The incidence and nature of injuries sustained on grass and 3rd generation artificial turf: a pilot study in elite Saudi National Team footballers

The Football Association Injury and Illness Surveillance Study: The Incidence, Burden and Severity of Injuries and Illness in Men's and Women's International Football

OBJECTIVES

To determine the incidence and characteristics of injury and illness in English men's and women's senior and youth international football.

METHODS

Time-loss injuries and illnesses, alongside match and training exposure, were collected across 8 seasons (2012-2020) in youth (U15, U16, U17, U18, U19) and senior (U20, U21, U23, senior) English men's and women's international teams. Analysis of incidence, burden, and severity of injury and illness was completed. Sex-specific comparisons were made between the senior and youth groups, and across the 8 seasons of data collection.

RESULTS

In men's international football, 535 injuries were recorded (216 senior; 319 youth) during 73,326 h of exposure. Overall, match injury incidence (31.1 ± 10.8 injuries/1000 h) and burden (454.0 ± 195.9 d absent/1000 h) were greater than training injury incidence (4.0 ± 1.0 injuries/1000 h) and burden (51.0 ± 21.8 d absent/1000 h) (both P < 0.001). In women's international football, 503 injuries were recorded (senior: 177; youth: 326) during 80,766 h of exposure and match injury incidence (27.6 ± 11.3 injuries/1000 h) and burden (506.7 ± 350.2 days absent/1000 h) were greater than training injury incidence (5.1 ± 1.8 injuries/1000 h) and burden (87.6 ± 32.8 days absent/1000 h) (both P < 0.001). In women's international football, a group × season interaction was observed for training injury incidence (P = 0.021), with the senior group recording a greater training injury incidence during the 2015-2016 season compared to the youth group (14.4 vs 5.7 injuries/1000 h; P = 0.022). There was no difference in injury severity between match and training for men's (P = 0.965) and women's (P = 0.064) international football.

CONCLUSIONS

The findings provide a comprehensive examination of injury and illness in English men's and women's senior and youth international football. Practitioners will be able to benchmark their team's injury and illness incidence and characteristics to the match-play and training information provided in the present study.

Incidence of football injuries sustained on artificial turf compared to grass and other playing surfaces: a systematic review and meta-analysis

Background

Prior reviews have not conducted statistical synthesis of injury incidence on artificial turf in football. To analyse and compare the incidence of injuries sustained playing football (soccer) on artificial turf compared to grass and other playing surfaces.

Methods

This was a systematic review and meta-analysis. We searched PubMed, Scopus, SPORTDiscus, and Web of Science databases in October 2022 without filters. All observational studies (prospective or retrospective) that analysed injuries sustained playing football on artificial turf and which included a control group that played on grass or other surface were included. Studies were included if they reported the number of injuries and the exposure time for the playing surfaces. Risk of bias was assessed by Newcastle-Ottawa Scale. A random effects model was used to calculate the pooled incidence rate ratios (IRR) with 95% confidence intervals. Protocol was registered with PROSPERO on October 30th, 2022. Registration number: CRD42022371414.

Findings

We screened 1447 studies, and evaluated 67 full reports, and finally included 22 studies. Risk of bias was a notable issue, as only 5 of the 22 studies adjusted their analysis for potential confounders. Men (11 studies: IRR 0.82, CI 0.72-0.94) and women (5 studies: IRR 0.83, CI 0.76-0.91) had lower injury incidence on artificial turf. Professional players had a lower incidence of injury (8 studies: IRR 0.79, CI 0.70-0.90) on artificial turf, whereas there was no evidence of differences in the incidence of injury in amateur players (8 studies: IRR 0.91, CI 0.77-1.09). The incidence of pelvis/thigh (10 studies: IRR 0.72, CI 0.57-0.90), and knee injuries (14 studies: IRR 0.77, CI 0.64-0.92) were lower on artificial turf.

Interpretation

The overall incidence of football injuries is lower on artificial turf than on grass. Based on these findings, the risk of injury can't be used as an argument against artificial turf when considering the optimal playing surface for football.

Funding

No specific funding was received for this study.

Lower Extremity Injury Rates on Artificial Turf Versus Natural Grass Playing Surfaces: A Systematic Review

BACKGROUND

No study has provided a comprehensive systematic review of sports injuries on artificial turf versus natural grass.

