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EFFECT OF AN INJURY PREVENTION PROGRAM ON
MUSCLE INJURIES IN ELITE PROFESSIONAL SOCCER
ADAM L. OWEN,
1,2
DEL P. WONG,
3
ALEXANDRE DELLAL,
4,5,6
DARREN J. PAUL,
7
EMMANUEL ORHANT,
4
AND STUART COLLIE
1
1
Sports Science Department, Rangers Football Club, Glasgow, Scotland;
2
Claude Bernard Lyon 1 University, Center of
Research and Innovation in Sport; University of Lyon, Villeurbanne, France;
3
Human Performance Laboratory, Technological
and Higher Education Institute of Hong Kong (THEi), Hong Kong;
4
FIFA Medical Excellence Center, Santy Orthopedic
Clinical, Sport Science and Research Department, Lyon, France;
5
OGC Nice, Fitness Training Department, Nice, France;
6
Center of Research and Innovation in Sport (CRIS), University of Lyon 1, Lyon, France; and
7
Sport Science Department,
ASPETAR Sports Medicine and Orthopedic Hospital, Doha, Qatar
ABSTRACT
Owen, AL, Wong, DP, Dellal, A, Paul, DJ, Orhant, E, and Collie, S.
Effect of an injury prevention program on muscle injuries in elite
professional soccer. J Strength Cond Res 27(12): 3275–
3285, 2013—Due to the continual physical, physiological,
and psychological demands of elite level soccer increasing
the incidence and risk of injuries, preventative training pro-
grams have become a common feature of soccer players train-
ing schedule. The aim of the current investigation was to
examine the effectiveness of a structured injury prevention pro-
gram on the number of muscle injuries and the total number of
injuries within elite professional soccer. The present study was
conducted over 2 consecutive seasons, of which the first
(2008–2009) being the intervention season and the second
the control season (2009–2010). In total, 26 and 23 elite male
professional soccer players competing within the Scottish Pre-
mier League and European competition participated. The train-
ing program was performed twice weekly for the entirety of the
season (58 prevention sessions). The results revealed an
increase in the total number of injuries within the intervention
season (88 vs. 72); however, this was largely due to the
greater number of contusion injuries sustained within the inter-
vention season (n= 44) when compared with control season
(n= 23). Significantly less muscle injuries were observed
during the intervention season (moderate effect), and this
occurred concomitant with a bigger squad size (large effect,
p,0.001). The findings from this study identify that a multi-
component injury prevention–training program may be appro-
priate for reducing the number of muscle injuries during
a season but may not be adequate to reduce all other injuries.
KEY WORDS soccer, injury, prevention, hamstring, muscle injury
INTRODUCTION
Soccer is regarded as a high intensity intermittent
contact sport exposing players to continual physical,
technical, tactical, psychological, and physiological
demands (5,11,40). At the elite level, the regular
demands of match play and training performed during the
season’s entirety makes players susceptible to injury. Intui-
tively, losing players to injury will be to the detriment of team
success (2), particularly for teams unable to replace players of
similar abilities due to limited resources. Therefore, injury pre-
vention programs have gained greater impetus as part of the
player’s daily training schedule.
At the elite male professional level within soccer, the
incidence of injuries during competitive match play is sug-
gested to be approximately 24.6–34.8 per 1000 match hours
(2,38,47) with injuries encountered during training sessions
showing to range between 5.8 and 7.6 per 1000 training hours
(2,47). Among the highest number of injuries per season are
those players competing in the English League (1.3 injuries per
player) (15,22). Almost one-third of all soccer-related injuries
are muscle related, with the majority (92%) affecting the fol-
lowing major muscle groups of the lower extremity: ham-
strings (37%), adductors (23%), quadriceps (19%), and calf
muscles (13%) (17,24). The Football Association Audit of
Injuries identified the hamstrings to be the most commonly
injured muscle, constituting 12% of all strains. Indeed, players
are 2.5 times more likely to sustain a hamstring than a quadri-
ceps strain during a game (24,55).
Although the cause of injury is not always known, there
are a number possible factors that may increase its incidence,
these may include insufficient warm-up (56), poor flexibility
(25,58), muscle imbalances (10,42), muscle weakness (9,31),
neural tension (49), fatigue (57), and previous injury (17,42).
Address correspondence to Adam L. Owen, adamleeowen@rangers.co.uk.
