Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season

Reported Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes Is Greatest in Female Soccer Players and Athletes Participating in Club Sports: A Systematic Review and Meta-analysis

PURPOSE

To identify the risk of anterior cruciate ligament (ACL) injury in adolescent athletes based on sex, sport, and sport affiliation.

METHODS

A literature search was performed using 3 online databases (PubMed, Cochrane Library, and EMBASE) from database inception to November 2023 per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies consisted of Level I or II studies reporting on ACL injury exposures in time (hours) or injuries per 1,000 athlete-exposures (AEs) (1 game or practice) in adolescent athletes. Exclusion criteria consisted of non-English studies, case reports, animal/cadaveric studies, and review articles. Methodological quality and bias assessment of the included studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. ACL injuries were analyzed and pooled to calculate incidence rates (IRs), per-season risk, and relative risk (RR) based on sex, sport, and sport affiliation (club sport participation vs school sport participation).

RESULTS

A total of 1,389 ACL injuries over 19,134,167 AEs were identified (IR, 0.075; 95% confidence interval [CI], 0.071-0.079). Of these, 670 ACL injuries were reported in female athletes over 7,549,892 AEs (IR, 0.089; 95% CI, 0.087-0.091) with 719 in males over 11,584,275 AEs (IR, 0.062; 95% CI, 0.058-0.067). The greatest RR for ACL injury in females was in soccer (RR, 3.12; 95% CI, 2.58-3.77) for AEs. The greatest per-season risk of ACL injuries reported in female athletes occurred in soccer (1.08%), basketball (1.03%), and gymnastics (1.01%). The greatest per-season risk of ACL injuries reported in male athletes occurred in football (0.82%), lacrosse (0.64%), and soccer (0.35%). Club sport participation, in both AEs (RR, 3.94; 95% CI, 3.19-4.87) and hours of exposure (RR, 1.57; 95% CI, 1.07-2.28), demonstrated an increased risk of ACL injury.

CONCLUSIONS

The risk of ACL injuries was 1.56-fold greater in adolescent female athletes compared with male athletes. The highest-risk sport for females was soccer. Participation in club sports possessed higher rates of injury compared with school sports.

LEVEL OF EVIDENCE

Level II; meta-analysis of Level I and II studies.

Can we evidence-base injury prevention and management in women's football? A scoping review

This review aimed, as part of a larger FIFA project aiming to steer women's football research, to scope literature on any level of competitive football for women, to understand the current quantity of research on women's football injuries. The study reviewed all injury-related papers scoped by a recent scoping review mapping all published women's football research with an updated search performed on 23 February 2021. Eligibility criteria assessment followed the recent scoping review with injury-specific research focus. A total of 497 studies were scoped. Most studies contained an epidemiological (N = 226; 45%) or risk factors assessment (N = 105; 21%). Less assessed areas included financial burden (N = 1; <1%) and injury awareness (N = 5; 1%). 159 studies (32%) assessed injuries of the whole body. The most common single location assessed in the literature was the knee (N = 134, 27%), followed by head/face (N =108, 22%). These numbers were, however, substantially lowered, when subdivided by playing level and age-group. The volume of research focuses especially on descriptive research and specific body locations (head/face and knee). Although information can be taken from studies in other sports, more football-specific studies to support management and prevention of injuries are warranted.

The Influence of Stud Characteristics of Football Boots Regarding Player Injuries

BACKGROUND

the main aim of this study was to analyze the relationship between sole pattern parameters of football boots with the frequency of injuries that occur in semiprofessional and amateur footballers.

METHODS

The study sample was composed of 77 male football players. All were at least 18 years old, played at least 10 h per week, gave signed informed consent to take part and properly completed the Visual Analogue Scale. This study analysed data from each player's medical history, including age, injuries, years of practice, field type and surface condition information.

RESULTS

The visual analogic score in semiprofessional players was higher (2.05 ± 2.43) than in amateur players (1.00 ± 1.1). A total of 141 lesions were collected, equivalent to 1.81 injuries for each football player studied (n = 77). The result of the ROC curve indicated that the player's years of practice could predict significantly (p < 0.05) the presence of lower limb injuries, with an area under the curve of 0.714.

CONCLUSIONS

This study described the predictive capacity of sole pattern characteristics concerning lower limb injuries in amateur and semiprofessional footballers. Football boot variables associated with the number of studs were associated with foot and ankle overload injuries.

The incidence and burden of injuries in elite English youth female soccer players

This study aimed to investigate the incidence, severity and burden of injury in English elite youth female soccer players. Qualified therapists at six English girls' academies prospectively recorded all injuries that required medical attention or caused time loss for matches and training in 375 elite youth female soccer players (under-10 [U10], U12, U14 and U16) during the 2019/2020 season. One hundred- and eleven time-loss injuries (52 from training, 59 from matches) were sustained, resulting in 1,946 days absent (779 days from training injuries, 1,167 days from match injuries) from soccer activities. The injury incidence for matches (9.3/1000 hours, 95% CIs: 7.2-11.9) was significantly greater than training (1.1/1000 hours, 95% CIs: 0.9-1.5, p < 0.001). Additionally, the injury burden for matches (183 days lost/1000 hours, 95% CIs: 142-237) was significantly greater than training (17 days lost/1000 hours, 95% CIs: 13-22, p < 0.001). Injury incidence and burden were greatest in the U16 age group and were found to increase with age. Whilst injury incidence and burden are greater in matches than training, a large proportion of preventable injuries, soft-tissue and non-contact in nature, were sustained in training. Findings provide comparative data for elite youth female soccer players.

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.

The effect of motor control training according to the Kinetic Control concept on the back pain of female football players

BACKGROUND

Due to a significant burden associated with training sessions and matches, female football players often suffer from lumbar pain. Physical exercise is considered an effective form of therapy for this condition. The exercises in the Kinetic Control concept are one of the forms of motor control training.

OBJECTIVE

The aim of the study was to evaluate the effectiveness of motor control training according to the Kinetic Control concept on the level of lumbar spine pain, degree of disability, functional level and load distribution of lower limbs in football players.

METHODS

The study included 18 football players, randomly divided into two study groups: A - female players implementing their training plan with additional Kinetic Control training (n= 9) and B (control) - female players implementing their training plan only (n= 9). Pain intensity was measured using Visual Analogue Scale (VAS) and Laitinen's questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). The asymmetry index was assessed in a balance test with open and closed eyes and a countermovement jump (CMJ).

