Injuries among male and female elite football players

Injuries in elite-level women's football-a two-year prospective study in the Irish Women's National League

We investigated the pattern of injuries in elite-level women's football in Ireland, during a two-season prospective injury surveillance study in the Women's National League (WNL). Seven out of the eight clubs (271 players) in the WNL were followed prospectively during the 2018 and 2019 seasons. The injury incidence rate in matches (19.2/1000 h) was 7.5 times higher than in training (2.5/1000 h). Players, on average, sustained 0.69 injuries per season (266 injuries/383 player seasons), which equates to 15 time-loss injuries per season for a squad of 22 players. The majority of the injuries sustained by players were lower extremity injuries (85%), of which, 46% had a non-contact injury mechanism. Muscle, ligament, and contusion injuries were the most common injury types, while the ankle, knee, and thigh were the most commonly injured body sites. The most common injuries sustained over the two seasons were lateral ankle sprains (13.9%), hamstring strains (12.4%), knee meniscus/cartilage injuries (7.5%), adductor strains (6%), quadriceps strains (4.5%), and ankle contusions (4.5%). The injuries with the highest injury burden were ACL injuries (59 days lost/1000 h), knee meniscus/cartilage injuries (23/1000 h), lateral ankle sprains (21/1000 h), hamstring strains (12/1000 h), MCL sprains (11/1000 h), and quadriceps strains (11/1000 h). There were 8 ACL tears documented over the 2 seasons, which accounted for 28% of all time lost to injury with a mean days lost per injury of 247. We recommend that clubs in the WNL in Ireland should implement injury risk mitigation strategies, with a particular focus on injuries with a high injury burden.

Head injuries in professional football (soccer): Results of video analysis verified by an accident insurance registry

BACKGROUND

Video analysis is one of the most commonly applied methods for analysing football injuries.

PURPOSE

The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men's professional football leagues in Germany.

METHODS

In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017-18) were compared to head injuries registered with the German statutory accident insurance.

RESULTS

Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0-30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1-87 days).

CONCLUSION

The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance.

Incidence of injury in adult elite women's football: a systematic review and meta-analysis

AIM

To estimate the incidence of injury in adult elite women's football and to characterise the nature and anatomical location of injuries.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Combinations of the key terms were entered into the following electronic databases (PubMed, SPORTDiscus, Science Direct and Discover) from inception to May 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

(1) Used a prospective cohort design; (2) captured data on elite adult women players; (3) reported injury incidence by anatomical site; (4) captured data of at least one season or national team tournament; (5) included a definition of injury; and (6) written in English.

RESULTS

The search identified 1378 records. Twelve studies published between 1991 and 2018 were included in our review and sampled 129 teams. In domestic club football, injury incidence rate was estimated to be 5.7/1000 hours (total), 19.5/1000 hours (match) and 3.1/1000 hours (training). In tournament, football match incidence was estimated to be 55.7/1000 hours. The knee (22.8%; 368/1822) was the most common site of injury in domestic club football. The ankle (23.7%, 105/443) was the most common site of injury in tournament football. Ligament sprains were the most common type of injury (27.8%), followed by muscle strains (19.1%). Severn studies (58%) had a high risk of bias associated with exposure definition and measurement and considerable heterogeneity exists between the included studies (I2=49.7%-95%).

SUMMARY/CONCLUSION

Ligament sprains occur more frequently in adult elite women football players. We advise caution in interpretating point estimates of the incidence of injury due to high statistical heterogeneity. Standardising injury reporting and the accurate recording of match and training exposure will overcome such limitations.

PROSPERO REGISTRATION NUMBER

CRD42019130407.su.

Hip and Groin Pain in Soccer Players

Purpose  The aim of this article is to illustrate the recent framework necessary to standardize studies on groin pain and review the existing literature on groin pain in football. Methods  The common pathological processes underlying groin pain such as muscle, tendon or ligament strain, bone injury or fracture, sport hernia, bursitis, osteitis pubis, and hip-related diseases have been reviewed and current management options have been considered. Results  Groin pain is considered a pain in pubic or lower abdominal or adductors region which can be monolateral or bilateral. It is common in high-intensity team sports and can negatively affect an athlete's professional carrier, causing serious disruption in the performance. Despite a high prevalence of groin pain in athletes, diagnosis and management of the underlying pathological processes remain a challenge for surgeons, radiologists, and physiotherapists alike. Conclusion  A multidisciplinary approach is essential for patients with groin pain allowing prompt diagnosis and initiation of treatment thus facilitating more rapid return to play and preventing potential long-term sequelae of chronic groin pathology.

Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children's Soccer: A Cluster Randomized Controlled Trial

Background:

Prevention of sports injuries is essential in youth, as injuries are associated with less future physical activity and thus greater all-cause morbidity.

Purpose:

To investigate whether a neuromuscular training warm-up operated by team coaches is effective in preventing acute lower extremity (LE) injuries in competitive U11-U14 soccer players.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Twenty top-level U11 to U14 soccer clubs in Finland were randomized into intervention and control groups and assessed for 20 weeks. Participants included 1403 players (280 female, 1123 male; age range, 9-14 years): 673 players (44 teams) in the intervention group and 730 players (48 teams) in the control group. The intervention group team coaches were introduced to a neuromuscular training warm-up to replace the standard warm-up 2 to 3 times per week. The control teams were asked to perform their standard warm-up. Injury data collection was done via weekly text messages. The primary outcome measure was a soccer-related acute LE injury, and the secondary outcome measure was an acute noncontact LE injury.

Results:

A total of 656 acute LE injuries occurred: 310 in the intervention group and 346 in the control group. The overall acute LE injury incidence was 4.4 per 1000 hours of exposure in the intervention group and 5.5 per 1000 hours of exposure in the control group, with no significant difference between groups (incidence rate ratio [IRR], 0.82 [95% CI, 0.64-1.04]). There were 302 acute noncontact LE injuries: 129 in the intervention group (incidence, 1.8 per 1000 hours) and 173 in the control group (2.7 per 1000 hours). A significant reduction in acute noncontact LE injuries of 32% (IRR, 0.68 [95% CI, 0.51-0.93]) was observed in the intervention group compared with the control group. Furthermore, significant reductions in injury incidence in favor of the intervention group were seen in the subanalyses of acute noncontact LE injuries, leading to ≤7 days of time loss and fewer ankle and joint/ligament injuries.

Conclusion:

A neuromuscular training warm-up operated by team coaches was found to be effective in preventing acute noncontact LE injuries in children’s soccer, but this was not seen in all acute LE injuries.

Clinical Relevance:

We encourage children’s soccer coaches and health care professionals to implement neuromuscular training warm-up in youth sports.

Registration:

ISRCTN14046021 (ISRCTN registry).

