Injury Profile in Women's Football: A Systematic Review and Meta-Analysis

Genome-Wide Association Study on Muscle Stiffness Identified Novel Locus for Predisposition to Muscle Strain Injury

PURPOSE

We aimed to screen the entire genome for genetic variants associated with passive muscle stiffness, which has been suggested as a risk factor for muscle strain injury.

METHODS

This genome-wide association study (GWAS) on passive muscle stiffness included 350 physically active young Japanese individuals. Three hamstring constituents were measured using ultrasound shear wave elastography. Skeletal muscle transcriptomes were compared across the genotypes of GWAS-identified variants in 48 healthy Japanese individuals. Association between GWAS-identified variants and history of muscle strain injury was examined in 1428 Japanese athletes.

RESULTS

Two loci on chromosome 11 demonstrated a genome-wide significant association with passive muscle stiffness of the biceps femoris long head (rs12807854 T/C: P = 5.19 × 10 -10 , rs78405694 T/C: P = 2.09 × 10 -8 ; linear regression analysis adjusted for sex, age, and stretching exercise habits). Skeletal muscle RNA sequencing revealed significantly elevated expression of extracellular matrix-related genes in muscles carrying stiffness-increasing alleles of these variants. Among athletes, rs12807854 T/C was significantly associated with a history of muscle strain injury ( P = 0.0254; logistic regression analysis adjusted for age, sex, competitive level, and main sport). Carriers of the C allele, associated with increased muscle stiffness, exhibited a heightened risk of muscle strain injury (odds ratio = 1.62; 95% confidence interval = 1.06-2.47 per C allele increase). By contrast, rs78405694 did not show a significant association with muscle strain injury in this population.

CONCLUSIONS

A novel locus associated with passive muscle stiffness and muscle strain injury was identified. Elucidating the detailed mechanisms linking the identified locus to passive muscle stiffness may lead to the development of new strategies to prevent muscle strain injuries.

Sports injuries in the emergency department: an observational study with a gender perspective

INTRODUCTION

Sports injuries are a significant concern in emergency departments and affect both amateur and professional athletes. With the increase in women's participation in sports, it is crucial to understand sex-specific injury characteristics, as patterns observed in men may not apply to women. This observational, descriptive and retrospective study aims to analyze sex differences in sports injuries to improve diagnosis, treatment, and prevention strategies. Our hypothesis is that sports injury patterns differ between sexes.

METHODS

Patients treated for sports injuries between 2020 and 2023 in the Emergency Department at our hospital were included in the study. Researchers collected data on demographics, sports practiced, types of injuries, and initial treatment, utilizing descriptive statistics, Student's t-test for continuous variables, Fisher's exact test for categorical variables, and variable correlation for data analysis.

RESULTS

A total of 977 patients were included in the study, 82% of whom were men. Significant differences were observed regarding the sport practiced (p < 0.001) and the type of injury (p = 0.02) between the groups. No differences were observed in injury location or the percentage of patients receiving each treatment modality. Specific correlations were also conducted between sports, type of injury, and location. Contusions, ligamentous injuries and dislocations were associated with specific sports and/or locations in men and women. Ligamentous injuries were observed in both sexes predominantly in the ankle and knee.

CONCLUSION

Increasing sports participation offers health benefits but also increases the risk of injuries. Our study aimed to investigate whether sports injury patterns differ between sexes. The results support this hypothesis, highlighting significant sex differences in injury patterns.

Analysis of musculoskeletal injuries in elite female soccer players: Cohort study in one Brazilian team

PURPOSE

The objectives of this study were to identify if preseason assessment variables predict lower limb musculoskeletal injuries in female soccer players and to compare characteristics between injured and non-injured athletes.

DESIGN

4-month retrospective cohort study.

SETTING

An elite women's soccer team from Brazil.

PARTICIPANTS

Twenty-seven female soccer players.

MAIN OUTCOMES MEASURES

Lower limb length and asymmetry, hamstring flexibility, isokinetic strength of the hamstrings and quadriceps, single hop, lunge test, mSEBT, Thomas, trunk mobility, hip adductor strength, Bent-knee fall-out for testing hip range of motion, lateral trunk flexor endurance, Hip Sit, and single-leg and countermovement jump were recorded at baseline. Logistic regression analyses were performed to identify predictors for the occurrence of lower limb musculoskeletal injuries.

RESULTS

The logistic regression showed a significant model for lower limb musculoskeletal injuries. Trunk mobility, Hip Sit test, and were associated with injury (p = 0.016; R2 = 0,589). The model correctly classified 84.8% of cases (84.6% sensitivity and 85% specificity). The area under the receiver operating characteristic curve was 0.68 (95% CI: 0.53, 0.83; P < 0.024) demonstrating acceptable discriminative ability.

CONCLUSION

The model showed that trunk mobility, Hip Sit, and Bent-knee fall-out were predictors of lower limb musculoskeletal injuries in female soccer players.

The prevalence and incidence of hip and groin injury in female field invasion team sports: A systematic review

OBJECTIVES

Hip and groin injury is more common in male athletes, but no systematic review has examined its prevalence and incidence in female field invasion team sport.

METHODS

Six databases were searched independently by two authors who selected eligible studies, assessed risk of bias and extracted data. Studies reporting the prevalence and/or incidence of hip and groin injury were included. Proportional meta-analyses provided pooled estimates and the Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence.

RESULTS

Twenty-five articles were selected for inclusion. The prevalence of time loss hip and groin injury ranged from 0 to 74 % (4.42 %, 1.91, 9.91), while non-time loss cases ranged from 1 to 35 % (9.54 %, 1.15, 48.91). Time loss cases represented 0-17 % of total injuries (4.10 %, 2.54, 6.56). The strength of the evidence for pooled estimates was very low due to inconsistency and publication bias. Incidence rates ranged from 0.3 to 1.02 per 1000 athlete-hours. Adductor-related injury was the most frequently reported diagnosis.

CONCLUSION

Hip and groin injury in female field sports is common but rates vary due to heterogeneity across studies. Standardised definitions and methodological approaches must be employed in future studies to facilitate data pooling and better quantify the injury burden in this cohort.

Effect of COVID-19 on Injury Incidence and Severity in Professional Female Football Players: A Cohort Prospective Study

BACKGROUND

Earlier statements suggested a negative impact of coronavirus disease 2019 (COVID-19) infection on sports performance and injury risk. With the COVID-19 pandemic under control and the dominance of a less-severe strain of the virus, there is a need to confirm whether these adverse effects still apply to the current situation.

HYPOTHESIS

Infected players would have a higher noncontact muscle injury incidence compared with noninfected counterparts.

STUDY DESIGN

Cohort observational study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Seven teams (n = 147 players) competing in the Spanish professional women's football league (Liga F) were prospectively monitored during the 2021-2022 season. Data from noncontact injuries were recorded and classified following the latest consensus statement from the International Olympic Committee. COVID-19 was certified by the medical staff by regular polymerase chain reaction analysis.

RESULTS

Ninety-two players suffered at least 1 noncontact muscle injury during the season. Injury incidence during the season was similar in players with COVID-19 (n = 83) and players without infection (5.1 ± 6.7 versus 4.9 ± 10.0 injuries/1000 h of play, respectively; P = 0.90). Players with COVID-19 were not more likely to suffer noncontact injuries compared with those players without infection (R2 = 0.02; odds ratio [OR] 95% confidence interval [95% CI] = 0.36-1.38; P = 0.31). There was no effect of COVID-19 on the days of absence due to injury (R2 = 0.01; OR 95% CI = 1.00-1.01; P = 0.44) or in the classification of the severity of the injury (P = 0.79).

CONCLUSION

COVID-19 has no significant effect on noncontact injury incidence and severity in professional female football players.

CLINICAL RELEVANCE

Currently, COVID-19 infection does not alter noncontact muscle injury risk in professional football and requires no further attention in terms of injury management. Usual return-to-play protocols apply to COVID-19 considering the particularities of each player since the severity of infection, period of inactivity, and effects on the player's health and performance.

High Injury Incidence Among Youth in the World's Largest Football Tournament

Gothia Cup is the world's largest youth football (soccer) tournament, held annually since 1975. In 2024, 33 060 players from over 72 countries participated in 4820 matches. Although studies have examined injuries among youth football, research during tournaments remains limited. This prospective study aimed to assess the incidence of injuries among youth football players in Gothia Cup. Secondary objectives included comparing injury by age, sex, and across days of the tournament. All visits at medical tents were recorded. An injury was defined according to FIFA's suggestion as any physical condition that prompted a football player to seek medical attention during the tournament. A total of 1184 injuries were reported, resulting in an overall injury rate of 15.4 injuries/1000 player hours (95% CI, 14.5-16.2). Girls experienced a higher injury rate than boys (16.7, 95% CI 15.0-18.3 vs. 14.7, 95% CI 13.7-15.7 injuries/1000 player hours). Injury incidence increased progressively throughout the tournament, with the lowest rate on the first day (8.8 injuries/1000 player hours, 95% CI 7.3-10.3) and highest on the last day (37.6 injuries/1000 player hours, 95% CI 25.5-49.7). Incidence varied significantly across age groups, with the youngest players (aged 11 and 12 years) exhibiting the highest injury rates (27.7, 95% CI 21.6-33.8 and 25.7, 95% CI 21.0-30.5, injuries/1000 player hours, respectively). Lower extremity injuries were most common. However, head injuries accounted for 7% of all injuries. These findings highlight the injury patterns in a large-scale, six-day youth football tournament, providing valuable insights for the development of medical strategies in future football tournaments.

