Soccer injuries: a review on incidence and prevention

Clinical and Basic Science of Cartilage Injury and Arthritis in the Football (Soccer) Athlete

Joint injuries are very common in the athletic population, especially professional soccer players, with an incidence of 10 to 35.5 injuries per 1000 hours. Most soccer-related joint injuries occur in the lower extremities, with 16% to 46% occurring in the knee and 17% to 40% occurring in the ankle. Because of the limited healing capacity of cartilage and other intra-articular soft tissue structures, such as anterior cruciate ligament (ACL) and meniscus, joint injuries often lead to the development of early disabling osteoarthritis. Osteoarthritis in soccer players is 5 to 12 times more frequent than in the general population and diagnosed 4 to 5 years earlier. It remains a major cause of disability from this sport. This review focuses on the epidemiology of soccer-related joint injuries and subsequent development of osteoarthritis in the hip, knee, and ankle joints. As well, two different pathways for pathogenesis are described: (1) primary osteoarthritis via direct trauma to the articular cartilage and (2) secondary osteoarthritis that occurs indirectly through injury to the soft tissue structures that subsequently result in articular cartilage degeneration and loss.

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.

Developing injury prevention policy through a multi-agency partnership approach: a case study of a state-wide sports safety policy in New South Wales, Australia

Sports injuries are an important public health issue. A multi-agency key stakeholder partnership was formed to develop a state-wide response to sports injury prevention in New South Wales, Australia. This study evaluated the partnership approach to injury prevention policy development. The partnership approach to policy development was evaluated pre- and post-partnership using semi-structured telephone interviews and questionnaire data gathered from participants. Participants were satisfied with the partnership operation and outcomes. Challenges included: maintaining focus and efficiency; time constraints; sector diversity limiting the likelihood of addressing needs and reaching consensus; and ensuring commitment from all relevant organisations. Potential benefits included: a sense of policy ownership; a broad-based approach across the sector and savings from resource sharing. Policy resulted from a shared understanding of the injury problem, and of an appropriate response. A credible industry leader, investment in partnership management and a consultative approach facilitated the success of the partnership.

Training effects of two different unstable shoe constructions on postural control in static and dynamic testing situations

OBJECTIVE

The aim of this study was to compare training effects on postural control using two different unstable shoe constructions.

SUBJECTS AND SETTING

Twenty-nine healthy subjects participated in this study and were randomly divided into three groups. Two experimental groups (10 subjects in each group) were assigned to a 6 week training program of specific sensorimotor exercises with unstable shoe constructions, one group using MBT(®) shoes and one group wearing Reflex Control(®) shoes (RC). Subjects in the control group (9 subjects) did not perform balance training.

MAIN OUTCOME MEASURES

Postural control was measured in one-leg stance in two testing conditions. We recorded postural sway on a force plate (static testing situation) and displacements of a moveable platform (dynamic testing situation) before and after the training period.

RESULTS

There were no effects of training with unstable shoe constructions on postural sway in the static testing condition (for comparison of groups: p = 0.990 and p = 0.119). However, the RC group showed statistically significant improvements in the dynamic testing situation (p = 0.014 compared to control subjects). In the MBT group improvements were not significantly different in comparison to control group (p = 0.518).

CONCLUSIONS

Our results indicate that exercises using unstable shoe constructions, particularly the RC, improve postural control only in dynamic conditions.

Comparison of the incidence, nature and cause of injuries sustained on dirt field and artificial turf field by amateur football players

Background

Data on the incidence, nature, severity and cause of match football injuries sustained on dirt field are scarce. The objectives of this study was to compare the incidence, nature, severity and cause of match injuries sustained on dirt field and artificial turf field by amateur male football players.

Methods

A prospective two-cohort design was employed. Participants were 252 male football players (mean age 27 years, range 18-43) in 14 teams who participated in a local championship carried on a dirt field and 216 male football players (mean age 28 years, range 17-40) in 12 teams who participated in a local championship carried on a artificial turf field in the same zone of the city. Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football.

Results

The overall incidence of match injuries for men was 36.9 injuries/1000 player hours on dirt field and 19.5 on artificial turf (incidence rate ratio 1.88; 95% CI 1.19-3.05).

Most common injured part on dirt field was ankle (26.7%) and on artificial turf was knee (24.3%). The most common injury type in the dirt field was skin injuries (abrasion and laceration) and in the artificial turf was sprain and ligament injury followed by haematoma/contusion/bruise.

Most injuries were acute (artificial turf 89%, dirt field 91%) and resulted from player-to-player contact (artificial turf 59.2%, dirt field 51.4%).

Most injuries were slight and minimal in dirt field cohort but in artificial turf cohort the most injuries were mild.

Conclusions

There were differences in the incidence and type of football match injuries sustained on dirt field and artificial turf.

Epidemiology of acute soccer injuries in canadian children and youth

OBJECTIVES

To describe acute injury characteristics in children and youth soccer players and to identify the characteristics of patients who required hospital admission.

METHODS

The analysis of the study was based on the Canadian Hospitals Injury Reporting and Prevention Program. A total of 32,149 patients (aged 5-19 years) with soccer-related injuries presenting to 16 participating hospital emergency departments from 1994 to 2004 were included in the analysis.

RESULTS

Males had the highest proportion of injuries (62%). The leading injuries were sprains/strains (38%), followed by fractures/dislocations (31%) and superficial injuries (23%). A total of 896 cases (3%) required hospital admission. Based on logistic regression analysis, being a male, playing unorganized soccer, having multiple body injuries, playing soccer outside school premises, and playing during the summer/fall increased the likelihood of hospital admission. Moreover, having a head/face/neck injury (Odds ratio [OR], 1.3; 95% confidence interval [95% CI], 1.1-1.7) and trunk injury (OR, 1.7; 95% CI, 1.2-2.4) as compared with an upper extremity injury and having injuries from contact with structures/surfaces (OR, 3.1; 95% CI, 2.2-4.3) and with other players (OR, 2.5; 95% CI, 1.8-3.5) as compared with ball contact had the highest odds of hospital admission.

