Injury surveillance in the World Football Tournaments 1998-2012

A prospective epidemiologic study of injuries and illnesses in the football matches of the 14th National Student Games of China

The aim of this study is to determine the incidence and characteristics of football player injuries and illnesses during the 14th National Student Games of China. The results indicate that 32 illnesses were reported, with 17 (53%) involving the gastrointestinal system, primarily caused by environmental factors (24, 69%). The illness incidence rate was 4.3 cases per 100 players or 10.2 cases per 1,000 player-days. Regarding injuries, 122 cases were reported, yielding an overall injury incidence rate was 38.9 per 1,000 game hours, or 1.14 per game. Most injuries resulted from collisions with other players, occurring predominantly 15 minutes before the end of the first half, and 30 minutes before the end of the game. Most of the injuries were in the ankle, thigh, knee joint, and groin. In conclusion, the injury incidence of football players in the 14th National Student Games of China is high, occurring from a variety of mechanisms. Physical contact should be emphasized during training, core strength, and stability training should be enhanced alongside comprehensive injury management and prevention strategies.

Imaging-detected sports injuries and imaging-guided interventions in athletes during the 2022 FIFA football (soccer) World Cup

OBJECTIVE

To describe imaging-detected musculoskeletal injuries and image-guided interventional procedures during the 2022 FIFA football (soccer) World Cup.

MATERIALS AND METHODS

Retrospective analysis of all radiologic examinations performed in a central medical facility for athletes was performed by two board certified musculoskeletal radiologists. Data on muscle, tendon, ligament, cartilage, and bone injuries were collected according to imaging modality and body part.

RESULTS

A total of 143 radiology examinations in 94 athletes were evaluated at the central medical facility. Magnetic resonance imaging (MRI) was the most utilized modality (67%), followed by radiography (12%), ultrasonography (9%), and computed tomography (4%). Image-guided interventions corresponded to 8% of all radiological examinations. There were 112 injuries described, affecting muscles and tendons (42%), ligaments (25%), cartilage (21%), and bone (12%). Most injured body parts were thigh (27%), foot and ankle (23%), knee (23%), and hip/groin (8%). Most injured players were within the age range of 24-35 years old (71%).

CONCLUSION

Imaging was utilized in 11% of players who participated in the 2022 FIFA World Cup in Qatar. MRI was the most utilized modality, and acute muscle tears were the most diagnosed type of injury. Diagnostic imaging played an important role in diagnosing sports-related injuries during the 2022 FIFA World Cup.

Management of radiology services during the 2022 FIFA football (soccer) World Cup

Diagnostic imaging is the predominant medical service sought for the assessment and staging of musculoskeletal injuries in professional sports events. During the 2022 FIFA Football (soccer) World Cup, a centralized medical care infrastructure was established. This article provides a comprehensive account of the radiological services implemented during this event, encompassing the deployment of equipment and human resources, the structuring of workflows to uphold athlete confidentiality, and initiatives aimed at enhancing communication. Communication channels were refined through radiology consultations held with national teams' health care providers and the adoption of audiovisual reports available in multiple languages, which could be accessed remotely by team physicians. Our established framework can be replicated in international professional football events for seamless integration and efficacy.

'After they see what you have, they contact you': a qualitative study of national team football players', coaches' and clinicians' experiences in engaging with a context-specific injury surveillance system

BACKGROUND

Sports injury surveillance systems aid injury prevention, but their development without considering end-users' perspectives has led to low adherence and honesty in self-reporting by players, compromising their effectiveness. Context-specific injury surveillance systems have been proposed to address these challenges, but there is a limited understanding of stakeholders' perceptions and experiences in using them.

OBJECTIVE

Following the implementation of a context-specific injury surveillance system with 100% player adherence over 60 weeks, the study aimed to investigate Under-21 Maltese national football team players', coaches' and clinicians' experiences of how and why they engaged with the system.

METHOD

Seventeen semi-structured interviews with Under-21 Maltese male national football team players (n = 12), their coaches (n = 3) and clinicians (n = 2) were conducted. Data were analysed using reflexive thematic analysis.

RESULTS

Participants highlighted questionnaire-related factors that motivated engagement with the context-specific injury surveillance system (theme 1) and factors influencing further engagement with the system based on stakeholders' actions (theme 2). Perceived outcomes experienced as a result of engaging with the injury surveillance system (theme 3), in turn, motivated players to continue reporting and engaging with the system.

CONCLUSION

To encourage players' sustained reporting, injury-related information collected from well-designed questionnaires should serve to stimulate communication and teamwork among stakeholders, to prevent injuries and enhance performance.

Biopsychosocial approach to sports injury: a systematic review and exploration of knowledge structure

BACKGROUND

Sports injuries are influenced by biological, psychological, and social factors. Therefore, an integrated approach to address these factors is essential. This study aimed to analyze the research trends and biopsychosocial factors influencing sports injuries. It also explored the knowledge structure of the biopsychosocial approach to sports injuries.

METHODS

A literature search was conducted using the PubMed, Cochrane Library, and RISS databases with the keywords 'Biopsychosocial' and 'Sports injury' for studies published between January 1, 2014, and August 31, 2024. Studies in which the abstract content did not match the purpose of this study were excluded. Two independent reviewers conducted a qualitative content analysis of the selected literature. Data on the study design, year of publication, biopsychosocial factors, and main findings were extracted. To explore the knowledge structure, a keyword-network analysis was performed using Python NetworkX.

RESULT

Five studies were selected based on the inclusion and exclusion criteria. All selected studies were published after 2021, reflecting recent research trends. Biopsychosocial factors influencing the occurrence of sports injuries include sex, team sports, neuroticism, previous injury, postpartum-related factors, mental health, and sleep status. Biopsychosocial factors influencing return to play after sports injury include self-reported knee function and psychological readiness to return to sport. The five most frequently occurring keywords were 'injury', 'factors', 'sports', 'pain' and 'runners'. 'Factors-injury' had the highest co-occurrence frequency, and the 'injury', 'factors', and 'sports' showed high scores in the centrality analysis.

CONCLUSION

A biopsychosocial approach to sports injuries represents a recent research trend. Identifying the biopsychosocial factors of sports injuries can help prevent injuries and promote rehabilitation. Therefore, the development of a biopsychosocial model to prevent sports injuries and promote rehabilitation has been proposed.

