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A comparison of injuries in elite male and female football players: A 5-Season prospective study
Abstract
The aim was to compare the epidemiology of injuries between elite male and female football players from the same club. Injuries and individual exposure time in a male team and a female team, both playing in the Spanish first division, were prospectively recorded by the club's medical staff for five seasons (2010-2015) following the FIFA consensus statement. Total, training and match exposure hours per player-season were 20% higher for men compared to women (P < 0.01). Total, training and match injury incidence were 30-40% higher in men (P ≤ 0.04) mainly due to a 4.82 [95% confidence interval (CI) 2.30-10.08] times higher incidence of contusions, as there were no differences in the incidence of muscle and joint/ligament injuries (P ≥ 0.44). The total number of absence days was 21% larger in women owing to a 5.36 (95% CI 1.11-25.79) times higher incidence of severe knee and ankle ligament injuries. Hamstring strains and pubalgia cases were 1.93 (95% CI 1.16-3.20) and 11.10 (95% CI 1.48-83.44) times more frequent in men, respectively; whereas quadriceps strains, anterior cruciate ligament ruptures and ankle syndesmosis injuries were 2.25 (95% CI 1.22-4.17), 4.59 (95% CI 0.93-22.76) and 5.36 (95% CI 1.11-25.79) times more common in women, respectively. In conclusion, prevention strategies should be tailored to the needs of male and female football players, with men more predisposed to hamstring strains and hip/groin injuries, and women to quadriceps strains and severe knee and ankle ligament injuries. This article is protected by copyright. All rights reserved.
... Consistent with previous studies, ligament injuries were observed more frequently than muscle injuries. This trend has also been noted in studies comparing male and female players, where ligament injuries are more prevalent among women, while muscle injuries are more common in men (Larruskain et al., 2017;Clausen et al., 2014). These differences may be attributed to biomechanical and hormonal factors, which likely contribute to the varying injury profiles between genders. ...
... These results have been similarly reported in studies of men's soccer (Larruskain et al., 2017), suggesting that the relationship between injury incidence and soccer-related activities is significantly influenced by the unique characteristics of the soccer discipline itself. Injury incidence is defined as the number of injuries per 1000 hours. ...
... While it has not been clearly established on whether female soccer players are more prone to quadriceps strains (Larruskain et al., 2017; or hamstring strains (Hallén et al., 2023;Nilstad et al., 2014), reports indicate that there is a tendency for a higher incidence of quadriceps strains compared to male soccer players (Larruskain et al., 2018). ...
Football is a sport where lower limb injuries are common in both genders. However, injury investigations have primarily focused on male players, with fewer studies addressing women. Specifically, there is limited research on injury epidemiology among women’s collegiate football players, leaving the current situation unclear. This study examines the epidemiology of injuries in women’s collegiate football over a nine-year period, focusing on (1) overall injury incidence, (2) injury location and type, (3) injury mechanism and circumstance, (4) injury severity and burden, and (5) recurrent injuries. The aim is to contribute to the existing knowledge on sports injuries and provide practical insights to mitigate injury risks and enhance the safety of women’s collegiate football players. Over nine seasons, a total of 357 injuries were recorded, of which 281 (78.7%) were classified as traumatic injuries and 76 (21.3%) as overuse injuries. The overall injury incidence rate was 5.4/1000 player hours. Data analysis revealed that ankle sprains were the most frequent injury, while ACL injuries caused the highest injury burden. Injury rates and burdens were significantly higher during matches compared to training. To mitigate match-related injuries, strategies should include monitoring individual player factors, adjusting training parameters (frequency, intensity, volume, type), and differentiating warm-up routines between training and matches.
... Despite the significant underrepresentation of female participants in sport medicine research [13,14], numerous studies have highlighted notable differences in the predominant injury types, incidence, and burden between male and female athletes [15][16][17][18]. These disparities have prompted calls for research on female-specific injury prevention programmes, including the effects of sex-specific biological factors [1,17,19]. ...
... Despite the significant underrepresentation of female participants in sport medicine research [13,14], numerous studies have highlighted notable differences in the predominant injury types, incidence, and burden between male and female athletes [15][16][17][18]. These disparities have prompted calls for research on female-specific injury prevention programmes, including the effects of sex-specific biological factors [1,17,19]. ...
... These cyclical changes in ovarian hormone concentrations, which can be observed in Figure 1, lead to distinct hormonal profiles that can be used to identify and differentiate menstrual phases [23,24]. Based on an idealised 28-day cycle, the menstrual cycle can be divided into the early follicular phase (days 1-5), mid follicular phase (days [6][7][8], late follicular phase (days 9-13), ovulation (day 14), early luteal phase (days [15][16][17][18][19][20], mid-luteal phase (days [21][22][23][24], and the late luteal phase (days [25][26][27][28] [21]. [22]. ...
... Female soccer players are at an increased risk of injuries, particularly quadriceps strains and severe ligament injuries to the knee and ankle joints [1]. Research indicates that the total number of absence days is 21% higher in women compared to men, due to a 5.36 times greater incidence of severe knee and ankle ligament injuries [1]. ...
... Female soccer players are at an increased risk of injuries, particularly quadriceps strains and severe ligament injuries to the knee and ankle joints [1]. Research indicates that the total number of absence days is 21% higher in women compared to men, due to a 5.36 times greater incidence of severe knee and ankle ligament injuries [1]. In addition, quadriceps strains, anterior cruciate ligament ruptures and ankle syndesmosis have been shown to be more common in female soccer players than in their male counterparts [1]. ...
... Research indicates that the total number of absence days is 21% higher in women compared to men, due to a 5.36 times greater incidence of severe knee and ankle ligament injuries [1]. In addition, quadriceps strains, anterior cruciate ligament ruptures and ankle syndesmosis have been shown to be more common in female soccer players than in their male counterparts [1]. Factors contributing to this increased risk include, but are not limited to, anatomical and structural differences between genders, hormonal effects and inadequate strength [2][3][4]. ...
Background/Objectives: This study examined the link between the Q angle, knee hyperextension, flexibility, strength profiles and injury occurrence in female adolescent soccer players. Methods: Thirty adolescent female soccer players (age range: 15–17 years; age: 15.47 ± 0.73 years; weight: 55.91 ± 7.44 kg; height: 160.01 ± 5.58 cm) were recruited for the study. The tests were conducted before the pre-season preparation period, and the players were monitored from the beginning to the end of the season. This study included players who sustained non-contact injuries throughout the season as well as those who did not sustain any injuries for comparison purposes. Players underwent an anthropometric assessment (height, weight, body fat, Q angle, knee hyperextension) and completed a sit-and-reach test and an isokinetic assessment at 60°/s. Results: The results showed that 36.67% of players sustained a non-contact injury during the season. Based on the isokinetic assessment at 60°/s, significant differences were observed between the two groups in the torque production of the right and left knee extensors [t(28) = 2.32, p = 0.03, d = 0.81 (large effect)] and the right and left knee flexors [t(28) = 2.04, p = 0.05, d = 0.71 (medium effect)], with the injured group demonstrating significantly greater interlimb asymmetries in torque between the right and left knee extensors, as well as the right and left knee flexors. Also, the injured group demonstrated significantly higher knee hyperextension values for both the right [t(28) = 6.12, p < 0.05, d = 2.22 (large effect)] and left legs [t(28) = 5.72, p < 0.05, d = 2.15 (large effect)]. Conclusions: interlimb asymmetries and knee hyperextension may contribute to the occurrence of lower body non-contact injuries in adolescent female soccer players.
... The incidence of injuries in sports is typically reported as rates per 1000 h of player exposure during matches or training sessions ((Σ injuries/Σ hours) × 1000)) [9,19]. Most prior reviews have focused on injury incidence in senior female soccer players (older than 18 years) [20][21][22]. For example, a systematic review with metanalysis by Lopez Valenciano et al. [19] reported an overall injury incidence of 6.1 (95% CI 4.6-7.7) ...
... The incidence of injuries to these joints can be up to twice as high as that of their male counterparts [9]. Furthermore, studies reveal that females are 2.5 times more susceptible to ACL ruptures and ankle sprains compared to males [20,43]. It appears that sex-related differences, such as anatomy and biomechanics [66], hormonal fluctuations [67], and neuromuscular control of the trunk, hip, knee, and ankle, are responsible for this phenomenon. ...
... In the first investigations, the percentage of injuries in the anterior thigh was higher than in the posterior thigh [6,57]. Results were similar when analyzing elite female players, where quadriceps strains were diagnosed more than hamstring strains [20]. It is possible that the lower activation of the iliacus (muscle responsible for hip flexion) in female soccer players during ball kicking, which has been considered the main injury mechanism of quadriceps strain [76], could expose female to greater injury to this musculature. ...
There has been growing interest in understanding the injury profiles of young female soccer players due to their increasing participation in the sport and the unique risk factors they face. This narrative review examines the incidence, mechanisms, and location of injuries in this population, alongside the primary risk factors and effective preventive strategies. Injury incidence is higher during matches than in training sessions, with contact injuries dominating in games and non-contact injuries prevailing in practice. Knee and ankle injuries are the most prevalent, with anterior cruciate ligament (ACL) injuries being particularly concerning due to their frequency and long-term impact. The interplay of intrinsic factors, such as hormonal fluctuations, anatomical characteristics, and biomechanics, with extrinsic factors like training load, surface type, and footwear significantly influences injury risk. Prevention programs, particularly those combining neuromuscular, balance, and strength training, demonstrate high efficacy, provided that adherence is maintained. Moreover, fostering awareness among players, coaches, and stakeholders about psychosocial factors and menstrual health further enhances injury prevention. Tailored strategies addressing the specific needs of young female soccer players are crucial to ensuring their safety, optimizing performance, and supporting their long-term athletic development.
... significantly higher in men than in women, however the rate of serious injuries (causing more than 28 days of absence) appears to be significantly higher in women [4,[21][22][23][24]. It would be expected to see higher incidents in men's football, since the men's game may have greater frequency and force of physical contact as it involves larger, faster players on the same-sized field. ...
... This may be due to gender differences in the experience of pain, which are multifactorial and depend on complex factors such as psychosocial factors and gonadal hormone levels [25]. In this context, the results of previous studies showed that women stay away from the pitch for longer periods due to on-field injuries [4,[21][22][23][24]. Another finding of our study that supports this might be that although women needed more frequent medical care during games, the rate of substitution rate due to field injuries was lower than in men. ...
... Another interesting finding of our study was about the lower substitution rates in women football due to these incidents. The literature indicates that the overall injury incidence was reported to be similar in men and women football, although the proportion of severe injuries has been shown to be higher in women [21,29]. However, we found that the rate of substitutions after the incidents in men was significantly higher than women (27.3% vs 15.3%, respectively). ...
To identify the incidence of injury time-out due to field injuries in highest level professional football (soccer) international tournaments and to compare the features of these incidents between men’s and women’s football. The incidence of stoppage time due to incidents and the resulting injury characteristics of professional football players participating in the 2018 FIFA Men’s World Cup (MWC) in Russia and the 2019 FIFA Women’s World Cup (WWC) in France were examined retrospectively through video analysis. In the 2018 MWC, a total of 123 injury time-outs with 132 treatments occurred in 64 matches, while in the 2019 WWC, 142 incidents with 150 injured players were recorded in 52 matches. The incidence of stoppage time was higher in women than in men (81.2 vs. 56.8 per 1000 match hours, respectively, p = 0.004), and accordingly, women had a higher overall incidence of injury (IRR = 1.4 [95%CI = 1.1–1.8], p = 0.005). Despite women required more medical care during games, the substitution rate after the incidents was higher for men (27.3% to 15.3%, p = 0.02). Almost three-quarters of incidents for both sexes were sudden-onset contact injuries and the most common site was the lower limb. Although more frequent match incidents were seen in women’s football, the rate of completing the game without being substituted was higher than that of men. Obtaining insight into the medical intervention requirements of players during the course of a game will aid in the identification of injury-related behavioral patterns among players.
... 5 The research gap means that practitioners are often applying research The few prospective injury surveillance studies that exist in women's football involving professional players are from domestic leagues or international teams in Western Europe and North America. [7][8][9] For professional players, these studies show overall injury rates that are between 1.93 and 8.3/1000 hours (h), and higher in matches compared to training. [7][8][9] Injuries predominantly affect the lower limbs (knee, ankle and thigh) with the most common injury representing muscle strains and ligament sprains. ...