CONCLUSIONS

Soccer accounted for a significant proportion of injuries presented to Canadian Hospitals Injury Reporting and Prevention Program emergency departments during 1994-2004. Further studies investigating potential interventional programs and techniques among this population are highly warranted.

Lesão do músculo obturador externo em atletas de futebol profissional

Diversos estudos têm analisado os diferentes tipos de lesões que acometem o jogador de futebol. Nota-se, no entanto, que nenhum cita a lesão do músculo obturador externo. Na medida em que este é um músculo pequeno e monoarticular, sua incidência provavelmente é baixa e pouco documentada na literatura. Sendo assim, o objetivo deste estudo é apresentar quatro casos de estiramentos do obturador externo em uma equipe profissional de futebol no ano de 2006. Os dados foram coletados a partir de um programa de armazenamento denominado Sistema de Preparação Desportiva que fornece dados referentes ao nome, diagnóstico, mecanismo de trauma, história clínica, tempo de afastamento e evolução. Todos os atletas que apresentaram imagem de ressonância nuclear magnética compatível com ruptura do obturador externo foram inclusos no estudo. Quatro lesões por estiramento do músculo obturador externo foram encontradas, de um total de 28 lesões por estiramento muscular durante o ano de 2006. Todos os atletas apresentavam dor difusa na região do quadril durante os movimentos de rotação lateral e medial do quadril. O mecanismo de trauma predominante foi o movimento de rotação lateral do tronco sobre o fêmur em cadeia cinética fechada. Concluímos que a lesão do obturador externo pode ser confundida com uma lesão dos músculos adutores do quadril, devido à localização da dor relatada pelo indivíduo. A avaliação clínica deve basear-se no relato do atleta e na realização dos testes funcionais, principalmente para os músculos rotadores do quadril. O exame de ressonância nuclear magnética foi fundamental para localizar, classificar e avaliar a extensão da lesão neste estudo

The Brazilian Football Association (CBF) model for epidemiological studies on professional soccer player injuries

OBJECTIVE

This study aims to establish a national methodological model for epidemiological studies on professional soccer player injuries and to describe the numerous relevant studies previously published on this topic.

INTRODUCTION

The risk of injury in professional soccer is high. However, previous studies of injury risk in Brazil and other countries have been characterized by large variations in study design and data collection methods as well as definitions of injury, standardized diagnostic criteria, and recovery times.

METHODS

A system developed by the Union of European Football for epidemiological studies on professional soccer players is being used as a starting point to create a methodological model for the Brazilian Football Association. To describe the existing studies on professional soccer player injuries, we developed a search strategy to identify relevant epidemiological studies. We included the Latin American and Caribbean Center on Health Sciences and Medline databases in our study.

RESULTS

We considered 60 studies from Medline and 16 studies from the Latin American and Caribbean Center on Health Sciences in the final analysis. Twelve studies were selected for final inclusion in this review: seven from the Latin American and Caribbean Center on Health Sciences and five from Medline. We identified a lack of uniformity in the study design, data collection methods, injury definitions, standardized diagnostic criteria, and the definition of recovery time. Based on the information contained within these articles, we developed a model for epidemiological studies for the Brazilian Football Association.

CONCLUSIONS

There is no uniform model for epidemiological studies of professional soccer injuries. Here, we propose a novel model to be applied for epidemiological studies of professional soccer player injuries in Brazil and throughout the world.

Countrywide campaign to prevent soccer injuries in Swiss amateur players

BACKGROUND

In Switzerland, the national accident insurance company registered a total of 42 262 soccer injuries, resulting in costs of approximately 145 million Swiss francs (~US$130 million) in 2003. Research on injury prevention has shown that exercise-based programs can reduce the incidence of soccer injuries.

PURPOSE

This study was conducted to assess the implementation and effects of a countrywide campaign to reduce the incidence of soccer injuries in Swiss amateur players.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

All coaches of the Schweizerischer Fussballverband (SFV) received information material and were instructed to implement the injury prevention program "The 11" in their training of amateur players. After the instruction, the coaches were asked to rate the quality and the feasibility of "The 11." Before the start of the intervention and 4 years later, a representative sample of about 1000 Swiss soccer coaches were interviewed about the frequency and characteristics of injuries in their teams. Teams that did or did not practice "The 11" were compared with respect to the incidence of soccer injuries.

RESULTS

A total of 5549 coaches for amateur players were instructed to perform "The 11" in the training with their teams. The ratings of the teaching session and the prevention program were overall very positive. In 2008, 80% of all SFV coaches knew the prevention campaign "The 11" and 57% performed the program or most parts of it. Teams performing "The 11" had an 11.5% lower incidence of match injuries and a 25.3% lower incidence of training injuries than other teams; noncontact injuries in particular were prevented by the program.

CONCLUSION

"The 11" was successfully implemented in a countrywide campaign and proved effective in reducing soccer injuries in amateur players. An effect of the prevention program was also observed in the population-based insurance data and health-care costs.

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

Background and aims

Approximately 16% of all sports injuries in the Netherlands are caused by outdoor soccer. A cluster-randomised controlled trial has been designed to investigate the effectiveness and cost-effectiveness of an injury prevention programme (‘The11’) for male amateur soccer players. The injury prevention programme The11, developed with the support of the World Football Association FIFA, aims to reduce the impact of intrinsic injury risk factors in soccer.

Methods

Teams playing at first-class amateur level in two districts in the Netherlands are participating in the study. Teams in the intervention group were instructed to apply The11 during each practice session throughout the 2009–10 season. All participants of the control group continued their practice sessions as usual. All soccer-related injuries and related costs for each team were systematically reported online by a member of the medical staff. Player exposure to practice sessions and matches was reported weekly by the coaches. Also the use of The11 during the season after the intervention season will be monitored.

Discussion

Our hypothesis is that integrating the The11 exercises in the warm-up for each practice session is effective in terms of injury incidence, injury severity, healthcare use, and its associated costs and/or absenteeism. Prevention of soccer injuries is expected to be beneficial to adult soccer players, soccer clubs, the Royal Dutch Football Association (KNVB), health insurance companies and society.