What do we know about beach soccer injuries? Systematic video analysis of four consecutive years with 580 match injuries

The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact (p < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) (p < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.

Effectiveness of FIFA 11+ Injury Prevention Programs in Reducing Head and Neck Injuries, Including Concussion, Among Soccer Players: A Systematic Review and Meta-Analysis

The Federation Internationale de Football Association (FIFA) 11+ and 11+ Kids injury prevention programs have shown success in reducing overall injury risk in soccer players, yet their specific impact on head and neck injuries remains inadequately explored.

PURPOSE

To evaluate the effectiveness of FIFA 11+ and 11+ Kids injury prevention programs in reducing the incidence of head and neck injuries among soccer players.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 investigators independently conducted searches in databases (Cochrane Library, PubMed, Web of Science, and PEDro) using keywords like "FIFA 11+," "football," "soccer," and "injury prevention." Only randomized controlled trials assessing FIFA 11+ programs in soccer players were included. Data analysis used the random effects model with RevMan Meta-Analysis software (version 5).

RESULTS

Among 397 studies, 4 met inclusion criteria. Pooled results from 7109 players and 532,341 exposure hours indicated a significant 40% reduction in head and neck injuries per 1000 hours of exposure in the intervention group compared to the control group (injury risk ratio 0.60, 95% CI, 0.41-0.88).

CONCLUSION

Implementing FIFA 11+ injury prevention programs significantly reduces the risk of head and neck injuries in soccer players, offering a compelling alternative to traditional warm-ups. This study contributes valuable evidence for optimizing injury prevention strategies in soccer training regimens.

Time-loss injuries and illnesses at the FIFA world cup Qatar 2022

The study aimed to analyse incidence and characteristics of time-loss injuries and illnesses during the FIFA World Cup Qatar 2022. Of 838 male football players, 705 consented to participate. Team medical staff reported 82 time-loss injuries, corresponding to an injury event incidence of 5.6 injuries/1000 h of total exposure (95%CI 4.5 to 7.0 injuries/1000 h), with a median of 2 time-loss injury events per team (IQR, 1 to 4.5, range 0-7). The total injury burden was 103 (95% CI 61 to 152) days per 1000 h. Muscle/tendon injuries had the highest incidence of tissue types (48 cases, 3.3/1000 h (95% CI 2.5 to 4.4), and hamstring muscle injuries were the most frequent diagnosis (16 cases, incidence 1.1/1000 h, 95% CI 0.6 to 1.8). Match injury event incidence was 20.6/1000 h (15.0 to 27.7) and training injury event incidence was 2.1/1000 h (1.4 to 3.1). The majority (52%) of sudden-onset injuries were non-contact injuries, 40% direct contact and 8% indirect contact. We recorded 15 time-loss illnesses, corresponding to an illness event incidence of 1.1 per 1000 competition days, (95% CI: 0.6 to 1.8), and illness burden of 2.1 (1.0 to 3.4) days lost per 1000 competition days. The most common illness was respiratory infection (12 cases, 80%). Match injury event incidence was the lowest in any FIFA World Cup since injuries have been monitored.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Chronic Traumatic Encephalopathy in Soccer Players: Review of 14 Cases

OBJECTIVE

Exposure to repetitive sports-related concussions or (sub)concussive head trauma may lead to chronic traumatic encephalopathy (CTE). Which impact (heading or concussion) poses the greatest risk of CTE development in soccer players?

DESIGN

Narrative review.

SETTING

Teaching hospital and University of Applied sciences.

PATIENTS

A literature search (PubMed) was conducted for neuropathologic studies in the period 2005-December 2022, investigating soccer players with dementia and a CTE diagnosis, limited to English language publications. 210 papers were selected for final inclusion, of which 7 papers described 14 soccer players.

ASSESSMENT

Magnetic resonance imaging studies in soccer players show that lifetime estimates of heading numbers are inversely correlated with cortical thickness, grey matter volume, and density of the anterior temporal cortex. Using diffusion tensor imaging-magnetic resonance imaging, higher frequency of headings-particularly with rotational accelerations-are associated with impaired white matter integrity. Serum neurofilament light protein is elevated after heading.

MAIN OUTCOME MEASURES

Chronic traumatic encephalopathy pathology, history of concussion, heading frequency.

RESULTS

In 10 of 14 soccer players, CTE was the primary diagnosis. In 4 cases, other dementia types formed the primary diagnosis and CTE pathology was a concomitant finding. Remarkably, 6 of the 14 cases had no history of concussion, suggesting that frequent heading may be a risk for CTE in patients without symptomatic concussion. Rule changes in heading duels, management of concussion during the game, and limiting the number of high force headers during training are discussed.

CONCLUSIONS

Data suggest that heading frequency and concussions are associated with higher risk of developing CTE in (retired) soccer players. However based on this review of only 14 players, questions persist as to whether or not heading is a risk factor for CTE or long-term cognitive decline.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Medical services at the FIFA world cup Qatar 2022

OBJECTIVE

The Football World Cup is among the biggest sporting events in the world, but data to inform the requirements of medical care for such tournaments are limited. This study describes the athlete and team medical services at the FIFA World Cup Qatar 2022 .

METHODS

Three different medical service entities were identified through a needs analysis based on expert advice, team physician interviews and questionnaires prior to the event: 'Team Services' to provide any workforce or equipment needs of the teams, a 'Polyclinic' to manage any acute medical demands, and a 'recovery centre' to improve game readiness throughout the tournament. All services had been set up prior to the tournament and thoroughly tested.

RESULTS

Of a total of 832 athletes, ~1300 team delegation and ~130 match officials, 167 individuals including 129 (77%) athletes and 38 (23%) non-athletes were assessed in the polyclinic. For the 129 athletes (median 4 players per team), medical imaging was the most requested service, which peaked during the group phase of the tournament. Most requests were received during normal working hours despite many games finishing late at night. 30 of the 32 participating teams solicited medical services for their players at least once. Three teams made use of the recovery facilities, and 17 teams requested additional medical equipment or clinical assistance.

CONCLUSION

Central imaging services was the most used medical resource at the FIFA World Cup Qatar 2022, and over half of teams required additional medical equipment or personnel. These data may inform planning of medical services for similar events in the future.