... [7][8][9] For professional players, these studies show overall injury rates that are between 1.93 and 8.3/1000 hours (h), and higher in matches compared to training. [7][8][9] Injuries predominantly affect the lower limbs (knee, ankle and thigh) with the most common injury representing muscle strains and ligament sprains. [7][8][9] A systematic review and meta-analysis of injuries in elite women's football estimated the incidence rate for adult elite women players in domestic club football to be 5.7/1000 h, though this did not include Australian data. ...
... [7][8][9] Injuries predominantly affect the lower limbs (knee, ankle and thigh) with the most common injury representing muscle strains and ligament sprains. [7][8][9] A systematic review and meta-analysis of injuries in elite women's football estimated the incidence rate for adult elite women players in domestic club football to be 5.7/1000 h, though this did not include Australian data. 10 More specifically, knee injuries were the most common site of injury in domestic club football (22 % of total injuries), whilst ligament sprains were the most common type of injury (27.8 %), followed by muscle strains (19.1 %). ...
... Match injury incidence was stable between the two seasons with a mean incidence of 23.9/1000-h. This was similar to the Norwegian, Spanish and German first division national leagues (Faude et al., 2005;Larruskain et al., 2018;Tegnander et al., 2008). In the BeNe League, Trinidad and Tobago league and English Women's Championship, match injury incidence ranged between 28 and 30/1000-h (Babwah, 2014;Blokland et al., 2017;Mayhew et al., 2022). ...
... In amateur and semi-professional players the overall injury burden was 127 and 213 days/1000-h with a mean time-loss of 23 and 27 days/injury, respectively (Hagglund et al., 2009;Horan et al., 2022). In professional teams the impact is higher with an injury burden of 216 days/1000-h, 35 days/injury in Spain and 468 days/ 1000-h, 58 days/injury in England (Larruskain et al., 2018;Mayhew et al., 2022). In 15 professional football clubs across Europe, a mean overall burden of 175 days/1000-h has been reported with a peak of 189 days/1000-h in one season (Hallen et al., 2024). ...
... In contrast with the Norwegian Premier League (Amundsen et al., 2023), quadriceps injuries was the most prevalent and frequent location of injury and, the second most burdensome diagnosis (first from muscle injuries). A similar trend has been found in the UEFA study, English Women's Championship and Spanish teams, including a substantial higher incidence of quadriceps strains when compared with the men of the same club (Hallen et al., 2024;Larruskain et al., 2018;Mayhew et al., 2022). Similarly to the UEFA study (70%) (Hallen et al., 2024), most of the quadriceps injuries (81%) occurred in training and 46% involved the muscle tendon junction or extended into the tendon. ...
This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women’s Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club’s international players’ lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player’s injury resilience in professional women footballers.
... This incidence injury rate is lower than 8.1/1,000 h found in men's football (Lopez-Valenciano et al., 2020). Conversely, there appears to be a greater occurrence of severe injuries in female players compared to their male counterparts (Roos et al., 2017), such as anterior cruciate ligament (ACL) ruptures and ankle syndesmosis injuries (Larruskain et al., 2018). In addition to this distinct injury profile, there exists sex-related specificity in both the physical and technical demands of the match, including the greater distance covered by male players in the highest speed zones . ...
... In addition to facing a more than 4.5 times higher risk of experiencing an ACL rupture (Larruskain et al., 2018), women's football players are less likely to return to play after an ACL reconstruction compared to their male counterparts (Brophy et al., 2012). Two-thirds of female footballers with ACL reconstruction who returned to sport sustained a new knee injury within 5-10 years, with 42% experiencing a new ACL injury (Faltstrom et al., 2021). ...
... Two-thirds of female footballers with ACL reconstruction who returned to sport sustained a new knee injury within 5-10 years, with 42% experiencing a new ACL injury (Faltstrom et al., 2021). Furthermore, a recent prospective study (Gasparin et al., 2024) revealed an overall incidence rate of ACL injuries among Brazilian elite footballers over twice as high than previously reported in European women's football scenes (Gaulrapp et al., 2010;Horan et al., 2022;Larruskain et al., 2018): 0.5/1,000 h vs. 0.09-0.24/1,000 h. ...
... Based on the IOC statement, injuries were categorized about the events where they occurred as training and competition injuries. The days of absence from training and competition were recorded as a measure of injury severity [31]. Injury prevalence was calculated as the number of players who were diagnosed with a non-contact injury during the season. ...
... Greater match-time exposure reduces the injury incidence, which suggests that non-starter players receive insufficient load and require particular post-game training. A threshold for several matches as starter (less than[25][26][27][28][29][30][31][32][33][34][35] and training decelerations (less than 5300) accounted for greater muscular and non-muscular injury in both starters and non-starter players. The accumulated matches as starter seems a potential and practical indicator of injury risk. ...
... Furthermore, the quadriceps play an important role during ball striking, sprinting, and jumping, while the hamstrings control running activity and stabilize the knee during turns, changes in direction, and tackles [46]. Due to this, the quadriceps and hamstrings are the muscles most frequently injured during pre-season and competition season, respectively [46][47][48]. ...
... Furthermore, the quadriceps play an important role during ball striking, sprinting, and jumping, while the hamstrings control running activity and stabilize the knee during turns, changes in direction, and tackles [46]. Due to this, the quadriceps and hamstrings are the muscles most frequently injured during pre-season and competition season, respectively [46][47][48]. Previous research has shown that weekly training loads can alter muscle stiffness and that elevated stiffness levels prior to a training session are a discriminating factor in injury incidence [2,18,19]. However, it is still unclear how these variables influence stiffness in both male and female professional soccer players. ...
This study aimed to evaluate changes in muscle contractile properties during a training microcycle in semi-professional female football players and explore their relationship with training load variables. Nineteen players (age: 23.9 ± 3.9 years; body mass: 60.6 ± 6.9 kg; height: 164.5 ± 6.7 cm) underwent myotonometric assessments of the biceps femoris (BF) and rectus femoris (RF) before and after the following training sessions: MD1 (i.e., 1 day after the match), MD3, MD4, and MD5. Training loads were quantified for each session, revealing significant variations, with MD4 exhibiting the highest values for high-speed running distance, number of sprints, and accelerations. Notably, MD3 showed the highest perceived exertion (RPE), while MD5 recorded the lowest total distance run. Myotonometric assessments indicated significant differences in stiffness of the RF in MD3 and BF in MD5, as well as RF tone in MD5. The findings underscore a notable relationship between training load and myotometric variables, particularly in muscle stiffness and tone. These results emphasize the need for further research to clarify how training loads affect muscle properties in female athletes.
... This is all the more concerning as HSI have a very high reinjury rate, ranging between 16% and 26% (1)(2)(3). They impact both amateur and professional soccer players (1,4), with heavy costs for the individual players [e.g., psychological, functional, and career impacts (5)], as well as for the soccer clubs and society. From a preventive viewpoint, extrinsic and intrinsic HSI risk factors have been widely investigated, mainly from physiological and biomechanical perspectives (6,7). ...
... Interviews were conducted and recorded from May to October 2021 via secure Zoom (Mean interview time = 57 ± 7 min). They were transcribed verbatim before Age (years) 17.9 ± 1.8 [15][16][17][18][19][20] Soccer experience (years) 11.0 ± 1.9 [9][10][11][12][13][14][15] Training and match sessions/week 7.4 ± 2.6 [3][4][5][6][7][8][9][10][11] Level Reserve of pro team 4 National (young) 3 ...
Introduction
Hamstring strain injuries (HSIs) remain one of the most burdensome injuries in soccer. Current recommendations to prevent sports injuries suggest the importance for coaches and medical staff to consider psychological and contextual risk factors and to specify them according to the injury type and context. HSI risk factors in soccer have been widely investigated, mainly from physiological and biomechanical perspectives. However, psychological and health-related risk factors are still unexplored. Therefore, the objective of this study was to determine the psychological and health-related risk factors for a first HSI in male competitive soccer.
Method
Individual semi-structured interviews were conducted with ten male competitive soccer players, who had recently sustained a HSI. Based on multifactorial models of sports injury causation, soccer players' individual, contextual, and situational risk factors at the time of their first HSI were investigated. Interviews were analyzed using thematic analysis with deductive and inductive approaches.
Results
Individual psychological risk factors included common at-risk personality traits, obsessive passion for soccer with competitive motivational goals, strong athletic identity, and poor health literacy. The injured players were exposed to a controlling coaching style, with a fear of negative staff evaluations, and had recently experienced life stressors. They were injured during matches or overload periods and were highly engaged in the activity.
Discussion
Previously injured soccer players exhibit a lack of perspective concerning the repercussions of their actions on their health. From a preventive viewpoint, these results suggest enhancing the players' health literacy, supporting their autonomy, and moderating the controlling coaching style.
... The high prevalence of hamstring strain injury (HSI) in high-speed running-based sports [1][2][3] has considerable implications for athletes and their teams/organisations in terms of time lost from training and competition [4], which results in diminished performance [5], and related financial costs [6]. The identification of several intrinsic factors including age [7], prior HSI [8], eccentric knee flexor strength [9], muscle-tendon unit stiffness [10] and muscle fascicle length [11] has helped increase our understanding of HSI risk and inform injury prevention/rehabilitation approaches. ...
... track sprinting and hurdles; association football; hockey; rugby union; and basketball) volunteered to participate in this study and provided their written informed consent. Male athletes were selected due to reports of higher HSI incidence in male vs. female team sport athletes [4]. ...
Biceps femoris long head (BFLH) aponeurosis size was compared between legs with and without prior hamstring strain injury (HSI) using within-group (injured vs. uninjured legs of previous unilateral HSI athletes) and between-group (previously injured legs of HSI athletes vs. legs of No prior HSI athletes) approaches. Currently healthy competitive male athletes with Prior HSI history (n=23; ≥1 verified BFLH injury; including a sub-group with unilateral HSI history; most recent HSI 1.6 ± 1.2 years ago) and pair-matched athletes with No prior HSI history (n=23) were MRI scanned. Anonymised axial images were manually segmented to quantify BFLH aponeurosis and muscle size. Prior unilateral HSI athletes’ BFLH aponeurosis maximum width, aponeurosis area, and aponeurosis:muscle area ratio was 14.0-19.6% smaller in previously injured vs. contralateral uninjured legs (paired t-test, 0.008≤p≤0.044). BFLH aponeurosis maximum width and area were also 9.4-16.5% smaller in previously injured legs (n=28) from prior HSI athletes vs. legs (n=46) of No prior HSI athletes (unpaired t-test, 0.001≤p≤0.044). BFLH aponeurosis size was smaller in legs with Prior HSI vs. those without prior HSI. These findings suggest BFLH aponeurosis size, especially maximum width, could be a potential cause or consequence of HSI, with prospective evidence needed to support or refute these possibilities.
... In our sample, no significant sex differences were observed in this pattern, as both male and female athletes presented similar injury distributions. However, previous studies have described a higher risk of ankle ligament injuries and anterior cruciate ligament (ACL) injuries among football players [14][15][16][17], especially in women. This increased susceptibility in female athletes has been attributed to both intrinsic factors (such as ligamentous laxity, limb alignment, and hormonal influences) [4][5][6]18], and extrinsic factors (including the type of sport, contact versus noncontact mechanisms, and athlete biomechanics) [8,9,12]. ...
Introduction
Sports injuries are a significant concern in emergency departments and affect both amateur and professional athletes. With the increase in women’s participation in sports, it is crucial to understand sex-specific injury characteristics, as patterns observed in men may not apply to women. This observational, descriptive and retrospective study aims to analyze sex differences in sports injuries to improve diagnosis, treatment, and prevention strategies. Our hypothesis is that sports injury patterns differ between sexes.
Methods
Patients treated for sports injuries between 2020 and 2023 in the Emergency Department at our hospital were included in the study. Researchers collected data on demographics, sports practiced, types of injuries, and initial treatment, utilizing descriptive statistics, Student’s t-test for continuous variables, Fisher’s exact test for categorical variables, and variable correlation for data analysis.
Results
A total of 977 patients were included in the study, 82% of whom were men. Significant differences were observed regarding the sport practiced (p < 0.001) and the type of injury (p = 0.02) between the groups. No differences were observed in injury location or the percentage of patients receiving each treatment modality. Specific correlations were also conducted between sports, type of injury, and location. Contusions, ligamentous injuries and dislocations were associated with specific sports and/or locations in men and women. Ligamentous injuries were observed in both sexes predominantly in the ankle and knee.
Conclusion
Increasing sports participation offers health benefits but also increases the risk of injuries. Our study aimed to investigate whether sports injury patterns differ between sexes. The results support this hypothesis, highlighting significant sex differences in injury patterns.