Increased risk of knee injuries and osteoarthritis in the non-dominant leg of former professional football players

The aim of the study was to evaluate differences in knee injuries and osteoarthritis between the dominant and non-dominant legs of former professional football players. The study cohort comprised 40 retired professional players with an average age of 49.2 years. Participants completed a questionnaire about their sports and personal history with special emphasis on knee injuries/operations of the dominant and non-dominant leg. Bilateral standing knee radiographs were taken. Overall, 29 footballers (73%) had experienced at least one moderate or severe knee injury and 18 (40%) had undergone at least one knee operation during their career. Among those injured, 14 (35%) players had suffered a dominant knee injury and 22 (55%) a non-dominant knee injury. Evidence of osteoarthritis (Kellgren-Lawrence scale > or = 2) was found in 17 (43%) dominant and 23 (58%) non-dominant knees. Professional football players have a significant risk of knee injuries and early osteoarthritis with preponderance in the non-dominant leg.

Effect of 2 soccer matches in a week on physical performance and injury rate

BACKGROUND

Recovery duration may be too short during the congested fixtures of professional soccer players with regard to maintaining physical performance and a low injury rate.

PURPOSE

To analyze the effects of 2 matches per week on physical performance and injury rate in male elite soccer players.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Match results, match-related physical performance, and injuries were monitored during 2 seasons (2007-2008 and 2008-2009) for 32 professional soccer players in a top-level team participating in the UEFA (Union of European Football Associations) Champions League. Total distance, high-intensity distance, sprint distance, and number of sprints were collected for 52 home matches. Injuries and player participation in matches and training were recorded throughout the full season.

RESULTS

Physical performance, as characterized by total distance covered, high-intensity distance, sprint distance, and number of sprints, was not significantly affected by the number of matches per week (1 versus 2), whereas the injury rate was significantly higher when players played 2 matches per week versus 1 match per week (25.6 versus 4.1 injuries per 1000 hours of exposure; P < .001).

CONCLUSION

The recovery time between 2 matches, 72 to 96 hours, appears sufficient to maintain the level of physical performance tested but is not long enough to maintain a low injury rate. The present data highlight the need for player rotation and for improved recovery strategies to maintain a low injury rate among athletes during periods with congested match fixtures.

Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study

BACKGROUND

Strain injuries of the posterior thigh are common in soccer. It seems that previous injury and age are important risk factors, but the literature is limited. This study was conducted to see if we could identify intrinsic risk factors for hamstring injuries among male soccer players.

HYPOTHESIS

We hypothesized that previous hamstring injuries, reduced function scores, abnormalities on a clinical examination, high maximum sprint speed, poor hamstring strength, or low hamstring/quadriceps ratio can predict increased risk of new hamstring injuries.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 508 players representing 31 amateur teams were tested during the 2004 preseason for potential risk factors for hamstring injury through a questionnaire on previous injury and function score (Hamstring Outcome Score [HaOS]), a clinical examination of the hamstring, and specific hamstring relevant tests. Generalized estimating equations were used in univariate analyses to identify candidate risk factors, and factors with a P value of <.10 were then examined in a multivariate model.

RESULTS

During the soccer season, 76 hamstring injuries, affecting 65 legs (61 players), were registered. Univariate analyses revealed previous acute hamstring injury (yes/no) (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.54-4.45), HaOS function score with all subscores except "Soreness" (OR for a 10-point difference in total score, 1.29; 95% CI, 1.08-1.54), age (OR, 1.25; 95% CI, 0.96-1.63), and player position (P = .09) as candidate predictors of high injury risk. In a multivariate analysis, the most important risk factor for injuries to the hamstring was previous acute hamstring injury (yes/no) (adjusted OR, 2.19; 95% CI, 1.19-4.03; P = .01).

CONCLUSION

In a multivariate analysis, previous acute hamstring injury was found to be a significant risk factor for new hamstring injuries. Previously injured players have more than twice as high a risk of sustaining a new hamstring injury.

[Knee and ankle injuries from playing football]

Soccer is the most common sport activity worldwide. Over the last two decades the increase in soccer players has mainly been due to increased interest by females. In general, soccer is a relatively safe sport activity, especially if minor injuries resulting in short periods of absence from playing or training are neglected. However, due to the high number of soccer players severe injuries are also frequent. These are a problem not only for the injured player and the team but may also become problematic for the socio-economic system. In up to 80-90% structures of the lower extremities are injured. For sufficient radiological diagnosis knowledge of the biomechanics of the soccer game and some details about the history of the injury may be of help. To prevent soccer injuries or keep the degree of injury low, special programs had been developed.

Osteocartilaginous lesions of the talus in soccer players

OBJECTIVE

The objective of this study is to describe the results of arthroscopic debridement for talar lesions in a population of soccer players.

PATIENTS

Patients were sixteen soccer players with osteochondral talar lesions, treated surgically between 1999 and 2004.

INTERVENTIONS

All patients were diagnosed clinically. Complementary imaging studies included X-ray, scintigraphy, and magnetic resonance imaging. All patients underwent arthroscopic debridement.

MAIN OUTCOME MEASUREMENTS

At 3.56 years of follow up, patient status was assessed using a visual analog scale (VAS) and the Ogilvie-Harris scale. The mean time to return to sports at the same level as that before the start of symptoms was evaluated.

RESULTS

The Ogilvie-Harris score showed 81.75% excellent results and 18.25% good results. The VAS score was 0.26 (0-2.2). Among the total, 93.75% of patients resumed sports activities at the same level as that before surgery.

CONCLUSIONS

Arthroscopic debridement of talar osteochondral lesions in soccer players provides excellent results. We consider this option the treatment of choice in this population.