RESULTS

There was a significant statistical difference between the groups (p< 0.05) in measurements using VAS, ODI and BPFS, in favor of group A. Asymmetry index values in tests on the dynamometer platform did not differ significantly between the groups (p> 0.05). A statistically significant correlation was found between the asymmetry index score in the closed-eye balance test (r= 0.567, p= 0.049) and the CMJ landing phase (r= 0.641, p= 0.033), and the level of pain measured using VAS.

CONCLUSIONS

Motor control training in the Kinetic Control concept reduced the pain symptoms of the lumbar spine and the degree of disability and increased the functional level in football female players.

Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review

Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.

Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes: A Systematic Review and Meta-analysis

BACKGROUND

The incidence of anterior cruciate ligament (ACL) injuries among adolescent athletes is steadily increasing. Identification of the highest risk sports for ACL injuries by sex and competitive setting (ie, practice vs match) is important for targeting injury prevention programs.

PURPOSE

To identify the risk of ACL injuries in adolescent athletes by sport, sex, and setting across a variety of common US and international sports.

STUDY DESIGN

Meta-analysis.

METHODS

Essentially, 3 online databases (PubMed, Embase, and Cochrane Library) were searched for all studies of ACL injuries per athlete-exposure (AE) or hours of exposure in adolescent athletes. Injuries were then pooled and incidence rates (IRs) reported per 1000 AEs or hours of exposure, with the relative risk (RR) of injuries calculated for sex-comparable sports. IRs per competitive setting (match vs practice) were also calculated.

RESULTS

A total of 1235 ACL injuries over 17,824,251 AEs were identified (IR, 0.069 [95% CI, 0.065-0.074]), with 586 of these injuries in girls across 6,986,683 AEs (IR, 0.084 [95% CI, 0.077-0.091]) versus 649 injuries in boys over 10,837,568 AEs (IR, 0.060 [95% CI, 0.055-0.065]). Girls had a higher overall rate of ACL injuries (RR, 1.40 [95% CI, 1.25-1.57]), with the most disproportionate risk observed in basketball (RR, 4.14 [95% CI, 2.98-5.76]). The risk of ACL injuries by sex was highest in girls' soccer (IR, 0.166 [95% CI, 0.146-0.189]) and boys' football (IR, 0.101 [95% CI, 0.092-0.111]). ACL injuries were over 8 (RR, 8.54 [95% CI, 6.46-11.30]) and 6 (RR, 6.85 [95% CI, 5.52-8.49]) times more likely to occur in a match versus a practice setting for female and male athletes, respectively.

CONCLUSION

The risk of ACL injuries overall approached nearly 1 per 10,000 AEs for female athletes, who were almost 1.5 times as likely as male athletes to suffer an ACL injury across all adolescent sports. A multisport female athlete was estimated to have a nearly 10% risk of ACL injuries over her entire high school or secondary school career. Specifically, male and female adolescents playing soccer, basketball, lacrosse, and football appeared at particular risk of injuries, a finding that can be used to target an injury intervention.

Determinants of lower-extremity injury severity and recovery in U.S. High School Soccer Players

Lower-extremity injuries are common among soccer players, yet few studies have attempted to identify determinants of lower-extremity injury severity and recovery within this group. We aim to identify determinants of lower-extremity injury severity and recovery among high school (HS) soccer players in the US. We used soccer-related injury observations recorded within the NATION-SP during 2011/12-2013/14. Odds of a season-ending game-related injury were higher than a season-ending practice-related injury (Adj. OR = 2.64, 95% CI = [1.39, 5.01]). Gender, setting, and playing surface emerged as significant determinants of any time loss following lower-extremity injuries in multivariable logistic regression models, and multivariable random effects Poisson regression models also revealed significant differences in recovery durations across levels of these variables for "similarly severe" injuries. Findings suggest that gender, injury setting, playing surface contribute to injury corollaries differently. Similar multi-method approaches are needed to identify determinants of injury severity and recovery in this group.

Injury analysis of a professional female soccer team in first division Italian season

BACKGROUND

Soccer, the most popular sport worldwide, has seen an exponential increase in women's participation at the elite level in the last few years. The main purpose of the current epidemiological study was to analyze the injury incidence, characteristics, and burden among elite female soccer players during a regular season.

METHODS

We recorded all injuries that occurred throughout the 2018-2019 competitive soccer season (August-April). The studied group consisted of 22 elite players, who were militant in the first national leagues from the first team of the same soccer club in the north of Italy. The 2006 FIFA consensus statement was used to design the injury registration form.

RESULTS

Throughout the 2018-2019 season, medical staff treated 35 injuries in 22 females. Of the total number of injuries reported in 9 months (5.8 injuries per 1000 hours of exposure), 7 (20%) occurred during matches and 28 (80%) during training sessions. The most common injury was represented by muscular disorders (18; 51.43%) which affected the thigh in 16 cases, and the lower leg and trunk in one case each. According to an anatomic site, most injuries occurred in the lower limbs (94,28%), with the majority affecting thighs (16; 45%), ankles (8; 23%), and knees (5; 14%).

CONCLUSIONS

Non-contact injuries are shown to be more frequent than contact injuries, which may be connected to the increasing athletic burden among athletes. Further prospective investigations are needed with a focus on prevention protocols.

Females Sustain more Ankle Injuries than Males in Youth Football

This prospective study evaluated the incidence and pattern of acute injuries in youth (9- to 14-year- old) football players. Ten football clubs [n=730 players (567 males, 163 females)] participated in the 20-week follow-up study (January-June 2015). Data was collected by sending a standardized weekly SMS to players' parents/guardians with follow-up interviews for injured players. During the study period, 278 players (38%) sustained 410 acute injuries. The overall injury incidence for males and females was 6.47 (95% CI, 5.84-7.09) injuries per 1000 h of football exposure. Most injuries (40%) caused minimal absence from sports. Eighty-four percent of the injuries affected the lower extremities, with the ankle (30%), knee (17%), and thigh (16%) being the most commonly injured body sites. Females had significantly higher ankle injury rate (IRR) 1.85 (95% CI, 1.18-2.91, p=0.007) and non-contact ankle injury rate IRR 2.78 (95% CI, 1.91-4.02, p<0.001) than males. In conclusion, our results showed that the acute injury incidence among youth football is moderately high, and females are at higher risk for ankle injuries. Injury prevention programs aimed at preventing ankle injuries should be considered in the future.

Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Hamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

Femur, Tibia, and Fibula Fractures Secondary to Youth Soccer: A Descriptive Study and Review of the Literature

Objectives Soccer is the most popular sport in the world and is one of the top sports with increased participation. Despite the vast and increasing numbers of soccer players, limited data are available on pediatric lower extremity injuries. In particular, the purpose of the study is to describe the epidemiology of femur, tibia, and fibula fractures secondary to youth soccer. Methods A retrospective review concerning soccer-related femur, tibia, and fibula fractures was conducted in children under the age of 18 years from January 1, 2000 to December 31, 2015 with statewide data from the Pennsylvania Trauma Systems Foundation (PTSF), Mechanicsburg, PA. Results A total of 258 youth soccer players were admitted for femur, tibia, and fibula fractures from 2000 to 2015. These fractures constituted 33% of soccer-related injuries in youth admitted at trauma centers. Sixty-five percent of the fractures involved the tibia and 34% involved the femur. Body contact injury resulted in 54% of the fractures and non-body contact injury resulted in 46% of the fractures. Athletes the age of 13 and older sustained 67% of the fractures and were more likely to incur contact injuries (p-value=0.000041) than those less than 13. Males sustained 67% of the fractures, and gender was not associated with the mechanism of injury (p-value=0.43). Open fractures included 10% of tibia fractures and did not occur in femur fractures. The growth plate was involved in 24% of the femur fractures and 17% of the tibia fractures. Conclusion Youth soccer has the potential for serious femur, tibia, and fibula fractures. Intervention programs should aim at reducing non-body contact mechanism in children < 13 years of age and body contact mechanism in children ≥ 13 years of age. Further research should investigate injury prevention methods such as potentially reducing body contact mechanism by improving the effectiveness of shin guards.

Hip and groin injury is the most common non-time-loss injury in female amateur football

PURPOSE

Hip and groin injuries in football are problematic due to their high incidence and risk of chronicity and recurrence. The use of only time-loss injury definitions may underestimate the burden of hip and groin injuries. Little is known about hip and groin injury epidemiology in female football. The first aim of this study was to examine the within-season (2014-2015) prevalence of total injury with and without time-loss in female amateur football players. The second aim was to study the within-season and preseason (2015-2016) prevalence of hip/groin injuries with and without time-loss. The third aim was to study the association between the duration of hip and groin injury in the 2014-2015 season and the severity of hip/groin problems during the 2015-2016 preseason.

METHODS

During the preseason, 434 Dutch female amateur football players completed an online questionnaire based on the previous season and current preseason. The hip and groin outcome score (HAGOS) was used to assess the severity of hip and groin injuries.

RESULTS

The hip/groin (17%), knee (14%), and ankle (12%) were the most frequent non-time-loss injury locations. The ankle (22%), knee (18%), hamstring (11%), thigh (10%), and hip/groin (9%) were the most common time-loss injury locations. The previous season prevalence of total injury was 93%, of which non-time-loss injury was 63% and time-loss injury was 37%. The prevalence of hip/groin injury was 40%, non-time-loss hip/groin injury was 36% and time-loss hip/groin injury was 11%. The preseason prevalence of hip/groin injury was 27%, non-time-loss hip/groin injury was 25%, and time-loss hip/groin injury was 4%. Players with longstanding hip/groin injury (> 28 days) in the previous season had lower HAGOS scores at the next preseason than players with short-term (1-7 days) or no hip/groin injury (p < 0.001). From all players with hip/groin injury from the previous season, 52% also sustained hip/groin injury in the following preseason, of which 73% were recurrent and 27% were chronic hip/groin injuries.

CONCLUSION

Injury risk, and especially non-time-loss hip and groin injury risk, is high in female amateur football. Three-quarters of the players with longstanding hip and groin injuries in the previous season have residual problems at the start of the following season.

LEVEL OF EVIDENCE

II.

Effects of the '11+ Kids' injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomised controlled trial

BACKGROUND

To assess the effects of the injury prevention programme '11+ Kids' on reducing severe injuries in 7 to 13 year old football (soccer) players.

METHODS

Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by '11+ Kids' two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models.

RESULTS

The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously.

CONCLUSIONS

'11+ Kids' has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the '11+ Kids' in children's football.

TRIAL REGISTRATION NUMBER

NCT02222025.

Trends and Epidemiologic Factors Contributing to Soccer-Related Fractures That Presented to Emergency Departments in the United States

Background:

Understanding the risks and trends of soccer-related injuries may prove beneficial in creating preventative strategies against season-ending injuries.

Hypothesis:

Soccer-related fractures will have decreased over the past 7 years.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 3.

Methods:

The National Electronic Injury Surveillance System (NEISS) database was queried to identify soccer-related injuries from 2010 through 2016. The sum of the weighted values provided in the NEISS database was used to determine injury frequency and allowed us to estimate the incidence and annual trends of soccer-related fractures. The estimated annual number of hospital admissions resulting from each fracture location was calculated. Statistical analyses were performed, and a linear regression was used to analyze the annual injury trends, reported as the correlation coefficient.

Results:

Over the 6-year period, there were an estimated 1,590,365 soccer-related injuries. The estimated annual frequency of soccer-related injuries slightly increased from 225,910 in 2010 to 226,150 in 2016 (P = 0.477). The most common injuries were sprains/strains (32.4%), followed by fractures (20.4%). Fractures at the wrist were the most common (18%), while upper leg fractures were the most common soccer-related fractures to be admitted to the hospital (51.6%). The annual trends of the most common soccer-related fractures demonstrated increases in shoulder (r = 0.740; R² = 0.547; P = 0.057) and wrist (r = 0.308; R² = 0.095; P = 0.502) fractures. There were no significant changes in the trends of soccer-related fractures of the lower arm (r = 0.009; R² = 7.3 × 10⁻⁵; P = 0.986), finger (r = 0.679; R² = 0.460; P = 0.094), lower leg (r = 0.153; R² = 0.024; P = 0.743), ankle (r = 0.650; R² = 0.422; P = 0.114), toe (r = 0.417; R² = 0.174; P = 0.353), or foot (r = 0.485; R² = 0.235; P = 0.270).

