Is it safe to use local anaesthetic painkilling injections in professional football?

The use of local anaesthetic painkilling injections in professional football can counter the performance-reducing impact of injury and lower the rate of players missing matches through injury. In the majority of cases, these injections are probably safe, although scientific evidence in this area is scant, particularly regarding long-term follow-up. The known long-term injury sequelae of professional football, such as increased rates of osteoarthritis of the knee (in particular), hip, ankle and lumbar spine, do not generally relate to the injuries for which local anaesthetic is commonly used. The most commonly injected injuries (acromioclavicular joint sprains, finger and rib injuries and iliac crest haematomas) are probably the safest to inject. There are risks of worsening injuries and known specific complications when local anaesthetic is used, and players requesting injections should be made aware of these. Local anaesthetic injections as painkillers should only be used when both the doctor and player consider that the benefits clearly outweigh the anticipated possible risks. Intra-articular injections to the knee, ankle, wrist, joints of the foot, and to the pubic symphysis and major tendons of the lower limb are best avoided in most circumstances. To enable the benefit and risk profile of local anaesthetic injections to be better understood, it is recommended that professional football competitions make local anaesthetics legal only with compulsory notification.     

Evaluating the level of injury in English professional football using a risk based assessment process

OBJECTIVES: To show how epidemiological data can be presented and analysed in frequency based and risk based formats and how risk based information can simplify management decisions on injury prevention strategies in professional football. METHODS: The club physiotherapists at four English professional football clubs prospectively recorded players' injuries over the period November 1994 to May 1997. The nature, location, and mechanism of each injury and the specific numbers of days that players were unavailable to train or play as a result of injuries were recorded. The rates of injury were evaluated on a risk matrix using the number of days and the estimated costs of absence as measures of injury consequences. RESULTS: There was a significant difference in the time lost through injury as a function of injury severity (p<0.001). Slight and minor injuries accounted for 51% of all injuries but represented only 17% of the risk from injury, whereas major injuries accounted for only 12% of the number of injuries and 47% of the risk. Player to player contact injuries accounted for 39% of the risk of injury, and football specific activities accounted for 47% of the risk. The risks of acute injury in professional football were three orders of magnitude greater than those in the construction, manufacturing, and service sectors of industry. CONCLUSIONS: The risks associated with minor, moderate, and major acute injuries and osteoarthritis in lower limb joints of professional footballers were found to be unacceptable when evaluated against work based risk criteria used by the Health and Safety Executive. All stakeholders within professional football were shown to have an important contribution to make in reducing the overall level of risk to players through the provision of risk prevention strategies.     

Triceps tendon ruptures in professional football players

BACKGROUND: Distal rupture of the triceps tendon is a rare injury, and treatment guidelines are not well established. HYPOTHESIS: Football players with triceps tendon ruptures will be able to return to their sport with minimal functional deficits. STUDY DESIGN: Uncontrolled retrospective review. METHODS: Twenty-one partial and complete ruptures of the triceps tendon were identified in 19 National Football League players over a period of 6 years. Team physicians retrospectively reviewed training room, clinical, and operative notes for each of these players. RESULTS: Most of the injured players were linemen. The most common mechanism of injury was an eccentric load to a contracting triceps. Seven players had prodromal symptoms prior to injury, and 5 had received a cortisone injection. Eleven elbows with complete tears underwent surgical repair. Of 10 players with partial tears, 6 healed without surgery. One player suffered a subsequent complete tear requiring surgery, and 3 with residual pain and weakness underwent surgical repair following the season. Two surgical complications occurred, both requiring a second operation. All of the players but 1 returned to play at least one season of professional football after their injury. CONCLUSIONS: Partial triceps tendon ruptures can heal without functional deficit. Surgical repair for complete ruptures generally produces good functional results and allows return to play.     

Risk assessment in professional football: an examination of accidents and incidents in the 1994 World Cup finals.

OBJECTIVE: To assess the risks to footballers' health and safety during competitive international matches, with identification of the most common causes of injury. METHODS: Videos of 44 of the 52 matches played during the 1994 World Cup finals staged in the USA were analysed. During each match, several relevant variables were recorded, including the number of fouls, injuries, treatments, times of incidents, identity of players treated or injured, and the injury mechanism. Additional information on players' injuries was obtained from the extensive media coverage of the event. RESULTS: Only 29% of injuries resulted from foul play, whereas 71% of injuries to players occurred where no foul play was adjudged by the referee to have taken place (P < 0.01). Defenders were found to be proportionately subjected to a greater risk of injury than other players (P < 0.05). Fifteen per cent of all injuries were judged to be at least moderate, resulting in the player missing at least one match. Frequency of moderate injury was 1026 injuries per 100,000 hours played. CONCLUSIONS: The major causes of injuries during international football matches were not found to be associated with foul play, as judged by the referees. However, in those cases where injuries occurred without a foul being committed, almost 50% involved player to player contact. This gives some cause for concern and is worth further investigation.     

