Astrid Junge

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players’ baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.

Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial

Objective To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football. Design Cluster randomised controlled trial with clubs as the unit of randomisation. Setting 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months). Participants 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group). Intervention A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements. Main outcome measure Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip). Results During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83). Conclusion Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players. Trial registration ISRCTN10306290.

Prevention of soccer injuries: a prospective intervention study in youth amateur players.

Background: Risk factors for soccer injuries and possibilities for prevention have been discussed by several authors, but only a few have investigated the effectiveness of preventive interventions. Purpose: The aim of the present study was to evaluate the effects of a prevention program on the incidence of soccer injuries in male youth amateur players. Study Design: Prospective controlled intervention study. Methods: Seven soccer teams took part in a prevention program that focused on education and supervision of coaches and players, while seven other teams were instructed to train and play soccer as usual. Over 1 year all injuries were documented weekly by physicians. Complete weekly injury reports were available for 194 players. Results: The incidence of injury per 1000 hours of training and playing soccer was 6.7 in the intervention group and 8.5 in the control group, which equates to 21% fewer injuries in the intervention group. The greatest effects were observed for mild injuries, overuse injuries, and injuries incurred during training. The prevention program had greater effects in low-skill than in high-skill teams. Conclusions: The incidence of soccer injuries can be reduced by preventive interventions, especially in low skill level youth teams. Coaches and players need better education regarding injury prevention strategies and should include such interventions as part of their regular training.

Soccer injuries: a review on incidence and prevention.

Several investigators have studied the incidence and causes of soccer injuries in male professional players; however, epidemiological data on injuries in female soccer players are limited. From the data presented, it can be estimated that, on average, every elite male soccer player incurs approximately one performance-limiting injury each year. Nine studies on the prevention of soccer injuries were found in the literature. There is some evidence that multi-modal intervention programmes result in a general reduction in injuries. Ankle sprains can be prevented by external ankle supports and proprioceptive/coordination training, especially in athletes with previous ankle sprains. With regard to severe knee injuries, the results of prevention studies are partly inconclusive; however, training of neuromuscular and proprioceptive performance as well as improvement of jumping and landing technique seem to decrease the incidence of anterior cruciate ligament injuries in female athletes. Prevention programmes are likely to be more effective in groups with an increased risk of injury. More methodologically well-designed studies are required to evaluate the effects of specific preventive interventions.

Sports injuries during the Summer Olympic Games 2008.

Background Standardized assessment of sports injuries provides important epidemiological information and also directions for injury prevention. Purpose To analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008. Study Design Descriptive epidemiology study. Methods The chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physicians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village. Results Physicians and/or therapists of 92 national teams covering 88% of the 10 977 registered athletes took part in the study. In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all ≥15% of the athletes) and lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming. Conclusion The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports. The identification of these factors should stimulate future research and subsequent policy change to prevent injury in elite athletes.

Active therapy for chronic low back pain part 3. factors influencing self-rated disability and its change following therapy

Design. Cross-sectional analysis of the factors influencing self-rated disability associated with chronic low back pain and prospective study of the relationship between changes in each of these factors and in disability following active therapy. Objectives. To examine the relative influences of pain, psychological factors, and physiological factors on self-rated disability. Summary of Background Data. In chronic LBP, the interrelationship between physical impairment, pain, and disability is particularly complicated, due to the influence of various psychological factors and the lack of unequivocal methods for assessing impairment. Investigations using new “belief” questionnaires and “sophisticated” performance tests, which have shown promise as discriminating measures of impairment, may assist in clarifying the situation. Previous studies have rarely investigated all these factors simultaneously. Methods. One hundred forty-eight patients with cLBP completed questionnaires and underwent tests of mobility, strength, muscle activation, and fatigability, and (in a subgroup) erector spinae size and fiber size/type distribution. All measures were repeated after 3 months active therapy. Relationships between each factor and self-rated disability (Roland and Morris questionnaire) at baseline, and between the changes in each factor and changes in disability following therapy, were examined. Results. Stepwise linear regression showed that the most significant predictors of disability at baseline were, in decreasing order of importance: pain; psychological distress; fear-avoidance beliefs; muscle activation levels; lumbar range of motion; gender. Only changes in pain, psychological distress, and fear-avoidance beliefs significantly accounted for the changes in disability following therapy. Conclusion. A combination of pain, psychological and physiological factors was best able to predict baseline disability, although its decrease following therapy was determined only by reductions in pain and psychological variables. The active therapy programm—in addition to improving physical function—appeared capable of modifying important psychological factors, possibly as a result of the positive experience of completing the prescribed exercises without undue harm.

Football Injuries during FIFA Tournaments and the Olympic Games, 1998-2001: Development and Implementation of an Injury-Reporting System

Background Standardized assessment of sports injuries provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and characteristics of injury. Purpose Development and implementation of an easy to use injury-reporting system to analyze the incidence, circumstances and characteristics of injury during major international football tournaments. Study Design Prospective survey. Methods A comprehensive injury report form was developed, and implemented during 12 international football tournaments. The physicians of all participating teams were asked to report all injuries after each match. The response rate was 84% on average. Results A total of 901 injuries were reported from 334 matches, which is equivalent to an incidence of 2.7 injuries per match. Approximately one injury per match resulted in a players absence from training or matches. On average 86% of the injuries arose as a result of contact with another player, and approximately half of all injuries were caused by foul play. The number of injuries per match differed substantially between the tournaments for players of different age, sex and skill-level. Conclusion An injury-reporting system has been implemented as matter of routine in FIFA tournaments. The consistent findings in the present study demonstrate the high quality of the data obtained.

