Soccer injuries: a review on incidence and prevention

Update: soccer injury and prevention, concussion, and chronic groin pain

Soccer, or football, as it is known in much of the world, is one of the most popular sports in the world. The purpose of this article was to provide a concise update on select soccer-specific medical issues published in the last year as they relate to soccer injury and prevention, concussions, and chronic groin pain. Both the Fédération Internationale de Football Association and the Union of European Football Associations published data from their longstanding injury tracking systems, providing foundation for further research. Concussion research continues to drive much interest, especially as it relates to heading and the controversy of subconcussive trauma. Lastly, our understanding of chronic groin pain continues to be refined as we try to understand the complexity of its pathophysiology and attempt to standardize a multispecialty approach of diagnosis and treatment.

The relationships between the center of mass position and the trunk, hip, and knee kinematics in the sagittal plane: a pilot study on field-based video analysis for female soccer players

Athletes with non-contact anterior cruciate ligament tears have common features in the sagittal plane; namely, the body’s center of mass (COM) is located posterior to the base of support, the trunk and knee joints are extended, and the hip angle is flexed. However, the relationships among these variables have not been assessed in field-based movements. This study sought to determine relationships between distances from the COM to the base of support and the trunk, hip, and knee positions in women while playing soccer. Sixty events (29 single-leg landing and 31 single-leg stopping events) were analyzed using two-dimensional video analysis. The relationships among the measurement variables were determined using the Pearson’s product-moment correlation coefficient, and stepwise multiple linear regression models were used to explore the relationships between the COM position and the kinematic variables. The distance from the COM to the base of support displayed a moderate negative relationship with the trunk angle (r = −0.623, p < .0001, r² = 0.388) and a strong positive relationship with the limb angle (r = 0.869, p < .0001, r² = 0.755). The limb, knee, and trunk angles were selected in the best regression model (adjusted r² = 0.953, p < .0001, f² = 20.277). These findings suggest that an increased trunk angle and a decreased limb angle at initial contact are associated with a safer COM position. Neuromuscular training may be useful for controlling the trunk and lower limb positions during dynamic activities.

Effect of Progressive Muscle Relaxation on Pain Threshold and Effectiveness of Footballers’ Training

Purpose. Relaxing in the athlete’s training process is underutilized. Relaxation techniques, however, should be taught from the very beginning of the footballer’s training career. The main aim of this study was to present the effect of progressive muscle relaxation on pressure pain threshold levels and the effectiveness of the footballer’s training. Methods. A sample of 32 football players participated in the therapeutic program consisting of 8 PMR sessions. Before and after applying a pressure therapy, the pain threshold in the lumbar region was measured by a dolorimeter and the Cooper test was carried out to determine the footballers’ level of endurance. Results. PMR training did not increase significantly the pain threshold level in the experimental group (p > 0.05), but it increased significantly the distance covered in the Cooper test (p = 0.04). Analysis of the Spearman rank correlation was also carried out (p = 0.81). Conclusions. PMR does not lower pain perception threshold. PMR therapy increases the distance measured by the Cooper test. In order to determine the role of PMR in injury prevention, further research is necessary.

Incidence and Nature of Medical Attendance Injuries in English Community Rugby Union

BACKGROUND

Previous research has identified injury patterns during community-level rugby union match play, but none have investigated the frequency and reasons for on-field injury management.

PURPOSE

To establish the frequency, reasons, and patterns of on-field injury management in English community rugby, including differences between different levels of play.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Over 3 seasons, injury information was collected from 46 (2009-2010), 67 (2010-2011), and 76 (2011-2012) English community clubs (Rugby Football Union [RFU] levels 3-9). Club injury management staff reported information for all medical attendances during match play, including details on the injury site and type, playing position (seasons 2010-2011 and 2011-2012 only), and whether the player was removed from play. Clubs were subdivided into groups A (RFU levels 3 and 4 [mainly semiprofessional]; n = 39), B (RFU levels 5 and 6 [mainly amateur]; n = 71), and C (RFU levels 7-9 [social and recreational]; n = 79) to differentiate playing levels.

RESULTS

The overall medical attendance incidence was 229 per 1000 player-match hours (95% CI, 226-232), with 45 players removed per 1000 player-match hours (95% CI, 44-46). Attendance incidence for group A (294 per 1000 player-match hours; 95% CI, 287-301) was higher compared with group B (213; 95% CI, 208-218; P < .001) and C (204; 95% CI, 200-209; P < .001). There was a higher incidence of attendances to forwards (254; 95% CI, 249-259) compared with backs (191; 95% CI, 187-196; P < .001). The head was the most common specific site of injury (55 per 1000 player-match hours; 95% CI, 53-57) but the lower limb region overall accounted for most attendances (87; 95% CI, 85-89) and the greatest chance of removal from the pitch (22; 95% CI, 21-23).

CONCLUSION

With the likelihood of 1 injury for each team per match severe enough for the player to leave the pitch and with at least 1 attendance for a head injury per match, there is clear evidence that pitch side staff should be trained to recognize potentially serious injuries.

Injuries in iran futsal national teams: a comparative study of incidence and characteristics

Background:

Futsal is a growing sport with lots of fans in many countries including Iran, but there are few papers in the literature which report injuries in top level futsal.

Objectives:

The aim of this study is to record and analyze the incidence and characteristics of injuries in Iran futsal national teams from March 2011 to September 2012.

Patients and Methods:

55 Iranian national futsal players participated in this prospective cohort study. Before entering the study, all players took part in Pre-Competition Medical Assessment (PCMA) in accordance with FIFA protocol. Team physicians recorded the injuries throughout the match and trainings in a special form which was designed for this purpose. Finally, data analysis was done with the SPSS software.

Results:

The total exposure time for all players was 24326 hours (21138 hours during training and 3188 hours during matches). During the study period, 32 of the 55 national players (58.2%) incurred 54 injuries (incidence rate = 2.22 injuries per 1000 players-hours). The incidence rate of injury in female players was significantly higher than male players (P = 0.001). The majority of injuries (85.2%) were located on the lower extremities. The ankle was the most frequent injury location (40.7%) and sprain was the most frequent type of injury.