Comparação da performance funcional do membro inferior entre jovens futebolistas e jovens não treinados

INTRODUÇÃO: Em atletas, a utilização de testes de performance funcional permite avaliar com maior validade ecológica possíveis alterações do membro inferior observadas na prática desportiva. OBJETIVO: O objetivo do presente estudo consistiu na comparação da performance funcional do membro inferior entre jovens futebolistas e jovens não treinados. METODOLOGIA: A amostra foi constituída por 39 jovens do sexo masculino, divididos em dois grupos: um grupo composto por 19 futebolistas (idade = 16,8 ± 0,83 anos; peso = 69,8 ± 6,2 kg; altura = 176,6 ± 0,5 cm) e outro composto por 20 sujeitos não treinados (idade = 16,6 ± 0,8 anos; peso = 66,3 ± 11,0 kg; altura = 172,0 ± 0,8 cm). Para avaliação da performance funcional do membro inferior foram utilizados três testes: o Single-Leg Hop Test, o Quadrant Jump Test e o Hexagon Test. RESULTADOS: Os jovens futebolistas obtiveram melhor performance do que os jovens não treinados em ambos os membros inferiores no Single-Leg Hop Test (membro inferior direito: 124 ± 62 cm, membro inferior esquerdo: 127 ± 68 cm versus membro inferior direito: 99 ± 10 cm, membro inferior esquerdo: 97 ± 12 cm; p < 0.001), em ambas as direções, na execução do Hexagon Test (sentido dos ponteiros do relógio: 5,1 ± 0,6 s, sentido inverso: 4,9 ± 0,5 s versus sentido dos ponteiros do relógio: 6,0 ± 0,4 s, sentido inverso: 5,7 ± 0,4 s; p < 0.001) e no Quadrant Jump Test (32,4 ± 2,5 pontos versus 28,2 ± 2,5 pontos, p < 0.001). Dentro de cada grupo não foi encontrada diferença entre os dois membros inferiores no Single-Leg Hop Test, nem entre as duas direções do Hexagon Test. CONCLUSÕES: Os resultados do presente estudo indicam que jovens futebolistas apresentam melhor performance funcional do membro inferior do que jovens não treinados.

Effects of SAQ Training and Small-Sided Games on Neuromuscular Functioning in Untrained Subjects

Purpose:

The main objective of this study was to investigate the efficacy of both programmed (speed, agility, and quickness; SAQ) and random (small-sided games; SSG) conditioning methods on selected neuromuscular and physical performance variables.

Methods:

Twenty volunteers (21.1 ± 4.0 y, 1.71 ± 0.09 m, 66.7 ± 9.9 kg; mean ± SD) completed the study. The study design used two physically challenging periodized experimental conditions (SAQ and SSG conditions) and a non exercise control condition (CON). Participants engaged in 12.2 ± 2.1 h of directed physical conditioning. All participants had at least 24 h of recovery between conditioning sessions, and each 1-h session included 15 min of general warm-up and a 45-min exercise session. Participants completed a battery of tests (15-m sprint, isokinetic flexion/extension, depth jump) before and following the training program.

Results:

There was a 6.9% (95% CI: -4.4 to 18.3) greater improvement in 5-m acceleration time and 4.3% (95% CI: -0.9 to 9.5) in 15-m mean running velocity time for the SAQ group compared with the SSG group. In addition, increases in maximal isokinetic concentric strength for both the flexor and extensor muscles, with the exception of 180 °/s flexion, were greater in the SAQ than SSG condition. The SAQ group also showed 19.5% (95% CI: -11.2 to 50.2) greater gain in reactive strength (contact time depth jump) and 53.8% (95% CI: 11.2 to 98.6) in mean gastrocnemius medialis activity in comparison with SSG.

Conclusions:

SAQ training should benefit the physical conditioning programs of novice players performing invasion games.

Injuries among male and female elite football players

All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P<0.001). However, no difference was found in the incidence of severe injury (absence >4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.

Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury.

Prophylactic ankle taping: elastic versus inelastic taping

BACKGROUND

The ankle is frequently injured in sporting activities, and therefore it is frequently protected with prophylactic ankle taping. This study aimed first, to compare the mechanical fatigue of two types of prophylactic ankle taping after 30 minutes of intense exercise, one made with elastic tape (ET) and the other with inelastic tape (IT), and second, to investigate the subjects' perception on the tape restriction and comfort.

MATERIALS AND METHODS

Twenty-seven active women (mean age, 20.6 +/- 4.1 years), without previous ankle injuries volunteered for the study. The participants were tested on three different conditions: with elastic ankle taping, with inelastic taping, and without taping, before and after 30 minutes of intense exercise. The ankle passive ranges of movement (ROMs) were measured before and after exercise, and a subjective scale on taping comfort and restriction was completed by the subjects.

RESULTS

Both types of ankle taping showed less ROM restriction after 30 minutes of exercise in inversion (IT = 27% and ET = 21%), and plantarflexion (IT = 8% and ET = 6%). The IT showed more loss of restriction than the ET, with significant differences in inversion (p < 0.05). The participants perceived the ET as more comfortable and less restrictive.

CONCLUSION

We would recommend the use of ET as the first choice for prophylactic ankle taping because it produces the same restriction in the ROM as the IT with less taping fatigue, and is perceived as more comfortable and less restrictive by the users.

Injuries and musculoskeletal complaints in referees--a complete survey in the top divisions of the swiss football league

OBJECTIVE

To analyze the extent and characteristics of injuries and musculoskeletal complaints in elite football referees and to analyze differences between match and assistant referees.

DESIGN

Retrospective cohort study.

SETTING

Training camp organized by the Swiss Referees Association.

PARTICIPANTS

All 71 referees of the 2 top divisions of the Swiss Football League (2005-2006 season).

INTERVENTIONS

The referees (66 males and 5 females) completed a questionnaire on their personal characteristics, referee qualifications, time spent in training and matches, career history of injuries, and musculoskeletal complaints caused by training or refereeing and were subsequently interviewed about the location, type, circumstances, and consequences of reported injuries.

MAIN OUTCOME MEASURES

Incidence of injuries, frequency of musculoskeletal complaints, type of injuries, and complaints.

RESULTS

A total of 41 injuries during the career were reported by 31 of 71 referees (44%). Injuries were incurred more frequently in training than during matches, and all injuries reported resulted in at least 2 weeks of absence from sport. About a quarter of the referees reported an injury, and almost 90% of the referees reported musculoskeletal complaints caused by refereeing during the preceding 12 months. In male referees, hamstring strains and ankle sprains were the most common injuries, and the hamstrings, knee, Achilles tendon, and calf were the most prevalent locations of musculoskeletal complaints. No significant difference in the incidence of injury or in the frequency of complaints was observed between match and assistant referees.