[Analysis of muscle injuries and return-to-training in elite Taekwondo athletes: results of a prospective cohort study over a period of five years]

BACKGROUND

 Muscle injuries frequently occur in sports involving explosive movement patterns, and they can cause considerable downtime. There is a lack of detailed data on muscle injuries in Olympic elite Taekwondo.

METHODS

 All injuries sustained by 76 elite Taekwondo athletes from a national Olympic training centre during training and competition were prospectively recorded over a period of five years. Data on muscle injuries, including location and time elapsed until return-to-training, were extracted from medical records. Injuries were diagnosed by means of MRI and were classified according to the British Athletes Muscle Injury System. The relationship between MRI classification subgroups and time elapsed until return-to-training was assessed.

RESULTS

 Mean age of athletes was 22.5 ± 3.2 (16-27) years with an average Taekwondo experience of 12.1 ± 4.0 (7-20) years. Hamstring muscles were most commonly injured (48.4 %), followed by quadriceps muscles (32.3 %) and calf muscles (9.6 %). The analysis of MRI injury subgroups showed grade 1 (32.2 %) and grade 2 (41.9 %) injuries in most cases. A positive correlation was found between injury groups and return-to-training (r = 0.56). The comparison between different injury groups and time elapsed until return-to-training also revealed significant differences (p < 0.0001).

CONCLUSION

 Hamstring muscles are the most injured muscles in Taekwondo besides the quadriceps femoris muscle. Most injuries were mild to moderate (grade 1-2). The time needed for return-to-training increased significantly with the severity of injuries diagnosed by MRI.

Anthropometric and musculoskeletal gender differences in young soccer players

BACKGROUND

This study aimed to clarify potential gender differences across a comprehensive set of anthropometric and musculoskeletal characteristics within a young soccer player population.

METHODS

This study included 227 (121 males and 106 females with mean ages of 19.0 and 17.5 years, respectively) young elite soccer players. Anthropometric measurements were obtained. In addition, general joint laxity tests assessing the wrist, elbow, shoulder, trunk, hip, knee, and ankle were performed. Muscle flexibility tests were performed on the iliopsoas, quadriceps femoris, hamstring, gastrocnemius, and soleus muscles. Moreover, isometric knee extension and flexion strength and isometric hip abduction strength were measured. Single- and double-leg balance tests were also performed.

RESULTS

Male soccer players were taller, heavier, and had lower fat mass and percent body fat, and greater skeletal muscle mass and body minerals than female soccer players. Female soccer players had significantly greater laxity in all tests for general joint laxity. Female soccer players demonstrated significantly better hamstring and soleus flexibility than male soccer players but worse iliopsoas flexibility. Consequently, no significant differences were noticed in the quadriceps and gastrocnemius muscles between the male and female soccer players. However, female soccer players demonstrated significantly weaker knee extension and flexion and hip abduction. The hamstring- quadriceps ratio was significantly lower in female soccer players. Although no significant difference exists in the center of pressure excursion in the double-leg balance test between male and female soccer players, female soccer players displayed a significantly lower center of pressure excursion in the single-leg balance test.

CONCLUSIONS

Young male and female soccer players demonstrate significantly different anthropometric and musculoskeletal profiles.

Injury Profile in Women's Football: A Systematic Review and Meta-Analysis

BACKGROUND

Football is the most popular sport among women; however, little is known about the injury profile in this population. This information would help design tailored injury risk mitigation strategies that may make football safer for women.

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis of epidemiological data of injuries in women´s football.

METHODS

A systematic review following PRISMA guidelines was performed up to January 2020 in PubMed, Web of Science, Sportdiscus and the Cochrane Library databases. Twenty-two studies reporting the incidence of injuries in women football were analysed. Two reviewers independently extracted data (intraclass correlation coefficient [ICC] for inter-reviewer reliability = 0.87) and assessed study quality using the STROBE statement, GRADE approach, Newcastle Ottawa Scale and Downs and Black assessment tools. Studies were combined in pooled analyses (injury incidence and injury proportion) using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in female football players was 6.1 injuries/1000 h of exposure. Match injury incidence (19.2 injuries/1000 h of exposure) was almost six times higher than training injury incidence rate (3.5 injuries/1000 h of exposure). Lower extremity injuries had the highest incidence rates (4.8 injuries/1000 h of exposure). The most common types of injuries were muscle/tendon (1.8 injuries/1000 h of exposure) and joint (non-bone) and ligament (1.5 injuries/1000 h of exposure), which were frequently associated with traumatic incidents. Slight/minimal injuries (1-3 days of time loss) were the most common. The incidence rate of injuries during matches in the top five world ranking leagues was higher than the rest of the leagues (19.3 vs 10.7 injuries/1000 h of exposure, respectively). The weighted injury proportion was 1.1 (95% confidence interval = 0.6-1.7) whereby on average players sustained more than one injury per season.

CONCLUSIONS

Female football players are exposed to a substantial risk of sustaining injuries, especially during matches that require the highest level of performance. To markedly reduce overall injury burden, efforts should focus on introducing and evaluating preventative measures that target match specific dynamics to make football players more capable of responding to the challenges that they have to deal with during match play.

REGISTRATION

This systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42019118152).

Injury prevention knowledge, beliefs and strategies in elite female footballers at the FIFA Women's World Cup France 2019

OBJECTIVES

This study assessed knowledge, beliefs and practices of elite female footballers regarding injury prevention.

METHODS

A survey was sent to players participating in the FIFA Women's World Cup France 2019. Questions covered three injury prevention domains: (1) knowledge; (2) attitudes and beliefs; (3) prevention practices in domestic clubs. Additionally, ACL injury history was assessed.

RESULTS

Out of 552 players, 196 women responded (35.5%). More than 80% of these considered injury risk to be moderate or high. Players listed knee, ankle, thigh, head and groin as the most important injuries in women's football. The most important risk factors identified were low muscle strength, followed by poor pitch quality, playing on artificial turf, too much training, reduced recovery and hard tackles. In these elite players, 15% did not have any permanent medical staff in their domestic clubs, yet more than 75% had received injury prevention advice and more than 80% performed injury prevention exercises in their clubs. Players identified the two most important implementation barriers as player motivation and coach attitude. Two-thirds of players used the FIFA 11+ programme in their clubs.

CONCLUSIONS

This diverse group of elite players demonstrated good knowledge of risk level and injury types in women's football. Of the risk factors emphasised by players, there was only one intrinsic risk factor (strength), but several factors out of their control (pitch quality and type, training volume and hard tackles). Still players had positive attitudes and beliefs regarding injury prevention exercises and indicated a high level of implementation, despite a lack of medical support.

