Risk factors associated with self-reported injury history in female youth soccer players

Investigation of exercise-related leg pain, fear of pain, kinesiophobia, and injury anxiety in athletes

BACKGROUND

This study aimed to investigate the relationship between exercise-induced leg pain, fear of pain, kinesiophobia and injury anxiety in amateur and professional athletes. Secondarily, the present study also aimed to investigate the relationship between women or men athletes and individual or team sports.

METHODS

A cross-sectional study was conducted with a total of 304 athletes. Participants were categorized as amateur and professional athletes, male and female athletes, individual and team athletes. Participants were evaluated with Exercise Induced Leg Pain Questionnaire (EILP), Fear of Pain Questionnaire (FOPQ), Sports Injury Anxiety Scale (SIAS), and Tampa Scale of Kinesiophobia (TSK). Parametric tests were used for statistical analysis. A statistical significance level of 0.05 was chosen.

RESULTS

Fear of pain and anxiety about sports injury were significantly less in men (p < 0.05). Loss of social support for sports injury anxiety was less in women (p < 0.05). Anxiety about sports re-injury was less in professional athletes (p < 0.05). Anxiety about letting down important Others and loss of social support were greater in team sports (p < 0.05). Besides, there was a positive, moderate, and significant correlation between the Fear of Pain Questionnaire- III Total and Tampa scale for kinesiophobia (r = 0.411, p < 0.01). Finally, a positive, moderate and significant correlation was found between Sport Injury Anxiety Scale Total and Tampa scale for kinesiophobia (r = 0.579, p < 0.01).

CONCLUSION

Exercise and movement were associated with psychological parameters related to injury and pain in athletes. Female athletes were found to have more injury anxiety and fear of pain. In addition, amateur athletes have more injury anxiety. Besides, injury anxiety was found to be higher in individuals in team sports. Future studies may further investigate these groups who are more disadvantaged in terms of anxiety, fear of pain and kinesiophobia. In addition, clinicians should pay attention to the criteria for a biopsychosocial approach by choosing appropriate descriptive phrases to avoid exacerbating athletes' anxiety.

Knee Mechanics, Strength and Flexibility: Assessing Injury Risk in Female Adolescent Soccer Players

BACKGROUND/OBJECTIVES

This study examined the link between the Q angle, knee hyperextension, flexibility, strength profiles and injury occurrence in female adolescent soccer players.

METHODS

Thirty adolescent female soccer players (age range: 15-17 years; age: 15.47 ± 0.73 years; weight: 55.91 ± 7.44 kg; height: 160.01 ± 5.58 cm) were recruited for the study. The tests were conducted before the pre-season preparation period, and the players were monitored from the beginning to the end of the season. This study included players who sustained non-contact injuries throughout the season as well as those who did not sustain any injuries for comparison purposes. Players underwent an anthropometric assessment (height, weight, body fat, Q angle, knee hyperextension) and completed a sit-and-reach test and an isokinetic assessment at 60°/s.

RESULTS

The results showed that 36.67% of players sustained a non-contact injury during the season. Based on the isokinetic assessment at 60°/s, significant differences were observed between the two groups in the torque production of the right and left knee extensors [t(28) = 2.32, p = 0.03, d = 0.81 (large effect)] and the right and left knee flexors [t(28) = 2.04, p = 0.05, d = 0.71 (medium effect)], with the injured group demonstrating significantly greater interlimb asymmetries in torque between the right and left knee extensors, as well as the right and left knee flexors. Also, the injured group demonstrated significantly higher knee hyperextension values for both the right [t(28) = 6.12, p < 0.05, d = 2.22 (large effect)] and left legs [t(28) = 5.72, p < 0.05, d = 2.15 (large effect)].

CONCLUSIONS

interlimb asymmetries and knee hyperextension may contribute to the occurrence of lower body non-contact injuries in adolescent female soccer players.

