Football injuries during the 2014 FIFA World Cup

Athlete health and safety at large sporting events: the development of consensus-driven guidelines

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

Evaluation of Muscle Injuries in Professional Football Players: Does Coach Replacement Affect the Injury Rate?

OBJECTIVES

To assess the incidence and characteristics of muscle injuries in professional football players and to assess if coach dismissal may be related with muscle injuries within 1-month period from the dismissal.

DESIGN

Prospective cohort study during 3 consecutive seasons.

SETTING

Turkish Super League football teams.

PARTICIPANTS

One hundred eighteen male football players.

MAIN OUTCOME MEASURES

Data on time-loss muscle injuries confirmed using magnetic resonance imaging were recorded, including type, body part, duration, and lay-off time, and training session and match exposure times. The muscle injury rate was evaluated at 2 weeks and 30 days after coach dismissal.

RESULTS

In total, 124 muscle injuries were recorded, with injury incidences of 2.3 muscle injuries per 1000 hours of exposure overall, 1.2 in training sessions, and 13.6 in matches. Injury time loss ranged from 3 to 67 days (median, 13 days). Eighteen percent of the injuries (n = 23) were recurrent; no association was found between recurrence rate and the player's age or position (P = 0.15, P = 0.27, respectively). Recurrent injuries caused more severe injuries (26.1%, P = 0.02) and longer median lay-off time (P = 0.01). During the study, teams A and B replaced 7 and 3 coaches, respectively. The injury incidence increased to 5.3 per 1000 hours of exposure in the 2 weeks after the coach dismissal, and decreased to 4.5 within 1 month of coach dismissal.

CONCLUSION

Given the link between coach dismissal and increased rates of muscle strain injuries, increased attentiveness to preventing muscle injuries during coaching transitions and to the impact of new training regimens is required by trainers and medical teams.

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes

OBJECTIVE

To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.

DESIGN

Longitudinal prospective surveillance study.

SETTING

Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.

PARTICIPANTS

Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.

INTERVENTIONS

Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.

MAIN OUTCOME MEASURES

The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.

RESULTS

Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.

CONCLUSIONS

The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

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.

Poor Sleep Quality's Association With Soccer Injuries: Preliminary Data

PURPOSE

To investigate the relationship between sleep quality and quantity and injuries in elite soccer players and to compare sleep-wake variables and injury characteristics.

METHODS

The current investigation was a prospective cohort study of 23 elite male soccer players competing for 2 teams over 6 mo in the highest-level Brazilian competition. The players' sleep behavior was monitored for 10 d in the preseason using self-reporting sleep diaries and wrist activity monitors to determine sleep duration and quality. Furthermore, injuries were recorded by the respective club's medical teams into a specific database. Details of injuries recorded included the type, location, and severity of each injury. The results were expressed as descriptive statistics, and the significance level was set at 5%. The Mann-Whitney U test was performed to compare the sleep variables between groups. Spearman correlation coefficient and linear-regression analysis were used.

RESULTS

The results indicated a moderate negative correlation between sleep efficiency and particular injury characteristics, including absence time, injury severity, and amount of injuries. The linear-regression analysis indicated that 44% of the total variance in the number of injuries can be explained by sleep efficiency, 24% of the total variance in the absence time after injury (days) can be explained by sleep efficiency, and 47% of the total variance in the injury severity can be explained by sleep efficiency.

CONCLUSIONS

Soccer players who exhibit lower sleep quality or nonrestorative sleep show associations with increased number and severity of musculoskeletal injuries.

Injury burden differs considerably between single teams from German professional male football (soccer): surveillance of three consecutive seasons

PURPOSE

The purpose of this study was to analyse unique injury data of the national statutory accident insurance for the two highest divisions in German male football (Bundesliga and 2. Bundesliga) over three consecutive seasons regarding inter-season, inter-division and inter-team differences.

METHODS

This was a prospective observational open cohort study over the seasons 2014/2015, 2015/2016 and 2016/2017. Every acute injury that was registered by clubs or physicians with the German statutory accident insurance for professional athletes (VBG) as part of occupational accident reporting and that led to time loss and/or to medical attention, was included.

RESULTS

The complete sample consisted of 1449 players. The study covered 2663.5 player seasons with an observed match exposure of 69,058 h and a projected training exposure of 529,136 h. In total, 7493 injuries were included. The overall incidence rate was 12.5 (± 0.28) injuries per 1000 exposure hours, which translated into match and training rates of 47.0 (± 1.62) and 8.02 (± 0.24) injuries per 1000 h, respectively.