Effectiveness of Plyometric and Eccentric Exercise for Jumping and Stability in Female Soccer Players-A Single-Blind, Randomized Controlled Pilot Study

Hamstring muscle injury is common in female soccer players. Changes affecting eccentric strength, flexibility, and the quadriceps–hamstring contraction cycle are risk factors associated with this type of injury. Methods: Seventeen soccer players were randomized to two groups: experimental (plyometric and eccentric exercises without external loads) and control (eccentric exercises without external loads). Eighteen sessions were scheduled over 6 weeks. The exercise program included three plyometric exercises (single-leg squat and lunge, 180 jump, and broad jump stick landing) and three eccentric exercises (Nordic hamstring exercise, diver, and glider). Dependent variables were jumping height (My Jump 2.0 App) and anterior, posteromedial, and posterolateral lower limb stability (Y-Balance test). Results: Following intervention, improvements were found in anterior and posteromedial stability (p = 0.04) in the experimental group. Posterolateral stability improved in athletes included in the control group (p = 0.02). There were differences in the repeated measures analysis for all variables, with no changes in group interaction (p > 0.05). Conclusions: Eccentric exercises, either combined with plyometric exercises or alone, can improve lower limb stability. No changes in jump height were noted in either group. There were no differences between the two groups in the variables studied. Future studies should analyze the effect of external loads on jumping stability and height in the performance of plyometric exercises.

Incidence of Acute Hamstring Injuries in Soccer: A Systematic Review of 13 Studies Involving More Than 3800 Athletes With 2 Million Sport Exposure Hours

OBJECTIVE

To estimate the incidence and recurrence rates of acute hamstring injuries in all levels of soccer.

DESIGN

Epidemiology systematic review.

LITERATURE SEARCH

We searched the PubMed (including MEDLINE), CINAHL, SPORTDiscus, Embase, and Cochrane Central Register of Controlled Trials electronic databases.

STUDY SELECTION CRITERIA

We included prospective studies of all levels of adult soccer players that registered acute hamstring injuries and provided a description of incidence of acute hamstring injuries per 1000 playing hours (or available data to calculate this).

DATA SYNTHESIS

Due to heterogeneity, we synthesized the data descriptively.

RESULTS

Thirteen studies including 3868 players met the inclusion criteria. Two of 13 included studies reported on hamstring injuries in women, and all reported the same in men. The incidence of acute hamstring injury ranged from 0.3 to 0.5 per 1000 exposure hours in women and 0.3 to 1.9 per 1000 exposure hours in men. Hamstring injuries accounted for 5% to 15% of all soccer-related injuries. Hamstring injury recurrence rates ranged from 4% to 68%, depending on the injury definition. Certainty of evidence ranged from moderate to very low.

CONCLUSION

The incidence of acute hamstring injury in soccer was 0.3 to 1.9 per 1000 exposure hours. The recurrence rate was 4% to 68%. The strength of the evidence was limited by a lack of methodological rigor, the use of varying definitions for acute hamstring injury, and heterogeneous methods of reporting on acute hamstring injuries. J Orthop Sports Phys Ther 2021;51(1):27-36. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9305.

Groin problems from pre- to in-season: a prospective study on 386 male Spanish footballers

This study investigated the weekly prevalence of groin problems over a 3-week football pre-season, compared to a 39-week competitive in-season. We registered time-loss groin injuries, and self-reported weekly groin-pain in 17 amateur male football teams (386 players). The average weekly prevalence of groin problems (prevalence ratio (PR)) was 1.8 times higher (95% CI 1.6 to 2.0) during pre-season (21%) compared to in-season (12%). We found a higher weekly prevalence (PR 1.8; 95% CI 1.6 to 2.1) of groin problems without time loss, during the pre-season (19%) compared to the in-season (10%), but no significant difference in the weekly prevalence of groin problems with time loss (PR 1.5; 95% CI 1.0 to 2.4). Attention should be given to optimal load progression, and early implementation of preventive measures during the football pre-season to reduce the prevalence of groin problems in both pre- and in-season.

Injuries and functional performance status in young elite football players: a prospective 2-year monitoring

BACKGROUND

Motor function, such as strength asymmetries of the lower extremities and impaired dynamic stability, have a predictive value for the risk of injury. The present study aimed to reveal potential associations between injury and motor performance.

METHODS

Two hundred and five male youth elite (association) football (soccer) players (mean: 13.5±4.5 years, 57.2±30.2 kg, 168±35 cm) were included. A test battery was conducted twice per season, over two consecutive seasons (four times). Mobility (Sit and Reach Test, SnR), dynamic stability (Single Leg Hop for Distance, SLHD), linear sprinting speed (10 m, 30 m [s]), agility (Zig-Zag test with and without dribbling a ball [s]), jump performance (countermovement jump (CMJ) and drop jump (DJ), in cm) and maximal isometric voluntary force (MIVF, in N) of the knee extensors and flexors were assessed. All injuries occurring over the two-year period, as well as training and competition exposure time, were collected and used as grouping variables for statistical difference testing.

RESULTS

One hundred and twenty-five injuries in 93 players occurred (an injury incidence of 2.7/1000 hours of exposure). Age was associated with injury incidence (r=0.191; P=0.006). Neither DJ, CMJ, SnR nor agility performance were statistically different between injured and non-injured participants (P>0.05). Group differences did occur for sprint and strength (P=0.011; P=0.016), but these lapsed after the inclusion of age as a covariate. Only for SLHD symmetry was a non-significant trend evident after the correction for age (P=0.08).

CONCLUSIONS

The occurrence of musculoskeletal injuries in junior football players are, probably, not related to baseline motor function. Group differences between injured and non-injured youth elite football players are mostly explained by age. Only the symmetry in SLHD could be a potential risk factor for injuries and merits further investigation.

Risk Factors in Elite, Adolescent Male Soccer Players: Prospective Study

Purpose. To find risk factors for soccer-related musculoskeletal injuries among elite, adolescent male soccer players. Methods. Prior to the season, various physical, clinical, and functional measurements were taken. One season was used as an injury surveillance period. Then, after the season, measures of potential risk factors were compared between (1) those players who sustained musculoskeletal injuries and (2) those who remained injury free. Results. Among 61 players, 37.7% (23/61) sustained soccer-related musculoskeletal injuries. After adjusting for covariates in a logistic regression model, presence of previous hip and low back injury (adjusted odds ratio [aOR] = 8.93, P = .046) and Functional Movement Screen (FMS) scores (aOR = 1.92, P = .022) were independently associated with musculoskeletal injures. Conclusion. Elite, adolescent male soccer players with a history of hip and back injury are at greater risk of sustaining a soccer-related musculoskeletal injury. In addition, our study indicated greater risk of sustaining a future soccer-related injury as FMS scores increase.

Epidemiology of injuries in professional football: a systematic review and meta-analysis

OBJECTIVE

We performed a systematic review and meta-analysis of epidemiological data of injuries in professional male football.