Swedish Olympic athletes report one injury insurance claim every second year: a 22-year insurance registry-based cohort study

PURPOSE

To describe injury incidence, time trends in injury incidence, and injury characteristics among Swedish Olympic athletes over 22 years based on insurance data, as a first step to inform injury preventive measures among Olympic athletes.

METHODS

The cohort comprised 762 elite athletes (54% males; age 26.5 ± 5.9 years) in 38 sports in the Swedish Olympic Committee support program 'Top and Talent' between 1999 and 2020, with total 3427 athlete-years included. Acute and gradual onset injuries were reported to the insurance registry by the athletes' medical staff.

RESULTS

A total of 1635 injuries in 468 athletes were registered. The overall injury incidence was 47.7 injuries/100 athlete-years (one injury per athlete every second year). An increasing trend in injury incidence was observed in the first decade 2001 to 2010 (annual change 6.0%, 95% CI 3.3-8.8%), while in the second decade 2011 to 2020 no change was evident (0.4%, 95% CI - 1.9 to 2.7%). Gymnastics, tennis, and athletics had the highest incidence (100.0, 99.3, and 93.4 injuries/100 athlete-years, respectively). Among sport categories, mixed and power sports had the highest incidence (72.8 and 69.5 injuries/100 athlete-years, respectively). Higher incidences were seen in the younger age groups (≤ 25 years) in mixed and skill sports. The injury incidence was comparable between male and female athletes, and summer and winter sports. Most injuries occurred in the lower limb, and specifically the knee (24%), foot/ankle (15%) and spine/pelvis (13%).

CONCLUSION

The results on injury patterns in different sports and age groups may guide preventive focus for health and performance teams working with Olympic athletes.

LEVEL OF EVIDENCE

II.

Analysis of injuries during the 2019 Rink Hockey World Championship

OBJECTIVES

The purpose of this study is to describe the incidence and characteristics of injuries at the 2019 Rink Hockey World Championship.

METHODS

A cross-sectional study was performed among rink hockey athletes from three National Teams (Argentina, Portugal, and Spain). All injuries were reported by the medical staff of each National Team during the preparation period and the competition in the 2019 World Championship (Barcelona, Spain). Injury rate was calculated as the number of injuries per 1000 hours of player-hours of exposure.

RESULTS

A total of 91 players (n = 61, 67% male; and n = 30, 33% female) participated in the study: 31 Senior Male (34%), 30 Senior Female (33%), and 30 Under-19 Male (33%). A total of 54 games were played by 9 teams from 3 countries, comprising of 4562 and 4380 hours of total athletic game and training exposure recorded, respectively. Fifty-one injuries (20 injuries with time-loss and 31 medical attention -injuries with no time-loss) were reported. The overall injury incidence rate was 11.2/1000 hours (95% CI, 8.5-14.7). The injury incidence during games (27.5; 95% CI, 11.6-65.2) was higher than the injury incidence during training sessions (3.4; 95% CI, 2-5.7). The incidence rate for game for the entire study period was 8.19 times higher (95% CI, 2.61-21.36) than that for training. The global injury burden was 45.4 days/1000 hours for a total exposure time. Acute was the most frequently documented onset and the non-contact was the most common mechanism. The most frequently reported injuries were head contusion (n = 5, 25%), followed by thigh injuries (n = 3, 15%).

CONCLUSIONS

The injury incidence reported in a Rink Hockey international competition was 11.2/1000 hours. The risk of injury was higher during games than during training. Prevention strategies for injuries in these kinds of championships may be worth discussing. The craniofacial injuries were the most frequently reported.

Epidemiology of injuries and illnesses in elite wheelchair basketball players over a whole season - a prospective cohort study

BACKGROUND

Wheelchair basketball is an adaptation of pedestrian basketball and one of the most popular Paralympic sports worldwide. The epidemiology of health problems in wheelchair basketball has been prospectively studied only during the Paralympic Games, the 2018 World Championships, the 2021 South America Wheelchair Basketball Championship, and one season of two American intercollegiate wheelchair basketball teams. The objective of the study was to prospectively monitor and analyze the prevalence, incidence, burden, and characteristics of injuries and illnesses in a wheelchair basketball league during an entire season for the first time.

METHODS

All players of the highest German wheelchair basketball league (Bundesliga) were invited to participate in the study. Included players completed the Oslo Sports Trauma Research Center Questionnaire once a week during the entire season 2020/21 to report health problems. Exposure was captured by self-reported training time and officially-recorded competition time.

RESULTS

Sixty of 117 players (51%, 47 male, 13 female) of the national league participated with an average response of 93%. Seventy health problems (5.5/1000 exposure hours [95% CI: 4.9-6.1]) were reported, including 54 injuries and 16 illnesses. Prevalence of health problems was 60% (95% CI: 48-72). Most injuries affected the shoulder (32% of all injuries), cervical spine/neck (17%), and hand (13%). More overuse injuries (2.9/1000 exposure hours [95% CI: 2.5-3.3]) than acute injuries (1.3/1000 exposure hours [95% CI: 1.0-1.6]) occurred. Of all health problems, 53% were associated with time-loss. The incidences of all health problems, illnesses, injuries, and overuse injuries were higher in women than in men.

CONCLUSIONS

Characteristics and frequency of injuries and illnesses during wheelchair basketball season differed from those during major wheelchair basketball tournaments. The high proportion of overuse injuries and the higher injury rates in women should be regarded in the development of individualized prevention measures. Since results from previous studies during major tournaments are only partially comparable to wheelchair basketball league play, further studies should follow.

Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends

Purpose

Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries.

Methods

Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle.

Results

The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle.

Conclusion

Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.

Epidemiology of Football Injuries of the German Bundesliga: A Media-Based, Prospective Analysis over 7 Consecutive Seasons

BACKGROUND

This study describes the implementation of a standardised, prospective injury database covering the entire 1st male German football league ("Bundesliga") based on publicly available media data. For the first time, various media sources were used simultaneously as the external validity of media-generated data was low in the past compared to data obtained by way of the "gold standard", i.e. by the teams' medical staffs.

METHODS

The study covers 7 consecutive seasons (2014/15-2020/21). The primary data source was the online version of the sport-specific journal "kicker Sportmagazin™" complemented by further publicly available media data. Injury data collection followed the Fuller consensus statement on football injury studies.