CONCLUSIONS

Future studies should be designed prospectively and should include a larger group of female referees. Regarding the incidence of injuries and frequency of musculoskeletal complaints related to refereeing, prevention programs for football referees should be developed, evaluated, and implemented.

Prevenção de lesões do ligamento cruzado anterior em futebolistas

A lesão do joelho é a mais comum entre as lesões graves apresentadas por futebolistas, destacando-se o ligamento cruzado anterior como um dos ligamentos do joelho mais frequentemente lesados. Assim, a prevenção de lesões do ligamento cruzado anterior em futebolistas deve ser encarada como uma preocupação constante para todos os agentes ligados à modalidade, independentemente do nível competitivo, idade e sexo dos praticantes. OBJETIVOS: O objetivo deste trabalho é a análise da importância do trabalho de prevenção de lesões do LCA em futebolistas que possa ser incorporado no treino de futebol. METODOLOGIA: A metodologia utilizada neste trabalho foi uma revisão da literatura. CONCLUSÕES: Propõe-se um programa de prevenção de lesões do ligamento cruzado anterior em futebolistas, com três sessões de treino semanais, englobando treino neuromuscular e treino proprioceptivo.

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players

BACKGROUND

Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large.

HYPOTHESIS

A simple on-field alternative warm-up program can reduce noncontact ACL injuries.

STUDY DESIGN

Randomized controlled trial (clustered); Level of evidence, 1.

METHODS

Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons.

RESULTS

Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries).

CONCLUSION

This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study

BACKGROUND

The relationship between muscle injury and strength disorders remains a matter of controversy.

PURPOSE

Professional soccer players performed a preseason isokinetic testing aimed at determining whether (1) strength variables could be predictors of subsequent hamstring strain and (2) normalization of strength imbalances could reduce the incidence of hamstring injury.

STUDY DESIGN

Cohort study (prognosis); Level of evidence, 1.

METHODS

A standardized concentric and eccentric isokinetic assessment was used to identify soccer players with strength imbalances. Subjects were classified among 4 subsets according to the imbalance management content. Recording subsequent hamstring injuries allowed us to define injury frequencies and relative risks between groups.

RESULTS

Of 687 players isokinetically tested in preseason, a complete follow-up was obtained in 462 players, for whom 35 hamstring injuries were recorded. The rate of muscle injury was significantly increased in subjects with untreated strength imbalances in comparison with players showing no imbalance in preseason (relative risk = 4.66; 95% confidence interval: 2.01-10.8). The risk of injury remained significantly higher in players with strength imbalances who had subsequent compensating training but no final isokinetic control test than in players without imbalances (relative risk = 2.89; 95% confidence interval: 1.00-8.32). Conversely, normalizing the isokinetic parameters reduced the risk factor for injury to that observed in players without imbalances (relative risk = 1.43; 95% confidence interval: 0.44-4.71).

CONCLUSION

The outcomes showed that isokinetic intervention gives rise to the preseason detection of strength imbalances, a factor that increases the risk of hamstring injury. Restoring a normal strength profile decreases the muscle injury incidence.

A cost-outcome approach to pre and post-implementation of national sports injury prevention programmes

In New Zealand (NZ), the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention programme. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Pre-implementation is used to determine the decision whether to invest in implementation and to determine the level of such investment for the injury prevention programme. Post-implementation is calculated two ways: unadjusted, assuming ceteris paribus; and adjusted assuming no prevention programme was in place. Post-implementation formulae provide a return on investment (ROI) for each dollar invested in the programme and cost-savings. The cost-outcome formulae approach allows ACC to manage expectations of the prevention programme as well as when it will provide a ROI, allowing it to take a long-term view for investment in sport injury prevention. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention.

Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 1: match injuries

OBJECTIVE

To compare the incidence, nature, severity and cause of match injuries sustained on grass and new generation artificial turf by male and female footballers.

METHODS

The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study of American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all match injuries. The number of days lost from training and match play was used to define the severity of an injury. Match exposures (player hours) were recorded on a team basis.

RESULTS

The overall incidence of match injuries for men was 25.43 injuries/1000 player hours on artificial turf and 23.92 on grass (incidence ratio 1.06; p = 0.46) and for women was 19.15 injuries/1000 player hours on artificial turf and 21.79 on grass (incidence ratio = 0.88; p = 0.16). For men, the mean severity of non-season ending injuries was 7.1 days (median 5) on artificial turf and 8.4 days (median 5) on grass and, for women, 11.2 days (median 5) on artificial turf and 8.9 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and contusion injuries to the lower limbs were the most common general categories of match injury on artificial turf and grass for both male and female players. Most injuries were acute (men: artificial turf 24.60, grass 22.91; p = 0.40; women: artificial turf 18.29, grass 20.64; p = 0.21) and resulted from player-to-player contact (men: artificial turf 14.73, grass 13.34; p = 0.37; women: artificial turf 10.72; grass 11.68; p = 0.50).

CONCLUSIONS

There were no major differences in the incidence, severity, nature or cause of match injuries sustained on new generation artificial turf and grass by either male or female players.

Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 2: training injuries

OBJECTIVE

To compare the incidence, nature, severity and cause of training injuries sustained on new generation artificial turf and grass by male and female footballers.

METHODS

The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study involving American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all training injuries. The number of days lost from training and match play was used to define the severity of an injury. Training exposures (player hours) were recorded on a team basis.

RESULTS

The overall incidence of training injuries for men was 3.34 injuries/1000 player hours on artificial turf and 3.01 on grass (incidence ratio 1.11; p = 0.21) and for women it was 2.60 injuries/1000 player hours on artificial turf and 2.79 on grass (incidence ratio 0.93; p = 0.46). For men, the mean severity of injuries that were not season ending injuries was 9.4 days (median 5) on artificial turf and 7.8 days (median 4) on grass and, for women, 10.5 days (median 4) on artificial turf and 10.0 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and muscle/tendon injuries to the lower limbs were the most common general categories of injury on artificial turf and grass for both male and female players. Most training injuries were acute (men: artificial turf 2.92, grass 2.63, p = 0.24; women: artificial turf 1.94, grass 2.23, p = 0.21) and resulted from player-to-player contact (men: artificial turf 1.08, grass 0.85, p = 0.10; women: artificial turf 0.47, grass 0.56; p = 0.45).

