Youth soccer players: patterns of injury involving the primary growth plates of epiphyses

Youth soccer (football) is immensely popular internationally. Earlier participation, sport sub-specialization, and year-around practice have led to an increased incidence of injury from both acute trauma and repetitive overuse. The growth plates (physes) of the immature skeleton are particularly vulnerable to injury and delayed diagnosis can lead to future growth disturbance and long-term morbidity. Familiarity with the various components of the growth plate complex necessary for ensuring normal endochondral ossification is fundamental in understanding the various patterns of imaging findings following injury. This review discusses the zonal columnar arrangement of the growth plate proper and the contrasting function of the vasculature within the subjacent epiphysis and metaphysis. This is followed by an evidence-based discussion of the common patterns of injury involving the epiphyseal primary growth plate observed among youth soccer players: subcategorized into physeal fractures (direct injury) and physeal stress injuries (indirect insult to subjacent metaphysis). In this section, the role of imaging and characteristic imaging features will be discussed. While the normal physiologic and pathophysiologic mechanisms can be applied to other growth plates, such as primary growth plates underlying the apophyses and secondary growth plates surrounding the secondary ossificiation centers, which also undergo endochondral ossification, the current review is focused on injuries involving the primary growth plates underlying epiphyses.

'More than likely the men come first. That's just very frustrating'. A qualitative exploration of contextual factors affecting the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club football in Ireland

OBJECTIVES

The aim of our study was to explore the contextual factors that affect the implementation of football injury prevention initiatives and the provision of effective injury management in the Irish Women's National League (WNL).

METHODS

We used a criterion-based purposive sampling approach to recruit coaches (n=7), players (n=17) and medical personnel (n=8) representing eight of the nine clubs in the WNL to participate in one-to-one semistructured interviews. Our study was located within an interpretivist, constructivist research paradigm. The interview data were analysed using reflexive thematic analysis.

RESULTS

The participants identified academic and work pressures, financial challenges, conflict with college football, inadequate facilities and gender inequity as being barriers to the implementation of injury prevention initiatives and the provision of effective injury management. Financial constraints within clubs were perceived to limit the provision of medical care and strength and conditioning (S&C) support and this was deemed to be associated with a heightened risk of injuries.

CONCLUSION

Specific contextual factors were identified which curtail the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club football in Ireland. Gender inequity was identified as one of the factors impacting the availability of high-quality medical care, S&C support, as well as access to training and match facilities. Our results provide new insights that could be used to inform the design and implementation of injury prevention and management initiatives for women football players in Ireland.

Hamstring muscle injury is preceded by a short period of higher running demands in professional football players

The aim of this study was to examine match running patterns before a hamstring muscle injury occurs during a match in male professional football players. A total of 281 male professional football players belonging to 7 teams from LaLiga were prospectively monitored over three seasons. Among these, 36 players suffered a non-contact hamstring muscle injury during an official match. The injuries were recorded by the medical staff, including the minute when the injury occurred. Running distances at different speed thresholds for 5 min and 15 min before the injury were compared to mean values of the previous 5 matches for the same time points. There were a total of 44 non-contact hamstring muscle injuries, which represents a hamstring muscle injury incidence of 3.34 injuries/1000 h of match exposure. The average time loss for these injuries was 33 ± 28 days (range 7 to 117 days). In the 15 min prior to the injury, players ran a similar distance as in control matches (p from 0.22 to 0.08). However, players ran a greater distance in the 5-min period before the injury than in control matches at 21.0-23.9 km/h (p < 0.001) and at ≥ 24 km/h (p < 0.001). The odds ratio for a hamstring muscle injury was 7.147 for those players who ran > 30.0 m at ≥ 21 km/h in a 5-min period (p < 0.001). Hamstring muscle injuries during competition were preceded by 5 min of higher running demands at > 21 km/h, compared with control matches. This suggests that a short period of unusual running increases the risk of hamstring muscle injury in professional football players.