RESULTS

During the 7 seasons, 6653 injuries occurred, thereof 3821 in training and 2832 in matches. The injury incidence rates (IRs) per 1000 football hours were 5.5 [95% CI 5.3-5.6], 25.9 [25.0-26.9] per 1000 match, and 3.4 [3.3-3.6] per 1000 training hours. Twenty-four per cent of the injuries (n = 1569, IR 1.3 [1.2-1.4]) affected the thigh, 15% (n = 1023, IR 0.8 [0.8-0.9]) the knee, and 13% (n = 856, IR 0.7 [0.7-0.8]) the ankle. Muscle/tendon injuries contributed 49% (n = 3288, IR 2.7 [2.6-2.8]), joint/ligament injuries 17% (n = 1152, IR 0.9 [0.9-1.0]), and contusions 13% (n = 855, IR 0.7 [0.7-0.8]). Compared to studies using injury reports from the clubs' medical staff, media data revealed similar proportional distributions of the injuries, but the IRs tended towards the lower end. Obtaining specific locations or diagnosis especially with regard to minor injuries is difficult.

CONCLUSIONS

Media data are convenient for investigating the quantity of injuries of an entire league, for identifying injuries for further subanalysis, and for analysing complex injuries. Future studies will focus on the identification of inter- and intraseasonal trends, players' individual injury histories, and risk factors for subsequent injuries. Furthermore, these data will be used in a complex system approach for developing a clinical decision support system, e.g. for return to play decisions.

Injuries and Illnesses During the 53rd FIS Nordic World Ski Championships 2021 in Oberstdorf: A Prospective Cohort Study

OBJECTIVE

For the 3 Nordic ski disciplines of cross-country skiing, Nordic combined, and ski jumping, data on injuries and illnesses during major sporting events only exist from the Winter Olympics of 2010 to 2018. So far, an investigation has not been conducted during the Nordic World Ski Championships.

DESIGN

Prospective cohort study.

SETTING

Fédération Internationale de Ski (FIS) Nordic World Ski Championships 2021 in Oberstdorf, Germany.

PARTICIPANTS

Overall, 663 athletes from 65 nations participated in the FIS Nordic World Ski Championships 2021. The study population included 344 athletes from 32 nations.

INTERVENTIONS

National medical teams were invited to report daily all newly incurred or exacerbated injuries and illnesses.

MAIN OUTCOME MEASURES

All reported injuries and illnesses that occurred during the championships from February 23 until March 7, 2021, were analyzed. Injury and illness rates were calculated with 95% confidence intervals (95% CIs).

RESULTS

The 32 reporting nations returned 88.4% of the daily report forms. The incidence of injuries was 4.7 (95% CI, 2.4-6.9) per 100 athletes in the 3 Nordic ski disciplines. The incidence of illness was also 4.7 (95% CI, 2.4-6.9) per 100 athletes with a relative proportion of infection-related illnesses of 31.3%.

CONCLUSIONS

Although the incidence of injuries of the Nordic disciplines was comparable with those of the 2010 to 2018 Winter Olympics, the incidence of illnesses was lower than during the previous 3 Winter Olympic Games with a lower rate of infection-related illnesses. This might be caused by the high hygiene measures due to the coronavirus disease 2019 pandemic.

Injury, illness, and medication use surveillance during the 2020 COSAFA Women's championship: a prospective cohort study of football players from Southern Africa

BACKGROUND

Systematic analyses of injuries, illnesses or medication use and their risk factors among female African athletes are scarce, which has implications for management of these athletes.

AIM

This prospective cohort study analysed the incidence and characteristics of injuries, illnesses and medication use during the 2020 COSAFA Women's Championship.

METHODS

The medical personnel of all participating teams reported all new injuries, illnesses and medication used by players daily.

RESULTS

Sixty-three injuries were reported: 45 match and 18 training injuries; 45.5 (95% CI: 32.2 to 58.8) injuries/1000 match-hours and 21.7 (95% CI: 11.7 to 31.7) injuries/1000 training-hours, respectively. Most (n = 55, 87%) were caused by contact with another player and involved the lower extremity (n = 43; 68%). Fifty-eight illnesses were reported: 44.4 (95% CI: 33.0 to 58.8) illnesses/1000 player-days, mostly diarrhoea (n = 25; 43.1%) and dysmenorrhoea (n = 18; 31%). No cases of COVID-19 were reported. In total, 175 medications were prescribed: 168.8 (95% CI: 143.8 to 193.8) medications/1000 player-days. Non-steroidal anti-inflammatory drugs (NSAIDs) (n = 60; 34.3%) and analgesics (n = 33; 18.9%) were the most commonly prescribed drugs.

CONCLUSION

Incidences of injury and illnesses were high but time loss was low, likely due to high NSAIDs use. Further studies should be conducted in order to inform appropriate prevention or management protocols in this population.

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.

Fractures in soccer: The current evidence, and how this can guide practice

This article reviews the current evidence on traumatic fractures in soccer, and assesses how this can guide practice. The incidence of traumatic soccer-related fractures was found to be 0.64 to 0.71/1000 in the general population. Demographics vary between the general population and professional soccer players, with 68% of traumatic soccer fractures occurring in the upper extremity in the general population, and only 23% of traumatic soccer fractures occurring in the upper extremity in professional players. Within the general population, around 80% of traumatic soccer-related fractures are managed non-operatively, with 20% managed operatively. The optimal treatment method is determined by fracture location and configuration. There is an increasing role for primary operative treatment in unstable, non-displaced fracture types, to facilitate an accelerated return to soccer. Around 86% of soccer players return to sport post-fracture. Return times vary by fracture locations and playing level, with elite players having quicker return times than the general population. Regarding injury prevention, shin guards appear to confer substantial benefit against tibial diaphyseal fractures. However, further research is required to determine the optimal preventative measures against fractures in soccer.

The epidemiology of injury and illness at the Vitality Netball World Cup 2019: an observational study

BACKGROUND

Netball is a physical game with sudden direction changes, decelerations, jumping and landing, stop/start maneuvers and restrictive footwork rules exposing players to injury. Close contact play and shared facilities during tournaments, increase illness risk.Objective: To describe incidence, period prevalence, types and severity of injuries and illnesses during the 10-day Vitality Netball World Cup 2019 (NWC).Methods: All players from 16 teams consented (n = 192). Medical staff recorded injuries (840 exposure hours), illnesses (1440 player-days) and time-loss. Main outcome measures included incidence (I) calculated as injury/1000 player-hours and illness/1000 player-days, period prevalence (PP) and severity (time-loss) of all match injuries and illnesses.