A prospective epidemiological study of injuries in four English professional football clubs

OBJECTIVE: To define the causes of injuries to players in English professional football during competition and training. METHOD: Lost time injuries to professional and youth players were prospectively recorded by physiotherapists at four English League clubs over the period 1994 to 1997. Data recorded included information related to the injury, date and place of occurrence, type of activity, and extrinsic Playing factors. RESULTS: In all, 67% of all injuries occurred during competition. The overall injury frequency rate (IFR) was 8.5 injuries/1000 hours, with the IFR during competitions (27.7) being significantly (p < 0.01) higher than that during training (3.5). The IFRs for youth players were found to increase over the second half of the season, whereas they decreased for professional players. There were no significant differences in IFRs for professional and youth players during training. There were significantly (p < 0.01) injuries in competition in the 15 minute periods at the end of each half. Strains (41%), sprains (20%), and contusions (20%) represented the major types of injury. The thigh (23%), the ankle (17%), knee (14%), and lower leg (13%) represented the major locations of injury, with significantly (p < 0.01) more injuries to the dominant body side. Reinjury counted for 22% of all injuries. Only 12% of all injuries were caused by a breach of the rules of football, although player to player contact was involved in 41% of all injuries. CONCLUSIONS: The overall level of injury to professional footballers has been showed to be around 1000 times higher times higher than for industrial occupations generally regarded as high risk. The high level of muscle strains, in particular, indicates possible weakness in fitness training programmes and use of warming up and cooling down procedures by clubs and the need for benchmarking players' levels of fitness and performance. Increasing levels of injury to youth players as a season progresses emphasizes the importance of controlling the exposure of young players to high levels of competition.     

Incidence of cervical spinal stenosis in professional and rookie football players

Sagittal canal/vertebral body ratios were measured on cervical spine lateral radiographs of 124 professional football players and 100 rookie football players. A total of 894 levels were measured in 224 players. Thirty-two percent (40) of the 124 professional football players, and 34% of the 100 rookies had a ratio of less than 0.80 at one or more levels from C3 to C6. The 0.80 ratio has been considered indicative of cervical spinal stenosis. This is the first time that the incidence of spinal stenosis, as determined by Torg's ratio, has been demonstrated in a population of professional and rookie football players. Because one-third of this population has cervical spinal stenosis as determined by the Torg ratio, other factors should be considered in the evaluation of a player with a transient quadriplegic episode when making continued play decisions.     

A profile of Australian football injuries presenting to sports medicine clinics

Most of the published data describing Australian football injuries is from hospital emergency departments and elite injury surveillance studies. There is a lack of good information about injuries to players at the lower levels of participation and those not severe enough to warrant hospital treatment. This study describes the profile of Australian football injuries that present to sports medicine clinics for treatment. New sports injury cases, presenting to five metropolitan Melbourne sports medicine clinics during a 12 month period in 1996-1997, were recorded through the Sports Medicine Injury Surveillance project. Both the patient and treating health professional provided personal and injury details. Australian football accounted for 29% of the 6479 recorded injury cases. The majority of injured players were male (99%) and from adult, community leagues (78%); the mean age was 23 years. Competition accounted for 78% of injuries and 72% of injured players presented for treatment to a sports physician/medical practitioner. Body contact accounted for half of all injuries and the most common injuries were medial ligament sprains of the knee (7%), lateral ligament sprains of the ankle (6%) and anterior cruciate ligament injuries (4%). In conclusion, sports medicine clinics treat a wide variety of football injuries and appear to be a good source of data about injuries to non-elite participants.     

Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League

The purpose of this study was to assess the safety of intramuscular corticosteroid injection in selected, severe hamstring injuries in professional football players. Clinicians have been reluctant to use corticosteroid injections in or around muscle-tendon units because of concern of incomplete healing or rupture. We retrospectively reviewed the computer database of one National Football League team for all hamstring injuries requiring treatment between January 1985 and January 1998. We found that 431 players had suffered such injury. We developed a clinical grading system to identify hamstring injury severity and to stratify players for treatment. Fifty-eight players (13%) sustained severe, discrete injuries with a palpable defect within the substance of the muscle and were treated with intramuscular injection of corticosteroid and anesthetic. There were no complications related to the injection of corticosteroid. Only nine players (16%) missed any games as a result of their injury. Final examination revealed no strength deficits, normal muscle bulk and tone, and the ability to generate normal power. We believe that the grading system we developed can assist in selection of injury type for injection. Although lack of a control group limits statements of efficacy of injection, our impression is that intramuscular corticosteroid injection hastens players' return to full play and lessens the game and practice time they miss.     

The playing habits and other commitments of elite junior Australian football players

The Victorian Football League Under 18 (VFL U18) competition provides a pathway to the elite senior level of Australian football. Players involved in the VFL U18 competition also play football in other contexts, including for school and local clubs, and can have considerable additional work and educational demands. A total of 103 elite junior Australian football players from six VFL U18 clubs participated in a survey that asked about their football playing habits and other commitments. The median age of players when they first joined their VFL U18 squad was 16.3 years. The players participated in a median of five weekly training sessions during the last two weeks of the 1999 preseason and played a median of five preseason games. Fifty percent of the players expected to participate in 3-4 training sessions per week and 25% expected to play more than two games per week during the 1999 season. Half of the players reported ambitions to play Australian Football League (AFL) football. Further research is needed to determine whether or not high participation levels have negative impacts on performance and injury risk in these players.     

Epidemiology of injuries in typical Scandinavian team sports

An investigation by questionnaire was undertaken in a group of 480 football players and 288 handball players (768 players). Of these 803 were injured, giving a player incidence of 4.1 injury/1000 football hours and 8.3 injury/1000 handball hours. The lower extremities were involved in 82% of the football injuries, whereas handball injuries were evenly distributed on both upper and lower extremities. The football injury prevalence was 0.36 per player, the handball injury prevalence 0.71 per player. Medical attention was given to 62% of the injured footballers and 47% of the injured handballers. Based on the injury pattern, some modifications to the rules and equipment in the two sports is suggested: The "boot-type" footwear should be tried out, and the soles in both games should correspond to the different playing surfaces that may be encountered. Stricter enforcement of the rules, and the use of a maximum size playing ground in both sports. Last, but not least a modification of the football rules concerning substitution is a must.     

Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League

BACKGROUND: Anterior cruciate ligament injuries are common in professional football players, and their career impact is unclear. PURPOSE: To quantify the affect of anterior cruciate ligament injuries on professional football player performance. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Anterior cruciate ligament injury data from the National Football League were collected during a 5-year period (1998-2002) for running backs and wide receivers. Recorded variables included player age, experience, position, time to return to competition, and yearly total yards and touchdowns. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after injury. A control group consisted of all running backs and wide receivers without an identified anterior cruciate ligament injury who competed in the 2000 season. RESULTS: Data were analyzed for 31 running backs and wide receivers with 33 anterior cruciate ligament injuries. More than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 +/- 5.4 weeks (mean +/- standard error) after injury. For the 24 anterior cruciate ligament-injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 +/- 1.1 preinjury to 6.5 +/- 0.9 postinjury. This decline in power rating per game played was statistically significant (P = .002) when compared with the change for the 146 control players. CONCLUSION: Nearly four fifths of National Football League running backs and wide receivers who sustain an anterior cruciate ligament injury return to play in a game. On return to competition, player performance of injured players is reduced by one third.     

Catastrophic head injuries in high school and college football players

BACKGROUND: Catastrophic head injuries in football are rare but tragic events. PURPOSE: To update the profile of catastrophic head injuries in high school and college football players and to describe relevant risk factors. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed 94 incidents of severe football head injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002). RESULTS: In the study period there were an average of 7.23 (standard deviation = 2.05) direct high school and college catastrophic head injuries in scholastic football participants per year. There were 0.67 injuries per 100 000 (95% confidence interval: 0.54, 0.81 per 100 000) high school and 0.21 injuries per 100 000 (95% confidence interval: 0.0, 0.49 per 100 000) college participants for a risk ratio of 3.28 (95% confidence interval: 0.81, 13.3). The injuries resulted in subdural hematoma in 75 athletes, subdural hematoma with diffuse brain edema in 10 athletes, diffuse brain edema in 5 athletes, and arteriovenous malformation or aneurysm in 4 athletes. Fifty-nine percent of the contacts reported that the athlete had a history of a previous head injury, of which 71% occurred within the same season as the catastrophic event. Thirty-nine percent of the athletes (21 of 54) were playing with residual neurologic symptoms from the prior head injury. There were 8 (9%) deaths as a result of the injury, 46 (51%) permanent neurologic injuries, and 36 (40%) serious injuries with full recovery. Most players sustained a major impact to the head either from tackling or being tackled. CONCLUSION: The incidence of catastrophic head injuries in football has remained low since the advent of the modern day football helmet in the early 1970s. The incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level. Although the reason for this discrepancy is unclear, an unacceptably high percentage of high school players were playing with residual symptoms from a prior head injury. Coaches, athletes, athletic trainers, and medical personnel need to adhere to the guideline that an athlete with any neurologic symptoms from a head injury should be strongly discouraged from returning to play.     

Rotator cuff contusions of the shoulder in professional football players: epidemiology and magnetic resonance imaging findings

BACKGROUND: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players. PURPOSE: To determine a single professional football team's incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From 1999 to 2005, a North American professional football team's injury records were retrospectively reviewed for athletes who had sustained a rotator cuff contusion of the shoulder during in-season participation. Those patients who had magnetic resonance imaging of the shoulder with a 1.5-Tesla magnet were reviewed by a musculoskeletal radiologist and graded according to the appearance and severity of clinical injury. RESULTS: Twenty-six players had a rotator cuff contusion. There was an average of 5.5 rotator cuff contusions per season (47% of all shoulder injuries). The predominant mechanism of injury was a direct blow in 70.3%. Magnetic resonance imaging findings included peritendon edema at the myotendinous junction, critical zone tendon edema, and subentheseal bone bruises. Treatment consisted of a protocol involving modalities and cuff rehabilitation in all patients. Six patients had persistent pain and weakness for a minimum of 3 days and were given a subacromial corticosteroid injection. Overall, 3 patients (11.4%) required later surgical treatment on the shoulder. CONCLUSION: Rotator cuff contusions accounted for nearly half of all shoulder injuries in the football players in this study. Magnetic resonance imaging is an extremely useful tool in determining severity of injury and integrity of the rotator cuff. The majority of athletes are able to return to sports with conservative treatment; a minority of shoulders might progress to more severe injuries such as rotator cuff tears.     

Performance-based outcomes following patellar tendon repair in professional athletes

ABSTRACT

Objectives: There are limited data on the impact of a patellar tendon repair to a professional athlete’s career. The purpose of this study was to determine differences return to play (RTP) rate, career length, and performance-based outcomes after a patellar tendon repair in professional athletes of four different sports.

Methods: Participants met inclusion criteria if initial reports of the date and type of surgery were corroborated by at least two independent sources of information through a well-established protocol of public newspaper archives, team injury reports, and player profiles. Players with other concomitant injuries of the knee or treated nonoperatively were excluded. One hundred and three athletes across professional baseball, basketball, American football, and soccer athletes were identified and met inclusion criteria. RTP rate, career length, and sports-specific performance statistics (i.e. player efficiency rating (PER) for professional basketball players) before and after surgery were collected for each athlete.

Results: Seventy-nine (76.7%) professional athletes successfully RTP. American football athletes had the lowest RTP rate and the largest drop in performance in post-operative season 1 (P < 0.001). These athletes also experienced the shortest adjusted career lengths (P = 0.003) compared to players in the other sports. Basketball athletes played significantly less games through post-operative seasons 1 to 3 (P < 0.05). Soccer athletes had less goals and assists per game and played fewer games (P < 0.05) in post-operative season 1 that recovered to baseline by seasons 2 and 3.

Conclusion: A patellar tendon rupture is a potentially devastating injury for the professional athlete. American football players appeared to have the worst postoperative outcome with the lowest RTP rate and a most significant decrease in performance in the first postoperative season. This procedure also had a significant short-term impact on soccer athletes who sustained decreases in short-term game performance. These findings are likely explained by the unique physical demands imposed by each sport.     

Recurrent concussion and risk of depression in retired professional football players

PURPOSE: The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. METHODS: A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) yr and an average professional football-playing career of 6.6 (+/-3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). RESULTS: Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (chi2=71.21, df=2, P<0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. CONCLUSION: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.     

Injury surveillance in male professional football; is medical staff reporting complete and accurate?

Since the 2000 season, an injury surveillance system has been established to monitor injury risk and injury patterns in the Norwegian professional football league. The aim of this study was to assess the accuracy of routine injury registration performed by medical staff in professional football. The team medical staff completed injury registration forms on a monthly basis throughout the 2007 season (January–October). Players were interviewed at the end of the season (October/November) about all injuries that occurred from July through September. Thirteen of fourteen teams, 296 of 310 A‐squad players were interviewed. An injury was recorded when a player was unable to take fully part in football training or match the day after injury. A total of 174 injuries were registered, 123 acute injuries and 51 overuse injuries. Of these, 141 were reported by medical staff and 122 by players. Eighty‐nine injuries (51%) were registered using both methods, 52 (30%) by medical staff only and 33 (19%) by player interviews only. Prospective injury surveillance by team medical staff in Norwegian male professional football underestimates the incidence of time‐loss injuries by at least one‐fifth.     

Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study.

OBJECTIVE: To examine the mechanisms of injury for concussions in university football, ice hockey, and soccer. DESIGN: Prospective analysis. SETTING: McGill University. PATIENTS: All athletes participating in varsity football, ice hockey, and soccer. MAIN OUTCOME MEASURES: Athletes participating in university varsity football, ice hockey, and soccer were followed prospectively to determine the mechanisms of injury for concussions, whether certain mechanisms of injury causing concussions were more common in any of the three sports, whether different areas of the body seem to be more vulnerable to a concussion after contact, and whether these areas might be predisposed to higher grades of concussion after contact. RESULTS: There were 69 concussions in 60 athletes over a 3-year period. Being hit in the head or helmet was the most common mechanism of injury for all 3 sports. The side/temporal area of the head or helmet was the most probable area to be struck, resulting in concussion for both football and soccer. When examining the body part or object delivering the concussive blow, contact with another player's helmet was the most probable mechanism in football. CONCLUSION: The mechanisms of injury for concussions in football are similar to previously published research on professional football players. The mechanisms of injury for concussions in soccer are similar to past research on Australian rules football and rugby.     

Analysis of more than 20,000 injuries in European professional football by using a citizen science-based approach: An opportunity for epidemiological research?

ObjectivesIt has been claimed that analyses of large datasets from publicly accessible, open-collaborated (“citizen science-based”) online databases may provide additional insight into the epidemiology of injuries in professional football. However, this approach comes with major limitations, raising critical questions about the current trend of utilizing citizen science-based data. Therefore, we aimed to determine if citizen science-based health data from a popular online database on professional football players can be used for epidemiological research, i.e. in providing results comparable to other data sources used in previously published studies.DesignRetrospective database analysis.MethodsTransfermarkt.com (Transfermarkt; Hamburg; Germany) is a publicly accessible online database on various data of professional football players. All information provided in the section “injury history” of football players from the top five European leagues over a period of ten seasons (2009/10–2018/19) was analyzed. Frequency, characteristics, and incidence of injuries were reported according to seasons and countries, and results compared with three previously published databases (a scientific injury surveillance, a media-based study, and an insurance database).ResultsOverall, 21,598 injuries of 11,507 players were analyzed from the Transfermarkt.com database. Incidence was 0.63 injuries per player-season (95% confidence interval 0.62 to 0.64) but significant differences between subgroups (countries, years) were found. In comparison to other databases, citizen science-based data was associated with lower injury incidences and higher proportions of severe injuries.ConclusionsWith few exceptions (e.g., severe injuries), the use of citizen science-based health data on professional football players cannot be recommended at present for epidemiological research.     

Body cell mass measured by bioelectrical impedance spectroscopy in professional football (soccer) players

AIM: The aim of this study was to measure body cell mass (BCM) in two football (soccer) teams and assess if there are differences in body composition among players of different field positions. METHODS: Two professional Italian (male) football teams, representing two different divisions (A and C), have been recruited. There were 14 players (4 forwards, 4 defenders, 6 midfielders) in A and 18 players (4 forwards, 4 defenders, 8 midfielders, 2 goalkeepers) in C. Fat free mass (FFM), fat mass (FM), percent body fat (%BF), and BCM have been assessed using bioelectrical impedance spectroscopy (BIS). RESULTS: There were no significant differences in age, body weight, height or body mass index between teams. Team A's BCM was approximately 4 kg greater than C (P=0.001). FFM was significantly greater in midfielders and defenders in A vs C (P=0.02). FFM was significantly lower in forwards compared to defenders within A (P=0.02). Within A, FM and %BF were significantly lower for defenders compared to forwards and midfielders (P=0.01), and BCM was significantly greater in forwards vs defenders (P=0.01), with no significant differences among other field positions. BCM was significantly greater in forwards vs midfielders and defenders within C (P=0.02), with no significant differences between midfielders and defenders. CONCLUSIONS: BCM, measured using BIS, represents an innovative, simple approach to assess body composition. The present study demonstrates that it is very important to analyze body composition in football players, not only with the aim to evaluate the variation of weight in a quantitative and qualitative way, but also with the purpose of selecting players for specific roles. Although these results must be considered not yet conclusive, they could be an important information for coaches, especially during the selection of young football players.