Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players

#ReadyToplay: hamstring injuries in women's football - a two-season prospective cohort study in the Norwegian women's premier league

In this two-season prospective cohort study (2020-2021), we aimed to describe the characteristics, clinical findings and magnetic resonance imaging (MRI) findings of hamstring injuries in the Norwegian women's premier league. Hamstring injuries were examined by team physiotherapists using a standardised clinical examination and injury form. Injury location and severity (modified Peetrons classification) were graded based on MRI by two independent radiologists. Fifty-three hamstring injuries were clinically examined, 31 of these with MRI. Hamstring injuries caused 8 days (median) lost from football (interquartile range: 3-15 days, range: 0-188 days), most were non-contact and occurred during sprinting. Gradual-onset (53%) and sudden-onset injuries (47%) were evenly distributed. The injuries examined with MRI were classified as grade 0 (52%), grade 1 (16%) or grade 2 (29%). One proximal tendinopathy case was not graded. Grade 2 injuries caused more time loss than grade 0 (19 ± 8 vs. 7 ± 7 days, p = 0.002). Of injuries with MRI changes, 60% were in the m. biceps femoris, mainly the muscle-tendon junction, and 40% in the m. semimembranosus, most in the proximal tendon. Compared to previous findings from men's football, a higher proportion of hamstring injuries in women's football had a gradual onset and involved the m. semimembranosus, particularly its proximal tendon.

Perceptions of Elite Young Male Football Players Regarding Injury Risk Factors and Prevention Strategies

CONTEXT

Football players aged 15-20 years experience injury incidence rates similar to those of professionals, with players injured in this age group being significantly less likely to reach the professional level. Understanding the factors that influence young footballers' acceptance, adoption, and compliance with injury prevention programs is crucial. Therefore, this study aimed to describe the perceptions of male football players from premier league academies regarding injury risk factors and prevention strategies.

DESIGN

Cross-sectional observational study.

METHODS

An online survey was used to explore perceptions of injury risk factors and prevention strategies among young football players (under-17 and under-20 teams) from premier league academies.

RESULTS

A total of 504 footballers (mean age: 18 [2] y) across 9 academies in 8 different cities participated in this study. No risk factor was elected as very important by at least half of participants. The top 5 injury risk factors elected by players were "poor hydration," "inadequate warm-up," "poor rest/sleep," "inadequate diet," and "poor strength/power." At least 1 quarter of participants considered "genetics," "advanced age," "attention level," "wheatear conditions," and "alcohol consumption" as irrelevant factors for injury. There was no consensus for any prevention strategy. Fourteen strategies were ranked as efficient by at least 3 quarters of participants. The top 5 prevention strategies elected by players were "warm-up before training/matches," "functional training," "hydration before and during training/matches," "flexibility training," and "workload monitoring." Lower than a half of participants endorsed "ankle braces" and "thermal shorts" for injury prevention.

CONCLUSIONS

The results of this study offer valuable insights into the perceptions of elite young football players regarding injury risk factors and the effectiveness of preventive strategies. These perceptions are essential for understanding how athletes view injury prevention approaches in their daily routines.

Influence of Neuromuscular Training Interventions on Jump-Landing Biomechanics and Implications for ACL Injuries in Youth Females: A Systematic Review and Meta-analysis

BACKGROUND

Various exercise interventions are recommended to reduce the risk of anterior cruciate ligament (ACL) injury in females. However, the extent to which these training interventions influence lower-limb landing biomechanics in youth female remains unclear.

OBJECTIVE

This systematic review and meta-analysis aimed to quantitatively summarise the effectiveness of various training interventions on jump-landing biomechanics in youth females.

METHODS

We systematically searched PubMed, SPORTDiscus, EMBASE and Scopus. Articles were included if they: (1) conducted research on uninjured youth females (reported mean age < 18 years) with no restriction on playing level/experience or physical activity level; (2) performed any form of training intervention for ≥ 4 weeks; (3) reported any lower-limb kinematic (flexion/extension, adduction/abduction or internal/external rotation angles) or kinetic (joint moments or vertical ground reaction forces) data during the landing phase of jump-landing tasks, pre- and post-training intervention for both experimental and control groups, using a two- or three-dimensional motion capture system; (4) were randomised- or non-randomised controlled trials. The quality of the randomised controlled trials was assessed using the Risk of Bias tool 2, whereas the Downs and Black checklist was used for assessing the quality of non-randomised controlled trials. A multi-level meta-analytical model was used for conducting the quantitative analysis.

RESULTS

Thirteen studies (7 randomised controlled, 6 non-randomised controlled studies) involving 648 female participants were included in the final analyses. With regards to the overall quality of the included studies, three studies had high risk of bias while ten studies had some concerns. As part of the meta-analysis, we were able to analyse seven kinematic variables and two kinetic variables in aggregate. Compared with controls, the experimental group had significantly increased peak knee flexion angle (g = 0.58, p = 0.05) and reduced knee valgus motion (g =  - 0.86, p = 0.05) post-intervention. The effects on other kinematic and kinetic variables ranged from trivial to moderate and were not significantly altered as a result of various training interventions.

CONCLUSION

The findings from the synthesised literature indicate that training interventions have small to moderate effects on peak knee flexion angle and knee valgus motion during jumping tasks. However, further research employing more consistent study designs and methodologies is required to better understand the changes in jump-landing biomechanics in the youth female population following training interventions.

Outcomes of a randomized controlled trial of neuromuscular training with real-time biofeedback in young female athletes

BACKGROUND

A large body of scientific work has been focused on reducing the high incidence rate of anterior cruciate ligament (ACL) injuries in young female compared to male soccer players. The purpose of this study was to determine the effects of a randomized clinical trial to reduce a risk factor of ACL injuries, knee abduction moment (KAM), with neuromuscular training and biomechanical biofeedback in adolescent female athletes.

METHODS

A prospective, randomized, active comparator, open blinded, end-point trial was conducted with 150 (age: 13.3 ± 2.2 yrs, height: 156.1 ± 1 0.6 cm, mass: 50.2 ± 11.3 kg) female soccer players. Each participant received neuromuscular training and randomized into one of three arms: 1) an active control, considered sham biofeedback (NMT), 2) a knee-focused biofeedback group (NMT + K), and 3) a hip-focused biofeedback group (NMT + H). The participants completed two assessments: a baseline session prior to the intervention and a post-intervention session. The primary outcome measure was change knee abduction moment during a double leg drop vertical jump (DVJ). Additionally, an unplanned single leg cutting task was also recorded. As an exploratory outcome measure, athletic exposures and ACL injuries were recorded weekly for six months following the post-test session.

RESULTS

A statistically significant reduction in KAM, during the DVJ, was found in all three intervention groups from baseline to the post-test (p < 0.05). However, statistically significant improvements in KAM during cutting was only observed in the NMT + H intervention group (p < 0.05). ACL injuries were not reported in any intervention group during the six months of follow up.

CONCLUSIONS

While female soccer players involved in neuromuscular training programs regardless of intervention group exhibit significant improvements in KAM during a double leg landing, those that engage in hip-focused biofeedback compared to knee-focused or sham biofeedback exhibit decreased KAM during an unanticipated cutting maneuver.

TRIAL REGISTRATION

The Institutional Review Board at High Point University approved the study protocol. The clinical trial was registered at Clinicaltrials.gov (Identifier: NCT02754700) on 28/04/2016..

Effects of Anticipation and Dual-Tasking on Lower Limb Biomechanics While Performing Change-of-Direction Tasks in Physically Active Individuals: A Systematic Review with Meta-Analysis

BACKGROUND

Anterior cruciate ligament (ACL) injuries are highly prevalent in team sport athletes and often occur while performing change-of-direction (COD) tasks in combination with high cognitive demands, such as decision making or divided attention. Given the expanding body of research in this field, an updated literature review is warranted, as the most recent meta-analysis on this topic included original studies published up to November 2020.