Effect of 6-week single leg countermovement jump training on force time metrics in elite female youth footballers

Female football participation has grown exponentially. Unfortunately, females exhibit greater injury risk than male athletes, and experience increased mechanical stress during adolescence. Force plates provide accurate and reliable force-time characteristics enabling profiling of injury risk and benchmarking using a variety of jump and isometric tasks. The purpose of this study was to determine whether test-retest reliability and force-time characteristics of SLCMJ, bilateral countermovement jump (CMJ), countermovement rebound jump (CMJ-R) and isometric mid-thigh pull (IMTP) change with six weeks of SLCMJ training. Twenty-eight elite youth female footballers (13.7 ± 1.1 years, 53.27 ± 8.82 kg, 162.20 ± 5.37 cm) completed six weeks of SLCMJ as part of a routine strength and plyometric training program. SLCMJ training did not influence test-retest reliability and resulted in favourable adaptations indicated through small to large changes in force-time characteristics for SLCMJ. Significant (p < 0.05) yet trivial to small favourable changes were observed for the CMJ and CMJ-R, with small increases observed for IMTP. The results of this study demonstrate that six weeks of SLCMJ training does not influence phase-specific test-rest reliability (i.e. braking and propulsion) and causes weekly fluctuations in force-time characteristics leading to improvements in SLCMJ, CMJ, CMJ-R and IMTP. Practitioners can use such information to inform training design and monitor athlete performance.

Injury incidence, prevalence, and burden in an Argentinian male youth soccer academy: one-season descriptive study

OBJECTIVE

To prospectively describe the incidence, severity, and burden of injuries in the youth divisions of an Argentinian professional soccer club during a competitive season.

METHODS

Two hundred and twelve male soccer academy players were grouped by age categories and maturity offset as pre-peak height velocity (PHV), circa-PHV and post-PHV. Injury characteristics were recorded as the International Olympic Committee suggests.

RESULTS

A total of 235 time-loss injuries were sustained by 101 different players. The overall injury incidence rate was of 5.8 injuries per 1000 hours (h), with a training and match injury incidence rate of 4.9 and 9.7 injuries per 1000 h, respectively. The prevalence over the season was 47%. Most of the injuries (202) affected the lower limbs (86.6%) and most of them were classified as muscle/tendon injuries (n = 117, 49.8%). Hamstring structural injury was the diagnosis with the highest burden in both circa and post-PHV groups.

CONCLUSIONS

The incidence, prevalence, and injury burden reported in this study would add valuable information to Argentinians' youth soccer institutions. Post-PHV players had higher incidence, severity, and burden compared to circa-PHV. Structural/functional injuries to the muscle/tendon represented the highest burden for type of injuries (41.1 per 1000 h), suggesting a need for implementing preventive measures.

Shoulder, arm, and elbow injuries in soccer players

Soccer is a global widespread sport with a high injury rate, mostly to the lower limbs. Even though upper limb injuries are much less common among soccer players, their prevalence has increased in recent years. This is due to several reasons/factors, including new and more aggressive tactics, a rise in the number of younger players with different levels of skeletal maturation, and due to the growth of women's participation in sports, which is in line with the fast progression in the degree of professionalism in women's soccer. This review paper aims to (a) describe the most common injuries in the shoulder, arm, and elbow in soccer players and (b) to show the role of different imaging modalities in diagnosing upper extremity injuries that can occur in this sport. Familiarity with these injuries and their mechanisms will lead to a quicker diagnosis and correct reporting of imaging of soccer players.

Gender/sex differences: Representation of women in lateral ankle sprain research

BACKGROUND

Women have historically comprised lower percentages of sports science research participants compared to men. Lateral ankle sprains (LAS) are a common musculoskeletal injury that may affect women more than men.

OBJECTIVE

The primary purpose was to assess the representation of women participants in LAS research. The secondary purpose was to analyze the representation of women as authors in this same work.

DESIGN

Observational study.

SETTING

Systematic reviews on LAS in adults published between May 2013 and April 2023.

PARTICIPANTS

Eleven systematic reviews on LAS with 77 unique original research studies (10, 080 participants, 335 authors) met inclusion criteria.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The main outcomes were the proportion of women as participants and in author roles (primary, senior, and overall).

RESULTS

Women were underrepresented as participants (41%, n = 4150). Women were also the minority gender/sex for authors overall (26%, n = 86) as well as primary (32%, n = 23) and senior (29%, n = 19) authors. No clear increase in the inclusion of women as research participants was observed over time (p = .4), nor was there a significant increase in women authors (p = .1). A greater proportion of participants were women when the primary author was a woman (p = .008).

CONCLUSION

Women are underrepresented in LAS research overall, and there is a lack of clear progress in representation over time. Similarly, women are a minority of study authors and data suggest a possible temporal trend of improvement. Efforts should be made to increase the proportion of women included in LAS research in order to support equitable evidence-based care.

Quantifying the Effects of Detraining on Female Basketball Players Using Physical Fitness Assessment Sensors

This study leverages physical fitness assessment sensors to investigate the effects of a brief in-season break (detraining period) on the physical performance of female basketball players. Sixty-seven players (Senior (n = 19), U18 (n = 19), and U14 (n = 29)) were evaluated before and after a 3-week break using sensor-derived data from a countermovement jump (CMJ), an Abalakov jump (ABK), a linear speed test (20 m sprint), a seated medicine ball throw test (SMBT), and a Basketball-Specific Agility Test (TEA-Basket). The Total Score of Athleticism (TSA), computed as the mean Z-Score across tests, served as a composite indicator of physical fitness. Data obtained from performance sensors revealed significant interactions between time and category for the CMJ, ABK, 20 m sprint, and SMBT, while TEA-Basket measurements showed no significant changes. Time and baseline fitness level interactions were also significant for the CMJ, ABK, and SMBT but not for sprint time or the TEA-Basket. Despite observed declines in explosive strength, speed, and upper-body power across all groups, TSA scores remained stable. These findings underscore the utility of sensor-based evaluation methods in highlighting the adverse effects of short-term detraining and emphasize the necessity of tailored training strategies during competitive breaks.

Data analytics practices and reporting strategies in senior football: insights into athlete health and performance from over 200 practitioners worldwide

Despite the rise of data generation in football, the expertise of data analytics within the sport is relatively underdeveloped. To further understand the landscape, a cross-sectional, observational study design was used to survey practitioners in senior, professional, or semi-professional football. Areas of interest included the personnel involved (the 'who'), the data collected (the 'what'), and the analytical techniques employed (the 'how'). A total of 206 practitioners completed an online survey, with representation from all six FIFA confederations. Of the 206 respondents, 86% were male, 13% female, and 1% preferred not to disclose their gender. Respondents were categorised as working in either the performance (73%), data (18%), or medical (9%) department. Heterogeneity was observed in responses across all departments regarding training load metrics, outcome metrics, methodological attributes, and measurement properties. Evidence sources used prior to implementing a new metric varied between departments, with performance (63%) and medical (67%) staff relying on professional industry and/or community, while data staff (57%) utilised more in-house projects. The analytical approach used most frequently was exploratory data analysis (90%), with modelling, forecasting, and predicting the least frequent (54%). Respondents reported using a mix of solutions for data storage, aggregating and analysing, and reporting and visualising data. Spreadsheets were cited as a popular solution for data wrangling and reporting tasks. The findings provide an overview of current data ecosystems and information systems in modern football organisations. These results can be used to improve data analytics service provision in football by helping identify areas for development and progression.

Jumping and Landing Kinematics in Spanish Female Soccer Players: A Comparison Between Elite and Non-Elite Athletes

Landing from a jump has been identified as a common situation of increased risk in sport and the tuck jump assessment (TJA) has been proposed for a comprehensive examination of landing mechanics. However, group-specific data on female athletes are limited. The purpose of this study was to examine the movement mechanics during a TJA in Spanish female soccer players and to explore potential differences between players of different performance levels. A total of 96 (elite and non-elite) female soccer players performed a TJA, and a rater visually graded the technique using the modified 10-item scoring system (0, 1, or 2 for "none", "small", or "large" flaws). Descriptive statistics were calculated. The association between the flaws and performance groups was assessed using the chi-square test. Almost 90% of all players involved were categorized with small and large flaws for the item "Lower extremity valgus at landing". The proportion of players categorized with technical flaws was also high for "Foot contact timing not equal" (85%) and "Does not land in same footprint" (82%). Differences between elite and non-elite players were only found for "Foot placement not parallel" and "Excessive landing contact noise" (p < 0.008). These results reveal the importance of implementing training programs to reduce jumping and landing deficits in female soccer players, independently of the players' level of performance.