Injuries in Team Sport Tournaments During the 2004 Olympic Games

Background Several authors have analyzed the incidence of injuries in a given sport, but only a few have examined the exposure-related incidence of injuries in different types of sports using the same methodology. Purpose Analysis of the incidence, circumstances, and characteristics of injuries in different team sports during the 2004 Olympic Games. Study Design Cohort study; Level of evidence, 2. Methods During the 2004 Olympic Games, injuries in 14 team sport tournaments (mens and womens soccer, mens and womens handball, mens and womens basketball, mens and womens field hockey, baseball, softball, mens and womens water polo, and mens and womens volleyball) were analyzed. After each match, the physician of the participating teams or the official medical representative of the sport completed a standardized injury report form. The mean response rate was 93%. Results A total of 377 injuries were reported from 456 matches, an incidence of 0.8 injuries per match (95% confidence interval, 0.75-0.91) or 54 injuries per 1000 player matches (95% confidence interval, 49-60). Half of all injuries affected the lower extremity; 24% involved the head or neck. The most prevalent diagnoses were head contusion and ankle sprain. On average, 78% of injuries were caused by contact with another player. However, a significantly higher percentage of noncontact (57%) versus contact injuries (37%) was expected to prevent the player from participating in his or her sport. Significantly more injuries in male players (46%) versus female players (35%) were expected to result in absence from match or training. The incidence, diagnosis, and causes of injuries differed substantially between the team sports. Conclusion The risk of injury in different team sports can be compared using standardized methodology. Even if the incidence and characteristics of injuries are not identical in all sports, prevention of injury and promotion of fair play are relevant topics for almost all team sports.

Injuries in female soccer players: a prospective study in the German national league.

Background In contrast to the high number of studies about soccer injuries in men, epidemiologic data in high-level female soccer players are scarce. Purpose Analysis of injury incidence in elite female soccer players. Study Design Descriptive epidemiology study. Methods There were 165 female soccer players (age, 22.4 ± 5.0 years) from 9 teams competing in the German national league, who were followed for one complete outdoor season. Their trainers documented the exposure to soccer on a weekly basis for each player, and the team physical therapists reported all injuries with regard to location, type, and circumstances of occurrence. An injury was defined as any physical complaint associated with soccer that limited sports participation for at least 1 day. Results There were 241 injuries sustained by 115 players (70%) reported; 39 injuries (16%) were owing to overuse, and 202 injuries (84%) were traumatic. Overall, 42% of the traumatic injuries occurred during training (2.8/1000 hours of training; 95% confidence interval, 2.2-3.4) and 58% during matches (23.3/1000 match hours; 95% confidence interval, 19.1-27.5); 102 of the traumatic injuries were caused by a contact situation, whereas 95 occurred without any contact. Most injuries (80%) were located at the lower extremities, concerning mainly the thigh (n = 44), knee (n = 45), and ankle (n = 43). Ankle sprain (n = 37) was the most often diagnosed injury. There were 51% minor injuries, 36% moderate injuries, and 13% major injuries. Eleven anterior cruciate ligament ruptures were observed during the season. Conclusion The results revealed a high injury incidence rate in games as well as a comparably low incidence rate during training. An important finding of this investigation was the frequent occurrence of anterior cruciate ligament ruptures. Preventive measures should thus focus on the high prevalence of anterior cruciate ligament tears, mostly occurring in noncontact situations.

Injury surveillance in multi-sport events: the International Olympic Committee approach

Background: The protection of athletes’ health by preventing injuries is an important task for international sports federations. Standardised injury surveillance provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and circumstances of injury. Numerous studies have evaluated sports injuries during the season, but few have focused on injuries during major sport events such as World Championships, World Cups or the Olympic Games. Objectives: To provide an injury surveillance system for multi-sports tournaments, using the 2008 Olympic Games in Beijing as an example. Methods: A group of experienced researchers reviewed existing injury report systems and developed a scientific sound and concise injury surveillance system for large multi-sport events. Results: The injury report system for multi-sport events is based on an established system for team sports tournaments and has proved feasible for individual sports during the International Association of Athletics Federations World Championships in Athletics 2007. The most important principles and advantages of the system are comprehensive definition of injury, injury report by the physician responsible for the athlete, a single-page report of all injuries, and daily report irrespective of whether or not an injury occurred. Implementation of the injury surveillance system, all definitions, the report form, and the analysis of data are described in detail to enable other researchers to implement the injury surveillance system in any sports tournament. Conclusion: The injury surveillance system has been accepted by experienced team physicians and shown to be feasible for single-sport and multi-sport events. It can be modified depending on the specific objectives of a certain sport or research question; however, a standardised use of injury definition, report forms and methodology will ensure the comparability of results.