Conclusion:

Despite the reported growing number of soccer players in the United States, the overall number of soccer-related injuries has remained relatively stable. Overall, 60% of reported fractures occurred in the upper extremity, with the wrist being the most common site, while lower extremity fractures were the most likely to lead to hospital admission.

Clinical Relevance:

This study offers an overview of the most common types of fractures that affect soccer players and may prove beneficial in creating preventative strategies against season-ending injuries.

Comparison of Thigh Muscle Strain Occurrence and Injury Patterns Between Male and Female High School Soccer Athletes

Context: Thigh muscle strains are among the most common injuries in high school soccer for both males and females. Similar results have been reported among college soccer players, specifically for hamstring strains. In college soccer, males have a higher injury rate than women, although they share common injury characteristics. Currently, no studies exist comparing the injury rate or injury characteristics of thigh muscle strains between sexes playing high school soccer. Objective: To compare thigh muscle strain injury rates and injury event characteristics among sexes participating in high school soccer. Design: Descriptive epidemiology study. Setting: A total of 100 nationally representative high schools that participated in the High School Sports-Related Injury Surveillance System, Reporting Information Online. Participants: High school soccer athletes who had a thigh muscle strain. Main Outcome Measures: Injury rates of thigh muscle strains were calculated between sexes. The occurrence of the following variables during a thigh muscle injury was compared between sexes: grade level, age, level of play, event type, time of practice, time of competition, basic injury mechanism, soccer activity, player position, field location, practice type, and time of season. Results: Males had a lower injury rate of thigh muscle strains during competition than females (rate ratio = 0.66; 95% confidence interval, 0.47–0.93). No differences between sexes existed in the distribution of first-time or recurrent event characteristics. When combining sexes, recurrent strains (93%) occurred more frequently on the offensive side of the field than first-time strains (59%), P < .001. The majority of strains occurred among the varsity players (71%), during running activities (60%) and practices (58%). Conclusions: Males were less likely to sustain a thigh muscle strain during competitions, but no other differences existed between sexes. The events surrounding all thigh muscle strains may be described with some common properties. Consideration of these characteristics may assist in the development of preventive and rehabilitative programs as well as direct future research on thigh muscle strains among high school soccer players.

Injuries in Spanish female soccer players

BACKGROUND

Epidemiologic research to learn the incidence, type, location, and severity of female soccer injuries and the risk factors for sustaining a sport injury is the first step in developing preventive policies. The aim of this study was to analyze the incidence of injuries in the population of female soccer players in Spain.

METHODS

The injuries incurred by 25,397 female soccer players were registered by the medical staff of the Spanish Football Federation during 1 season. A standardized medical questionnaire was used to classify the injury according to type, severity, location, and injury mechanism. A total of 2108 injuries was reported with an incidence of 0.083 injuries per player per season. Most injuries were in the lower limbs (74.0%), mainly affecting knee (30.4%) and ankle joints (17.9%).

RESULTS

The proportion of injuries derived from contact with another player was higher during matches (33.7%) than during training (11.4%; p < 0.001). Noncontact injuries were classified as severe more frequently than were contact injuries (51.0% vs. 42.6%; p < 0.001). A higher incidence of injury was found in adult soccer players (≥18 years) vs. their counterparts younger than18 years (0.094 vs. 0.072 injuries per player per year, respectively; p < 0.001). There were no differences between age groups in any other injury variable (e.g., type, mechanism, location, or severity; p > 0.05).

CONCLUSION

Most female soccer injuries were located at the knee and ankle; the injury mechanism determined the playing time lost; and the player's age did not affect injury characteristics.

Association between frontal plane knee control and lower extremity injuries: a prospective study on young team sport athletes

Background/aim

Poor frontal plane knee control can manifest as increased dynamic knee valgus during athletic tasks. The purpose of this study was to investigate the association between frontal plane knee control and the risk of acute lower extremity injuries. In addition, we wanted to study if the single-leg squat (SLS) test can be used as a screening tool to identify athletes with an increased injury risk.

Methods

A total of 306 basketball and floorball players participated in the baseline SLS test and a 12-month injury registration follow-up. Acute lower extremity time-loss injuries were registered. Frontal plane knee projection angles (FPKPA) during the SLS were calculated using a two-dimensional video analysis.

Results

Athletes displaying a high FPKPA were 2.7 times more likely to sustain a lower extremity injury (adjusted OR 2.67, 95% CI 1.23 to 5.83) and 2.4 times more likely to sustain an ankle injury (OR 2.37, 95% CI 1.13 to 4.98). There was no statistically significant association between FPKPA and knee injury (OR 1.49, 95% CI 0.56 to 3.98). The receiver operating characteristic curve analyses indicated poor combined sensitivity and specificity when FPKPA was used as a screening test for lower extremity injuries (area under the curve of 0.59) and ankle injuries (area under the curve of 0.58).

Conclusions

Athletes displaying a large FPKPA in the SLS test had an elevated risk of acute lower extremity and ankle injuries. However, the SLS test is not sensitive and specific enough to be used as a screening tool for future injury risk.

Physiological Demands, Morphological Characteristics, Physical Abilities and Injuries of Female Soccer Players

The popularity of female soccer is increasing as well as the number of females playing soccer. Similarly, over the last twenty or so years, research in soccer has increased significantly, but a large disparity exists in the volume of studies involving male and female players. As a consequence of this, female players remain less well understood compared to males. The purpose of the present narrative review was to describe morphological characteristics, physiological demands, physical abilities and injuries in female soccer players. Physiological demands are similar between men's and women's soccer, but competitive women's matches were characterized by nearly 33% less distance covered, although at higher intensity levels (maximum speeds greater than 15 km/h) than typically found in the men's game. Sub-elite female players also tended to run less at higher intensity levels at the end of both halves in comparison with elite female players. High intensity running is an important factor of success in soccer since many critical moments of the game occur under this condition. The ability to rapidly change direction also determined elite, sub-elite and amateur levels. The implementation of functional training, which focused on soccer-specific drills and plyometric exercises, to improve explosive power, may improve conditioning in female soccer players as well as decrease the risk of injuries which was 3-8 times higher in females compared to males. This review presents an in-depth overview of the most influential factors for determining success in female soccer.

The FIFA 11+ injury prevention program for soccer players: a systematic review

Background

Soccer is one of the most widely played sports in the world. However, soccer players have an increased risk of lower limb injury. These injuries may be caused by both modifiable and non-modifiable factors, justifying the adoption of an injury prevention program such as the Fédération Internationale de Football Association (FIFA) 11+. The purpose of this study was to evaluate the efficacy of the FIFA 11+ injury prevention program for soccer players.