RESULTS

39 players sustained 46 match injuries (I = 54.76; PP = 20.31%). Lower limb injuries (I = 29.76), specifically the ankle (I = 13.10) were most common with lateral ankle ligament sprains the highest (I = 17.39). Contact injuries (I = 40.48) significantly exceeded non-contact injuries (I = 14.29; p = 0.0124). Center players sustained most injuries (n = 12; 26%; I = 14.29), followed by goalkeepers (n = 10; 22%; I = 11.90) and goal defenders (n = 8; 17%; I = 9.52). Injuries occurred in almost 50% of matches, and 67% did not result in time-loss. Time-loss injuries (n = 14; 33%) were most frequent in the lower limb (n = 10; 71%) specifically involved lateral ankle ligaments (n = 4; 29%), attributable to contact (n = 11; 79%) and mostly implicated center players and goal defenders (n = 4 each; 29% each). 11 players contracted 11 illnesses (I = 7.64; PP = 5.72%) with respiratory tract illness contributing 36%. Most illnesses did not result in time-loss (91%).

CONCLUSION

This is the first study reporting injury and illness during an NWC. Contact was the main mechanism of injury, and 2/3 of injuries did not result in time-loss. The ankle is most commonly injured and center players sustain most injuries. Non-respiratory system disease was most frequent, but upper respiratory tract infection remains the most common diagnosis. Targeted surveillance studies using similar methodology are required to develop injury and illness preventative strategies in elite netball.

Incidence, burden, and pattern of injuries in Spanish male youth soccer players: A prospective cohort study

OBJECTIVES

To explore the incidence, burden, and pattern of injuries in Spanish male youth soccer players during a 9-month competitive season (from September to May-June).

DESIGN

Prospective cohort study.

PARTICIPANTS

314 young (10-19 years) soccer players.

MAIN OUTCOME MEASURES

Incidence, burden, location, type, severity, mechanism, and circumstance of injuries, as well as potential differences by tactical position, month of the year, age group, and maturity status.

RESULTS

A total of 146 time-loss injuries were sustained by 101 different players. This resulted in an overall injury incidence of 3.1 injuries per 1000 h, a training injury incidence of 1.8 injuries per 1000 h, and a match injury incidence of 11.2 injuries per 1000 h. The probability of injury over the season was 34%. Most of the injuries affected the lower extremity and were classified as muscle/tendon injuries, with hamstring muscle injuries representing the most burdensome diagnosis. The incidence of injuries increased with age and maturation, but a heightened risk of overuse injuries during periods around peak height velocity was also identified.

CONCLUSIONS

These findings suggest a need for implementing specific injury prevention measures. Due to the high burden shown, these measures should mainly focus on reducing the number and severity of hamstring muscle injuries.

Injuries in elite level male beach soccer players: a prospective three year study

OBJECTIVES

The aim of this study was to investigate the incidence and characteristics of match and training injuries in elite-level national male beach soccer players.

METHOD

The incidence, mechanism, location, type, severity, and burden of injuries of the Turkish national beach soccer team were recorded between 2017 and 2019.

RESULTS

A total of 136 injuries occurred during the study period. Total injury incidence was 238.9 injuries/1,000 match hours (MHs) and 37.7 injuries/1,000 training hours (THs) (p < 0.001). Twenty-seven injuries led to time-loss, and the incidences for match and training injuries were 36.7 and 7.9 per 1,000 hours, respectively. Of medical attention injuries (MAI) caused by trauma, 54.6% (n = 53) were due to another player and, 60.9% (n = 14) of time-loss injuries (TLI) caused by trauma were due to non-contact trauma (p < 0.001). While 82% (n = 91) of training injuries occurred in lower extremities, 29% (n = 9) of match injuries occurred in the head/neck region (p < 0.001). Head injury incidence was 45.9 per 1,000 match hours. Of MAI, 50% (n = 57) were contusion, and 32.1% (n = 9) of TLI were strain (p < 0.001). Also, the most common injury subtype was foot/toe contusion during match and training (19.4%; n = 6, 27.9%; n = 31, respectively). The majority of injuries 91.9% (n = 125) had slight severity.

CONCLUSION

Head trauma, tendon injury, and foot/toe contusion are important for clinical practice in beach soccer. Protective measures (rule regulation, use of protective equipment, etc.) should be considered to prevent these injuries.

Sex differences in injury rates in team-sport athletes: A systematic review and meta-regression analysis

BACKGROUND

Team-sport players have a particularly high injury risk. Although female sex is considered a risk factor, it is still unknown whether female and male team-sport players, in fact, differ in their injury rates. We aimed to compare injury rates between female and male players by systematically reviewing and meta-analyzing injury surveillance studies of both sexes in order to evaluate sex-specific differences in team-sport injuries.

METHODS

Studies that prospectively collected injury data for high-level female and male players (age ≥16 years) in basketball, field hockey, football (soccer), handball, rugby (union and sevens), and volleyball were included. Two reviewers (AZ and ALR) independently assessed study quality and extracted data for overall, match, training, and severe injuries (>28 days' time loss) as well as data regarding injury locations and types. Incidence rate ratios (IRRs) were pooled in a meta-analysis, and meta-regression analysis was performed when 10 or more studies were available.

RESULTS

Of 20 studies, 9 studies reported injury data from football, 3 studies from rugby, 3 studies from handball, 1 study from basketball, 1 study from field hockey, 2 studies from volleyball, and 1 study from basketball and field hockey. For overall injuries, the pooled IRR = 0.86 (95% confidence interval (95%CI): 0.76-0.98) indicated significantly more injuries in male than in female players. For injury location, the pooled IRR showed higher injury rates in male athletes than in female athletes for upper extremity, hip/groin, thigh, and foot injuries. Female players had a significantly higher rate of anterior cruciate ligament injuries (IRR = 2.15, 95%CI: 1.27-3.62) than male players. No significant sex-specific differences in IRR were found for match, training, severe injuries, concussions, or ankle sprains.

CONCLUSION

Our meta-analysis provides evidence for sex-specific differences in the injury rates in team sports. Further epidemiological studies including both sexes in sports other than football are needed in order to strengthen the evidence.

