence base on injury prevention strategies for military personnel.

METHODS

Literature was systematically searched and extracted from five databases, and reported according to PRISMA guidelines. Sixty one articles meeting the inclusion criteria and published during the period 2008-2015 were selected for systematic review.

RESULTS

The retrieved articles were broadly categorised into six injury prevention strategies; (1) conditioning, (2) footwear modifications, (3) bracing, (4) physical activity volume, (5) physical fitness, and (6) leadership/supervision/awareness. The majority of retrieved articles (n=37 (of 61) evaluated or systematically reviewed a conditioning intervention of some nature. However, the most well-supported strategies were related to reducing physical activity volume and improving leadership/supervision/awareness of injuries and injury prevention efforts.

CONCLUSIONS

Several injury prevention strategies effectively reduce musculoskeletal injury rates in both sexes, and many show promise for utility with military personnel. However, further evaluation, ideally with prospective randomised trials, is required to establish the most effective injury prevention strategies, and to understand any sex-specific differences in the response to these strategies.

Injury Prevention Exercise Programs for Professional Soccer: Understanding the Perceptions of the End-Users

OBJECTIVE

To evaluate the perceptions of professional soccer players and staff members toward injury prevention exercise programs (IPEPs).

DESIGN

Self-report survey.

SETTING

Four professional soccer teams in 4 different countries.

PARTICIPANTS

126 players, coaches, physiotherapists, and fitness coaches were invited to participate, with 72 respondents.

MAIN OUTCOME MEASURES

Web-based survey detailing perceptions of lower limb (LL) injury susceptibility and seriousness, the value of IPEPs in general, and more specifically the International Federation of Association Football (FIFA) 11+.

RESULTS

The vast majority of the respondents believed that professional soccer players are at high risk of LL injuries (93%) and that players should perform evidence-based injury prevention exercises (98%). They also agreed that LL injuries can shorten a player's career (85%), cause physical problems later in life (82%), and negatively impact on team performance (77%). However, perceptions varied across teams regarding which types of injury prevention exercises are effective, who holds responsibility for injury prevention, and when IPEPs should be performed. Specific knowledge of the FIFA 11+ was very low and 47% of respondents believed the program would need modification for use in their team.

CONCLUSIONS

Players and staff members in professional soccer teams strongly support the use of evidence-based IPEPs. However, perceptions vary considerably between teams regarding which exercises can prevent injuries, who holds the responsibility for injury prevention, and when preventive exercises should be performed. Enhancing the ultimate impact of IPEPs in professional soccer requires a detailed understanding of each team's specific implementation context.

Elastin: a possible genetic biomarker for more severe ligament injuries in elite soccer. A pilot study

BACKGROUND

The study of new genetic biomarkers in genes related to connective tissue repair and regeneration may help to identify individuals with greater predisposition to injury, who may benefit from targeted preventive measures, and those who require longer recovery time following a muscle, ligament or tendon injury. The present study investigated whether single nucleotide polymorphisms of the Elastin gene could be related to MCL injury.

METHODS

60 top class football players were studied to identify single nucleotide polymorphisms for the Elastin (ELN) gene using Allelic Discrimination analysis. Each player was followed for 7 seasons, and each MCL injury was noted.

RESULTS

Ligament injury rate, severity and recovery time are related to specific genotypes observed in the elastin gene, especially the ELN-AA (16 MCL) and the ELN-AG (3 MCL). Players with the ELN-GG genotype sustained no MCL injury during the 7 seasons of the study.

CONCLUSIONS

The identification of polymorphisms in the ELN gene may be used as a novel tool to better define an athlete's genotype, and help to plan training and rehabilitation programmes to prevent or minimize MCL ligament injuries, and optimize the therapeutic and rehabilitation process after soft tissue injuries, and manage the workloads during trainings and matches.

Injury prevention strategies at the FIFA 2014 World Cup: perceptions and practices of the physicians from the 32 participating national teams

Purpose

The available scientific research regarding injury prevention practices in international football is sparse. The purpose of this study was to quantify current practice with regard to (1) injury prevention of top-level footballers competing in an international tournament, and (2) determine the main challenges and issues faced by practitioners in these national teams.