27(12)/3275–3285
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VOLUME 27 | NUMBER 12 | DECEMBER 2013 | 3275
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Thus, devising and implementing training programs that
attempt to address some of these issues would obviously
be looked upon favorably with strength and conditioning
coaches and management team. The justification, for exam-
ple, of strength training drills within a program is based on
the notion that a strength imbalance will increase the likeli-
hood of injury in the weaker leg. It has been reported that
players are 2.6 times more likely to suffer an injury in the
weaker leg if this imbalance is ;15% (10,44). Given the
contribution of the quadriceps and hamstring during a num-
ber of soccer actions (i.e. kicking, jumping, running), it is not
surprising that muscular strength is deemed an important
facet. The hamstring in particular is a key contributor during
deceleration as it works eccentrically to slow the body down
and is one reason why eccentric hamstring strength training
(Nordic hamstring lowers) is a popular choice from both an
injury prevention and performance enhancement viewpoint
(2,3). Likewise, the importance of balance training is becom-
ing more apparent in many sporting disciplines, not least
soccer (12,28). Through
greater functional postural acti-
vation, balance training is con-
sidered to be an effective (36)
strategy shown to reduce the
incidence of ankle sprains
(13,48,51), hamstring and gas-
trocnemius strains, patellar ten-
dinopathy, and other lower
extremity pathologies (34,37)
amongst team sport players.
Similarly, the role of core
stability in injury prevention
has gained greater recognition
over recent years as an injury
prevention–training method.
Core stability is defined as the ability to control the position
and motion of the trunk over the pelvis to allow optimum
production, transfer, and control of force and motion to the
terminal segment in integrated athletic activities (4,50). Made
up of the paraspinals, quadratus lumborum muscle, abdominal
muscles, hip girdle musculature, diaphragm, and the pelvic
floor muscles (1,53), the core is considered important for effi-
cient biomechanical function necessary to maximize force gen-
eration and minimize joint loads in various activities (26), and
thus possibly decreases the incidence of injury (54).
In a professional club setting, such physical characteristics
are rarely trained in isolation and are likely to be delivered as
part of a multicomponent training program. However, the
effectiveness of multicomponent training programs in soccer
has scarcely been reported in the literature. One example
that included exercises for stability, flexibility, coordination,
power, and reaction time showed a 21% reduction in the
incidence of injury per 1000 hours of training and playing
soccer, from 6.7 in the intervention group and 8.5 in the
TABLE 1. Fitness characteristics of subjects.
Details Intervention Season Control Season
Age (yrs) 28.6 63.75 27.4 64.85
Height (cm) 183.7 65.48 181.8 64.32
Weight (kg) 79.3 68.16 78.7 68.31
V
_
O
2
max (mL$kg
21
$min
21
) 53.78 65.63 54.56 65.24
1RM squat (kg) 156.8 622.4 159.2 620.7
10 m sprint (s) 1.78 60.08 1.77 60.07
20 m sprint (s) 3.09 60.13 3.08 60.11
Sum of 8 skinfolds (mm) 57.66 617.59 59.43 616.05
TABLE 2. Injury Definition.
Muscle strain/tear Implies damage or tearing of (part or all) to the muscle fibers or attaching tendons
Ligament Tear Implies damage or tears to the ligamentous fibers
Ligament Strain Slight damage or strain of the ligamentous fibers
Capsular Occurs when there is damage to the fibrous layers of a joint capsule
Contusion Occurs during a direct blow/contact from another player or object and causes
damage to underlying muscle fibers and connective tissue without breaking the skin
Fracture/dislocation Implies damage to a bone when the tissue of the bone is broken
Tendonitis Tendonitis is generally deemed as an overuse injury. It implies that there is
an inflammation or irritation (tear or swelling) of a tendon occurring
Impingement Impingement injuries may occur as a result of loss of competency of the
rotator cuff. Pain from any cause, such as overuse or injury, may lead to disuse
Back/neck Damage or injury occurring to either the back or neck region
Meniscus Injury to the meniscus is a rupturing of 1 or more of the fibrocartilage strips in the knee
Other Implies not being able to train due to illness or injury not categorized above
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control group, albeit in amateur soccer players (30). In con-
trast, a recent study showed the injury incidence to be almost
equal between an intervention group (9.6 per 1000 hours) and
control group (9.7 per 1000 hours), although the intervention
group sustained significantly fewer knee injuries (50). The
tendency within research studies, however, has been to gen-
erally investigate their effectiveness (multi component
training programs) over relatively short periods. There
seems to be few studies reporting the effectiveness of a mul-
ticomponent training program in elite-level soccer players
for the entirety of the season. Therefore, the aim of the
current investigation was to (a) examine the effectiveness
of a structured injury prevention program on the number
of muscle injuries; and (b) investigate the effect of the
Figure 1. Proprioception program.
Figure 2. Functional strength program.
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program on the total number of injuries across the 2 sea-
sons. It is hypothesized that the injury prevention tech-
nique used during the intervention season would
significantly reduce the number of muscle injuries when
compared with the control
season. It is also hypothesized
that there be a significant
reductioninthetotalnumber
of injuries when comparing
the intervention season with
the control.