Methodology

This meta-analysis was based on the PRISMA 2015 protocol. A search using the keywords “FIFA,” “injury prevention,” and “football” found 183 articles in the PubMed, MEDLINE, LILACS, SciELO, and ScienceDirect databases. Of these, 6 studies were selected, all of which were randomized clinical trials.

Results

The sample consisted of 6,344 players, comprising 3,307 (52%) in the intervention group and 3,037 (48%) in the control group. The FIFA 11+ program reduced injuries in soccer players by 30%, with an estimated relative risk of 0.70 (95% confidence interval, 0.52–0.93, p = 0.01). In the intervention group, 779 (24%) players had injuries, while in the control group, 1,219 (40%) players had injuries. However, this pattern was not homogeneous throughout the studies because of clinical and methodological differences in the samples. This study showed no publication bias.

Conclusion

The FIFA 11+ warm-up program reduced the risk of injury in soccer players by 30%.

Risk Factors for Lower Extremity Overuse Injuries in Female Youth Soccer Players

Background:

Youth soccer injuries are common and of increasing concern, with sport specialization occurring at younger ages. Limited research is available regarding overuse injuries and risk factors in young female athletes.

Purpose:

To identify the number and rate of overuse injuries in female soccer players (ages 12-15 years), describe the anatomic location and type of injury, and evaluate contributing risk factors.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A total of 351 female youth soccer players, ages 12 to 15 years, from Washington State were evaluated from 2008 to 2012. Players with lower extremity overuse injuries were identified through weekly emails and were interviewed by telephone to obtain data on injury type and body region. We evaluated the association between overuse injuries and preseason risk factors, including joint hypermobility, hip and knee muscle strength, and jump biomechanics, using Poisson regression to estimate relative risk (RR) and 95% CIs.

Results:

The incidence rate for first-time lower extremity overuse injuries was 1.7 per 1000 athlete-exposure hours (AEH; 95% CI, 1.4-2.2), and that for repeat injuries was 3.4 per 1000 AEH (95% CI, 2.1-5.6). Knee injuries accounted for 47% of overuse injuries. Increased valgus was associated with a 3.2-fold increased risk (95% CI, 1.52-6.71) for knee injury. A 1–standard deviation (SD) increase in hamstring strength was associated with a 35% decreased risk (RR, 0.65; 95% CI, 0.46-0.91) for overuse knee injuries, and a 1-SD increase in quadriceps strength was associated with a 30% decreased risk (RR, 0.70; 95% CI, 0.50-0.98). A 1-SD increase in hip flexor strength was associated with a 28% decreased risk (RR, 0.72; 95% CI, 0.51-1.00) for overuse knee injuries, and a 1-SD increase in external rotation strength was associated with a 35% decreased risk (RR, 0.65; 95% CI, 0.46-0.91). Playing on more than 1 soccer team was associated with a 2.5-fold increased risk (95% CI, 1.08-5.35) for overuse knee injuries, and participating in other physical activities was associated with a 61% decreased risk (odds ratio, 0.39; 95% CI, 0.15-0.81).

Conclusion:

In this study, lower extremity overuse injuries in female youth soccer players affected primarily the knee. Lower knee separation distance, decreased lower extremity strength, and playing on more than 1 soccer team increased injury risk.

The preventive effect of a soccer-specific ankle brace on acute lateral ankle sprains in girls amateur soccer players: study protocol of a cluster-randomised controlled trial

BACKGROUND

Acute lateral ankle sprains are the single most often diagnosed injury in female soccer players and often result in an inability to play. This highlights the need for effective prevention strategies. Proprioceptive training and/or the use of an external support to decrease inversion of the ankle joint can prevent or reduce the number of acute lateral ankle sprains. The effectiveness of a soccer-specific ankle brace in reducing first-time and recurrent acute lateral ankle sprains has never been investigated in girl soccer players. If effective, ankle braces could be introduced into soccer.

STUDY DESIGN

Cluster-randomised controlled trial.

METHODS

Girl amateur soccer players (aged 14-18 years) will be allocated to an intervention or control group. The intervention group will be instructed to wear soccer-specific ankle braces on both ankles during soccer training and matches; the control group will continue playing soccer as usual. Primary outcomes are the incidence and severity of acute lateral ankle sprains. Secondary outcomes are the prognostic value of generalised joint hypermobility and functional stability on the risk of acute lateral ankle sprains and compliance with the intervention.

DISCUSSION

The findings from this study may provide evidence to support the use of a soccer-specific ankle brace to prevent lateral ankle sprains during soccer. We hypothesise that this brace will reduce the incidence of ankle sprains among young amateur girl soccer players by 50%. The prevention of such injuries will be beneficial to players, clubs and society.

TRIAL REGISTRATION NUMBER

The Netherlands Trial Register (NTR): NTR6045; Pre-results.

The Epidemiology of High Ankle Sprains in National Collegiate Athletic Association Sports

BACKGROUND

Ankle sprains are among the most common injuries experienced by collegiate athletes. The type of ankle sprain is rarely differentiated in epidemiological studies. This differentiation is necessary, as each ankle sprain type has a unique injury mechanism and recovery period. High ankle sprains commonly result in long recovery periods. Thus, a further examination of the epidemiology of high ankle sprains is warranted.

PURPOSE

To describe the epidemiology of high ankle sprains in National Collegiate Athletic Association (NCAA) sports during the 2009/2010-2014/2015 academic years.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

NCAA Injury Surveillance Program high ankle sprain data and athlete-exposures (AEs) from 25 sports were evaluated. Certified athletic trainers recorded sport-related injury, event, and AE data during team-sanctioned events. High ankle sprain injury rates per 10,000 AEs were calculated. Percentage distributions were calculated for the amount of time lost from sport and percentage of recurrent injuries. Injury rate ratios (RRs) and 95% CIs compared injury rates by event type, participation restriction time, and sex. 95% CIs not containing 1.00 were considered statistically significant.