Injury Prevention Strategies in Female Football Players: Addressing Sex-Specific Risks

There has been rapid growth in women's football worldwide; however, research on injury prevention strategies and physiological considerations specific to female athletes remains insufficient. Women's football has experienced an increase in injury prevalence, despite being underrepresented in sports literature, with less than 25% of research focused on this demographic. The incidence of injuries, particularly among young elite female footballers, is notably high, impacting long-term health outcomes such as osteoarthritis and contributing to shorter playing careers. Certain injuries, such as anterior cruciate ligament (ACL) ruptures, occur at significantly higher rates in women compared to men, underscoring sex-specific risk factors that must be addressed in injury prevention programs (IPPs). This narrative review aims to evaluate the effectiveness of IPPs tailored for female football players and to address their heightened susceptibility to injuries compared to males. Research studies and review articles were identified using a literature search of the PubMed, SportDiscus, and Google Scholar databases from 1990 to December 2024. Biological factors, including hormonal influences-such as increased ACL laxity during the menstrual cycle-and musculoskeletal differences, such as muscle strength imbalances, reduced joint stability, and hip weakness, significantly contribute to this increased risk. Despite the existence of injury prevention protocols like FIFA 11+, their consistent application and adaptation to meet the unique needs of female footballers remain limited. In addition to physical injuries, mental health is a critical concern. Female football players exhibit higher rates of depression and anxiety compared to their male counterparts, influenced by factors such as injury-related stress and menstrual cycle variations. In conclusion, the growing participation of women in football highlights the urgent need for research and implementation of injury prevention strategies specifically tailored to female players.

Match and training injury epidemiology in elite UK netball: a prospective cohort study over one season

Objective

To describe the incidence and characteristics of match and training injuries in the UK Vitality Netball Superleague (VNSL).

Methods

Ninety players were observed over one 14-month VNSL season (2021), including pre-, in- and post-season periods. Team physiotherapists recorded injuries using an online surveillance system, classifying them by location, type, mode, mechanism and impact, including severity (time-loss days, TL) and medical attention days (MA). Injury incidence (I) and TL/MA injury burden were calculated per 1000 player hours. χ2 analysis compared match and training differences.

Results

Thirty-nine players sustained 70 injuries (n=35 match, 35 training). Match incidence exceeded training (I=41.12 vs 1.10 injuries). Acute injuries were higher in matches (27 vs 17), while overuse injuries were higher in training (18 vs 3; p=0.001). Contact injuries were higher in matches (21 vs 7), and non-contact injuries were higher in training (10 vs 6; p=0.028). Acute ankle ligament injuries in matches caused substantial TL burden (411.7 days lost), while overuse lower leg injuries in training led to high MA burden (13.8). Anterior cruciate ligament (ACL) injuries were infrequent but burdensome (TL 496). The centre position sustained the most injuries (41%).

Conclusion

This study underpinned implementing the first injury surveillance system in the elite UK netball competition, revealing match injury rates ~40 times higher than in training, with distinct injury characteristics. Findings suggest that prevention should target acute lower limb injuries and overuse conditions. Further research should assess the impact of playing with overuse injuries.

Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies

This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women's Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club's international players' lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player's injury resilience in professional women footballers.

Physical Conditioning and Functional Injury-Screening Profile of Elite Female Soccer Players: A Systematic Review

PURPOSE

To identify the physical conditioning and functional injury-screening characteristics of elite female soccer players.

METHODS

This review was prospectively registered (PROSPERO CRD4202346765). Searches were conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Web of Science (from inception in March 2023 to July 2023). Updated searches were conducted in October 2023 and April 2024. Included studies were quantitative studies conducted on female soccer players. Main outcomes were functional and physical profiles. Screening, data extraction, and quality assessment (Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales) were performed. Mean differences between preseason and in-season testing periods were estimated by Hedges g effect size. Methods and results were reported according to PRISMA guidelines.

RESULTS

The search yielded 1727 articles, of which 10 were included. Overall methodological quality of the studies was strong, with a moderate level of evidence. Players exhibited mean maximal oxygen uptake of 52.6 (4.5) mL·min-1·kg-1, 20-m linear-sprint performance of 3.58 (0.18) seconds, countermovement jump of 31.0 (2.9) cm, unilateral countermovement jump of 14.4 (2.1) cm, and quadriceps and hamstring peak torque at 60°·s-1 of 133 (23) and 87 (17) N·m, respectively. Mean scores recorded during in-season were 2% to 22% better than in preseason (effect size: small to very large).

CONCLUSIONS

This review provides valuable normative physical conditioning and functional injury-risk assessment data for elite female soccer players. Coaches and conditioning staff can use these insights to interpret their own records and optimize their training processes. Furthermore, this study identifies methodological limitations to address in future research.

Injury surveillance in Spanish professional female soccer players: A three-season retrospective study

INTRODUCTION

Despite the popularity of soccer at the male elite level, data on the incidence of injuries in female players are limited. The study aimed to evaluate the injury incidence and rates in female soccer players in a professional setting over 3 consecutive seasons.

METHODS

Data compiled from 71 elite female players with different playing positions and belonging to the same team were analyzed. The location and severity of injuries were reported according to international consensus statements on the process of conducting epidemiological studies in professional soccer. The injury incidence rate (IIR) for matches and practices and the rate ratio (RR) were calculated, and time-loss injuries during the season were also recorded.

RESULTS

A total of 53 injuries were documented, with an overall IIR of 1.08 injuries per 1000 h and an overall rate ratio of 0.61. The lower limbs were the most affected region (86,8 %). The majority of these injuries occurred around the thigh and knee and were predominantly traumatic, with markedly higher rates of injury during match play (2.78 injuries per 1000 h) when compared to injury incidence during training (0.79 injuries per 1000 h). Traumatic injuries accounted for 48 (91 %) and 24 (45,3 %) were indirect contact injuries. Reinjuries amounted to 15 % of total injuries and August was the predominant month for injury, being goalkeepers the least injured players (13.2 %).

CONCLUSIONS

Female professional soccer players displayed injury incidence rates and patterns comparable to those of male players. This study provides epidemiological information that will help to inform future injury surveillance studies and the development of prevention strategies to reduce the number of injuries in elite female soccer players, focusing specifically on thigh and knee regions. All match involvements should be considered when exploring associations between the type of exposure and injury risk.

The effect of foam rolling on local and distant pain sensitivity assessed with pressure pain thresholds in healthy participants and musculoskeletal pain patients: A systematic review

INTRODUCTION

The self-treatment with a foam roller is a popular form of myofascial release, although the underlying mechanisms, particularly on pain sensitivity, remain unclear. It is hypothesized that the hypoalgesic local effects are probably due to changes in fascial and muscle tissue, whereas remote effects may be influenced by central endogenous pain modulation. This systematic review aimed to quantify the difference between local and remote hypoalgesic effects of the foam rolling intervention.

METHOD

A systematic search was conducted in the databases Pubmed, Cochrane Library, Web of Science, and CINAHL. Published randomized controlled trials and non-randomized controlled trials investigating the effects of foam rolling on Pressure Pain Thresholds (PPTs) in healthy individuals and patients with musculoskeletal pain were included. Quality assessment and evidence synthesis were performed according to Cochrane Handbook recommendations. A meta-analysis was performed using standardized mean differences and 95% CIs.

RESULTS

Local PPTs changed after rolling in a pre-post comparison with a small effect size: SMD = -0.42 (95 % CI = -0.57 to -0.26); I2 = 1 %. Remote PPTs also changed after rolling in a pre-post comparison with a small effect size: SMD = -0.47 (95 % CI = -0.80 to -0.14); I2 = 0 %. Foam rolling showed no effect on local PPTs when compared with a control group: SMD = 0.10 (95 % CI = -0.19 to 0.39); I2 = 0 %.

CONCLUSION

No consistent effects of foam rolling on PPTs were demonstrated in healthy individuals.

Effects of In-Season Strength Training on Physical Fitness and Injury Prevention in North African Elite Young Female Soccer Players

BACKGROUND

Strength training (ST) primarily enhances physical fitness (e.g., muscle strength, power, speed) and bone density in female soccer players. Less information is available on the injury preventive effects of ST in female athletes. Accordingly, this study aimed to investigate the effects of a 12-week in-season ST on measures of physical fitness and injury occurrence in young elite female soccer players.