CONCLUSIONS

There were no major differences between the incidence, severity, nature or cause of training injuries sustained on new generation artificial turf and on grass by either men or women.

Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer: a randomized controlled trial

BACKGROUND

Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury.

HYPOTHESIS

The rate of reinjury is reduced using a coach-controlled rehabilitation program.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups.

RESULTS

There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.16-0.72, P = .0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11-0.57, P < .001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%).

CONCLUSION

The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.

Tackle mechanisms and match characteristics in women's elite football tournaments

BACKGROUND

Several tools have been used for assessing risk situations and for gathering tackle information from international football matches for men but not for women.

PURPOSE

To analyse activities in women's football and to identify the characteristics and risk potentials of tackles.

STUDY DESIGN

Retrospective video analysis.

METHOD

Video recordings of 24 representative matches from six women's top-level tournaments were analysed for tackle parameters and their risk potential.

RESULTS

3531 tackles were recorded. Tackles in which the tackling player came from the side and stayed on her feet accounted for nearly half of all challenges for the ball in which body contact occurred. 2.7% of all tackles were classified as risk situations, with sliding-in tackles from behind and the side having the highest risk potential. Match referees sanctioned sliding-in tackles more often than other tackles (20% v 17%, respectively). Tackle parameters did not change in the duration of a match; however, there was an increase in the number of injury risk situations and foul plays towards the end of each half.

CONCLUSIONS

Match properties provide valuable information for a better understanding of injury situations in football. Staying on feet and jumping vertically tackle actions leading to injury were sanctioned significantly more times by the referee than those not leading to injury (p<0.001), but no such difference was seen for sliding-in tackles (previously reported to have the highest injury potential in women's football). Therefore, either the laws of the game are not adequate or match referees in women's football are not able to distinguish between sliding-in tackles leading to and those not leading to injury.

Injuries in female football players in top-level international tournaments

BACKGROUND

Despite the growing popularity of women's football and the increasing number of female players, there has been little research on injuries sustained by female football players.

PURPOSE

Analysis of the incidence, characteristics and circumstances of injury in elite female football players in top-level international tournaments.

STUDY DESIGN

Prospective survey.

METHODS

Injuries incurred in seven international football tournaments were analysed using an established injury report system. Doctors of all participating teams reported all injuries after each match on a standardised injury reporting form. The mean response rate was 95%.

RESULTS

387 injuries were reported from 174 matches, equivalent to an incidence of 67.4 injuries/1000 player hours (95% CI 60.7 to 74.1) or 2.2 injuries/match (95% CI 2.0 to 2.4). Most injuries (84%; 317/378) were caused by contact with another player. The injuries most commonly involved the lower extremity (n = 248; 65%), followed by injuries of the head and neck (n = 67, 18%), trunk (n = 33, 9%) and upper extremity (n = 32, 8%). Contusions (n = 166; 45%) were the most frequent type of injury, followed by sprains or ligament rupture (n = 96; 26%) and strains or muscle fibre ruptures (n = 31; 8%). The most common diagnosis was an ankle sprain. There were 7 ligament ruptures and 15 sprains of the knee. On average 1 injury/match (95% CI 0.8 to 1.2) was expected to result in absence from a match or training.

CONCLUSION

The injury rate in women's top-level tournaments was within the range reported previously for match injuries in elite male and female players. However, the diagnoses and mechanisms of injury among the female players differed substantially from those previously reported in male football players.

Fratura-luxação traumática do quadril no futebol: relato de caso

De ocorrência rara no futebol, esporte coletivo mais praticado no mundo, as fraturas de acetábulo que se associam às luxações da articulação do quadril são lesões com grande potencial de gerar seqüelas graves e limitantes. O rápido atendimento, a precisão do diagnóstico e procedimentos de salvamento da articulação pela redução e correta fixação são essenciais para perspectiva de retomar a atividade física regular praticada anteriormente ou outra que se adapte à nova situação.

Epidemiology of Injuries in Hong Kong Elite Badminton Athletes

This study retrospectively reviewed the injury epidemiology on 44 Hong Kong elite badminton players in 2003. Team training records were reviewed to retrieve the training and competition hours, while the medical records from the physiotherapy department were reviewed to obtain information regarding injuries. A total of 253 injuries (128 recurrent and 125 new injuries) were recorded, which accounted for an overall incidence rate of 5.04 per 1,000 player hours. Elite senior athletes had a higher incidence rate of recurrent injuries, while elite junior and potential athletes had a higher incidence rate of new injuries. A total of 1,219 visits (4.82 per athlete) to the physiotherapy department were recorded, which cost HK$487,600 (HK$1,928 per injury). Most new injuries were strain (80 injuries), and the most frequently injured body sites were the back (17 injuries), the shoulder (15 injuries), the thigh (15 injuries), and the knee (15 injuries). One-sided exact test showed that a previous injury experience significantly associated with the occurrence of new injury.

Poor peak dorsiflexor torque associated with incidence of ankle injury in elite field female hockey players

This study set out to determine the incidence of ankle injuries amongst provincial female field hockey players in KwaZulu-Natal (KZN), South Africa, during the 2004 field hockey season and relate this to their injury and playing profile, proprioceptive ability and peak isokinetic torque of the ankle plantar and dorsiflexor muscles. Players participating in the senior, U21 and U19/high school provincial A teams (n=47) detailed their hockey playing and training history and injuries sustained during the 2004 season. A subsample of injured and matched, uninjured controls (n=18) underwent anthropometric, proprioceptive and isokinetic testing. Incidence of injury in the 2004 season was 0.98 per player or 6.32 injuries per 1000 player/h(-1), with 25.5% of players (n=12) reporting injuries to the ankle joint. All ankle injuries occurred on artificial turf and 75% occurred during a match. Forwards and links that had been playing for six to seven years presented with the highest incidence of ankle injuries. Injured players were able to maintain balance on a proprioceptive board for 10.31+/-8.2 s versus 23.9+/-15.3 s in matched, uninjured controls (p=0.078). Both mean (27.4+/-5.5 Nm versus 32.7+/-4.7 Nm) and median (27.0, 23.0-31.5 versus 31.8, 30.0-35.1 Nm) peak isokinetic torque of the dorsiflexors of injured legs was significantly lower than in uninjured, contralateral legs of the injured players (p=0.01 and 0.03, respectively). Poor peak dorsiflexion torque in the injured leg was identified as a factor associated with ankle injury in this sample of injured, elite field hockey players.