OBJECTIVE

The aim of this systematic review was to examine the effects of anticipation and/or dual-tasking on lower limb biomechanics during COD tasks in healthy individuals.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

A systematic literature search was conducted in the electronic databases PubMed, Web of Science, CINAHL and SPORTDiscus from inception until February 2024. The included studies examined the effects of anticipation and/or dual-tasking on knee kinetics and kinematics in the frontal and sagittal planes during COD tasks.

METHODS

A multilevel meta-analysis was performed to aggregate the results of studies comparing unanticipated versus anticipated CODs on lower limb biomechanics. Due to the limited available literature on dual-task versus single-task conditions, this aspect was analyzed qualitatively.

RESULTS

The meta-analysis included 17 studies involving 355 individuals from different sports (e.g., soccer, American Football). No statistically significant differences were found between unanticipated and anticipated CODs for knee abduction and flexion moments as well as knee abduction angles (p > 0.05). Significantly higher knee flexion angles were found in unanticipated CODs (SMD = 0.74, 95% CI: 0.30-1.19; p < 0.01). Qualitative analyses of six studies including 171 individuals provided initial evidence for higher knee abduction moments and flexion angles during anticipated CODs while performing a secondary task concurrently.

CONCLUSION

Findings from quantitative and qualitative analyses indicate that anticipation and dual-tasking during COD performance have an impact on injury-related aspects of lower limb biomechanics. Hence, cognitive challenges should be implemented in injury risk screening and preventive strategies. Further studies with high methodological quality are needed to improve the understanding of the biomechanical and cognitive interplay in injury-threatening situations.

PROSPERO REGISTRATION NUMBER

CRD42023433074.

DATE OF REGISTRATION

13.10.2023.

Comparative Effectiveness of Multi-Component, Exercise-Based Interventions for Preventing Soccer-Related Musculoskeletal Injuries: A Systematic Review and Meta-Analysis

Background: Soccer is a high-intensity sport characterized by a considerable incidence of injuries, particularly among professional male players, with injury rates ranging from 5.9 to 9.6 per 1000 player-hours. Lower limb injuries, including those affecting the knee, ankle, hip/groin, and hamstring muscles, are particularly prevalent. Additionally, a history of prior injuries may exacerbate the risk of recurrence. In response to these concerns, various injury prevention programs have been developed and implemented, targeting different genders and age groups. Methods: This systematic review and meta-analysis, conducted with the PRISMA guidelines, critically evaluated randomized RCTs across diverse genders and age groups to assess the efficacy of multi-component exercise-based injury prevention programs in reducing musculoskeletal injuries among soccer players. Comprehensive searches were conducted in ClinicalTrials.gov, CENTRAL, EMBASE, PubMed, Scopus, and Web of Science, with no language restrictions applied. Results: A total of 15 RCTs met the predefined inclusion criteria. The intervention programs were found to be significantly effective in reducing lower limb injuries, with a pooled RR of 0.73 (95% CI: 0.63 to 0.84, p = 0.035). Subgroup analyses further revealed a significant reduction in the incidence of hamstring, knee, and ankle injuries following the implementation of these programs. Conclusions: Multi-component exercise-based injury prevention programs demonstrate considerable efficacy in reducing musculoskeletal injuries in soccer players, spanning various age groups and genders. These findings underscore the potential of such programs in professional soccer injury management and highlight their importance in the development of comprehensive injury prevention strategies.

Preserving Knee Health and Delivering Specialized Care for Active Older Athletes

CONTEXT

Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population.

EVIDENCE ACQUISITION

Nonsystematic review with critical appraisal of existing literature.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy.

CONCLUSION

With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

Observational study.

SETTING

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

PARTICIPANTS

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

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Injury risk reduction programs including balance training reduce the incidence of anterior cruciate ligament injuries in soccer players: a systematic review and meta-analysis

BACKGROUND

Anterior cruciate ligament (ACL) injuries are exceedingly common among soccer players and severely impact their careers and health. This study evaluates the effects of injury risk reduction programs, including balance training exercises, on the incidence of ACL injuries in soccer players through a meta-analysis. The aim is to promote the health of soccer players, enhance their athletic performance, and provide valuable insights for further research in the field of sports medicine.

METHODS

This study strictly adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted through PubMed, EBSCO, and Web of Science databases, covering all entries from the inception of the databases until February 2024.

RESULTS

Eligible studies were individually assessed using the Cochrane Risk of Bias Tool version 2, and the quality of the evidence obtained was rigorously evaluated using the GRADE approach. Data analysis and processing were performed using Stata 18 software. Eight studies were ultimately selected for inclusion in the meta-analysis, encompassing 20,336 participants and 1,512,099 exposure hours, with 190 cases of ACL injuries identified among soccer players. The pooled results indicated that, compared to the control group, groups using injury risk reduction programs that included balance training had a 58% reduction in the overall rate of ACL injuries per 1,000 exposure hours (IRR 0.42, 95% CI: 0.27 to 0.66). The overall study heterogeneity was low, with an I2value of 33.3% and a P-value of 0.186. Subgroup analyses showed that in trials involving male participants, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.29 to 0.88), with an I2 value of 44.8% and P = 0.178. In trials involving female participants, ACL injuries were reduced by 61% (IRR 0.39, 95% CI: 0.24 to 0.62), with an I2 value of 42.5% and P = 0.157. In trials with participants training less than three times per week, ACL injuries were reduced by 43% per 1,000 exposure hours compared to the control group (IRR 0.57, 95% CI: 0.35 to 0.93), with an I2 value of 0.00% and P = 0.727. In trials with participants training three times or more per week, ACL injuries were reduced by 57% (IRR 0.43, 95% CI: 0.21 to 0.88), with an I2 value of 28.2% and P = 0.238. In trials with participants training for 20 min or more per week, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.26 to 0.93), with an I2 value of 1.2% and P = 0.363. In trials with participants training less than 20 min per week, ACL injuries were reduced by 46% (IRR 0.54, 95% CI: 0.33 to 0.91), with an I2 value of 0.00% and P = 0.544.

CONCLUSION

In summary, injury risk reduction programs that include balance training significantly reduce the risk of ACL injuries in soccer players. The reduction in injuries is more pronounced in female athletes, and high-frequency training along with longer-duration interventions further enhance the preventative effects.

The effects of a 6-week sand- vs. Land-based jump training programme on frontal plane knee angle and jump performance in adolescent female football players

Our study investigated the effects of a six-week jump-training intervention (sand- vs land- based incorporated in a warmup), on frontal plane knee angle and jump performance of adolescent female football players. Fifty-six females were randomly allocated to either the SAND or LAND group. Thirty-nine females completed the programme twice weekly and were eligible for analysis. Two-dimensional frontal plane projection angle (FPPA), countermovement jump (CMJ) and reactive strength index (RSI) (10-5 repeated jump test) were measured 1-week pre- and post-intervention. Analysis of covariance was used to model post-intervention group differences. Compatibility curves were used to visualise parameter estimates alongside p- values, and surprisal (S) value transforms. Mean difference (X - ) and compatibility intervals (CI) (95|75%) for FPPA for SAND vs. LAND were X -  = 1.29° (-0.11 to 2.69°|0.49 to 2.10°) for the dominant limb, and X -  = 1.80° (0.56 to 3.04°|1.09 to 2.51°)| for the non-dominant limb. Interval estimates for jump performance were imprecise and unclear. The data indicates that including a sand surface within a jump training intervention could be beneficial when aiming to improve knee control in asymptomatic adolescent female football players, with no apparent detriment to jumping performance.Clinical trials registration: The trial was registered with clinicaltrials.gov prior to study recruitment (NCT04502615).

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

PURPOSE

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

DESIGN

4-month retrospective cohort study.

SETTING

An elite women's soccer team from Brazil.

PARTICIPANTS

Twenty-seven female soccer players.