METHODS

Thirty elite female soccer players (15.4 ± 1.9 years; maturity offset + 2.3 ± 1.1 years) participated in this study, and were randomly assigned to a strength training group (STG, n = 14) or an active control (CG, n = 16) group. ST lasted twelve weeks and included full body muscle strengthening exercises using primarily weight machines at progressive intensities ranging between 40 and 85% of the one-repetition-maximum (1-RM). The CG practiced a traditional soccer training program. Overall, training volumes of the two groups were similar with a training load (rating of perceived exertion × time) of 1158.4 ± 67.7 arbitrary unity (AU) for the STG and 1188.8 ± 44.1 AU for the CG. Pre and post training, the following physical fitness tests were applied: dynamic muscle strength (relative [to body mass] and absolute 1-RM bench/leg press, lat-pull down), jump performance (countermovement jump [CMJ], squat jump [SJ], five-jump-test [5JT]), linear-sprint speed (5-m, 10-m, 30-m), change-of-direction speed (T-test with and without ball), sport-specific performance (Yo-Yo Intermittent Level1 [YYIRTL1], and repeated shuttle sprint ability [RSSA]). The injury rate per 1000-h exposure was monitored throughout the soccer season.

RESULTS

No significant baseline differences were observed between groups. Statistically significant group-by-time interactions were found for absolute (p < 0.001, d = 2.59) and relative 1-RM bench press (p < 0.001, d = 2.39), absolute 1-RM lat-pull down (p < 0.001, d = 1.68), and relative 1-RM leg press (p < 0.001, d = 1.72). Significant group-by-time interactions were observed for CMJ (p = 0.005, d = 1.27), RSSAmean (p = 0.007, d = 0.81), and RSSAtotal (p < 0.001, d = 1.90). Post-hoc tests indicated that the STG group demonstrated greater improvements in all tested variables compared to CG (1.2 < d < 2.5). However, no significant interaction effects were noted for measures of linear sprint speed and YYIRTL1 performance. Additionally, non-contact injuries during the season were significantly lower (p = 0.003, d = 1.31) in the STG (0.48/1000 h of exposure) than the CG (2.62/1000 h of exposure).

CONCLUSIONS

Twelve weeks of an in-season ST resulted in larger physical fitness improvements and fewer injuries compared with an active control in elite young female soccer players. Accordingly, ST should be systematically applied in female soccer to enhance performance and prevent injuries.

Gender differences in foot and ankle sporting injuries: A systematic literature review

BACKGROUND

In response to the all-time high of female sports participation, there has been increasing scientific discourse and media interest in women's sporting injuries in recent years. In gender comparable sports the rate of foot and ankle injury for women is higher than for men. There are intrinsic and extrinsic factors which may explain this difference.

METHODS

A systematic literature search was performed according to the PRISMA guidelines of PubMed, Ovid EMBASE and OVID MEDLINE. Relevant key terms were used to narrow the scope of the search prior to screening. Case reports, review articles, paediatric patients, non foot and ankle injuries and combat sports were excluded. We used dual author, two pass screening to arrive at final included studies.

RESULTS

2510 articles were screened after duplicate exclusion. 104 were included in this literature review. We identified lack of reporting gender difference in the literature.We identified that females have higher frequency and severity of injury. We provide an overview of our current understanding of ankle ligament complex injuries, stress fractures, ostochondral lesions of the talus and Achilles tendon rupture. We expand on the evidence of two codes of football, soccer and Australian rules, as a "case study" of how injury patterns differ between genders in the same sport. We identify gender specific characteristics including severity, types of injury, predisposing risk factors, anatomy, endocrinology and biomechanics associated with injuries. Finally, we examine the effect of level of competition on female injury patterns.

CONCLUSIONS

There is a lack of scientific reporting of gender differences of foot and ankle injuries. Female athletes suffer foot and ankle injuries at higher rates and with greater severity compared to males. This is an under-reported, yet important area of orthopaedics and sports medicine to understand, and hence reduce the injury burden for female athletes.

Match Injury Incidence for a New Zealand Amateur Domestic Female Soccer Team over Two Consecutive Seasons

OBJECTIVE

To determine the match injury incidence for a New Zealand amateur domestic female soccer team over two consecutive seasons.

METHODS

A descriptive, epidemiological observational study was conducted to determine match injury incidence for 49 players over two domestic seasons. Match exposure and injury burden were calculated.

RESULTS

A total of 84 match-related injuries resulted in a match injury incidence of 145.5 (95% confidence interval (CI): 117.4 to 180.1) per 1000 match h. Attackers had a higher incidence of injuries for total (200.0 per 1000 match h) and missed matches (152.4 per 1000 match h). The lower limbs had the highest injury incidence (105.6 per 1000 match h), with ankle injury being the most reported (43.3 per 1000 match h) lower limb injury. Over three quarters (75.3%) of the injuries recorded were missed match injuries. Sprains/strains were the most recorded total (86.6 per 1000 match h) injury type. Fractures were recorded as having the highest mean injury burden (68.7 ± 70.4 days).

DISCUSSION

Historically, there was a paucity of injury burden data for female football; however, the data presented within this study can be utilised to support the identification of injury patterns and areas to be included within injury reduction programmes.

Practitioners' perspective of non-contact injury risk factors and injury prevention programming in professional North American male soccer

OBJECTIVE

To evaluate non-contact injury prevention strategies of professional men's soccer clubs in elite North American league soccer. To understand the application, perceived effectiveness and barriers to implementation.

DESIGN

Online cross-Sectional Study.

SETTING

North American elite soccer teams.

PARTICIPANTS

96 medical and performance support staff of elite North American teams.

MAIN OUTCOME MEASURE

The survey consisted of 20 questions and captured 1) practitioners' demographics; 2) perceptions of risk factors; 3) the use of assessment and monitoring strategies; and 4) perceptions of the implementation of injury prevention programmes'.

RESULTS

Injury prevention programmes were perceived as 'effective' (Median 4, Interquartile range 4-4) and reduced injury rates (n = 94, 98%, 95 CI% 93 to 99). A range of potential risk factors were rated as "very important" (4.58 ± 0.52 Likert scale points; mean ± standard deviation). A multi-disciplinary approach to the design, application and monitoring of programmes was generally adopted. Competing training priorities (n = 75, 78%, 95 CI% 69 to 85) and game schedules (n = 71, 74%, 95 CI% 64 to 82) were the most prevalent barriers to injury prevention implementation.

CONCLUSIONS

Injury prevention programmes were perceived as effective in reducing non-contact injuries. Managing the conflicting priorities between scheduling training, tactical and conditioning goals were considered the key barriers to desired implementation.

Four distinct patterns of anterior cruciate ligament injury in women's professional football (soccer): a systematic video analysis of 37 match injuries

BACKGROUND

To identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women's professional football by means of video match analysis.

METHODS

ACL match injuries sustained in Germany's first women's league during the 2016-2017 to 2022-2023 seasons were prospectively analysed by three expert raters using a standardised observation form. Epidemiological and injury data, as well as the medical history of ACL tears, were obtained from media reports and the statutory accident insurance for professional athletes.

RESULTS

Thirty-seven ACL injuries sustained in official football matches were included in the video analysis, of which 24 (65%) had associated knee injuries, mainly meniscus and collateral ligament injuries. According to the categorised contact mechanisms, 17 (46%) were non-contact injuries, 14 indirect contact injuries (38%) and six direct contact injuries (16%). Of the 17 non-contact injuries, seven (41%) occurred during the first 15 min of the match. Contact mechanisms did not differ between primary and secondary ACL injuries to the same or the contralateral side. Most injuries (80%) of field players occurred during horizontal movements such as sprinting (n=9, 26%), change-of-direction manoeuvres (n=7, 19%), stopping (n=5, 14%) and lunging (n=5, 14%). Four distinct repetitive patterns of ACL match injuries were identified: (1) non-contact 'pressing ACL injury' (n=9), (2) indirect contact 'parallel sprinting and tackling ACL injury' (n=7), (3) direct contact 'knee-to-knee ACL injury' (n=6) and (4) non-contact 'landing ACL injury' (n=4).

CONCLUSION

Most of the identified patterns of ACL injuries in women's professional football have great potential for prevention.

Use of the concussion check protocol for concussion assessment in a female soccer team over two consecutive seasons in New Zealand

AIM

Address deficiencies in access to sports sideline medical care by using a Concussion Check Protocol (CCP) for non-medically-trained people.

METHOD

A prospective observational cohort study was undertaken on a single amateur female club-based soccer team over two consecutive years in New Zealand utilising a non-medically trained support person termed a Safety officer. CCP is an extension of the King-Devick test with features such as warning signs and symptoms of concussion built into the application. All players suspected of having a potential concussive injury were tested on the match sideline.

RESULTS

The study overall incidence of match-related concussions was 20.8 (95% CI: 11.8 to 36.6) per 1000 match-hrs, with mean missed-match duration of 31 (95% CI: 27.9 to 34.1) days. Twelve players over the study had a significantly slower post-injury KD (49.9 [44.3 to 64.1]s; χ2(1) = 11.0; p = 0.0009; z = -2.9; p = 0.0033; d = 0.30) and/or reported symptoms, compared with their own baseline (47.2 [44.3 to 64.1]s). CCP had an overall sensitivity of 100% (95% CI: 73.5% to 100.0%), specificity of 100% (95% CI: 69.2% to 100.0%) and positive predictive value (PPV) of 100% (84.6% to 100.0%).