METHODS
Experimental Approach to
the Problem
The study was conducted over 2
consecutive seasons (2008–2009,
2009–2010). The first season
(2008–2009) was the interven-
tion season, and the second
was the control season. During the intervention season, the
players performed a multicomponent prevention intervention
twice weekly (unless 2 3competitive matches per week) and
before the technical and tactical training (58 prevention
TABLE 3. The functional strength program.
Exercise
Repetitions
Session 1–10 11–20 21–30 31–40 41–58
Bilateral
Nordic Hamstring curls 2 34236238336338
Unilateral
X-band lateral walks 2 382392310 2 311 2 312
Single leg deadlifts 2 34236238336338
Side plank clam 2 310 2 310 2 311 2 311 2 312
Split squat 2 36237238336338
Bird-dog 2 382392310 3 36338
Figure 3. Core stability program.
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sessions were performed). During the injury intervention
program, players were randomly divided into 4 groups, each
session players would move through each of the 4 stations
(balance; functional strength; core stability; mobility). The
control season players performed no set structured preven-
tion intervention pretraining after the preseason phase, that
is, 9 prevention sessions were performed. A qualified phys-
iotherapist was present to ensure correct execution of exer-
cises during all sessions. Injury was classified according to
training or match incidence, the muscles concerned, the
cause, and the nature of the injury.
Subjects
A total of 26 soccer players participated in the study. The
study involved a squad of 26 (first season: 2008–2009) play-
ers during the intervention season and a squad of 23 players
during the control season whose age, height, body mass,
maximal aerobic capacity, lower body strength (1RM squat),
10 and 20 m sprint time, and sum of 8 skinfold sites (taken at
the biceps, triceps, subscapular, iliac crest, supraspinale,
abdominal, mid-thigh, and calf ) were taken at the beginning
of each season across the inves-
tigation (Table 1). The study
was conducted by the Sport
Science Department at
Rangers Football Club after
approval by the Ethics Com-
mittee of the Sport Science
and Research Department,
Claude Bernard Lyon 1 Uni-
versity. Each subject provided
a written informed consent in
accordance with the Helsinki
Declaration with subjects hav-
ing the option of withdrawing
from the study at any time
without penalty. The partici-
pants were free of all injury
and able to participate within
the intervention at the initial period of each season. To ensure
team and player confidentiality, all injury data were
anonymized.
Injuries
Only training or match injuries were included within this
investigation. Recordable injuries were defined as an injury
received during training or competition, which prevented
participation in normal training or competition for more
than 48 hours, not including the day of the injury (24). The
classifications and definitions of injuries used within this
investigation follow closely the recommended guide-
lines proposed by International Soccer Injury Consensus
Groups (21) and are of similar definitions to those used in
other injury-related articles in professional soccer (Table 2)
(6,52).
Injury Prevention Program
Balance.
1. The first exercise performed as part of the balance train-
ing area was a single leg balance performed on the floor
(stable base) for 30 seconds. In pairs, 1 partner serves
soccer ball with raised foot to partner opposite to volley
back 1 touch. Player then aims to catch ball from return
volley and switches leg after 30 seconds.
2. The progression to the second exercise performed as part
of this area was a single leg balance on an Airex pad (TN,
USA) (unstable base) for 30 seconds. In pairs, 1 partner
aims to volley soccer ball back with raised foot to server
without foot touching the floor. Player switches leg after
30-second duration.
3. The final progressive exercise performed within this area
involved players performing a single leg balance on a tram-
pet (Reebok, MA, USA) for 30 seconds. Again, in pairs,
1 partner aims to volley soccer ball back to server with
raised foot although continually bouncing on the trampet
(Reebok, MA). Player switches leg after 30 seconds
duration.
TABLE 4. The core development program.
Exercise
Repetitions
Session
1–10 11–20 21–30 31–40 41–58
Static
Plank (s) 2 330 2 340 3 330 3 340 3 345
Side plank (s) 2 320 2 325 2 330 3 320 3 325
Dynamic (med-ball weight) 3 kg 3 kg 5 kg 5 kg 5 kg
Rotational med-ball throws 2 382310 2 362382310
Overhead med-ball toss 2 362382310 3 36338
Med-ball rolls 2 382382310 3 36338
Bridging 2 36238236336338
TABLE 5. Mobility exercises.
Exercise Repetitions
Forward leg wings 10 3left leg
10 3right side
Sideways leg swings 10 3left leg
10 3right leg
Cat stretch 10 3
Forward lunge walks 10 3left leg
10 3right leg
Zig-zag running 5 runs (over
a 15 m distance)
Hurdle hip walks 5 3left; 5 x right side
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All exercises were to be performed single leg (no knee
flexion) (Figure 1). The players were instructed to perform
3 sets of 30 seconds on each leg before switching roles
(i.e. pass to volley).