METHOD

Forty-four studies have reported the incidence of injuries in football. Two reviewers independently extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement and Newcastle Ottawa Scale. Studies were combined in a pooled analysis using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in professional male football players was 8.1 injuries/1000 hours of exposure. Match injury incidence (36 injuries/1000 hours of exposure) was almost 10 times higher than training injury incidence rate (3.7 injuries/1000 hours of exposure). Lower extremity injuries had the highest incidence rates (6.8 injuries/1000 hours of exposure). The most common types of injuries were muscle/tendon (4.6 injuries/1000 hours of exposure), which were frequently associated with traumatic incidents. Minor injuries (1-3 days of time loss) were the most common. The incidence rate of injuries in the top 5 European professional leagues was not different to that of the professional leagues in other countries (6.8 vs 7.6 injuries/1000 hours of exposure, respectively).

CONCLUSIONS

Professional male football players have a substantial risk of sustaining injuries, especially during matches.

Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players

Objective

To evaluate the effects of injury prevention programmes on injury incidence in any women’s football code; explore relationships between training components and injury risk; and report injury incidence for women’s football.

Design

Systematic review and meta-analysis.

Data sources

Nine databases searched in August 2019.

Eligibility criteria

Randomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Study inclusion criteria were: ≥20 female football players in each study arm (any age, football code or participation level) and injury incidence reporting.

Results

Twelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged <18 years). All studies (except one) had a high risk of bias. Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92). For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95). While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results. The incidence of overall injuries in women’s football was 3.4 per 1000 exposure hours; with ankle injuries most common.

Conclusion

In women’s football, there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively.

PROSPERO registration number

CRD42018093527.

Concussion incidence and recovery in Swedish elite soccer - Prolonged recovery in female players

OBJECTIVES

Sport-related concussions are an increasingly recognized health problem. Soccer is the most popular sport in the world although recent studies on concussion incidence are scarce. Here, a nationwide prospective study on concussion incidence, symptom severity, risk factors, gender differences, and return-to-play after concussion was performed in 51 Swedish elite soccer teams during the 2017 season.

METHODS

In the 1st and 2nd soccer leagues for men and women, a Sport Concussion Assessment Tool (SCAT)-based questionnaire study was performed at preseason (baseline) and from 48 hours to 3 months post-concussion.

RESULTS

We followed 959 players (389 women, 570 men) for 25 146 player game hours (9867 hours for women, 15 279 hours for men). Concussion incidence (n = 36 concussions during the season) was 1.19/1000 player game hours (females 1.22/1000 hours, males 1.18/1000 hours; P = .85). Twenty-seven percent of all players (8% of females, 40% of males) continued to play immediately after the concussion. When compared to male players, female players had worse initial symptom severity scores (median and IQR 30 (17-50.5) vs 11 (4-26.25), P = .02) on SCAT and longer return-to-play (P = .02). Risk factors for concussion were baseline symptoms and previous concussion.

CONCLUSION

In Swedish elite soccer, the concussion incidence was 1.19/1000 without gender differences. Most players recovered to play within 4 weeks post-injury. Almost one third of players continued to play at time of concussion. Female players had worse initial symptoms and longer return-to-play time than males, and a prolonged recovery beyond 3 months was only observed among female players.

Epidemiology of hip and groin injuries in Swedish male first football league

PURPOSE

This study aimed to investigate the incidence, pattern, and burden of hip/groin injuries in Swedish professional male football players over five consecutive seasons.

METHODS

Injury history from 16 football teams in the Swedish male first football league was evaluated during five consecutive seasons. The team's medical staff recorded team exposure and time-loss injuries prospectively between 2012 and 2016.

RESULTS

In total, 467 time-loss injuries located in the hip/groin area were recorded among 1,687 professional male football players, with an overall incidence and burden of 0.82/1,000 h and 15.6/1,000 h, respectively. There appeared to be an increased risk of hip/groin injuries during the last two seasons (2015-2016); however, the difference was not statistically significant (n.s). Recurrent injury rate was relatively low (14%), and overuse injuries accounted for the majority of injuries and absence days. Muscle injuries were the main injury type, while kicking and sprinting/running were the primary causes of injury. Goalkeepers had the lowest percentage of injuries and absence days.

CONCLUSION

Hip/groin injuries are a substantial problem in football, but does not seem to be an increasing phenomenon in the Swedish male first football league. Index and overuse injuries accounted for the majority of injuries and absence days. Thus, the focus should be on preventing hip/groin injuries to lower the injury rate. These new findings should be taken into consideration when designing and implementing preventive training interventions.

LEVEL OF EVIDENCE

II.

Injury incidence, characteristics and burden among female sub-elite futsal players: a prospective study with three-year follow-up

The main purpose of the current study was to analyze the injury incidence, characteristics and burden among sub-elite female futsal players. Individual exposure to match play and training, injury incidence and characteristics (player position, injury mechanism, type of injuries, severity of injuries, recurrent vs. new injuries, season variation of injury pattern) in a female futsal team were prospectively recorded for three consecutive seasons (2015-2018). Incidences were calculated per 1,000 h of exposure. A total of 30 injuries were reported during the three seasons within a total exposure of 4,446.1 h. The overall, match and training incidence of injuries were 6.7, 6.4 and 6.8 injuries/1,000 h of exposure, respectively. Most injuries had a non-contact mechanism (93%), with the lower extremity being the most frequently injured anatomical region (5.62 injuries/1,000 h of exposure). The most common type of injury was muscle/tendon (4.9 injuries/1,000 h of exposure) followed by joint (non-bone) and ligament (1.3 injuries/1,000 h of exposure). The injuries with the highest injury burden were those that occurred at the knee (31.9 days loss/1,000 h exposure), followed by quadriceps (15.3 day loss/1,000 h) and hamstring (14.4 day loss/1,000 h) strains. The first few weeks of competition after pre-season and soon after the Christmas break were the time points when most injuries occurred. These data indicate that sub-elite female futsal players are exposed to a substantial risk of sustaining an injury. To reduce overall injury burden, efforts should be directed toward the design, implementation and assessment of preventative measures that target the most common diagnoses, namely, muscle/tendon and ligament injuries.

Lower limb musculoskeletal screening in elite female Australian football players

OBJECTIVE

To report physical characteristics of lower-limb strength, endurance, range of motion, balance, and pain during adductor squeeze in elite female Australian Football (AF) players, and to examine the effect of limb dominance, previous AF experience, age, and previous level of sports participation on these characteristics.

DESIGN

Cross-sectional study.

SETTING

Three elite AF clubs.

PARTICIPANTS

Eighty-five female players. All were aged ≥18, contracted for the 2018 season, and participated in pre-season training.