Epidemiological analysis of injury occurrence and current prevention strategies on international amateur football level during the UEFA Regions Cup 2019

INTRODUCTION

Football is the most popular sport worldwide and results in a high frequency of injuries. So far, mainly injuries in professional football have been investigated, and the literature lacks data regarding detailed injury epidemiology and current prevention data in amateur football tournaments.

MATERIALS AND METHODS

A prospective cohort study investigated an international amateur football tournament, the UEFA Regions' Cup, which took place in 2019 in Germany. Injury epidemiology, current prevention strategies of the teams and the implementation of the UEFA concussion protocol were investigated in detail by means of standardized injury definitions and data samples for football (Fuller et al., Scand J Med Sci Sports 16:83-92, https://doi.org/10.1111/j.1600-0838.2006.00528.x , 2006).

RESULTS

138 player of 8 teams participated in this study, while 39 players were excluded. Overall injury incidence was 12.5 per 1000 h total football exposure, 43.5 per 1000 h for match exposure. No injuries were registered during training. Injury prevalence was 14.1% per player and 1.1 injuries per match were registered. The lower extremity was predominantly affected by injuries (71.4%) and the majority of injuries (78.6%) were non-severe injury types like contusions (50%) and sprains (18.2%). Two head injuries, one contusion and one skin lesion, were handled by the guidelines of the UEFA concussion protocol. 44.4% of the players indicated at least one previous injury before tournament, 45.3% of them during the last two football seasons before start of the tournament. Injury prevention performance was included in all participating teams during the tournament by warm up or training strategies (100%). During the warm-up program just 5 exercises of the FIFA 11 + program was detected by this investigation in participating teams to be done by more half of the teams. Running exercises were the most frequently performed exercises, while trunk muscle exercises were less represented (14.3%).

CONCLUSION

This study presents for the first time epidemiological injury and prevention data of the UEFA Regions Cup. Injury incidence was higher compared to injury reports of regular seasons, but lower compared to other amateur football tournaments. Currently used prevention programs revealed trunk muscle exercises as often neglected.

Regions at Risk in the Knee Joint of Young Professional Soccer Players: Longitudinal Evaluation of Early Cartilage Degeneration by Quantitative T2 Mapping in 3 T MRI

PURPOSE

The study aims to detect regions at risk for (pre-)osteoarthritis in the tibiofemoral joint of young professional soccer players by evaluating cartilage composition by T2 mapping in a 3 T magnetic resonance imaging setting.

METHODS

In this longitudinal study, 20 professional adolescent soccer players were included. Tibiofemoral cartilage was assessed by quantitative T2 mapping and T2 values were evaluated by regions of interest analysis. Statistical evaluation, using Wilcoxon signed-rank tests, was performed to compare global T2 values and subregional T2 values between a baseline and a follow-up investigation 4.3 years later. Based on the average of playing time (15 years) we divided the cohort in 2 groups and differences were evaluated.

RESULTS

When comparing baseline and follow-up, our findings showed statistically significant increases of the global medial tibial and femoral T2 values. The most noticeable results of the subregional T2 analysis were statistically significant increases in the medial posterior zones (deep femoral 36.1 vs. 39.5, P = 0.001; superficial femoral 57.0 vs. 62.4, P = 0.034; deep tibial 28.3 vs. 34.1, P = 0.009; superficial tibial 43.2 vs. 55.3, P = 0.002).

CONCLUSION

The elevation of T2 values in the medial, especially medial posterior, compartment of the knee joint indicates that these regions are at risk for early cartilage degeneration already at the time of adolescence. The findings can help individualize and optimize training concepts and to be aware of the chronic stress on these vulnerable areas. Prevention programs should be established in young players to avoid further cartilage damage.

Epidural hematoma from impact while zorbing

Injuries suffered while participating in extreme sports account for numerous emergency department visits. Isolated head injuries are a common presentation. Zorbing is an activity native to New Zealand. Like many emerging extreme sports there is little information regarding its safety. We conservatively managed a patient who suffered a skull fracture and epidural hematoma while zorbing. Publications (especially in the medical literature) are lacking regarding zorbing-related injuries. We hope that presenting this case will help elucidate the possibility of severe head injury despite the protective bubble offered by the sport.

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.

PROSPECTIVE STUDY OF INJURIES OCCURRED DURING BRAZILIAN FOOTBALL CHAMPIONSHIP IN 2019

Objective:

To determine the incidence and risk factors for injuries that occurred during the matches of the Brazilian Football Championship.

Methods:

A prospective study was carried out with the collection of data referring to injuries that occurred during the 2019 Brazilian Football Championship. The injuries were recorded by the responsible physician of each team, through an online injury mapping system.

Results:

Among the 645 athletes who were included in the study, 214 (33.2%) of the players had at least one injury during the tournament. In total, 257 injuries were recorded during the Brazilian Championship, with an average of 0.68 injuries per game. 59.1% of the injured athletes were over 26 years old. The most common type of injury was muscle strain (37.7%) and forwards were the most affected (33.6%).

Conclusion:

Muscle injuries were the most frequent in the tournament, with the thigh muscles being the most affected. Most of the affected players were over 26 years old, there were 20.5 injuries for every 1000 hours of play and the incidence of injuries was approximately 33%, with attackers being the most affected (33.6%). Level of Evidence III, Study of nonconsecutive patients; without consistently applied reference “gold” standard.

Head Impact Situations in Professional Football (Soccer)

To assess head impact incidents (HIIs) and to distinguish diagnosed head injuries from other incidents, a video observation analysis of match HIIs was conducted in the German Bundesliga (2017/18 season). Video recordings of each match were screened to identify the respective events. Head injury data were identified by a prospective injury registry. HII and head injury incidence rates (IR) were calculated with 95% CIs. The total number of HIIs was 1,362 corresponding to an IR of 134.9/1000 match hours (95% CI 127.9–142.2). In 123 HII (IR 12.2, 95% CI 10.2–14.5) the contact was classified as severe. Head contact with the opponent was the most frequent cause (85%). The most frequent mechanism was in 44% (combined) the arm and elbow-to-head, followed by head-to-head and hand-to-head contacts (each 13%). In 58%, the HIIs occurred during header duels. Twenty-nine head injuries were recorded (IR 2.9, 95% CI 2.0–4.1). Concussions/traumatic brain injuries accounted for 48%, head/facial fractures 24%, head/facial contusions 21%, and lacerations/abrasions 7%. The number of HIIs not classified as concussions/more severe trauma was high. Identification of HIIs and head injury severity should be improved during on-field assessment as many head injuries might go unrecognised based on the large number of HIIs.