MAIN OUTCOMES MEASURES

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

RESULTS

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

CONCLUSION

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

The Epidemiology of Injuries and Illnesses During SailGP Season 4: A Prospective Cohort Study

INTRODUCTION

Sailing is a high-intensity sport that demands a combination of physical strength, endurance, and technical skill. Sail Grand Prix (SailGP), inaugurated in 2019, epitomises a transformative approach to professional sailing. This study aims to provide a comprehensive analysis of injury and illness epidemiology among SailGP elite sailors, comparing injury and illness types and locations across different sailing activities.

METHODS

This prospective cohort study analysed injury and illness data from professional sailors throughout season 4 (2023/2024) of the professional sailing league. Data were collected on the number of hours spent in training, racing, and foiling, alongside injury reports, categorising injury types and locations. Incidence rates were calculated per 1000 h of sailing and 365 athlete days. Injuries were stratified by sex, position on the boat, and specific sailing activities to provide a detailed comparison.

RESULTS

A total of 100 sailors participated in the Sail GP 2024 season, accumulating 4919.84 h of recorded sailing activity: 2186.03 h in racing and 2733.80 h in training. The overall injury incidence rate was 9.96 per 1000 h of activity (95% CI: 7.17-12.75) and 7.43 per 365 athlete days (95% CI: 4.99-9.86). The injury rate was notably higher for foiling at 26.52 per 1000 h (95% CI: 19.09-33.94) compared to general sailing at 14.51 per 1000 h (95% CI: 10.44-18.57). Racing posed a greater injury risk than training, with an injury rate of 11.89 per 1000 h (95% CI: 7.77-16.46) compared to 8.41 per 1000 h for training (95% CI: 5.12-12.07). Grinders had the greatest rate of injuries at 3.86 (2.24, 5.69) injuries per 1000 h of sailing. The illness incidence rate was 5.14 per 1000 h (95% CI: 3.21-7.28), with respiratory illnesses being the most frequently reported.

CONCLUSION

This study highlights the injury and illness risks amongst elite sailors in Sail GP. Males were at higher risk of injury, with the position of grinders being the most commonly injured. Ankle and knee injuries were the most prevalent. Future research should focus on developing sport-specific injury prevention programmes and examining long-term outcomes in sailors.

Injury risk profile for soccer players: identification of the risk factors for soccer-related injuries - an umbrella review

This review aimed to identify risk factors for soccer injuries and provide researchers the needed elements to build a soccer-player's injury risk profile. An umbrella review was conducted following the PRIOR criteria (OSF registration link: https://osf.io/jr7xe/). A literature search was run to identify studies investigating soccer-related injury risk factors. We included systematic reviews published between 2013 and 2023 related to soccer and analysed the identified risk factors to classify these in intrinsic and extrinsic, group in categories and identify relationships between risk factors and injury location. Among 240 risk factors, 181 (75.4%) were classified as intrinsic and 59 (24.6%) as extrinsic. We grouped risk factors in 14 categories. Finally, we found relationships between risk factors and injury locations for 159 factors, with the knee representing the body area most affected by risk factors (N = 101), followed by the ankle (N = 65) and the thigh (N = 65).

Injury Prevention Strategies in Dance: A Systematic Review

Background: Dance is a popular activity worldwide that comes with inherently high injury rates. Despite the call for implementation and evaluation of injury prevention strategies, the utility and efficacy of injury prevention practices in dance are unknown. Objective: The primary objective of this systematic review was to describe dance-specific injury prevention strategies in any dance population. The secondary objective was to evaluate the effectiveness of these strategies in the reduction of injury prevalence or incidence rates. Methods: Six electronic databases were searched to March 2024 (Medline, EMBASE, SportDiscus, CINAHL, SCOPUS, Cochrane). Selected studies met a priori inclusion criteria that required original data describing an injury prevention strategy for any genre of dance. Studies were excluded if; no injury outcomes were reported, no injury prevention strategy was utilized, or if dance was used as a therapeutic intervention/fitness. Two reviewers independently assessed abstracts and full texts for inclusion. Study quality was evaluated using the Joanna Briggs Institute Level of Evidence tool. Results: From 2209 potentially relevant records, 8 studies met criteria for inclusion. Injury prevention strategies were diverse across conditioning and exercise programs, neuromuscular training warm-up, psychological coping skills training, and educational programs, with a range of duration and adherence measures. Due to inconsistent injury surveillance methodology, efficacy of these programs could not be determined. Quality of included studies was moderate to high, with moderate to low risk of bias. Conclusions: Efficacy and adherence to dance-specific injury prevention strategies are understudied in the dance science literature. Conditioning and exercise programs are currently the most common injury prevention strategies, with initial evidence suggesting they may be efficacious in reducing injury rates. Further research using valid injury surveillance methodologies and standardized injury definitions to examine the efficacy of these strategies in reducing dance-related injury is needed. Level of evidence: I.

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

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

Moving Beyond the Checklist-An Enhanced Approach to Context-Driven Overuse Injury Prevention in Overhead Youth Athletes

The increasing discussions regarding the research-to-practice gap in sport injury prevention have led to a growing focus on the significance of context in injury prevention programs. A context-driven injury prevention program is advantageous to address and enhance injury prevention efforts in specific populations. Considering the prevalent concern for overuse injuries among overhead youth athletes, and the developmental and contextual factors unique to this population, this review introduces the OverHead Youth Athlete (OH-YA) overuse injury prevention process. Tailored to address the challenges of working with overhead youth athletes, the context-specific four-step framework includes the following: (1) development of a context-specific instrument with strong sample representation, (2) determination of the context-specific injury burden magnitude and associated factors, (3) development of a context-specific intervention with end-users, and (4) evaluation of the context-specific intervention. This framework would likely help maximize the use of typically limited resources in youth sports. Using shoulder overuse injuries among overhead youth athletes as a case study, the OH-YA overuse injury prevention process provides an enhanced approach to context-driven overuse injury prevention while illustrating the importance and integration of context to minimize the "research-to-practice" gap.

What Do Women (With Serious Knee Injury) Want to Know About Knee Health? Identifying Research Priorities With a Consumer Advisory Group

OBJECTIVES: To (1) establish a women's knee health consumer advisory group (CAG) via an evidence-informed process and (2) identify the CAG's research priorities to inform future projects. DESIGN: Mixed-methods priority-setting study. METHODS: The CAG was established, grounded in a participatory action research approach and using the Patient Engagement in Research Framework, to inform a 4-phase process: (1) understand, (2) plan, (3) undertake, and (4) evaluate. We identified the CAG's priorities for knee health research via a mixed-methods approach using the nominal group technique (NGT). We adopted a constructivist epistemology, using reflexive thematic analysis to construct codes and themes inductively. RESULTS: Six women (mean age of 35 years) joined the CAG, generating, reviewing, and discussing 70 ideas during NGT phases 1 to 3. We constructed 14 codes, grouped into 3 key themes: (1) best practice management and support for serious knee injury and rehabilitation, (2) social and gendered factors; and (3) physical, psychological, and personal factors. Voting and ranking (NGT phases 3-6) revealed the CAG's highest priority for future research was "Knowledge of, and access to specialised knee rehabilitation and practitioners." CONCLUSION: Establishing a CAG was an achievable and novel approach to identifying consumer priorities to enhance women's knee health outcomes. Women wanted improved access to information and best-practice care via genuine therapeutic relationships with practitioners who understand the gendered-social rehabilitation environment. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 15 January 2025. doi:10.2519/jospt.2025.12869.