... COD movements are associated with non-contact ACL injuries in multidirectional sports and females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads during COD which can increase ACL loading (Donelon et al., 2024). In order to reduce the prevalence of this injury in this population, improving COD technique could help reduce injury burden, as ACL injuries are 4.52 times more frequent in women's soccer than in men's soccer (Larruskain et al., 2017). That is why this capacity is essential in resistance training in women's soccer. ...
Objective: The aim of this study was to analyze the effects of an 8 weeks in-season Rotary inertia devices (RID) training program on change of direction (COD) performance and on reduce the unilateral deficit between legs in semi-professional female soccer players. Methodology: 32 semi-professional female soccer players were divided into an experimental group (EG, n=16) and in a control group (CG, n=16). All the players participated in 3 specific soccer training sessions per week lasting an hour and a half, to which was added the weekly match league competition. The GE performed two training sessions per week with rotary inertia devices, while the CG did not perform any additional resistance training program during the 8 weeks that the work lasted. Results: Time in the V-cut test, 10m and 20m curved sprints to the right (CSHr and CSFr, respectivelly), and to the left (CSHl and CSFl, respectivelly), time in 10 m (T10) and 20 m (T20) linear sprint test, the time difference between CSHr-CSHl and between CSHr-CSHl, were assessed. There is a significant reduction in the unilateral CSHr-CSHl deficit of the EG with respect to the CG (p-value=0.015; SE=0.375). Conclusions: In conclusion, the use of this type of exercises carried out with rotary inertia resistance (frontal movements and lateral movements with rotary inertia devices) have achieved the balance of the unilateral deficit in a curved sprint task during 8 weeks of training in a group of semi-professional female soccer players.
... Hamstring injuries occur with greater incidence during matches [6], and 56% of hamstring injuries occur during the second hour of sports practice [7]. The incidence is 30% higher in men than in women [8]. Additionally, 20% of soccer players will experience a hamstring injury during their career, with a 20% recurrence rate [9]. ...
Hamstring muscle injuries account for 12% of all injuries in soccer players. Several studies claim that the hamstring/quadriceps (H/Q) strength ratio has the potential to predict hamstring injuries, although the current evidence is not robust enough to definitively support this claim. Therefore, the main objective of the present study is to analyze whether there are changes in the H/Q ratio at different knee flexion angles and establish a measurement protocol capable of reducing the high prevalence of hamstring injury. We performed an observational study with 24 third-division soccer players. The conventional isokinetic H/Q strength ratio and H/Q strength ratio were measured at different knee flexion angles (15°, 30°, 45°, 60°, and 75°) at 60°/s and 180°/s. The conventional H/Q ratio differs from the H/Q ratios at 15° and 30° knee flexion at 60°/s and from the H/Q ratios at 15°, 45°, 60°, and 75° at 180°/s (p < 0.05). Based on the results obtained in this study, we recommend calculating the H/Q ratios at 15° and 30° knee flexion in the protocol for measuring the flexor and extensor strength of the knee. This additional data will establish more specific cut-off points that could predict and prevent future hamstring muscle injuries.
... Indeed, the muscle collagen fractional synthesis rate is elevated in response to exercise in eumenorrheic women but not in OC users, 12 who also experience slower recovery from post-exercise strength loss and increased perceived muscle soreness. 11 Hamstring strains are among the most prevalent injuries in female sports, such as football 13 and athletics. 14 As muscle injury mechanisms are partly dependant on the muscle strain, 15 the potential association of the MC with hamstring's response to stretch has been investigated using shear wave elastography measurements. ...
... With the increasing popularity of women's soccer, there is also a rise in professional standards, and players at different levels may be exposed to higher training and competitive demands than before, which can have impact for their performance and health [3,4]. In women's soccer, a high incidence of injuries is a significant and recurring reality, regardless of performance level [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Generally, athletes after severe injury are more susceptible to re-injury, experience functional deficits, reduced quality of life, and are at increased risk of obesity compared to uninjured athletes [25]. ...
As female soccer's popularity and participation rise, injury rates are expected to increase due to the sport's complexity, highlighting the importance of regular health and neuromuscular function screenings for injury prevention. The aim of the study was to determine how neuromuscular warm-up affects the contractility of the lower limb muscles and its significance in the prevention of injuries in female soccer players. The research sample consisted of 36 female soccer players, who were divided into an experimental (EG) and a control (CG) group with an average age 17.45 ± 2.63 years (EG) and 16.24 ± 1.09 years (CG). The contractility of the lower limb muscles was monitored using Tensiomyography (TMG). We evaluated bilaterally five muscles of the lower limbs for each soccer player: m. biceps femoris, m. gastrocnemius medialis, m. gluteus maximus, m. vastus lateralis, and m. vastus medialis. The experimental factor in the research, implemented during the warm-up phase of the training session, was neuromuscular warm-up over 12 weeks of EG. To assess the effect of the intervention program on changes in the muscle contractility of the soccer players, we employed the non-parametric Wilcoxon signed-rank test for dependent samples and the Mann-Whitney U test for independent samples. Results indicates that the speed of muscle contraction (Tc) and muscle stiffness (Dm) vary among different muscles and even between dominant and non-dominant limbs of soccer players. The impact of neuromuscular warm-up on contraction time and maximal displacement was negligible, except for a moderate effect in m. gluteus maximus of the non-dominant limb. Although the impact of neuromuscular warm-up on lower limb muscle contractility was not significant, more regular monitoring and inclusion of neuromuscular warm-up at a higher weekly frequency may have beneficial effects.
... Systematic injury surveillance forms the basis for developing preventive measures in sports. Previous 1, 2 1 1 studies have predominantly focused on injuries occurring during competitions (single-sport tournaments or multi-sport events) or have investigated incidence within a single sport over time [1][2][3]. Various across-sport surveillance studies of elite athletes have reported on injury incidence during competitions by the International Olympic Committee (IOC) [4][5][6][7]. An expert group convened by the IOC has established an injury surveillance system for multi-sport events [8] that has been used at major international competitions such as the Olympic Games and World Championships. ...
Introduction
Injury trends among international athletes across sports remain underexplored in out-of-competition settings, particularly among Asians. The aim of this descriptive epidemiological study is to investigate the characteristics of injuries among Japanese international athletes during pre-competition medical check-ups from 2008 to 2019.
Methods
We analyzed the medical check-up data of candidates for international multi-sport events according to the International Olympic Committee consensus statement. At the medical check-up, athletes' injuries were categorized into two groups based on clinical assessment. "Injuries" refer to conditions that necessitate immediate treatment or further detailed examination. On the other hand, "complaints" encompass both such "injuries" and conditions for which treatment has already commenced, allowing athletes to continue participating in competitions or training while still requiring ongoing medical monitoring. The cohort was categorized into youth and adult groups, with adults defined as those aged ≥18 years.
Results
Overall, 10,854 athletes (4,966 females, 45.8%; 5,888 males, 54.2%; median age 22.0 {20.0-25.0} years, 56 sports) were enrolled; 2,333 “injuries” were registered (21.5 “injuries” per 100 athletes). The “injury” prevalence was 16.2% (95% CI, 0.16-0.17) and significantly associated with females (odds ratio {OR} 1.21; 95% CI, 1.09-1.34) and adult group (OR, 1.35; 95% CI, 1.08-1.69) based on binomial logistic regression analysis. Of a total of 10,027 “complaints” (92.4 “complaints” per 100 athletes), the “complaint” prevalence was 55.3% (95% CI, 0.54-0.56) and higher in females (OR, 1.44; 95% CI, 1.33-1.55) and adult group (OR, 1.50; 95% CI, 1.29-1.75). Stratified by sport, male soccer players had a higher “injury” prevalence than females (95% CI, 0.45-0.98), whereas females had a higher “injury” prevalence in hockey (1.70-7.29) and fencing (1.12-5.44). The “complaint” prevalence was higher in females for athletics, skiing, swimming, hockey, judo, badminton, fencing, water polo, weightlifting, and golf. There was no significant difference between the sexes in other sports. The knee (“injury,” 20.1%; “complaint,” 20.2%), lumbosacral (15.5%; 17.0%), ankle (13.0%; 15.4%), and shoulder (13.0%; 12.1%) were most commonly affected. The injury proportion ratio for the ankle was “injury”/“complaint” 0.82 (95% CI, 0.72-0.94), with the ankle “complaint” proportion being higher than “injury.” When stratified by injury location and sex, knee “injury” was more common in males (206 in females vs. 262 in males; 95% CI, 0.59-0.88), whereas ankle “complaint” was more common in females (842 in females vs. 700 in males; 95% CI, 1.04-1.29).
Conclusion
This is the first cross-sectional report of injuries in Asian international athletes outside of competition periods. Injury prevalence was higher in females than in males and in adults than in youths. Sex differences in injury varied by site and severity. These findings may suggest the need for more tailored injury prevention and performance support strategies for international competitions.
... (1) Son el tipo de lesiones muscu lares más frecuentes en los equipos de fútbol profesional que causan más días de ausencia que cualquier otro ac cidente durante la temporada deportiva (24 % de todas las ausencias por lesiones), con una media de 9 días de tiempo de recuperación. (2,3,4) Las medidas de resultado informadas por el paciente (PROM, por sus siglas en inglés) son cada vez más im portantes en la práctica clínica actual para este fin. (5) La validación de escalas de evaluación funcional es crucial en el ámbito de la rehabilitación deportiva, especial mente para lesiones recurrentes como las de los isquio tibiales. ...
Objetivo: Traducir y adaptar transculturalmente el cuestionario de resultados de isquiotibiales (HaOS, por sus siglas en ingles) para sujetos argentinos con antecedentes de lesiones de isquiotibiales y analizar su consistencia interna y confiabilidad. Materiales y métodos: Se realizó un estudio prospectivo y longitudinal en tres fases: (1) traducción del HaOS del inglés al español, (2) adaptación transcultural para la población argentina y (3) evaluación de sus propiedades psicométricas. Se analizaron las correlaciones ítem-ítem e ítem-total mediante los coeficientes de Pearson o Spearman, y se evaluó la confiabilidad mediante un modelo de efectos aleatorios de dos vías (ICC2,1). La confiabilidad se clasificó como pobre (ICC <0,50), moderada (0,50-0,75), aceptable (0,75-0,90) o excelente (>0,90). Resultados: Veintiocho sujetos (93 %) no encontraron dificultades para responder el cuestionario en la prueba piloto. Diecisiete (56,6 %) lo consideraron normal, diez (33,3 %) fácil, y cuatro (13,3 %) muy fácil. La consistencia interna del HaOS fue alta, con un alfa de Cronbach de 0,935 (IC 95 %: 0,903; 0,967) y una correlación ítem-ítem promedio de 0,317, lo que indica una homogeneidad razonable. Las correlaciones ítem-total variaron de -0,119 a -0,707, con una media de -0,534. La confiabilidad test-retest fue excelente, con un ICC de 0,982 (IC 95 %: 0,969; 0,989). Conclusión: La traducción, adaptación transcultural, consistencia interna y confiabilidad del HaOS para la población argentina demuestran que es una herramienta confiable para evaluar la función en sujetos con lesiones de isquiotibiales.
... a possible explanation for not finding any significant effect in female players in the current study is the limited number of studies (only two by the same authors) and the higher prevalence of injury in males in comparison to females. 45,46 although direct comparison cannot be made, a previous systematic review and meta-analysis concluded that the reduction of the risk among females with fifa11 and or fifa11+ did not reach a significant reduction level which supports the current study finding. 20 a systematic review and meta-analysis was conducted by al attar et al. 20 on the effectiveness of warming-up programs designed by the fifa Medical and research centre (F-MARC) including the FIFA 11+ program. ...
Introduction:
The FIFA 11+ preventive program is designed to reduce the incidence of injury in sports. However, to gain a better understanding of its effect a systematic review and meta-analysis is needed. The current review aims to investigate the effect of the FIFA 11+ preventive program on injury incidence among male and female football players.
Evidence acquisition:
This study used Scopus, PEDro, SPORTDiscus, and ProQuest as data sources. The initial selection of the studies, thorough assessment of the tile, and abstract. Extraction of the necessary study data was conducted by two independent researchers. Another two independent researchers assessed the quality of each included study against 39 used criteria. These criteria were combined from several popular quality assessment scales. The incidence of injuries measured in the lower extremities in football players after addressing the FIFA11+ was the outcome of interest.
Evidence synthesis:
This review included 12 trials of variable methodological quality from which 10 trials were selected for the meta-analysis. In general, the FIFA11+ program showed a significant reduction (P<0.1) in lower limb injury incidence for male young and adults in comparison to other programs. However, evidence of its effectiveness in females is lacking and more studies are needed.