Developmental differences of kinematic and muscular activation patterns in instep soccer kick

Kinematic and neuromuscular activity differences amongst soccer players in different age groups were examined in this study. Thirty male soccer players evenly divided into three age groups (Group 1: age 12-13; Group 2: age 14-15; Group 3: age 16-17) were asked to perform instep kicks towards a target 11 m away. Their anthropometrics, instep kick kinematics, resultant ball velocities, both legs isokinetic strength, and electromyography (EMG) during kicking were compared amongst the three age groups. There were significant differences in height, body mass, body mass index, ball velocities, and isokinetic strength values amongst three age groups. Also, kicking kinematics including angular and linear velocities of hip, knee, ankle, and toe were significantly different (p < 0.05) amongst groups in several kicking phases. Furthermore, the activities of m. rectus femoris, m. vastus medialis, m. biceps femoris were significantly different amongst groups (p < 0.05). The ball velocities and leg strength parameters increased with age, neuromuscular activations, and kinematic parameters differed especially in leg-coking and forward swing phase of instep soccer kick. It should be concluded that an increase of resultant ball velocity of the instep kick is closely associated with chronical age, the development of leg muscle strength, and the neuromuscular activity of the kicking leg.

Multiplanar lumbar, pelvis and kick leg sequencing during soccer instep kicking from different approach angles

Multiplanar kinematic and kinetic sequencing from different approach angles can highlight how soccer players perform fast and accurate kicks. This study therefore aimed to a) determine multiplanar torso, pelvis and kick leg sequencing during instep kicks and b) highlight the effect of different approach angles on these sequencing patterns. Twenty male soccer players (mass 77.9 ± 6.5 kg, height 1.71 ± 0.09 m, age 23.2 ± 3.7 years) performed kicks from self-selected (∼30-45°), straight (0°) and wide (67.5°) approaches and multiplanar lumbo-pelvic, hip and knee angular velocities, moments and powers were derived from 3D motion analysis. The results suggest tension arc release between the upper and lower body functions as a two-stage mechanism. The first phase of arc release was characterised by increases in concentric hip flexion and transverse lumbo-pelvic velocities towards the ball. The second phase was characterised by increasing concentric lumbo-pelvic flexion and knee extension work to angularly accelerate the kicking knee towards foot-to-ball contact. Further, alterations in kinematic and kinetic sequencing helped maintain performance (ball and foot velocities at ball contact) and accuracy at approach angles other than self-selected. These findings can help coaches and practitioners design effective training practices.

A rare soccer-related injury: Traumatic posterior hip fracture-dislocation - Case series and overview of the literature

BACKGROUND

Soccer is one of the most popular sports with millions of active professional and non-professional players worldwide. Traumatic hip dislocations are rare in soccer but can lead to major sequelae both physically and psychologically. The aim of this review was to obtain insight into the outcomes after surgerically repaired hip fracture-dislocation in soccer players as well as rehabilitation and prevention.

METHODS

Two cases of a posterior hip fracture-dislocation that occurred during an amateur soccer match are presented and mechanism of injury, complications and rehabilitation were analysed. Follow-up of both patients was at least one year after surgery. Questionnaires and physical examinations were obtained to quantify and qualify outcome.

RESULTS

In both cases the hip-dislocations were reduced within 3 h after injury. Semi-elective open reduction and internal fixation was performed within seven days. In one case, there was a concomitant Pipkin fracture and sciatic nerve neuropathy. There were no postoperative complications. Follow-up showed full of range of motion and normal hip functionality in both cases. However, both patients indicated a reduced quality of life and anxiety related to the accident.

CONCLUSION

Traumatic hip fracture-dislocations during soccer practice are extremely rare. Despite uncomplicated fracture healing after surgery and return of hip function, both patients still suffer from psychological problems resulting in a decreased quality of life. Further research is required to enhance psychological outcomes, as well as to facilitate return to pre-injury levels of participation and engagement in sports following traumatic hip fracture-dislocations related to soccer.

'Setting the Benchmark' Part 2: Contextualising the Physical Demands of Teams in the FIFA World Cup Qatar 2022