CONCLUSION

Findings of 2.7 injuries per player and season underline the need of effective preventive approaches. Higher injury incidences in seasons after international tournaments suggest an increasing risk of injury with increasing number of matches. However, large differences between the single teams from the same division indicate that a reduction in the injury burden is generally possible. Continuing the presented injury surveillance might be helpful to identify injury trends in the future and to evaluate the effectiveness of preventive approaches under real-life conditions.

LEVEL OF EVIDENCE

Level  II.

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.

Incidence of Football and Futsal Injuries Among Youth in Malaysian Games 2018

Introduction:

Football and futsal were the main sports in the Malaysian Games. However, they were associated with a risk of injury. The purpose of the study was to analyse the incidence, circumstances, and characteristics of football and futsal injuries during the Malaysian Games of 2018.

Materials and method:

During the tournament, 14 teams participated in men’s football, 12 teams in men’s futsal and 11 teams in women’s futsal. The biannual event involved athletes aged under 21 years. A medical report form used by FIFA Medical Assessment and Research Centre (F-Marc), was provided to the physiotherapists and team doctors of all the teams to report all injuries after each match.

Results:

The response rate was 84.62% in football and 59.76% in futsal. A total of 48 injuries were reported from 26 football matches, equivalent to 64.64 injuries per 1000 match hours (95%CI 46.35 to 82.93). In futsal, a total of 48 injuries from 41 matches were reported, equivalent to 292.42 injuries per 1000 match hours (95% CI 209.7 to 375.14). The rate of injury in women futsal players was higher compared to men: 358.21 versus 247.04 injuries per 1000 match hours (p=0.224). Futsal recorded higher injuries per 1000 match hours than football (p<0.001).

Conclusion:

The rate of severe injury in futsal and football recorded in the study as compared to previous studies gave rise to serious concerns. Hence, there was an urgent need to pay more attention to injury prevention strategies.

Meniscal Injuries in the Olympic and Elite Athletes

INTRODUCTION

Elite and Olympian athletes are often stretching the upper limits of normal physiology and biomechanics of the musculoskeletal system in their efforts to excel in their sport. For them to get back to their sport at the same level after injury, the management, repair techniques, and rehabilitation protocols should be robust to permit healing of tissues to allow supra-normal loading and performance. The knee and the meniscus are commonly injured in these sports. Yet, the incidence, mechanisms, types of injuries to the meniscus, and their management are not known across different sports in the Olympics.

METHODS

We set out to look into the incidence and the trends of publications on meniscal injuries of the knee in Olympic games. A search of the PubMed and Scopus for these injuries using a search strategy gave 79 and 116 articles, respectively.

RESULTS

There were very few publications giving the incidence of meniscal injuries in the Olympics. Football is the sport with the highest rate of meniscal injuries. Different sports are popular in different countries, and depending on the popularity and the country reporting these injuries, incidences differed. There was data available from India and Brazil for Elite athlete from diverse sports, whereas most data from other countries were for football and soccer. Knee was found to be the second most commonly injured part of the body in both Winter and Summer Olympics as well as the Youth Winter Olympics. Data were not available from the Youth Summer Olympics to make any conclusions. The number of publications on this topic is low. We presented the timeline of publications and citations of articles on this topic. The top country, language, journal, university, and author were USA, English, American Journal of Sports Medicine, Hospital of Special Surgery in New York and Brophy RH, respectively. The data on the risk factors for meniscal injuries were analyzed, discussed, and presented for football, as this was the most extensively studied sport.

CONCLUSIONS

Even though the knee is one of the commonly injured anatomical locations in elite athletes, there is a lack of literature on meniscal injuries in this subset of population. We looked at possible reasons and made recommendations to improve data collection on these injuries.

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.

Sports injury and illness incidence in the PyeongChang 2018 Olympic Winter Games: a prospective study of 2914 athletes from 92 countries

Objective

To describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.

Methods

We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.

Results

In total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1 day and >7 days of absence from sport, respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.

Conclusion

Overall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.

Educational concussion module for professional footballers: from systematic development to feasibility and effect

Objectives

To describe: (1) how we developed a concussion module and (2) whether the concussion module is feasible (in terms of relevance, added value and suitability) and enhances knowledge and changes attitude of professional footballers about concussion.

Developing the concussion module

We developed the concussion module based on two structured and systematic processes. First, our needs assessment (questionnaire and interviews) in professional football (especially players) revealed that a 5–10 min concussion module was needed, ideally disseminated during club visits. Second, the objectives were defined (from published literature and by experts) as to disseminate essential information about what concussion is (definition), how to recognise it and the importance of removing a player with (suspected) concussion from the football field. We included an introductory video featuring a high-profile professional footballer and an animated educational component on defining concussion, recognising it and removing affected players from the field.

