Injuries among male and female elite football players

The UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play

BACKGROUND

Medial collateral ligament (MCL) injury is the most common knee ligament injury in professional football.

AIM

To investigate the rate and circumstances of MCL injuries and development over the past decade.

METHODS

Prospective cohort study, in which 27 professional European teams were followed over 11 seasons (2001/2002 to 2011/2012). Team medical staffs recorded player exposure and time loss injuries. MCL injuries were classified into four severity categories. Injury rate was defined as the number of injuries per 1000 player-hours.

RESULTS

346 MCL injuries occurred during 1 057 201 h (rate 0.33/1000 h). The match injury rate was nine times higher than the training injury rate (1.31 vs 0.14/1000 h, rate ratio 9.3, 95% CI 7.5 to 11.6, p<0.001). There was a significant average annual decrease of approximately 7% (p=0.023). The average lay-off was 23 days, and there was no difference in median lay-off between index injuries and reinjuries (18 vs 13, p=0.20). Almost 70% of all MCL injuries were contact-related, and there was no difference in median lay-off between contact and non-contact injuries (16 vs 16, p=0.74).

CONCLUSIONS

This largest series of MCL injuries in professional football suggests that the time loss from football for MCL injury is 23 days. Also, the MCL injury rate decreased significantly during the 11-year study period.

EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries

INTRODUCTION

Exercise programmes are used in the prevention and treatment of adductor-related groin injuries in soccer; however, there is a lack of knowledge concerning the intensity of frequently used exercises.

OBJECTIVE

Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals.

MATERIALS AND METHODS

40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises.

RESULTS

There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p<0.0001). There was a significant difference between legs in three of the eight exercises (35-48%, p<0.0001). The peak nEMG results for the gluteals and the abdominals showed relatively low values (5-48% nEMG, p<0.001).

CONCLUSIONS

Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes.

Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster-randomised trial

QUESTION

Is an injury prevention program consisting of 10 exercises designed to improve stability, muscle strength, co-ordination, and flexibility of the trunk, hip and leg muscles (known as The11) cost effective in adult male amateur soccer players?

DESIGN

Cost-effectiveness analysis of a cluster-randomised controlled trial.

PARTICIPANTS

479 adult male amateur soccer players aged 18-40 years.

INTERVENTION

The intervention group was instructed to perform the exercises at each training session (2 to 3 sessions per week) during one soccer season. The exercises focus on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilisation, and plyometrics with straight leg alignment. The control group continued their usual warm-up.

OUTCOME MEASURES

All injuries and costs associated with these injuries were compared between groups after bootstrapping (5000 replications).

RESULTS

No significant differences in the proportion of injured players and injury rate were found between the two groups. Mean overall costs in the intervention group were €161 (SD 447) per athlete and €256 (SD 555) per injured athlete. Mean overall costs in the control group were €361 (SD 1529) per athlete and €606 (SD 1944) per injured athlete. Statistically significant cost differences in favour of the intervention group were found per player (mean difference €201, 95% CI 15 to 426) and per injured player (mean difference €350, 95% CI 51 to 733).

CONCLUSIONS

The exercises failed to significantly reduce the number of injuries in male amateur soccer players within one season, but did significantly reduce injury-related costs. The cost savings might be the result of a preventive effect on knee injuries, which often have substantial costs due to lengthy rehabilitation and lost productivity.

TRIAL REGISTRATION

NTR2416.

Video analysis of situations with a high-risk for injury in Norwegian male professional football; a comparison between 2000 and 2010

BACKGROUND

A recent study from Norwegian male professional football found that the risk of acute match injuries increased from 2002 to 2007.

OBJECTIVE

To compare the incidence of incidents with a propensity for injury, from the 2000 season to the 2010 season in Norwegian male professional football using video analysis.

METHODS

We conducted a video analysis of incidents in Norwegian professional football. An incident was recorded if the match was interrupted by the referee, and the player lay down for more than 15 s, and appeared to be in pain or received medical treatment. We also conducted a video analysis of all player-to-player contact situations occurring during 30 randomly selected matches.