This study aimed to contextualise and benchmark the physical demands of teams in the FIFA World Cup Qatar 2022. With FIFA's official approval, all sixty-four games were analysed during the competition (n = 32 teams) using a multi-camera computerised tracking system. On average, teams during Qatar 2022 covered around 108.1 ± 3.6 km in total, with 9.0 ± 0.9 and 2.3 ± 0.3 km covered at the higher intensities (≥20.0 and ≥25.0 km · h-1), respectively. Compared to the FIFA World Cup Russia 2018, national teams in Qatar 2022 covered only 3% more total distance but 16-19% more distance at the higher intensities (P < 0.01; Effect Size [ES]: 0.9-2.0). When the data was adjusted based on the number of minutes played, tournament differences at the higher intensities were less pronounced (9-12%; P < 0.01; ES: 0.7-1.3). The United States, Canada, Saudi Arabia, Germany and IR Iran covered 19-34% more high-intensity distance than Argentina, Ecuador, Qatar, Poland and Costa Rica during the 2022 tournament (P < 0.01; ES: 3.2-3.5). Match-to-match variation of each team in Qatar 2022 revealed Ecuador and Uruguay were particularly consistent for the distances covered at higher intensities (Coefficient of Variation [CV]: 2-3%), whilst Japan demonstrated considerable variation (CV: 23-29%). Teams generally covered more total distance on a per-minute basis in the first versus the second half (P < 0.01; ES: 1.2), but no differences existed at higher intensities (P > 0.05; ES: 0.0-0.1). Correlations between the number of high-intensity runs and various phase of play events across all teams were strongest for defensive transitions and recoveries, in addition to progressions up the pitch and into the final third (r = 0.63-0.75; P < 0.01). The present findings provide valuable context into the contemporary team demands of international football. This information could be useful for practitioners to benchmark team performances and to potentially understand the myriad of factors impacting physical performances.

'Setting the Benchmark' Part 1: The Contextualised Physical Demands of Positional Roles in the FIFA World Cup Qatar 2022

This study aimed to contextualise and benchmark the positional role demands during the FIFA World Cup Qatar 2022. With FIFA's official approval, all sixty-four games were analysed during the competition (n=722) using a multi-camera computerised tracking system. During a typical FIFA World Cup Qatar 2022 match, defensive and central midfielders covered 8-19% more total distance than other positional roles (P<0.01; Effect Size [ES]: 0.8-2.5). The distances covered at higher intensities (≥20 and ≥25 km · h-1) were 16-92% and 36-138% higher for wide midfielders and wide forwards compared to central defenders, defensive and central midfielders as well as centre forwards (P<0.01; ES: 0.7-2.2 and ES: 0.6-1.4). Defensive and central midfielders covered a greater proportion of their distance at higher intensities (≥20 and ≥25 km · h-1) out-of-possession (71-83%; P<0.01; ES: 1.4-3.0), whilst attacking midfielders, wide and centre forwards more in-possession (55-68%; P<0.01; ES: 1.6-3.3). Nine out of the top ten sprint speeds attained at the tournament were from wide positional roles (35.3-35.7 km · h-1). All positional roles demonstrated a second half reduction in total distance covered compared to the first half (P<0.01; ES: 0.8-1.3). A decline between halves for the distances covered at higher intensities (≥20 and ≥25 km · h-1) were more evident in attacking midfielders, wide defenders and midfielders than for other positional roles (P<0.01; ES: 0.3-0.7). Defensive midfielders and centre forwards were found to have the highest coefficient of variation (CV: 30.9-35.9% and 67.7-67.8%) for the distances covered at higher intensities (≥20 and ≥25 km · h-1) compared to other positional roles. The current findings provide valuable contextual information about the contemporary positional demands of international football. This could be useful in the development and prescription of specific training regimes for national teams.

A new statistical approach to training load and injury risk: separating the acute from the chronic load

The relationship between recent (acute) training load relative to long-term (chronic) training load may be associated with sports injury risk. We explored the potential for modelling acute and chronic loads separately to address current statistical methodology limitations. We also determined whether there was any evidence of an interaction in the association between acute and chronic training loads and injury risk in football. A men's Qatar Stars League football cohort (1 465 players, 1 977 injuries), where training load was defined as the number of minutes of activity, and a Norwegian elite U-19 football cohort (81 players, 60 injuries), where training load was defined as the session rating of perceived exertion (sRPE). Mixed logistic regression was run with training load on the current day (acute load) and cumulative past training load estimated by distributed lag non-linear models (chronic load) as independent variables. Injury was the outcome. An interaction between acute and chronic training load was modelled. In both football populations, we observed that the risk of injury on the current day for different values of acute training load was highest for players with low chronic load, followed by high and then medium chronic load. The slopes varied substantially between different levels of chronic training load, indicating an interaction. Modelling acute and chronic loads separately in regression models is a suitable statistical approach for analysing the association between relative training load and injury risk in injury prevention research. Sports scientists should also consider the potential for interactions between acute and chronic load.