Functional Strength. The exercises used within this area of the
intervention are described below (Figure 2 and Table 3):
1. The Nordic hamstring exercise is performed from a kneel-
ing starting position on a soft foundation. The players
were instructed to slowly lower their body toward the
ground using the hamstrings to control the movement,
whereas the feet are held by a partner.
2. Players were instructed to hold the resistance band
(Theraband, United Kingdom) in position and bend
slightly at the knee. Players were then instructed to step
laterally for the required number of repetitions to both
their left and right side.
3. During this exercise players were to start in a single leg
stance, holding a kettlebell weight (Adidas, OR, USA) in
the opposite hand to the standing leg. Players were then
instructed to lower down and touch the weight down to
ground although maintaining a straight line through their
back before returning to starting position.
4. This exercise required players placing a resistance
band (Theraband, UK) material around knees while in a
side-plank position. Players were then instructed to raise
their knee although ensuring their heels remained touch-
ing without moving.
5. Players for this exercise were instructed to start in a split
squat stance although holding a kettlebell weight (Adi-
das, OR, USA) in each hand. The technique then
included dropping the back leg to ground so that their
knee touched the ground before returning to the starting
position.
Figure 4. Mobility exercises.
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6. Players for this exercise were required to start on hands
and knees and maintain with a straight back throughout
the movement. Players then activate the gluteals through
alternate reserve leg lifts although ensuring no rotation
through the hips occurs.
Core Stability. Exercises used for the core stability develop-
ment area are described below (Figure 3 and Table 4):
1. Players were instructed to lie face down although balanc-
ing on forearms and toes ensuring a straight posture is
maintained throughout the duration of the static hold.
2. Players were instructed to lie on their side although bal-
ancing on forearm and side of foot, although trying to
maintain a straight posture throughout the static hold.
3. Players stand side on to the wall in a fixed open stance.
They were then instructed to throw the medball (Reebok,
MA, USA) against the wall rotating from 1 side to another
via underarm throw in order to rebound ball off the wall.
4. Players face wall in a fixed open stance although holding
a medball (Reebok, MA, USA) above head. Upon instruc-
tion, players throw ball to rebound off wall keeping a tight-
controlled posture.
5. Players lying on their back with medball (Reebok, MA)
placed between knees, which are in a flexed position. Play-
ers were then instructed to roll the ball to the left and right
with the outside of their knee touching the ground.
6. Lying on back with knees bent, players push through
heels and raise lower back upwards although contracting
Figure 6. Number of injury classifications: Intervention vs. control season.
Figure 5. Injury sustained during training and matches during the 2 seasons.
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gluteals. Players are also instructed to activate core region
throughout movement.
Mobility. Players were instructed to perform various self-
selected mobility exercises and movements (Table 5 and
Figure 4):
1. Forward leg swings (players in pairs perform leg swings
forward and backwards to increase range of movement
through hamstrings and hip region).
2. Sideways leg swings (players in pairs perform lateral leg
swings with the aim of increasing mobility around the hip
and groin region).
3. Cat Stretch (on knees and hands, players lift head up and
down although being instructed to arch back to increase
movement through lumbar region).
4. Forward lunge walks (players walk forward and drop
into a lunge position, hold for 1–2 seconds and then alter-
nate legs).
5. Zig-zag runs (running forward in a zig-zag formation,
cutting from left foot to right foot).
6. Hip mobility hurdle stepovers (alternating legs forward
and backwards over a 3-feet hurdle) (Barratt, United
Kingdom).
Statistical Analyses
Data are expressed as mean and 6SD values. Independent
sample t-test was employed to examine the difference between
intervention and control seasons (2008–2009 vs. 2009–2010).
Pearson product moment correlation coefficient was used
to examine the relationship between variables. The magni-
tude of the correlations was determined using the modified
scale (28): trivial: r,0.1; low: 0.1–0.3; moderate: 0.3–0.5;
high: 0.5–0.7; very high: 0.7–0.9; nearly perfect .0.9; and
perfect: 1. Linear regression was used to estimate the number
of muscle strains/tears by other measured variables. Signifi-
cant level was defined as p #0.05.
Effect size was also used in the present study to provide
information on the magnitude of treatment effect. There has
recently been a proposed a scale for determining the
magnitude of effect sizes in strength training research (46).
In this classification, the researcher took the training status of
the participants into consideration by separating them into
3 groups as follows: untrained (consistent training less than
1 year), recreationally trained (consistent training from 1 to
5 years), and highly trained (consistent training of more than
5 years) (46). Because the players in this study were pro-
fessional players, the scale for “highly trained” was selected
for interpretation as follows: trivial (effect size ,0.25), small
(0.25–0.50), moderate (0.50–1.0), and large (.1.0).
RESULTS
In total, 103 matches were played across the 2 seasons (first
season: 48 vs. second season: 55). Players were involved in
154.5 hrs of match play across the 2 seasons (first
t
season:
72 hours vs. second season: 82.5 hours) with 4.36 61.57 vs.