PURPOSE

To comprehensively examine the risk of overall injuries and multiple types of lower extremity injuries across all sports, all levels of competition, and on both old-generation and new-generation artificial turf.

STUDY DESIGN

Systematic review; Level of evidence, 3.

METHODS

A systematic review of the English-language literature was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All included articles compared overall injury rates or lower extremity (hip, knee, or foot and ankle) injury rates on artificial turf and natural grass. All sports, levels of competition, and turf types were included. Studies were excluded if they did not include overall injury rates or lower extremity injury rates. Because of the heterogeneity of the included studies, no attempt was made to aggregate risk ratios to conduct a quantitative meta-analysis.

RESULTS

A total of 53 articles published between 1972 and 2020 were identified for study inclusion. Most studies on new-generation turf (13/18 articles) found similar overall injury rates between playing surfaces. When individual anatomic injury locations were analyzed, the greatest proportion of articles reported a higher foot and ankle injury rate on artificial turf compared with natural grass, both with old-generation (3/4 articles) and new-generation (9/19 articles) turf. Similar knee and hip injury rates were reported between playing surfaces for soccer athletes on new-generation turf, but football players, particularly those at high levels of competition, were more likely to sustain a knee injury on artificial turf than on natural grass.

CONCLUSION

The available body of literature suggests a higher rate of foot and ankle injuries on artificial turf, both old-generation and new-generation turf, compared with natural grass. High-quality studies also suggest that the rates of knee injuries and hip injuries are similar between playing surfaces, although elite-level football athletes may be more predisposed to knee injuries on artificial turf compared with natural grass. Only a few articles in the literature reported a higher overall injury rate on natural grass compared with artificial turf, and all of these studies received financial support from the artificial turf industry.

Limited implementation of the Nordic hamstring exercise in professional and semi-professional soccer

Background/Purpose:

In soccer players, non-contact injuries are most common, especially hamstring muscle injuries, which can be prevented by the Nordic hamstring exercise (NHE). This study assessed the professional and semi-professional soccer players and coaches’ awareness, implementation, and opinion of the NHE efficacy in reducing hamstring injuries.

Methods:

A questionnaire regarding the awareness, implementation, and opinions of the NHE’s efficacy in reducing hamstring muscle injuries was distributed.

Results:

The survey was completed by 812 (88.3% male and 11.7% female) players and coaches. Of these, 395 (48.6%) were aware of the NHE, and 355 (43.7%) implemented it in their current practice. Those implementing NHE had a positive opinion about its efficacy in reducing hamstring injuries.

Conclusion:

Further efforts and research are warranted to increase the international awareness and implementation of the NHE and educate soccer players and coaches about the importance of its implementation and effectiveness in preventing hamstring injury.

Epidemiology of injuries in professional football: a systematic review and meta-analysis

OBJECTIVE

We performed a systematic review and meta-analysis of epidemiological data of injuries in professional male football.

METHOD

Forty-four studies have reported the incidence of injuries in football. Two reviewers independently extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement and Newcastle Ottawa Scale. Studies were combined in a pooled analysis using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in professional male football players was 8.1 injuries/1000 hours of exposure. Match injury incidence (36 injuries/1000 hours of exposure) was almost 10 times higher than training injury incidence rate (3.7 injuries/1000 hours of exposure). Lower extremity injuries had the highest incidence rates (6.8 injuries/1000 hours of exposure). The most common types of injuries were muscle/tendon (4.6 injuries/1000 hours of exposure), which were frequently associated with traumatic incidents. Minor injuries (1-3 days of time loss) were the most common. The incidence rate of injuries in the top 5 European professional leagues was not different to that of the professional leagues in other countries (6.8 vs 7.6 injuries/1000 hours of exposure, respectively).

CONCLUSIONS

Professional male football players have a substantial risk of sustaining injuries, especially during matches.

Injury burden differs considerably between single teams from German professional male football (soccer): surveillance of three consecutive seasons

PURPOSE

The purpose of this study was to analyse unique injury data of the national statutory accident insurance for the two highest divisions in German male football (Bundesliga and 2. Bundesliga) over three consecutive seasons regarding inter-season, inter-division and inter-team differences.

METHODS

This was a prospective observational open cohort study over the seasons 2014/2015, 2015/2016 and 2016/2017. Every acute injury that was registered by clubs or physicians with the German statutory accident insurance for professional athletes (VBG) as part of occupational accident reporting and that led to time loss and/or to medical attention, was included.