Changes in physical and technical match performance variables in football players promoted from the Spanish Second Division to the First Division

The aim of this study was to compare physical and technical match performance variables in football players who competed in the Spanish second division for one season and were promoted to the top (first) division in the following season. A total of 97 male outfield football players who were promoted from the second to the first division of the Spanish professional football league within the same team were analysed. Data were recorded using the TRACAB (ChyronHego, New York, USA) multicamera computerised optical tracking system during five seasons (2015-2016 to 2019-2020). A one-way ANOVA repeated measures analysis showed that players executed a greater number of high-intensity running (HIR) efforts (P < 0.001; ES: 0.258), as well as covering greater HIR distance (P < 0.010; ES: 0.106) and total running distance (TD) (P < 0.010; ES: 0.080), when they played in the first division compared with the second division. Moreover, players performed a lower number of passes (P < 0.01; ES = 0.116), short passes (P < 0.01; ES = 0.106), long passes (P < 0.05; ES = 0.067), dribbles (P < 0.001; ES = 0.146) and shots (P < 0.01; ES = 0.074) in the first division compared to the second division. No significant differences were found for any of the defensive variables evaluated. In conclusion, being promoted from the second to the first division of professional football requires players to adapt to greater physical demands and a reduced number of technical actions.

Patterns of ankle injury in soccer: MRI clues to traumatic mechanism

Understanding the traumatic mechanisms of ankle injuries in soccer is crucial for an accurate and complete MRI diagnosis. Many ankle injuries share universal mechanisms seen in other athletic activities, but certain patterns are found to be more specific and relatively unique to soccer. Ankle impingement syndromes encountered in soccer encompass a spectrum of disorders that include anterior and posterior impingement categories, with anterior impingement representing pathology relatively specific to soccer. Lateral ligamentous sprains are one of the most common injuries; however, there is a higher rate of injuries to the medial structures in soccer as compared to other sports. Ankle fractures are uncommon in soccer while bone contusions and chondral and osteochondral injuries frequently accompany ligamentous sprains. Tendon abnormalities in soccer most commonly result from overuse injuries and typically affect peroneal tendons, posterior and anterior tibialis tendons, and Achilles tendon. Acute Achilles tendon ruptures occur in both recreational players and elite soccer athletes. Tibialis anterior friction syndrome may mimic tibial stress fractures. Long-term sequelae of acute traumatic and chronic overuse ankle injuries in professional soccer players manifest as ankle osteoarthritis that is more prevalent compared to not only the general population, but also to former elite athletes from other sports. This article examines the most common and specific injuries in soccer in order of their frequency.

Maturation-dependent patterns of knee injuries among symptomatic pediatric soccer players on MRI

OBJECTIVE

To systematically investigate the prevalence of knee MRI findings among symptomatic pediatric soccer players with respect to skeletal maturity and to identify predictors of surgery.

METHODS

This IRB-approved, HIPAA-compliant retrospective study included soccer players (< 18 years of age) who underwent MRI examinations in the past 5 years (2018-2023). Two radiologists retrospectively and independently reviewed all examinations to categorize skeletal maturity and to identify osseous and soft tissue findings. Findings were compared between maturation groups, and logistic regression models were used to identify predictors of surgery.

RESULTS

Ninety-seven players (45 boys, 52 girls) included 39 skeletally immature, 21 maturing, and 37 mature knees. Kappa coefficient for interobserver reliability ranged between 0.65 and 1.00. Osgood-Schlatter disease (OSD) was more common among immature than maturing and mature knees (25% vs 14% and 5%, p = 0.04); anterior cruciate ligament (ACL) injury was more common among maturing and mature than immature knees (59% and 48%, vs 15%, p < 0.01); and meniscal tears were more common among mature than immature and maturing knees (medial, 41% vs 18% and 14%, p = 0.03; lateral, 43% vs 21% and 19%, p = 0.04). Players in the mature group were more likely to undergo surgery (p = 0.01). The presence of an effusion (OR = 19.5, 95% CI 2.8-240.9, p = 0.01), ACL injury (OR = 170.0, 95% CI 1.3-6996.9, p < 0.01), and lateral meniscal tears (OR = 10.8, 95% CI 1.8-106.1, p = 0.02) were independent predictors of surgery.

