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Corsini A, Bisciotti A, Canonico R, Causarano A, Del Vescovo R, Gatto P, Gola P, Iera M, Mazzoni S, Minafra P, Nanni G, Pasta G, Pulcini I, Salvatori S, Scorcu M, Stefanini L, Tenore F, Palermi S, Casasco M, Calza S. Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The "Italian Injury Study" during the Serie a Championship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5182. [PMID: 36982090 PMCID: PMC10048896 DOI: 10.3390/ijerph20065182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury. METHODS A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database. RESULTS Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19. CONCLUSIONS This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stefano Mazzoni
- Sport Medicine Department—Milan Lab, Associazione Calcistica Milan, 20149 Milano, Italy
| | | | - Gianni Nanni
- Bologna Football Club 1909, 40132 Bologna, Italy
| | | | | | | | | | | | | | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | | | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy
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Wezenbeek E, Denolf S, Willems TM, Pieters D, Bourgois JG, Philippaerts RM, De Winne B, Wieme M, Van Hecke R, Markey L, Schuermans J, Witvrouw E, Verstockt S. Association between SARS-COV-2 infection and muscle strain injury occurrence in elite male football players: a prospective study of 29 weeks including three teams from the Belgian professional football league. Br J Sports Med 2022; 56:bjsports-2021-104595. [PMID: 35487684 PMCID: PMC9062454 DOI: 10.1136/bjsports-2021-104595] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between SARS-CoV-2 infection and muscle strain injury in elite athletes. METHODS A prospective cohort study in three Belgian professional male football teams was performed during the first half of the 2020-2021 season (June 2020-January 2021). Injury data were collected using established surveillance methods. Assessment of SARS-CoV-2 infection was performed by a PCR test before each official game. RESULTS Of the 84 included participants, 22 were infected with SARS-CoV-2 and 14 players developed a muscle strain during the follow-up period. Cox's proportional hazards regression analyses demonstrated a significant association between SARS-CoV-2 infection and the development of muscle strain (HR 5.1; 95% CI 1.1 to 23.1; p=0.037), indicating an increased risk of developing muscle strains following SARS-CoV-2 infection. All athletes who sustained a muscle strain after infection were injured within the first month (15.71±11.74 days) after sports resumption and completed a longer time in quarantine (14.57±6.50 days) compared with the infected players who did not develop a muscle strain (11.18±5.25 days). CONCLUSION This study reported a five times higher risk of developing a muscle strain after a SARS-CoV-2 infection in elite male football players. Although this association should be examined further, it is possible that short-term detraining effects due to quarantine, and potentially pathological effects of the SARS-CoV-2 infection are associated with a higher risk of muscle strain injury.
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Affiliation(s)
- Evi Wezenbeek
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sander Denolf
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | | | - Dries Pieters
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Jan G Bourgois
- Department of Performance and Sports Sciences, KAA Ghent, Ghent, Belgium
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | | | - Matthias Wieme
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Robbe Van Hecke
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Laurence Markey
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Joke Schuermans
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Steven Verstockt
- Department of Electronics and Information Systems, Ghent University, Gent, Belgium
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