Conclusions:
The FIFA 11+ program is recommended to be used and implemented as a preventive strategy in males. Although, the result showed a significant reduction in injury incidence in adult males, heterogeneity between studies is high which may reduce the generalizability of the results. More studies are needed to investigate the effect of the FIFA 11+ program on females.
... A 5-season cohort study found that quadriceps strains were the most frequently diagnosed muscle injury and responsible for 10% of the days that elite female players were away from the field of play. 5 Hence, quadriceps strains contribute to the adverse effects of injuries on team performance and the financial well-being of clubs. 6 As observed for hamstring strain injury, 7 a previous quadriceps injury is the strongest risk factor for a future strain injury in this muscle. ...
Context : The quadriceps femoris is consistently ranked among the muscles most prone to sustain strain injuries in sports involving kicking and sprinting actions. Given the documented preventive effect of Nordic hamstring curl programs against hamstring strain injuries, incorporating exercises that induce eccentric overload on the quadriceps could potentially help mitigate strain injuries within this muscle group. The Reverse Nordic Curl (RNC) has emerged as a viable field-based exercise for eccentrically working the quadriceps. This study aimed to compare quadriceps muscle eccentric activation during the RNC with 3 bodyweight squat-based exercises: single-leg squat (SLS), Bulgarian squat, and forward lunge. Design : Cross-sectional study. Methods : Twenty-three healthy volunteers (15 men) were monitored for rectus femoris, vastus lateralis, and vastus medialis electromyographic signal, as well as knee range of motion, while performing 10 repetitions of each exercise. Electromyography data acquired during eccentric phases were normalized by maximum voluntary isometric contraction of the knee extensors. The exercises were compared based on the electromyography and knee range of motion values. Results : RNC generated a similar rectus femoris and vastus medialis eccentric activation compared with the squat-based exercises ( P > .05 for all), and a lower vastus lateralis activation than SLS ( P < .001). Among the bodyweight squat-based exercises, SLS generated greater eccentric activation than forward lunge and Bulgarian squat for the 3 muscles ( P < .05 for all). RNC was performed with lower knee-flexion range of motion than bodyweight squat-based exercises ( P < .001). Conclusions : RNC did not produce superior eccentric quadriceps activation compared to bodyweight squat-based exercises, even proving to be less demanding for the vastus lateralis compared to the SLS. These findings may assist practitioners in selecting exercises to elicit quadriceps eccentric stimulus, with a focus on preventing strain injuries.
... Larruskain et al. (2018): Quadriceps strain (16%), ankle ligament injury (13%), hamstring strain (13%), hip adductor strain (12%), knee ligament injury (9%).Mayhew et al. (2021): Ankle sprain (43%), quadriceps strain (16%), knee ligament sprain or strain (12%). ...
The frequency and nature of sports injuries depend primarily on the specific sport that an individual play. In this article we review systematic reviews to identify and highlight the most prevalent injuries in basketball, football, volleyball, ice hockey, rugby, and handball. We collected data on the prevalence rates of the most common injuries across these sports, revealing that the most common injuries are lateral ankle sprains, concussions, hamstring strains, quadriceps strains, and various internal knee derangements. Notably, the majority of these injuries affect the lower extremities, which are under the most stress during athletic activities. We also provide insights into preventive measures for the three most common injuries. This compilation of data from different sports will prove valuable to kinesiologists, coaches, and sports professionals, helping them to develop comprehensive training programs aimed at preventing injury and improving overall athletic performance.
... According to the number of days lost from normal training and competition, injury severity was recorded as minimal (1-3 days), mild (4-7 days), moderate (8-28 days), or severe (>28 days). 10 Injury prevalence was calculated as the number of players who were diagnosed with a noncontact injury during the season. Injury incidence was individually calculated for each football player by dividing the number of injuries suffered by the player during the season and the total time of football exposure. ...
Background
Earlier statements suggested a negative impact of coronavirus disease 2019 (COVID-19) infection on sports performance and injury risk. With the COVID-19 pandemic under control and the dominance of a less-severe strain of the virus, there is a need to confirm whether these adverse effects still apply to the current situation.
Hypothesis
Infected players would have a higher noncontact muscle injury incidence compared with noninfected counterparts.
Study Design
Cohort observational study.
Level of Evidence
Level 3.
Methods
Seven teams (n = 147 players) competing in the Spanish professional women’s football league (Liga F) were prospectively monitored during the 2021-2022 season. Data from noncontact injuries were recorded and classified following the latest consensus statement from the International Olympic Committee. COVID-19 was certified by the medical staff by regular polymerase chain reaction analysis.
Results
Ninety-two players suffered at least 1 noncontact muscle injury during the season. Injury incidence during the season was similar in players with COVID-19 (n = 83) and players without infection (5.1 ± 6.7 versus 4.9 ± 10.0 injuries/1000 h of play, respectively; P = 0.90). Players with COVID-19 were not more likely to suffer noncontact injuries compared with those players without infection ( R ² = 0.02; odds ratio [OR] 95% confidence interval [95% CI] = 0.36-1.38; P = 0.31). There was no effect of COVID-19 on the days of absence due to injury ( R ² = 0.01; OR 95% CI = 1.00-1.01; P = 0.44) or in the classification of the severity of the injury ( P = 0.79).
Conclusion
COVID-19 has no significant effect on noncontact injury incidence and severity in professional female football players.
Clinical Relevance
Currently, COVID-19 infection does not alter noncontact muscle injury risk in professional football and requires no further attention in terms of injury management. Usual return-to-play protocols apply to COVID-19 considering the particularities of each player since the severity of infection, period of inactivity, and effects on the player’s health and performance.
... anterior cruciate ligament (ACL and meniscus tears). Female athletes have a significantly higher risk of traumatic knee injury than males in cutting sports such as floorball (Tervo et al., 2019), handball (Raya--González et al., 2020) and soccer (Larruskain et al., 2017) and high school female athletes seem to top the statistics for prevalence of ACL injury (Beck et al., 2017). To reduce morbidity and costs of traumatic knee injury, it has been suggested that prevention training should be applied to all young athletes, not only those identified as high risk athletes through screening (Arundale et al., 2018). ...
... Female football players are more vulnerable to severe injuries than their male counterparts (Larruskain et al., 2017). Therefore, prevention and rehabilitation strategies should be tailored to the needs of female football players, which could positively influence the further development and general level of interest in women's football among youth. ...
Hip strength has been shown to influence the incidence of injury in women's football. The first objective of our study was to examine the differences in isometric strength of the adductors and abductors between two test positions (0° vs. 45° hip angle). Our second objective was to verify the sensitivity of the two test positions in discriminating between women footballers with and without a history of groin pain in the last twelve months. One hundred and one elite players from the Slovenian women's football league were tested. The isometric strength of the adductors, abductors, and the ratio between hip abductor and adductor strength in two different test positions were assessed. We found statistically significant differences (p < 0.05; effect size range 0.12-0.13) between the two test positions in hip adduction, abduction strength, and abductor/adductor strength ratio. The ROC analysis showed that only the abductor/adductor strength ratio at the 0° hip angle position can differentiate between players with and without a history of groin pain, with an optimal cutoff point of ≤ 1.01 (p < 0.05; AUC = 0.734). The results should help practitioners plan hip strength training for returning to sport or preventing groin pain among women football players. Research in Sports Medicine: Taylor & Francis
... This outcome indicates a shift in the typical female injury profile, reported to be more prone to quadriceps muscle injuries and anterior cruciate ligament (ACL) ruptures and toward greater susceptibility to hamstring injuries. 6 Parallel to this shift, the physical demands of women soccer games are increasing. 4,7 For instance, a 30% increase in total distance covered at high speed was observed from the 2015 to the 2019 female soccer World Cup. 3 Therefore, it is plausible that the evolution of injury type in elite women's soccer partially relates to the increased physical demands of their training and games. ...
Purpose: To identify the physical conditioning and functional injury screening characteristics of elite female soccer players. Methods: This review was prospectively registered (PROSPERO CRD4202346765). Searches were conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Web of Science (from inception in March to July 2023). Updated searches were conducted in October 2023 and April 2024. Included studies were quantitative studies conducted on female soccer players. Main outcomes were functional and physical profiles. Screening, data extraction and quality assessment (Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales) were performed. Mean differences between pre-season and in-season testing periods were estimated by Hedges g effect size. Methods and results were reported according to PRISMA guidelines. Results: The search yielded 1727 articles, of which 10 were included. Overall methodological quality of the studies was strong, with moderate level of evidence. Players exhibited mean maximal oxygen uptake of 52.6±4.5 mL∙min-1∙kg-1, 20m linear sprint performance of 3.58±0.18 s, countermovement jump of 31.0±2.9 cm, unilateral countermovement jump of 14.4±2.1 cm, and quadriceps and hamstring peak torque at 60º∙s-1 of 133±23 and 87 ± 17 N•m, respectively. Mean scores recorded during inseason were 2-22% better than in preseason (effect size: small to very large). Conclusions: This review provides valuable normative physical conditioning and functional injury risk assessment data for elite female soccer players. Coaches and conditioning staff can use these insights to interpret their own records and optimize the training processes. Furthermore, this study identifies methodological limitations to address in future research.
... Larruskain et al. (2018): Quadriceps strain (16%), ankle ligament injury (13%), hamstring strain (13%), hip adductor strain (12%), knee ligament injury (9%).Mayhew et al. (2021): Ankle sprain (43%), quadriceps strain (16%), knee ligament sprain or strain (12%). ...
The frequency and nature of sports injuries depend primarily on the specific sport that an individual play. In this article we review systematic reviews to identify and highlight the most prevalent injuries in basketball, football, volleyball, ice hockey, rugby, and handball. We collected data on the prevalence rates of the most common injuries across these sports, revealing that the most common injuries are lateral ankle sprains, concussions, hamstring strains, quadriceps strains, and various internal knee derangements. Notably, the majority of these injuries affect the lower extremities, which are under the most stress during athletic activities. We also provide insights into preventive measures for the three most common injuries. This compilation of data from different sports will prove valuable to kinesiologists, coaches, and sports professionals, helping them to develop comprehensive training programs aimed at preventing injury and improving overall athletic performance.
... The last intrinsic factor are the dysfunctions of the kinetic chain, these are pipes of the dynamic and static alignment that are involved in the biomechanics of the practiced sport, these having to be corrected [15]. Turning to extrinsic factors, we mention training errors, weather conditions, the quality of the field on which the player trains or plays a match, inadequate equipment, improper nutrition and fatigue [16]. In most cases, training errors are due to those who train athletes, often focusing on the massive development to the detriment of antagonistic groups, so many of the injuries in football occur in the posterior muscles of the thigh, neglected, lacking tone and strength, the priority being the development of the quadriceps [17]. ...
... In addition, we must take into account conditional and biomechanical differences and other aspects such as injury incidence. 17,18 Nevertheless, we must not forget that men's football has had a temporal advantage that has allowed for greater professionalization and still provides it with an economic, social, and sporting advantage today. For all these reasons, it is common to find higher performance in some variables associated with performance in men's football compared to women's football. ...
The technical−tactical performance of women’s football has improved markedly in recent years. Despite this improvement, there are still differences between men’s football and women’s football. The objectives of this study were to know the technical and tactical key performance indicators (KPIs) that differentiate elite men’s and women’s football teams as well as to determine which statistical techniques demonstrate superior classification ability and interpretability in football terms. For this purpose, 768 matches corresponding to the latest editions of the UEFA Champions League, UEFA Euro and FIFA World Cup for men and women were analyzed. First, the differences at the bivariate level were analyzed using student’s t-test for independent sample ( p < 0.05) for the male and female teams. Secondly, three data mining classification algorithms were applied: (i) Artificial Neural Network (ANN), (ii) Binary Logistic Regression, and (iii) Decision Tree. Significant differences were found between men’s football and women’s football in variables related to technical elements such as lost balls (ES = 1.19), ball recoveries (ES = 1.00), and accurate passes (ES = 0.97), as well as regulatory aspects like fouls (ES = 0.59), successful tackles (ES = 0.46), and yellow cards (0.45). On the other hand, the classification models presented excellent or good predictive capability [Range AUC 0.774−0.982], with very small differences between the ANN’s and logistic regression models. This result justifies the use of simpler models as the linear regression model to understand the differences between men’s and women’s football. Moreover, the observed differences may offer insights for future efforts aimed at enhancing the performance of women’s football.
... [6][7][8] Female athletes participating in intermittent team sports (including football) are reported to have a 2-6 times higher risk of injury than male athletes. 9 10 The annual prevalence of ACL injuries in female players ranges from 0.5% to 6.0%. For both male and female players, studies have consistently shown a 7-65 times higher incidence of ACL injury during match play. ...