CONCLUSION

Differential patterns of injury were found among symptomatic pediatric soccer players; the presence of an effusion, ACL injury, and lateral meniscal tears were independent predictors of surgery, likely contributing to the higher rates of surgery among skeletally mature players.

Relationship between external and internal load indicators and injury using machine learning in professional soccer: a systematic review and meta-analysis

This study verified the relationship between internal load (IL) and external load (EL) and their association on injury risk (IR) prediction considering machine learning (ML) approaches. Studies were included if: (1) participants were male professional soccer players; (2) carried out for at least 2 sessions, exercises, or competitions; (3) correlated training load (TL) with non-contact injuries; (4) applied ML approaches to predict TL and non-contact injuries. TL included: IL indicators (Rating of Perceived Exertion, RPE; Session-RPE, Heart Rate, HR) and EL indicators (Global Positioning System, GPS variables); the relationship between EL and IL through index, ratio, formula; ML indicators included performance measures, predictive performance of ML methods, measure of feature importance, relevant predictors, outcome variable, predictor variable, data pre-processing, features selection, ML methods. Twenty-five studies were included. Eleven addressed the relationship between EL and IL. Five used EL/IL indexes. Five studies predicted IL indicators. Three studies investigated the association between EL and IL with IR. One study predicted IR using ML. Significant positive correlations were found between S-RPE and total distance (TD) (r = 0.73; 95% CI (0.64 to 0.82)) as well as between S-RPE and player load (PL) (r = 0.76; 95% CI (0.68 to 0.84)). Association between IL and EL and their relationship with injuries were found. RPE, S-RPE, and HR were associated with different EL indicators. A positive relationship between EL and IL indicators and IR was also observed. Moreover, new indexes or ratios (integrating EL and IL) to improve knowledge regarding TL and fitness status were also applied. ML can predict IL indicators (HR and RPE), and IR. The present systematic review was registered in PROSPERO (CRD42021245312).

LOW BACK PAIN ESTIMATES IN PROFESSIONAL SOCCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective

To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players.

Methods

Systematic review and meta-analysis.

Results

The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days).

Conclusion

Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.

Long-term continuous exercise training counteracts the negative impact of the menopause transition on cardiometabolic health in hypertensive women - a 9-year RCT follow-up

PURPOSE

The study examined effects of 9-yrs of multicomponent exercise training during the menopause interval on cardiometabolic health in hypertensive women.

METHODS

Sedentary, middle-aged women (n = 25) with mild-to-moderate arterial hypertension were randomized into a soccer training (multicomponent exercise; EX; n = 12) or control group (CON; n = 13). EX took part in 1-h football training sessions, 1-3 times weekly, for a consecutive 9-years, totaling ∼800 training sessions, while CON did not take part in regular exercise training. 22 participants entered menopause during the intervention.

RESULTS

A time×group interaction effect (P = 0.04) of 8.5 mmHg in favour of EX was observed for changes in mean arterial pressure (MAP) (EX: -4.8 [-10.7;1.1] mmHg, CON +3.7 [-2.0;9.3] mmHg). Time×group interaction effects in favour of EX were also observed for total body weight (4.6 kg, P = 0.008, EX: +0.7 [-1.7;3.0] kg, CON: +5.3 [3.0;7.6] kg, total fat percentage (5.7%-points, P = 0.02; EX (-1.9 [-4.4;0.6] %-points; P = 0.13), CON +3.8 [1.4;6.2] %-points and for total cholesterol (1.2 mmol/l, P = 0.03, EX: -0.5 [-1.0;-0.1] mmol/l, CON: +0.7 [0.2;1.1] mmol/l. EX reduced (P = 0.02) plasma low-density lipoprotein cholesterol by -0.4 [-0.8;-0.1] mmol/l, whereas an increase (P = 0.01) of 0.4 [0.1;0.8] mmol/l occurred in CON (interaction. P < 0.001). A time×group interaction (P = 0.004) existed for changes in exercise capacity in favour of EX. Fasting glucose remained unchanged in EX and increased (P < 0.001) by 0.7 [0.4;1.0] mmol/l in CON (time×group interaction P = 0.02).

CONCLUSION

In conclusion, long-term multicomponent exercise training fully counteracts the detrimental effects of the menopause transition on cardiometabolic health in hypertensive women.

The Effect of Kinesio Taping Applied to Quadriceps and Gastrocnemius Muscles on Speed, Agility and Flexibility: A Cross-Sectional Study

OBJECTIVE

This study aims to examine the effect of kinesio tape (KT) applied to different parts of the body on speed, agility and flexibility.

