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.     

Effect of ankle disk training on postural control in patients with functional instability of the ankle joint

The postural control of ten male soccer players with functional instability (FI) of the ankle joint, i.e., recurrent sprains and/or a feeling of giving way, was studied before and after ankle disk training. Postural control was studied by means of stabilometry and an optoelectronic movement recording system. In the present study, we found increased postural sway in men with functional instability, which is in line with previous studies. We found improved postural control after ankle disk training as shown by stabilometry. Postural correction patterns were restored, and segmental displacement amplitudes reached even supranormal values. A subgroup of players with unilateral FI also decreased postural sway when standing on the non-symptomatic, untrained foot after ankle disk training. This bilateral improvement and the restored postural correction pattern do not tally with Freemans proprioceptive theory for postural control, but stresses the importance of central motor programs.     

Proprioception and ankle injuries in soccer

Because soccer attracts many participants and leads to a substantial number of injuries, especially of the lower extremities, it is important to study possibilities for injury prevention and proper rehabilitation to return safely to activities. Ankle sprains can be prevented by external ankle supports and proprioceptive-coordination training, especially in athletes with previous ankle sprains. Proprioception is a broad concept that includes balance and postural control with visual and vestibular contributions, joint kinesthesia, position sense, and muscle reaction time. Proprioceptive feedback is crucial in the conscious and unconscious awareness of a joint or limb in motion. Enhancement of functional joint stability by proprioceptive (or neuromuscular) training is important both in prevention and rehabilitation of athletic injuries.     

Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players

BACKGROUND: Ankle sprains are frequent injuries in soccer. Several strategies can be used to prevent further ankle sprains in athletes: the most common are proprioceptive training, strength training, and orthoses. OBJECTIVE: To investigate which of these 3 interventions is the most effective in preventing ankle sprains in athletes with previous ankle inversion sprain. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS AND MEASURES: Eighty male soccer players (age, 24.6 +/- 2.63 years; height, 175.60 +/- 4.36 cm; weight, 64.26 +/- 8.37 kg) in the first division of a men's league who had experienced previous ankle inversion sprain were randomly selected from an original population of 120 players. The subjects were individually and randomly assigned to 4 study groups: group 1 (n = 20) followed the proprioceptive program, group 2 (n = 20) followed the strength program, group 3 (n = 20) used orthoses, and group 4 (n = 20) was the control group. Data on the frequency of ankle sprain reinjury were collected at the end of the session. RESULTS: There were no significant differences among the groups in the number of exposures. The incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group (relative risk of injury, 0.13; 95% confidence interval, 0.003-0.93; P = .02). The findings with respect to the strength and orthotic groups in comparison with the control group were not significant (relative risk of injury, 0.5; 95% confidence interval, 0.11-1.87; P = .27 for strength; relative risk of injury, 0.25; 95% confidence interval, 0.03-1.25; P = .06 for orthotic group). CONCLUSION: Proprioceptive training, compared with no intervention, was an effective strategy to reduce the rate of ankle sprains among male soccer players who suffered ankle sprain.     

The prevention of ankle sprains in sports. A systematic review of the literature

To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. Ten citations of studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention. Methods tested included wrapping the ankle with tape or cloth, orthoses, high-top shoes, or some combination of these methods. Most studies indicate that appropriately applied braces, tape, or orthoses do not adversely affect performance. Based on our review, we recommend that athletes with a sprained ankle complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Both coaches and players must assume responsibility for prevention of injuries in sports. Methodologic limitations of published studies suggested several areas for future research.     

Prevention of soccer injuries. Supervision by doctor and physiotherapist

To study the efficacy of an injury prevention program in a randomized trial, 12 teams (180 players) in a male senior soccer division were followed up for 6 months. The 12 teams were allocated at random to two groups of six teams, one being given a prophylactic program and the other serving as control. The program was based on previous studies of injury mechanisms. It comprised (1) correction of training, (2) provision of optimum equipment; (3) prophylactic ankle taping; (4) controlled rehabilitation; (5) exclusion of players with grave knee instability; (6) information about the importance of disciplined play and the increased risk of injury at training camps; and (7) correction and supervision by doctor(s) and physiotherapist(s). The injuries in the test teams were 75% fewer than in the controls. The most common types of soccer injuries, sprains and strains to ankles and knees, were all significantly reduced. It is concluded that the proposed prophylactic program, including close supervision and correction by doctors and physiotherapists, significantly reduces soccer injuries.     