Body Composition Changes over a Collegiate Playing Career in NCAA Division I Women's Soccer Players

ABSTRACT

Tinsley, GM, Meyer, MK, Ptak, SM, Yu, D, Provost, JA, Hansen, NJ, and Carbuhn, AF. Body composition changes over a collegiate playing career in NCAA Division I women's soccer players. J Strength Cond Res 39(1): e40-e55, 2025-Although body composition is known to influence success in organized sport, the longitudinal body composition changes produced by sport specialization are not well characterized for women's soccer. To address this need, this study reports the body composition changes of NCAA Division I women's soccer players over their entire collegiate playing career. Serial dual-energy x-ray absorptiometry (DXA) scans were performed throughout players' involvement in collegiate women's soccer. Analyses of all players with multiple DXA scans (n = 80) and players with ≥3 years of DXA data (n = 17) were performed using linear mixed-effects models that included effects of time, playing position, game minutes, and interactions. In all athletes (n = 80; 2.1 ± 1.2 years of participation), significant increases in bone mass (1.4%), total lean mass (1.7%), and fat-free mass index (0.3 kg·m-2) occurred. These changes coincided with increased arm and leg bone mass, increased lean mass in all regions, and decreased body fat percentage and leg fat mass. In athletes with ≥3 years of collegiate data (n = 17; 3.5 ± 0.4 years of participation), larger increases in bone mass (3.0%), bone mineral density (2.2%), total lean mass (2.5%), fat-free mass index (0.4 kg·m-2), and segmental bone and lean mass were observed. Larger decreases in body fat percentage and leg fat mass were also noted. Although playing position was related to body composition characteristics, changes in outcomes were generally unrelated to position or game minutes. In summary, beneficial changes in multiple aspects of body composition were observed over years of participation in a collegiate women's soccer program.

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

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

Poor knee strength is associated with higher incidence of knee injury in adolescent female football players: The Karolinska football injury cohort

PURPOSE

To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players.

METHODS

Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated with Cox regression for the association between the baseline tests and the incidence of substantial knee injury (moderate/severe reduction in training volume or performance, or complete inability to participate in football). Exposures were categorized in tertiles (high, medium and low values). The highest tertile was used as reference.

RESULTS

376 players were included without substantial knee injury at baseline (mean age, 13.9 ± 1.1 years), and 71 (19%) reported at least one substantial knee injury during the follow-up. Several associations were found; the strongest was that players in the lowest tertile of knee extension strength had a higher incidence of knee injuries than players in the highest tertile (HRR, 2.28; 95% CI, 1.20-4.38). Players in the lowest tertile of trunk rotation ROM in lunge position half-kneeling (HRR, 0.50; 95% CI, 0.27-0.94) had lower incidence of knee injuries than players in the highest tertile.

CONCLUSIONS

Poor knee strength and high trunk ROM were associated with an increased incidence of substantial knee injury in adolescent female football players. Therefore, knee-strengthening exercises during season may be recommended.

LEVEL OF EVIDENCE

Level II.

Injury prevention in youth football (soccer): a comprehensive description of the development process of the 'FUNBALL' programme

Many football injury prevention programmes (IPPs) have been developed to target various injuries and populations. There was no specific IPP for youth players in place before. However, several existing IPPs designed for adults were also assessed in the youth population. All the existing ones face the challenge of long-term adherence even though efficacy has been demonstrated for many weeks to seasons. The main barriers to a successful long-term implementation of IPPs are time constraints and the lack of attractiveness for the players as they do not contain football-specific and motivating exercises. Increasing its attractiveness was the main aspect of designing the programme. To achieve this, a new approach was used. The 'FUNBALL' programme includes competitive, pair-based exercises and frequent ball use. It offers more flexibility as there is a choice between two different exercises for each category. It was developed through close collaboration between the research community, closely involved in real-life football, and the end-users. Tailoring IPPs to the preferences of end-users could mean a significant advancement on long-term adherence compared with previous programmes. However, further research is needed to assess this assumption.

A systematic review and network meta-analysis on the effectiveness of exercise-based interventions for reducing the injury incidence in youth team-sport players. Part 1: an analysis by classical training components

OBJECTIVES

The primary purposes were (a) to estimate the pooled effects of injury prevention programs (IPPs) on reducing overall and some specific body regions (lower extremity, thigh, knee, and ankle) injury incidence rates (IIRs) and (b) to compare the effects of single- and multi-component IPPs on mitigating injury risk in youth team sport athletes. A secondary objective was to explore the individual effects of different components on these IIRs.

MATERIALS AND METHODS

Searches were performed up to 15 January 2024 in PubMed, Web of Science, SPORTDiscus, and Cochrane Library. Eligible criteria were: exercise-based interventions evaluated against a control group, overall IIRs were reported, and youth (≤19 years old) team sport players. Two reviewers extracted data and assessed trial quality using the Consolidated Standards of Reporting Trials (CONSORT) statement, the Physiotherapy Evidence Database Scale (PEDro), and a risk of bias tool (Cochrane Back and Neck Group). Pooled effects were calculated by Frequentist random effects pairwise and network meta-analyses.

RESULTS

Twenty-one studies were included. IPPs reduced overall, lower extremities, thigh, knee, and ankle IIRs by an average of approximately 35%. Most of the IPPs demonstrated statistically significant risk mitigation effects for overall and lower extremity injuries compared to control group. Interventions comprised exclusively of strength ([IRR = 0.3 [95%CI = 0.10-0.93]) and flexibility (IRR = 0.49 [95%CI = 0.36-0.68]), as well as those including stability exercises, were the most effective measures for reducing injuries in youth team sports.

CONCLUSIONS

The implementation of current IPPs in training sessions for several weeks has shown to be an effective strategy for reducing the risk of injury in youth team sport athletes by one-third. Indirect evidence suggests that strength, flexibility, and stability might be exercise components with the highest risk mitigation effects; however, more research is crucial to confirm our estimates with direct evidence.

A systematic review and network meta-analysis on the effectiveness of exercise-based interventions for reducing the injury incidence in youth team-sport players. Part 2: an analysis by movement patterns

The objectives of this network meta-analysis were: (a) to estimate and compare the pooled effects of some injury prevention programs (IPPs) whose exercise-based components were categorized using a movement pattern-specific taxonomy on reducing overall and some specific body regions (lower extremity, thigh, knee, and ankle) injury incidences in youth team sport athletes and (b) to explore the individual effects of these components on the injury incidence rates (IIRs) previously mentioned. Searches were performed in PubMed, Web of Science, SPORTDiscus, and Cochrane Library. Eligible criteria were: exercise-based interventions comprised of exercises involving athletic motor skill competencies and evaluated against a control group, overall IIRs were reported, and youth (≤19 years old) team sport players. For the current analysis, a taxonomy based on movement patterns was employed for exercise component identification (upper body pushing and pulling; lower body concentric and eccentric; core; mechanics; acceleration; and lower body stability). Pooled effects were calculated by frequentist random effects pairwise and network meta-analyses. Nineteen studies were included. Most of the IPPs exhibit risk reduction when compared to their control groups on overall, lower extremity, and ankle injuries. Interventions comprised of lower body concentric and eccentric, core, mechanics, and lower body stability exercises were the most effective measures for reducing these injuries. None of the IPPs demonstrated to be effective for reducing thigh injuries, and contradictory results were found for knee injuries. Individual analysis at component level revealed that the lower body (bilateral and unilateral, concentric, and eccentric) component was the only one associated with a significant reduction on overall injuries. Indirect evidence suggests that interventions incorporating lower body concentric and eccentric, core, mechanics, and lower body stability exercises might be the most effective for reducing overall, lower extremity, and ankle injuries in youth team sports.

Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and Meta-analysis

CONTEXT

Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations.

OBJECTIVE

To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success.

DATA SOURCES

A total of 5 databases were searched through September 26, 2022.

STUDY SELECTION

Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis.

RESULTS

A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls.

CONCLUSION

The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.