METHOD

32 male volunteers aged 18-38 years participated in the study. KT was applied to the quadriceps and gastrocnemius muscles of the athletes at 4 different times with intervals of one week. As measurements, 30-meter sprint test, agility T test and sit and reach test for flexibility were performed. Independent samples T-Test and Mann Whitney U test, repeated measures analysis of variance and the Friedman test were used for statistical analysis.

RESULTS

No significant difference was found between the speed, agility and flexibility values of KT applied to quadriceps and gastrocnemius muscles (p>0.05). It was found that there was an increase in agility performance in both muscle groups in the 48th hour measurements after the KT application, it increased speed performance only in gastrocnemius muscle (p<0.05) and did not increase flexibility performance in both muscle groups. There was no statistically significant improvement in the 30th minute and 24th hour measurements (p>0.05).

CONCLUSION

It can be suggested that applying KT to quadriceps and gastrocnemius muscles with 25-50% tension for 48 hours is effective in improving the agility performance.

Mental health symptoms and correlates among amateur football players: a cross-sectional study

The objective of this study was to evaluate mental health problems reported by Turkish amateur football players. A total of 4516 Turkish amateur football players were invited to complete an anonymous online survey including demographic and COVID-19 pandemic related questions, the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, and Athlete Psychological Strain Questionnaire. A total of 1263 players participated in the study (27.9% response rate). Single players reported higher depression and anxiety scores than married players. Higher depression, anxiety, and athletes-specific stress scores were reported by players with an annual income <$5,000 and those reporting an income loss >75% during the COVID-19 pandemic. Players with a sports injury history, psychiatric illness, sleep problems, and perceived inadequate social and/or organizational support reported poorer indices relative to their counterparts. Implementation of mental health screening among amateur football players may assist in detecting vulnerabilities and initiating appropriate timely intervention.

Training Load and Current Soreness Predict Future Delayed Onset Muscle Soreness in Collegiate Female Soccer Athletes

Background

Delayed onset muscles soreness (DOMS) is an indication of muscle stress and trauma that develops from excessive musculoskeletal loads. Musculoskeletal loads can be measured with wearable devices, but there is limited research on specific training load metrics that most correlate with DOMS after activity.

Purpose

To determine the predictive capabilities of training load variables on the development of lower extremity DOMS in female collegiate soccer athletes throughout an entire season.

Study Design

Prospective Cohort.

Methods

Twenty-seven collegiate female soccer athletes reported their lower extremity DOMS each day prior to all soccer activity. Participants wore Polar heart rate and global positioning monitors to capture training load measures. Pearson correlation coefficients were used to assess the relationships between the training load variables and change in DOMS when collapsed across dates. Separate linear mixed models were performed with the following day's DOMS as the outcome variable, training load and the current day's DOMS as predictor variables, and participants serving as random intercepts.

Results

All training load variables significantly predicted change in DOMS, with number of decelerations (ρ=0.72, p <0.001), minutes spent at greater than 80% of maximum heart rate (HRmax) (ρ=0.71 , p <0.001), and distance (ρ=0.70 , p <0.001) best correlating with change in DOMS. Linear mixed models revealed a significant interaction of all training load and current day's DOMS on the following day's DOMS (p<0.001), but number of decelerations, HRmax, and total number of accelerations demonstrated the highest coefficient of determination (R2 marginal=33.2% - 29.2% , R2 conditional= 46.9% - 44.8%).

Conclusions

Training load variables paired with the current day's DOMS significantly predict lower extremity DOMS in the future, with number of decelerations, accelerations, and HRmax best predicting future DOMS. Although this demonstrates that training load variables predict lower extremity DOMS, future research should incorporate objective measures of strength or jump kinetics to identify if similar relationships exist.

Level of Evidence

Level 3.

