A Prospective Analysis of the Injury Incidence of Young Male Professional Football Players on Artificial Turf

Injury incidence and risk factors in youth soccer players: a systematic literature review. Part I: epidemiological analysis

The analysis of the epidemiological data and the risk factors underlying injuries is crucial to promote prevention strategies in young soccer players. The objective of the present study was to perform a systematic literature review on the epidemiological data, described in the first part, and injury risk factors, presented in the second part. After electronic database searching, articles in line with the inclusion criteria were selected for the systematic review. Epidemiological data were extracted and discussed in this first part of the review. Data were grouped as follows: injury incidence, injury severity, and re-injury, injury types, injury mechanisms, and anatomical location. The principal findings of this first part of the review are as follows: (1) injury incidence is higher in older players and during matches than during training; (2) sex and maturity status may increase risk of injury; (3) male soccer players are more prone to muscle strains and ligament sprains while female players suffer more ligament sprains; (4) most injuries are located in the ankle and thigh in young male soccer players, and in the ankle and knee in female players; (5) severe injuries are less frequent but the incidence increases in older players. Re-injuries represent only a small percentage. Although soccer is considered a safe sport, many injuries are recorded in young soccer players every year. Injury predisposition changes in relation to age, sex, and biological age. Coaches and physical trainers should be aware of individual differences in order to promote prevention strategies and personalised training.

Injury incidence and risk factors in youth soccer players: a systematic literature review. Part II: Intrinsic and extrinsic risk factors

Injury is defined as a complex phenomenon determined by the non-linear interaction of several intrinsic and extrinsic factors. The objective of the present study was to perform a systematic literature review on the injury risk factors in young soccer players. After electronic database searching, articles in line with the inclusion criteria were selected for the systematic review. Injury risk factor data were extracted and grouped in intrinsic and extrinsic risk factors. The main findings of the current review are as follows: (1) alteration in neuromuscular control such as limb asymmetry and dynamic knee valgus are important intrinsic risk factors; (2) maturation status may impair neuromuscular control and increase the risk of injury; (3) fatigue and poor recovery contribute to the onset of overuse injuries; (4) the impact of anthropometric factors is still unclear; (5) previous injuries increase the risk of re-injuries; (6) highly skilled players are more exposed to risk of injuries; (7) high external workloads increase the risk of injuries; (8) playing position, as well as sport specialization, exposes young soccer players to greater injury risk. Many factors (e.g., neuromuscular control, training load, maturity status) can modify the susceptibility to injury in young soccer players. Being aware of the complex interaction between these factors is essential to identify players at higher risk of injury, develop adequate prevention strategies, and from a scientific point of view move from a reductionist to a complex system approach.

Growth, maturation and injuries in high-level youth football (soccer): A mini review

Understanding the challenges football (soccer) players face during adolescence is fundamental to avoid disruptions in their development due to injury. This mini review will describe basic concepts of somatic growth and biological maturity, examine data from 53 prospective epidemiological studies on high-level youth football players and discuss how age, growth and maturity may affect the injury patterns observed. Based on the existing evidence, at least every third player sustains an injury during a football season. The thigh (median for studies of boys: 25%, median for girls: 21%), ankle (b: 18%, g: 30%), knee (b: 17%, g: 18%) and hip/groin (b: 14%, g: 10%) are the body parts injured most often, while muscle strains (b: 31%, g: 25%), sprains (b: 20%, g: 27%) and contusions (b: 17%, g: 16%) are the most common injury types. Injury trends are, however, not consistent throughout adolescence, and players' age, maturity status and position relative to peak height velocity (PHV) have shown to influence the number, type and location of injuries sustained. Despite a high volume of observational injury studies published on high-level youth players, girls (7 studies) and settings outside of Europe (included in 23% of studies) are underrepresented and should receive extra attention in the future. Based on the available epidemiological data, tailored injury reduction programmes can be considered in youth football, alongside application of general training principles such as progression, variation and individualization which may be especially important during vulnerable phases such as the adolescent growth spurt.

Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis

BACKGROUND

To conduct a systematic review and meta-analysis of epidemiological data of injuries in male and female youth football players.

METHODS

Searches were performed in MEDLINE/PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases. Studies were considered if they reported injury incidence rate in male and female youth (≤19 years old) football players. Two reviewers (FJRP and ALV) extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation approach determined the quality of evidence. Studies were combined using a Poisson random effects regression model.

RESULTS

Forty-three studies were included. The overall incidence rate was 5.70 injuries/1000 h in males and 6.77 injuries/1000 h in females. Match injury incidence (14.43 injuries/1000 h in males and 14.97 injuries/1000 h in females) was significantly higher than training injury incidence (2.77 injuries/1000 h in males and 2.62 injuries/1000 h in females). The lower extremity had the highest incidence rate in both sexes. The most common type of injury was muscle/tendon for males and joint/ligament for females. Minimal injuries were the most common in both sexes. The incidence rate of injuries increased with advances in chronological age in males. Elite male players presented higher match injury incidence than sub-elite players. In females, there was a paucity of data for comparison across age groups and levels of play.