Assessment of Return to Sport After ACL Reconstruction With Soft Tissue Autograft in Adolescent Athletes: Quadriceps Versus Hamstring Tendon

Background

Quadriceps tendon soft tissue autograft represents an increasingly popular graft option for anterior cruciate ligament reconstruction (ACLR), particularly for adolescents, some of whom have an open physis, precluding use of graft options with bone plugs.

Purpose/Hypothesis

The purpose of this study was to quantify return-to-sport performance assessments in adolescents at 6 months after ACLR with all-soft tissue quadriceps tendon autograft (ACLR-Q) versus hamstring tendon autograft (ACLR-HS). It was hypothesized that ACLR-Q would be associated with improved hamstring strength and hamstring-to-quadriceps (HS:Q) ratios compared with ACLR-HS, albeit with decreased quadriceps strength.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Included were patients aged 12 to 19 years who underwent primary ACLR by a single surgeon and who completed a return-to-sport performance assessment between 5 and 9 months postoperatively. The performance assessment included manual muscle strength tests (hamstring, quadriceps, hip abductor and adductor), dynamic balance test (Y-balance), and functional hop tests (single hop, triple hop, crossover hop, 6-m timed hop). Data were converted to limb symmetry indices, and limb symmetry index deficits were compared between the ACLR-Q and ACLR-HS cohorts using the Student t test or Wilcoxon-Mann-Whitney test.

Results

An initial cohort of 90 ACLR-Q patients was compared with 54 ACLR-HS patients, with no significant differences in patient characteristics. Differences in meniscal repair rates, however, prompted use of propensity score matching on age, sex, body mass index, meniscectomy, and meniscal repair to produce comparable subcohorts. The matching resulted in 67 ACLR-Q and 52 ACLR-HS patients. Hamstring strength deficits were significantly greater in ACLR-HS versus ACLR-Q patients (-40.5% vs -5.7%; P < .001). Quadriceps strength deficits were significantly greater in ACLR-Q versus ACLR-HS patients (-12.8% vs -0.4%; P < .001). ACLR-Q patients had a significantly greater HS:Q ratio on the operative knee (P < .001) and significantly higher Y-balance composite score deficits (-2.9% vs -0.4%; P = .01) than ACLR-HS patients. There were no significant differences in hop test performance between groups.

Conclusion

Adolescent athletes who underwent ACLR-Q showed significantly greater quadriceps strength deficits but significantly smaller hamstring strength deficits than those who underwent ACLR-HS, leading to more favorable HS:Q ratios in ACLR-Q patients at 6 months postoperatively.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

LEVEL OF EVIDENCE

Level II. Trial registration number NCT04272047, Clinical trials.

Predicting Risk Factors of Lower Extremity Injuries in Elite Women's Football: Systematic Review and Meta-Analysis

This study identified and analyzed the risk factors of lower extremity injuries (LEI) in elite women football players to improve career and health outcomes. To address this aim, a systematic review and meta-analysis methodology was used. In total, four relevant research articles were identified through database searching and screening using the PRISMA flow diagram. From these articles, eight predictors were identified that influence the risk of LEI among elite women football players: higher body mass index (OR 1.51, 95% CI); previous knee injury (OR 3.57, 95% CI); low normalized knee separation (≤10th percentile) (RR 1.92, 95% CI); all previous injury (previous ACL tear: OR 5.24, 95% CI; ankle sprain: 1.39, 95% CI; knee sprain: 1.50, 95% CI); and previous injury in the lower body (OR 2.97, 95% CI). Meanwhile, lower knee valgus angle in a drop-jump landing (OR 0.64, 95% CI) was found to decrease the risk of LEI among elite women football players.

Correlation between preseason body composition and sports injury in an English Premier League professional football team

Objectives

To identify the correlation between preseason body composition and incidence coupled with injury burden throughout the season in adult male professional football players.