The Relative Age Effect in the Two Professional Men's Football Leagues in Spain

The age difference among individuals of the same group is known as Relative Age. Relative Age Effect refers to the consequences derived from it, such as delayed physical, cognitive and mental development of children born later in the year. The aim of this study was to observe the Relative Age Effect by analyzing players' dates of birth throughout three seasons in the two professional football competitions in Spain based on the game positions and the teams' classification at the end of the season. The sample was made up of players (n=4097) from both professional competitions (nLaLiga Santander=1864), and (nLaLiga Smartbank=2233). The data were collected from two public-access football statistics websites. The cut-off date was established on January 1, the year was divided into four quartiles (Q1: January-March, Q2: April-June, Q3: July-September and Q4: October-December). Results confirmed significant differences on dates of births' distribution (p<0.05) for the competitions - LaLiga Santander and LaLiga Smartbank - during three seasons, as well as for player position, with a larger effect observed for goalkeepers and defenders. Significant difference was also observed depending on classification. Results show a clear decreasing percentage of those born in quartile 4 in relation to those born in quartile 1, it can be concluded that the Relative Age Effect phenomenon is present in the Spanish professional football which may lead to an inappropriate talent selection technique in football, with recruitment oriented to the short term, to immediate results, and possibly caused by the early start of the player selection process.

Imaging of muscle injuries in soccer

Accurate diagnosis of muscle injuries is a challenge in everyday clinical practice and may have profound impact on the recovery and return-to-play decisions of professional athletes particularly in soccer. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI), in addition to the medical history and clinical examination, make a significant contribution to the timely structural assessment of muscle injuries. The severity of a muscle injury determined by imaging findings has a decisive influence on therapy planning and affects prognosis. Imaging is of high importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be needed. This narrative review will discuss ultrasound and MRI for the assessment of sports-related muscle injuries in the context of soccer, including advanced imaging techniques, with the focus on the clinical relevance of imaging findings for the prediction of return to play.

Air pollution, a worthy opponent? How pollution levels impair athlete performance across physical, technical, and cognitive domains

INTRODUCTION

Air pollution is a global issue known to effect on human health and performance. In the context of highly skilled athletes, the influence of air pollution on players' physical and technical abilities are established, yet its effects on cognitive performance have received little consideration. This study aims to address this research gap by comprehensively examining the influence of air pollution on the performance of highly skilled athletes using a holistic approach, including both the athlete's brain and body.

METHODS

Between 2016 and 2022, a total of 799 soccer players (578 males, 221 females) belonging to a German professional first division club were measured on a battery of performance assessments, including physical, technical, and cognitive tests. The performance data were combined with the average daily concentration of three pollutants: PM10, O3 and NO2.

RESULTS

Increased levels of PM10 and O3 were primarily associated with decreased physical and technical performance, including slower sprinting times, impaired change of direction and worse speed and accuracy in the technical assessment. For instance, if the assessment test was held when PM10 levels were at 20 μg/m3, players ran an average 22 ms slower on the 30 m sprint test, 36 ms slower on the change of direction test and showed a 1 % decrease in accuracy on the technical assessment (p < .001). Furthermore, higher concentrations of NO2 negatively impacted cognitive performance across four separate tests of athletes' executive functions (p < .05).

CONCLUSION

By encompassing physical, technical, and cognitive assessments, this study highlights the multifaceted nature of performance impairments resulting from air pollution exposure in a population characterized by have exceptional abilities across all three domains. These findings underscore the widespread impact of pollution on a diverse sample of athletes and emphasize the need to consider air pollution in the broader context of its effects on human health and the environment.

Changes in head staff members in male elite-level football teams are associated with increased hamstring injury burden for that season: the UEFA Elite Club Injury Study

Objective

To evaluate whether a change of head coach or other head staff before or during a season is correlated to hamstring injury (HI) burden in male elite-level football (soccer) in Europe.

Methods

The survey was conducted using a questionnaire reporting any staff change within the team. Data about the head staff changes and hamstring injury burdens were collected from 14 teams participating in the Elite Club Injury Study (ECIS) during the 2019/2020, 2020/2021 and 2021/2022 seasons.

Results

On average, replacing the head coach before or during a season happens in every second season. All changes, except for the change of the head coach during a season, indicate an association with an increase in HI burden (ranging from 10% to 81%). However, only changes in the fitness coach and team doctor roles reached statistical significance. The HI burden seems to be influenced by adding new staff members, such as the head of fitness/performance coach in 36% of the teams and the team doctor in 17%. New head coaches starting the season with their own, for the team new, fitness/performance coach was highly associated with increased HI burden (p<0.001).

Conclusions

Bringing their own fitness/performance coaches is common for managers entering a new elite male football club. However, this paper has highlighted that this trend seems to lead to a three times increase in HI burden. Similarly, replacing the team doctor was also associated with increased HI burden. Instability among head staff members in male elite-level football teams seems associated with increased HI burden during the season.