RESULTS

The overall high ankle sprain injury rate was 1.00 per 10,000 AEs. Overall, 56.7% of high ankle sprain injuries occurred during competitions, and 9.8% of high ankle sprain injuries were recurrent. Men's football (2.42/10,000 AEs), wrestling (2.11/10,000 AEs), and ice hockey (1.19/10,000 AEs) had the highest high ankle sprain injury rates. In sex-comparable sports, men had higher injury rates (RR, 1.77; 95% CI, 1.28-2.44). Player contact was the most common injury mechanism (60.4%), and 69.0% of injuries resulted in ≥1 day of participation restriction, with 47.1% resulting in ≥7 days of participation restriction and 15.8% resulting in >21 days of participation restriction.

CONCLUSION

High ankle sprains resulted in significant participation restriction time from sport participation. The majority of high ankle sprain injuries resulted from player contact and were observed in contact/collision sports. The large proportion of high ankle sprains resulting from player contact, specifically in male contact sports, is worthy of further investigation.

CLINICAL RELEVANCE

The enhanced understanding of the epidemiology of high ankle sprains provided in our study will aid clinicians in developing targeted injury prevention strategies to mitigate the negative consequences of these injuries.

Patellofemoral Kinematics and Tibial Tuberosity-Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

BACKGROUND

Patellofemoral pain (PFP) is a prevalent disorder among female adolescents. Overuse is frequently cited as the cause of pain for this population. What is currently unclear, however, is if the patella demonstrates abnormal tracking patterns relative to the femoral trochlear groove in female adolescents with PFP.

PURPOSE

The aim of this case-control study was to determine if abnormal patellar tracking patterns are present in female adolescents with PFP. The secondary aim was to identify if an increased tibial tuberosity-trochlear groove (TT-TG) distance is associated with the observed kinematic patterns.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twenty female adolescent knees from 12 patients with PFP and 20 age-matched female knees from 13 healthy controls were recruited for this study. Patellofemoral kinematics (eg, lateral patellar displacement) during a repetitive knee extension-flexion maneuver was quantified by dynamic cine phase-contrast magnetic resonance imaging (MRI). Static MRI scans were used to determine the TT-TG distance.

RESULTS

Relative to the control cohort, female adolescents with PFP demonstrated significantly greater lateral displacement at 10° (3.2 mm; P < .001), 20° (2.3 mm; P < .001), and 30° (1.7 mm; P = .014) of knee flexion. A subgroup within this cohort (7 knees from 5 patients) demonstrated extreme lateral maltracking >2 SDs of the mean of the control cohort. This subgroup also demonstrated a greater TT-TG distance relative to the controls (Δ = 4.2 mm; P = .001).

CONCLUSION

This study demonstrates abnormal lateral patellar displacement in the absence of patellar tilt in female adolescents with PFP. Because all adolescents from both cohorts participated in impact sports, it appears that rigorous athletic training alone is inadequate to produce symptoms in this population. Rather, PFP may derive from a combination of physical activity in the context of pathological kinematics.

CLINICAL RELEVANCE

Abnormal patellar tracking patterns and abnormal static alignment have been shown to contribute to the etiology of patellofemoral pain in adults. This study demonstrates that pathologic patellar tracking patterns are present in adolescent females with patellofemoral pain.

Leisure-time sport and overuse injuries of extremities in children age 6-13, a 2.5 years prospective cohort study: the CHAMPS-study DK

OBJECTIVES

It is not known which sports are most likely to cause overuse injuries of the extremities in children. In this study, we report on the incidence of overuse injuries of the upper and lower extremities in children who participate in various leisure-time sports and relate this to the frequency of sport sessions.

DESIGN

Natural experiment including a prospective cohort study.

SETTING

10 state schools in 1 Danish municipality: Svendborg.

PARTICIPANTS

1270 children aged 6-13 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.

OUTCOMES MEASURES

Over 2.5 years, parents answered weekly SMS-track messages (a) on type and frequency of leisure-time sports undertaken by their child, and (b) reporting if their child had experienced any musculoskeletal pain. Children with reported pain were examined by a clinician and diagnosed as having an overuse injury of an extremity or not. The incidence of diagnosed overuse injury was calculated for each of the 9 most common sports in relation to 5-week periods. Incidence by frequency of sessions was calculated, and multivariable analysis was performed taking into account age, sex and frequency of physical education classes at school.

RESULTS

Incidence of overuse injuries of the lower extremity ranged from 0.2 to 3.3 for the 9 sports, but was near 0 for overuse injuries of the upper extremities. There was no obvious dose-response. The multivariate analysis showed soccer and handball to be the sports most likely to result in an overuse injury.

CONCLUSIONS

Among a general population of schoolchildren, overuse injuries of the lower extremities were not common and overuse injuries of the upper extremities were rare. Organised leisure-time sport, as practised in Denmark, can be considered a safe activity for children.

The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports

BACKGROUND

Ankle sprains are a common injury in collegiate sports. Few studies have examined the epidemiology of individual ligament injuries, specifically the lateral ligament complex (LLC) of the ankle.

PURPOSE

To describe the epidemiology, including the estimated yearly national incidence, of LLC sprains among National Collegiate Athletic Association (NCAA) athletes.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Injury surveillance data for 25 sports from the NCAA Injury Surveillance Program (NCAA-ISP) for the academic years 2009-2010 to 2014-2015 were used for analysis. All injuries included for analysis had a diagnosis of an LLC sprain. LLC sprain rates and rate ratios (RRs) with 95% CIs were calculated. From the sample, national estimates of the annual incidence of LLC sprains across the entire student-athlete body from these 25 sports were also calculated.

RESULTS

During the 2009-2010 to 2014-2015 academic years, 2429 LLC sprains were reported, for a rate of 4.95 per 10,000 athlete-exposures (AEs). LLC sprains comprised 7.3% of all reported collegiate sports injuries in the NCAA-ISP. Also, an estimated 16,022 LLC sprains occurred annually among the 25 sports. The sports with the highest LLC sprain rates were men's basketball (11.96/10,000 AEs) and women's basketball (9.50/10,000 AEs). Most LLC sprains occurred during practices (57.3%); however, the LLC sprain rate was higher in competitions than in practices (RR, 3.29; 95% CI, 3.03-3.56). Also, 11.9% of LLC sprains were identified as recurrent injuries, with the largest proportions of recurrent LLC sprains being found within women's basketball (21.1%), women's outdoor track (21.1%), women's field hockey (20.0%), and men's basketball (19.1%). In 44.4% of LLC sprains, the athlete returned to play in less than 24 hours; in 3.6%, the athlete required more than 21 days before returning to play (including those who did not return to play at all).