Background
To identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women’s professional football by means of video match analysis.
Methods
ACL match injuries sustained in Germany’s first women’s league during the 2016–2017 to 2022–2023 seasons were prospectively analysed by three expert raters using a standardised observation form. Epidemiological and injury data, as well as the medical history of ACL tears, were obtained from media reports and the statutory accident insurance for professional athletes.
Results
Thirty-seven ACL injuries sustained in official football matches were included in the video analysis, of which 24 (65%) had associated knee injuries, mainly meniscus and collateral ligament injuries. According to the categorised contact mechanisms, 17 (46%) were non-contact injuries, 14 indirect contact injuries (38%) and six direct contact injuries (16%). Of the 17 non-contact injuries, seven (41%) occurred during the first 15 min of the match. Contact mechanisms did not differ between primary and secondary ACL injuries to the same or the contralateral side. Most injuries (80%) of field players occurred during horizontal movements such as sprinting (n=9, 26%), change-of-direction manoeuvres (n=7, 19%), stopping (n=5, 14%) and lunging (n=5, 14%). Four distinct repetitive patterns of ACL match injuries were identified: (1) non-contact ‘pressing ACL injury’ (n=9), (2) indirect contact ‘parallel sprinting and tackling ACL injury’ (n=7), (3) direct contact ‘knee-to-knee ACL injury’ (n=6) and (4) non-contact ‘landing ACL injury’ (n=4).
Conclusion
Most of the identified patterns of ACL injuries in women’s professional football have great potential for prevention.
... 1,2 In women's premier league football, the prevalence of groin injuries is uncertain, with studies ranging from 2% to 16% of all time-loss injuries. [3][4][5][6][7][8] Groin injuries often develop gradually and players commonly persist in training and playing despite experiencing symptoms. 1 These injuries can therefore be underrepresented in studies utilizing a time-loss definition of injury 1 and recording all health problems regardless of time loss or medical attention has been recommended. ...
Objective
To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics.
Methods
During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC‐H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player‐reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI).
Results
On average, 3.9% (95% CI: 3.4–4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3–2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player‐reported groin injuries (53%). Adductor‐related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris‐related (12%). Pubic‐related injuries caused most time loss (median: 24 days, IQR: 5–133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies).
Conclusion
The incidence rate and burden of groin injuries were high. Adductor‐related injuries were most common, but pubic‐related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.
... Female soccer players have been found to be at a greater risk of developing injuries, such as those associated with the anterior cruciate ligament, which force them to leave the game (Lin et al., 2018) and have 21% more absence caused by injury compared with male soccer players (Larruskain et al., 2018). In addition, the menstrual cycle reportedly results in injury occurrence and a decline in physical performance (Martin et al., 2021). ...
This research aimed to elucidate whether there were differences in physical characteristics and performance across starter and non-starter players in Japanese elite-level female soccer in college. Twenty-four college players (age: 19.8 ± 0.8 years, body height: 160.3 ± 4.0 cm, body mass: 55.2 ± 5.2 kg) participated in this study. We assessed the college players in the field and laboratory on two separate days. We found a significantly low value in the starter players’ group than the nonstarter players’ group in the 10-m sprint and 5 × 10-m shuttle run. For the maximum isokinetic contraction, 300°/s of hip extensor as concentric in the starter players was significantly higher than that of the non-starter players, and we found no statistical differences in the other laboratory-based assessments. This study suggested that although there was no significant difference in maximal muscle strength between starter and non-starter players, non-starter players may be inferior in field tests.
Context
Flag football is a rapidly growing sport with injuries frequently presenting to emergency departments (EDs). Current literature on flag football lacks mechanisms of injury and any information pertaining to female athletes. The purpose of this study was to examine demographic-specific injury trends in those playing flag football.
Evidence Acquisition
The National Electronic Injury Surveillance System (NEISS) was queried for flag football injuries presenting to United States EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury site, diagnosis, and disposition were recorded. NEISS narratives were used to identify mechanisms of injury. National estimates (NEs) were calculated using the NEISS statistical sample weight. Annual injury trends were evaluated by linear regression.
Study Design
Descriptive epidemiology study.
Level of Evidence
Level 3.
Results
There were 2508 flag football injuries (NE, 86,443) analyzed from 2013 to 2022; 78.2% were sustained by male athletes. Linear regression analysis revealed no significant trend in annual injuries ( P = 0.16) from 2013 to 2022. The most common mechanism of injury was player-player collision (35.7%). The 2 age groups most affected by flag football injuries were middle school-aged (11-13 years) (20.8%) and high school-aged (14-18 years) (23.7%). The area of the body most affected for pediatric (<18 years) groups was the head, while adults most frequently injured their fingers. In addition, the most common mechanism for the pediatric age group was fracture (21.3%), whereas adult age groups most frequently suffered from strain/sprain injuries.
Conclusion
The number of injuries from flag football identified in this study has not decreased throughout the last decade, aside from 2020 - potentially due to the prevalence of COVID-19. Collisions were the most frequent mechanism of injury across all age groups. Whereas younger athletes frequently sustained head injuries and fractures, older athletes typically sustained strain/sprain injuries and finger injuries.
The aim of this study was to investigate if an 8‐week high‐volume protocol of the Adductor Strengthening Programme was more effective than a low‐volume protocol in increasing and maintaining isometric hip adduction strength in female football players. We randomized 52 players from the Norwegian women's 1st and 2nd division to a low‐volume (220 reps/side) or high‐volume (394 reps/side) group. Both groups performed an 8‐week protocol of the Adductor Strengthening Programme and a 10‐week maintenance protocol with 1 session/week (16 reps/side/session). We measured isometric hip adductor torque (Nm/kg) in a long‐lever squeeze test (at 0° and 15° hip abduction) using the ForceFrame at baseline, weeks 4, 6, 8, and 18. Both groups increased their isometric hip adduction strength over the 8‐week period (low‐volume 0°: 0.13 [95% CI: 0.07–0.20] Nm/kg, 15°: 0.22 [95% CI: 0.07–0.36] Nm/kg; high‐volume 0°: 0.13 [95% CI: 0.04–0.22] Nm/kg, 15°: 0.31 [95% CI: 0.18–0.45] Nm/kg), with no between‐group difference in either test position (0°: ‐0.01 [95% CI: −0.11‐0.01] Nm/kg; 15°: 0.10 [95% CI: −0.09‐0.29] Nm/kg). Also, both groups maintained their strength throughout the 10‐week maintenance period, with no between‐groups difference in either test position (0°: 0.12 [95% CI: −0.01‐0.24] Nm/kg; 15°: 0.06 [95% CI: −0.11‐0.23] Nm/kg). Our results indicate that an 8‐week high‐volume protocol of the Adductor Strengthening Programme was not more effective in increasing isometric adductor strength in female football players than a low‐volume protocol. Both groups increased their strength over the 8‐week training period and maintained their strength during the 10‐week maintenance period.
Trial registration: The study protocol was uploaded to Open Science Framework before unblinding and analyzing the data (https://osf.io/7xfw4/)
Frauen erleiden im Fußball häufiger Knieverletzungen als Männer. Sind die Gründe dafür bekannt, kann im Reha-Prozess, aber auch schon präventiv das Risiko für eine (Wieder-)Verletzung verringert und der Wiedereinstieg in den Sport sicherer geplant werden.
Introduction Sports and games are not only an entertainment but also a highly competitive and professional field 1 in developed and developing countries. Sports activities provide better cultural and social understanding, opportunities for global recognition, and contribute to the better health and overall development of the country. 2 As the two sides of a coin, sports also has both negative and positive sides. While sports helps in psychosocial and personal development of an individual, the risk of injury and fear of failure which leads to poor mental health remain as some of the serious problems-6. In sports industry, to maintain high-level status, both growing and established athletes had to go through stress and pressure. These athletes train hardly to achieve maximum output, with maximum intensity and volume in their practice time 3. This overload and lack of rest can lead to major injuries 4. The athlete's poor physiological and physical conditions pave way to injury like lack of flexibility, strength and coordination in muscles and tendons. The physical conditions such as players' environment factors like practicing level, nature of the sports and position of the player in the game also matters. 5-7 So the major hazard in sports is injury which will lead to poor performance in the field of sports and poor metal health. 3,6,8 In recent decades, studies show a significant growth in the participation of women in sports. 9 The increased visibility and success of female athletes globally have contributed to a more inclusive sports culture, although disparities in treatment still exist. 10,11 If comparing college level and high school level players, 2 to 10 fold females have a high risk of chances in injury. 12 Overuse injury types are highly evident in the adolescent females. 13 The locations of injuries that happen in the human body are knee, ankle, and thigh and the common types of injuries are sprains or strains, contusions, and fractures. 14,15 The anterior cru-ciate ligament and patellofemoral injuries are the major women's lower body injuries, cartilage and muscle injuries, fractures are less common were tendonitis and inflammation. 16-19 Simultaneously, a unique set of injury risks, including higher rates of Anterior Crucial Ligament (ACL) injuries and stress fractures, compared to men, often due to anatomical and hormonal differences. 20 Moreover, in the case of women, most injuries occur during practice sections or during the competitions. 17 The games were mainly injuries happen are soccer, gymnastics, ice hockey, and basketball. 6,18 Several bio-psychosocial factors lead to the chance of injury. 6 When the disturbance and imbalance of knee neuromechanics, strength, flexibility. 13 Unbalanced loading and rest time lead to fatigue in the player and this causes injury. 4 Addressing these gender-specific risks through tailored training and prevention programs is crucial for enhancing the safety and longevity of
We investigated whether 10 weeks of pre‐season soccer training (including high‐intensity resistance exercise) with hydrolysed collagen (COL) supplementation would confer greater changes in patellar tendon (PT) mechanical and material properties compared with placebo (PLA) in professional female soccer athletes. Eleven athletes from the first team squad of a Football Association Women's Championship soccer club volunteered to participate in this study (age, 25.7 ± 4.2 years; height, 1.68 ± 0.04 m; mass, 64.0 ± 4.6 kg). Participants were pair‐matched for baseline knee extensor maximum isometric voluntary contraction torque, age, height and mass and were randomly assigned to the COL group (n = 6) or PLA group (n = 5). Participants were given 30 g COL or energy‐matched (36.5 g maltodextrin and 8.4 g fructose) PLA, plus 500 mg vitamin C before each training session, which consisted of high‐intensity lower‐limb resistance exercise, plyometric or pitch‐based exercise 3 days/week for 10 weeks during the pre‐season period. We assessed knee extensor maximum isometric voluntary contraction torque and PT properties using isokinetic dynamometry and ultrasonography before and after the intervention. The PT stiffness [COL, +15.4% ± 3.1% (d = 0.81) vs. PLA, +4.6% ± 3.0% (d = 0.32), P = 0.002] and Young's modulus [COL, +14.2% ± 4.0% (d = 0.65) vs. PLA, +3.4% ± 2.8% (d = 0.15), P = 0.004] increased more in COL than in PLA. There was a main effect of training on PT cross‐sectional area (P = 0.027), but no interaction effect (P = 0.934). To conclude, 10 weeks of pre‐season soccer training (incorporating high‐intensity resistance exercise) with 30 g COL increased PT stiffness and Young's modulus more than training alone in professional female soccer athletes. This has positive implications for improving athletic performance and mitigating injury risk.
With over 250 million players worldwide, soccer is the most popular sport in the world. The overall number of players at professional, amateur, and recreational levels has increased along with an increase in player diversity, including age and sex. These increases in player numbers, as well as a variety of demographics, have resulted in an increase in soccer-related injuries. Injury in the professional setting can lead to time off the field and an effect on team results and earnings. Injury at the amateur and recreational levels can lead to time off work, away from other activities, and change in activities of daily living. We provide an extensive list of common injuries sustained by soccer players, their pathophysiology, diagnosis, treatment, and general guidelines on return to play.
Women's football is a fast-growing sport with a significant global presence. There has been no bibliometric analysis in the field of women's football, which could help figure out the importance of this study area and identify knowledge gaps. Therefore, this study reviews the scholarly literature on women's football using bibliometric data from Scopus from 1984 to February 2024. Using multiple performance and science mapping techniques, we map the research landscape, highlighting key contributors and trends in women's football literature. The foremost contributors are the United States, Leeds Beckett University, the European Regional Development Fund (European Commission), and the Journal of Strength and Conditioning Research. Based on the analysis, we predict that the keywords may be relevant to women's football research in the future. In the concluding section, we delineate the study's limitations and propose avenues for future research expansion.
Background
The influence of external workload variables on the development of calf muscle strainsin football players has not been previously explored.