Methods

A retrospective case series was performed for linear regression analysis of preseason body composition variables and injury data. R2 >0.10 was deemed of adequate correlation.

Results

All 36 professional football players in the male first team of an English Premier League professional football team were recruited, with none lost to follow-up. The total and mean incidence of injuries was 83.00 and 2.31 (95% CI 1.72 to 2.89), respectively. The mean injury burden was 58.32 (95% CI 37.67 to 78.98) days missed. Simple linear regression analysis indicated no significant or adequate correlations between incidence and preseason body composition variables. Injury burden revealed non-significant adequate negative correlations to body mass (R2=0.17), body mass index (BMI) (R2=0.15), waist circumference (R2=0.17), total bone mineral density (BMD) (R2=0.11) and mean embedded structures (R2=0.10).

Conclusions

Players with decreased body mass, BMI, waist circumference, total BMD and mean embedded structures may be prone to greater injury burden. Further studies with a larger sample size that incorporates multiple football teams are warranted to investigate this.

Predictive Analytic Techniques to Identify Hidden Relationships between Training Load, Fatigue and Muscle Strains in Young Soccer Players

This study aimed to analyze different predictive analytic techniques to forecast the risk of muscle strain injuries (MSI) in youth soccer based on training load data. Twenty-two young soccer players (age: 13.5 ± 0.3 years) were recruited, and an injury surveillance system was applied to record all MSI during the season. Anthropometric data, predicted age at peak height velocity, and skeletal age were collected. The session-RPE method was daily employed to quantify internal training/match load, and monotony, strain, and cumulative load over the weeks were calculated. A countermovement jump (CMJ) test was submitted before and after each training/match to quantify players' neuromuscular fatigue. All these data were used to predict the risk of MSI through different data mining models: Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM). Among them, SVM showed the best predictive ability (area under the curve = 0.84 ± 0.05). Then, Decision tree (DT) algorithm was employed to understand the interactions identified by the SVM model. The rules extracted by DT revealed how the risk of injury could change according to players' maturity status, neuromuscular fatigue, anthropometric factors, higher workloads, and low recovery status. This approach allowed to identify MSI and the underlying risk factors.

Evaluation of the Functional Movement Screen (FMS) in Identifying Active Females Who are Prone to Injury. A Systematic Review

Background

The validity of the Functional Movement Screen (FMS) in identifying active females who are predisposed to injury has not been specifically reviewed. This study aims to synthesize the literature on the ability of the FMS to identify at-risk active females.

Methods

Six online databases, including PubMed, Medline, Web of Science, Science Direct, SPORTDiscus and Google Scholar, were searched for the period of April 2006 to September 2021. Out of the 61 potential references, 17 were reviewed in detail with respect to the inclusion criteria; ten were ultimately included. The risk of bias, applicability and level of the studies were then identified using the QUADAS-2 and a checklist for assessing methodological quality. The following data were obtained from the included studies: year of publication, title, study type, participants’ demographic, sample size, FMS cutoff point, injury definition, statistical analyses used, FMS results and study level.

Results

Generally, the quality of eight studies was poor to moderate due to both small sample sizes and short follow-up periods. Except for a study on military members, all studies were carried out on team sports players. The overall bias of the studies was low, but there was an unclear amount of bias for participant selection. Two studies reported no predictive validity for the FMS, while three defended its predictive validity; the rest partially supported the FMS as a valid diagnostic tool. The reliability of the recommended cutoff point was confirmed, though cutoffs higher than 14 were significantly associated with the predictive ability of the FMS.

Conclusion

Although the FMS is reliable for clinical practice, and the current literature shows promise regarding the predictive ability of the FMS among active females, concerns remain regarding its validity in identifying at-risk females. Given the lack of clarity in the literature on the use of the FMS in females, further well-organized studies with larger sample sizes and longer monitoring periods are highly recommended. The sensitivity and specificity of the recommended cutoff of ≤ 14 has considerably decreased , and higher cutoff values should be applied to increase the FMS predictive ability.