RESULTS

The complete sample consisted of 1449 players. The study covered 2663.5 player seasons with an observed match exposure of 69,058 h and a projected training exposure of 529,136 h. In total, 7493 injuries were included. The overall incidence rate was 12.5 (± 0.28) injuries per 1000 exposure hours, which translated into match and training rates of 47.0 (± 1.62) and 8.02 (± 0.24) injuries per 1000 h, respectively.

CONCLUSION

Findings of 2.7 injuries per player and season underline the need of effective preventive approaches. Higher injury incidences in seasons after international tournaments suggest an increasing risk of injury with increasing number of matches. However, large differences between the single teams from the same division indicate that a reduction in the injury burden is generally possible. Continuing the presented injury surveillance might be helpful to identify injury trends in the future and to evaluate the effectiveness of preventive approaches under real-life conditions.

LEVEL OF EVIDENCE

Level  II.

Injury Surveillance in Major League Soccer: A 4-Year Comparison of Injury on Natural Grass Versus Artificial Turf Field

BACKGROUND

Artificial playing surfaces are becoming more common due to decreased cost of maintenance and increased field usability across different environmental conditions. The Fédération Internationale de Football Association (FIFA) has approved newer generation artificial turf for soccer competition at the elite level, but many elite-level athletes prefer to play on natural grass surfaces due to a perceived increase in injury rate, discomfort, and fatigability on artificial turf.

HYPOTHESIS

Injury rates and rates of individually categorized types of injury experienced on artificial turf are noninferior to rates of injury on the standard comparator, natural grass, in elite-level Major League Soccer athletes.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Over the course of 4 Major League Soccer seasons (2013-2016), athlete injury data were recorded electronically. Injury data recorded in matches between 2 Major League Soccer teams were then analyzed. Playing surface was known for each venue, and all artificial turf surfaces were rated as 2-star according to FIFA criteria. Incidence rate ratios (Artificial Turf ÷ Natural Grass) were calculated with a 95% CI (α = .05) for both overall injury incidence and individual injury subgroups. A noninferiority margin (δ) of 0.15 was used to determine noninferiority of injury incidence rates.

RESULTS

A total of 2174 in-game injuries were recorded during the study period, with 1.54 injuries per game on artificial turf and 1.49 injuries per game on natural grass (incidence rate ratio, 1.033; 95% CI, 0.937-1.139). Within injury subgroups, overall ankle injury, Achilles injury, and ankle fracture were found to have a statistically higher incidence on artificial turf. Artificial turf was found to be noninferior to natural grass for overall foot injury and forefoot injury. No statistically significant differences were found in knee injuries between the 2 surfaces.

CONCLUSION

The overall rate of injury on artificial turf was noninferior to that on natural grass. Within individual injury categories, a higher rate of ankle injury was found on artificial turf. No other injury subgroup demonstrated statistically significant differences between surfaces.

CLINICAL RELEVANCE

FIFA 2-star rated artificial turf is a viable alternative to natural grass in elite-level soccer competition. Innovative research methods for comparing artificial turf versus natural grass may elucidate relative advantages with respect to player safety.

The effect of the change of football turf on knee kinematics of adolescent male football players

BACKGROUND

The aim of this study was to investigate the effect of the change of football turf on knee kinematics of adolescent male football players.

METHODS

Thirteen adolescent male football players were tested by a portable infrared motion analysis system based on markers. The angular displacements of flexion/extension,valgus/varus and internal/external rotation were calculated respectively when players performed 90° shuttle running on artificial turf and natural turf.

RESULTS

The maximum valgus angle and range of valgus/varus were larger when they were changed from artificial turf to natural turf (P<0.05). There were no significant differences in the maximum flexion angle, maximum extension angle, range of flexion/extension, maximum varus angle, maximum internal rotation angle, maximum external rotation angle and range of internal/external rotation (P>0.05).

CONCLUSIONS

The change of football turf has a significant effect on knee kinematics of adolescent male football players. The risk of noncontact anterior cruciate ligament (ACL) injury is increased when players who are changed from artificial turf to natural turf.