Injury Characteristics Among Japanese International Athletes: Report on the Pre-competition Medical Check-Up Data of the Japanese Olympic Committee

Introduction Injury trends among international athletes across sports remain underexplored in out-of-competition settings, particularly among Asians. The aim of this descriptive epidemiological study is to investigate the characteristics of injuries among Japanese international athletes during pre-competition medical check-ups from 2008 to 2019. Methods We analyzed the medical check-up data of candidates for international multi-sport events according to the International Olympic Committee consensus statement. At the medical check-up, athletes' injuries were categorized into two groups based on clinical assessment. "Injuries" refer to conditions that necessitate immediate treatment or further detailed examination. On the other hand, "complaints" encompass both such "injuries" and conditions for which treatment has already commenced, allowing athletes to continue participating in competitions or training while still requiring ongoing medical monitoring. The cohort was categorized into youth and adult groups, with adults defined as those aged ≥18 years. Results Overall, 10,854 athletes (4,966 females, 45.8%; 5,888 males, 54.2%; median age 22.0 {20.0-25.0} years, 56 sports) were enrolled; 2,333 "injuries" were registered (21.5 "injuries" per 100 athletes). The "injury" prevalence was 16.2% (95% CI, 0.16-0.17) and significantly associated with females (odds ratio {OR} 1.21; 95% CI, 1.09-1.34) and adult group (OR, 1.35; 95% CI, 1.08-1.69) based on binomial logistic regression analysis. Of a total of 10,027 "complaints" (92.4 "complaints" per 100 athletes), the "complaint" prevalence was 55.3% (95% CI, 0.54-0.56) and higher in females (OR, 1.44; 95% CI, 1.33-1.55) and adult group (OR, 1.50; 95% CI, 1.29-1.75). Stratified by sport, male soccer players had a higher "injury" prevalence than females (95% CI, 0.45-0.98), whereas females had a higher "injury" prevalence in hockey (1.70-7.29) and fencing (1.12-5.44). The "complaint" prevalence was higher in females for athletics, skiing, swimming, hockey, judo, badminton, fencing, water polo, weightlifting, and golf. There was no significant difference between the sexes in other sports. The knee ("injury," 20.1%; "complaint," 20.2%), lumbosacral (15.5%; 17.0%), ankle (13.0%; 15.4%), and shoulder (13.0%; 12.1%) were most commonly affected. The injury proportion ratio for the ankle was "injury"/"complaint" 0.82 (95% CI, 0.72-0.94), with the ankle "complaint" proportion being higher than "injury." When stratified by injury location and sex, knee "injury" was more common in males (206 in females vs. 262 in males; 95% CI, 0.59-0.88), whereas ankle "complaint" was more common in females (842 in females vs. 700 in males; 95% CI, 1.04-1.29). Conclusion This is the first cross-sectional report of injuries in Asian international athletes outside of competition periods. Injury prevalence was higher in females than in males and in adults than in youths. Sex differences in injury varied by site and severity. These findings may suggest the need for more tailored injury prevention and performance support strategies for international competitions.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of supervision and athlete age and sex on exercise-based injury prevention programme effectiveness in sport: A meta-analysis of 44 studies

We aimed to evaluate the influence of supervision, athlete age and sex and programme duration and adherence on exercise-based injury prevention programme effectiveness in sport. Databases were searched for randomized controlled trials evaluating exercise-based injury prevention programme effectiveness compared to "train-as-normal". A random effects meta-analysis for overall effect and pooled effects by sex and supervision and meta-regression for age, intervention duration and adherence were performed. Programmes were effective overall (risk ratio (RR) 0.71) and equally beneficial for female-only (0.73) and male-only (0.65) cohorts. Supervised programmes were effective (0.67), unlike unsupervised programmes (1.04). No significant association was identified between programme effectiveness and age or intervention duration. The inverse association between injury rate and adherence was significant (β=-0.014, p = 0.004). Supervised programmes reduce injury by 33%, but there is no evidence for the effectiveness of non-supervised programmes. Females and males benefit equally, and age (to early middle age) does not affect programme effectiveness.

High-intensity resistance training and collagen supplementation improve patellar tendon adaptations in professional female soccer athletes

We investigated whether 10 weeks of pre-season soccer training (including high-intensity resistance exercise) with hydrolysed collagen (COL) supplementation would confer greater changes in patellar tendon (PT) mechanical and material properties compared with placebo (PLA) in professional female soccer athletes. Eleven athletes from the first team squad of a Football Association Women's Championship soccer club volunteered to participate in this study (age, 25.7 ± 4.2 years; height, 1.68 ± 0.04 m; mass, 64.0 ± 4.6 kg). Participants were pair-matched for baseline knee extensor maximum isometric voluntary contraction torque, age, height and mass and were randomly assigned to the COL group (n = 6) or PLA group (n = 5). Participants were given 30 g COL or energy-matched (36.5 g maltodextrin and 8.4 g fructose) PLA, plus 500 mg vitamin C before each training session, which consisted of high-intensity lower-limb resistance exercise, plyometric or pitch-based exercise 3 days/week for 10 weeks during the pre-season period. We assessed knee extensor maximum isometric voluntary contraction torque and PT properties using isokinetic dynamometry and ultrasonography before and after the intervention. The PT stiffness [COL, +15.4% ± 3.1% (d = 0.81) vs. PLA, +4.6% ± 3.0% (d = 0.32), P = 0.002] and Young's modulus [COL, +14.2% ± 4.0% (d = 0.65) vs. PLA, +3.4% ± 2.8% (d = 0.15), P = 0.004] increased more in COL than in PLA. There was a main effect of training on PT cross-sectional area (P = 0.027), but no interaction effect (P = 0.934). To conclude, 10 weeks of pre-season soccer training (incorporating high-intensity resistance exercise) with 30 g COL increased PT stiffness and Young's modulus more than training alone in professional female soccer athletes. This has positive implications for improving athletic performance and mitigating injury risk.

Mitigating the Risks of Lower Extremity Injuries in Soccer: A Comprehensive Analysis of Lower Extremity Injury Rates in Soccer Between 2014 and 2023

Objective

With events such as the Copa America 2024, the 2026 World Cup, and the arrival of European stars in Major League Soccer (MLS), the already observed and forecasted rise of soccer in the United States (US) seems to be an inevitable outcome. Although regular participation in soccer features several benefits, including increasing cardiovascular health, decreasing stress, and promoting interpersonal relationships, the risk of injury, as is the case in any sport, is ever present. Although many sports that are popular in America feature high rates of concussion, rotator cuff injuries, and general upper extremity injuries, soccer, being more strenuous on the lower-half of the body, features a disproportionate rate of lower extremity injuries. An analysis of the frequencies of these injuries, relative to factors such as year of injury, age, gender, location of injury, and diagnosis of injury, may help organizational bodies and soccer leagues implement new regulations regarding the usage of protective equipment and rules regarding gameplay. This study aims to illuminate these takeaways in an effort to better patient care outcomes in soccer-related injuries.

Method

This paper utilized the National Electronic Injury Surveillance System Database (NEISS) to compile data on lower extremity soccer-related injuries within the defined study period, 2014-2023. Inclusion criteria for the study involved all patients presenting to the emergency department (ED) within the study period and within the defined age range of 0 to 69 years old, with injuries sustained from or related to soccer. Using NEISS, trends were elucidated discriminating based on year of injury, sex, age group, location of injury, and diagnosis group of injury.

Results

Within the defined study period of 10 years, from 2014-2023, there were approximately 843,063 total soccer-related lower extremity injuries which presented to various EDs across the US. Regarding majorities, the most injuries were sustained in 2014 (12.84% of total injuries), most patients sustaining injuries were male (66.6% of all patients), and within the age range of 10-19 years old (63.24% of all patients), with the most instances occurring at age 15. Lower extremity injuries were most reported to be affecting the ankle with 306,797 incidences (36.39% of total injuries seen) and the most frequent diagnosis group was reported to be strains/sprains with 396,420 (47.02% of total injuries seen) total occurrences.

Conclusion

This study analyzes the incidents of lower extremity injuries while participating in soccer for the last 10 years, 2014-2023. The study provides new data regarding the frequency of injuries and their relative rate with respect to year of injury, age group, sex, location of injury, and diagnosis. The results of this study show injury majorities and trends which can be used to dictate changes in regulation regarding gameplay and the utilization of protective equipment in order to mitigate injuries related to the lower extremities in soccer.