5.0 62.19 matches played per month throughout the inves-
tigation. Results from the study highlighted a higher total
number of injuries sustained within the intervention season
(n= 88) when compared with the control season (n= 72);
however, no levels of significance were found between them
(p= 0.21). Further examination indicated that on average
863.16 injuries per month occurred during the intervention
season vs. control season 6.54 63.69 per month, respec-
tively. In addition to the previous findings, the study revealed
(Figure 5) how number of injuries sustained during compet-
itive match play was higher in the control season when
compared with the intervention season (p,0.001), but less
training injuries were observed during the intervention sea-
son (25 vs. 26). During both seasons, muscle strains/tears
were the most common injury sustained; however, signifi-
cantly increased numbers were observed during the control
season (Figure 6). During the intervention season, the num-
ber of muscle strain/tears was less (25% of total injuries) than
the control season (52% of total injuries) (moderate effect),
and this occurred concomitant with bigger squad size (large
effect, p,0.001).
There were trivial to small effects between the 2 seasons in
the number of competitive games played, number of training
session performed, and number of match injuries (Figure 5).
Linear regression shown that number of training sessions
performed, number of prevention sessions performed, and
number of competitive games played were effective predic-
tors of number of muscle strain/tear (R= 0.66, R
2
= 43%,
SEE = 1.82, p,0.05).
DISCUSSION
The aim of the current study was to examine the effectiveness
of a structured injury prevention program on the number of
muscle injuries and the total number of injuries within elite
professional soccer. The primary findings from the investiga-
tion concur with our hypothesis as the structured injury
prevention intervention significantly reduced the number of
no:muscle strain=tear ¼22:13 þ 0:90 no:training session 2 0:30 no:prevention session performed
þ 0:06 squad size þ 0:51 no:competitive games played:
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muscle injuries with a reduction of 43% (large effect) when
compared with the control season, even though there were
slightly more competitive matches played during this inter-
vention season. However, our second hypothesis, that total
number of injuries would also be reduced was not shown.
The majority of injury prevention–training studies have
generally examined the effects of individual components
on injury incidence. However, this is not representative of
a soccer-specific environment where the time constraints
dealt necessitates the development of a mixed conditioning
approach that allows for the simultaneous development of
several fitness qualities. From a practical perspective, injury
prevention programs are implemented with the expectation
that they will elicit improvements in performance and
reduce the incidence of injury; however, this is not always
representative of research findings. Although direct compar-
isons should be avoided, the results of the present study do
partially agree with those of Junge et al. (30), where the
training intervention program elicited the greatest effect on
mild injuries. However, the results of the present study
demonstrate that the training program was ineffective at
reducing the total number of injuries. In fact, somewhat sur-
prisingly, there was a 9% increase in the total number of
injuries when compared with the control season (88 vs. 72
injuries) and a greater number of ligament strains during the
intervention season (;17) than the control season (;7).
Although not directly comparable, the findings from van
Beijsterveldt et al. (50) and those of the present study do
possibly highlight the need to further understand the etiol-
ogy of injuries and design injury prevention programs
accordingly. The greater number of injuries within the inter-
vention season, however, was largely due to the number
(52.27%) of unavoidable contusion injuries (intervention sea-
son n= 44 vs. control season n = 23) when compared with
the control season. These findings are in agreement with
previous research (8,32) who reported how contusion inju-
ries are extremely common and unavoidable in soccer due to
the nature of the game. Nevertheless, such findings do raise
issues regarding the implementation of new and/or different
training methods, particularly for those players at the elite
level, and should be a consideration for future training inter-
ventions and further investigation. It is not unreasonable to
suggest that the greater training history associated with elite-
level players may in itself prove problematic when imple-
menting new and/or different training exercises. This seems
relevant given that a training prevention program is more
likely to elicit greater effects in low-skill than in high-skill
teams (30) and the incidence of injuries, albeit youth soccer
players, seems to be the lowest in those with the least
amount of soccer exposure time (47).
Although often the objective, it is questionable whether
some types of exercise-based injury prevention programs
actually facilitate true learning of new biomechanical and
neuromuscular characteristics (41,43). Whereas, the effects
of short duration exercise-based injury prevention programs
may induce transient changes in the performance of func-
tional tasks that regress after cessation of the program. To
experience biomechanical and/or neuromuscular changes, it
is likely that extended duration training periods are necessary
to facilitate long-term retention of movement control (41).
Yet, performing injury prevention drills over a prolonged
period, as done in the present study, may still be insufficient
to induce large reductions in the incidence of specific injuries.
Essentially, players may respond differently to the training
intervention program and should be a consideration for fur-
ther detailed investigation. Alternatively, despite the program
being performed during the entirety of the season, it is possi-
ble that the session or individual exercises themselves may
have been of insufficient duration required to elicit large train-
ing adaptations. This is pertinent to elite-level athletes who
generally possess relatively high levels of general fitness and
would unlikely experience gains similar to lesser skilled indi-
viduals despite being at a greater risk of injury (16).