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

BACKGROUND

Football is the most popular sport among women; however, little is known about the injury profile in this population. This information would help design tailored injury risk mitigation strategies that may make football safer for women.

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis of epidemiological data of injuries in women´s football.

METHODS

A systematic review following PRISMA guidelines was performed up to January 2020 in PubMed, Web of Science, Sportdiscus and the Cochrane Library databases. Twenty-two studies reporting the incidence of injuries in women football were analysed. Two reviewers independently extracted data (intraclass correlation coefficient [ICC] for inter-reviewer reliability = 0.87) and assessed study quality using the STROBE statement, GRADE approach, Newcastle Ottawa Scale and Downs and Black assessment tools. Studies were combined in pooled analyses (injury incidence and injury proportion) using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in female football players was 6.1 injuries/1000 h of exposure. Match injury incidence (19.2 injuries/1000 h of exposure) was almost six times higher than training injury incidence rate (3.5 injuries/1000 h of exposure). Lower extremity injuries had the highest incidence rates (4.8 injuries/1000 h of exposure). The most common types of injuries were muscle/tendon (1.8 injuries/1000 h of exposure) and joint (non-bone) and ligament (1.5 injuries/1000 h of exposure), which were frequently associated with traumatic incidents. Slight/minimal injuries (1-3 days of time loss) were the most common. The incidence rate of injuries during matches in the top five world ranking leagues was higher than the rest of the leagues (19.3 vs 10.7 injuries/1000 h of exposure, respectively). The weighted injury proportion was 1.1 (95% confidence interval = 0.6-1.7) whereby on average players sustained more than one injury per season.

CONCLUSIONS

Female football players are exposed to a substantial risk of sustaining injuries, especially during matches that require the highest level of performance. To markedly reduce overall injury burden, efforts should focus on introducing and evaluating preventative measures that target match specific dynamics to make football players more capable of responding to the challenges that they have to deal with during match play.

REGISTRATION

This systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42019118152).

Injury prevention knowledge, beliefs and strategies in elite female footballers at the FIFA Women's World Cup France 2019

OBJECTIVES

This study assessed knowledge, beliefs and practices of elite female footballers regarding injury prevention.

METHODS

A survey was sent to players participating in the FIFA Women's World Cup France 2019. Questions covered three injury prevention domains: (1) knowledge; (2) attitudes and beliefs; (3) prevention practices in domestic clubs. Additionally, ACL injury history was assessed.

RESULTS

Out of 552 players, 196 women responded (35.5%). More than 80% of these considered injury risk to be moderate or high. Players listed knee, ankle, thigh, head and groin as the most important injuries in women's football. The most important risk factors identified were low muscle strength, followed by poor pitch quality, playing on artificial turf, too much training, reduced recovery and hard tackles. In these elite players, 15% did not have any permanent medical staff in their domestic clubs, yet more than 75% had received injury prevention advice and more than 80% performed injury prevention exercises in their clubs. Players identified the two most important implementation barriers as player motivation and coach attitude. Two-thirds of players used the FIFA 11+ programme in their clubs.

CONCLUSIONS

This diverse group of elite players demonstrated good knowledge of risk level and injury types in women's football. Of the risk factors emphasised by players, there was only one intrinsic risk factor (strength), but several factors out of their control (pitch quality and type, training volume and hard tackles). Still players had positive attitudes and beliefs regarding injury prevention exercises and indicated a high level of implementation, despite a lack of medical support.

Concussion in soccer: a comprehensive review of the literature

Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes

OBJECTIVE

To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.

DESIGN

Longitudinal prospective surveillance study.

SETTING

Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.

PARTICIPANTS

Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.

INTERVENTIONS

Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.

MAIN OUTCOME MEASURES

The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.

RESULTS

Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.

CONCLUSIONS

The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high-level football

Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours, or even days after the injury. A standardized approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury. A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football program for high‐level players have been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football program. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for return to sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Incidence of Football and Futsal Injuries Among Youth in Malaysian Games 2018

Introduction:

Football and futsal were the main sports in the Malaysian Games. However, they were associated with a risk of injury. The purpose of the study was to analyse the incidence, circumstances, and characteristics of football and futsal injuries during the Malaysian Games of 2018.

Materials and method:

During the tournament, 14 teams participated in men’s football, 12 teams in men’s futsal and 11 teams in women’s futsal. The biannual event involved athletes aged under 21 years. A medical report form used by FIFA Medical Assessment and Research Centre (F-Marc), was provided to the physiotherapists and team doctors of all the teams to report all injuries after each match.

Results:

The response rate was 84.62% in football and 59.76% in futsal. A total of 48 injuries were reported from 26 football matches, equivalent to 64.64 injuries per 1000 match hours (95%CI 46.35 to 82.93). In futsal, a total of 48 injuries from 41 matches were reported, equivalent to 292.42 injuries per 1000 match hours (95% CI 209.7 to 375.14). The rate of injury in women futsal players was higher compared to men: 358.21 versus 247.04 injuries per 1000 match hours (p=0.224). Futsal recorded higher injuries per 1000 match hours than football (p<0.001).

Conclusion:

The rate of severe injury in futsal and football recorded in the study as compared to previous studies gave rise to serious concerns. Hence, there was an urgent need to pay more attention to injury prevention strategies.

Prevalence of MRI-Detected Ankle Injuries in Athletes in the Rio de Janeiro 2016 Summer Olympics

OBJECTIVE

To describe the prevalence, severity, and location of ankle injuries as assessed on magnetic resonance imaging (MRI) in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

METHODS

We analyzed all ankle MRIs that were acquired for suspected injury as reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic. Images were interpreted retrospectively according to standardized criteria.

RESULTS

A total of 11,274 athletes participated in the Games, of which 89 (8.8%) were referred for an ankle MRI. Eighty-eight of the 89 (99%) had at least 1 abnormal finding, and some had as many as 27, for an average of 6.2 abnormalities per examination. Around one-fifth of all abnormal findings were considered pre-existing (21%) and 79% were assumed to be the result of an acute or subacute injury. The highest proportion of acute/subacute injuries per athlete occurred in ball sports (7.0 injuries per examination) and in the age group >30. Most pre-existing findings per athlete were identified in the group of others (no track and field or ball sports athletes) with 2.5 findings per examination and respectively in the age group >30 (1.7).