Conclusions:

Injuries are common among futsal players and female players are more prone to injuries than male players. The ankle is the most frequent site and sprain is the most frequent type of injury among futsal players.

Frequency and trends in foot and ankle injuries within an English Premier League Football Club using a new impact factor of injury to identify a focus for injury prevention

BACKGROUND

Foot and ankle injuries are common in football. Prevention strategies exist in order to decrease the incidence of such injuries and minimize the number of days that a player is unavailable for selection.

METHODS

Injuries were recorded over a 4-season period while the team was playing in the English Premier League (EPL). We present the epidemiology of foot and ankle injuries within a professional football club and offer a calculation that may be of use in the future to identify areas of injury prevention.

RESULTS

Anterior Talo-Fibular Ligament (ATFL) injuries and fifth metatarsal fractures were of high impact as they were both common and resulted in significant time periods where the player was unavailable.

CONCLUSIONS

This is the first time an EPL club has been prepared to publish data regarding injury. Our findings may be used by others to focus their prevention strategies on the injuries with the highest impact.

The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review

The FIFA 11+ is a simple, and easy to implement, sports injury prevention program comprising a warm up of 10 conditioning exercises. The aim of this systematic review was to evaluate the impact of the FIFA 11+ on injury incidence, compliance and cost effectiveness when implemented among football players. MEDLINE, EMBASE and Scopus databases were searched using the search terms “FIFA 11+”, “football”, “soccer”, “injury prevention”, and “The 11”. The titles and abstracts were screened by two independent reviewers and the data were filtered by one reviewer using a standardized extraction form and thereafter checked by another one. The risk of bias and the methodological quality of the studies were evaluated through the PEDro score and Critical Appraisal Skills Programme (CASP). A total of 911 studies were identified, of which 12 met the inclusion criteria of the review. The FIFA 11+ has demonstrated how a simple exercise program completed as part of warm-up can decrease the incidence of injuries in amateur football players. In general, considerable reductions in the number of injured players, ranging between 30% and 70%, have been observed among the teams that implemented the FIFA 11+. In addition, players with high compliance to the FIFA 11+ program had an estimated risk reduction of all injuries by 35% and show significant improvements in components of neuromuscular and motor performance when participating in structured warm-up sessions at least 1.5 times/week. Most studies had high methodological quality and a low risk of bias. Given the large number of people who play football at amateur level and the detrimental impact of sports injuries on a personal and societal level, the FIFA 11+ can be considered as a fundamental tool to minimize the risks of participation in a sport with substantial health benefits.

Injury prevention in male veteran football players - a randomised controlled trial using "FIFA 11+"

The warm-up programme "FIFA 11+" has been shown to reduce football injuries in different populations, but so far veteran players have not been investigated. Due to differences in age, skill level and gender, a simple transfer of these results to veteran football is not recommended. The purpose of this study was to investigate the preventive effects of the "FIFA 11+" in veteran football players. Twenty veteran football teams were recruited for a prospective 9-month (1 season) cluster-randomised trial. The intervention group (INT, n = 146; 45 ± 8 years) performed the "FIFA 11+" at the beginning of each training session, while the control group (CON, n = 119; 43 ± 6 years) followed its regular training routine. Player exposure hours and injuries were recorded according to an international consensus statement. No significant difference was found between INT and CON in overall injury incidence (incidence rate ratio [IRR]: 0.91 [0.64-1.48]; P = 0.89). Only severe injuries reached statistical significance with higher incidence in CON (IRR: 0.46 [0.21-0.97], P = 0.04). Regular conduction (i.e. once a week) of the "FIFA 11+" did not prevent injuries in veteran footballers under real training and competition circumstances. The lack of preventive effects is likely due to the too low overall frequency of training sessions.

The acute effects of vibration training on balance and stability amongst soccer players

Acute whole body vibration training (WBVT) is a tool used amongst coaches to improve performance prior to activity. Its effects on other fitness components, such as balance and stability, along with how different populations respond are less well understood. The aim of the current research is to determine the effect of acute WBVT on balance and stability amongst elite and amateur soccer players. Forty-four healthy male soccer players (22 elite and 22 amateur) were assigned to a treatment or control group. The intervention group then performed 3 × 60 seconds static squat on vibration platform at 40 Hz (±4 mm) with Y balance test (YBT) scores and dynamic postural stability index (DPSI) measured pre and post. DPSI was significantly lower in the elite players in the acute WBVT compared to amateur players (F1, 40= 6.80; P = 0.013). YBT anterior reach distance showed a significant improvement in both amateur and elite players in the acute WBVT group (F1, 40= 32.36; P < 0.001). The improvement in DPSI amongst the elite players indicates a difference in responses to acute high frequency vibration between elite and amateur players during a landing stability task. The results indicate that acute WBVT improves anterior YBT reach distances through a possible improvement in flexibility amongst both elite and amateur players. In conclusion, acute WBVT training appears to improve stability amongst elite soccer players in comparison to amateur players, the exact reasoning behind this difference requires further investigation.

Impact of sports on health of former professional soccer players in Brazil

OBJECTIVE:

To evaluate the social, economic and health aspects related to former professional soccer players in Brazil.

METHODS:

This was a cross-sectional study with the participation of 100 male Brazilian former professional soccer players. For characterization of the sample variables such as age, current and past weight, height, BMI (Body Mass Index) and player position were evaluated. In all analyzes it was considered P <0.05.

RESULTS:

In the group of former players evaluated, 78% were overweight and 4% were considered obese. During their careers, 54% of now ex-soccer players underwent drugs infiltration in the knee. Currently, former athletes presented on average 5.4 points on the VAS pain scale, with 97% of ex-players complaining of knee pain.

CONCLUSION:

The results of this study show that these individuals had large weight gain after retirement, high frequency of drug injections in the knee during their careers and chronic pain in this joint after retirement. Level of Evidence III, Cross-Sectional Study.

Early osteoarthritis and reduced quality of life after retirement in former professional soccer players

OBJECTIVES

This study aims to compare the prevalence of osteoarthritis in two groups: one comprising former professional soccer players and the other comprising non-professional-athlete participants.