In summary, the present study shows how performing
a multicomponent injury prevention intervention twice
weekly throughout the course of a training season can have
a significantly positive effect on reducing muscle injuries
(strains/tears) within the elite level of professional soccer.
However, further research within this area is needed to
confirm this. Interestingly, the total number of injuries was
greater during the intervention season. Hence, the results
from the present study highlight the possible benefits of
injury prevention–training programs but also identify that
such strategies may not be appropriate to combat different
types of injuries. Doing so may require specific individualized
training exercises that are relevant to player’s weaknesses or
inabilities, particularly for those at the elite level.
PRACTICAL APPLICATIONS
Injury prevention–training strategies are a common feature
in a practitioners training schedule. Despite a plethora of
training exercises being available to use within a multicom-
ponent training program, there seems little evidence-based
guidance as to what exercises may be considered effective in
actually reducing the incidence of injury. The present study
reveals how a multicomponent injury prevention program
within the elite level of professional soccer can have signif-
icant effect on the incidence of muscle strains and tears,
which are regarded as the most commonly encountered
injury in soccer across many levels. However, the injury pre-
vention–training program may not be adequate in reducing
the total number of injuries. Therefore, when implementing
a multicomponent injury prevention–training program, prac-
titioners should clearly justify what they intend to address
during the chosen exercises and overall training session. This
is an important issue as simply including certain exercises may
unlikely reduce the different types of injury equally. Therefore,
giving priority to a specific element (exercise, duration, inten-
sity, load, etc.) within a multicomponent training program
may be a more appropriate way to address players weakness,
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previous injury, or susceptibility to injury. Although undeni-
ably a difficult task, by establishing what physical component
may be more effective in reducing specific injuries, the prac-
titioner may have greater scope to develop more time efficient
and appropriate individualized training drills.
REFERENCES
1. Akuthot, V and Nadler, SF. Core strengthening. Arch Phys Med
Rehabil 85(3 Suppl 1): S86–S92, 2004.
2. Arnason, A, Andersen, TE, Holme, I, Engebretsen, L, and Bahr, R.
Prevention of hamstring strains in elite soccer: An intervention
study. Scand J Med Sci Sports 18: 40–48, 2008.
3. Askling, C, Karlsson, J, and Thorstensson, A. Hamstring injury
occurrence in elite soccer players after preseason strength
training with eccentric overload. Scand J Med Sci Sports 13: 244–250,
2003.
4. Borghuis, AJ, Lemmink, KA, and Hof, AL. Core muscle response
times and postural reactions in soccer players and non-players.
Med Sci Sports Exerc 43: 108–114, 2011.
5. Carling, C. Analysis of physical activity profiles when running
with the ball in a professional soccer team. J Sports Sci 28: 319–326,
2010.
6. Carling, C, Le Gall, F, and Dupont, G. Are physical performance
and injury risk in a professional soccer team in match play affected
over a prolonged period of fixture congestion. Int J Sports Med 33:
36–42, 2012.
7. Chatzopoulos, DE, Michailidis, CJ, Giannokos, AK, Alexiou, KC,
Patikas, DA, Antonopoulos, CB, and Kotzamanidis, CM.
Postactivation potentiation effects after heavy resistance exercise
on running speed. J Strength Cond Res 21: 1278–1281, 2007.
8. Crisco, JJ, Jokl, P, Heinen, GT, Connell, MD, and Panjabi, M.
A muscle contusion injury model biomechanics, physiology, and
histology. Am J Sports Med 22: 702–710, 1994.
9. Croisier, JL. Factors associated with recurrent hamstring injuries.
Sports Med 34: 681–695, 2004.
10. Croisier, JL, Ganteaume, S, Binet, J, Genty, M, and Ferret, JM.
Strength imbalances and prevention of Hamstring injury in
professional soccer players: A prospective study. Am J Sports Med
36: 1469–1475, 2008.
11. Dellal, A, Chamari, K, Owen, AL, Wong, DP, Lago-Penas, C, and
Hill‐Haas, S. Influence of technical instructions on the physiological
and physical demands of small‐sided soccer games. Eur J Sport Sci
11: 341–346, 2011.
12. DiStefano, LJ, Padua, DA, Blackburn, JT, Garrett, WE,
Guskiewicz, KM, and Marshall, SW. Integrated injury prevention
program improves balance and vertical jump height in children.
J Strength Cond Res 24: 332–342, 2010.
13. Docherty, CL, Moore, JH, and Arnold, BL. Effects of strength
training development and joint position sense in functionally
unstable ankles. J Athl Train 33: 310–314, 1998.