Foot and Ankle Injuries in Professional Soccer Players

Soccer is a physically demanding and highly competitive sport with a high rate of injuries. The foot and the ankle joint are especially at danger. Risk factors of foot and ankle injuries in soccer players are: lack of structured warm up training, neuromuscular deficits, inadequate training, chronic fatigue, previous injuries, foul play, artificial turf, and others. While the most common injury is the ankle sprain, complex injuries like fractures, ligament tears, and cartilage damage can occur. Such injuries have a high impact on the player's career. Professional soccer players are pressured to meet the expectations of the clubs, and the public. While most injuries to the foot and ankle joint can be treated conservatively, complex injuries require anatomic reconstruction to allow for quick rehabilitation and return to play earliest possible.     

Previous injuries and persisting symptoms in female soccer players

One hundred and fifty players in a female senior soccer division, starting up a new season, were examined for past injuries and persisting symptoms. An incidence of 0.18 injury/player/year was found, which is not significantly different from previously reported injury rates for male soccer. Sprains to the lower extremity and shin-splints were the most common previous injuries. Forty-three percent of the players had some kind of persistent symptom as a result of a past injury. Symptoms from previous ankle and knee sprains and from overuse injuries were the most common. Players who had sustained an ankle joint injury were more prone to have persistent symptoms (p less than 0.05) if they had persistent mechanical instability. Compared to previous retrospective studies on men's soccer, the women showed a higher rate of previous patellar dislocations. These injuries often caused persistent symptoms. The women showed fewer serious knee injuries. This might depend on a real difference in incidence or is just a reflection of female players ceasing to play soccer after a severe knee injury.     

The effect of a balance training program on the risk of ankle sprains in high school athletes

BACKGROUND: Ankle sprains are the most common musculoskeletal injuries that occur in athletes, and they have a profound impact on health care costs and resources. HYPOTHESIS: A balance training program can reduce the risk of ankle sprains in high school athletes. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Seven hundred and sixty-five high school soccer and basketball players (523 girls and 242 boys) were randomly assigned to either an intervention group (27 teams, 373 subjects) that participated in a balance training program or to a control group (28 teams, 392 subjects) that performed only standard conditioning exercises. On-site athletic trainers recorded athlete exposures and sprains. RESULTS: The rate of ankle sprains was significantly lower for subjects in the intervention group (6.1%, 1.13 of 1000 exposures vs 9.9%, 1.87 of 1000 exposures; P = .04). Athletes with a history of an ankle sprain had a 2-fold increased risk of sustaining a sprain (risk ratio, 2.14), whereas athletes who performed the intervention program decreased their risk of a sprain by one half (risk ratio, 0.56). The ankle sprain rate for athletes without previous sprains was 4.3% in the intervention group and 7.7% in the control group, but this difference was not significant (P = .059). CONCLUSION: A balance training program will significantly reduce the risk of ankle sprains in high school soccer and basketball players.     

Stabilometry in functional instability of the ankle and its value in predicting injury

Stabilometry is an objective method used for studying postural equilibrium quantitatively. Stabilometric recordings were made in 127 soccer players to demonstrate functional instability of the ankle joint. The presence of previous ankle joint injuries, i.e., sprains or fractures, was documented. Reference values for stabilometry were obtained from a group of 30 normally-active non-soccer players without a history of injury to the ankle joint. A pathological stabilometric value was defined as one exceeding the mean value of the reference group by 2 SD. In players with a history of previous ankle joint injury no increased postural sway was found. On the other hand, players showing abnormal stabilometric values ran a significantly (P less than 0.001) higher risk of sustaining an ankle injury during the following season compared to players with normal values. Players with a history of previous ankle joint injury did not run a higher risk compared to players without previous injury. The findings indicate that an ankle joint injury did not result in a persistent functional instability; however, such instability did increase the risk of ankle joint injury.     

Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players

BACKGROUND: Ankle sprains are the most common form of acute injury in volleyball. A prevention programme consisting of technical training, proprioceptive training, and external support was previously designed to reduce the rate of ankle sprains in volleyball players. OBJECTIVE: To investigate which of these three interventions is the most effective in preventing ankle sprain in female volleyball players. METHODS: Participants were 52 players who suffered ankle sprains during the season 1998-1999. They were divided randomly into three preventive groups: group 1 (n = 18) followed the technical training programme; group 2 (n = 17) followed the proprioceptive programme; group 3 (n = 17) used orthosis. The players followed their respective programmes for the whole of the 1999-2000 season. Data were collected at the end of the season. RESULTS: The three preventive strategies were all effective in preventive further ankle sprain. Technical training was slightly more effective than the other two methods. Orthosis was not effective in athletes who had suffered ankle sprains more than three times during their careers. Under those circumstances, technical training and proprioceptive training were equally effective at preventive further sprains. CONCLUSIONS: Technical training and proprioceptive training are effective methods of preventing ankle sprain in volleyball players who have suffered this injury four or more times during their career. Orthosis appears effective only in players with fewer than four previous sprains.     

Relationship between balance ability, training and sports injury risk

Traditionally, balance training has been used as part of the rehabilitation programme for ankle injuries. More recently, balance training has been adopted to try and prevent injuries to the ankle and knee joints during sport. The purpose of this review is to synthesise current knowledge in the area of balance ability, training and injury risk, highlight the findings and identify any future research needs. A number of studies have found that poor balance ability is significantly related to an increased risk of ankle injuries in different activities. This relationship appears to be more common in males than females.Multifaceted intervention studies that have included balance training along with jumping, landing and agility exercises have resulted in a significant decrease in ankle or knee injuries in team handball, volleyball and recreational athletes. It is unknown which component of the multifaceted intervention was most effective and whether the effects are additive. As a single intervention, balance training has been shown to significantly reduce the recurrence of ankle ligament injuries in soccer, volleyball and recreational athletes; however, it has not been clearly shown to reduce ankle injuries in athletes without a prior ankle injury. Balance training on its own has also been shown to significantly reduce anterior cruciate ligament injuries in male soccer players. Surprisingly, it was also found to be significantly associated with an increased risk of major knee injuries in female soccer players and overuse knee injuries in male and female volleyball players. The studies with the contrasting findings differed in aspects of their balance training programmes.It would appear that balance training, as a single intervention, is not as effective as when it is part of a multifaceted intervention. Research is required to determine the relative contribution of balance training to a multifaceted intervention so as to generate an effective and efficient preventative programme that can be adopted by athletes of most levels.     

Ankle injuries in basketball players

We carried out a retrospective study of the frequency of ankle sprains in basketball players. A questionnaire about previous ankle injuries, time off after such injuries, current ankle problems, personal data, number of practice hours and the use of prophylactic measures was sent out to 102 basketball players in a second division league in Sweden. Ninety-six players answered. 92% of them had suffered an ankle sprain while playing basketball, and of these 83% reported repeated sprains of one ankle. In the last two seasons, 78% of the players had injured at least one ankle. The injury frequency in the investigation was 5.5 ankle injuries per 1000 activity hours. 22% of the players used some kind of prophylactic support of their ankle joints. Because of the great number of ankle sprains and the disability in terms of time away from sports that they cause, prevention of these injuries is essential.     

A one season prospective cohort study of volleyball injuries

Objective: To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains.

Methods: 486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury.

Results: 100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites.

Conclusions: Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.

     

Injuries in Norwegian female elite soccer: a prospective one-season cohort study

Female soccer has become increasingly popular during the last two decades. According to the International Football Association (FIFA) there are approximately 40 million registered female soccer players in the world. Three studies in elite soccer have shown an injury incidence during games ranging from 12.6 to 23.3 injuries per 1,000 h. A very high incidence of ACL-injuries ranging from 0.31 to 2.2 per 1,000 game hours has also been shown. We followed the Norwegian female elite series during the 2001 season to estimate the incidence and characteristics of injuries. A total of 181 female soccer players on ten teams were followed during the 2001 elite season in Norway. We recorded baseline data, match and training exposure and injury data as type of injury, location and severity of injury. The mean age of the players was 23 years (range 17–34). A total of 189 injuries were recorded and 19 (10%) of these were overuse injuries; 89 (47%) occurred during games and 100 (53%) during training sessions. The incidence of acute injuries was 23.6 per 1,000 game hours and 3.1 per 1,000 training hours. The majority of the injuries occurred in the lower extremities (81%), but there were also a significant number of head injuries (6.3%). The most common injury type was ankle sprain (17.2%). Half of the injuries were minor, with training or game absence of less than 7 days. Midfielders sustained the most injuries (32.6%) with an incidence of 42.4 per 1,000 game hours. We recorded two ACL-injuries and two PCL-injuries during the season. They all occurred during games, and the incidence was therefore calculated to 0.6 per 1,000 game hours for both injury types. The incidences of injuries reported for female soccer varies considerably, with the highest numbers reported from Germany and the present study. These studies have also the highest incidence of minor injuries registered. The location of the injuries is quite similar compared to other reports, but the number of ankle sprains seems to be higher in our study, whereas the number of knee and thigh injuries is lower. There has been much attention to ACL injuries in team handball and hamstring injuries in soccer in Norway, and this could have influenced the team’s pre-season training, resulting in a reduction in the incidence of these injury types. The high number of ankle injuries has to be addressed to see whether this is a result of inadequate rehabilitation routines leading to re-injuries, or other factors. The high number of ACL-injuries in these reports is alarming and needs special attention in the future.     