Hypothesis
Overloaded players would have an increased risk of calf muscle strain injury.
Study Design
Prospective observational study.
Level of Evidence
Level 4.
Methods
A total of 41 professional football players from 1 team were monitored for 2 consecutive seasons. Total distance covered (TD), and distances covered at high-intensity running, high sprint running, low (LACC) and high (HACC) acceleration, low (LDEC) and high (HDEC) deceleration, and at high metabolic load distance (HMLD) were monitored with GPS units. Accumulated players’ external workload in the week before injury was compared with the weekly mean value of the 6 weeks before injury occurred for each player.
Results
Ten players (24.3%) suffered 16 calf muscle strain injuries (3.1 injuries per 1000 hours of match play; 0.5 injuries per 1000 hours of training exposure). Players with a calf muscle injury were older ( p = 0.03), with higher body weight ( p = 0.01) and height ( p = 0.03). Injured players displayed substantially higher total training volume ( p < 0.01), TD ( p < 0.01), LACC ( p < 0.01), LDEC ( p < 0.01), HACC ( p < 0.01), HDEC ( p < 0.01), and HMLD ( p = 0.03) in the week before injury, in comparison with the mean values of these variables in the 6 weeks before injury.
Conclusion
A week with a higher-than-habitual external workload might increase the risk of calf muscle strain injury in professional football players. Calf muscle injuries were preceded by a week with unusually high workloads associated with accelerating and decelerating distances and higher training volumes.
Clinical Relevance
Monitoring external workload indicators may be helpful in determine players with a higher risk of calf muscle strain injury due to excessive workload during training/competition.
Background
Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.
Objective
The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.
Methods
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science’(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.
Results
Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4–5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17–1.34), bone stress injury (RR 3.4; 95% CI 2.1–5.4) and concussion (RR 8.46; 95% CI 1.04–68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31–3.88) and hamstring injuries (RR 2.4; 95% CI 1.8–3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37–2.7) to 2.8 (2.45–3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.
Discussion
Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14–20], tier-4: 16.9 ± 1.9 [11–21], tier-3: 16.9 ± 1.5 [11–20], tier-2: 16.3 ± 2.2 [11–20], tier-1 studies: 15.6 ± 1.3 [14–17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes’ propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.
Conclusions
Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.
Trial Registry
PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).
Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.
The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions.
A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting.
Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper.
The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.
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Context:
Among US collegiate soccer players, the incidence rate and the event characteristics of hamstrings strains differ between sexes, but comparisons in the return-to-participation (RTP) time have not been reported.
Objective:
To compare the RTP time between male and female collegiate soccer players and analyze the influence of event characteristics on the RTP time for each sex.
Design:
Descriptive epidemiology study.
Setting:
Data were collected from collegiate teams that voluntarily participated in the National Collegiate Athletic Association Injury Surveillance System.
Patients or other participants:
Collegiate soccer athletes who sustained 507 hamstrings strains (306 men, 201 women) during the 2004 through 2009 fall seasons.
Main outcome measure(s):
Nonparametric statistics were used to evaluate RTP time differences between sexes and among categories of each event characteristic (ie, time of season, practice or competition, player position). Negative binomial regression was used to model the RTP time for each sex. All analyses were performed separately for first-time and recurrent strains.
Results:
We found no differences in the RTP time between sexes for first-time (median: men = 7.0 days, women = 6.0 days; P = .07) or recurrent (median: men = 11 days, women = 5.5 days; P = .06) hamstrings strains. For male players with first-time strains, RTP time was increased when the strain occurred during competition or the in-season/postseason and varied depending on the division of play. Among female players with first-time strains, we found no differences in RTP time within characteristics. For male players with recurrent hamstrings strains, the RTP time was longer when the injury occurred during the in-season/postseason. Among female players with recurrent strains, RTP time was longer for forwards than for midfielders or defenders.
Conclusions:
Although we found no differences in the RTP time after hamstrings strains in male and female collegiate soccer players, each sex had unique event characteristics that influenced RTP time.
The risk of injury in professional football has been estimated at about 1000 times greater than for typical industrial occupations generally regarded as high risk.1 Hence, prevention of injury in football should be of the utmost importance, and conducting injury surveillance studies is the fundamental first step in the process of prevention.2
The worldwide football organisation Federation of International Football Association (FIFA) and the Union of European Football Association (UEFA) and many national federations have all observed a high risk of injury in football and have initiated and supported research with the aim of avoiding injuries and keeping players on the pitch.
In this issue, you will discover important findings of the UEFA Champions League (UCL) injury study. However, the UCL study is limited to men's professional football in Europe, which is only one part of football over the whole world.
FIFA and its research department, F-Medical Assessment and Research Centre, have carried out many studies of great importance for football overall over a period of 18 years. Two such studies are presented. Bizzini, Junge and Dvorak ( see page 803 ) provide an overview of the development, scientific evaluation and dissemination of FIFA's injury prevention programmes, FIFA 11 and 11 +. In these studies, FIFA has demonstrated how simple exercise-based programmes can decrease the incidence of injuries in youth and amateur players. Further, FIFA has systematically documented all injuries in world football tournaments since 1998. Junge and Dvorak present an overview of these surveys indicating that the injury incidence at matches might be influenced by the playing style, intensity of the match and refereeing ( see page 782 ).
In 2001, UEFA initiated a research project with the aim of reducing the number and severity of injuries …
Groin injuries are troublesome in men's and women's football.
To review the literature on the epidemiology of groin injury in senior football and compare injury occurrence between sexes.
Studies were identified through a search of PubMed, EMBASE, CINAHL and Web of Science, in the reference lists of the selected articles and the authors' bibliographies. The number of injuries, percentage of groin injury from all injuries and rate of groin injury per 1000 h were extracted. Exposure and injury data were aggregated across included studies and the absolute differences in groin injury proportion and rate of groin injury were compared between sexes. Risk of bias was assessed using a 5-item checklist.
34 articles met the study criteria and were included. The proportion of groin injury in club-seasonal football was 4-19% in men and 2-14% in women. Aggregated data analysis (29 studies) showed a higher relative proportion of groin injury in men than in women (12.8% vs 6.9%, absolute difference 5.9%, 95% CI 4.6% to 7.1%). The rate of groin injury varied from 0.2 to 2.1/1000 h in men and 0.1 to 0.6/1000 h in women's club football, and aggregated analysis (23 studies) showed a more than two-fold higher rate in men (0.83/1000 h vs 0.35/1000 h, rate ratio 2.4, 95% CI 2.0 to 2.9). High risk of bias was identified for participant selection (18 studies), exposure (17 studies) and precision estimate (16 studies).
Groin injuries are frequent in senior football and are more common in men than women. Future research needs to be of higher quality.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Purpose:
To evaluate the effect of simulated soccer on the hamstrings eccentric torque-angle profile and angle of peak torque (APTeccH), and on the hamstrings:quadriceps torque ratio at specific joint angles (ASHecc:Qcon).
Methods:
The authors assessed dominant-limb isokinetic concentric and eccentric knee flexion and concentric knee extension at 120°/s in 9 semiprofessional male soccer players immediately before and after they completed the Loughborough Intermittent Shuttle Test (LIST).
Results:
The LIST resulted in significant decreases in eccentric hamstrings torque at 60°, 50°, and 10° and a significant (21.8%) decrease in ASHecc:Qcon at 10° (P < .05). APTeccH increased from 7.1° ± 1.0° to 18.8° ± 4.2° (P < .05). Eccentric hamstrings peak torque significantly declined from 185.1 ± 70.4 N·m pre-LIST to 150.9 ± 58.5 N·m post-LIST (P = .002), but there were no significant changes in hamstrings or quadriceps concentric peak torque (P = .312, .169, respectively).
Conclusions:
Simulated soccer results in a selective loss of eccentric hamstrings torque and hamstrings-to-quadriceps muscle balance at an extended joint position and a shift in the eccentric hamstrings APT to a shorter length, changes that could increase vulnerability to hamstrings injury. These findings suggest that injury-risk screening could be improved by evaluating the eccentric hamstrings torque-angle profile and hamstrings strength-endurance and that the development of hamstrings fatigue resistance and long-length eccentric strength may reduce injury incidence.
Background:
The incidence of lower extremity injuries in female soccer players is high, but the risk factors for injuries are unknown.
Purpose:
To investigate risk factors for lower extremity injuries in elite female soccer players.
Study design:
Cohort study; Level of evidence, 3.
Methods:
Players in the Norwegian elite female soccer league (N = 12 teams) participated in baseline screening tests before the 2009 competitive soccer season. The screening included tests assessing maximal lower extremity strength, dynamic balance, knee valgus angles in a drop-jump landing, knee joint laxity, generalized joint laxity, and foot pronation. Also included was a questionnaire to collect information on demographic data, elite-level experience, and injury history. Time-loss injuries and exposure in training and matches were recorded prospectively in the subsequent soccer season using weekly text messaging. Players reporting an injury were contacted to collect data regarding injury circumstances. Univariate and multivariate regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for ±1 standard deviation of change.
Results:
In total, 173 players underwent complete screening tests and registration of injuries and exposure throughout the season. A total of 171 injuries in 107 players (62%) were recorded; ligament and muscle injuries were the most frequent. Multivariate analyses showed that a greater body mass index (BMI) (OR, 1.51; 95% CI, 1.21-1.90; P = .001) was the only factor significantly associated with new lower extremity injuries. A greater BMI was associated with new thigh injuries (OR, 1.51; 95% CI, 1.08-2.11; P = .01), a lower knee valgus angle in a drop-jump landing was associated with new ankle injuries (OR, 0.64; 95% CI, 0.41-1.00; P = .04), and a previous knee injury was associated with new lower leg and foot injuries (OR, 3.57; 95% CI, 1.27-9.99; P = .02), whereas none of the factors investigated influenced the risk of new knee injuries.
Conclusion:
A greater BMI was associated with lower extremity injuries in elite female soccer players.
Clinical relevance:
Increased knowledge on risk factors for lower extremity injuries enables more targeted prevention strategies with the aim of reducing injury rates in female soccer players.
The aim of this study was to examine gender differences in match performance characteristics of elite soccer players. Fifty-four male and fifty-nine female soccer players were tracked during UEFA Champions League matches using a multi-camera system (Amisco, Nice, France). Male players covered more (P<.01) distance than female players in total during a match (Effect Size [ES]: 0.5) and at higher speed thresholds (>15, >18, 18-21, 21-23, 23-25 and >27kmh(-1); ES: 0.7-1.4). Decrements in the second versus first half (P<.01) were only evident in female players for the distance covered in total and at selected speed thresholds (12-15, >12 and >15kmh(-1); ES: 0.6). Male central midfielders covered more (P<.01) total distance during a match than female central midfielders and at selected speed thresholds (15-23kmh(-1); ES: 1.3-2.2). Male full-backs and wide midfielders covered a greater distance (P<.01) than female players in the same positions at higher speed thresholds (>15, 21-23, 23-25, 25-27 and >27kmh(-1); ES: 1.5-3.1). The distance covered during the most intense 5min period of the match (>15kmh(-1)) was higher (P<.01) in male compared to female players (ES: 1.0) but no distance deficit in the next versus the average 5min period was observed for either gender (ES: 0.1-0.2). No gender differences were found for technical events such as the number of ball touches, time in possession of the ball or total duels won during both halves and the entire match (ES: 0.1-0.3). However, female players lost the ball more often (P<.05) and displayed lower pass completion rates than male players during both halves and the entire match (ES: 0.5-0.9). The data demonstrate that large gender differences exist for match performance characteristics of players competing at the highest competitive standard of European soccer. Such detailed analyses could be useful for gender-specific training information for optimal preparation. However, more research is warranted to establish gender-specific speed thresholds for elite soccer players.
Ankle injury is common in football, but the circumstances surrounding them are not well characterised.
To investigate the rates, especially time-trends, and circumstances of ankle injuries in male professional football.
27 European clubs with 1743 players were followed prospectively between 2001/2002 and 2011/2012. Time loss injuries and individual-player exposure during training sessions and matches were recorded. Injury rate was defined as the number of injuries/1000 h.
A total of 1080 ankle injuries were recorded (13% of all injuries) with lateral ligament ankle sprain being the most common injury subtype (51% of all ankle injuries). The rates of ankle injury and ankle sprain were 1/1000 h and 0.7/1000 h, respectively. The ankle sprain rate declined slightly over time during the 11-year study period (on average 3.1%/season) with a statistically significant seasonal trend (p=0.041). Foul play according to the referee was involved in 40% of the match-related ankle sprains. Syndesmotic sprains and ankle impingement were uncommon causes of time loss (3% each of all ankle injuries).