METHODS

Twenty-seven male former professional soccer players and 30 male volunteers from different non-sports professional areas participated in the study. All participants underwent bilateral knee radiography and magnetic resonance imaging. In addition, the quality of life, knee pain and joint function were evaluated and compared using questionnaires given to all participants in both groups. Specific knee evaluations, with regard to osteoarthritis and quality of life, were performed in both groups using the Knee Injury and Osteoarthritis Outcome Score subjective questionnaires and the Short-form 36. The chi-squared test, Fisher's exact test, the Mann-Whitney U test and Student's t-test were used for group comparisons.

RESULTS

The between-groups comparison revealed significant differences in the following: pain, symptoms and quality of life related to the knee in the Knee Injury and Osteoarthritis Outcome Score subscales; the physical aspects subscale of the SF-36; total whole-organ magnetic resonance imaging scores with regard to the dominant and non-dominant knees. Former soccer players had worse scores than the controls in all comparisons.

CONCLUSIONS

Both the clinical and magnetic resonance evaluations and the group comparisons performed in this study revealed that former soccer players have a worse quality of life than that of a control group with regard to physical aspects related to the knee; these aspects include greater pain, increased symptoms and substantial changes in radiographic and magnetic resonance images of the knee.

Shinguards effective in preventing lower leg injuries in football: Population-based trend analyses over 25 years

OBJECTIVES

The majority of football injuries are caused by trauma to the lower extremities. Shinguards are considered an important measure in preventing lower leg impact abrasions, contusions and fractures. Given these benefits, Fédération Internationale de Football Association introduced the shinguard law in 1990, which made wearing shinguards during matches mandatory. This study evaluated the effect of the introduction of the shinguard law for amateur players in the Netherlands in the 1999/2000-football season on the incidence of lower leg injuries.

DESIGN

Time trend analyses on injury data covering 25 years of continuous registration (1986-2010).

METHODS

Data were retrieved from a system that records all emergency department treatments in a random, representative sample of Dutch hospitals. All injuries sustained in football by patients aged 6-65 years were included, except for injuries of the Achilles tendon and Weber fractures. Time trends were analysed with multiple regression analyses; a model was fitted consisting of multiple straight lines, each representing a 5-year period.

RESULTS

Patients were predominantly males (92%) and treated for fractures (48%) or abrasions/contusions (52%) to the lower leg. The incidence of lower leg football injuries decreased significantly following the introduction of the shinguard law (1996-2000: -20%; 2001-2005: -25%), whereas the incidence of all other football injuries did not. This effect was more prominent at weekends/match days. No gender differences were found.

CONCLUSIONS

The results significantly show a preventive effect of the shinguard law underlining the relevance of rule changes as a preventive measure and wearing shinguards during both matches and training sessions.

Soccer injuries and recovery in Dutch male amateur soccer players: results of a prospective cohort study

OBJECTIVE

To describe characteristics of outdoor soccer injury and recovery among Dutch soccer players.

DESIGN

Prospective cohort study.

SETTING

The 2009-2010 competitive season (33 weeks).

PARTICIPANTS

Four hundred fifty-six Dutch male soccer players of 23 amateur teams.

MAIN OUTCOME MEASURES

Coaches recorded individual exposure to all soccer activities. Paramedics or sports trainers collected information on the occurrence (e.g., location, type, circumstances) and consequences (eg, absenteeism, medical treatment) of injuries.

RESULTS

In total, 424 time-loss injuries were sustained by 60% (n = 274) of the players, with 23% (n = 105) having more than 1 injury. This corresponds to an overall density of 9.6 (8.7-10.5) injuries per 1000 player hours; 3.9 (3.3-4.7) in training sessions and 20.4 (18.1-23.1) in soccer matches. Almost 30% (n = 123) of the injuries lasted for more than 1 month, 14% (n = 58) were reinjuries (causing longer absence than new injuries), and 54% (n = 230) of the injuries were given medical treatment. The most common diagnoses were muscle/tendon (38%) or joint/ligament injuries (23%) of the lower extremities. After regaining the ability to fully take part in soccer training or matches, 27.4% of the players (n = 116) still reported complaints.

CONCLUSIONS

Two recommendations based on the above-mentioned results are (1) prevention should primarily focus on these most common diagnoses and (2) players resuming soccer activities after an injury should be given special attention to resolve the remaining complaints and to prevent reinjuries.

Epidemiology of injuries in First Division Spanish football

The aim was to examine the injuries sustained by Spanish football players in the First Division and to compare injury-related variables in the context of both competition and training. The injury data were prospectively collected from 16 teams (427 players) using a specific web-based survey during the 2008/2009 season. A total of 1293 injuries were identified (145 were recurring injuries). The overall injury incidence was 5.65 injuries per 1000 h of exposure. Injuries were much more common during competition than during training (43.53 vs. 3.55 injuries per 1000 h of exposure, P < 0.05). Most of the injuries (89.6%) involved the lower extremities, and overuse (65.7%) was the main cause. Muscle and tendon injuries were the most common types of injury (53.8%) among the players. The incidence of training injuries was greater during the pre-season and tended to decrease throughout the season, while the incidence of competition injuries increased throughout the season (all P < 0.05). In conclusion, the results of this study suggest the need for injury prevention protocols in the First Division of the Spanish Football League to reduce the number of overuse injuries in the muscles and tendons in the lower extremities. In addition, special attention should be paid during the pre-season and the competitive phase II (the last four months of the season) in order to prevent training and competition injuries, respectively.

Football injuries in children and adolescent players: are there clues for prevention?