14. Dupont, G, Nedelec, M, McCall, A, McCormack, D, Berthoin, S,
and Wisløff, U. Effect of 2 soccer matches in a week on
physical performance and injury rate. Am J Sports Med 38:
1752–1758, 2010.
15. Ekstrand, J, Walden, M, and Hagglund, M. A congested football
calendar and the wellbeing of players: Correlation between match
exposure of European footballers before the World Cup 2002 and
their injuries and performances during that World Cup. Br J Sports
Med 38: 493–497, 2004.
16. Ekstrand, J, Gillquist, J, Moller, M, Oberg, B, and Liljedahl, S.
Incidence of soccer injuries and their relation to training and team
success. Am J Sports Med 11: 63–67, 1983.
17. Ekstrand, J, Hagglund, M, and Walden, M. Injury incidence and
injury patterns in professional football: The UEFA injury study.
Br J Sports Med 45: 553–558, 2011.
18. Engebretsen, AH, Myklebust, G, Holme, I, Engebretsen, L, and
Bahr, R. Prevention of injuries among male soccer players:
A prospective, randomized intervention study targeting players
with previous injuries or reduced function. Am J Sports Med 36:
1052–1060, 2008.
19. Fousekis, K, Tsepis, E, and Vagenas, G. Multivariate isokinetic
strength asymmetries of the knee and ankle in professional soccer
players. J Sports Med Phys Fitness 50: 465–474, 2010.
20. Greig, M and Siegler, JC. Soccer-specific fatigue and eccentric
hamstrings muscle strength. J Athl Train 44: 180–184, 2009.
21. Hagglund, M, Walden, M, and Ekstrand, J. UEFA injury study, an
audit of European Championships 2006–2008. Br J Sports Med 43:
483–489, 2005.
22. Hawkins, RD and Fuller, CW. An examination of the frequency and
severity of injuries and incidents at three levels of professional
football. Br J Sports Med 32: 326–332, 1998.
23. Hawkins, RD and Fuller, CW. Risk assessment in professional
football: An examination of accidents and incidents in the 1994
World Cup finals. Br J Sports Med 30: 165–170, 1996.
24. Hawkins, RD, Hulse, MA, Wilkinson, C, Hodson, A, and
Gibson, M. The association football medical research programme:
An audit of injuries in professional football. Br J Sports Med 35:
43–47, 2001.
25. Hartig, DE and Henderson, JM. Increasing hamstring flexibility
decreases lower extremity overuse injuries in military basic trainees.
Am J Sports Med 27: 173–176, 1999.
26. Hibbs, AE, Thompson, KG, French, D, Wrigley, A, and Spears, I.
Optimising performance by improving core stability and core
strength. Sports Med 38: 995–1008, 2008.
27. Høy, K, Lindblad, BE, Terkelsen, CJ, Helleland, HE, and
Terkelsen, CJ. European soccer injuries. A prospective epidemiologic
and socioeconomic study. Am J Sports Med 20: 318–322, 1992.
28. Hrysomallis, C. Balance ability and athletic performance. Sports Med
41: 221–232, 2011.
29. Heidt, RS, Sweeterman, LM, Carlonas, RL, Traub, JA, and
Tekulve, FX. Avoidance of soccer injuries with pre season
conditioning. Am J Sports Med 28: 659–662, 2000.
30. Junge, A, Rosch, D, Peterson, L, Graf-Baumann, T, and Dvorak, J.
Prevention of soccer injuries: a prospective intervention study in
youth amateur players. Am J Sports Med 30: 652–659, 2002.
31. Junge, A and Dvorak, J. Soccer injuries: A review on incidence and
prevention. Sports Med 34: 929–938, 2004.
32. Kakavelakis, K, Vlazakis, S, Vlahakis, I, and Charissis, G. Soccer
injuries in childhood. Scand J Med Sci Sports 13: 175–178, 2003.
33. Knapik, J, Bauman, C, Jones, B, Harris, J, and Vaughan, L. Pre-season
strength and flexibility imbalances associated with athletic injuries in
female collegiate athletes. Am J Sports Med 19: 76–81, 1991.
34. Kraemer, R and Knobloch, K. A soccer-specific balance training
program for hamstring muscle and patellar and achilles tendon
injuries: An intervention study in premier league female soccer.
Am J Sports Med 37: 1384–1393, 2009.
35. Lago-Penas, C, Rey, E, Lago-Ballesteros, J, Casais, L, and
Dominguez, E. The influence of a congested calendar on physical
performance in elite soccer. J Strength Cond Res 25: 2111–2117, 2011.
36. McHugh, M, Tyler, T, Mirabella, M, Mullaney, M, and Nicholas, S.
The effectiveness of a balance training intervention in reducing the
incidence of non-contact ankle sprains in high school football
players. Am J Sports Med 35: 1289–1294, 2007.