Lateral ligament ankle sprain constituted half of all ankle injuries in male professional football, whereas ankle impingement syndromes were uncommon. The ankle sprain rate decreased slightly over time, but many ankle sprains were associated with foul play. Our data extend the body of literature that provides football policy makers with a foundation to review existing rules and their enforcement.
Background:
The influence of injuries on team performance in football has only been scarcely investigated.
Aim:
To study the association between injury rates and team performance in the domestic league play, and in European cups, in male professional football.
Methods:
24 football teams from nine European countries were followed prospectively for 11 seasons (2001-2012), including 155 team-seasons. Individual training and match exposure and time-loss injuries were registered. To analyse the effect of injury rates on performance, a Generalised Estimating Equation was used to fit a linear regression on team-level data. Each team's season injury rate and performance were evaluated using its own preceding season data for comparison in the analyses.
Results:
7792 injuries were reported during 1 026 104 exposure hours. The total injury incidence was 7.7 injuries/1000 h, injury burden 130 injury days lost/1000 h and player match availability 86%. Lower injury burden (p=0.011) and higher match availability (p=0.031) were associated with higher final league ranking. Similarly, lower injury incidence (p=0.035), lower injury burden (p<0.001) and higher match availability (p<0.001) were associated with increased points per league match. Finally, lower injury burden (p=0.043) and higher match availability (p=0.048) were associated with an increase in the Union of European Football Association (UEFA) Season Club Coefficient, reflecting success in the UEFA Champions League or Europa League.
Conclusions:
Injuries had a significant influence on performance in the league play and in European cups in male professional football. The findings stress the importance of injury prevention to increase a team's chances of success.
Background International sports bodies should protect the health of their athletes, and injury surveillance is an important pre-requisite for injury prevention. The Fédération International de Football Association (FIFA) has systematically surveyed all football injuries in their tournaments since 1998.
Aims Analysis of the incidence, characteristics and changes of football injury during international top-level tournaments 1998–2012.
Methods All newly incurred football injuries during the FIFA tournaments and the Olympic Games were reported by the team physicians on a standardised injury report form after each match. The average response rate was 92%.
Results A total of 3944 injuries were reported from 1546 matches, equivalent to 2.6 injuries per match. The majority of injuries (80%) was caused by contact with another player, compared with 47% of contact injuries by foul play. The most frequently injured body parts were the ankle (19%), lower leg (16%) and head/neck (15%). Contusions (55%) were the most common type of injury, followed by sprains (17%) and strains (10%). On average, 1.1 injuries per match were expected to result in absence from a match or training. The incidence of time-loss injuries was highest in the FIFA World Cups and lowest in the FIFA U17 Women's World Cups. The injury rates in the various types of FIFA World Cups had different trends over the past 14 years.
Conclusions Changes in the incidence of injuries in top-level tournaments might be influenced by the playing style, refereeing, extent and intensity of match play. Strict application of the Laws of the Games is an important means of injury prevention.
Background:
Hamstring strains are common among soccer athletes, and they have a high incidence of recurrence. Among American collegiate soccer players, men have an overall higher incidence rate of hamstring strains than women.
Purpose:
This research compares the hamstring strain injury rates in event and athlete characteristics between male and female college soccer athletes.
Study design:
Descriptive epidemiology study.
Methods:
Data describing partial and complete hamstring strains were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for men's and women's soccer from 2004 to 2009. Incidence rate ratios (IRRs) comparing the incidence of hamstring strains between the sexes as well as during games versus practices and the preseason versus the in-season were calculated. χ(2) tests were used to compare the occurrence of hamstring strains across different event and athlete characteristics.
Results:
Men were 64% more likely than women to sustain a hamstring strain (IRR, 1.64; 95% CI, 1.37-1.96). Men had significantly higher rates of hamstring strains than women during both games (IRR, 2.42; 95% CI, 1.82-3.23) and practices (IRR, 1.34; 95% CI, 1.06-1.68). There were no differences between men and women in injury rates during the preseason, but men were significantly more likely to sustain a hamstring strain during the in-season (IRR, 1.98; 95% CI, 1.56-2.52). Men had a significantly higher proportion of recurrent hamstring strains compared with women (men, 22%; women, 12%; P = .003). There were no significant differences in the distribution of strains in event or athlete characteristics between men and women for first-time or recurrent hamstring strains.
Conclusion:
In collegiate soccer, men have significantly higher rates of hamstring strains than women, and regardless of the recurrence status, the event and athlete characteristics were similar for both sexes. Identifying common characteristics may assist in the targeted development of preventive and rehabilitative programs as well as continued research on hamstring strains among collegiate soccer players.
Quadriceps muscle strains frequently occur in sports that require repetitive kicking and sprinting, and are common in football in its different forms around the world. This paper is a review of aetiology, mechanism of injury and the natural history of rectus femoris injury. Investigating the mechanism and risk factors for rectus femoris muscle injury aims to allow the development of a framework for future initiatives to prevent quadriceps injury in football players.
Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the last three decades. This failure is most likely due to the following: (1) a lack of studies with high level of evidence into the identification and prevention of hamstring injuries and (2) a reductionist approach of the current literature. The objectives of this article are to review and critique the current literature regarding isolated risk factors, and introduce a new concept for a more comprehensive scientific understanding of how multiple risk factors contribute to hamstring strain injury. The authors hope that this new conceptual model can serve as a foundation for future evidence-based research and aid in the development of new prevention methods to decrease the high incidence of this type of injury.
Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.
Football (soccer), the most popular sport worldwide, is associated with a high injury risk, and the knee joint is often affected. Several studies have found female players to be more susceptible to knee injury, anterior cruciate ligament (ACL) injury in particular, compared to their male counterparts. There is, however, some controversy regarding the magnitude of this risk increase and a few studies have found no differences. The influence of age and activity type on gender-related differences in injury risk is only scarcely investigated. In this paper, the literature reporting gender-specific ACL injury risk in football is reviewed. A literature search yielded 33 relevant articles that were included for review. These show that female players have a 2-3 times higher ACL injury risk compared to their male counterparts. Females also tend to sustain their ACL injury at a younger age than males, and a limiting factor in the existing literature is that age is not adjusted for in comparisons of ACL injury risk between genders. Furthermore, the risk increase in females is primarily evident during match play, but type of exposure is also rarely adjusted for. Finally, the studies included in this review share important methodological limitations that are discussed as a starting point for future research in the field.
Recovery duration may be too short during the congested fixtures of professional soccer players with regard to maintaining physical performance and a low injury rate.
To analyze the effects of 2 matches per week on physical performance and injury rate in male elite soccer players.
Cohort study; Level of evidence, 3.
Match results, match-related physical performance, and injuries were monitored during 2 seasons (2007-2008 and 2008-2009) for 32 professional soccer players in a top-level team participating in the UEFA (Union of European Football Associations) Champions League. Total distance, high-intensity distance, sprint distance, and number of sprints were collected for 52 home matches. Injuries and player participation in matches and training were recorded throughout the full season.
Physical performance, as characterized by total distance covered, high-intensity distance, sprint distance, and number of sprints, was not significantly affected by the number of matches per week (1 versus 2), whereas the injury rate was significantly higher when players played 2 matches per week versus 1 match per week (25.6 versus 4.1 injuries per 1000 hours of exposure; P < .001).
The recovery time between 2 matches, 72 to 96 hours, appears sufficient to maintain the level of physical performance tested but is not long enough to maintain a low injury rate. The present data highlight the need for player rotation and for improved recovery strategies to maintain a low injury rate among athletes during periods with congested match fixtures.
To study the injury characteristics in professional football and to follow the variation of injury incidence during a match, during a season and over consecutive seasons.
Prospective cohort study where teams were followed for seven consecutive seasons. Team medical staff recorded individual player exposure and time-loss injuries from 2001 to 2008.
European professional men's football.
The first team squads of 23 teams selected by the Union of European Football Associations as belonging to the 50 best European teams.
Injury incidence.
4483 injuries occurred during 566 000 h of exposure, giving an injury incidence of 8.0 injuries/1000 h. The injury incidence during matches was higher than in training (27.5 vs 4.1, p<0.0001). A player sustained on average 2.0 injuries per season, and a team with typically 25 players can thus expect about 50 injuries each season. The single most common injury subtype was thigh strain, representing 17% of all injuries. Re-injuries constituted 12% of all injuries, and they caused longer absences than non re-injuries (24 vs 18 days, p<0.0001). The incidence of match injuries showed an increasing injury tendency over time in both the first and second halves (p<0.0001). Traumatic injuries and hamstring strains were more frequent during the competitive season, while overuse injuries were common during the preseason. Training and match injury incidences were stable over the period with no significant differences between seasons.
The training and match injury incidences were stable over seven seasons. The risk of injury increased with time in each half of matches.
The aim of this study was to investigate the effect of a multi-directional soccer-specific fatigue protocol on sprinting kinematics in relation to hamstring injury risk. Nine semi-professional soccer players (Mean +/- SD: Age: 21.3 +/- 2.9 year; Height 185.0 +/- 8.7 cm; Body Mass 81.6 +/- 6.7 kg) completed the SAFT(90); a multi-directional, intermittent 90 min exercise protocol representative of soccer match-play. The 10m sprint times and three-dimensional kinematic data were recorded using a high-speed motion capture system (Qualisys Track Manager) every 15 min during the SAFT(90). A significant time dependent increase was observed in sprint time during the SAFT(90) (P<0.01) with a corresponding significant decrease in stride length (P<0.01). Analysis of the kinematic sprint data revealed significantly reduced combined maximal hip flexion and knee extension angle, indicating reduced hamstring length, between pre-exercise and half-time (P<0.01) and pre-exercise and full-time (P<0.05). These findings revealed that the SAFT(90) produced time dependent impairments in sprinting performance and kinematics of technique which may result from shorter hamstring muscle length. Alterations in sprinting technique may have implications for the increased predisposition to hamstring strain injury during the latter stages of soccer match-play.
Females have often been reported to have a greater muscle fatigue resistance than males, especially during exercise at low-to-moderate intensities. Differences in muscle mass, muscle metabolism and voluntary activation patterns have been the primary explanations for the differences in performance and physiological responses to exercise between sexes. However, while ample data are available for isometric contractions, dynamic activity is a less studied mode of exercise, and there is even less information regarding multiple-sprint exercise (MSE). This is surprising given that MSE places unique demands on metabolic processes in the muscle where energy supply oscillates between fuelling contractile activity and restoring homeostasis. As such, MSE provides a rich area for future applied research. This review examines the limited data available concerning the physiological responses of males and females to sprint exercise, and discusses the methodological confounds arising from non-appropriate comparison methods. Based on original findings, we highlight that sex differences in the absolute mechanical work performed during a given task might explain a significant part of the differences in physiological responses of males and females to sprint exercise. We therefore suggest that future studies using male and female subjects to answer basic physiological questions use mechanical work as a covariate.
We analyzed the injury data collected from the 10 teams (237 players) that constituted Major League Soccer during its inaugural season. The overall injury rate was 6.2 per 1000 hours of participation. An injury rate of 2.9 per 1000 hours was noted for practice and 35.3 per 1000 hours was found for games. The difference was statistically significant. With regard to severity, 36% of injuries (143 of 399) were categorized as an incident (no time lost from competition). Of the 256 injuries that caused the player to lose playing time, 59% were classified as minor (<7 days lost), 28% as moderate (7 to 29 days lost), and 13% as major (>30 days lost). Seventy-seven percent of the injuries (197 of 256) were to the lower extremity; most frequently affected were the knee (N = 54) and ankle (N = 46). Neither the player's age nor playing position was found to be associated with prevalence or severity of injury. We believe that this information serves to underscore the notion that soccer, as it is played at the professional level, is a sport with a relatively low incidence of injury.
To show how epidemiological data can be presented and analysed in frequency based and risk based formats and how risk based information can simplify management decisions on injury prevention strategies in professional football.
The club physiotherapists at four English professional football clubs prospectively recorded players' injuries over the period November 1994 to May 1997. The nature, location, and mechanism of each injury and the specific numbers of days that players were unavailable to train or play as a result of injuries were recorded. The rates of injury were evaluated on a risk matrix using the number of days and the estimated costs of absence as measures of injury consequences.
There was a significant difference in the time lost through injury as a function of injury severity (p<0.001). Slight and minor injuries accounted for 51% of all injuries but represented only 17% of the risk from injury, whereas major injuries accounted for only 12% of the number of injuries and 47% of the risk. Player to player contact injuries accounted for 39% of the risk of injury, and football specific activities accounted for 47% of the risk. The risks of acute injury in professional football were three orders of magnitude greater than those in the construction, manufacturing, and service sectors of industry.