Football (soccer) is the world's most popular sport with most players being younger than 18 years. Playing football can induce beneficial health effects, but there is also a high risk of injury. Therefore, it is necessary to implement measures for preventing injuries. The present review analyzes and summarizes published scientific information on the incidence and characteristics of football injuries in children and adolescent players to arrive at sound conclusions and valid considerations for the development of injury-prevention programs. A literature search was conducted up to November 2012. Fifty-three relevant scientific publications were detected. Thirty-two studies fulfilled the inclusion criteria for pooled analysis. Additional information from the remaining 21 studies was considered where appropriate to obtain a broader perspective on the injury problem in children and youth football. Training injury incidence was nearly constant for players aged 13-19 years, ranging from 1 to 5 injuries per 1,000 h training. Match injury incidence tended to increase with age through all age groups, with an average incidence of about 15 to 20 injuries per 1,000 match hours in players older than 15 years. Between 60 and 90 % of all football injuries were classified as traumatic and about 10-40 % were overuse injuries. Most injuries (60-90 %) were located at the lower extremities with the ankle, knee, and thigh being mostly affected. The frequency of upper-extremity and head/face injuries was higher in those studies that analyzed match injuries only. The most common injury types were strains, sprains, and contusions (10 up to 40 % each). There is some evidence that the risk of traumatic injuries and, in particular, of sustaining a fracture, contusion, or concussion was higher during match play than in practice sessions. Fractures were more frequent in children younger than 15 years than in older players. About half of all time-loss injuries led to an absence from sport of less than 1 week, one third resulted in an absence between 1 and 4 weeks, and 10 to 15 % of all injuries were severe. Separate data for players under the age of 11 years are almost absent. Maturation status seems to have an influence on injury characteristics, although evidence is not conclusive at this time. Three main areas seem to be of particular relevance for future prevention research in young football players: (1) the substantial number of severe contact injuries during matches, (2) the high number of fractures in younger players, and (3) the influence of maturation status and growth spurts.

The effectiveness of preventive programs in decreasing the risk of soccer injuries in Belgium: national trends over a decade

BACKGROUND

Although characterized by a relatively high injury rate, soccer is the world's most popular sport. In Belgium, the national Royal Belgian Football Association involves about 420,000 licensed players, whose injury reports are collected in a nationwide registry. Over a period of 10 years, the association has introduced the Fédération Internationale de Football Association preventive programs and has initiated a stringent postponement policy of competition in case of nonoptimal weather conditions.

HYPOTHESIS

The authors questioned whether these preventive programs effectively decreased the incidence of soccer-related injuries.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The authors compared the incidence, location, timing, and severity of all registered soccer injuries in Belgium during 2 complete seasons separated by a decade (1999-2000 vs 2009-2010).

RESULTS

A total of 56,364 injuries were reported, with an average of 6.8 injuries per 100 players per season. There was a 21.1% reduction in injury rate in the second season (rate ratio = 0.789; 95% confidence interval, 0.776-0.802), predominantly caused by a significant reduction in injuries during the winter period. In both seasons, an injury peak was noted during the first 3 months of the season. Recreational players had a higher risk for injury than national-level players (7.2 vs 4.4 injuries per 100 players per season; rate ratio = 1.64; 95% confidence interval, 1.59-1.69). The relative proportion of severe injuries was higher for female players and male youth players in general.

CONCLUSION

The introduction of injury preventive programs has led to a significant reduction of soccer-related injuries, especially during the winter period. However, there is still room for improvement, and preventive programs can become more effective when specific parameters are targeted, such as adequate conditioning of players in the preseason.

The perceptions of professional soccer players on the risk of injury from competition and training on natural grass and 3rd generation artificial turf

BACKGROUND

The purpose of this study was to describe professional soccer players' perceptions towards injuries, physical recovery and the effect of surface related factors on injury resulting from soccer participation on 3rd generation artificial turf (FT) compared to natural grass (NG).

METHODS

Information was collected through a questionnaire that was completed by 99 professional soccer players from 6 teams competing in Major League Soccer (MLS) during the 2011 season.

RESULTS

The majority (93% and 95%) of the players reported that playing surface type and quality influenced the risk of sustaining an injury. Players believed that playing and training on FT increased the risk of sustaining a non-contact injury as opposed to a contact injury. The players identified three surface related risk factors on FT, which they related to injuries and greater recovery times: 1) Greater surface stiffness 2) Greater surface friction 3) Larger metabolic cost to playing on artificial grounds. Overall, 94% of the players chose FT as the surface most likely to increase the risk of sustaining an injury.

CONCLUSIONS

Players believe that the risk of injury differs according to surface type, and that FT is associated with an increased risk of non-contact injury. Future studies should be designed prospectively to systematically track the perceptions of groups of professional players training and competing on FT and NG.

Residual mechanical effectiveness of external ankle tape before and after competitive professional soccer performance

OBJECTIVE

To evaluate the presupposed preventive residual mechanical effectiveness of the widespread use of adhesive elastic ankle tape after a nonlaboratory, realistic soccer-specific outfield intervention reflecting a soccer halftime.

DESIGN

A prospective nonrandomized test-retest design was used.

SETTING

Laboratory.

PARTICIPANTS

Seventeen professional male outfield players (mean age, 25.5) without any signs of chronic ankle instability.

INTERVENTION

Participants were investigated before and after a 45-minute soccer-specific field intervention.

MAIN OUTCOME MEASURES

The passive inversion range of motion (ROM) of the ankle was tested unloaded on a self-developed inversion device with and without a standardized ankle tape before and after the intervention. Additionally, electromyography signal was taken to assure the inactivity of the protective evertor muscles, and reliability tests for the inversion device (test-retest and trial to trial) were conducted in 12 healthy controls.

RESULTS

Tape restricted the maximum passive inversion ROM of the uninjured ankle significantly to 50.3%. The protection declined nearly completely after 45 minutes of outfield soccer performance to a negligible nonsignificant ROM restriction of 9.7%. Pearson correlation coefficient for the reliability was 0.931 (P ≤ 0.001) for the test-retest and 0.983 (P ≤ 0.001) for the trial-to-trial test.

CONCLUSIONS

The initial significant protection of external ankle-tape support declines almost completely without relevant remaining residual mechanical effect after 45 minutes, reflecting a soccer halftime. The so far presupposed residual mechanical effectiveness of tape to prevent injury is increasingly irrelevant during soccer performance and consequently antidromic to the increasing injury risk toward the end of a soccer halftime.

Injuries among Spanish male amateur soccer players: a retrospective population study

BACKGROUND

Soccer is the most popular sport worldwide, with about 265 million players, both professionals and amateurs. Most research investigating soccer injuries has focused on professional players because they have greater exposure time, but most soccer players are at the recreational level.