MAIN OUTCOME MEASURES

The physical characteristic assessments included; pain on adductor squeeze, weight-bearing lunge, side bridge, isometric hip abduction and adduction strength, and the modified star excursion balance test.

RESULTS

The adductor squeeze had low pain scores, with 93% of players scoring ≤2 on the numerical rating scale. Other assessment results were (mean ± SD): 10.8 ± 2.7 cm for weight-bearing lunge, 95 ± 39s for side bridge, 1.85 ± 0.23 and 1.85 ± 0.36Nm/kg for hip abduction and adduction strength respectively, and 92 ± 8% for the modified star excursion balance test. There was no clinically relevant effect of limb dominance, previous AF experience, age, or previous level of sports on physical characteristics.

CONCLUSIONS

Physical characteristics for five assessments are reported. These data can be used for comparison purposes in the screening and clinical management of elite female AF players.

Prospective Evaluation of Injuries occurred during the Brazilian Soccer Championship in 2016

Objective  To identify the incidence, the prevalence, the characteristics, and the possible risk factors for injuries occurring during the matches of the Brazilian Soccer Championship.

Methods  A prospective study was carried out to collect data on the injuries that occurred during the 2016 Brazilian Soccer Championship. Lesions were recorded by the physician responsible for each team through an online software.

Results  Among the 864 athletes included in the study, 231 (26.7%) of the players presented some injury during the tournament. In total, 312 injuries were recorded during the Brazilian Soccer Championship, with an average of 0.82 injuries per game. The incidence of injuries was 24.9 injuries per 1,000 match hours. Midfielders and forwards presented, respectively, an injury risk 3.6 and 2.4 times higher than goalkeepers.

Conclusion  The prevalence and incidence of lesions were, respectively, 26.7% and 24.9 injuries per 1,000 match hours. The most frequently affected body segment was the lower limbs (76.3%), and the athletes acting in midfield and forward positions were the most affected. Moreover, the greater prevalence of injuries occurred in the first part of the championship.

Short-term Effect of Ultrasound-Guided Iliopsoas Peritendinous Corticosteroid Injection

OBJECTIVES

Treatment for iliopsoas tendinopathy includes ultrasound (US)-guided iliopsoas peritendinous corticosteroid injection. Evidence is lacking regarding US-guided iliopsoas injection efficacy in patients with iliopsoas tendinopathy and intra-articular (IA) hip abnormalities. The purpose of this study was to examine the efficacy of US-guided iliopsoas corticosteroid injection for iliopsoas tendinopathy in patients with and without IA hip abnormalities.

METHODS

This work was a prospective study evaluating patients aged 12 to 50 years with iliopsoas tendinopathy. Participants completed a Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire before and 6 weeks after injection. The main outcome measure was the change in HOOS subcategory scores. Independent variables included time and hip status. Normal hips were compared to abnormal hips with IA abnormalities. A 2-way repeated measures analysis of covariance with effect size (η² ) was used to determine injection effects on HOOS scores before and 6 weeks after injection.

RESULTS

A total of 178 patients (154 female and 24 male) were analyzed. Time effects were found for both normal and abnormal hips in all HOOS subcategories: symptoms (P = .041; η²  = 0.050), pain (P = .001; η²  = 0.184), activities of daily living (P = .011; η²  = 0.076), function in sports and recreation (P = .001; η²  = 0.151), and quality of life (QOL; P = .001; η²  = 0.193). Significant differences between normal versus abnormal hips were found in the sports and recreation (P = .032; η²  = 0.056) and QOL scores (P = .001; η²  = 0.135).

CONCLUSIONS

In patients with iliopsoas tendinopathy, US-guided iliopsoas corticosteroid injection improved outcomes regardless of coexisting IA hip abnormalities. Patients without IA hip abnormalities showed greater improvement in sports and recreation and QOL scores compared to patients with IA hip abnormalities. Ultrasound-guided iliopsoas injection for iliopsoas tendinopathy may advance short-term care and help continue with nonsurgical treatment regimens.

Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification

OBJECTIVE

To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact).

DATA SOURCES

A systematic review was performed using the electronic databases PubMed (1969-January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969-January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology).

STUDY SELECTION

Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English.

DATA EXTRACTION

Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis.

DATA SYNTHESIS

We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, P < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, P < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories.

CONCLUSIONS

Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.

Basic Psychological Needs Satisfaction and Frustration, Stress, and Sports Injury Among University Athletes: A Four-Wave Prospective Survey

The prevalence of sports injury among athletes is rather high, suggesting the need to better understand the causes of sports injury, including the risk factors, for preventive purposes. Grounded in basic psychological needs theory (BPNT) and the Model of Stress and Athletic Injury, the aim of this four-wave prospective survey study was to investigate the relationships among basic psychological needs satisfaction and frustration, stress responses, and sports injury. Study variables, including basic psychological need satisfaction/frustration, and perceived stress, were measured using a survey from 112 university athletes at the 1st, 2nd, and 3rd months of the study. Sports injury was assessed using a self-report form at the 2nd, 3rd, and 4th months of study. Results of the Bayesian multilevel analysis showed that basic psychological need satisfaction negatively predicted sports injuries, whereas stress was a positive predictor. In addition, basic psychological need satisfaction had an indirect effect on injury occurrence via stress. However, basic psychological need frustration did not predict sports injury. BPNT is a viable model to provide additional explanations to psychological risk factors of injury. Intervention programs may be formulated based on the evidence obtained on the model.

UEFA model in identification of types, severity and mechanism of injuries among footballers in the Nigerian Women's Premier League

Objective

To prospectively investigate the injury profile and the incidence rate per 1000 hours exposure during training and actual league matches in the Nigerian Women’s Premier League (NWPL) and to develop an adequate information pool, using the UEFA injury study model in order to develop appropriate injury prevention strategies.

Methods

241 women footballers from the eight football clubs that participated in the 2015/2016 Nigerian Women Premier league (NWPL) season were selected for the study and prospectively followed for a period of 6 months. The UEFA injury report forms and Competitive Aggressiveness and Anger Scale were sent to the various clubs, and the forms administered on them as at when due. The forms were analysed using descriptive statistics.

Results

There was a high incidence rate per 1000 hours of exposure during training sessions (10.98 injuries/1000 hours) and matches (55.56 injuries/1000 hours); the predominant injury type was muscle rupture/strain injuries (35.49%), while moderate severity injuries were the most frequent. The predominant injury mechanism was traumatic injuries caused by contact with other players as a result of a tackle by other players (14.5%). No statistical association was established between the level of aggression and the prevalent types of injury (p=0.63).

Conclusions

The organisers of the league and indeed the referees should ensure that the rules of the game are upheld, and foul or overly aggressive play is penalised. Medical staff and coaches should consider evidence-based injury prevention strategies to reduce the risk of the common injuries sustained in the NWPL.