Current anti-doping policy: a critical appraisal

BACKGROUND

Current anti-doping in competitive sports is advocated for reasons of fair-play and concern for the athlete's health. With the inception of the World Anti Doping Agency (WADA), anti-doping effort has been considerably intensified. Resources invested in anti-doping are rising steeply and increasingly involve public funding. Most of the effort concerns elite athletes with much less impact on amateur sports and the general public.

DISCUSSION

We review this recent development of increasingly severe anti-doping control measures and find them based on questionable ethical grounds. The ethical foundation of the war on doping consists of largely unsubstantiated assumptions about fairness in sports and the concept of a "level playing field". Moreover, it relies on dubious claims about the protection of an athlete's health and the value of the essentialist view that sports achievements reflect natural capacities. In addition, costly antidoping efforts in elite competitive sports concern only a small fraction of the population. From a public health perspective this is problematic since the high prevalence of uncontrolled, medically unsupervised doping practiced in amateur sports and doping-like behaviour in the general population (substance use for performance enhancement outside sport) exposes greater numbers of people to potential harm. In addition, anti-doping has pushed doping and doping-like behaviour underground, thus fostering dangerous practices such as sharing needles for injection. Finally, we argue that the involvement of the medical profession in doping and anti-doping challenges the principles of non-maleficience and of privacy protection. As such, current anti-doping measures potentially introduce problems of greater impact than are solved, and place physicians working with athletes or in anti-doping settings in an ethically difficult position. In response, we argue on behalf of enhancement practices in sports within a framework of medical supervision.

SUMMARY

Current anti-doping strategy is aimed at eradication of doping in elite sports by means of all-out repression, buttressed by a war-like ideology similar to the public discourse sustaining international efforts against illicit drugs. Rather than striving for eradication of doping in sports, which appears to be an unattainable goal, a more pragmatic approach aimed at controlled use and harm reduction may be a viable alternative to cope with doping and doping-like behaviour.

Injury incidence in a men's elite bandy league: an epidemiological study of a full regular season

Bandy is a popular European winter team-sport. The best bandy teams participate in semi-professional leagues, where the play-off games attract more than 10,000 spectators. Injury patterns in elite bandy have not been investigated previously. The aim of this study is to examine the incidence and types of injuries sustained during elite bandy games for men. Twelve of the 16 teams in the Swedish elite bandy league during the 2002 season participated in the study. In total, 36 injuries were recorded, corresponding to 7.3 injuries/1000 player game hours and 5.7 injuries/1000 athlete exposures. Collision was the most common injury cause (47%), while contusion was the most common injury type (25%), followed by fracture (22%) and ligament rupture (19%). The study showed that the injury incidence in elite bandy is low, but also that the injuries that are still sustained are relatively severe. This pattern can be explained by the fact that even though bandy rules do not allow body checks, collisions between skaters moving at high speeds still cause the majority of injuries. Further studies of the injury rehabilitation practices, and the implementation and evaluation of safety programs in elite bandy are warranted.

From sports injury prevention to safety promotion in sports

Every fifth unintentional injury treated at a healthcare facility in the industrialised part of the world is associated with sports or physical exercise. This article reviews the literature regarding the theoretical and practical underpinnings for community-based sports safety promotion, including both professional and recreational sports. While injury prevention entails the implementation of specific interventions in terms of structural or educational measures, sports safety promotion includes also the antecedent and wider campaigns that are required to succeed with these measures. Comprehensive sports safety promotion programmes thus require that the perspective on the sports injury problem is made broader than consideration of the individual athlete. The results display that involvement in sports safety issues from the sports federations that formulate policies and allocate resources is necessary for coordinated implementation of programme actions. The authorities responsible for sports facilities and legislations in the civil society also need to be included, because of the fact that they control many of the central safety determinants in the sporting environment. It is concluded that the sports injury problem needs to be addressed in liaison with the leaders of socially defined sports communities and the governments representing geographically defined civic communities, and that the safety-supporting environment in professional sports is underdeveloped compared with other areas of working life.

Soccer

Soccer has rules, regulations, and a style of play that is unlike any other sport. The characteristics of soccer, along with required functional activities, obviously place a significant demand on the physical and technical skills of each athlete. Consequently, many of the patterns of injuries and medical problems are unique. This article describes the physical demands of soccer; reviews the epidemiology; and discusses the mechanisms, pathologic findings, and treatment of soccer-related injuries and medical problems.

Quantifying the functional rehabilitation of injured football players

OBJECTIVE

To determine whether quantified, auditable records of functional rehabilitation can be generated using subjective assessments of players' performance in fitness tests routinely used in professional football.

METHOD

Ten sequential test elements grouped into three phases (fitness, ball and match skills, match pace football) were used to monitor players' functional recovery from injury. Physiotherapists subjectively assessed players' performance in each test element using a six point subjective rating scale. Satisfactory performance in each element of the assessment programme added 10% to the injured player's recovery score. Daily recovery scores for injured players were recorded against the time spent in functional rehabilitation.

RESULTS

Rehabilitation data for 118 injuries sustained by 55 players over two seasons were recorded. The average time in functional rehabilitation depended on the time spent in pre-functional rehabilitation and the nature and location of injury. Benchmark functional rehabilitation curves (y = mln(x) + c) were developed for thigh (n = 15) and lower leg (n = 8) muscle strains and knee (n = 7) and ankle (n = 9) ligament sprains (R(2) = 0.95-0.98).