Methods

A survey was administered to physicians of the 32 competing national teams at the FIFA 2014 World Cup. The survey included 4 sections regarding perceptions and practices concerning non-contact injuries: (1) risk factors, (2) screening tests and monitoring tools, (3) preventative strategies and (4) reflection on their experience at the World Cup.

Results

Following responses from all teams (100%), the present study revealed the most important intrinsic (previous injury, accumulated fatigue, agonist:antagonist muscle imbalance) and extrinsic (reduced recovery time, training load prior to and during World Cup, congested fixtures) risk factors during the FIFA 2014 World Cup. The 5 most commonly used tests for risk factors were: flexibility, fitness, joint mobility, balance and strength; monitoring tools commonly used were: medical screen, minutes/matches played, subjective and objective wellness, heart rate and biochemical markers. The 5 most important preventative exercises were: flexibility, core, combined contractions, balance and eccentric.

Conclusions

The present study showed that many of the National football (soccer) teams’ injury prevention perceptions and practices follow a coherent approach. There remains, however, a lack of consistent research findings to support some of these perceptions and practices.

Injury prevention exercise programmes in professional youth soccer: understanding the perceptions of programme deliverers

BACKGROUND

There are well-known challenges to implementing injury prevention strategies in amateur soccer, but information from other soccer settings is scarce. This cross-sectional survey analysed the injury prevention perceptions of soccer coaches, fitness coaches and physiotherapists from 4 male teams in a professional youth soccer academy.

METHODS

The respondents (n=18) completed a web-based survey relating to lower limb (LL) soccer injuries, the value and practicality of injury prevention exercise programmes (IPEPs) in general and, more specifically, the IPEP endorsed by FIFA, the FIFA 11+.

RESULTS

There were very high levels of agreement regarding players' susceptibility to LL injury and the seriousness of these injuries. Respondents agreed unanimously that players should perform evidence-based injury prevention exercises. Despite 61% of respondents having previously heard of the FIFA 11+, just 6% reported current use of the full programme, with a further 22% reporting modified use. 22% believed the FIFA 11+ contained adequate variation and progression for their team and 78% felt it needed improvement. Respondents identified multiple barriers and facilitators to maintaining IPEPs, relating either to the programme content (eg, exercise variation), or the delivery and support of the programme (eg, coach acceptance).

CONCLUSIONS

The coaches, fitness coaches and physiotherapists of professional youth teams support the use of IPEPs, but enhancing their impact requires tailoring of programme content, along with adequate delivery and support at multiple levels. The findings suggest that the FIFA 11+ needs modification for use in professional youth soccer teams.

Programas de exercício na prevenção de lesões em jogadores de futebol: uma revisão sistemática

Dentre as lesões ocorridas em jogadores de futebol, as lesões dos isquiotibiais são as mais frequentes. Programas de exercício que previnam o seu aparecimento e diminuam a sua recorrência e severidade são de extrema importância para os fisioterapeutas, treinadores e jogadores. Conhecer as evidências científicas sobre a eficácia de programas de exercício na prevenção de lesões dos isquiotibiais, em jogadores de futebol masculino. Os estudos foram selecionados para revisão em diferentes bases de dados. Para avaliar a qualidade metodológica dos estudos e a força de evidência dos resultados utilizou-se a escala da Base de dados de Evidência em Fisioterapia (PEDro) e o sistema de classificação Melhor Síntese de Evidência, respectivamente. Os programas de exercício utilizados foram: força concêntrica e excêntrica; força excêntrica Nordic Hamstrings; The FIFA 11+; e elasticidade. As variáveis estudadas foram a incidência de lesões, a incidência de novas lesões, a recorrência de lesões, a severidade das lesões e o risco de lesão. O programa de força concêntrica e excêntrica e o programa de força excêntrica Nordic Hamstrings parecem ser os mais eficazes na redução da incidência das lesões e da incidência de novas lesões dos isquiotibiais, respetivamente (evidências limitadas). O programa de exercício de força excêntrica Nordic Hamstring não é eficaz na diminuição do risco de lesão (evidências limitada) e na melhoria da severidade das lesões (evidência moderada). O programa The FIFA 11+ não é eficaz na redução da incidência das lesões (evidência limitada). Há evidências contraditórias nas variáveis restantes.