CONCLUSION

Our study demonstrated a high prevalence of acute and subacute, but also pre-existing injuries in Olympic athletes undergoing ankle MRI. Tendon injuries were the most common acute injuries, found mainly in ball sports athletes. Most pre-existing ankle injuries were identified at the ligaments.

Health promotion by International Olympic Sport Federations: priorities and barriers

Objective

To identify changes in International Federations’ priorities and the barriers to implementing athlete and global health initiatives. Results should influence the work of the International Federation medical committees, the IOC and the Association of Summer Olympic International Federation.

Methods

The 28 Summer and 7 Winter International Federations participating in the most recent Olympic Games (2016; 2018) were surveyed to (i) identify the importance of 27 health topics, (ii) assess their progress on implementation health-related programmes and (iii) the barriers to implementation of these programmes. We compared International Federations’ activities in 2016 and 2017.

Results

The response rate was 83%. Health topics which most International Federations regarded as important and in which the International Federations felt insufficiently active were ‘team physician certification’, ‘prevention of harassment and abuse’, ‘eating disorders/disordered eating’, ‘mental health’ and ‘injury surveillance’. Compared with 2016, there was a decrease in International Federations’ activities in ‘injury surveillance’, ‘nutritional supplements’ and ‘hyperandrogenism’. The main barrier to implementing health-related programmes was ‘International Federation political support/willingness’, followed by ‘knowledge’. ‘Time’ and ‘coach support’ were more often reported than ‘finances’, or ‘IOC or Association of Summer Olympic International Federations partnership’.

Conclusion

If International Federations are going to promote health of athletes and global health promotion through physical activity (sport), International Federation leadership must change their focus and provide greater political support for related initiatives. Improving coach and athlete knowledge of the health issues could also facilitate health programme delivery. Time constraints could be mitigated by sharing experiences among the International Federations, Association of Summer Olympic International Federations and the IOC. International Federations should focus on those health-related topics that they identified as being important, yet rate as having insufficient activity.

Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football

PURPOSE

Injuries are a common occurrence in football. Sufficient epidemiological data are available in professional football but not in salaried semi-professional football. This study investigates the injury incidence at different levels of semi-professional football with focus on junior football.

METHODS

The data were based on injury reports provided by players and medical staff over the 2015-2016 season, which corresponded to the consensus statement for data samples in football. This study investigated the injury incidence and prevalence of five skill levels of semi-professional football (the fourth to the seventh league and elite junior football).

RESULTS

1130 players had sustained 2630 injuries over the 2015-2016 season. The overall injury incidence was 9.7 per 1000 h football exposure; prevalence with at least one injury was 79%. The highest overall injury incidence in elite junior football was 10.4 in 1000 h football exposure. The fifth league had the lowest incidence with 9.0 in 1000 h football (p < 0.05). Traumatic injuries most often occurred in the fourth league (3.9 in 1000 h football). The body areas most affected by traumatic injury were knees, ankles and thighs. Elite junior players had a significantly higher incidence of overuse complaints (7.4 in 1000 h football) than the fourth league (5.4, p = 0.005). The body areas most affected by overuse complaints were the lower back, thigh and groin. No differences were found between the different positions on field.

CONCLUSIONS

Salaried semi-professional football involves a high overall injury incidence. The highest incidence, particularly of overuse injuries, was seen in elite junior football. These findings should be incorporated in specific injury prevention training or screenings beginning in junior football. Level of evidence II.

Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York

There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.

Time Trends of Head Injuries Over Multiple Seasons in Professional Male Football (Soccer)

The present study aimed to investigate time trends of head injuries and their injury mechanisms since a rule change as monitoring may help to identify causes of head injuries and may advance head injury prevention efforts. Based on continuously recorded data from the German football magazine “kicker Sportmagazin ^® ” as well as other media sources, a database of head injuries in the 1 ^st German male Bundesliga was generated comprising 11 seasons (2006/07–2016/17). Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) were calculated. Time trends were analysed via linear regression. Two hundred thirty-eight match head injuries occurred (IR 1.77/1000 match hours, 95% CI 1.56–2.01). There were no significant seasonal changes, expressed as annual average year-on-year change, in IRs over the 11-year period for total head injuries (p=0.693), facial/head fractures (p=0.455), lacerations/abrasions (p=0.162), and head contusions (p=0.106). The annual average year-on-year increase for concussion was 6.4% (p=0.004). Five head injury mechanisms were identified. There were no seasonal changes in injury mechanisms over the study period. The concussion subcategory increased slightly over the seasons, which may either be a result of increasing match dynamics or raised awareness among team physicians and players.

Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements

Background:

Tendon overuse injuries are an issue in elite footballers (soccer players) and may affect tendon function. Achilles and patellar tendinopathy are the most frequent pathologies. Tendon stiffness, the relationship between the force applied to a tendon and the displacement exerted, may help represent tendon function. Stiffness is affected by training and pathology. Nevertheless, information regarding this mechanical property is lacking for elite soccer athletes.

Hypothesis:

Achilles and patellar tendon stiffness assessed using myotonometric measurements will be greater in elite soccer athletes than in control participants.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 4.

Methods:

Forty-nine elite soccer athletes and 49 control participants were evaluated during the 2017 preseason. A handheld device was used to measure Achilles and patellar tendon stiffness. Dominant and nondominant limbs were assessed for both groups.

Results:

A significantly stiffer patellar tendon was found for both the dominant and the nondominant limb in the elite soccer athletes compared with the control group. Nevertheless, no differences were found in Achilles tendon stiffness between groups. When comparing between playing positions in soccer athletes, no significant differences were found for both tendons.

Conclusion:

Greater patellar tendon stiffness may be related to an improvement in force transmission during muscle contraction. On the other hand, it seems that after years of professional training, Achilles tendon stiffness does not change, conserving the storing-releasing function of elastic energy. The nonsignificant differences between positions may be attributable to the years of homogeneous training that the players underwent.

Clinical Relevance:

The present study shows another technique for measuring mechanical properties of tendons in soccer athletes that could be used in clinical settings. In the future, this technique may help clinicians choose the best exercise protocol to address impairments in tendon stiffness.