CONCLUSION

Sideline use of CCP was undertaken successfully by non-medically trained people and provided a reliable platform for concussion identification.

Injury Profile in Youth Female Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

An increasing number of epidemiological studies assessing the incidence, prevalence and severity of injury in youth female sport are available. However, no study has sought to synthesise the current evidence base across all youth female sport. As such, a systematic review and meta-analysis of injury in this cohort is necessary to understand the diversity of injury and its associated burden between sports in addition to identifying the density of research available.

OBJECTIVE

To conduct a systematic review and meta-analysis of epidemiological data of injuries in youth female athletes with particular attention to injury incidence, mean days lost and injury burden.

METHODS

Searches were performed in PubMed, EBSCO (SPORTDiscus with Full Text MEDLINE, APA PsycINFO, CINAHL, Academic Search Complete) and Cochrane databases. Studies were considered if they reported time-loss injury incidence or prevalence in youth female (≤ 19 years old) athletes. Study quality and risk of bias were assessed using STROBE-SIIS extension, Newcastle-Ottawa Scale, and funnel plots, respectively. Injury incidence and burden rate data were modelled using a mixed-effect Poisson regression model. Days lost data were modelled using a generalised linear mixed model.

RESULTS

Thirty-two studies were included. The overall incidence rate, mean days lost per injury, and burden rate were 4.4 injuries per 1000 h (95% CI 3.3-5.9), 10 days (95% CI 6-15), and 46 days per 1000 h (95% CI 23-92), respectively. Forty percent of athletes sustained at least one time-loss injury. Competitive level was a significant moderator of match and training injury incidence, with elite youth athletes presenting greater pooled injury incidence estimates than non-elite athletes (p = 0.0315 and p = 0.0047, respectively). The influence of moderators on days lost and injury burden could not be determined due to an insufficient number of studies for analysis.

CONCLUSION

Despite a broad inclusion criterion, there is limited injury surveillance research available across youth female sport. Outside of soccer, little research density is evidenced with single studies available in popular team sports such as Australian football and rugby union. Insufficient study numbers reporting mean days lost and injury burden data were available for analysis, and pooled days lost data could only be estimated for soccer. This highlights a need for future research to report days lost data alongside injury number and exposure so burden can be calculated and the full risk of injury to youth female athletes can be identified.

Injury prevention in Brazilian women's football: Perceptions of physiotherapists and practices within elite clubs

OBJECTIVES

To describe the perceptions of physiotherapists and the injury prevention practices implemented within elite women's football clubs in Brazil.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PARTICIPANTS

Head physiotherapists from 32 Brazilian elite clubs.

MAIN OUTCOME MEASURES

Structured questionnaire.

RESULTS

Physiotherapists identified ACL rupture as the primary target for prevention. The top-five perceived injury risk factors included 'early return to sport after injury', 'workload too high', 'previous injury', 'poor sleep/rest', and 'muscle strength/power deficit'. 'Adoption of return to sport criteria' was almost unanimously recognized as a very important preventive strategy. 'Poor infrastructure' was elected as the main barrier to implementing prevention programs. From a practical standpoint, at least two-third of clubs implemented multi-component exercise interventions for injury prevention. These interventions typically encompassed flexibility/mobility, balance/proprioception, lumbo-pelvic stability, and agility exercises, alongside exposure to sprinting. Strength training routines typically included traditional, functional, and eccentric exercises. Most teams also employed other prevention strategies, including adoption of return to sport criteria, internal workload monitoring, post-exercise recovery modalities, preseason risk factor screening, and application of rigid strapping tapes.

CONCLUSIONS

This study provided unprecedented insights into the physiotherapists' perceptions and injury prevention practices implemented within elite women's football clubs.

Effects of the menstrual cycle on the performance of female football players. A systematic review

Background

Women's football has been booming for a few years now, which has led to an increase in the expectation of the players' performance, leading to a more detailed study of women's physiology in the field of sports.

Objectives

To analyze the scientific evidence on the influence of menstruation on the performance of female footballers, as well as to analyze the methodological quality of the studies included in this review.

Materials and methods

The possible hormonal effects of the menstrual cycle phases on the performance of female footballers were analyzed. The databases used to conduct the searches were Pubmed, Scopus, Virtual Health Library, Web of Science, EBSCO and the Cochrane Library. All included studies met the inclusion criteria. The Cochrane risk of bias tool was used. This systematic review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023390652).

Results

A total of nine clinical trials were included in this review. A low quality of evidence was observed in the studies. Not all the results support the idea that the menstrual cycle phases can alter the performance of female footballers.

Conclusion

This systematic review shows that there is a great deal of controversy about the influence of the menstrual cycle phases on the performance of female footballers. Studies are focused on solely biological factors and gender is normally no part of those studies. Further research with larger samples, and taking not only biological but also sociological factors, are necessary to determine the effects of menstruation on the performance of female footballers.

Uncovering injuries in Brazilian elite women's football: A prospective cohort study

OBJECTIVES

To elucidate the injury profile in Brazilian elite women's football.

DESIGN

Prospective cohort study.

METHODS

Time-loss injuries, along with match and training exposure, were monitored throughout a full season in four Brazilian elite clubs.

RESULTS

Sixty-three out of 133 players (47 %) sustained 112 time-loss injuries along the season, leading to 0.8 injuries per player on average. The overall injury incidence rate was 5.0 injuries per 1000 h of exposure. Sudden onset injuries occurred at a rate of 4.2/1000 h of overall exposure, with rates of 15.9/1000 h during matches and 2.9/1000 h during training sessions. Forty-eight percent of the time-loss injuries were attributed to non-contact events. Gradual onset injuries accounted for 16 % of the injuries, resulting in a rate of 0.8/1000 h of overall exposure. The most affected locations were knee and thigh (29 % of all injuries for each), followed by ankle (17 %) and hip/groin (13 %). Muscle/tendon was the most affected tissue (47 % of all injuries), followed by ligament/joint capsule (33 %), bone (10 %), and cartilage/synovium/bursa (7 %). Ankle sprains, hamstring strains, and anterior cruciate ligament injuries accounted for over one-third of the injuries. Mild, moderate, and severe injuries account for 40 %, 43 %, and 17 % of cases, respectively. Overall, 18 % of cases were categorized as re-injuries, and 40 % of those occurred within 2 months of the index injury.

CONCLUSIONS

This study provides the initial understanding into the injury profile of Brazilian elite women's football. This information should serve as a guiding resource for injury prevention programs.

'Considering the reality, I am very lucky': how professional players and staff perceive injury prevention and performance protection in women's football

OBJECTIVE

To explore the beliefs and perceptions of professional female footballers and staff regarding injury prevention and performance protection in professional women's football.

METHODS

This qualitative study applied semistructured interviews with 18 participants from 3 top-tier teams from 2 countries (Portugal and England) and 4 nationalities, including 2 physiotherapists, 5 players, 3 team doctors, 2 head coaches, 3 strength and conditioning coaches, 2 managers, and 1 head of performance. Data analysis applied constant comparison analysis, using principles of grounded theory. There were no major differences in the perspectives of players and staff, and the findings are presented together.

RESULTS

Identifying and reporting injuries and recognising potential injury risk factors were mentioned to influence the prevention of injury. Participants stated that the growth and evolution of women's football could influence injury risk. Before reaching the professional level, exposure to potential risk factors, such as lack of recovery, limited awareness and opportunities for prevention (eg, preventive exercises and load management strategies), was believed to impact players' injury risk. Players further described their experiences and the 'bumpy road' to becoming a professional player, their current context and potential future improvements for women's football regarding injury prevention and performance protection.

CONCLUSION

Professional female football players face different injury risks during different moments of their careers. According to elite players and staff, amateur and semiprofessionals have limited resources and lack injury prevention strategies. Professional players and staff perceived the current preventive measures as good and relied on the value of individualised care and a multidisciplinary approach. In the future, more resources and structured injury prevention strategies are needed in youth and non-professional levels of women's football to reduce injury risk and allow more players to reach their maximal performance.

UEFA Women's Elite Club Injury Study: a prospective study on 1527 injuries over four consecutive seasons 2018/2019 to 2021/2022 reveals thigh muscle injuries to be most common and ACL injuries most burdensome

OBJECTIVE

Injuries in women's football (soccer) have scarcely been investigated, and no study has been conducted in the highest competitive level involving club teams from different countries. Our aim was to investigate the time-loss injury epidemiology and characteristics among women's elite football players over four seasons.

METHODS

596 players from 15 elite women's teams in Europe were studied prospectively during the 2018/2019 to 2021/2022 seasons (44 team seasons). Medical staff recorded individual player exposure and time-loss injuries. Injury incidence was calculated as the number of injuries per 1000 playing hours and injury burden as the number of days lost per 1000 hours.