Level of evidence The level of evidence was determined to be 2b.

Functional and Anthropometrical Screening Test among High Performance Female Football Players: A Descriptive Study with Injury Incidence Analysis, the Basque Female Football Cohort (BFFC) Study

The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women's football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1-5; 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.

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.

The relationship between physical fitness attributes and sports injury in female, team ball sport players: a systematic review

BACKGROUND

Understanding the relationships between physical fitness characteristics and sports injury may assist with the development of injury minimisation programs. The purpose of this systematic review was to investigate the association between physical fitness attributes and sports injury in female, team ball sport players.

METHODS

Four scientific databases (MEDLINE, EMBASE, SPORTDiscus, Scopus) and reference lists of relevant research were searched for eligible studies up to September 2, 2019. Full-text articles examining the relationship between physical fitness and sports injury in female, team ball sport players were included. A modified Downs and Black checklist was used to assess methodological quality. Data synthesis determined summary conclusions based on the number of significant relationships divided by the total relationships investigated and reported as a percentage. Level of certainty was identified for summary conclusions based on level of evidence. Sub-analyses regarding competition level, age, and single injury types were also conducted.

RESULTS

A total of 44 studies were included. Data synthesis revealed no associations (low to moderate certainty) between body composition (1/9; 11%), flexibility (18-20%), and balance (2/8; 25%) and 'any injury' classification. No associations (mostly of moderate certainty) were found between flexibility (0-27%), muscular strength (0-27%), and body composition (14-33%) and various body region injury classifications, whereas mixed summary conclusions were shown for balance (0-48%). Many associations between physical fitness and sports injury were deemed 'unknown' or with an insufficient level of certainty. Sub-analyses revealed no association between strength and noncontact ACL injuries (0/5; 0%) or ankle sprains (0/12; 0%), and between flexibility and ankle sprains (1/5; 20%); however, insufficient certainty of these results exists. Clear associations were concluded between balance and lower body injuries in female, non-elite (10/16; 63%) and junior (9/12; 75%) team ball sport players, with moderate and insufficient certainty of these results, respectively.

CONCLUSION

Limited evidence is available to demonstrate relationships between physical fitness and sports injury in female, team ball sport players. High-quality evidence investigating the multifactorial nature of sports injury, including the interactions physical fitness qualities have with other injury determinants, is needed to better understand the role of physical fitness in minimising sports injuries in female, team ball sport players.

TRIAL REGISTRATION

CRD42017077374 (PROSPERO on September 14, 2017).

Effect of Graft Type on Thigh Circumference, Knee Range of Motion, and Lower-Extremity Strength in Pediatric and Adolescent Males Following Anterior Cruciate Ligament Reconstruction

CONTEXT

To treat anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) surgery is currently a standard of the care. However, effect of graft type including bone-patellar tendon-bone (BTB), hamstring tendon, or iliotibial band (ITB) on thigh size, knee range of motion (ROM), and muscle strength are understudied.

OBJECTIVE

To compare postoperative thigh circumference, knee ROM, and hip and thigh muscle strength in adolescent males who underwent ACLR, based on the 3 different autograft types: BTB, hamstring (HS), and ITB.

SETTING

Biomechanical laboratory.

PARTICIPANTS

Male ACLR patients who are younger than 22 years of age (total N = 164).

INTERVENTION

At 6- to 9-month postoperative visits, thigh circumference, knee ROM, and hip and thigh muscle strength were measured.

MAIN OUTCOME MEASURES

Deficits of each variable between the uninvolved and ACLR limb were compared for pediatric and adolescent ACLR males in the BTB, HS, and ITB cohorts. Baseline characteristics, including physical demographics and meniscus tear status, were compared, and differences identified were treated as covariates and incorporated in analysis of covariance.