Feasibility and effect

A quasiexperimental study (pretest post-test design) was conducted among 61 professional footballers. These players were asked to complete two questionnaires related to knowledge about and attitude towards concussion and feasibility of the module: one before and one after viewing the concussion module. Potential increase in knowledge and attitude was explored by comparing the pretest and post-test scores of the Rosenbaum Concussion Knowledge and Attitudes Survey with the non-parametric Wilcoxon signed-rank test (p<0.05). The mean knowledge score of the participants was stable between tests (Z=213; p=0.16), while mean attitude score increased significantly (Z=331; p=0.01). Nearly all participants (85%–100%) were positive about the relevance, added value, duration and form of the concussion module.

Conclusion

The developed educational concussion module leads to better attitude of professional footballers towards concussion.

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.

Time Trends of Head Injuries Over Multiple Seasons in Professional Male Football (Soccer)

The present study aimed to investigate time trends of head injuries and their injury mechanisms since a rule change as monitoring may help to identify causes of head injuries and may advance head injury prevention efforts. Based on continuously recorded data from the German football magazine “kicker Sportmagazin ^® ” as well as other media sources, a database of head injuries in the 1 ^st German male Bundesliga was generated comprising 11 seasons (2006/07–2016/17). Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) were calculated. Time trends were analysed via linear regression. Two hundred thirty-eight match head injuries occurred (IR 1.77/1000 match hours, 95% CI 1.56–2.01). There were no significant seasonal changes, expressed as annual average year-on-year change, in IRs over the 11-year period for total head injuries (p=0.693), facial/head fractures (p=0.455), lacerations/abrasions (p=0.162), and head contusions (p=0.106). The annual average year-on-year increase for concussion was 6.4% (p=0.004). Five head injury mechanisms were identified. There were no seasonal changes in injury mechanisms over the study period. The concussion subcategory increased slightly over the seasons, which may either be a result of increasing match dynamics or raised awareness among team physicians and players.

Hooliganism and maxillofacial trauma: The surgeon should be warned

INTRODUCTION

With more than 270 million spectators, football - or soccer - is the most popular sport in the world. International football events generate many risky situations, including hooliganism and are an opportunity to analyze the incidence and the particularities of associated trauma. We sought to underline the potential rapid and brutal increase in maxillofacial trauma during a world-class competition.

MATERIAL AND METHODS

A retrospective multicenter study of the epidemiology of maxillofacial traumas during the UEFA 2016 Cup was conducted. All the medical data from each UEFA 2016 World Cup matches from 10 June 2016 to 10 July 2016 were collected. Only the maxillofacial traumas requiring a surgery under general anesthesia and a hospitalization were included.

RESULTS

11 patients from 3 different cities were included. The main etiology was interpersonal violence (7/11), followed by road accidents (3/11). Open reduction with internal fixation of a mandibular fracture was the most performed surgery (9/11). Patients were 18 to 50 year-old, with an average age of 30.6 years.

DISCUSSION

This study underlines the violence of riots between "ultra" supporters during the 2016 UEFA cup. We noticed an upsurge of maxillofacial trauma severe enough to require a surgery under general anesthesia. Hooligan behaviors should be known by every practitioner dealing with trauma care, and may requires transitional adjustment of public health policy.

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.

Epidemiological Findings of Soccer Injuries During the 2017 Gold Cup

Background:

Surveillance programs are vital to analyze the cause and nature of lesions and ultimately establish protocols of action to lower injury rates.

Purpose:

To evaluate the adherence of team doctors to an electronic surveillance system and determine the incidence and characteristics of injuries among soccer players participating in the 2017 Gold Cup.

Study Design:

Descriptive epidemiological study.

Methods:

All data were collected from the electronic medical reports submitted during each match of the 2017 Gold Cup. Twelve teams participated in the tournament (each with 23 players), for a total of 276 players. A 19-question online survey was filled out by the team physician after each injury. Each report contained the player’s number, the exact time of injury (minute of play), the location and diagnosis of injury as indicated by a previously defined code, and its severity in terms of the number of days of absence from training and match play.

Results:

The electronic reporting system had a response rate of 100.0%, with 97.2% of questions answered completely. The mean age of injured players was 27 years (range, 21-35 years) and was not statistically significantly different from the overall mean player age (P > .05). There were no significant differences in the frequency of injuries when analyzed by player position (P = .743). The overall rate of injuries was 1.04 per match, with the most common injuries being contusions (42.3%), sprains (7.7%), strains (7.7%), and fractures (7.7%). These injuries were more commonly the result of contact (75.0%) than noncontact (25.0%) mechanisms (P < .001). Injuries most commonly occurred between the 60th and 75th minute of play when comparing all 15-minute time intervals (P = .004).