The effects of plyometric training on physical fitness and skill-related performance in female basketball players: a systematic review and meta-analysis

Objective

This study aims to analyze the effects of plyometric training (PT) on physical fitness and skill-related performance in female basketball players.

Method

Five databases, including Web of Science, Scopus, PubMed, EBSCOhost, and Google Scholar, were used to select articles published up to 20 December 2023, using a combination of keywords related to PT and female basketball players. The risk of bias and the certainty of evidence in included articles were assessed using the Cochrane risk of bias (RoB2) tool and "The Grading of Recommendations Assessment, Development, and Evaluation" (GRADE).

Results

Ten studies were included for the systematic review, and eight for the meta-analysis, totalling 246 female basketball players aged 14.5-22.5 years. Most of these players were highly trained. Most of the included studies exhibited concerns regarding the risk of bias. The PT programs lasted 4-8 weeks, conducted 2-3 sessions per week, with sessions lasting 20-90 min and including 29-190 jumps. In the systematic review, most studies showed that PT significantly improved performance in countermovement jump (CMJ), squat jump (SJ), Sargent jump, standing long jump, lateral hop, medicine ball throw, t-Test, Illinois agility, lane agility drill, linear 20-m sprint, stable and dynamic leg balance, dribbling, passing, shooting, and various basketball-specific tests, as well as increased muscle volume and thigh cross-sectional area. However, some studies showed PT to induce no significant changes in performance during CMJ, t-Test, Illinois agility, knee extensor/flexor strength, linear sprint, and single leg balance tests. In the meta-analysis, CMJ height (ES = 0.37; p = 0.036), vertical jump (VJ) peak power (ES = 0.57; p = 0.015), VJ peak velocity (ES = 0.26; p = 0.004), and t-Test performance time (ES = 0.32; p = 0.004) were significantly improved with small effects following PT.

Conclusion

The effect of PT on performance in female basketball players was mixed. Most studies indicated that PT could improve various measures of physical fitness and skill-related performance, but performance remained unchanged in some tests. More studies with established tests are needed to investigate the effect of PT on female basketball players in the future.

Systematic Review Registration

https://inplasy.com/, Identifier INPLASY2023120078.

Injury Prevention Training in Girls' and Women's Elite Football in Denmark: A Survey of Practices and Perceptions

Through a national cross-sectional survey, the present study investigated the use and content of injury prevention training (IPT), and associated attitudes and beliefs, involving stakeholders in Danish girls' and women's elite football (U14, U16, U18, and Danish Women's League teams). A total of 168 stakeholders (coaches, physical performance coaches, physiotherapists, medical doctors, and club management) from 18 Danish elite clubs were invited to participate. Of these, 158 were eligible to participate, and 110 participants (69.6% response rate) provided 191 valid survey responses, as some provided more than one response due to multiple affiliations within the same club. The use of IPT ranged from 91.1% to 100% across team levels, with approximately 50% reporting up to 1-2 h/week. Interestingly, only 52.9%-72.7% of the responses indicated use of an evidence-based IPT program, with lowest adoption at the U14 and Danish Women's League teams. The FIFA 11+ was the most used evidence-based IPT program. The majority of the participants (>72%) had positive perceptions regarding IPT impact on injury reduction. These findings indicate that, while IPT is broadly used across Danish girls' and women's elite football teams, the implementation of evidence-based IPT programs varies, with lower adoption of these programs among the youngest and senior elite teams. Hence, there is a need to enhance integration of IPT programs proven effective in girls' and women's elite football. Notably, stakeholders expressed positive perceptions regarding the impact of IPT on injury reduction, which provides valuable support for future efforts to strengthen IPT in football practice.

The 11+ injury prevention programme decreases rate of hamstring strain injuries in male collegiate soccer players

OBJECTIVES

To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk.

METHODS

This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men's soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme.

RESULTS

The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance.

CONCLUSION

The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis

BACKGROUND

Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.

OBJECTIVE

The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.

RESULTS

Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.

DISCUSSION

Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.

CONCLUSIONS

Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.

TRIAL REGISTRY

PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).

Efficacy of a new injury prevention programme (FUNBALL) in young male football (soccer) players: a cluster-randomised controlled trial

OBJECTIVES

To evaluate the efficacy of a new multicomponent, exercise-based injury prevention programme in football players 13-19 years old.

METHODS

Two-arm cluster-randomised controlled trial with clubs as the unit of randomisation. 55 football teams from Kosovo of the under 15, under 17 and under 19 age groups were randomly assigned to the intervention (INT; 28 teams) or the control group (CON; 27 teams) and were followed for one football season (August 2021-May 2022). The INT group performed the 'FUNBALL' programme after their usual warm-up at least twice per week, while the CON group followed their usual training routine. The primary outcome measure was the overall number of football-related injuries. Secondary outcomes were region-specific injuries of the lower limbs (hip/groin, thigh, knee, lower leg, ankle and foot) and injury severity.

RESULTS

319 injuries occurred, 132 in the INT and 187 in the CON group. The INT group used the 'FUNBALL' programme in 72.2% of all training sessions, on average 2.2 times per week. There was a significantly lower incidence in the INT group regarding the overall number of injuries (incidence rate ratio (IRR) 0.69, 95% CI 0.55 to 0.87), the number of thigh injuries (IRR 0.62, 95% CI 0.39 to 0.98), of moderate (time loss between 7 and 28 days) (IRR 0.65, 95% CI 0.44 to 0.97) and of severe injuries (time loss >28 days) (IRR 0.51, 95% CI 0.28 to 0.91).

CONCLUSION

The 'FUNBALL' programme reduced the incidence of football-related injuries among male adolescent football players, and its regular use for injury prevention in this population is recommended.

TRIAL REGISTRATION NUMBER

NCT05137015.

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

OBJECTIVES

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

DESIGN

Cross-sectional study.

SETTING

Online survey.

PARTICIPANTS

Head physiotherapists from 32 Brazilian elite clubs.

MAIN OUTCOME MEASURES

Structured questionnaire.

RESULTS

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

CONCLUSIONS

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

Extrinsic Risk Factors for Primary Noncontact Anterior Cruciate Ligament Injury in Adolescents Aged between 14 and 18 years: A Systematic Review

BACKGROUND

Adolescents present a high incidence of ACL injury compared with other age groups. Examining the risk factors that predispose adolescents to primary noncontact ACL injury is a key strategy to decrease the number of injuries in this population.

OBJECTIVE

The aim of this systematic review was to summarise the existing literature investigating extrinsic risk factors that have been linked with primary noncontact ACL injury risk (identified either using ACL injury occurrence or using screening tests measuring biomechanical mechanisms for noncontact ACL injury) in adolescents including research investigating: (1) the association between extrinsic risk factors and primary noncontact ACL injury risk; and (2) whether primary noncontact ACL injury risk was different in populations or groups exposed to different extrinsic risk factors in adolescents.

METHODS

The same search strategy was used in MEDLINE, SPORTDiscus, CINAHL, PubMed and Embase. Articles were included if: written in English; published in peer-reviewed journals; investigating and discussing primary noncontact ACL injury risk associated with extrinsic risk factors; they were original research articles with an observational design; and participants presented a mean age ranging between 14 and 18 years. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS) was used to assess the quality and risk of bias of the articles included in this systematic review.

RESULTS

The systematic review included 16 eligible articles published up to August 2022 about extrinsic risk factors for primary noncontact ACL injury including: sport (8 studies); sport exposure amount (5); sport level (3); sport season (1); environment (2); equipment (1). Differences in biomechanical risk factors predisposing to ACL injury were reported by sport in female adolescents playing basketball and soccer; however, no good evidence of differences in primary noncontact ACL injury rate by sport was reported in both male and female adolescents. There was contrasting evidence about associations between sport exposure and biomechanical and neuromuscular risk factors predisposing to ACL injury or primary noncontact ACL injury rate in both male and female adolescent players from different sports. There was weak evidence of differences in biomechanical risk factors predisposing to ACL injury by environmental condition in both male and female adolescents playing soccer and season phase in male adolescents playing basketball. Lastly, few good-quality articles suggested that higher sport level might be associated with increased primary noncontact ACL injury rate in female adolescents playing basketball and floorball and that bracing might not prevent primary noncontact ACL injuries in both male and female adolescent players from different sports.