PURPOSE

To undertake a retrospective epidemiological study of the injuries sustained in Spanish amateur soccer during the 2010-2011 season.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

Any injuries incurred by the 134,570 recreational soccer players (aged 18-55 years) registered with the Spanish Football Federation were reported to the federation's medical staff. A standardized medical questionnaire, based on the Fédération International de Football Association (FIFA) Medical and Research Centre (F-MARC) consensus for collection procedures in studies of soccer injuries, was used to classify the injury according to type, severity, location, and treatment.

RESULTS

A total of 15,243 injuries were reported, with an average of 0.11 injuries per player and per year. From the total number of injuries, 67.2% were classified as injuries that resulted in time loss, while the remaining 32.7% were injuries that required medical attention. Most injuries led to a minimum of 1 competitive match being missed (87%), and only 2.5% were recurrent injuries. The rate of injuries per 1000 hours of play was double during games (1.15/1000 hours) compared with during training (0.49/1000 hours). From the total number of injuries reported, 7.7% corresponded to goalkeepers, 24.2% to forwards, 33.8% to defenders, and 34.3% to midfielders. The knee (29.9%) and ankle joints (12.4%) were the most common body locations injured, while ligament sprains and ruptures accounted for 32.1% of the total injuries attended. Older amateur players (age ≥30 years) had a greater number of injuries per year and per 1000 hours of play than their younger counterparts.

CONCLUSION

The risk of injury in amateur soccer is lower than that previously reported in professional players. The most common complaints in amateur players are knee ligament injuries. Further research is needed to investigate ways of reducing the incidence of injuries in amateur soccer.

Relative risk for concussions in young female soccer players

The objective of this study was to determine the relative risk and reported symptoms of concussions in 11- to 13-year-old, female soccer players. For this, a survey to compare the reported incidence of concussion in age-matched female soccer players to nonsoccer players was performed. The survey included 342 girls between the ages of 11 and 13: 195 were involved in an organized soccer team and 147 were not involved in organized soccer but were allowed to participate in any other sport or activity. A total of 94 of the 195 soccer players, or 48%, reported at least one symptom consistent with a concussion. The most prevalent symptom for these girls was headache (84%). A total of 34 of the 147 nonsoccer players, or 23%, reported at least one symptom consistent with a concussion in the previous six months. These results determined that the relative risk of probable concussions among 11- to 13-year-old, female soccer players is 2.09 (p < .001, α = .05, CI = 95%). This demonstrates that the relative risk of probable concussions in young female soccer players is significantly higher than in a control group of nonsoccer players of the same sex and age.

Soccer-specific warm-up and lower extremity injury rates in collegiate male soccer players

CONTEXT

A number of comprehensive injury-prevention programs have demonstrated injury risk-reduction effects but have had limited adoption across athletic settings. This may be due to program noncompliance, minimal exercise supervision, lack of exercise progression, and sport specificity. A soccer-specific program described as the F-MARC 11+ was developed by an expert group in association with the Federation Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC) to require minimal equipment and implementation as part of regular soccer training. The F-MARC 11+ has been shown to reduce injury risk in youth female soccer players but has not been evaluated in an American male collegiate population.

OBJECTIVE

To investigate the effects of a soccer-specific warm-up program (F-MARC 11+) on lower extremity injury incidence in male collegiate soccer players.

DESIGN

Cohort study.

SETTING

One American collegiate soccer team followed for 2 seasons.

PATIENTS OR OTHER PARTICIPANTS

Forty-one male collegiate athletes aged 18-25 years.

INTERVENTION(S)

The F-MARC 11+ program is a comprehensive warm-up program targeting muscular strength, body kinesthetic awareness, and neuromuscular control during static and dynamic movements. Training sessions and program progression were monitored by a certified athletic trainer.

MAIN OUTCOME MEASURE(S)

Lower extremity injury risk and time lost to lower extremity injury.

RESULTS

The injury rate in the referent season was 8.1 injuries per 1000 exposures with 291 days lost and 2.2 injuries per 1000 exposures and 52 days lost in the intervention season. The intervention season had reductions in the relative risk (RR) of lower extremity injury of 72% (RR = 0.28, 95% confidence interval = 0.09, 0.85) and time lost to lower extremity injury (P < .01).

CONCLUSIONS

This F-MARC 11+ program reduced overall risk and severity of lower extremity injury compared with controls in collegiate-aged male soccer athletes.

How effective are exercise-based injury prevention programmes for soccer players? : A systematic review

BACKGROUND

The incidence of soccer (football) injuries is among the highest in sports. Despite this high rate, insufficient evidence is available on the efficacy of preventive training programmes on injury incidence.

OBJECTIVE

To systematically study the evidence on preventive exercise-based training programmes to reduce the incidence of injuries in soccer.

DATA SOURCES

The databases EMBASE/MEDLINE, PubMed, CINAHL, Cochrane Central Register of controlled trials, PEDro and SPORTDiscus™ were searched for relevant articles, from inception until 20 December 2011. The methodological quality of the included studies was assessed using the PEDro scale.

STUDY SELECTION

The inclusion criteria for this review were (1) randomized controlled trials or controlled clinical trials; (2) primary outcome of the study is the number of soccer injuries and/or injury incidence; (3) intervention focusing on a preventive training programme, including a set of exercises aimed at improving strength, coordination, flexibility or agility; and (4) study sample of soccer players (no restrictions as to level of play, age or sex). The exclusion criteria were: (1) the article was not available as full text; (2) the article was not published in English, German or Dutch; and (3) the trial and/or training programme relates only to specific injuries and/or specific joints. To compare the effects of the different interventions, we calculated the incidence risk ratio (IRR) for each study.

RESULTS

Six studies involving a total of 6,099 participants met the inclusion criteria. The results of the included studies were contradictory. Two of the six studies (one of high and one of moderate quality) reported a statistical significant reduction in terms of their primary outcome, i.e. injuries overall. Four of the six studies described an overall preventive effect (IRR<1), although the effect of one study was not statistically significant. The three studies that described a significant preventive effect were of high, moderate and low quality.