Conclusion:

This study supports the use of electronic injury reporting, which demonstrated a high level of adherence among an international cohort of team physicians and has significant potential for improving injury surveillance and tracking responses to prevention programs. Injury rates in the Gold Cup were similar to those in previous studies and demonstrated the highest rates late in the second half of the game, specifically between the 60th and 75th minute of play.

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.

Muscle Strength Is a Poor Screening Test for Predicting Lower Extremity Injuries in Professional Male Soccer Players: A 2-Year Prospective Cohort Study

BACKGROUND

Lower extremity muscle strength tests are commonly used to screen for injury risk in professional soccer. However, there is limited evidence on the ability of such tests in predicting future injuries.

PURPOSE

To examine the association between hip and thigh muscle strength and the risk of lower extremity injuries in professional male soccer players.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Professional male soccer players from 14 teams in Qatar underwent a comprehensive strength assessment at the beginning of the 2013/2014 and 2014/2015 seasons. Testing consisted of concentric and eccentric quadriceps and hamstring isokinetic peak torques, eccentric hip adduction and abduction forces, and bilateral isometric adductor force (squeeze test at 45°). Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff throughout each season. Univariate and multivariate Cox regression analyses were used to calculate hazard ratios (HRs) with 95% CIs.

RESULTS

In total, 369 players completed all strength tests and had registered injury and exposure data. Of these, 206 players (55.8%) suffered 538 lower extremity injuries during the 2 seasons; acute muscle injuries were the most frequent. Of the 20 strength measures examined, greater quadriceps concentric peak torque at 300 deg/s (HR, 1.005 [95% CI, 1.00-1.01]; P = .037) was the only strength measure identified as significantly associated with a risk of lower extremity injuries in multivariate analysis. Greater quadriceps concentric peak torque at 60 deg/s (HR, 1.004 [95% CI, 1.00-1.01]; P = .026) was associated with the risk of overuse injuries, and greater bilateral adductor strength adjusted for body weight (HR, 0.75 [95% CI, 0.57-0.97; P = .032) was associated with a lower risk for any knee injury. Receiver operating characteristic curve analyses indicated poor predictive ability of the significant strength variables (area under the curve, 0.45-0.56).

CONCLUSION

There was a weak association with the risk of lower extremity injuries for 2 strength variables: greater quadriceps concentric muscle strength at (1) high and (2) low speeds. These associations were too small to identify an "at-risk" player. Therefore, strength testing, as performed in the present study, cannot be recommended as a screening test to predict injuries in professional male soccer.

Injuries Among Recreational Football Players: Results of a Prospective Cohort Study

OBJECTIVES

To establish the incidence and patterns of football injuries and associated consequences in daily life and labor loss, among public employees.

DESIGN

Prospective cohort study.

SETTING

Football tournament between public employees in Turkey.

PARTICIPANTS

A total of 1821 recreational players from 78 teams.

MAIN OUTCOME MEASURES

Injury rates (injuries per 1000 hours of football exposure) during tournament by age group, as well as prevalence, severity, and injury types were recorded. The data regarding the occurrence (eg, location, type, circumstances) and consequences (eg, absenteeism, medical treatment, labor loss) of injuries were collected.

RESULTS

Of the 1821 football players registered for participation, 57% (n = 1038) were included in the study with the returned questionnaire forms. In total, 257 matches were played with a total exposure time of 5654 hours. A total of 218 injuries were recorded in 192 players (10.5%), resulting in a mean of 0.85 time-loss injuries per match (38.6 per 1000 hours). Severe injuries constituted 42.6% of all injuries, and 28.9% of all injuries caused the participants to be absent at least 1 day for the next working day. The total labor loss was 1196 days for all injuries. The rate of missing subsequent working day was significantly less for muscle injuries (P < 0.05).

CONCLUSIONS

The risk of injury in recreational football players is relatively high causing significant labor loss. The results suggest that prevention programs should consider specific injury characteristics, as there is a greater incidence of muscle and anterior cruciate ligament injuries in this population.