Injury and illness epidemiology in soccer - effects of global geographical differences - a call for standardized and consistent research studies

Soccer is the most popular sport in the world. While injuries and illnesses can affect the players’ health and performance, they can also have a major economic impact on teams. Moreover, several studies have shown the favourable association between higher player availability and team success. Therefore, injury prevention could directly impact clubs’ financial balance and teams’ performance via increased player availability. To be able to develop effective methods of injury prevention, it is vital to first determine the scope and the degree of the problem: the mechanisms and types of injuries, their frequency and severity, etc. According to the most widely known prevention model, systematic injury surveillance is the first and most fundamental step towards injury prevention. Since epidemiological studies have shown that injuries and illnesses in soccer players differ from region to region, it is important to establish a specific injuries and illness database in order to guide specific preventive actions. Since Asia is the largest continent, with the highest number of soccer players, and in the light of the long-term research on injuries performed in UEFA clubs, the authors of the present article present the AFC surveillance. Some methodological issues related to this prospective design study are discussed. The definition of injury and illness and the methods to track players’ exposure are described along with the potential challenges related to such a vast scale study. This article is also a call for action to have consistent and standardized epidemiological studies on soccer injuries and illnesses, with the aim to improve their prevention.

A Prospective Analysis of the Injury Incidence of Young Male Professional Football Players on Artificial Turf

Background:

The effects of synthetic surfaces on the risk of injuries is still debated in literature and the majority of published data seems to be contradictory. For such reasons the understanding of injury incidence on such surfaces, especially in youth sport, is fundamental for injury prevention.

Objectives:

The aim of this study was to prospectively report the epidemiology of injuries in young football players, playing on artificial turfs, during a one sports season.

Patients and Methods:

80 young male football players (age 16.1 ± 3.7 years; height 174 ± 6.6 cm; weight 64.2 ± 6.3 kg) were enrolled in a prospective cohort study. The participants were then divided in two groups; the first included players age ranging from 17 to 19 (OP) whereas the second included players age ranging from 13 to 16 (YP). Injury incidence was recorded prospectively, according to the consensus statement for soccer.

Results:

A total of 107 injuries (35 from the OP and 72 from the YP) were recorded during an exposure time of 83.760 hours (incidence 1.28/1000 per player hours); 22 during matches (incidence 2.84/1000 per player hours, 20.5%) and 85 during training (incidence 1.15/1000 per player hours, 79.5%). Thigh and groin were the most common injury locations (33.6% and 21.5%, respectively) while muscle injuries such as contractures and strains were the most common injury typologies (68.23%). No statistical differences between groups were displayed, except for the rate of severe injuries during matches, with the OP displaying slightly higher rates compared to the YP. Severe injuries accounted for 10.28% of the total injuries reported. The average time lost due to injuries was 14 days. Re-injuries accounted for 4.67% of all injuries sustained during the season.

Conclusions:

In professional youth soccer injury rates are reasonably low. Muscle injuries are the most common type of injuries while groin and thigh the most common locations. Artificial turf pitches don’t seem to contribute to injury incidence in young football players.

Can the natural turf pitch be viewed as a risk factor for injury within Association Football?

OBJECTIVES

A review of the current literature is used to propose a 'conceptual model for relative pitch hardness' and how this may affect incidence of injury within Association Football. Based upon the injury risk and causation model of Meeuwisse et al. (Clin J Sport Med 2007; 17(3):215), it may provide researchers a necessary framework to guide future research investigations.

DESIGN

A literature review.

METHODS

A comprehensive search of electronic databases available until October 2014, and supplemental hand searching was conducted to identify relevant studies. Studies were deemed relevant if they met the following criteria: published in English, presented or referenced in an epidemiological study or provided data directly and/or related to the surface of the football pitch, ball or boot to surface interaction and injury. Further information was sourced on surface hardness, players' movement patterns and physiological demands within football.

RESULTS

Papers varied in methodological quality, with comparative studies examining injury rates on artificial versus natural turf pitches being most prevalent. No prospective studies were found that objectively measured the relationship between hardness of natural turf and injury risk within football.

CONCLUSIONS

The literature review into natural turf pitches and injury within football has largely been unable to confirm that pitch hardness can be viewed as a significant extrinsic risk factor. Methodological concerns, including objectivity in pitch assessment and uniformity in defining injuries undermine the efficacy of available work. Future studies are needed utilising objective assessment tools to draw more definitive conclusions regarding pitch hardness as an extrinsic factor for injury within football.