DISCUSSION

The findings emphasise the need for further research to clarify the evidence about extrinsic risk factors and primary noncontact ACL injury in adolescents to develop ACL injury prevention guidelines that would help practitioners and researchers identify adolescents at risk and design future interventions. Future epidemiological studies should collect data about extrinsic factors as well as data about primary noncontact injury separately from secondary injuries or contact injuries to better inform primary noncontact ACL injury prevention in adolescents.

REGISTRATION

https://doi.org/10.17605/OSF.IO/VM82F (11/08/2021).

Injury Prevention Programmes Fail to Change Most Lower Limb Kinematics and Kinetics in Female Team Field and Court Sports: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND

One mechanism by which exercise interventions may be effective in reducing anterior cruciate ligament (ACL) injury risk is through changes in lower limb biomechanics. Understanding how training programmes affect lower-limb kinematics and kinetics may help refine injury prevention programmes.

OBJECTIVE

The aim of this systematic review and meta-analysis was to assess the effect of injury prevention programmes on kinematics and kinetics during tasks related to ACL injury in female team field and court sports.

DATA SOURCES

Five databases were searched in October 2022.

ELIGIBILITY CRITERIA

Randomised controlled trials assessing the effect of injury prevention programmes compared with usual training/no training on lower limb kinematics and kinetics in female team field and court sports were eligible for review.

RESULTS

Sixteen studies were included. A total of 976 female athletes were included. Most of the studies included interventions with multiple components (12/16). Commonly used components were plyometrics (12/16), strength (8/16), and balance/stability (7/16). Thirteen studies had routine training or sham interventions as the control group and three studies had no training. Very low certainty evidence suggests that injury prevention programmes increase knee flexion angles (mean difference = 3.1° [95% confidence interval 0.8-5.5]); however, very low to low certainty evidence suggests no effect on hip flexion angles/moments, knee flexion moments, hip adduction angles/moments, knee adduction angles/moments, hip internal rotation angles/moments, ankle dorsiflexion angles, and ground reaction forces, compared with usual training/no training.

CONCLUSION

Injury prevention programmes may be effective in increasing knee flexion angles during dynamic landing and cutting tasks but may have no effect on other lower limb biomechanical variables. As such, the benefits of injury prevention programmes may be mediated by factors other than altered biomechanics and/or may happen through other biomechanical measures not included in this review.

What exercise programme is the most appropriate to mitigate anterior cruciate ligament injury risk in football (soccer) players? A systematic review and network meta-analysis

OBJECTIVES

To examine the effectiveness of different exercise-based interventions to mitigate the risk of anterior cruciate ligament injury in football players, and to determine which is the most appropriate for them, specifically for female football players.

DESIGN

Four databases were accessed in July 2023 using the keywords football, soccer, athletic injuries, anterior cruciate ligament, knee injuries, injury prevention, exercise-based programme, and risk factor.

METHODS

Randomised controlled trials that evaluated any exercise-based injury prevention intervention compared with a control group on the prevention of anterior cruciate ligament injury in football players were included.

RESULTS

Eleven studies were included. Data were presented as logarithm hazard ratio, credible intervals and standard deviation. FIFA 11+ was the most effective in reducing anterior cruciate ligament injury risk in football players (logarithm hazard ratio = -1.23 [95% credible intervals: -2.20, -0.35]; SD = 0.47), followed by the Knäkontroll programme (logarithm hazard ratio = -0.76 [95% credible intervals: -1.60, -0.03]; standard deviation = 0.42). For females, only Knäkontroll had a significant impact on reducing the risk of anterior cruciate ligament injury (logarithm hazard ratio = -0.62 [95% credible intervals: -1.71, 0.62]; standard deviation = 0.58).

CONCLUSIONS

Our results support the use of FIFA 11+ and Knäkontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females. Knäkontroll is postulated as the programme with the greatest preventive nature, although these results should be interpreted with caution due to the lack of the sample.

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

OBJECTIVES

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

DESIGN

Prospective cohort study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Injury prevention for women and girls playing Australian Football: programme cocreation, dissemination and early adopter coach feedback

Background

Adherence to injury prevention programmes may improve with greater end-user involvement and application of implementation frameworks during development. We describe the cocreation, initial dissemination and feedback from programme early adopters (coaches), to develop the first evidence-informed injury prevention programme for women playing community Australian Football (Prep-to-Play).

Methods

We used a pragmatic seven-step process for developing sports injury prevention programmes to (1) gain organisational support, (2) compile research evidence, (3) consult experts, (4) engage end-users, (5) test programme acceptability, (6) evaluate against theory and (7) gain early adopter feedback. All Australian Football-registered coaches of women's/girls' teams were sent a postseason survey to determine initial awareness, adoption and implementation (steps 5 and 6). Purposively selected coaches were invited to interviews/focus groups (step 7) to identify competency, organisational and leadership implementation drivers with a deductive thematic analysis applied.

Results

Prep-to-Play was cocreated using previous efficacious programmes and expert input (steps 1-4), and disseminated via the national sporting organisation in preseason 2019 to all registered coaches (step 5). 343 coaches (90 women) completed the postseason survey and 22 coaches (5 women) participated in an interview (n=9) or focus group (n=13) (steps 6 and 7). 268 coaches (78%) were aware of Prep-to-Play. Of those aware, 218 (81%) had used (at least one element) Prep-to-Play, and 143 (53%) used it at least twice per week. Competency drivers included local expert-delivered face-to-face workshops complimented by online content and ongoing support. Organisational drivers included coach education integrated into existing league/club. Leadership drivers included compulsory injury prevention education integrated into coach reaccreditation processes or incentivisation via recognition (eg, professional development points).

Conclusions

Cocreation and organisational support resulted in high programme awareness and adoption. However, high fidelity implementation and maintenance may need to be facilitated by competency, organisational and leadership drivers. Responsibility should be shared among all stakeholders.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

If we build it together, will they use it? A mixed-methods study evaluating the implementation of Prep-to-Play PRO: an injury prevention programme for women's elite Australian Football

OBJECTIVES

We evaluated the implementation of Prep-to-Play PRO, an injury prevention programme for women's elite Australian Football League (AFLW).

METHODS

The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of Prep-to-Play PRO were assessed based on the proportion of AFLW players and/or staff who: were aware of the programme (R), believed it may reduce anterior cruciate ligament injury (E), attempted to implement any/all programme components (A), implemented all intended components as practically as possible (I) and intended future programme implementation (M). Quantitative and qualitative data were triangulated to assess 58 RE-AIM items (evidence of yes/no/unsure/no evidence) and the 5 RE-AIM dimensions (fully achieved=evidence of yes on >50% dimension items, partially achieved=50% of items evidence of yes and 50% unsure or 50% mix of unsure and unanswered, or not met=evidence of yes on <50% dimension items).

RESULTS

Multiple sources including AFLW training observations (n=7 total), post-implementation surveys (141 players, 25 staff), semistructured interviews (19 players, 13 staff) and internal programme records (9 staff) contributed to the RE-AIM assessment. After the 2019 season, 8 of 10 (80%) AFLW clubs fully met all five RE-AIM dimensions. All 10 clubs participating in the AFLW fully achieved the reach (R) dimension. One club partially achieved the implementation (I) dimension, and one club partially achieved the effectiveness (E) and adoption (A) dimensions.

CONCLUSION

The Prep-to-Play PRO injury prevention programme for the AFLW achieved high implementation, possibly due to the programme's deliberately flexible approach coupled with our pragmatic definition of implementation. Engaging key stakeholders at multiple ecological levels (organisation, coaches, athletes) throughout programme development and implementation likely enhanced programme implementation.

Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females' characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes.