Investigation of the Influence of Reduced Graphene Oxide Flakes in the Dielectric on Surface Characteristics and Material Removal Rate in EDM

Background: Touch (rugby/football) is a minimal contact sport for which the type and incidence of injuries remains unknown in Europe. Objectives: To establish the incidence, severity and nature of injuries sustained during a four-day European Touch Championship competition. Methods: A prospective cohort design was adopted to record match-related injuries during the European Touch Championships 2016. Injuries were collected from five countries and classified using the Orchard Sports Injury Classification (OSICS-10). Data were combined from all participating countries and injury incidence was recorded as number of injuries/1000 player hours. Results: A total of 135 injuries were recorded during the tournament with injury incidence calculated as 103.5 injuries per 1000 player match hours. Injuries were mainly recorded as transient (76%) occurring most frequently in the lower limb (69%). Injuries occurred more frequently on successive days, with exception to the final day of the tournament. The number of injuries was not different between the first and second half of matches and there was no relationship between the day of the tournament and the half of the match that injury occurred. Conclusion: Match injury incidence was 103.5 injuries per 100 player match hours. The most injured site was that of the lower limb, with the most common injury type reported as muscle/tendon injury. It is postulated that fatigue plays a role in injury incidence during a multiday tournament.

Adductor squeeze test and groin injuries in elite football players: A prospective study

OBJECTIVE

To examining the relationship between hip adductor strength and groin injury incidence during the competitive season of professional football teams.

DESIGN

Prospective Cohort study.

SETTING

Controlled laboratory environment.

PARTICIPANTS

Seventy-one players volunteered to participate.

MAIN OUTCOME MEASURES

In the pre-season, maximal hip adductor strength was measured by means of the isometric adductor squeeze test. Hip adductor strength, normalized by body mass, was compared between players who suffered a groin injury (n = 18) vs uninjured players (n = 53). Risk ratios (RR) were used to evaluate the likelihood of players to suffer this type of injury.

RESULTS

Most of the reported groin injuries occurred during competitive matches (5.5 per 1000 match hours). Maximal isometric hip adductor strength was lower in the groin-injured group compared with their uninjured counterparts (429.8 ± 100 vs 564 ± 58.7 N, d = -1.58 and 5.40 ± 1.27 vs 7.71 ± 0.89 N/kg, d = -1.88, respectively). Results revealed that values of maximal isometric adductor strength lower than 465.33 N increased the probability to suffer a groin injury by 72%. Furthermore, values of force relative to body mass lower than 6.971 N/kg increased the probability to suffer a groin injury by 83%.

CONCLUSION

The assessment of Hip adductor strength, in addition to other measurements, might help practitioners to determine the probability of suffering an overuse groin injuries in elite football players.

Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football

PURPOSE

Injuries are a common occurrence in football. Sufficient epidemiological data are available in professional football but not in salaried semi-professional football. This study investigates the injury incidence at different levels of semi-professional football with focus on junior football.

METHODS

The data were based on injury reports provided by players and medical staff over the 2015-2016 season, which corresponded to the consensus statement for data samples in football. This study investigated the injury incidence and prevalence of five skill levels of semi-professional football (the fourth to the seventh league and elite junior football).

RESULTS

1130 players had sustained 2630 injuries over the 2015-2016 season. The overall injury incidence was 9.7 per 1000 h football exposure; prevalence with at least one injury was 79%. The highest overall injury incidence in elite junior football was 10.4 in 1000 h football exposure. The fifth league had the lowest incidence with 9.0 in 1000 h football (p < 0.05). Traumatic injuries most often occurred in the fourth league (3.9 in 1000 h football). The body areas most affected by traumatic injury were knees, ankles and thighs. Elite junior players had a significantly higher incidence of overuse complaints (7.4 in 1000 h football) than the fourth league (5.4, p = 0.005). The body areas most affected by overuse complaints were the lower back, thigh and groin. No differences were found between the different positions on field.

CONCLUSIONS

Salaried semi-professional football involves a high overall injury incidence. The highest incidence, particularly of overuse injuries, was seen in elite junior football. These findings should be incorporated in specific injury prevention training or screenings beginning in junior football. Level of evidence II.

Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York

There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.

Effect of Estrogen on Musculoskeletal Performance and Injury Risk

Estrogen has a dramatic effect on musculoskeletal function. Beyond the known relationship between estrogen and bone, it directly affects the structure and function of other musculoskeletal tissues such as muscle, tendon, and ligament. In these other musculoskeletal tissues, estrogen improves muscle mass and strength, and increases the collagen content of connective tissues. However, unlike bone and muscle where estrogen improves function, in tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates. High estrogen levels can decrease power and performance and make women more prone for catastrophic ligament injury. The goal of the current work is to review the research that forms the basis of our understanding how estrogen affects muscle, tendon, and ligament and how hormonal manipulation can be used to optimize performance and promote female participation in an active lifestyle at any age.

National injury prevention measures in team sports should focus on knee, head, and severe upper limb injuries

PURPOSE

To examine acute injuries in licensed floorball, football, handball, and ice hockey players in all ages nationwide in Sweden, and to identify the most common and severe injuries in each body location and recommend injury prevention measures.

METHODS

Using national sport insurance data from years 2006-2015 was the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), calculated in the four team sports. The most common injury type and injured body part was identified, with a particular focus of the severe injuries. Comparison between sexes was made.

RESULTS

In total, there were 92,162 registered injuries in all sports together. Knee injuries were most common, and also had the highest incidence of PMI, in all ball sports and in female ice hockey players. In male ice hockey, the most common injury was a dental and face injury, and PMI injuries were mostly in the shoulder. The most severe PMI injuries were rare and most often a face/eye injury in male floorball and ice hockey, a concussion in female ice hockey, and a knee injury in female floorball, and in both sexes in football and handball.

CONCLUSIONS

To achieve the greatest impact in reducing the adverse effects of acute sport injuries nationwide in Sweden, preventive measures should focus on knee injuries in all the investigated team sports. The severe head/face and upper limb injuries also need attention. Protective equipment, neuromuscular training programs, rules enforcements, and fair-play interventions may reduce the incidence of injuries.

A Pilot RCT Investigating the Effects of Targeted Compression on Athletes With Pelvic/Groin Pain

CONTEXT

Athletic pelvic/groin pain is a common yet often challenging problem to both diagnose and manage. A new tool has been developed based on the clinical effects of applied force on the pelvis. Early findings indicate that this customized compression orthosis may have a positive effect on pelvic/groin pain and performance measures.

OBJECTIVES

To inform the design and test the practicality of procedures for a future definitively powered randomized controlled trial and to provide an estimate of the effect size of this orthosis on selected clinical and performance measures.