Are We Jumping to the Wrong Conclusions? Longer Jumps and More Hops in Female Football Players Who Went on to Sustain a Primary or Secondary ACL Injury Compared to Those Who Did Not

BACKGROUND

Different functional performance tests are used to assess patients in the clinic and before return to sport (RTS), where the rehabilitation goal is to reach good strength and jumping ability. A limb symmetry index of ≥ 90% is a common target in rehabilitation before RTS. The aim of this short communication is to use data from our 2-year prospective cohort study on female football players, either with or without an anterior cruciate ligament (ACL) reconstruction, to discuss whether hop performance in 3 commonly used hop tests can inform safe football participation, that is, with a low risk for ACL injury or reinjury.

METHOD

At baseline, 117 active female football players (mean age ± standard deviation, 20 ± 2 years) were included 19 ± 9 months after ACL reconstruction as well as 119 matched female knee-healthy players (age 19 ± 3 years). All players performed a single hop for distance test, 5-jump test and side hop test at baseline and were then prospectively followed for 2 years. Twenty-eight (24%) players sustained a second ACL injury and 8 (7%) sustained a primary ACL injury.

RESULTS

Longer jumps in the 5-jump test (922 cm vs. 865 cm, Cohen's d =  - 0.60) and more hops in the side hop test for both limbs (41-42 hops vs. 33-36 hops, d =  - 0.43 to - 0.60) were seen in players who sustained a second ACL injury compared with those who did not. Longer jumps in the single hop for distance test (both limbs) (139-140 cm vs. 124-125 cm, d =  - 0.38 to - 0.44), in the 5-jump test (975 cm vs. 903 cm, d = -0.42) and more hops in the side hop test (both limbs) (48-49 hops vs. 37-38 hops, d =  - 0.38 to - 0.47) were seen in players who sustained a primary ACL injury compared with those who did not.

CONCLUSIONS

The average hop performance, i.e. longer jumps or more hops, was greater in players who went on to sustain a primary or secondary ACL injury compared to those who did not over a two-year follow-up period. Even though hop tests are not used in isolation to evaluate readiness to RTS, their interpretation needs consideration in the decision-making process of returning to pivoting sports.

Management of radiology services during the 2022 FIFA football (soccer) World Cup

Diagnostic imaging is the predominant medical service sought for the assessment and staging of musculoskeletal injuries in professional sports events. During the 2022 FIFA Football (soccer) World Cup, a centralized medical care infrastructure was established. This article provides a comprehensive account of the radiological services implemented during this event, encompassing the deployment of equipment and human resources, the structuring of workflows to uphold athlete confidentiality, and initiatives aimed at enhancing communication. Communication channels were refined through radiology consultations held with national teams' health care providers and the adoption of audiovisual reports available in multiple languages, which could be accessed remotely by team physicians. Our established framework can be replicated in international professional football events for seamless integration and efficacy.

Prepare to fail or failing to prepare? Acute performance after the 11+ with and without strength exercises

Objectives

The 11+ is an effective injury prevention warm-up programme but is often poorly adopted in practice. One reason for low compliance is the claim that the strength training part of the programme acutely impairs muscle performance before the football activity. This study aims to compare the acute effects of the 11+ with (WU+S) or without (WU-S) the strength training part on performance.

Methods

Fifteen female junior football players completed WU+S and WU-S on two separate days in randomised order. Maximal voluntary torque in knee extension and flexion (60°/s and 180°/s) and countermovement jump (CMJ) were tested before and after performing the warm-up protocol. Sprint performance and rating of perceived exertion (RPE) were assessed post-warm-up.

Results

Warm-up with strength training reduced peak torque in knee flexion at 180°/s more than WU-S, while no differences were found at 60°/s. Knee extension work was reduced more with WU+S than WU-S at 180°/s, but no differences at 60°/s. Peak torque angle and CMJ were unaffected. Players were slower on 20 and 30 m sprints after WU+S than WU-S. The RPE was higher after WU+S than WU-S, but there were no differences in readiness to train between the two protocols.

Conclusion

Performing the 11+ programme as a warm-up routine with the strength training part can impair subsequent knee flexion torque at high velocity and sprint performance in female junior football players compared with performing the 11+ warm-up without the strength part.