CONCLUSION

LLC sprains were the most commonly reported injury diagnosis among United States collegiate student-athletes. Continued examination of interventions that aim to reduce the incidence, severity, and recurrence of LLC sprains, specifically in women, is warranted.

Association between sports type and overuse injuries of extremities in children and adolescents: a systematic review

BACKGROUND

Sporting activities can cause injuries and overuse injuries of the extremities (OIE) in children have been shown to be more common than injuries caused by trauma. The lower extremity is more frequently affected than the upper extremity in OIE, but it is not known whether injury site and diagnosis vary in different sporting activities.

PURPOSE

To identify any differences between sports in relation to diagnoses and anatomical areas most likely to be injured.

METHODS

A search was made in November 2014 and again in June 2016 in PubMed, SportDiscus, PsycInfo and Web of Sciences. Search terms were: « overuse injuries OR cumulative trauma disorders OR musculoskeletal injuries » AND « extremity OR limb » AND « physical activity OR sport OR risk factor OR predictors OR exercises » AND « child OR adolescent OR young adults ». Inclusion criteria were: 1) prospective, retrospective, or cross-sectional study design; 2) age ≤19 years; 3) the articles must clearly state if reported cases were classified as traumatic or overuse injuries; 4) reporting on OIE in relation to a particular sports type, and 5) sample size >50. A blinded systematic review was conducted.

RESULTS

In all, nine of the 736 identified articles were included, studying soccer, handball, orienteering, running, dance, and gymnastics. The incidence of OIE was given only in a few articles but at least the site and diagnosis of OIE were identifiable. The lower limb is more often affected than the upper in all sports covered, and, in general, the lower leg and knee are the two most often affected areas. However, in handball, the elbow was the second most often reported area, and in gymnastics injuries of the foot appeared to be more frequent than in the other sports. No differences in diagnoses were observed between sports types.

CONCLUSION

Our work contributes new information, namely that the site of OIE in children and adolescents appears to vary only somewhat between different types of sports. Further well-designed surveillance studies are needed to improve knowledge that can help prevent injuries in children and adolescents participating in sports activities.

Risk assessment of back pain in youth soccer players

The purpose of this study is to identify several responsible parameters for back pain (BP) in youth soccer players to create a risk assessment tool for early prevention.

An iPad-based survey was used to screen for parameters in a cross-sectional study. This questionnaire includes items regarding anthropometric data, training habits and sports injuries and was put into practice with 1110 athletes. Sex (odds ratio (OR): 1.84), age group (1.48) and playing surface (1.56) were significantly associated with BP. A history of injuries especially to the spine and hip/groin increased the likelihood for evolving recurrent BP (1.74/1.40). Overall 15 factors seem to influence the appearance of pain and were integrated into a feasible nomogram. The nomogram provides a practical tool to identify the risks of developing BP for youth soccer players. Although most factors we identified are non-modifiable, this method allows to rank the importance of factors and especially their prevention treatments for athletes.

Predictors of FIFA 11+ Implementation Intention in Female Adolescent Soccer: An Application of the Health Action Process Approach (HAPA) Model

The Fédération Internationale de Football (FIFA) 11+ warm-up program is efficacious at preventing lower limb injury in youth soccer; however, there has been poor adoption of the program in the community. The purpose of this study was to determine the utility of the Health Action Process Approach (HAPA) behavior change model in predicting intention to use the FIFA 11+ in a sample of 12 youth soccer teams (coaches n = 10; 12–16 year old female players n = 200). A bespoke cross-sectional questionnaire measured pre-season risk perceptions, outcome expectancies, task self-efficacy, facilitators, barriers, and FIFA 11+ implementation intention. Most coaches (90.0%) and players (80.0%) expected the program to reduce injury risk but reported limited intention to use it. Player data demonstrated an acceptable fit to the hypothesized model (standardized root mean square residual (SRMR) = 0.08; root mean square of error of approximation (RMSEA) = 0.06 (0.047–0.080); comparative fit index (CFI) = 0.93; Tucker Lewis index (TLI) = 0.91) Task self-efficacy (β = 0.53, p ≤ 0.01) and outcome expectancies (β = 0.13 p ≤ 0.05) were positively associated with intention, but risk perceptions were not (β = −0.02). The findings suggest that the HAPA model is appropriate for use in this context, and highlight the need to target task self-efficacy and outcome expectancies in FIFA 11+ implementation strategies.

Trauma injuries sustained by female footballers

Soccer is becoming the leading sport for women worldwide with 21 million females registered with the Federation Internationale de Football Association (FIFA). It is now the top female sport in England with 131 678 registered players and 9600 registered clubs. Several studies have looked at the injury rates amongst female players. Some injuries have been highlighted as more common in women. This article looks at the epidemiology of injuries in women's soccer and in particular anterior cruciate ligament injuries, ankle injuries and concussion. It will discuss the diagnosis and management needed for these injuries in female soccer players. With this increasing popularity, clinicians will see more female players sustaining trauma through playing soccer. Early and appropriate management of these injuries is essential if women are to continue to enjoy soccer at a recreational level and succeed at a competitive level, perhaps with a podium finish in 2012.

Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion

Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures.

Risk Factors for Injuries in Professional Football Players

AIM

The aim of this study was to identify risk factors related to the occurrence of injuries in football players.

MATERIALS AND METHODS

The study included 216 football players from 12 teams in the elite football league. Football-related injury data were collected prospectively during the 2012/2013 competitive season. At baseline the following information was collected for the players: anthropometric measurements (weight, height, BMI, subcutaneous skinfolds), playing experience, injury history, physical fitness performance test (agility run), peak oxygen uptake. The incidence, type and severity of injuries and training and game exposure times were prospectively documented for each player.

RESULTS

Most of the players (n = 155, 71.7%) sustained the injures during the study period. The overall injury incidence during the regular season was 6.3 injuries per 1000 athlete-exposures (95% confidence interval, 4.31-9.67). Multivariate logistic regression analysis showed that playing experience (odds ratio [OR] = 0.44; 95% CI = 0.32-0.61, p < 0.01), age (OR = 2.05; 95% CI = 1.49-2.81, p < 0.01) and a previous injury (OR = 4.4; 95% CI = 2.14-9.07, p < 0.01) were significantly correlated to increased risk of injuries. Body mass index was not associated with risk of injury. Strains (34.19%) and sprains (25.81%) were the major injury types. Twenty-seven percent of injured players were absent from football for more than 1 month, with knee injuries (25.42%) being the most severe type.