RESULTS

1527 injuries were recorded in 463 players with an injury incidence of 6.7 (95% CI 6.4 to 7.0) injuries per 1000 hours and a nearly fourfold higher incidence during match play compared with training (18.4, 95% CI 16.9 to 19.9 vs 4.8, 95% CI 4.5 to 5.1; rate ratio 3.8, 95% CI 3.5 to 4.2). Thigh muscle injuries (hamstrings 12%, 188/1527, and quadriceps 11%, 171/1527) were the most frequent injury, while anterior cruciate ligament (ACL) injury had the highest burden (38.0 days lost per 1000 hours, IQR 29.2-52.1) with median days lost of 292 (IQR 246-334) days. Concussions constituted 3% (47/1527) of all injuries, with more than half of them (55%, 26/47) due to ball-related impact.

CONCLUSION

An elite women's football team can expect approximately 35 time-loss injuries per season. Thigh muscle injury was the most common injury and ACL injury had the highest injury burden.

Tactics analysis and evaluation of women football team based on convolutional neural network

In order to realize the process of player feature extraction and classification from multi-frequency frame-changing football match images more quickly, and complete the tactical plan that is more conducive to the game, this paper puts forward a method for analyzing and judging the tactics of women's football team based on Convolutional Neural Network (CNN). By extracting the players' performance in recent training and competition from continuous video frame data, a multi-dimensional vector input data sample is formed, and CNN is used to analyze the players' hidden ability before the game and the players' mistakes in different positions on the field to cope with different football schedules. Before the formal test, 10 games of 2021-2022 UEFA Women's Champions League were randomly selected and intercepted to train the CNN model. The model showed excellent accuracy in the classification of image features of various football moves and goal angles, and the overall classification accuracy of each category exceeded 95%. The accuracy of classifying a single match is above 88%, which highlights the reliability and stability of the model in identifying and classifying women's football matches. On this basis, the test results show that: according to the analysis of players' personal recessive ability before the game, after model image recognition and comparison, the difference between the four scores of players' personal recessive ability with CNN mode and the manual score of professional coaches was smaller, and the numerical difference was within the minimum unit value, and the numerical calculation results were basically the same. According to the analysis of players' mistakes in different positions on the field, CNN was used to monitor the real-time mistakes. It was found that the two players in the forward position made the highest mistakes, and they were replaced by substitute players at 73.44 min and 65.28 min after the team scored and kept the ball, respectively. After the substitute players played, the team's forward position mistake rate decreased obviously. The above results show that CNN technology can help players get personal recessive ability evaluation closer to professional evaluation in a shorter time, and help the coaching team to analyze the real-time events better. The purpose of this paper is to help the women's football team complete the pre-match tactical training, reduce the analysis time of players' mistakes in the game, deal with different opponents in the game and improve the winning rate of the game.

Application of a Custom Device to Measure Isometric Knee Strength: Possible Injury Correlation in Professional Soccer (Football) Players

Injury in sports is an occurrence that prevents athletes from participating in training and competitions and has an incidence of 8.1 injuries/1000 h of practice. This translates into a cost and also into danger, especially if the event is repeated, for the health of the athlete; the injury certainly has a multifactorial causality. On the other hand, having instruments that can represent an alarm could be helpful for those involved in sports science. We used a specifically designed instrument, presented in a previous work, which shows excellent reliability and repeatability in measuring the strength of the knee flexors and extensors to test 107 players belonging to three different teams playing in the Italian Serie A. We took three measurements, beginning of the season, mid-season, and close to the end of the season. This retrospective study on 107 professional soccer players demonstrates that isometric force-related parameters of the knee extensors and flexors are associated with the risk of injury to lower limbs. Logistic regression evidenced a significant correlation between the parameter indicating the imbalance of the force between the flexors of the two limbs (p≤0.05, OR = 1.089) and the occurrence of injuries. Survival analyses (p≤0.001) evidenced a correlation between the population survival time and the injury incidence. We demonstrated that the analysis of the strength imbalance is correlated with injury occurrence, but it is well known that sports injuries are a multifactorial event; so, they cannot be predicted by only one parameter. However, the method proposed in this paper could represent a useful tool for sport scientists.

Higher age and present injury at the start of the season are risk factors for in-season injury in amateur male and female football players-a prospective cohort study

PURPOSE

To describe the injury prevalence, injury pattern, and potential baseline risk factors for injuries in male and female adolescent and adult amateur football players.

METHODS

This prospective study followed adolescent and adult amateur football players over one season March-October 2020. The study was completed by 462 players (130 men, age 20.0 ± 5.7, 14-46 years) who answered a baseline survey and a weekly web survey during the season. A total of 1456 weekly surveys were registered from males and 5041 from females. Injuries were recorded with the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O2). Potential baseline risk factors (age, performance of strength/conditioning training, participation in other sports, perceived importance of sporting success, self-rated training and match load, perceived balance between training/match load and recovery, previous/present injury at start of season, and injury beliefs) and their association with injury were analysed with Poisson regressions within each sex.

RESULTS

Males reported 95 injuries (262 injury weeks, weekly prevalence 18.0% (95% CI 16.1-20.1)) and females 350 injuries (1206 injury weeks, weekly prevalence 23.9% (95% CI 22.8-25.1)). Gradual-onset injuries accounted for 57% of the injuries in males and 66% in females. For males, substantial injuries were most common in the hip/groin (weekly prevalence 3.8%), ankle (2.1%), posterior thigh (2.0%), and knee (2.0%); and for females, in the knee (4.3%), ankle (2.5%), and lower leg/Achilles tendon (2.0%). Significant risk factors for injury were higher age (rate ratio males 1.05 per year increase (95% CI 1.02-1.08), females 1.03 (95% CI 1.01-1.05)), and present injury at baseline (males 1.92 (95% CI 1.27-2.89), females 1.58 (95% CI 1.19-2.09)).

CONCLUSION

At any given week, almost one in five male and one in four female amateur football players reported new or ongoing injuries. Hip/groin injuries were more frequent in males, while female players had a higher prevalence of knee injuries. Older players and those with an existing injury at the start of the season were more prone to new injury during the season. Rehabilitation of pre-season injury and complaints are key to reduce the injury burden in amateur football.

LEVEL OF EVIDENCE

Level II. Trial registration number NCT04272047, Clinical trials.

Epidemiology of Injuries in Professional and Amateur Football Men (Part II)

Background (1): Men's football is a physically demanding contact sport that involves intermittent bouts of sprinting, jogging, walking, jumping and changes of direction. The physical demands of the game vary by level of play (amateur club, sub-elite and open club or international), but injury rates at all levels of the men's football game remain the highest of all sports. Objective: The aim of this study is to conduct a systematic review of data from the epidemiological literature regarding the profile, severity and mechanisms of injuries and the frequency of recurrent injuries in professional and amateur football players. Methods (2): A systematic review, according to PRISMA guidelines, was performed up to June 2023 in the databases of PubMed, Web of Science, Google academic, Google scholar and the Diva portal. Twenty-seven studies that reported data on the type, severity, recurrence and mechanisms of injury in professional and amateur men's football were selected and analyzed. Two reviewers independently audited data and assessed the study quality using the additional and adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): In professional male football players, the mean prevalence of muscle/tendon injuries was 39.78%, followed by joint and ligament injuries-21.13%, contusions-17.86%, and fractures-3.27%, and for amateur football players, the prevalence's were 44.56% (muscle/tendon injuries), 27.62% (joint and ligament injuries), 15.0% (contusions) and 3.05% (fracture), respectively. The frequency of traumatic injuries was higher in amateur football players (76.88%) compared to professional football players (64.16%), the situation being reversed in the case of overuse injuries: 27.62% in professional football players and 21.13% in amateur football players. Most contact injuries were found in professional footballers (50.70%), with non-contact injuries predominating in amateur footballers (54.04%). The analysis of the severity of injuries showed that moderate injuries dominated in the two categories of footballers; the severe injuries in amateur footballers exceeded the severe injuries recorded in professional footballers by 9.60%. Recurrence proportions showed an inverse relationship with the level of play, being higher in amateur footballers (16.66%) compared to professional footballers (15.25%). Conclusions (4): Football-related injuries have a significant impact on professional and amateur football players and their short- and long-term health status. Knowing the frequency of severe diagnoses, such as strains, tears and cramps of the thigh muscles, ankle ligament sprains and hip/groin muscle strain requires the establishment of adequate programs to prevent them, especially in amateur football players, who are more prone to serious injuries.

Health problems occurring in national-level female soccer players are different between leagues and throughout the season: a 6-month prospective cohort study

Objectives

This study investigated the prevalence and severity of health problems in national-level female soccer players with respect to league and seasonality.

Methods

In a prospective cohort study, 46 female soccer players aged 22.8±3.9 years playing in the three highest leagues in Switzerland were surveyed biweekly using the Oslo Sports Trauma Research Centre health problem (OSTRC-H) questionnaire. All definitions and measures followed the OSTRC-H-specific recommendations. The 6-month observation period included parts of the off-season and one half of the match season.