CONCLUSIONS

Conflicting evidence has been found for the effectiveness of exercise-based programmes to prevent soccer injuries. Some reasons for the contradictory findings could be different study samples (in terms of sex and soccer type) in the included studies, differences between the intervention programmes implemented (in terms of content, training frequency and duration) and compliance with the programme. High-quality studies investigating the best type and intensity of exercises in a generic training programme are needed to reduce the incidence of injuries in soccer effectively.

Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries

Background

Categorical grading and other measurable MRI parameters are frequently utilised for predicting the outcome of hamstring injuries. However, the reliability and smallest detectable difference (SDD) have not been previously evaluated. It therefore remains unclear if the variability in previously reported results reflects reporting variation or actual injury status.

Methods

25 hamstring injuries were scored by two experienced radiologists using the Peetrons grading and specific prognostic MRI parameters: distance from ischial tuberosity (cm), extent (cranio to caudal, anterior to posterior, medial to lateral; (cm)), maximum cross-sectional area (%), volume (cm³) of the oedema. The interobserver and intraobserver reliability was calculated along with the SDDs for each scale variable.

Results

There were 3 Grade 0 (12%), 11 grade 1 (44%), 9 grade 2 (36%) and 2 grade 3 (8%) injuries. Cronbach's α values for grading were 1.00 (inter) and 0.96 (intra), respectively. The intraclass correlation coefficients for the prognostic MRI parameters were between 0.77 and 1.0. The SDDs varied between each parameter.

Conclusions

Excellent interobserver and intraobserver reliability was found for grading and prognostic MRI parameters in acute hamstring injuries. In daily practice and research, we can be confident that scoring hamstring injuries by experienced radiologists is reproducible. The documented SDDs allow meaningful clinical inferences to be made when assessing observed and reported changes in MRI status.

The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care

Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

Implementation of the FIFA 11+ football warm up program: how to approach and convince the Football associations to invest in prevention

In the last decade, injury prevention has received a lot of attention in sports medicine, and recently international sports-governing bodies, such as the International Olympic Committee, declared the protection of the athletes' health as one of their major objectives. In 1994, the Fédération Internationale de Football Association (FIFA) established its Medical Assessment and Research Centre (F-MARC) with the aim 'to prevent football injuries and to promote football as a health-enhancing leisure activity, improving social behaviour'. Since then, FIFA has developed and evaluated its injury-prevention programmes 'The 11' and 'FIFA 11+' have demonstrated in several scientific studies how simple exercise-based programmes can decrease the incidence of injuries in amateur football players. This paper summarises 18 years of scientific and on-field work in injury prevention by an international sports federation (FIFA), from formulating the aim to make its sport safer to the worldwide dissemination of its injury-prevention programme in amateur football.

The hypertrophy of the lateral abdominal wall and quadratus lumborum is sport-specific: an MRI segmental study in professional tennis and soccer players

The aim was to determine the volume and degree of asymmetry of quadratus lumborum (QL), obliques, and transversus abdominis; the last two considered conjointly (OT), in tennis and soccer players. The volume of QL and OT was determined using magnetic resonance imaging in professional tennis and soccer players, and in non-active controls (n = 8, 14, and 6, respectively). In tennis players the hypertrophy of OT was limited to proximal segments (cephalic segments), while in soccer players it was similar along longitudinal axis. In tennis players the hypertrophy was asymmetric (18% greater volume in the non-dominant than in the dominant OT, p = 0.001), while in soccer players and controls both sides had similar volumes (p > 0.05). In controls, the non-dominant QL was 15% greater than that of the dominant (p = 0.049). Tennis and soccer players had similar volumes in both sides of QL. Tennis alters the dominant-to-non-dominant balance in the muscle volume of the lateral abdominal wall. In tennis the hypertrophy is limited to proximal segments and is greater in the non-dominant side. Soccer, however, is associated to a symmetric hypertrophy of the lateral abdominal wall. Tennis and soccer elicit an asymmetric hypertrophy of QL.

Physiological and performance responses to the FIFA 11+ (part 2): a randomised controlled trial on the training effects

The aim of this study was to examine the training effects of an injury prevention programme on neuromuscular control, strength and performance in male amateur football players. Eighty-one players were allocated to the "FIFA 11+" (n = 42) or a control group (CON, n = 39). The "FIFA 11+" group performed the programme 3 times a week for 9 weeks; the control group completed the usual warm-up. Primary outcomes were: time-to-stabilisation test and eccentric/concentric flexors strength. Secondary outcomes were: eccentric/concentric extensors strength, star excursion balance test, core-stability test, vertical jump, sprint, and agility. After controlling for covariates, significant between-group differences after the intervention (in favour of the "FIFA 11+" players) were found for time-to-stabilisation (-2.8%, 90% confidence interval [CI] -4.4 to -1.2%) and core-stability (-8.9%, -14.6 to -3.1%). Differences were also found for eccentric (3.8%, 1.4 to 6.2%) and concentric flexors strength (3.2%, 0.6 to 5.9%) at 60° · s(-1) but this difference was only possibly meaningful (62.4%) from a practical point of view. No substantial and/or significant differences were found for the other outcomes. Performing "FIFA 11+" for 9 weeks can improve neuromuscular control. Possible worthwhile differences were found for flexors strength but there were no substantial effects in the other performance measures.

Upper extremity injuries in male elite football players

PURPOSE

To investigate the epidemiology of upper extremity injuries in male elite football players and to describe their characteristics, incidence and lay-off times.

METHODS

Between 2001 and 2011, 57 male European elite football teams (2,914 players and 6,215 player seasons) were followed prospectively. Time-loss injuries and exposure to training and matches were recorded on individual basis.

RESULTS

In total, 11,750 injuries were recorded, 355 (3 %) of those affected the upper extremities giving an incidence of 0.23 injuries/1,000 h of football. The incidence in match play was almost 7 times higher than in training (0.83 vs. 0.12 injuries/1,000 h, rate ratio 6.7, 95 % confidence interval 5.5-8.3). As much as 32 % of traumatic match injuries occurred as a result of foul play situations. Goalkeepers had a significantly higher incidence of upper extremity injuries compared to outfield players (0.80 vs. 0.16 injuries/1,000 h, rate ratio 5.0, 95 % confidence interval 4.0-6.2). The average absence due to an upper extremity injury was 23 ± 34 days.