37. Olsen, O, Myklebust, G, Engebretsen, L, Holme, I, and Bahr, R.
Exercises to prevent lower limb injuries in youth sports: Cluster
randomized controlled trial. BMJ 330: 449, 2005.
38. Olsen, L, Scanlan, A, MacKay, M, Babul, S, Reid, D, Clark, M, and
Raina, P. Strategies for prevention of soccer related injuries: A
systematic review. Br J Sports Med 38: 89–94, 2004.
Injury Prevention in Professional Soccer
3284
Journal of Strength and Conditioning Research
the
TM
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
39. Orchard, JW. On the value of team medical staff: can the
“moneyball” approach be applied to injuries in professional football?
Br J Sports Med 43: 963–965, 2009.
40. Owen, A, Wong, DP, McKenna, M, and Dellal, A. Heart rate
responses and technical comparison between small- vs. large-sided
games in elite professional soccer. J Strength Cond Res 25: 2104–
2110, 2011.
41. Padua, DA, Di Stefano, LJ, Marshall, SW, Beutler, AI, Motte, SJ, and
Di Stefano, MJ. Retention of movement pattern changes after
a lower extremity injury prevention program is affected by program
duration. Am J Sports Med 40: 300–306, 2012.
42. Parry, L and Drust, B. Is injury the major cause of elite soccer
players being unavailable to train and play during the competitive
season? Phys Ther Sport 7: 58–64, 2006.
43. Paterno, MV, Myer, GD, Ford, KR, and Hewett, TE.
Neuromuscular training improves single-limb stability in young
female athletes. J Orthop Sports Phys Ther 34: 305–316, 2004.
44. Rahnama, N, Lees, A, and Bambaecichi, E. A comparison of muscle
strength and flexibility between the preferred and non-preferred leg
in English soccer players. Ergonomics 48: 1568–1575, 2005.
45. Requena, B, de Villarreal, ES, Gapeyeva, H, Ereline, J, Garcia, I, and
Paasuke, M. Relationship between postactivation potentiation of
knee extensor muscles, sprinting and vertical jumping performance
in professional soccer players. J Strength Cond Res 25: 367–373, 2011.
46. Rhea, MR. Determining the magnitude of treatment effects in
strength training research through the use of the effect size.
J Strength Cond Res 18: 918–920, 2004.
47. Schmikli, SL, de Vries, WR, Inklaar, H, and Backx, FJ. Injury
prevention target groups in soccer: Injury characterstics and
incidence rates in male junior and senior players. J Sci Med Sport 14:
199–203, 2011.
48. Stasinopoulos, D. Comparison of three preventive methods in order
to reduce the incidence of ankle inversion sprains among female
volleyball players. Br J Sports Med 38: 182–185, 2004.
49. Turl, SE and George, KP. Adverse neural tension: a factor in
repetitive hamstring strain? J Orthop Sports Phys Ther 27: 16–21,
1998.
50. Van Beijsterveldt, AM, van de Port, IG, Krist, MR, Schmikli, SL,
Stubbe, JH, Frederiks, JE, and Backx, FJ. Effectiveness of an injury
prevention program for adult male amateur soccer players: A cluster
randomised controlled trial. Br J Sports Med 2008.
51. Verhagen, E, van der, Beek, A, Twisk, J, Bouter, L, Bahr, R, and
van Mechelen, W. The effect of a proprioceptive balance board
training program for the prevention of ankle sprains: A
prospective controlled trial. Am J Sports Med 32: 1385–1393,
2004.
52. Walden, M, Hagglund, M, and Ekstrand, J. UEFA Champions
League study: A prospective study of injuries in professional
football during the 2001-2002 season. Br J Sports Med 39: 542–546,
2005.
53. Willardson, JM. Core stability training: Applications to sports
conditioning programs. J Strength Cond Res 21: 979–985, 2007.
54. Willson, JD, Dougherty, CP, Ireland, ML, and Davis, IM. Core
stability and its relationship to lower extremity function and injury.
J Am Acad Orthop Surg 13: 316–325, 2005.
55. Woods, C, Hawkins, RD, Maltby, S, Hulse, M, Thomas, A, and
Hodson, A; and Football Association Medical Research Programme.
The Football Association Medical Research Programme: An audit
of injuries in professional football—analysis of hamstring injuries. Br J
Sports Med 38: 36–41, 2004.
56. Woods, K, Bishop, P, and Jones, E. Warm-up and stretching in
the prevention of muscular injury. Sports Med 37: 1089–1099, 2007.
57. Worrell, TW. Factors associated with hamstring injuries: An
approach to treatment and preventative measures. Sports Med 17 :
338–345, 1994.
58. Zakas, A, Balaska, P, Grammatikopoulou, MG, Zakas, N, and
Vergou, A. Acute effects of stretching duration on the range of
motion of elderly women. J Bodyw Mov Ther 9: 270–276, 2005.
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