CONCLUSION

The high injury incidence rates and sex differences identified for the most common location and type of injury reinforce the need for implementing different targeted injury-risk mitigation strategies in male and female youth football players.

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.

Incidence, burden, and pattern of injuries in Spanish male youth soccer players: A prospective cohort study

OBJECTIVES

To explore the incidence, burden, and pattern of injuries in Spanish male youth soccer players during a 9-month competitive season (from September to May-June).

DESIGN

Prospective cohort study.

PARTICIPANTS

314 young (10-19 years) soccer players.

MAIN OUTCOME MEASURES

Incidence, burden, location, type, severity, mechanism, and circumstance of injuries, as well as potential differences by tactical position, month of the year, age group, and maturity status.

RESULTS

A total of 146 time-loss injuries were sustained by 101 different players. This resulted in an overall injury incidence of 3.1 injuries per 1000 h, a training injury incidence of 1.8 injuries per 1000 h, and a match injury incidence of 11.2 injuries per 1000 h. The probability of injury over the season was 34%. Most of the injuries affected the lower extremity and were classified as muscle/tendon injuries, with hamstring muscle injuries representing the most burdensome diagnosis. The incidence of injuries increased with age and maturation, but a heightened risk of overuse injuries during periods around peak height velocity was also identified.

CONCLUSIONS

These findings suggest a need for implementing specific injury prevention measures. Due to the high burden shown, these measures should mainly focus on reducing the number and severity of hamstring muscle injuries.

Use of GPS to measure external load and estimate the incidence of muscle injuries in men's football: A novel descriptive study

Measurement of external load in players provides objective information to optimise the weekly balance between training and recovery to improve performance and prevent injuries. Our aim was to evaluate the incidence of sports-related muscle injuries of the lower limb in relation to external load, measured by global positioning system (GPS), in football players. A descriptive study was carried out. Data were collected from 71 professional male football players (30 professionals and 41 youth players) from an elite football club competing in the Spanish and European League in the 2017-2018 season. As external load variables, we measured High Metabolic Load Distance (HMLD), High Speed Running (HSR), Player Load (PL), and Total Distance (TD) through GPS. Injury rate (IR) was calculated both in relation to such GPS load metrics and to load exposure time. We considered categories (youth and professional), playing positions (centre back, full back, midfielder, and forward), and training day with respect to match-day (-4MD, -3MD, -2MD, -1MD, MD, +1MD, +2MD). The GPS load metrics HMLD, HSR, PL, and TD showed very similar patterns across categories and positions, but varied according to training session or MD. The highest loads were observed on MD and three days prior to the match (-3MD). Similarly, the overall IR, both calculated per load exposure time and per GPS load metrics, was highest on MD and -3MD. Again, no differences were observed between youth and professional players. Midfielders demonstrated the highest IR in all metrics, followed by the forwards. In conclusion, this study suggests that external load and incidence of muscle injuries are directly proportional. Therefore, the measurement of more external load variables other than load exposure time, such as the GPS metrics HMLD, HSR, PL, and TD may help to describe the pattern and magnitude of injuries. Future studies based on ours may help to further improve the understanding of the incidence of muscle injuries on the basis of external loads measurements in different football teams.

Elite Athletes and COVID-19 Lockdown: Future Health Concerns for an Entire Sector

In this editorial, we focused our attention on elite athletes during the COVID-19 lockdown. A high level of physical fitness is required by elite athletes irrespective of the specific type of sport. Generally speaking, elite athletes avoid long periods of rest during and at the end of the competitive season. Normally, elite athletes stop training or reduce training volume and intensity for a period that ranges from two weeks to a maximum of four weeks.

Injury Surveillance in Major League Soccer: A 4-Year Comparison of Injury on Natural Grass Versus Artificial Turf Field

BACKGROUND

Artificial playing surfaces are becoming more common due to decreased cost of maintenance and increased field usability across different environmental conditions. The Fédération Internationale de Football Association (FIFA) has approved newer generation artificial turf for soccer competition at the elite level, but many elite-level athletes prefer to play on natural grass surfaces due to a perceived increase in injury rate, discomfort, and fatigability on artificial turf.

HYPOTHESIS

Injury rates and rates of individually categorized types of injury experienced on artificial turf are noninferior to rates of injury on the standard comparator, natural grass, in elite-level Major League Soccer athletes.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Over the course of 4 Major League Soccer seasons (2013-2016), athlete injury data were recorded electronically. Injury data recorded in matches between 2 Major League Soccer teams were then analyzed. Playing surface was known for each venue, and all artificial turf surfaces were rated as 2-star according to FIFA criteria. Incidence rate ratios (Artificial Turf ÷ Natural Grass) were calculated with a 95% CI (α = .05) for both overall injury incidence and individual injury subgroups. A noninferiority margin (δ) of 0.15 was used to determine noninferiority of injury incidence rates.

