Return to football training and competition after lockdown caused by the COVID-19 pandemic: medical recommendations

Case Report: Return to Sport Following the COVID-19 Lockdown and Its Impact on Injury Rates in the German Soccer League

The Bundesliga made headlines for becoming the first major sports league to return to sport worldwide following COVID-19 lockdown. To-date, there lacks retrospective studies on longitudinal injury rates to elucidate the effect isolation measures had on the health and safety of professional athletes. This study sought to compare injury rates experienced by Bundesliga athletes before and after the COVID-19 lockdown. Data was collected from public injury and player reports regarding the Bundesliga, with injury defined as trauma resulting in loss of game time. Descriptive statistics were used to present differences in injury incidence between all Bundesliga Match days pre- and post-lockdown. Between the league's resumption and completion on May 16 and June 27, 2020, injuries occurred in 21 forwards (FW), 11 central midfielders (CM), 12 wide midfielders (WM), 16 central defenders (CD), 6 fullbacks (FB), and 2 goalkeepers. Players had 1.13 (95% CI 0.78, 1.64) times the odds of being injured following the COVID-19 lockdown, with a 3.12 times higher rate of injury when controlling for games played compared to injury rates pre-lockdown (0.84 injuries per game vs. 0.27 injuries per game). The most frequent injury group was muscular injuries with 23 injuries total, with 17% of athletes experiencing injury during their first competitive match following lockdown. Injury rate increased over 3-fold following COVID-19 lockdown. Athletes did not experience an increased rate of injury with more cumulative competitive matches played. High injury incidence for players yet to complete their first competitive match may imply suboptimal sport readiness following home confinement.

Playing Non-Professional Football in COVID-19 Time: A Narrative Review of Recommendations, Considerations, and Best Practices

The coronavirus disease (COVID-19) pandemic in 2020 resulted in widespread interruption of team sports training and competitions. Our aim was to review the recommendations and best practices in return to play in non-professional football after activity lockdown. The authors searched two electronic databases (PubMed, Web of Science) to extract studies published before September 15 2020. Twenty studies explained recommendations, considerations, or best practices in return to play in football, and all of them were clustered into three groups: (1) training load management (n = 10), (2) medical recommendations (n = 9), and (3) recovery related issues (n = 5). The way to establish a progression in training process should be based on training load management and managing the number of stimuli per time. Following the studies, this training process should be divided into three phases: phase 1-physical distancing should be maintained; phases 2 and 3-group training should start. Medical considerations were clustered into different groups: general, pre- and post- training, during training, education, planning to return to competition, and suggestions for post confinement weeks. In particular, social issues, strict hygiene questions, and continuous PCR testing should be considered in return to play over football season. Finally, since a correlation has been found between high-intensive training loads and immunoglobulin A, nutritional and lifestyle recovery strategies should be performed. Moreover, since immunosuppression has been related to congested schedules (<72 h between matches), football federations should avoid this situation.

Applying digital technology to promote active and healthy confinement lifestyle during pandemics in the elderly

Although recognized as effective measures to curb the spread of the COVID19 outbreak, social distancing and home confinement have generated a mental health burden with older adults who are considered to be more vulnerable to psychosocial strains. To date, the application of digital technologies in response to COVID-19 pandemic has been narrowed to public-health needs related to containment and mitigation. However, information and communications technology (ICT)-based initiatives directed toward prediction and prevention of psychosocial support are still limited. Given the power of digital health solutions to allow easy and accurate characterization and intervention for health and disease, as well as to flatten the COVID19 incidence curves in many countries, our ECLB-COVID19 consortium is highlighting the importance of providing innovative ICT-based solutions (ICT-COVID-Companion) to improve elderly physical and mental health, thereby preventing/dampening psychosocial strain during pandemics. Based on innovative approaches (e.g., emotional/social computing, open social platform, interactive coaching, gamification, fitness-tracker, internet of things) and smart digital solutions (smartwatch/smartphone), smart companions must provide safe personalised physical, mental and psychosocial health surveillance. Additionally, by delivering personalised multi-dimension crisis-oriented health recommendations, such innovative crisis-oriented solutions would help (i) facilitate a user’s adherence to active and healthy confinement lifestyle (AHCL), (ii) achieve a rapid psychosocial recovery in case of depression issues and (iii) enhance preparedness for eventual future pandemics.

The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review

Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy.

Players' physical performance in LaLiga across the season: insights for competition continuation after COVID-19

Due to the COVID-19 outbreak, professional football players competing in LaLiga were confined at home for ~8 weeks and then they were allowed to train to prepare the first competitive match for 4 weeks. As the duration of summer break in the prior four seasons of LaLiga (from 2015-2016 to 2018-2019) was of similar length to the suspension of the championship due to COVID-19 (~12 weeks), we have analysed the running performance of teams competing in LaLiga in these four seasons to anticipate players’ physical performance after the resumption of the competition. The analysis includes the average running distance per game for each of the 38 matchdays that compose LaLiga. One-way ANOVA revealed that there was a main effect of the matchday on total running distance per match (p = 0.001), and in the distance covered between 14.0 and 20.9 km/h (p < 0.001), between 21.0 and 23.9 km/h (p < 0.001) and at above 24.0 km/h (p < 0.001). Overall, the post-hoc analysis revealed that the running patterns progressively increased during the first 8-10 matchdays and then reached a plateau which was significantly different to matchday-1 (p < 0.05). This analysis reveals that, in the prior four competitive seasons of LaLiga, players’ physical performance was lower at the beginning of the season and the teams needed approximately 8-10 matchdays to reach a steady state running performance. These data suggest that football players will progressively increase their performance across the 11 matchdays remaining to complete LaLiga.