CONCLUSIONS

Upper extremity injuries are uncommon among male elite football players. Goalkeepers, however, are prone to upper extremity injury, with a five times higher incidence compared to outfield players.

LEVEL OF EVIDENCE

II.

The health profile of professional soccer players: future opportunities for injury prevention

Injuries are a major adverse event during a soccer player's career; they require medical and surgical treatment and rehabilitation and thus may interrupt the player's activity, often with severe physical and psychological sequel. Specialists have tried to identify the risk factors for injuries, in an attempt to discover predictors that could be prevented and or eliminated before the injury occurs, but the results are scarce. This article reviews the epidemiology of the frequency and occurrence of injuries in Italian soccer players, reports a list of preventable risk factors that are associated with injuries, and identifies preventable risk factors. We have identified personal factors (age, previous traumatic events, physical and biological characteristics of the player, life style habits such as smoking, alcohol, and diet, changes in physical-athletic aspects of the players, such as increased muscle strength, and use of medications) as possible risk factors for injuries. However, environmental factors such as changes in training techniques, field composition, and shoes structure may also have a major influence. This summary indicates that appropriate preventive measures can be undertaken to prevent injuries in professional soccer players. Professionals who are in close contacts with the players should be informed of the predictors of injuries and should be trained to intervene and plan appropriate preventive measures.

Evolution of World Cup soccer final games 1966-2010: game structure, speed and play patterns

OBJECTIVES

There are relatively few performance analysis studies on field sports investigating how they evolve from a structural or tactical viewpoint. Field sports like soccer involve complex, non-linear dynamical systems yet consistent patterns of play are recognisable over time and among different sports. This study on soccer trends helps build a framework of potential causative mechanisms for these patterns.

DESIGN

Retrospective correlational study.

METHODS

Broadcast footage of World Cup finals between 1966 and 2010 was used to assess patterns of play and stop periods, type and duration of game stoppages, ball speed, player density (congestion) and passing rates. This involved computer-based ball tracking and other notational analyses. These results were analysed using linear regression to track changes across time.

RESULTS

Almost every variable assessed changed significantly over time. Play duration decreased while stoppage duration increased, both affecting the work: recovery ratios. Ball (game) speed increased by 15% over the 44-year period. Play structure changed towards a higher player density with a 35% greater passing rate.

CONCLUSIONS

Increases in soccer ball speed and player density show similarities with other field sports and suggest common evolutionary pressures may be driving play structures. The increased intensity of play is paralleled by longer stoppage breaks which allow greater player recovery and subsequently more intense play. Defensive strategies dominate over time as demonstrated by increased player density and congestion. The long-term pattern formations demonstrate successful coordinated states within team structures are predictable and may have universal causative mechanisms.

The effects of exertion on the postural stability in young soccer players

OBJECTIVE

: Analyze the effects of physical exertion during a soccer match on the functional capacity and stability of the lower limbs of young soccer players.

METHODS

: We analyzed 10 soccer players who underwent functional capacity assessment of the lower limbs by a Hop Test protocol and evaluation of the level of postural stability in the Biodex Stability System (Biodex, Inc., Shirley, NY) before and immediately after a friendly game lasting 45 minutes.

RESULTS

: After the match, there was a decrease in overall stability index (F_(1,23) = 7.29 P = .024) and anterior posterior index (APSI) (F_(1,23) = 5.53 P = .043). Fatigue in the dominant limb was responsible for the significant deficit in OSI (F_(1,23) = 3.16, P = .047) and APSI (F_(1,23) = 3:49, P = .029), while the non-dominant limb did not cause any change in the pre and post-game.

CONCLUSION

: A football match can cause decreased stability and functional capacity of the lower limbs in young players. Level of Evidence III, Pre-test and Post-test Study (Case-control).

Epidemiological Study on Professional Football Injuries During the 2011 Copa America, Argentina

OBJECTIVE

Develop an epidemiological study of injuries occurred among male professional football players during the Copa America 2011, held in Argentina.

METHODS

We conducted a retrospective study of injuries sustained during the 43rd edition of the Copa America football in Argentina, in 2011. The lesions were evaluated by the medical department of the selections and reported to the CONMEBOL. The data were compiled and reported in accordance with rules established by the FIFA Medical Assessment and Research Centre (F-MARC) in 2005.

RESULTS

There was a higher prevalence of lesions in the lower limbs. Thighs and knees were the most affected segments. The most frequent diagnoses were muscle injuries. The injuries were mostly minor degrees of severity and there was little difference in the prevalence of lesions according to the stages of the match, with slight predominance in the final 15 minutes. The incidence of lesions per 1,000 game hours was similar to the average found in the literature.

CONCLUSIONS

The results obtained allowed us to outline a profile of the prevalence, distribution per body segment, minute in which occurred and severity of injuries in professional football players of participating teams in the Copa America 2011 in Argentina. The extreme rigor of referees may be partly attributed to the highly competitive nature of international tournaments. However, this results cannot be considered definitive because of the need to be compared to other epidemiological studies with same design using similar concepts and criteria.

Injuries in Portuguese youth soccer players during training and match play

CONTEXT

Epidemiologic information on the incidence of youth soccer injuries in southern Europe is limited.

OBJECTIVE

To compare the incidence, type, location, and severity of injuries sustained by male subelite youth soccer players over the 2008-2009 season.

DESIGN

Descriptive epidemiology study.

SETTING

Twenty-eight Portuguese male youth soccer teams.

PATIENTS OR OTHER PARTICIPANTS

A total of 674 youth male subelite soccer players in 4 age groups: 179 U-13 (age range, 11-12 years), 169 U-15 (age range, 13-14 years), 165 U-17 (age range, 15-16 years), and 161 U-19 (age range, 17-18 years).

MAIN OUTCOME MEASURE(S)

Injuries that led to participation time missed from training and match play prospectively reported by medical or coaching staff of the clubs.