[Biomechanical screening for injury prevention : The importance of 3D-motion analysis in high performance sports]

Standardized clinical diagnostic procedures cannot assess the functionality of the anatomical structures in sport-specific movement. Biomechanical screening is able to detect deficits but is not sufficiently and objectively precise with the current clinical examination tools including conventional imaging techniques. The fields of use of functional testing methods are versatile and range from injury prevention analysis, screening during rehabilitation phases up to the return-to-play decision. Using simple musculoskeletal function analysis it is difficult to assess the risk of injuries. The main advantage of instrumented 3D-motion analysis is its potential to generate objective, reliable and reproducible data with exact joint angles, muscle activity, as well as loading inside the joints during movement. These marker-based motion analysis procedures are more time-consuming and more cost intensive and necessitate in particular biomechanical and medical knowledge to assess the analytical data in terms of clinical relevance. In the absence of scientific studies on biomechanical analyses in professional sports, this study shows preliminary approaches to this topic.

Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries

PURPOSE

The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury.

METHODS

In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population.

RESULTS

The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected.

CONCLUSION

In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms.

LEVEL OF EVIDENCE

Level III.

Chronic Traumatic Encephalopathy Presenting as Alzheimer's Disease in a Retired Soccer Player

The relationship between soccer and chronic traumatic encephalopathy (CTE) is not well established. We report clinicopathological correlations in an 83-year-old retired center-back soccer player, with no history of concussion, manifesting typical Alzheimer-type dementia. Examination revealed mixed pathology including widespread CTE, moderate Alzheimer's disease, hippocampal sclerosis, and TDP-43 proteinopathy. This case adds to a few CTE cases described in soccer players. Furthermore, it corroborates that CTE may present clinically as typical Alzheimer-type dementia. Further studies investigating the extent to which soccer is a risk for CTE are needed.

ANALYSIS OF MEDICAL ASSISTANCE PROVIDED TO SPECTATORS AT THE 2014 FIFA WORLD CUP MATCHES

Objective:

Several studies have already described the main injuries to soccer players during FIFA World Cup events; however, little is known about the main reasons spectators require medical assistance during these matches. The aim of this study is to assess the number of cases and main reasons spectators required medical assistance during the 2014 World Cup matches in Brazil.

Methods:

Data were collected from spectators who received medical assistance on all game days, and factors related to the assistance provided were analyzed.

Results:

Medical assistance was given to spectators in a total of 6,222 cases during the 64 games played in Brazil, an average of 97.2 times per game. The total number of spectators removed from the stadiums by ambulance was 167, a mean of 2.6 removals per game. The main reasons spectators required medical assistance during the World Cup games were headache, gastrointestinal problems, and trauma.

Conclusions:

Most spectators required medical assistance during the World Cup games for headache, gastrointestinal problems, and trauma; this information is fundamental to develop new prevention strategies and plan medical assistance for large-scale events. Level of Evidence IV; Case series.

ORTHOPEDIC INJURIES IN MEN'S PROFESSIONAL SOCCER IN BRAZIL: PROSPECTIVE COMPARISON OF TWO CONSECUTIVE SEASONS 2017/2016

PURPOSE

The purpose is to compare the incidence and characteristics of injuries sustained in two consecutive seasons of the São Paulo State Football Championship.

METHODS

Prospective study performed using an electronic form previously developed by the Medical Committee of the São Paulo State Football Federation, sent to the physicians responsible for the tournament's series A1 and A2 teams, after each round.

RESULTS

17.63 injuries sustained per 1000 hours of matches in the A1 series and 14.91 injuries sustained per 1000 hours of matches in the A2 series. Incidence of injuries per 1000 hours of matches decreased from 24.16 to 17.63 in the A1 series (p<0.037) and from 19.10 to 14.01 in the A2 series (p<0.064). External defenders suffered most injuries, while muscular injuries were most common and lower limbs, the most affected areas. Most injuries occurred between 30 and 45 minutes of the match and only 11.9% of the injuries required surgery.

CONCLUSIONS

Prevalence and frequency of injuries decreased between seasons. Most injuries were sustained in the lower limbs; strains were the most common injuries, followed by strains and contusions; MRIs were the most frequently requested exams and most injuries were classified as moderate (8-28 days). Level of evidence III, Cross-Sectional Study.

Monitoring loads and non-contact injury during the transition from club to National team prior to an international football tournament: A case study of the 2014 FIFA World Cup and 2015 Asia Cup

OBJECTIVES

Injured and non-injured national team footballers were compared for external and internal loads during transition from club to National team training camp.

DESIGN

Prospective Case Study.

METHODS

Load and injury data were collected from the same National team prior to and during training camps of 2 tournaments; World (n=17) and Asian Cups (n=16). External (number sessions) and internal (s-RPE) loads were collected 4-weeks prior to and during camps. The acute:chronic load ratio was calculated for the first week of camp based on the mean of previous 4-weeks. Respective loads and ratios were compared between injured and non-injured players for non-contact injuries occurring during camp.