CONCLUSIONS

A structured, quantified rehabilitation programme based on routine fitness and skills exercises and a graded subjective assessment of performance provides an auditable record of a player's functional recovery from a range of lower limb injuries and a transparent exit point from rehabilitation. The proposed method provides a permanent record of the functional rehabilitation of players' injuries and evidence based data to support management's return to play decisions.

The effects of soccer training and timing of balance training on balance ability

The purpose of the present study was to investigate the effects of a soccer training session on the balance ability of the players and assess whether the effectiveness of a balance program is affected by its performance before or after the regular soccer training. Thirty-nine soccer players were randomly divided into three subject groups (n=13 each), one control group (C group), one training group that followed a balance program (12 weeks, 3 times per week, 20 min per session) before the regular soccer training (TxB group), and one training group that performed the same balance program after the soccer training (TxA group). Standard testing balance boards and the Biodex Stability System were used to assess balance ability in the C, TxB, and TxA groups at baseline (T0) and after completing the balance program (T12). The same tests and additional isokinetic knee joint moment measurements were carried out in the TxB and TxA groups pre- and post-soccer training. Two main results were obtained: (1) No differences (p>0.05) were found in balance ability and knee joint moment production between pre- and post-soccer training. (2) The balance program increased (p<0.01) the balance ability in the TxB and TxA groups, and the improvement in the TxA group was greater (p<0.05) than that in the TxB group post-soccer training. Result (1) is in contrast to the notion of a link between fatigue induced by a soccer training session or game and injury caused by impaired balance, and result (2) has implications for athletic training and rehabilitation.

Ecology of player-to-player contact in boys' youth soccer play

INTRODUCTION

Youth soccer (football) injuries occur for a wide range of reasons, but the most frequent cause of injury is via player-to-player contact. This study was designed to study the ecology of collisions between players during youth soccer play.

METHOD

Six teams of 11- and 12-year-old male players were followed over the course of a full season. Games were videotaped and reviewed to address three primary questions: how frequently do player-to-player collisions occur; when and where on the field do those collisions occur; and what is the rate of falls and injuries as a result of player-to-player contact.

RESULTS

A total of 1,279 player-to-player collisions was observed, or an average of 65.59 collisions per game. Nearly half of the observed collisions resulted in one or both players falling to the ground, and about one-tenth resulted in the referee calling a foul, but very few of the collisions (less than 1%) resulted in an injury. Collisions occurred relatively consistently throughout the games, no matter what the score was. They occurred most frequently in the midfield area, when the ball was on or near the ground, and when players were attempting to retrieve a loose, uncontrolled ball.

CONCLUSIONS

Results are discussed with respect to implications for injury prevention.

Measurement and Evaluation of Dynamic Joint Stability of the Knee and Ankle After Injury

Injuries to the lower extremity, specifically the knee and ankle joints of the human body can occur in any athletic event and are most prevalent in sports requiring cutting and jumping manoeuvres. These joints are forced to rely on the dynamic restraints to maintain joint stability, due to the lack of bony congruence and the inability of the static restraints to handle the forces generated during functional tasks. Numerous variables (proprioception, postural control, electromyography, kinetics/kinematics, dynamic stability protocols) have been measured to better understand how the body maintains joint stability during a wide range of activities from static standing to dynamic cutting or landing from a jump. While the importance of dynamic restraints is not questioned, a recent impetus to conduct more functional or sport-specific testing has emerged and placed a great deal of emphasis on dynamic joint stability and how it is affected by lower extremity injuries. Evidence suggests that surgery and aggressive rehabilitation will not necessarily restore the deficits in dynamic joint stability caused by injury to the anterior cruciate ligament or lateral ankle ligaments. In today's athletic society, there is a major push to return athletes to play as quickly as possible. However, the ramifications of those decisions have not been fully grasped. If an athlete is not fully recovered, a quick return to play could start a vicious cycle of chronic injuries or permanent disability.

Injuries in female soccer players: a prospective study in the German national league

BACKGROUND

In contrast to the high number of studies about soccer injuries in men, epidemiologic data in high-level female soccer players are scarce.

PURPOSE

Analysis of injury incidence in elite female soccer players.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

There were 165 female soccer players (age, 22.4 +/- 5.0 years) from 9 teams competing in the German national league, who were followed for one complete outdoor season. Their trainers documented the exposure to soccer on a weekly basis for each player, and the team physical therapists reported all injuries with regard to location, type, and circumstances of occurrence. An injury was defined as any physical complaint associated with soccer that limited sports participation for at least 1 day.

RESULTS

There were 241 injuries sustained by 115 players (70%) reported; 39 injuries (16%) were owing to overuse, and 202 injuries (84%) were traumatic. Overall, 42% of the traumatic injuries occurred during training (2.8/1000 hours of training; 95% confidence interval, 2.2-3.4) and 58% during matches (23.3/1000 match hours; 95% confidence interval, 19.1-27.5); 102 of the traumatic injuries were caused by a contact situation, whereas 95 occurred without any contact. Most injuries (80%) were located at the lower extremities, concerning mainly the thigh (n = 44), knee (n = 45), and ankle (n = 43). Ankle sprain (n = 37) was the most often diagnosed injury. There were 51% minor injuries, 36% moderate injuries, and 13% major injuries. Eleven anterior cruciate ligament ruptures were observed during the season.

CONCLUSION

The results revealed a high injury incidence rate in games as well as a comparably low incidence rate during training. An important finding of this investigation was the frequent occurrence of anterior cruciate ligament ruptures. Preventive measures should thus focus on the high prevalence of anterior cruciate ligament tears, mostly occurring in noncontact situations.

Frauenfußball

Women's soccer participation is becoming a trend in sport. With increasing number of licensed female soccer players, there is also an increase in sport specific injuries. This fact has socioeconomic importance. The larger pelvic bone leading to an increased internal rotation of the femur, the narrower intercondylar notch as well as the unfavorable strength ratio of the hamstrings vs. the quadriceps muscle lead to an increased risk for injuries of the anterior cruciate ligament in female soccer.Several studies showed that intervention programs based on neuromuscular or proprioceptive training or intensive strengthening of the hamstrings can reduce the incidence of injuries. Moreover, the importance of sufficient rehabilitation after injuries has to be emphasized, as the reoccurrence of injury is high.