Results

The average 2-weekly health problem prevalence was 37.3% (illnesses: 8.8%; sudden onset injuries-both acute and repetitive mechanisms: 19.7%; repetitive gradual onset injuries: 12.4%) and 25.1% for substantial problems as defined in the OSTRC-H context (7.3%; 12.0% and 7.3%, respectively). The absolute injury rates amounted to 148 injuries per 100 players per half season, of which 96 injuries per 100 players per half season were substantial. Female players in the 2nd and 3rd highest national leagues showed more gradual onset injuries (p<0.001) and fewer illnesses than those in the top league (p<0.05). At the same time, there were no league-specific differences in sudden onset injuries. Such injuries had a higher cumulative severity score than gradual onset injuries. Among sudden onset injuries, the ankle was the most affected body part, while the thigh was affected by for gradual onset injuries. The average 2-weekly health problem prevalence values steadily increased during the match season.

Conclusion

Among national-level female soccer players, the risk of health problems is relatively high and differs between leagues and across seasons.

A systematic literature review of injury epidemiology and surveillance practices in elite adult female field-based team sport

OBJECTIVES

To describe injury incidence and surveillance practices in elite adult female field-based team sports.

DESIGN

Systematic literature review.

METHODS

This review was prospectively registered (PROSPERO CRD42022318642). CINAHL, PubMed, MEDLINE, Scopus, SPORTDiscus, Web of Science, Open Grey and Google Scholar were searched from inception to 30th June inclusive. Peer reviewed original research articles that reported the incidence of injury sustained by females aged ≥18 years in elite field-based team sports were included. The Newcastle Ottawa Scale was used to assess the risk of bias.

RESULTS

Twenty prospective cohort studies investigating injury incidence in Australian football, American football, soccer, field hockey, rugby, rugby-7s and cricket were eligible. A higher injury incidence in match play compared to training was reported with the highest match and training incidence (132.7 and 42.1/1000 h of exposure respectively) in Australian football. The majority of the reported injuries were to the lower limb and involved muscle/tendon or joint/ligaments. There was heterogeneity in definitions of injury, severity and exposure, variations in methods of injury data collection and reporting with, not all data being collected/reported optimally, which limited comparison of studies.

CONCLUSIONS

This review highlights the lack of and need for injury data specific to this cohort. Establishing the incidence of injury with a robust injury surveillance system is the first step in the sequence of injury prevention. It requires consistency in definitions and methodologies, providing accurate and useful injury data, to guide targeted injury prevention strategies.

Low adoption in women's professional football: teams that used the Nordic Hamstring Exercise in the team training had fewer match hamstring injuries

Objectives

The primary objective was to study the reach, effectiveness, adoption, implementation and maintenance of the Nordic Hamstring Exercise (NHE) programme in women's elite teams in Europe in the 2020-21 season. The secondary objective was to compare hamstring injury rates between teams that used the NHE programme regularly in team training and teams that did not.

Methods

Eleven teams participating in the Women's Elite Club Injury Study during the 2020-21 season provided data about injury rates and the implementation of the NHE programme.

Results

One team (9%) used the full original NHE programme, and four teams used the programme in the team training during parts of the season (team training group, n=5). Five teams did not use the NHE, or used it only sporadically for individual players, and one team used NHE only for players with a previous or current hamstring injury (no team training group, n=6). The team training group had a lower incidence of hamstring injuries during match-play (1.4 vs 4.0, p=0.028) than the non-team training group while no difference between groups was shown for the hamstring injury incidence in training (0.6 vs 0.7, p=0.502).

Conclusion

A low adoption of the NHE programme was reported during the 2020-21 season. However, teams that used NHE for the whole team or most players had a lower hamstring injury incidence at match-play than teams that did not use the NHE or used it for individual players only.

Most modifiable risk factors for hamstring muscle injury in women's elite football are extrinsic and associated with the club, the team, and the coaching staff and not the players themselves: the UEFA Women's Elite Club Injury Study

PURPOSE

To describe the perceived importance of suggested hamstring injury risk factors according to chief medical officers (CMOs) of European women's professional football clubs. A secondary objective was to compare if these perceptions differed between teams with a lower-than-average and higher-than-average hamstring injury burden.

METHODS

The CMOs of eleven European professional women's football clubs were initially asked to suggest modifiable risk factors for hamstring injury. These risk factors were rated in according with their perceived importance on a 5-graded Likert scale. Participating teams were divided in two groups depending on their hamstring injury burden during the 2020/21 season. The LOW group consisted of six teams that had a lower-than-average hamstring injury burden. The HIGH group consisted of five teams that had a higher-than-average hamstring injury burden.

RESULTS

Twenty-one risk factors were suggested, most of which were extrinsic in nature, hence associated with the coaching staff, the team or the club organization rather than with the players themselves. The risk factors with the highest average importance were: "lack of communication between medical staff and coaching staff" and "load on players" (each with a weighted average of 3.9), followed by "lack of regular exposure to high-speed football actions during training" and "playing matches 2-3 times a week" (weighted average of 3.8 and 3.7). Differently from the LOW group, the HIGH group perceived the coaching factors (style of coach leadership, training/exercise surveillance by coaching staff) as more important.

CONCLUSION

In accordance to the eleven CMOs recruited in this study, most risk factors for hamstring injuries are extrinsic in nature and associated with the club, the team, and the coaching staff, and not the players themselves.

LEVEL OF EVIDENCE

Level III.

Collagen supplementation augments changes in patellar tendon properties in female soccer players

We investigated the effect of collagen hydrolysate supplementation on changes in patellar tendon (PT) properties after 10 weeks' training in female soccer players from a Football Association Women's Super League Under 21 s squad. We pair-matched n = 17 players (age: 17 ± 0.9 years; height: 1.66 ± 0.06 m; mass: 58.8 ± 8.1 kg) for baseline knee extension (KE) maximum isometric voluntary contraction (MIVC) torque, age, height, and body mass, and randomly assigned them to collagen (COL) or placebo (PLA) groups (COL n = 8, PLA n = 9). Participants consumed 30 g collagen hydrolysate supplementation or energy-matched PLA (36.5 g maltodextrin, 8.4 g fructose) and plus both groups consumed 500 mg vitamin C, after each training session, which comprised bodyweight strength-, plyometric- and/or pitch-based exercise 3 days/week for 10 weeks in-season. We assessed KE MIVC torque, vastus lateralis muscle thickness and PT properties using isokinetic dynamometry and ultrasonography before and after 10 weeks' soccer training. KE MIVC torque, muscle thickness and tendon cross-sectional area did not change after training in either group. However, COL increased PT stiffness [COL, +18.0 ± 12.2% (d = 1.11) vs. PLA, +5.1 ± 10.4% (d = 0.23), p = 0.049] and Young's modulus [COL, +17.3 ± 11.9% (d = 1.21) vs. PLA, +4.8 ± 10.3% (d = 0.23), p = 0.035] more than PLA. Thus, 10 weeks' in-season soccer training with COL increased PT mechanical and material properties more than soccer training alone in high-level female soccer players. Future studies should investigate if collagen hydrolysate supplementation can improve specific aspects of female soccer performance requiring rapid transference of force, and if it can help mitigate injury risk in this under-researched population.

The perception of injury risk and prevention among football players: A systematic review

Football is associated with a certain risk of injury, leading to short- and long-term health consequences. However, the perception of football players about injury risk and prevention strategies is poorly documented. The present article reviewed the literature about perceptions, beliefs, attitudes and knowledge toward injury risk and prevention strategies in football players. An electronic search was performed in PubMed, Scopus, Web of Science, and APA PsychINFO until July 2022. Studies were eligible if they included the perceptions, beliefs, attitudes, and knowledge about injury risk and prevention in football players from any competitive level. The risk of bias was assessed in included studies using the Joanna Briggs Institute critical appraisal checklist. A total of 14 studies were included. Most football players agreed that their risk of injury is high and prevention strategies are important, however they do not intend to use some of these strategies. The most frequent perceived injury risk factors were low muscle strength, lack of physical fitness, fatigue, excessive training and type and condition of surfaces. The most frequent perceived injury prevention factors were warm-up, workload monitoring and strength and conditioning training. It is essential to acknowledge perceived injury risk factors, as well as a better understanding of how coaching and medical departments' perceptions match with players' perceptions, and a modification in the perceptions of the several stakeholders at different levels of action.

Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis

BACKGROUND

To conduct a systematic review and meta-analysis of epidemiological data of injuries in male and female youth football players.

METHODS

Searches were performed in MEDLINE/PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases. Studies were considered if they reported injury incidence rate in male and female youth (≤19 years old) football players. Two reviewers (FJRP and ALV) extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation approach determined the quality of evidence. Studies were combined using a Poisson random effects regression model.