RESULTS

Seven non-contact injuries occurred during World Cup camp and 1 during Asian Cup (preventing statistical analyses). Small-to-moderate effect sizes were found for lower chronic internal loads (ES=0.57; 90% CI: 0.39-1.08) and higher acute:chronic ratio (ES=0.45; 90% CI: 0.31-0.87) for injured compared to non-injured players. Moderate-large effects (ES=0.83; 90% CI: 0.56-1.60) were evident for increased acute:chronic ratio for number of sessions in injured compared to non-injured players. However, small-moderate effect sizes were present for lower chronic training and match loads (ES=0.55; 90% CI: 0.38-1.06) in injured players prior to the World Cup camp, alongside an increased number of sessions in week 1 of camp (ES=0.47; 90% CI: 0.33-0.91).

CONCLUSIONS

Players incurring non-contact injury during training camp prior to an international tournament performed less prior chronic external and internal load and a concomitant higher relative increase in camp, thus representing a practical marker to monitor in national teams.

Soccer (Football Association) and chronic traumatic encephalopathy: A short review and recommendation

Chronic traumatic encephalopathy (CTE) was initially described in boxers, but in recent years it has been reported in other settings, particularly in contact sports and military personnel. Soccer (football association) had previously been (and still is) considered relatively safe when compared to other sports, such as American football. However, a few cases of professional soccer players with CTE have been reported in the last few years. It is still unknown how frequent this condition is in soccer players, and the role played by heading the ball remains elusive. Other traumas to the head, face and neck caused by contact with another player's head, arm or other body parts are among the most frequent in soccer. In spite of the lack of more in-depth knowledge, there is reasonable evidence for recommending severe punishment (red card and suspension for several matches) for players causing avoidable trauma to another player's head.

Genetic testing for exercise prescription and injury prevention: AIS-Athlome consortium-FIMS joint statement

BACKGROUND

There has been considerable growth in basic knowledge and understanding of how genes are influencing response to exercise training and predisposition to injuries and chronic diseases. On the basis of this knowledge, clinical genetic tests may in the future allow the personalisation and optimisation of physical activity, thus providing an avenue for increased efficiency of exercise prescription for health and disease.

RESULTS

This review provides an overview of the current status of genetic testing for the purposes of exercise prescription and injury prevention. As such there are a variety of potential uses for genetic testing, including identification of risks associated with participation in sport and understanding individual response to particular types of exercise. However, there are many challenges remaining before genetic testing has evidence-based practical applications; including adoption of international standards for genomics research, as well as resistance against the agendas driven by direct-to-consumer genetic testing companies. Here we propose a way forward to develop an evidence-based approach to support genetic testing for exercise prescription and injury prevention.

CONCLUSION

Based on current knowledge, there is no current clinical application for genetic testing in the area of exercise prescription and injury prevention, however the necessary steps are outlined for the development of evidence-based clinical applications involving genetic testing.

Health promotion through sport: international sport federations’ priorities, actions and opportunities

Objective

To identify areas of priority and activity for international sportsfederations (IFs) with respect to athlete health and safety, and global health. Results serve to direct the work of the Association of Summer Olympic IF Medical and Scientific Consultative Group, the International Olympic Committee and to influence IFs’ planning and priorities.

Methods

The 28 IFs participating in the Summer Olympic Games (2016) were asked to rank the relative importance of 11 health-related topics and to report their activities or research initiatives on 27 identified topics using an electronic survey. A comparison with a similar survey (2012) was made.

Results

The response rate was 100%. In general, the ‘fight against doping’ had the highest priority followed by ‘image as a safe sport’. The topics with the lowest importance ratings were ‘increasing the number of elite athletes’, and ‘health of the general population’. Despite ranking ‘health of your athletes,’ as a top priority, IFs are not addressing all aspects of athlete health. In comparison with 2012, there was a significant decrease in priority for IFs is ‘health of the general population’.

Conclusion

Despite the widespread knowledge of the importance of the promotion of physical activity (sport) on global health, the decreasing priority and programming of the IFs on physical activity promotion is concerning. Although IFs have prioritised the protection of the health of elite athletes, there are gaps in programming demonstrating that IFs are missing important areas of athlete health. Improving recreational athlete health programming could also benefit population health as well as improve IF fan base and sport participation.

Assessment of Head Collision Events During the 2014 FIFA World Cup Tournament

This study uses video footage observations of all 64 matches of the 2014 FIFA World Cup to assess the incidence, characteristics, and sideline outcome assessments of player head collisions.