RESULTS

A total of 2174 in-game injuries were recorded during the study period, with 1.54 injuries per game on artificial turf and 1.49 injuries per game on natural grass (incidence rate ratio, 1.033; 95% CI, 0.937-1.139). Within injury subgroups, overall ankle injury, Achilles injury, and ankle fracture were found to have a statistically higher incidence on artificial turf. Artificial turf was found to be noninferior to natural grass for overall foot injury and forefoot injury. No statistically significant differences were found in knee injuries between the 2 surfaces.

CONCLUSION

The overall rate of injury on artificial turf was noninferior to that on natural grass. Within individual injury categories, a higher rate of ankle injury was found on artificial turf. No other injury subgroup demonstrated statistically significant differences between surfaces.

CLINICAL RELEVANCE

FIFA 2-star rated artificial turf is a viable alternative to natural grass in elite-level soccer competition. Innovative research methods for comparing artificial turf versus natural grass may elucidate relative advantages with respect to player safety.

Playing football on artificial turf as a risk factor for fifth metatarsal stress fracture: a retrospective cohort study

OBJECTIVE

The fifth metatarsal stress fracture is a common injury among football players. Although several risk factors have been proposed, the association between the playing surface and development of fifth metatarsal stress fractures (MT-5) has not been evaluated. We conducted an epidemiological study using a computer-based survey to investigate the association between the playing surface and development of MT-5.

METHODS

This study included 1854 football players, of which 41 experienced MT-5 within the past 24 months. Baseline demographic data and the percentage of time spent playing on artificial turf and clay fields were compared between the non-MT-5 and MT-5 player groups, and the risks for development of MT-5 associated with the playing surfaces were estimated by univariate and multivariate analyses.

RESULTS

There were significant differences in body mass index, years of play, playing categories and playing time on artificial turf between non-MT-5 and MT-5 groups (p<0.05). Generalised estimating equations analyses adjusted for multiple confounders demonstrated that relative to the risk of playing <20% of the time on each surface, the OR (OR: 95% CI) for MT-5 for playing on artificial turf >80% of the time increased (3.44: 1.65 to 7.18), and for playing on a clay field 61%-80% of the time, the OR decreased (0.25: 0.11 to 0.59).

CONCLUSIONS

A higher percentage of playing time on an artificial turf was a risk factor for developing MT-5 in football players. This finding could be beneficial for creating strategies to prevent MT-5.

Epidemiological profile of soccer-related injuries in a state Brazilian championship: An observational study of 2014-15 season

BACKGROUND

Soccer related injuries are often reported in studies, but epidemiological research on this theme is rare in Brazil, Furthermore, the conditions in which athletes have returned to sports practice, namely, either symptomatic or asymptomatic, have been neglected in research.

OBJECTIVES

The aim of this study was to describe the epidemiological features of injuries among professional Brazilian soccer players in relation to location, type, mechanism, severity, recurrence, treatment and, lastly, symptoms in return to sport.

STUDY DESIGN

Descriptive and cross-sectional, observational study.

STUDY CENTER

School of Physical Therapy of the University of Mato Grosso do Sul, Brazil.

METHODS

116 male professional athletes of teams from a Brazilian state championship were interviewed and information about injuries was recorded using a retrospective reported morbidity questionnaire. Data were analyzed in mean ± SD for physical characteristics and sports practice history in absolute and relative frequencies (chi-square test with Bonferroni's correction) for characterization of soccer injuries in terms of type, location, severity, recurrence and symptoms in return to sport.

RESULTS

The numbers of injuries per athlete and per injured athlete were 0.92 and 1.43 respectively. The injuries of muscle-tendon unit and the joint types localized on lower limbs constituted the most important clinical occurrences with significant difference both in relation to other types (p < 0.05). Moderate and severe injuries were the most frequent occurrences. In relation to mechanisms for each type of injury, body contact was at least three times more responsible for injury cases. This type of mechanism was associated with a significantly greater impairment of joint structures. Concerning occurrence and recurrence of cases, the number of recurrent injuries of the muscle-tendon unit reached about 7.5% of the first-time injuries, while the number of joint recurrent injuries integrated almost 40% of the first-time cases. Significant differences between first-time injuries and recurrent injuries were found only for muscle-tendon and joint structures (p < 0.05), while significant differences among the type of injuries within each type of occurrence (first-time or recurrent injuries) were also found between muscle-tendon and joint injuries (p < 0.05). In relation to athletes with symptoms, in return to sport, 77.6% of them were treated for their injuries but more than half of them returned with symptoms still present when compared to those who returned without any symptoms. Among athletes who did not receive treatment, a lower percentage (58.3%) returned to the sport with symptoms still present. Significant associations between treatment and symptomatology were not found.