RESULTS

A total of 1287 incidents were identified during the two seasons. The corresponding rate of incidents was 74.4 (95% CI 67.3 to 81.5) in the 2000 season and 109.6 (95% CI 102.3 to 116.9) in the 2010 season, a significant increase from 2000 to 2010 (rate ratio 1.47, 95% CI 1.31 to 1.66). We observed a significantly higher rate of opponent-to-player contact and non-contact incidents in the 2010 season, but no change in the proportion of fouls or sanctions awarded by the referee. The rate of player-to-player contact situations in both heading and tackling duels was lower during the 2010 season.

CONCLUSIONS

We found an increased rate of non-contact and opponent-to-player contact incidents in both heading and tackling duels in the 2010 season compared with 10 years earlier, even if there was no increase in the frequency of player-to-player contact situations.

Terminology and classification of muscle injuries in sport: the Munich consensus statement

Objective

To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies.

Methods

Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system.

Results

The response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub)total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type.

Conclusions

A consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature.

What are the new things

Consensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries.

Level of evidence

Expert opinion, Level V.

Incidence of injury in Gaelic football: a 4-year prospective study

BACKGROUND

Gaelic football is a national sport of Ireland. While predominantly played in Ireland, it is recognized in North America, the United Kingdom, Europe, and Australasia. Its high-velocity, multidirectional, and high physical contact elements expose players to a risk of injury. To date, prospective injury data for Gaelic football has been of short duration.

PURPOSE

To describe the incidence and nature of sport-related injuries in elite male Gaelic football players over 4 consecutive seasons.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Over the period 2007 to 2010, a total of 851 Gaelic football players were tracked. Players were members of county-level teams who volunteered to be included in the study. Team injury, training, and match play data were submitted by the team physiotherapist on a weekly basis through a dedicated web portal to the National Gaelic Athletic Association (GAA) injury database. Injury was defined using a time loss criterion, in accordance with consensus statements in sports applicable to Gaelic games.

RESULTS

A total of 1014 Gaelic football injuries were recorded. Incidence of injury was 4.05 per 1000 hours of football training. Match-play injury rates were 61.86 per 1000 hours. Muscle was the most frequently injured tissue (42.6%) and fractures accounted for 4.4% of Gaelic football injuries. Lower extremity injuries predominated (76.0%). Hamstring injuries were the single most common injury overall, representing almost one quarter (24%) of all injuries and over half of muscle injuries. Anterior cruciate ligament (ACL) injuries accounted for 13% of knee injuries. The majority of injuries were defined as new injuries (74.7%), with recurrent injuries constituting 23% of all injuries. The majority (59%) of match play injuries occurred in the second half of the match. Eighty six percent of injuries caused over one week's absence from play.

CONCLUSION

These findings illustrate injury patterns in Gaelic football using a prospective methodology, over 4 consecutive seasons. Comparison with published literature suggests that Gaelic football match play injury risk is greater than soccer but less than rugby union.

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.

Prevalência de lesões em atletas do futsal feminino brasileiro: um estudo retrospectivo

INTRODUÇÃO: O futsal vem se destacando no cenário internacional como uma das modalidades em maior ascensão. Na literatura, são escassos os estudos que relatam as lesões no gênero feminino nesta modalidade. OBJETIVO: O objetivo deste estudo foi identificar a prevalência de lesões em atletas do futsal feminino brasileiro. MÉTODOS: A amostra correspondeu às atletas que participaram da Liga Nacional de Futsal 2011, totalizando 135 atletas. Investigou-se a prevalência de lesões apresentadas durante toda a temporada de 2010. RESULTADOS: Das 135 atletas, 73 (54,1%) apresentaram algum tipo de lesão, sendo identificados 104 traumas. As lesões nos membros inferiores corresponderam a 86,5% do total, com 28,9% (n = 30) no tornozelo, 24% (n = 25) na coxa e o joelho correspondeu a 23,1% (n = 24). Quanto à forma, 51,9% (n = 54) ocorreram sem contato e 46,1% (n = 48) por contato direto. Durante o treinamento técnico/tático ou treinamento físico ocorreram 59,6% das lesões (n = 62) e 40,4% (n = 42), durante os jogos. Das lesões, 58,6% ocorreram pela primeira vez e 40,4% são recidivas. Não foi encontrada associação entre acompanhamento fisioterapêutico em treinos e competições, com o número e a gravidade das lesões. Também não há relação com o membro dominante e o hemicorpo do trauma. CONCLUSÕES: As atletas do futsal feminino brasileiro apresentam grande prevalência de lesões, principalmente no tornozelo, coxa e joelho, sendo que a maioria delas ocorre nos treinamentos. Lesões que acontecem sem contato com outro adversário prevaleceram em relação aos traumas com contato, fato que se opõe aos demais achados da literatura. O número de primeiras lesões foi maior em relação às recidivas e, quanto à gravidade, prevaleceram as lesões moderadas. Para minimizar o número de lesões, são necessárias estratégias específicas de prevenção, enfatizando os segmentos do tornozelo, joelho e coxa.