DESIGN

Pilot randomized controlled trial with participants randomly allocated to an intervention or waiting-list control group.

SETTING

The training location of each athlete.

PARTICIPANTS

24 athletes with subacute and chronic pelvic conditions were proposed to be recruited.

INTERVENTION

A customized compression orthosis, delivering targeted compression to the pelvic girdle.

OUTCOME MEASURES

Measures were the active straight leg raise (ASLR) test, squeeze test, broad jump, and the multiple single-leg hop-stabilization test.

RESULTS

A total of 16 athletes completed the study. The invention group demonstrated moderate to large estimated effect sizes on the squeeze test and active straight leg raise tests (d = 0.6-1.1) while wearing the orthosis. Small effect sizes (d = 0.2) were seen on jump distance and the dominant leg balance score. Compared with the control group, the intervention group also showed moderate to large estimated effect sizes on the active straight leg raise measures (d = 0.5-0.9) when wearing sports shorts.

CONCLUSIONS

The protocol was feasible. Effect sizes and recruitment/attrition rates suggest that the intervention holds promise and that a future definitively powered randomized controlled trial appears feasible and is indicated.

Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review

BACKGROUND

Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries.

OBJECTIVE

The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football.

METHODS

Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary.

RESULTS

The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men's football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players.

CONCLUSION

Future research should focus on concussion in women's contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided.

Hemorheological alterations following an acute bout of nordic hamstring exercise in active male participants1

BACKGROUND

The Nordic hamstring exercise (NHE) has been proven to be an effective preventive technique for hamstring injuries. Hemorheological parameters (erythrocyte deformability and aggregation) play a critical role in exercise influencing oxygenation. Although previous studies presented hemorheological alterations induced by different types of exercise, changes in red blood cell (RBC) deformability and aggregation following NHE remain unknown. Present study was designed to explore possible alterations in hemorheological and oxidative parameters after an acute bout of NHE.

METHODS

10 healthy, male, active students (mean age 19.9±0.23, BMI: 21.56±0.54) participated to the study. They performed a single session of seven-repetitions of NHE followed by a familiarisation period. Blood samples were obtained before and immediately after the exercise from the antecubital vein. Hemorheological parameters were measured by an ektacytometer.

RESULTS

NHE did not change deformability, hematocrit and oxidative stress but, increased RBC aggregation index (AI, p = 0.011) and decreased RBC aggregation half time (t½, p = 0.009).

CONCLUSIONS

Our results suggest that, increased RBC aggregation following an acute bout of NHE may result in increased plasma skimming and thus ease the flow of blood.

Epidemiology of injuries in outdoor and indoor hockey players over one season: a prospective cohort study

Objectives

To determine the incidence and characteristics of hockey (‘field hockey’) injuries over the course of one outdoor and indoor season. Comparisons of female versus male players, outdoor versus indoor season and match versus practice were performed.

Methods

Female and male teams of the first, second, third, regional and youth divisions were recruited among a local hockey association in Northern Germany, and followed over an indoor and an outdoor season. Exposure times and location, type, severity and cause of injuries during practice and matches were documented by the coaches or medical staff and collected weekly. Prevalence and incidence rates were calculated.

Results

Of the 232 players (mean±SD age 20.7±4.7 years, 68.1% male, 31.9% first division), 84 players (36.2%) suffered 108 new injuries during the season. The overall incidence rate was 3.7 injuries per 1000 player hours (95% CI 3.0 to 4.4). The injury incidence was lower in practice (2.7 per 1000 player practice hours, 95% CI 2.0 to 3.3) than in matches (9.7 per 1000 player match hours, 95% CI 6.8 to 12.7), and was similar for female and male players as well as during the outdoor and the indoor season. Most injuries affected the lower limb (thigh, knee and ankle) and occurred without contact (58.3%). Severe injuries (n=34; 31.5%) were predominantly located at the knee and hand/finger.

Conclusion

Hockey players have a high prevalence and incidence of injuries, especially at the lower limb.

Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis

BACKGROUND

Hamstring injuries are among the most common non-contact injuries in sports. The Nordic hamstring (NH) exercise has been shown to decrease risk by increasing eccentric hamstring strength.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the injury prevention programs that included the NH exercise on reducing hamstring injury rates while factoring in athlete workload.

METHODS

Two researchers independently searched for eligible studies using the following databases: the Cochrane Central Register of Controlled Trials via OvidSP, AMED (Allied and Complementary Medicine) via OvidSP, EMBASE, PubMed, MEDLINE, SPORTDiscus, Web of Science, CINAHL and AusSportMed, from inception to December 2015. The keyword domains used during the search were Nordic, hamstring, injury prevention programs, sports and variations of these keywords. The initial search resulted in 3242 articles which were filtered to five articles that met the inclusion criteria. The main inclusion criteria were randomized controlled trials or interventional studies on use of an injury prevention program that included the NH exercise while the primary outcome was hamstring injury rate. Extracted data were subjected to meta-analysis using a random effects model.

RESULTS

The pooled results based on total injuries per 1000 h of exposure showed that programs that included the NH exercise had a statistically significant reduction in hamstring injury risk ratio [IRR] of 0.490 (95 % confidence interval [CI] 0.291-0.827, p = 0.008). Teams using injury prevention programs that included the NH exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures.

CONCLUSIONS

This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42015019912).

Epidemiology of Hip and Groin Injuries in Collegiate Athletes in the United States

Background:

Hip and groin pain is a common complaint among athletes. Few studies have examined the epidemiology of hip and groin injuries in collegiate athletes across multiple sports.

Purpose:

To describe the rates, mechanisms, sex-based differences, and severity of hip/groin injuries across 25 collegiate sports.

Study Design:

Descriptive epidemiology study.

Methods:

Data from the 2009-2010 through 2013-2014 academic years were obtained from the National Collegiate Athletic Association Injury Surveillance Program (NCAA ISP). The rate of hip/groin injuries, mechanism of injury, time lost from competition, and need for surgery were calculated. Differences between sex-comparable sports were quantified using rate ratios (RRs) and injury proportion ratios (IPRs).

Results:

In total, 1984 hip/groin injuries were reported, giving an overall injury rate of 53.06 per 100,000 athlete-exposures (AEs). An adductor/groin tear was the most common injury, comprising 24.5% of all injuries. The sports with the highest rates of injuries per 100,000 AEs were men’s soccer (110.84), men’s ice hockey (104.90), and women’s ice hockey (76.88). In sex-comparable sports, men had a higher rate of injuries per 100,000 AEs compared with women (59.53 vs 42.27, respectively; RR, 1.41 [95% CI, 1.28-1.55]). The most common injury mechanisms were noncontact (48.4% of all injuries) and overuse/gradual (20.4%). In sex-comparable sports, men had a greater proportion of injuries due to player contact than women (17.0% vs 3.6%, respectively; IPR, 4.80 [95% CI, 3.10-7.42]), while women had a greater proportion of injuries due to overuse/gradual than men (29.1% vs 16.7%, respectively; IPR, 1.74 [95% CI, 1.46-2.06]). Overall, 39.3% of hip/groin injuries resulted in time lost from competition. Only 1.3% of injuries required surgery.