RESULTS

Forty-three studies were included. The overall incidence rate was 5.70 injuries/1000 h in males and 6.77 injuries/1000 h in females. Match injury incidence (14.43 injuries/1000 h in males and 14.97 injuries/1000 h in females) was significantly higher than training injury incidence (2.77 injuries/1000 h in males and 2.62 injuries/1000 h in females). The lower extremity had the highest incidence rate in both sexes. The most common type of injury was muscle/tendon for males and joint/ligament for females. Minimal injuries were the most common in both sexes. The incidence rate of injuries increased with advances in chronological age in males. Elite male players presented higher match injury incidence than sub-elite players. In females, there was a paucity of data for comparison across age groups and levels of play.

CONCLUSION

The high injury incidence rates and sex differences identified for the most common location and type of injury reinforce the need for implementing different targeted injury-risk mitigation strategies in male and female youth football players.

Injury incidence rates in women's football: a systematic review and meta-analysis of prospective injury surveillance studies

OBJECTIVE

To review the literature to establish overall, match and training injury incidence rates (IIRs) in senior (≥18 years of age) women's football (amateur club, elite club and international).

DESIGN

Systematic review and meta-analysis of overall, match and training IIRs in senior women's football, stratified by injury location, type and severity.

DATA SOURCES

MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO and Web of Science were searched from earliest record to July 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

(1) football players participating in a senior women's football league (amateur club or elite club) or a senior women's international football tournament; (2) the study had to report IIRs or provide sufficient data from which this outcome metric could be calculated through standardised equations; (3) a full-text article published in a peer-reviewed journal before July 2021; (4) a prospective injury surveillance study and (5) case reports on single teams were ineligible.

RESULTS

17 articles met the inclusion criteria; amateur club (n=2), elite club (n=10), international (n=5). Overall, match and training 'time-loss' IIRs are similar between senior women's elite club football and international football. 'Time-loss' training IIRs in senior women's elite club football and international football are approximately 6-7 times lower than their equivalent match IIRs. Overall 'time-loss' IIRs stratified by injury type in women's elite club football were 2.70/1000 hours (95% CI 1.12 to 6.50) for muscle and tendon, 2.62/1000 hours (95% CI 1.26 to 5.46) for joint and ligaments, and 0.76/1000 hours (95% CI 0.55 to 1.03) for contusions. Due to the differences in injury definitions, it was not possible to aggregate IIRs for amateur club football.

CONCLUSION

Lower limb injuries incurred during matches are a substantial problem in senior women's football. The prevention of lower limb joint, ligament, muscle and tendon injuries should be a central focus of injury prevention interventions in senior women's amateur club, elite club and international football.

PROSPERO REGISTRATION NUMBER

CRD42020162895.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

BACKGROUND

Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.

OBJECTIVE

To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.

METHODS

Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

RESULTS

Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48-62, I2 = 82%; females: 63%, 95% CI 53-71, I2 = 84%; males: 50%, 95% CI 42-58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05-0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03-0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10-0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03-0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32-0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15-0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02-0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01-0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high.

CONCLUSION

This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Does the Number of Substitutions Used during the Matches Affect the Recovery Status and the Physical and Technical Performance of Elite Women's Soccer?

The aim of this study was to compare the effect of a new rule for substitutions (four and five) with the rule before the COVID-19 pandemic (up to three) on recovery status, physical and technical performance, internal workload, and recovery process in elite women soccer players. Thirty-eight matches from 2019 to 2020 from the Brazilian Championships were analyzed. All data for the two conditions (≤3 and 4-5 substitutions) were compared using an independent t-test. The physical demands measured by a global positioning system (GPS) and the technical (obtained from Instat) and internal workload (rating of perceived exertion [RPE]) were assessed. The recovery process was measured by the total quality recovery (TQR) 24 h after each match. No differences were observed in any physical and technical parameters between 4-5 and ≤3 substitutions (p > 0.05). Moreover, 4-5 substitutions demonstrated lower RPE (p < 0.001) and workload-RPE (p < 0.001), higher TQR (p = 0.008), and lower time played by the player (p < 0.001), compared to ≤3. Thus, the new provisory rule for substitutions improved the balance between stress and recovery.

Association of the ACTN3 rs1815739 Polymorphism with Physical Performance and Injury Incidence in Professional Women Football Players

The p.R577X polymorphism (rs1815739) in the ACTN3 gene causes individuals with the XX genotype to be deficient in functional α-actinin-3. Previous investigations have found that XX athletes are more prone to suffer non-contact muscle injuries, in comparison with RR and RX athletes who produce a functional α-actinin-3 in their fast-twitch fibers. This investigation aimed to determine the influence of the ACTN3 R577X polymorphism on physical performance and injury incidence of players competing in the women’s Spanish first division of football (soccer). Using a cross-sectional experiment, football-specific performance and epidemiology of non-contact football-related injuries were recorded in a group of 191 professional football players. ACTN3 R577X genotype was obtained for each player using genomic DNA samples obtained through buccal swabs. A battery of physical tests, including a countermovement jump, a 20 m sprint test, the sit-and-reach test and ankle dorsiflexion, were performed during the preseason. Injury incidence and characteristics of non-contact injuries were obtained according to the International Olympic Committee (IOC) statement for one season. From the study sample, 28.3% of players had the RR genotype, 52.9% had the RX genotype, and 18.8% had the XX genotype. Differences among genotypes were identified with one-way analysis of variance (numerical variables) or chi-square tests (categorical variables). Jump height (p = 0.087), sprint time (p = 0.210), sit-and-reach distance (p = 0.361), and dorsiflexion in the right (p = 0.550) and left ankle (p = 0.992) were similar in RR, RX, and XX football players. A total of 356 non-contact injuries were recorded in 144 football players while the remaining 47 did not sustain any non-contact injuries during the season. Injury incidence was 10.4 ± 8.6, 8.2 ± 5.7, and 8.9 ± 5.3 injuries per/1000 h of football exposure, without differences among genotypes (p = 0.222). Injury rates during training (from 3.6 ± 3.7 to 4.8 ± 2.1 injuries per/1000 h of training exposure, p = 0.100) and match (from 47.8 ± 9.5 to 54.1 ± 6.3 injuries per/1000 h of match exposure, p = 0.209) were also similar in RR, RX, and XX football players. The ACTN3 genotype did not affect the mode of onset, the time needed to return to play, the type of injury, or the distribution of body locations of the injuries. In summary, women football players with different genotypes of the p.R577X ACTN3 polymorphism had similar values of football-specific performance and injury incidence. From a practical perspective, the ACTN3 genotyping may not be useful to predict performance or injury incidence in professional women football players.

Body Composition and Determination of Somatotype of the Spanish Elite Female Futsal Players

Background: In any sport, it is of the utmost importance to identify variables capable of positively influencing scores. Futsal is a sport of intermittent high-intensity intervals that requires the athletes’ physical, technical, and tactical skills. There are no specific recommendations on anthropometry–body composition for this sport. The aim of this study was to describe the somatotype and the anthropometric characteristics, body composition, and somatotype of a group of Spanish elite female futsal players of the first-division league. Methods: Eighty-eight players (24 ± 4.94 years) from 14 teams of the first women’s division of the Spanish Futsal League were evaluated. Measurements were taken according to the anthropometric protocol of the International Society for the Advancement of Kinanthropometry (ISAK). Body composition (BC) and somatotype were calculated according to the 4-component model and Heath-Carter, respectively. Results: Pivot and goalkeeper positions were most different from the rest. Both were the heaviest positions and presented the largest mesomorphic data (4.13 ± 1.29 and 3.67 ± 0.95), kg of bone mass (10.60 ± 1.00 and 10.37 ± 1.08), and kg of lean mass (29.80 ± 1.25 and 29.12 ± 2.12), for the pivot and goalkeeper, respectively. Conclusion: The evaluation and evolution of the somatotype and BC is an assessment tool that could be a useful guide for technical and medical staff.

The Role of the Results of Functional Tests and Psychological Factors on Prediction of Injuries in Adolescent Female Football Players

Football is a popular sport among adolescent females. Given the rate of injuries in female footballers, identifying factors that can predict injuries are important. These injuries are often caused by complex reasons. The aim of this study was to investigate if the combination of demographic (age, number of training and match play hours/week), psychosocial (perceived stress, adaptive coping strategies) and physiological factors (functional performance) can predict a traumatic injury in adolescent female footballers. A cohort consisting of 419 female football players aged 13-16 years was established. Baseline questionnaires covered potential risk factors for sport injuries, and measurements included football-related functional performance tests. Data were collected prospectively with a weekly online questionnaire for 52 weeks covering, e.g., injuries, training, and match play hours/week. A total of 62% of the players reported at least one traumatic injury during the 52 weeks. The coping strategy "positive reframing" had the strongest association with the risk of traumatic injuries. The combination of more frequent use of the coping strategy, positive reframing, and high levels of physical performance capacity may prevent a traumatic injury in adolescent female footballers. Coaches are encouraged to adopt both physiological and psychological factors when preventing injuries in young female footballers.