RESULTS

Data were from 164 adolescent male ACLR patients [mean age 15.7 (1.2) years]. There were no statistical differences in thigh circumference, knee ROM, hip abductor, and hip-extensor strength among the 3 autografts. However, patients with BTB demonstrated 12.2% deficits in quadriceps strength compared with 0.5% surplus in HS patients (P = .002) and 1.2% deficits in ITB patients (P = .03). Patients with HS showed 31.7% deficits in hamstring strength compared with 5.4% deficits in BTB (P = .001) and 7.7% deficits in ITB (P = .001) groups at 6- to 9-month postoperative visits.

CONCLUSION

Adolescent male ACLR patients with BTB and HS autografts demonstrated significant deficits in quadriceps and hamstring strength, respectively, at 6 to 9 months postoperatively. Minimal lower-extremity strength deficits were demonstrated in pediatric male ACLR patients undergoing ITB harvest.

Off-Season Training Habits and BMI, Not Preseason Jump Measures, Are Associated with Time-Loss Injury in Female Collegiate Soccer Players

The primary purpose of this study was to determine the effectiveness of the standing long jump (SLJ) and the single-leg hop (SLH) tests to discriminate lower quadrant (low back and lower extremities) injury occurrence in female collegiate soccer players. The secondary purpose of this study was to determine associations between injury and off-season training habits or anthropometric measures. SLJ, SLH, and anthropometric measures were collected during a preseason screening clinic. Each subject completed a questionnaire providing demographic information and off-season training habits. Each athlete performed three SLJ and three SLH per leg. SLJ and SLH scores were not associated with an increased risk of a noncontact time-loss lower quadrant (LQ) injury. Athletes with a higher BMI or who reported less time training during the off-season were two times more likely to sustain an injury. Athletes who had both a higher body mass index (BMI) and lower off-season training habits were three times (relative risk = 3.1 (95% CI: 1.7, 5.5) p-value = 0.0001) more likely to sustain a noncontact time-loss lower quadrant injury. Preseason SLJ and SLH scores do not discriminate injury risk in female collegiate soccer players. Higher BMI and lower off-season training habits are associated with an increased risk of LQ injury.

Association between training volume and lower extremity overuse injuries in young female athletes: implications for early sports specialization

BACKGROUND

Recent studies indicated greater risk of overuse injuries among young female athletes than their male counterparts. However, few studies have focused on female athletes and the effect of single-sport participation on lower extremity overuse injuries.

OBJECTIVE

The objective of this study is to identify an independent risk variable for lower extremity overuse injuries based on status of sport participations (single- and multisports) in young female athletes.

METHODS

In this cross-sectional study, 12-18-year-old female athletes were asked to complete electronic questionnaires describing their current sport participation and previous injury history. Range of motion (ROM), muscular strength, and performance parameters were measured at the time of completion of electronic questionnaires. Potential risk variables were compared between single- and multisport athletes and entered into a logistic regression model. Adjusted odds ratio (aOR), 95% confidence intervals (95% CIs), and p values were recorded to find an association with increased likelihood of lower extremity overuse injuries.

RESULTS

The study cohort comprised 236 female young athletes (single-sport athletes: N = 60, multisport athletes: N = 176). A few variables including age, BMI, weekly hours of training for a sport, knee ROM, ankle ROM, and knee extensor strength were identified as potential risk variables. A logistic regression analysis showed an independent association between increased weekly hours of training for a sport and greater likelihood of histories of lower extremity overuse injuries (aOR = 1.091, 95% CIs: 1.007-1.183, p = .034).

CONCLUSION

Although status of single- or multisports participation was not a significant risk variable, increased training volume was found to be an independent contributing factor for greater likelihood of lower extremity overuse injury histories in 12-18 years female athletes. The current study identified that single-sport athletes trained nearly twice as many hours per week when compared to multisport athletes, which may explain an underlying mechanism of sports specialization.