Prevention of anterior cruciate ligament injuries in soccer

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained normally and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the control group and 0.15 injuries per team per year in the proprioceptively trained group (P<0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.     

Soccer injuries and their mechanisms: a prospective study

In order to study the incidence and mechanisms of injury in soccer and to recommend prophylactic measures, 180 players in a senior male soccer division were followed prospectively for 1 yr. Attendance records for games and practice sessions were kept, and all injuries were examined and treated by the same orthopaedic surgeon. One hundred twenty-four players incurred 256 injuries, mostly sprains and strains of the lower extremities. Of these, 62% were considered minor with ankle sprains being the most common (17%), while 11% were considered major with knee ligament sprains being the most frequent (32%). Overuse injuries were most frequent in the preseason training period. Traumatic leg injuries involved players with inadequate or no shin guards. Of the traumatic knee injuries, 11 of 18 (61%) occurred during a collision; non-contact knee injuries were frequently seen in those players with a history of knee injury and existing instability. Study of injury sequence disclosed that a minor injury was often followed within two months by a major one. In addition, with severe injuries incurred during fouls, the individual causing the penalty was injured. This prospective study suggested that those with knee instability and those allowed to resume play with poorly rehabilitated or clinically unhealed injuries are more apt to sustain further injury. Some injuries can be avoided by using better equipment and by observance of the rules.     

Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season

In this prospective study, injuries in 153 adolescent female soccer players were recorded during one outdoor season (April-October). The overall injury incidence rate was 6.8 per 1000 h soccer (games and practice) and the incidence rate of traumatic injury 9.1 and 1.5 per 1000 player-hours in games and practice, respectively. Sixty-three players (41%) sustained 79 injuries. Sixty-six percent of the injuries were traumatic and 34% were overuse injuries. Most of the traumatic injuries occurred during games. Eighty-nine percent of the injuries were located in the lower extremities and 42% occurred in the knee or ankle. The most frequent type of injury was ankle sprain (22.8%). Forty-one percent of the traumatic injuries and 56% of the ankle sprains were re-injuries. Most of the injuries were of moderate severity (52%), while 34% were minor and 14% were major. Most of the major injuries were traumatic such as knee ligament injuries and ankle sprains.     

Hormonal therapy: ACL and ankle injury

BACKGROUND: No definitive explanation for the difference in rate of male and female noncontact ACL injury has been found. The hormonal environment, known to be different in men and women has been hypothesized as a possible source for this difference in injury rate. PURPOSE: To confirm earlier work looking at periodicity of noncontact ACL injury. To increase sample size by adding ankle sprains. To determine the rate of noncontact ACL injury and ankle sprains in collegiate basketball and soccer. To determine if the use of oral contraceptives affects the rate of noncontact ACL injury and ankle sprains. METHODS: Data was collected from a sample of NCAA schools over the 2000-2001 basketball and the 2001-2002 basketball and soccer seasons. RESULTS: Recall and prospective data collection of length of menstrual cycle did not produce equivalent results. Periodicity was present only in the recall group of "off pill" users. The rate of noncontact ACL injury and noncontact ankle sprains was twice as high in basketball as in soccer. There was no difference in rate of injuries between those athletes using hormonal therapy and those athletes not using hormonal therapy. CONCLUSIONS: Noncontact ACL injuries and ankle sprains occurred at significantly higher rates in basketball than in soccer but this rate difference was not linked to hormonal therapy usage. The overall rate of noncontact ACL injury and ankle sprain to women's collegiate basketball and soccer players is very low.