The functional movement test 9+ is a poor screening test for lower extremity injuries in professional male football players: a 2-year prospective cohort study

Background

The 9+ screening battery test consists of 11 tests to assess limitations in functional movement.

Aim

To examine the association of the 9+ with lower extremity injuries and to identify a cut-off point to predict injury risk.

Methods

Professional male football players in Qatar from 14 teams completed the 9+ at the beginning of the 2013/2014 and 2014/2015 seasons. Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff during these seasons. Univariate and multivariate Cox regression analyses were used to calculate HR and 95% CI. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity and identify the optimal cut-off point for risk assessment.

Results

362 players completed the 9+ and had injury and exposure registration. There were 526 injuries among 203 players (56.1%) during the two seasons; injuries to the thigh were the most frequent. There was no association between 9+ total score and the risk of lower extremity injuries (HR 1.02, 95% CI 0.99 to 1.05, p=0.13), even after adjusting for other risk factors in a multivariate analysis (HR 1.01, 95% CI 0.98 to 1.04, p=0.37). ROC curve analysis revealed an area under the curve of 0.48, and there was no cut-off point that distinguished injured from non-injured players.

Conclusion

The 9+ was not associated with lower extremity injury, and it was no better than chance for distinguishing between injured and uninjured players. Therefore, the 9+ test cannot be recommended as an injury prediction tool in this population.

Perceptions of football players regarding injury risk factors and prevention strategies

Current approaches regarding injury prevention focus on the transfer of evidence into daily practice. One promising approach is to influence attitudes and beliefs of players. The objective of this study was to record player’s perceptions on injury prevention. A survey was performed among players of one German high-level football (soccer) club. 139 professional and youth players between age 13 and 35 years completed a standardized questionnaire (response rate = 98%). It included categories with (1) history of lower extremity injuries, (2) perceptions regarding risk factors and (3) regularly used prevention strategies.

The majority of players (84.2%) had a previous injury. 47.5% of respondents believe that contact with other players is a risk factor, followed by fatigue (38.1%) and environmental factors (25.9%). The relevance of previous injuries as a risk factor is differently perceived between injured (25%) and uninjured players (0.0%). Nearly all players (91.5%) perform stretching to prevent injuries, followed by neuromuscular warm up exercises (54.0%). Taping is used by 40.2% of previously injured players and 13.6% of players without a history of injuries. In conclusion, the perception of risk factors and performed preventive strategies are inconsistent with scientific evidence. Future transfer strategies should incorporate the players beliefs and attitudes.

Osteoarthritis in Football

Football is currently the most popular sporting activity in the world. Multiple reports have shown that a high incidence of osteoarthritis is found in football players. Evidence clearly shows that traumatic injury significantly predisposes players for such pathophysiology. Injuries are frequent in amateur as well as professional football players, with knee and ankle accounting for the most severe injuries. Many professional athletes lose playing time due to injuries and many are forced into early retirement. Posttraumatic osteoarthritis is a common finding among ex-football players with numbers well above the normal population. Today's surgical techniques are advanced and capable of restoring the joint to a certain extent. However, a restitution ad integrum is reached only in very rare cases. Professional football players that return to play after serious injuries perform their extremely strenuous activity on morphologically compromised joints. Incomplete rehabilitation and pressure to return to play after an injurious event clearly put the athlete at an even higher risk for joint degeneration. Prevention strategies, improved surgical management, strict rehabilitation, as well as future aspects such as early suppression of inflammation, personalized medicine, and predictive genomics DNA profiling are needed to reduce incidence and improve the health perspectives of football players.

Injury and illness epidemiology in soccer - effects of global geographical differences - a call for standardized and consistent research studies

Soccer is the most popular sport in the world. While injuries and illnesses can affect the players’ health and performance, they can also have a major economic impact on teams. Moreover, several studies have shown the favourable association between higher player availability and team success. Therefore, injury prevention could directly impact clubs’ financial balance and teams’ performance via increased player availability. To be able to develop effective methods of injury prevention, it is vital to first determine the scope and the degree of the problem: the mechanisms and types of injuries, their frequency and severity, etc. According to the most widely known prevention model, systematic injury surveillance is the first and most fundamental step towards injury prevention. Since epidemiological studies have shown that injuries and illnesses in soccer players differ from region to region, it is important to establish a specific injuries and illness database in order to guide specific preventive actions. Since Asia is the largest continent, with the highest number of soccer players, and in the light of the long-term research on injuries performed in UEFA clubs, the authors of the present article present the AFC surveillance. Some methodological issues related to this prospective design study are discussed. The definition of injury and illness and the methods to track players’ exposure are described along with the potential challenges related to such a vast scale study. This article is also a call for action to have consistent and standardized epidemiological studies on soccer injuries and illnesses, with the aim to improve their prevention.