Conclusion:

Hip/groin injuries are most common in sports that involve kicking or skating and sudden changes in direction and speed. Most hip/groin injuries in collegiate athletes are noncontact and do not result in time lost from competition, and few require surgery. This information can help guide treatment and prevention measures to limit such injuries in male and female collegiate athletes.

Perceived motivational factors for female football players during rehabilitation after sports injury - a qualitative interview study

Compliance with a rehabilitation program is significant among athletes following a sports injury. It is also one of the main factors that influence the rehabilitation process; moreover, the outcome is also influenced by the athlete’s motivation. It is primarily an autonomous motivation, resulting in rehabilitation adherence. The aim of this study was to investigate the perceived motivation of female football players during rehabilitation after a sports injury and the extent to which these motivating factors were autonomous. Qualitative interviews, based on a semistructured interview guide with injured female football players undergoing rehabilitation, were analyzed using content analysis. The motivational factors that were described were their set goals, social support as well as external and internal pressures during rehabilitation. The perceived autonomy varied somewhat but overall, they experienced external motivation; therefore, the behavior was not entirely self-determined. Results are expected to provide a better understanding of women football players’ motivation in relation to their rehabilitation; hence, physiotherapists and coaches who are part of the rehabilitation process can contribute by increasing the autonomous motivation, thus, improving the compliance and outcome of the rehabilitation.

Injuries in Spanish female soccer players

BACKGROUND

Epidemiologic research to learn the incidence, type, location, and severity of female soccer injuries and the risk factors for sustaining a sport injury is the first step in developing preventive policies. The aim of this study was to analyze the incidence of injuries in the population of female soccer players in Spain.

METHODS

The injuries incurred by 25,397 female soccer players were registered by the medical staff of the Spanish Football Federation during 1 season. A standardized medical questionnaire was used to classify the injury according to type, severity, location, and injury mechanism. A total of 2108 injuries was reported with an incidence of 0.083 injuries per player per season. Most injuries were in the lower limbs (74.0%), mainly affecting knee (30.4%) and ankle joints (17.9%).

RESULTS

The proportion of injuries derived from contact with another player was higher during matches (33.7%) than during training (11.4%; p < 0.001). Noncontact injuries were classified as severe more frequently than were contact injuries (51.0% vs. 42.6%; p < 0.001). A higher incidence of injury was found in adult soccer players (≥18 years) vs. their counterparts younger than18 years (0.094 vs. 0.072 injuries per player per year, respectively; p < 0.001). There were no differences between age groups in any other injury variable (e.g., type, mechanism, location, or severity; p > 0.05).

CONCLUSION

Most female soccer injuries were located at the knee and ankle; the injury mechanism determined the playing time lost; and the player's age did not affect injury characteristics.

Effect of the 11+ injury prevention programme on fundamental movement patterns in soccer players

No studies have assessed whether changes in an individual’s fundamental movement patterns can be achieved with the 11+ prevention programme in soccer players. The aim of this study was to assess the effect of the 11+ compared with a standard warm-up on fundamental movement patterns using the Functional Movement Screen (FMS) in amateur male soccer players. Twenty-three male soccer players (age: 24.7±.3.8 years; height: 1.77±0.58 m; body mass: 73.9±6.2 kg) were randomly assigned to the 11+ (n= 12) or control (n= 11) group. The intervention programme had to be carried out 3 times a week over 6 weeks. The 11+ warm-up lasted ~25 minutes and was conducted before starting regular practice, replacing the team’s standard warm-up. The control group warmed up with standard jogging, ball exercises, and active stretching to match the duration of the 11+. Within-group analysis revealed significant improvements in the FMS total score in the 11+ (+10.51%; d= 0.83) and control group (+7.99%; d= 0.68) from pre-test to post-test. In the between-group analysis, there were no significant differences between groups. At the post-test a significantly greater number of players in the 11+ group exhibited a score that improved to above the injury threshold (≤14) (p= 0.046). This study suggests that regular implementation of the 11+ injury prevention programme may not produce additional improvements in fundamental movement patterns other than those produced by a standard warm-up.

'What's my risk of sustaining an ACL injury while playing football (soccer)?' A systematic review with meta-analysis

OBJECTIVE

To estimate the incidence proportion (IP) and incidence rate (IR) of ACL injury in football players.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

PubMed, CINAHL and SPORTDiscus electronic databases were searched from inception to 20 January 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDY

Studies that reported the total number of participants/population by sex, total number of ACL injuries by sex and total person-time by sex were included.

RESULTS

Twenty-eight studies were included. The IP and IR of ACL injury in female football players were 2.0% (95% CI 1.2% to 3.1%) and 2.0/10 000 athlete exposures (AEs) (95% CI 1.6 to 2.6; I²=91%) over a period of one season to 4 years. The IP and IR of ACL injury in male players were 3.5% (95% CI 0.7% to 8.2%) and 0.9/10 000 AEs (95% CI 0.7 to 1.1; I²=94%). Studies that evaluated matched cohorts of female and male players showed no difference in IP (relative risk=1.2; 95% CI 0.9 to 1.6; P=0.47) over a period of one season to 4 years. Women were at greater risk than men (incidence rate ratio (IRR)=2.2; 95% CI 1.6 to 3.1; I²=83%; P<0.001). When accounting for participation level, the difference in IR between women and men was greatest for intermediate players (IRR=2.9; 95% CI 2.4 to 3.6) compared with amateur (IRR=2.6; 95% CI 1.4 to 4.8) and elite (IRR=2.0; 95% CI 1.1 to 3.4) players.

SUMMARY/CONCLUSION

Overall, more men sustained ACL injury in football. There was no difference in the relative risk of ACL injury between female and male football players in a window that spanned one season to 4 years. The IR of ACL injury among women was 2.2 times higher than the IR of ACL injury among men. The reported sex disparity in ACL injury was independent of participation level.

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis

Objective

To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports.

Design

Systematic review with best-evidence synthesis.

Data sources

Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017.

Eligibility criteria for selecting studies

Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria.

Results

Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power.

Conclusions

All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.

PROSPERO trial registration number

CRD42015026850.

Professional football players at risk for non-acute groin injuries during the first half of the season: A prospective cohort study in The Netherlands

OBJECTIVES

To study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands.

DESIGN

Prospective cohort study.

METHODS

Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012-2013 season.

RESULTS

A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%).

CONCLUSIONS

A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment.