The incidence and nature of injuries sustained on grass and 3rd generation artificial turf: A pilot study in elite Saudi National Team footballers

Purpose of the studyTo compare the incidence, severity and nature of injuries sustained by Saudi National Team footballers during match-play and training on natural grass and 3rd generation (3G) artificial turf.MethodInjury data was collected on all Saudi National Team players competing at the Gulf Cup (Yemen December 2010: 3G) and the Asian Cup (Qatar January 2011; grass). A total of 49 players were studied (mean ± SD; Age 27 ± 4 yr; body mass 71.4 ± 6.7 kg; height 176.8 ± 6.3 cm; professional playing experience 9 ± 3 yr) of which 31 competed at the Gulf Cup, 32 at the Asian Cup (14 at both). A prospective cohort design was used to investigate the incidence, nature and severity of injuries sustained with data collected using a standardised injury questionnaire. All data were collected by the team physiotherapist with the definition of injury set at any injury that required player and clinician contact. Injury and exposure data were collected and reported for games, training and all football activity.ResultsA total of 82 injuries [incidence – 56.1 per 1000 h total game and training exposure] were recorded at the Asian Cup (grass) and 72 injuries [incidence – 37.9 per 1000 h total game and training exposure] were recorded at the Gulf Cup (3G). Incidence data for training, game and all football exposure injury rates were higher when playing on grass. The vast majority of injuries on both surfaces were very minor that, whilst requiring medical attention, did not result in loss of match/training exposure. Injuries that resulted in 1–3 days absence from training or game play had similar incidence rates (Grass: 7.4 vs. 3G: 7.4 injuries per 1000 h exposure). More severe injuries were less frequent but with a higher incidence when playing on grass. Lower limb injuries were the most common in both tournaments with a higher incidence on grass (Grass: 14.2 vs. 3G: 7.9 injuries per 1000 h exposure). Muscle injuries were the most frequent of all injuries with similar incidence rates on both surfaces (Grass: 5.4 vs. 3G: 4.7 injuries per 1000 h exposure). Injuries that involved player contact were also more common on grass (Grass: 11.5 vs. 3G: 3.2 injuries per 1000 h exposure).ConclusionWhether reporting all injuries or just those that prevented players from taking part in training or match play, injury incidence rates were generally higher when Saudi National Team footballers played on grass than on 3G artificial surface. Although this is a small study, the unique quasi-repeated measures study design with elite Saudi National Team footballers, adds to the current belief that 3G artificial turf does not increase injury risk in football.     

Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players

ObjectiveTo determine if pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can identify Gaelic football players at risk of developing groin injury.DesignProspective study.SettingSenior inter-county Gaelic football team.ParticipantsFifty-five male elite Gaelic football players (age = 24.0 ± 2.8 years, body mass = 84.48 ± 7.67 kg, height = 1.85 ± 0.06 m, BMI = 24.70 ± 1.77 kg/m²) from a single senior inter-county Gaelic football team.Main outcome measuresOccurrence of groin injury during the season.ResultsTen time-loss groin injuries were registered representing 13% of all injuries. The odds ratio for sustaining a groin injury if pre-season adductor squeeze test score was below 225 mmHg, was 7.78. The odds ratio for sustaining a groin injury if pre-season HAGOS function, sport and recreation subscale score was < 87.5 was 8.94. Furthermore, for each additional point on the numerical rating scale pain rating during performance of the adductor squeeze test, the odds of groin injury increased by 2.16.ConclusionThis study provides preliminary evidence that pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can be used to identify Gaelic football players at risk of developing groin injury.     

Incidence of injuries among professional football players in Spain during three consecutive seasons: A longitudinal,retrospective study

ObjectivesThe aim of the study was to determine risk factors that maybe be associated with a higher incidence of injuries in elite football players in the Spanish league during a three-year follow-up. Injury was defined as a musculoskeletal complaint (pain and/or discomfort) reported by players to the medical staff and receiving medical attention.DesignA longitudinal retrospective study.Settingand participants: Seventy-one players from Malaga Football Club, who were in the first squad team for three consecutive seasons.Main outcome measuresIncidence, location, severity of injuries were reported according to the Injury Consensus Group for football injuries.ResultsThree hundred and fifty six injuries were found, with the highest proportion (44%) being located in the thigh. We found 6.9 (SD 5.87) injuries per 1000 h of match time and 0.23 (SD 0.22) per 1000 h of training. Forwards presented the highest rates in both incidence and severity of injury. Exposure to training was inversely related to the total number of injuries, which means that the greater the exposure to training the lesser the number of injuries.ConclusionsThis information can assist clinicians in the identification of risk factors and, thus, the elaboration of prevention programmes that reduce football injuries.     

Hypermobility, injury rate and rehabilitation in a professional football squad – A preliminary study

ObjectivesTo determine if joint hypermobility is a risk factor for injury in a professional football squad. Primary objectives were to estimate the prevalence of hypermobility amongst a professional football squad and to undertake an audit of injuries sustained over a season. Secondary objectives were to relate the injury audit findings and hypermobility levels to time missed through injury, assessed by training days and competitive first team games missed after musculo-skeletal injury.HypothesisIncreasing levels of joint hypermobility may result in an increased risk of injury in a contact sport such as professional football.DesignA prospective observational study consisting of the Beighton joint hypermobility screen and an injury audit (season 2007/8).SettingA second tier, English professional football club.ParticipantsThirty-three male professional footballers aged 18–35 years.Main outcome measuresThe Beighton joint hypermobility screen and a seasonal injury audit.ResultsThe prevalence of joint hypermobility was found to be between 21 and 42% depending on the cut-off score used for the Beighton scale. Similar injury rates were found in both the hypermobile and non-hypermobile participants (6.2 as compared to 6.3 injuries/1000 h exposure respectively). Once injured, the hypermobile group showed a tendency towards missing more competitive first team games (12 as compared to 5/season in non-hypermobiles) and training days (71 as compared to 31 days/season in non-hypermobiles). These findings were not statistically significant.ConclusionsThe prevalence of joint hypermobility in a cohort of professional footballers is comparable to previous studies in athletic populations and is dependent upon which Beighton cut-off score is selected. It may be inferred from this preliminary study that the return to play timescales in hypermobile individuals may be extended so as to minimise the potential risk of re-injury and limit the socioeconomic costs associated with time out of competition.     

The epidemiology of injury for an elite junior Australian Football cohort

ObjectivesTo implement an injury recording protocol in a junior elite Australian Football competition and determine the injury profile of this population.DesignLongitudinal cohort study.MethodsPlayers from an elite Under 18 Australian Football competition were tracked throughout one football season in terms of participation or non-participation in the football competition. Injury reporting forms were collected for all players who were not available for selection as a result of injury.ResultsThe cohort consisted of 532 players who provided consent for inclusion in the study (100% of players in the competition). There were 256 injuries sustained during the season. Results were standardised to a 40 man team to allow comparison with results from the Australian Football League. The injury incidence was 17.1 new injuries per club (95% CI 14.1–19.4), and prevalence 63.3 missed matches per club (95% CI 59.1–67.1). The category “Ankle joint injuries” was the most commonly reported (n = 34) and “Collision with another player” was the main injury mechanism (n = 75).ConclusionsThe most commonly injured region in junior elite Australian Football was the ankle and collision with another player was the most common injury mechanism. As with previous reports on junior Australian Football, injury incidence was low in comparison to the senior elite competition. Defining the injury profile guides injury prevention strategies. Analysis of injury in junior elite football may provide a unique opportunity to affect both junior and senior injury rates.     

Training habits and injuries of masters' level football players: A preliminary report

ObjectiveTo profile training habits and injuries in football players participating in a national Masters tournament.MethodsA cross-sectional retrospective study design was used to survey male football players attending the 2008 New Zealand Masters Games. Information regarding player demographics, football injuries, football related training, and risk factors for injury were collected.Results199 Players were recruited, with a median age of 44 yrs (range 35–73) and a median football playing history of 15 yrs (range 0–66). Irrespective of age, 112 (84%) players included a warm-up and 104 (78%) included a stretching regime in their regular training programme. In the 12 months prior to the tournament, 128 football related injuries were reported by 93 players (64 injuries/100 players or 46 injured players/100 players). The most frequently injured region was the lower limb; specifically the lower leg (n = 23), ankle (n = 18), hamstring (n = 17), knee (n = 15), and Achilles tendon (n = 15).ConclusionThis study provides a preliminary insight into the training habits and injury profiles of Masters football players. Despite all players including some form of injury prevention strategy in their training, a significant number of players experienced an injury in the 12 months prior to the tournament.     

Injuries in amateur soccer players on artificial turf: A one-season prospective study

BackgroundEpidemiological studies in soccer are important for injury prevention. However, most of the available information is limited to elite players.ObjectiveTo determine the epidemiology of injuries in amateur soccer players on artificial turf.DesignProspective cohort study during one competitive season (2010–2011).SettingAmateur soccer players. Participants: 231 players (aged 24.7; range: 18–38 years).Main outcome measuresInjury incidence was recorded prospectively according to the consensus statement for soccer.Results213 injuries were recorded; 57% of the players suffered injuries. Injury incidence was 5.1 (95% CI: 4.3–5.9) injuries/1000 h exposure. Injury incidence was higher in matches than in training (32.2 [95% CI: 23.1–41.3] vs. 2.4 [95% CI: 1.8–3.0] injuries/1000 h; p < 0.001). The thigh (22.1%), knee (20.2%), and ankle (19.2%) were the most affected regions. The most frequent diagnoses were thigh strain/muscle rupture (18.3%), and ankle and knee strain/ligament injury (17.3% and 11.3%, respectively). Time-loss due to injury was 20.3 (95% CI: 16.8–23.73) days. Most injuries (79%) were traumatic; 21% were overuse injuries. Re-injuries accounted for 10% of all injuries sustained during the season.ConclusionsInjury incidence in amateur soccer players is higher during matches played on artificial turf than during training sessions.     

Epidemiology of football injuries in Asia: A prospective study in Qatar

ObjectivesTo investigate the incidence, characteristics and patterns of football injuries at club level in Qatar.DesignProspective cohort study.MethodsData were prospectively collected from the first division football league clubs in Qatar, in accordance with the international consensus statement on football injury epidemiology. An injury was defined as any physical complaint sustained during football activity resulting in the inability to participate fully in the next training or match. Individual injuries and exposure of each player were recorded by the medical staff of each team over one season.ResultsA total of 217 injuries were recorded, with an injury rate during matches of 14.5/1000 h (95% CI: 11.6–18.0) compared with 4.4/1000 h during training sessions (95% CI: 3.7–5.2). More than one third of all injuries were muscle strains (36.4%). Hamstring strains (54.4% of all muscle strains) exhibited a higher incidence than all other injury types (p < 0.001). The thigh was the most frequent injury location (41.9%, p < 0.001). Reinjuries (15% of total injuries) were mainly comprised of muscle strains associated with a higher severity compared with new injuries.ConclusionsDespite the different environmental, social and cultural setting, our findings are comparable with previous data from European club football, confirming the previous finding at national team level that there are no regional peculiarities of football injuries in this part of the Asiatic continent.The relatively high overuse injury incidence rate and the high recurrence rate for (severe) thigh muscle strains, especially during games, warrants prevention strategies.     

Epidemiology of injury in English Professional Football players: A cohort study

ObjectiveTo estimate the current incidence and location of injury in English professional football.DesignProspective cohort study conducted over one competitive season (2015/16).SettingProfessional football players competing in the English Football League and National Conference.Participants243 players from 10 squads (24.3 ± 4.21 per squad).Main outcome measureInjury incidence, training and match exposure were collected in accordance with the international consensus statement on football injury epidemiology.Results473 injuries were reported. The estimated incidence of injury was, 9.11 injuries/1000 h of football related activity. There was a higher incidence of injury during match play (24.29/1000 h) compared to training (6.84/1000 h). The thigh was the most common site of injury (31.7%), muscle strains accounted for 41.2% of all injuries. The hamstrings were the most frequently strained muscle group, accounting for 39.5% of all muscle strains and 16.3% of all injuries. Moderate severity injuries (8–28 days) were the most common (44.2%).ConclusionsIncidence of injury has increased over the last 16 years with muscle strains remaining the most prevalent injury. The hamstrings remain the most commonly injured muscle group.     

Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001

The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity. The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8/1000 h-1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8/1000 h of football, in both seasons. A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.     

Association between eccentric knee flexor strength and hamstring injury risk in 185 elite Gaelic football players

Hamstring strains are the most common time-loss injury in elite Gaelic football affecting over 20% of players per season. Thus, there is a need to identify factors contributing to the onset of hamstring injuries in order to inform injury risk management strategies. The current study investigated whether eccentric knee flexor strength and between-limb imbalances were associated with increased risk of sustaining a time-loss hamstring injury in elite Gaelic football players. A total of 185 elite male players (26.9 ± 2.7 years, 86.4 ± 6.2 kg, 183.4 ± 5.6) were prospectively followed for 12 weeks from the day of testing. Injury data were provided by the team medical staff. Twenty-eight players (16%) sustained a time-loss hamstring injury following testing. Players that did not sustain a hamstring injury had greater average between-limb asymmetries (uninjured = 9.1%, 95% CI 7.8-10.1; injured = 5.1%, 95% CI 3.7-6.7; P = .001). Eccentric knee flexor strength profiles were not associated with increased or decreased risk of sustaining a hamstring injury and did not alter the post-test probability of sustaining a hamstring injury across the investigation period. These findings do not support the use of eccentric knee flexor strength metrics in managing hamstring injury risk in elite male Gaelic football players.     

The “sequence of prevention” for musculoskeletal injuries among adult recreational footballers: A systematic review of the scientific literature

ObjectiveTo gather epidemiological information related to all steps of Van Mechelen's “sequence of prevention” for musculoskeletal injuries among adult recreational football players.MethodsA systematic review of the scientific literature was conducted in Medline via Pubmed. Therefore, two highly sensitive search strategies based on three groups of keywords (and related search terms) were used.ResultsIn total, 33 relevant original studies were included in our systematic review. The results of our systematic review showed that the incidence of musculoskeletal injuries among recreational adult football players ranged from 9.6 to 15.8 injuries per 1000 exposure hours. These injuries are especially located in the ankle, knee, groin and hamstring, being associated with previous injury and match exposure. The FIFA11 + injury prevention programme and the Nordic Hamstring Exercise (NHE) were found to be effective for the reduction or prevention of musculoskeletal injuries among adult recreational football players.ConclusionsOur systematic review showed that musculoskeletal injuries are common among recreational adult football players, while effective preventive programmes are available. Further studies should focus on the identification and understanding of the key factors responsible for the optimal adoption, implementation and maintenance of these measures.     

UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season

Background: No previous study on adult football involving several different countries has investigated the incidence and pattern of injuries at the highest club competitive level. Objective: To investigate the risk exposure, risk of injury, and injury pattern of footballers involved in UEFA Champions League and international matches during a full football season. Method: Eleven top clubs (266 players) in five European countries were followed prospectively throughout the season of 2001–2002. Time-lost injuries and individual exposure times were recorded during all club and national team training sessions and matches. Results: A total of 658 injuries were recorded. The mean (SD) injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5 (11.0) injuries per 1000 match hours and 5.8 (2.1) injuries per 1000 training hours). The risk of match injury was significantly higher in the English and Dutch teams than in the teams from France, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per 1000 hours; p = 0.008). Major injuries (absence >4 weeks) constituted 15% of all injuries, and the risk of major injury was also significantly higher among the English and Dutch teams (p = 0.04). National team players had a higher match exposure, with a tendency towards a lower training injury incidence than the rest of the players (p = 0.051). Thigh strain was the most common injury (16%), with posterior strains being significantly more common than anterior ones (67 v 36; p<0.0001). Conclusions: The risk of injury in European professional football is high. The most common injury is the thigh strain typically involving the hamstrings. The results suggest that regional differences may influence injury epidemiology and traumatology, but the factors involved are unclear. National team players have a higher match exposure, but no higher risk of injury than other top level players.     

The epidemiology of back injuries in elite Gaelic football athletes: An 8-year prospective study

ObjectivesTo describe the epidemiology of back injury in elite male Gaelic football athletes between 2008 and 2016.DesignProspective cohort study.SettingInjury data from the National GAA Injury Surveillance Database.ParticipantsElite male Gaelic football athletes.Main outcome measuresIncidence of injury as a rate per 1000 h of exposure.Results38 datasets were analysed. Out of a total of 1606 time-loss injuries, 76 were back injuries (4.73%, 95% CI 3.80%–5.88%). The incidence of back injuries in match play was 1.72 (CI 95% 1.21 to 2.45) and in training was 0.2 (CI 95% 0.14 to 0.28) injuries per 1000 h of exposure. The majority of back injuries (63.16%, CI 95% 51.93–73.12) were new, as opposed to recurrent (35.53% CI 95% 25.7–46.74). Most back injuries were acute (51.32%, CI 95% 40.29–62.22), compared to chronic (31.58%, CI 95% 22.23–42.7) or overuse (11.84%, CI 95% 6.36–21.00). The majority of back injuries occurred during non-contact player activities (n = 60, 78.94% CI 95% 68.50–86.60).ConclusionsBack injury rates in Gaelic football are similar to soccer and Australian football but less than rugby union. Further research is needed to understand the factors leading to the onset and recurrence of back injury in Gaelic football athletes.     

Epidemiology and moderators of injury in Gaelic football: A systematic review and meta-analysis

ObjectivesTo quantify the incidence, location and severity of injuries in Gaelic football and to identify potential moderators of those injuries.DesignSystematic review and meta-analysis.MethodsA comprehensive search strategy of six electronic databases was undertaken independently by two researchers in March 2020. Studies must have prospectively investigated injuries sustained by Gaelic footballers over a minimum duration of six months. The Newcastle-Ottawa Scale was used to assess risk of bias. Studies were combined in a pooled analysis using an inverse variance method.ResultsTwelve prospective cohort studies were eligible. The total injury incidence was 10.7 injuries/1000 h of exposure. Match incidence (55.9 injuries/1000 h) was much higher than training (4.6 injuries/1000 h). The lower limb accounted for over 70% of all injuries, with hamstring injuries ranging from 22 to 24% of all injuries. Non-contact injuries were the most common injury mechanism. Players aged >30 were at greatest risk of injury with incidence risk ratios ranging from 1.2 to 2.3. High aerobic fitness and chronic workloads were associated with reduced risk of injury in elite Gaelic footballers.ConclusionsElite Gaelic football athletes are twelve times more likely to get injured during match play compared to training. The lower limb is the most affected body region, and most injuries occur by non-contact mechanisms. Athlete age of greater than 30, poor aerobic fitness and sudden increments in training workload all increase the likelihood of injury. By understanding the incidence and nature of injuries in Gaelic football, targeted injury prevention strategies can be developed and implemented.     

Does generalised ligamentous laxity increase seasonal incidence of injuries in male first division club rugby players?

Objectives: To investigate if ligamentous laxity increases seasonal incidence of injury in male first division club rugby players, and to determine if strength protects against injury in hypermobile and tight players. Methods: Fifty one male first division club rugby players were examined for ligamentous laxity using the Beighton-Horan assessment and graded with an overall laxity score ranging from 0 (tight) to 9 (hyperlax). Each participant was classified into a group determined by their laxity score: tight (0–3), hypermobile (4–6), or excessively hypermobile (7–9). The incidence of joint injuries was recorded prospectively throughout the rugby season and correlated with laxity score. Differences between the groups were analysed. Results: The overall prevalence of generalised joint hypermobility was 24% (12/51). The incidence of injuries was significantly higher in hypermobile (116.7 per 1000 hours) than tight (43.6 per 1000 hours) players (p = 0.034). There were no significant differences in peak strength between the hypermobile and tight groups. Conclusions: The laxity of the players may explain the differences in injury rates between these groups. Peak strength does not protect the hypermobile joint against injury. It appears that hypermobility may cause an increase in the injury rate of male first division club rugby players.     

Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study

Objective

To compare injury risk in elite football played on artificial turf compared with natural grass.

Design

Prospective two‐cohort study.

Setting

Male European elite football leagues.

Participants

290 players from 10 elite European clubs that had installed third‐generation artificial turf surfaces in 2003–4, and 202 players from the Swedish Premier League acting as a control group.

Main outcome measure

Injury incidence.

Results

The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91).

Conclusions

No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low.     

Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players

Groin pain is a condition with a high prevalence in young Australian football players. It is considered that early identification of this condition allows for optimal management. Eighty-six players from two elite under-age Australian football sides were screened weekly for hip adductor muscle strength, using a hand-held dynamometer and for the onset of groin pain. The maximum variation in the average hip adductor muscle strength values of the sample was a 2.6% decrease from baseline in week 7 of the study. Twelve players (14% of the sample studied) reported groin pain for two consecutive weeks and were considered to have an onset of groin injury. The mean hip adductor muscle strength of these players was decreased significantly from baseline by an average of 11.75 ± 2.50% at the week of pain onset (F = 264.76 (1,11), p < 0.001), and 5.82 ± 5.16% in the week preceding the onset of pain (F = 14.03 (1,10), p = 0.004). These results confirm that hip adductor muscle strength is decreased both preceding and during the onset of groin injury in elite under-age Australian footballers.