Rehabilitation after Articular Cartilage Repair of the Knee in the Football (Soccer) Player

BACKGROUND

Participation in football can put both male and female players at an increased risk for knee osteoarthritis. There is a higher prevalence of focal chondral defects in the knee of athletes compared to nonathletes. The management of chondral defects in the football player is complex and multifactorial.

OBJECTIVE

The aim of this study is to provide an overview of the current strategies for rehabilitation after articular cartilage repair of the knee in the football player.

DESIGN

A review of current literature and the scientific evidence for rehabilitation after articular cartilage repair of the knee.

CONCLUSIONS

Articular cartilage repair has been shown to allow return to sport but rehabilitation timescales are lengthy. Successful rehabilitation for a return to football after articular cartilage repair of the knee requires the player to be able to accept the load of the sport. This necessitates a multidisciplinary approach to rehabilitation, especially in the transition from therapy to performance care. It should be recognized that not all players will return to football after articular cartilage repair. The evidence base for rehabilitative practice after articular cartilage repair is increasing but remains sparse in areas.

Subsequent injury definition, classification, and consequence

OBJECTIVE

To examine if different definitions of "recurrent injury" affect the distribution of subsequent injury types and their consequences.

DESIGN

Secondary analysis of prospective injury data.

SETTING

Circus shows.

PARTICIPANTS

Circus artists (n = 1281).

MAIN OUTCOME MEASURES

A subsequent injury after an index injury was categorized as (1) new injury: different location; (2) local injury: same location, different type; and (3) recurrent injury: same location/type. Subsequent injuries were stratified according to when they occurred after the index injury: early (≤90 performances), late (91-540 performances), and delayed (>540 performances). "Healed injury" was either date of return to full participation (RTP) or last treatment.

RESULTS

Eight hundred twenty-one artists (64%) incurred 2 medical attention injuries, and 296 artists (23%) incurred 2 time loss injuries. In both medical attention and time loss injuries, recurrent (range, 7.5%-8.3%) and local injuries (range, 4%-7%) occurred less frequently than subsequent new injuries (range, 81%-87%). Time loss injuries recurred later than medical attention injuries. The pattern of early, late, and delayed injuries was similar for new, local, and recurrent injuries. A greater number of "early" injuries are seen with the treatment definition compared with RTP. Subsequent injuries had similar number of treatments and missed performances (consequences) as index injuries.

CONCLUSIONS

In our data, there were a greater number of local and recurrent time loss injuries compared with medical attention injuries, but the injury definition did not affect the relative number of early, late, or delayed injuries. Recurrent injuries are an important component of injury prevention, and clear definitions when presenting recurrent injury data are necessary.

Epidemiology of patellar tendinopathy in elite male soccer players

BACKGROUND

Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described.

PURPOSE

This study was undertaken to investigate and describe the epidemiology of patellar tendinopathy in elite male soccer players and evaluate potential risk factors.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Between 2001 and 2009, the authors followed 51 European elite soccer clubs (2229 players) from 3 different cohorts: the Swedish First League cohort (SWE) and Union of European Football Associations (UEFA) Champions League cohort (UCL), both playing on natural grass; and the Artifical Turf cohort (ART), playing on third-generation artificial turf. Individual player exposure in training and matches and time-loss injuries were recorded.

RESULTS

In total, 137 patellar tendinopathies were recorded, comprising 1.5% of all injuries and corresponding to an incidence of 0.12 injuries/1000 hours. Each season, 2.4% of players were affected, with most injuries (61%) resulting in absence up to 1 week or less. Twenty percent of tendinopathies were recurrent complaints. No significant difference in season prevalence (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.60-1.44; P = .74) or incidence (rate ratio [RR] 1.20; 95% CI, 0.82-1.75; P = .36) was observed between teams playing on artificial turf and natural grass, respectively. Multivariate logistic regression showed that a high total exposure hours (OR, 1.02 per 10-hour increase; 95% CI, 1.00-1.04; P = .033) was a significant risk factor for patellar tendinopathy, and increased body mass was borderline significant (OR, 1.15 per 5-kg increase; 95% CI, 1.00-1.33; P = .055). In addition, 2 acute partial tendon ruptures were recorded, but no total rupture.