Mechanisms and situations of anterior cruciate ligament injuries in professional male soccer players: a YouTube-based video analysis

BACKGROUND

Soccer is considered the most popular sport in the world concerning both audience and athlete participation, and the incidence of ACL injury in this sport is high. The understanding of injury situations and mechanisms could be useful as substratum for preventive actions.

PURPOSE

To conduct a video analysis evaluating the situations and mechanisms of ACL injury in a homogeneous population of professional male soccer players, through a search entirely performed on the YouTube.com Web site focusing on the most recent years.

METHODS

A video analysis was conducted obtaining videos of ACL injury in professional male soccer players from the Web site YouTube. Details regarding injured players, events and situations were obtained. The mechanism of injury was defined on the basis of the action, duel type, contact or non-contact injury, and on the hip, knee and foot position.

RESULTS

Thirty-four videos were analyzed, mostly from the 2014-2015 season. Injuries occurred mostly in the first 9 min of the match (26%), in the penalty area (32%) or near the side-lines (44%), and in non-rainy conditions (97%). Non-contact injuries occurred in 44% of cases, while indirect injuries occurred in 65%, mostly during pressing, dribbling or tackling. The most recurrent mechanism was with an abducted and flexed hip, with knee at first degrees of flexion and under valgus stress.

CONCLUSIONS

Through a YouTube-based video analysis, it was possible to delineate recurrent temporal, spatial and mechanical characteristics of ACL injury in male professional soccer players.

LEVEL OF EVIDENCE

Level IV, case series.

Injury data of major international field hockey tournaments

BACKGROUND

Detailed injury data are not available for international tournaments in field hockey. We investigated the epidemiology of field hockey injuries during major International Hockey Federation (Fédération Internationale de Hockey, FIH) tournaments in 2013.

MATERIALS AND METHODS

FIH injury reports were used for data collection. All major FIH tournaments for women (n=5) and men (n=11) in 2013 were included. The main focus of this study was to assess the pattern, time, site on the pitch, body site and mechanism of each of the injuries. We calculated the average number of injuries per match and the number of injuries per 1000 player match hours.

RESULTS

The average number of injuries was 0.7 (95% CI 0.5 to 1.0) per match in women's tournaments and 1.2 (95% CI 0.8 to 1.7) per match in men's tournaments. The number of injuries per 1000 player match hours ranged from 23.4 to 44.2 (average 29.1; 95% CI 18.6 to 39.7) in women and 20.8 to 90.9 (average 48.3; 95% CI 30.9 to 65.8) in men. Most injuries occurred in the circle (n=25, 50%, in women, n=95, 51%, in men). The rate of injuries increased after the first quarter. Injuries to the head and face (n=20, 40%) were most common in women. The head/face (n=51, 27%) and the thigh/knee (n=52, 28%) were equally affected in men. The ball caused the most injuries, followed by the stick, collisions and tripping/falling. There were no deaths or injuries that required hospital treatment in the entire cohort.

SUMMARY

Field hockey has a low incidence of acute injuries during competition.

The association of environmental heat stress with performance: analysis of the 2014 FIFA World Cup Brazil

Objective

The 2014 FIFA World Cup Brazil included 64 matches in temperate to tropical environmental conditions. We analysed performance data in relation to the environmental conditions to identify potential association.

Methods

Wet-bulb globe temperature (WBGT) parameters were obtained at the centre of the field 1 h before the start of play. Environmental stress was estimated (low, moderate and high) for each match using WBGT and relative humidity. Various physical and technical performance indices were recorded during each match (average of both teams).

Results

Over the 64 matches, 28 were played under low, 20 under moderate and 16 under high environmental stress. There was no difference in actual playing time (p=0.517), total distance covered (p=0.491), number of goals scored (p=0.485) and number of cards (p=0.618) between the matches played under different environmental stress categories. The number of sprints was lower in high than in moderate or low environmental stress (−10%, p<0.05) but peak speed was unaffected. The distance covered at high intensity was also lower under high (24.8±2.8 m/min/player) than low environmental stress (26.9±2.3 m/min/player, p=0.02). Number of passes was not different but the rate of successful passes was higher under high (76.8±4.4%) than low (73.6±10.8%) environmental stress (p=0.031).

Conclusions

Top-level players seem to modulate their activity pattern during matches in a hot and humid environment (ie, less high-intensity but more low-intensity running and successful passes) to preserve the global match characteristics (ie, similar actual playing time, total distance covered, peak running speed and goals scored).