RESULTS

In total, 199 injuries reported in 191 players accounted for 14.6 ± 13.0 days of absence from practice. The incidence was 1.2 injuries per 1000 hours of exposure to soccer (95% confidence interval [CI] = 0.8, 1.6), with a 4.2-fold higher incidence during match play (4.7 injuries per 1000 hours of exposure; 95% CI = 3.0, 6.5) than during training (0.9 injuries per 1000 hours of exposure; 95% CI = 0.6, 1.3) (F₁,₆₇₃ = 17.592, P < .001). The overall incidence of injury did not increase with age (F₁,₆₇₃ = 1.299,P = .30), and the incidence of injury during matches (F₁,₆₇₃ = 2.037, P = .14) and training (F₁,₆₇₃ = 0.927, P = .44) did not differ among age groups. Collisions accounted for 57% (n = 113) of all injuries, but participation time missed due to traumatic injury did not differ among age groups (F₃,₁₁₀ = 1.044, P = .38). Most injuries (86%, n = 172) involved the lower extremity. The thigh was the most affected region (30%, n = 60) in all age groups. Muscle strains were the most common injuries among the U-19 (34%, n = 26), U-17 (30%, n = 17), and U-15 (34%, n = 14) age groups, whereas contusions and tendon injuries were the most common injuries in U-13 players (both 32%, n = 8). The relative risk of injury slightly increased with the age of the competitors.

CONCLUSIONS

The higher incidence of injury during matches than training highlights the need for education and prevention programs in youth soccer. These programs should focus on coach education aimed at improving skills, techniques, and fair play during competitions with the goal of reducing injuries.

The effects of one-half of a soccer match on the postural stability and functional capacity of the lower limbs in young soccer players

OBJECTIVE

Most injuries occur during the final 15 minutes of each half of a soccer match, suggesting that physical exertion may influence changes in neuromuscular control and the body's ability to stabilize the joints of the lower extremities. The aim of this study was to analyze the effects of one-half of a soccer match on the functional capacity and stability of the lower limbs in young soccer players.

METHODS

We analyzed 27 soccer players by evaluating the functional capacity of their lower limbs using the hop test protocol and their level of postural stability using the Biodex Stability System. The evaluations were performed before and after 45 minutes of game time.

RESULTS

After the match, there was a decrease in the overall stability index (OSI) (F(1,23) = 5.64, p = 0.026) and the anterior-posterior stability index (APSI) (F(1,23) = 5.24,p = 0.032). In the single and triple hop tests, there was a higher functional capacity in the dominant limb compared to the non dominant limb in the pre- and post-game comparisons.

CONCLUSION

The results of this study show that there is a decrease in the stability of the lower limbs in young soccer players after a 45 minutes soccer match, but the same result was not found for the functional capacity.

Return to play in athletes following ankle injuries

BACKGROUND

The decision to return to play following an ankle injury is a multifactorial process involving both physical and psychological parameters. The current body of literature lacks evidence-based guidelines to assist in the decision.

OBJECTIVE

THIS ARTICLE REVIEWS THE EVIDENCE TO SUPPORT SUCH TESTING: the dorsiflexion lunge test, star excursion balance test, agility T-test, and sargent/vertical jump test. The importance of psychological factors is also highlighted.

EVIDENCE ACQUISITION

The primary literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms "ankle AND injury" and the following limits activated: English language. A secondary search was then conducted with the search terms "return to play" and "sport injuries and return to play."

RESULTS

Various functional tests have been used to determine whether a patient is able to return to play following an ankle injury. This study documented four tests that have been used to assess range of motion, balance and proprioception, agility and strength and the reasoning as to why these tests are used.

CONCLUSIONS

Functional testing provides objective measures for gauging an athlete's progression through the rehabilitation process. Testing balance and proprioception, strength, range of motion, and agility coupled with psychological assessment evaluates readiness for return to play.

Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial

Background

The incidence rate of soccer injuries is among the highest in sports, particularly for adult male soccer players.

Purpose

To investigate the effect of the ‘The11’ injury prevention programme on injury incidence and injury severity in adult male amateur soccer players.

Study design

Cluster-randomised controlled trial.

Methods

Teams from two high-level amateur soccer competitions were randomly assigned to an intervention (n=11 teams, 223 players) or control group (n=12 teams, 233 players). The intervention group was instructed to perform The11 in each practice session during one soccer season. The11 focuses on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilisation and plyometrics with straight leg alignment. All participants of the control group continued their practice sessions as usual.

Results

In total, 427 injuries were recorded, affecting 274 of 456 players (60.1%). Compliance with the intervention programme was good (team compliance=73%, player compliance=71%). Contrary to the hypothesis, injury incidences were almost equal between the two study groups: 9.6 per 1000 sports hours (8.4–11.0) for the intervention group and 9.7 (8.5–11.1) for the control group. No significant differences were found in injury severity, but a significant difference was observed in the location of the injuries: players in the intervention group sustained significantly less knee injuries.

Conclusions

This study did not find significant differences in the overall injury incidence or injury severity between the intervention and control group of adult male soccer players. More research is recommended, focusing on injury aetiology and risk factors in adult male amateur soccer players.

Risk factors for hamstring injuries in male soccer players: a systematic review of prospective studies

Hamstring injuries are common injuries in soccer players. In view of the high incidence and the serious consequences, identifying risk factors related to hamstring injuries is essential. The aim of this systematic review was therefore to identify risk factors for hamstring injuries in male adult soccer players. PubMed, Embase/Medline, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus were systematically searched, and prospective studies investigating risk factors for hamstring injuries in adult male soccer players were included. The methodological quality of the included articles was assessed using a standardized set of predefined criteria. Seven of the 11 studies identified, involving a total of 1775 players and 344 hamstring injuries, met the inclusion criteria. All but one of the included studies met at least five of nine methodological criteria, causing them to be qualified as 'high quality'. The included studies used univariate as well as multivariate analyses to identify risk factors for hamstring injury. The results from the multivariate analyses suggest that previous hamstring injury is most strongly related to hamstring injury. Conflicting evidence is found for age and hamstring length or flexibility as risk factors for the occurrence of hamstring injuries.