CONCLUSION

Although mainly mild in nature, patellar tendinopathy is a fairly common condition in elite soccer and the recurrence rate is high. Exposure to artificial turf did not increase the prevalence or incidence of injury. High total amount of exposure was identified as a risk factor for patellar tendinopathy.

Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports

PURPOSE

Groin injuries and chronic pain are relatively common in soccer and other contact sports. Our aim was to define the gender-related frequency of both acute and chronic groin injuries in soccer compared to non-contact endurance sports.

METHODS

A 12-month study of 613 professional athletes was conducted in 2006. Premier league soccer players (77 males and 90 females) answered retrospectively 70 multi-choice questions of sport injuries. Factors related to groin injuries were compared with corresponding data of elite-level swimmers (n = 154), long-distance runners (n = 143) and cross-country skiers (n = 149).

RESULTS

In soccer, 125/167 players had 375 injuries (274 acute and 101 overuse injuries) and the number of acute injuries were 146/274 (53%) in males and 128/274 (47%) in females (p = 0.368). Acute groin injury was reported in 15/167 (9.0%) of elite soccer players compared to 3/154 (2.0%) in swimmers (p = 0.006) and 1.4% in both long-distance running (n = 2) and skiing (n = 2, p = 0.003). Male soccer players had acute groin injuries nearly three times more frequently than females. Chronic persistent groin pain was found in only one male and two female soccer players and no athletes in endurance sports.

CONCLUSIONS

Almost every tenth soccer player had an acute groin injury. Long-standing groin pain was not frequent in soccer and it was not found in non-contact endurance sport at the elite-level.

Anterior cruciate ligament injury in elite football: a prospective three-cohort study

Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.

The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective

Football (soccer), the most popular sport worldwide, is associated with a high injury risk, and the knee joint is often affected. Several studies have found female players to be more susceptible to knee injury, anterior cruciate ligament (ACL) injury in particular, compared to their male counterparts. There is, however, some controversy regarding the magnitude of this risk increase and a few studies have found no differences. The influence of age and activity type on gender-related differences in injury risk is only scarcely investigated. In this paper, the literature reporting gender-specific ACL injury risk in football is reviewed. A literature search yielded 33 relevant articles that were included for review. These show that female players have a 2-3 times higher ACL injury risk compared to their male counterparts. Females also tend to sustain their ACL injury at a younger age than males, and a limiting factor in the existing literature is that age is not adjusted for in comparisons of ACL injury risk between genders. Furthermore, the risk increase in females is primarily evident during match play, but type of exposure is also rarely adjusted for. Finally, the studies included in this review share important methodological limitations that are discussed as a starting point for future research in the field.

Comparison of injuries sustained on artificial turf and grass by male and female elite football players

The objective of this study was to compare incidences and patterns of injury for female and male elite teams when playing football on artificial turf and grass. Twenty teams (15 male, 5 female) playing home matches on third-generation artificial turf were followed prospectively; their injury risk when playing on artificial turf pitches was compared with the risk when playing on grass. Individual exposure, injuries (time loss) and injury severity were recorded by the team medical staff. In total, 2105 injuries were recorded during 246,000 h of exposure to football. Seventy-one percent of the injuries were traumatic and 29% overuse injuries. There were no significant differences in the nature of overuse injuries recorded on artificial turf and grass for either men or women. The incidence (injuries/1000 player-hours) of acute (traumatic) injuries did not differ significantly between artificial turf and grass, for men (match 22.4 v 21.7; RR 1.0 (95% CI 0.9-1.2); training 3.5 v 3.5; RR 1.0 (0.8-1.2)) or women [match 14.9 v 12.5; RR 1.2 (0.8-1.8); training 2.9 v 2.8; RR 1.0 (0.6-1.7)]. During matches, men were less likely to sustain a quadriceps strain (P=0.031) and more likely to sustain an ankle sprain (P=0.040) on artificial turf.