CONCLUSION

The risk factors that increase injury rates in football players were previous injury, higher age and years of playing. Future research should include adequate rehabilitation program to reduce the risk of injuries.

Enhanced knee joint function due to accelerated rehabilitation exercise after anterior cruciate ligament reconstruction surgery in Korean male high school soccer players

This study was conducted on Korean male high school soccer players who underwent anterior cruciate ligament reconstruction (ACLR) to identify the effects of an accelerated rehabilitation exercise (ARE) program on knee joint isometric strength, thigh circumference, Lysholm score, and active balance agility. We assigned eight test participants each to a physical therapy group (PTG) and an accelerated rehabilitation exercise group (AREG), and compared differences between the groups. Both the PTG and AREG showed significant increases in 30° away and 60° toward isometric strength after treatment. In addition, significant differences were observed in these strength tests between the two groups. Both groups also showed significant increases in thigh circumference, Lysholm score, and active balance agility after treatment, but no significant differences were observed between the two groups. We conclude that the ARE treatment was more effective for improving isometric strength of the knee joint than that of physical therapy, and that an active rehabilitation exercise program after ACLR had positive effects on recovery performance of patients with an ACL injury and their return to the playing field.

Low back pain in female elite football and handball players compared with an active control group

PURPOSE

The purpose of this cross-sectional study was to compare the prevalence of low back pain (LBP) among female elite football and handball players to a matched non-professional active control group.

METHODS

The participants were requested to answer a questionnaire based on standardized Nordic questionnaires for musculoskeletal symptoms to assess the prevalence of LBP. Included participants were elite female football (n = 277) and handball players (n = 190), and a randomly selected control group from the Norwegian population (n = 167).

RESULTS

Fifty-seven percentage of the football players, 59 % of the handball players and 60 % of the control group had experienced LBP the previous year. There were no significant group differences in the prevalence of LBP ever (p = 0.62), the previous year (p = 0.85) or the previous 7 days (p = 0.63). For both sports, there was a significant increase in prevalence of LBP from the resting period to the competitive periods of the season (p ≤ 0.001). Seventy percent of the goalkeepers in both football and handball had experienced LBP the previous year.

CONCLUSION

There were no difference in LBP among female elite football and handball players compared with the control group. However, female elite athletes in football and handball reported a high prevalence of LBP compared to previous studies. The variations in LBP and playing positions indicate that specific field positions, in football and handball, is a risk factor for developing LBP.

Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football

Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P < 0.001]. Risk of time-loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self-reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time-loss knee injury in adolescent female football.

Middle school injuries: a 20-year (1988-2008) multisport evaluation

CONTEXT

Data on the incidence of injury in middle school sports are limited.

OBJECTIVE

To describe overall, practice, and game injury rate patterns in 29 middle school sports.

DESIGN

Descriptive epidemiology study.

SETTING

Injury data collected over a 20-year period (1988-2008) at a single school.

PATIENTS OR OTHER PARTICIPANTS

Boy (n = 8078) and girl (n = 5960) athletes participating in 14 and 15 middle school sports, respectively.

MAIN OUTCOME MEASURE(S)

Injury status and athlete-exposures (AEs) were collected by certified athletic trainers. Incidence rates per 1000 AEs (injuries/AEs) were calculated for overall incidence, practices and games, injury location, injury type, and injury severity (time lost from participation). Rate ratios (RRs) and 95% confidence intervals (CIs) were used to compare injury rates for sex-matched sports.

RESULTS

Football had the highest injury rate for all injuries (16.03/1000 AEs) and for time-loss injuries (8.486/1000 AEs). In matched middle school sports, girls exhibited a higher injury rate for all injuries (7.686/1000 AEs, RR = 1.15, 95% CI = 1.1, 1.2) and time-loss injuries (2.944/1000 AEs, RR = 1.09, 95% CI = 1.0, 1.2) than boys (all injuries: 6.684/1000 AEs, time-loss injuries: 2.702/1000 AEs). Girls had a higher injury rate during practices (3.30/1000 AEs) than games (1.67/1000 AEs, RR = 1.97, 95% CI = 1.7, 2.4) for all sports. Only gymnastics (RR = 0.96, 95% CI = 0.3, 3.8) had a higher game injury rate for girls. Practice and game injury rates were nearly identical for boys in all sports (RR = 0.99, 95% CI = 0.9, 1.1). Only football (RR = 0.49, 95% CI = 0.4, 0.6) and boys' wrestling (RR = 0.50, 95% CI = 0.3, 0.8) reported higher game injury rates. Tendinitis injuries accounted for 19.1% of all middle school injuries.

CONCLUSIONS

The risk for sport-related injury at the middle school level was greater during practices than games and greater for girls than boys in sex-matched sports. Conditioning programs may be needed to address the high rate of tendinitis injuries.

The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist.

OBJECTIVE

Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity.

METHODS

We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields.

RESULTS

One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain.

CONCLUSIONS

Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

Chronic ankle instability in sporting populations

BACKGROUND

Chronic ankle instability (CAI) is a term used to identify certain insufficiencies of the ankle joint complex following an acute ankle injury. Acute ankle injuries are often associated with sporting mishaps; however, this review was the first to identify the aspects of CAI (perceived instability, mechanical instability and recurrent sprain), and persisting symptoms following an ankle sprain, that have been reported within sporting cohorts.

OBJECTIVE

To determine the presence of common aspects of CAI within individual sports.

METHODS

A systematic search of the MEDLINE, Web of Science, CINAHL, SPORTDiscus and AMED databases up until 1 October, 2013 produced 88 studies appropriate for review. A calculated weighted percentage of the outcome data allowed the comparison of figures across a range of sports.

RESULTS

Soccer, basketball and volleyball were the most represented sports and recurrent ankle injury/sprain was the most reported aspect of CAI. Soccer had the highest percentage of participants with recurrent sprain (61%) and mechanical instability (38%), whilst track and field had the highest percentage of participants with perceived instability (41%). Gymnasts had the highest percentage of ankles with persisting symptoms following an initial ankle sprain.

CONCLUSION

This review was the first to assess aspects of CAI within sporting cohorts and has identified limitations to the research reporting these data. The problem of CAI across a range of sports remains unclear and thus advocates the need for further controlled research in the area to ascertain the true extent of CAI within sporting populations.

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

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