Outcomes of bone-patellar tendon-bone autograft and quadriceps tendon autograft for ACL reconstruction in an all-female soccer player cohort with mean 4.8-year follow up

OBJECTIVE

The purpose is to compare functional outcomes, return to soccer rates, and revision rates in an all-female soccer player cohort undergoing quadriceps tendon (QT) autograft ACLR versus bone-patellar tendon-bone (BPTB) autograft ACLR.

METHODS

Female soccer players who sustained an ACL rupture and underwent primary anatomic, single-bundle ACLR with BPTB autograft or QT autograft were included. Demographic and surgical characteristics were collected. Outcomes of interest included Tegner score, International Knee Documentation Committee (IKDC) score, Marx score, return to soccer rates, and failure rates.

RESULTS

Data on 23 patients undergoing BPTB autograft ACLR and 14 undergoing QT autograft ACLR was available. Average age was 18.7 years, and average follow up was 4.8 years. Overall, 76 ​% (28/37) returned to soccer and 5.4 ​% (2/37) underwent revision ACLR. No major significant differences were found in demographic or surgical characteristics. No differences were found in postoperative IKDC scores, preoperative, postoperative, or change from pre-to postoperative Marx activity scores, or pre-and postoperative Tegner scores between the groups. QT autograft ACLR patients had significantly less change in Tegner scores pre-to postoperatively compared to the BTPB autograft ACLR group (0.6 ​± ​1.2 versus 2.1 ​± ​1.8; p ​= ​0.02). Both groups had similar rates of return to soccer [78 ​% (18/23) BPTB autograft ACLR versus 71 ​% (10/14) QT autograft ACLR; p ​= ​0.64] and rates of revision (8.7 % (2/23) BPTB autograft ACLR; 0 % (0/14) QT autograft ACLR.

CONCLUSION

Results of this study suggest that BPTB autograft ACLR and QT autograft ACLR produce comparable, successful functional and return to soccer outcomes in this all-female soccer player cohort study. Larger, prospective studies are needed to improve the strength of conclusions and provide more information on the optimal graft choice for female soccer players. Surgeons can use the results of this study to counsel female soccer players on expected outcomes after ACLR.

LEVEL OF EVIDENCE

III.

Hip Range of Motion During Passive and 1-Leg Exercises Is Greater in Women: A Meta-analysis and Systematic Review

PURPOSE

To summarize sex-related differences in hip range of motion (ROM), including flexion, extension, abduction, adduction, internal rotation, and external rotation.

METHODS

We performed a systematic search of 3 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Embase). The search terms were as follows: hip, pelvis, range of motion, kinematic, men, and women. Included studies reported sex-specific data on hip ROM in healthy, uninjured adults. To generate hip ROM mean differences, a DerSimonian-Laird random-effects model was used. Effect sizes were pooled for each exercise. Subgroup analyses compared hip ROM by physical activity group: passive ROM, 1-leg hop or jump, 2-leg hop or jump, 2-leg drop or landing, 1-leg squat, 2-leg squat, walking, and jogging/running. Positive effect sizes represent greater ROM in women.

RESULTS

Thirty-eight studies with 3,234 total subjects were included; of these subjects, 1,639 were women (50.1%). The mean age was 25.3 years. An effect difference was considered statistically significant if P < .05 and clinically significant if the mean difference was greater than 4.0°. Women showed statistically and clinically significantly greater hip flexion in passive ROM (mean difference, 6.4°) and during the 1-leg hop or jump exercise (mean difference, 6.5°). Women also showed statistically and clinically significantly greater hip adduction during the 1-leg hop or jump (mean difference, 4.5°) and 1-leg squat (mean difference, 4.4°) exercises, as well as statistically and clinically significantly greater hip internal rotation in passive ROM (mean difference, 8.2°). In contrast, men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise (mean difference, -9.1°). No clinically significant differences in extension, abduction, or external rotation were found between women and men.

CONCLUSIONS

On average, women showed statistically and clinically significantly greater flexion, adduction, and internal rotation during passive and 1-leg exercises whereas men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise.

LEVEL OF EVIDENCE

Level IV, meta-analysis and systematic review of Level II-IV studies.

Impact of the COVID-19 pandemic on the psychological aspects and mental health of elite soccer athletes: a systematic review

Introduction

Investigation of the psychological impact on soccer athletes during the pandemic is essential given their unique challenges, including training disruptions and competition postponements. Understanding these effects will allow the development of specific strategies to preserve the mental health and performance of elite athletes, contributing to effective interventions with both short and long-term benefits.

Objective

To analyze the impact of the COVID-19 pandemic on the psychological aspects and mental health of elite soccer athletes.

Method

The review adhered to PRISMA criteria, and the study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022341545). Searches were conducted until July 2023 in databases including Cochrane, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science. Only original, peer-reviewed studies in English, Portuguese, or Spanish assessing the impact of the COVID-19 pandemic on the psychological aspects and mental health of elite soccer athletes were included.

Results

The search identified 1,055 records and 43 studies were included in this review between 2020 and 2023. In total, the sample included 16,321 soccer athletes of different age groups. Anxiety, depression, mood states, and mental well-being were the most investigated variables. Increased levels of anxiety, depression, and worsening mental well-being were observed in elite soccer athletes. Maintaining fitness during the pandemic showed positive results. Other variables, such as coping, resilience, and sleep quality monitoring, were less widely investigated. Evaluating methodological quality was considered regular for observational and experimental studies.

Conclusion

The study reveals a negative impact of the COVID-19 pandemic on elite soccer athletes, considering psychological aspects and their mental health, notably heightened anxiety and depression. Observational methods predominated, showing mood swings linked to individual characteristics and fitness maintenance efforts. Studies with better-designed methodological approaches and controlled experimental interventions are recommended in the future to mitigate the negative effects of the pandemic on soccer players.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier (CRD42022341545).

#ReadyToPlay: health problems in women's football-a two-season prospective cohort study in the Norwegian premier league

OBJECTIVES

To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league.

METHODS

During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported.

RESULTS

We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss.

CONCLUSION

One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe.

Anterior cruciate ligament injury occurrence, return to sport and subsequent injury in the Australian High Performance Sports System: A 5-year retrospective analysis

OBJECTIVES

To report anterior cruciate ligament (ACL) injury occurrence, return to sport (RTS) timeframes and ACL subsequent injuries recorded in the Australian High Performance Sports System according to athlete sex.

METHODS

ACL injury data of injured athletes were prospectively collected by the treating sports and exercise physicians and physiotherapists within the Australian High Performance Sports System between January 1, 2015 and May 31, 2020. RTS time frames for ACL injuries and the proportion of subsequent ACL injuries were calculated. The RTS time was compared between sexes, age groups and ACL injury categories using the Mann-Whitney U test and the Kruskal-Wallis test.

RESULTS

A total of 132 ACL injuries were reported in 108 athletes (77 female, 31 male). ACL injuries accounted for 6.4% of all reported knee injuries, with almost half (48.5%) of the ACL injuries reported to occur during training. Median RTS time was 369 days (IQR = 273-487), with RTS times reducing with increasing age (X2 (Zbrojkiewicz et al., 2018) = 11.781, p = 0.008). The presence of concurrent knee pathology did not significantly affect the RTS timeframes. ACL injuries were most frequently reported in netball, winter sports, basketball, field hockey and gymnastics. One quarter of the ACL reported (n = 34, 25.8%) were subsequent to a prior ACL injury, with the majority of these injuries occurring to the ipsilateral knee (n = 26) as opposed to contralateral knee (n = 6).

CONCLUSIONS

Despite ACL injuries accounting for a small proportion of all knee injuries reported in the Australian High Performance Sports System, more than a quarter are subsequent to a previous ACL injury. Shorter RTS times were observed in older athletes; however, considerable periods of time-loss occur as a consequence of ACL injuries. Effective primary prevention, rehabilitation processes, and ongoing tertiary prevention strategies are warranted in this population.