The risks associated with minor, moderate, and major acute injuries and osteoarthritis in lower limb joints of professional footballers were found to be unacceptable when evaluated against work based risk criteria used by the Health and Safety Executive. All stakeholders within professional football were shown to have an important contribution to make in reducing the overall level of risk to players through the provision of risk prevention strategies.
Analyses of tackle parameters in injury situations have provided valuable information regarding men's football. However, there are no similar data for women's football.
To categorise the tackle mechanisms leading to injury in elite women's football.
Retrospective video analysis of injury situations.
Events associated with all reported injuries during six women's top-level tournaments were analysed on video recordings for tackle parameters.
More than half of all injuries were due to tackles from the side (52%, 103/200), whereas tackles from behind were much less commonly involved in injury situations (11%, 21/200). One-footed (65%, 130/200) and upper body (21%, 42/200) tackle actions were most common. Sliding-in tackles leading to injury were the least likely to be sanctioned by match referees. Tackling players (45%, 90/200) were almost as likely to be injured as the tackled player (55%).
The present study found differences between injury mechanisms in women's football and previously published data on men's football. Further research, especially using video analysis, is needed for a better understanding of risk situations in football.
Objective:
To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's soccer and to identify potential areas for injury prevention initiatives.
Background:
The NCAA sanctioned its first men's soccer championship in 1959. Since then, the sport has grown to include more than 18 000 annual participants across 3 NCAA divisions. During the 15 years from 1988-1989 to 2002-2003, the NCAA Injury Surveillance System accumulated game and practice injury data for men's soccer across all 3 NCAA divisions.
Main results:
The injury rate was 4 times higher in games compared with practices (18.75 versus 4.34 injuries per 1000 athlete-exposures, rate ratio = 4.3, 95% confidence interval = 4.2, 4.5), and preseason practices had a higher injury rate than in-season practices (7.98 versus 2.43 injuries per 1000 athlete-exposures, rate ratio = 3.3, 95% confidence interval = 3.1, 3.5). In both games and practices, more than two thirds of men's soccer injuries occurred to the lower extremities, followed by the head and neck in games and the trunk and back in practices. Although player-to-player contact was the primary cause of injury during games, most practice injuries occurred without direct contact to the injured body part. Ankle ligament sprains represented the most common injury during practices and games, whereas knee internal derangements were the most common type of severe injury (defined as 10+ days of time loss).
Recommendations:
Sprains, contusions, and strains of the lower extremities were the most common injuries in men's collegiate soccer, with player-to-player contact the primary injury mechanism during games. Preventive efforts should focus on the player-to-player contact that often leads to these injuries and greater enforcement of the rules that are in place to limit their frequency and severity. Emphasis also should be placed on addressing the high rate of first-time and recurrent ankle ligament sprains.
Aim:
To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's soccer injuries during the 2009/2010-2014/2015 academic years.
Methods:
This descriptive epidemiology study used NCAA Injury Surveillance Program (NCAA-ISP) data during the 2009/2010-2014/2015 academic years, from 44 men's and 64 women's soccer programmes (104 and 167 team seasons of data, respectively). Non-time-loss injuries were defined as resulting in <24 h lost from sport. Injury counts, percentages and rates were calculated. Injury rate ratios (RRs) and injury proportion ratios (IPRs) with 95% CIs compared rates and distributions by sex.
Results:
There were 1554 men's soccer and 2271 women's soccer injuries with injury rates of 8.07/1000 athlete exposures (AE) and 8.44/1000AE, respectively. Injury rates for men and women did not differ in competitions (17.53 vs 17.04/1000AE; RR=1.03; 95% CI 0.94 to 1.13) or practices (5.47 vs 5.69/1000AE; RR=0.96; 95% CI 0.88 to 1.05). In total, 47.2% (n=733) of men's soccer injuries and 47.5% (n=1079) of women's were non-time loss. Most injuries occurred to the lower extremity and were diagnosed as sprains. Women had higher concussion rates (0.59 vs 0.34/1000AE; RR=1.76; 95% CI 1.32 to 2.35) than men.
Conclusions:
Non-time-loss injuries accounted for nearly half of the injuries in men's and women's soccer. Sex differences were found in competition injuries, specifically for concussion. Further study into the incidence, treatment and outcome of non-time-loss injuries may identify a more accurate burden of these injuries.
Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players’ baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.
54 ▸ Additional material is published online only. To view these files please visit the journal online (http://dx.doi. org/10.1136/bjsports-2013-092313). To cite: McCrory P, Meeuwisse WH, Aubry M, et al. Br J Sports Med 2013;47:250–258. PREAMBLE This paper is a revision and update of the recommen-dations developed following the 1st (Vienna 2001), 2nd (Prague 2004) and 3rd (Zurich 2008) International Consensus Conferences on Concussion in Sport and is based on the deliberations at the 4th International Conference on Concussion in Sport held in Zurich, November 2012. 1–3 The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further concep-tual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the Background section. This document is developed primarily for use by physi-cians and healthcare professionals who are involved in the care of injured athletes, whether at the recre-ational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving, and therefore management and return to play (RTP) decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document, the Concussion Recognition Tool (CRT), the Sports Concussion Assessment Tool V.3 (SCAT3) and/or the Child SCAT3 card and none are subject to any restrictions, provided they are not altered in any way or con-verted to a digital format. The authors request that the document and/or the accompanying tools be dis-tributed in their full and complete format. This consensus paper is broken into a number of sections 1. A summary of concussion and its management, with updates from the previous meetings; 2. Background information about the consensus meeting process; 3. A summary of the specific consensus ques-tions discussed at this meeting; 4. The Consensus paper should be read in conjunc-tion with the SCAT3 assessment tool, the Child SCAT3 and the CRT (designed for lay use).
Background
Researchers have suggested that there are sex differences in outcomes after sport-related concussions. Factors such as sport type/rules, age, and body mass index (BMI) may influence these differences.
Hypotheses/Purpose
The purposes of this study were (1) to examine neurocognitive performance after concussions between male and female soccer players and (2) to compare concussion symptoms between male and female soccer players. We hypothesized that female concussed soccer players would report more concussion symptoms and worse cognitive performance compared with male concussed soccer players.
Study Design
Cohort study; Level of evidence, 2.
Methods
A total of 39 male (mean BMI, 22.21 ± 2.34 kg/m ² ; mean age, 17.69 ± 2.10 years) and 56 female (mean BMI, 23.47 ± 2.66 kg/m ² ; mean age, 17.78 ± 2.30 years) concussed soccer players participated in this study. Participants were similar in age, history of concussion, sport, and time since injury. Participants completed computerized neurocognitive tests and symptom reports at baseline and 8 days after injury. Body mass index served as a covariate in all analyses.
Results
After adjusting for BMI, results from a repeated-measures analysis of covariance (ANCOVA) revealed a group by time interaction for visual memory (F 1,82 = 5.50; P = .021). Specifically, female concussed soccer players (mean score, 68.7 ± 15.2) performed worse at 8 days after a concussion compared with male concussed athletes (mean score, 77.2 ± 8.9). Results of another ANCOVA for total concussion symptoms indicated an interaction for group by time (F 1,82 = 4.26; P = .04). Specifically, female concussed soccer players (mean score, 11.9 ± 15.7) reported more total concussion symptoms at 8 days compared with male concussed athletes (mean score, 5.3 ± 7.4). There were significant main effects for sex on verbal (F 1,82 = 5.98; P = .017) and visual (F 1,82 = 4.65; P = .034) memory, with female athletes reporting lower scores than male athletes. Female athletes also reported more symptoms on the migraine-cognitive-fatigue (F 1,82 = 10.8; P = .001) and sleep (F 1,82 = 9.2; P = .003) clusters than male athletes.
Conclusion
In contrast to recent studies, after controlling for BMI, female athletes exhibited lower performance on visual memory composite scores and higher scores on total symptoms than male athletes after concussions.
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Syndesmotic and medial ankle sprains constitute up to 15% of all ankle sprains in athletic populations and can result in significant time lost to injury and long-term disability.
The objective of this study was to estimate the rate of syndesmotic and medial ankle sprain injuries and identify risk factors associated with these injuries within the physically active cadet population at the United States Military Academy (USMA).
Cohort study; Level of evidence, 2.
The Cadet Illness and Injury Tracking System (CIITS) database at USMA was queried for all ankle injuries between 2005 and 2009. Sex, level of competition, and exposure to sport were among risk factors analyzed.
Among 20 336 person-years, 1206 cadets sustained ankle sprain. Syndesmotic (6.7%) and medial (5.1%) ankle sprains had an incidence rate (IR) of 4.8 and 3.5 per 1000 person-years, respectively. Compared with women, men were 3 times more likely to experience medial ankle sprain (IR ratio [IRR] 3.37; 95% confidence interval [CI]: 1.05, 10.74], but there was no difference in rate of syndesmotic sprains by sex (IRR 1.06; 95% CI: 0.58, 1.95). Athletics accounted for 81% of syndesmotic sprains and 64% of medial sprains. Sprint football (52.3), team handball (men's, 34.7), soccer (men's, 30.5; women's, 6.5), and basketball (men's, 24.8; women's, 6.7) had the highest syndesmotic IR per 100 000 athlete-exposures. Medial sprain IR was highest in men's rugby (16.6) and gymnastics (14.0). When analyzed by athlete-exposure, male intercollegiate athletes had a greater risk of syndesmotic sprain than their female counterparts (3.53; 95% CI: 1.26, 9.83). Furthermore, intercollegiate level of competition had an increased risk of syndesmotic sprain when compared with intramural level (IRR 2.41; 95% CI: 1.03, 5.65).
Male athletes have an over threefold greater risk of medial ankle sprain. Male sex and higher level of competition are risk factors for syndesmotic ankle sprain during athletics.
Injury risk in soccer varies by sex. Female soccer players face a greater risk of anterior cruciate ligament injury and patellofemoral problems, while male players are more likely to experience sports hernia symptoms. The purpose of this study was to test the hypothesis that females have different lower-extremity alignment and muscle activation patterns than males during the soccer kick.
Thirteen male and twelve female college soccer players underwent three-dimensional motion analysis and electromyography of seven muscles (iliacus, gluteus maximus, gluteus medius, vastus lateralis, vastus medialis, hamstrings, and gastrocnemius) in both the kicking and the supporting lower extremity and two additional muscles (hip adductors and tibialis anterior) in the kicking limb only. Five instep and five side-foot kicks were recorded for each player. Muscle activation was recorded as a percentage of maximum voluntary isometric contraction.
The male soccer players had significantly higher mean muscle activation than their female counterparts with respect to the iliacus in the kicking limb (123% compared with 34% of maximal voluntary isometric contraction; p = 0.0007) and the gluteus medius (124% compared with 55%; p = 0.005) and vastus medialis muscles (139% compared with 69%; p = 0.002) in the supporting limb. The supporting limb reached significantly greater mean hip adduction during the stance phase of the kick in the females compared with that in the males (15 degrees and 10 degrees, respectively; p = 0.006).
Differences between the sexes in lower extremity alignment and muscle activation occur during the soccer instep and side-foot kicks. Decreased activation of the hip abductors and greater hip adduction in the supporting limb during the soccer kick in female athletes may be associated with their increased risk for anterior cruciate ligament injury.
Since the 2000 season, an injury surveillance system has been established to monitor injury risk and injury patterns in the Norwegian professional football league. The aim of this study was to assess the accuracy of routine injury registration performed by medical staff in professional football. The team medical staff completed injury registration forms on a monthly basis throughout the 2007 season (January-October). Players were interviewed at the end of the season (October/November) about all injuries that occurred from July through September. Thirteen of fourteen teams, 296 of 310 A-squad players were interviewed. An injury was recorded when a player was unable to take fully part in football training or match the day after injury. A total of 174 injuries were registered, 123 acute injuries and 51 overuse injuries. Of these, 141 were reported by medical staff and 122 by players. Eighty-nine injuries (51%) were registered using both methods, 52 (30%) by medical staff only and 33 (19%) by player interviews only. Prospective injury surveillance by team medical staff in Norwegian male professional football underestimates the incidence of time-loss injuries by at least one-fifth.
Recent publicity and some scientific reports suggest increasing success in treating an entity called "sports hernia" - more accurately named athletic pubalgia. The primary purpose of this article is to portray what we believe to be the key concept for understanding this wide variety of abdominal and groin injuries that afflict high performance athletes. These injuries have been plaguing athletes for a long time, and past treatments, based on concepts of occult hernia or simple strains, have generally failed. The former concepts do not take into account the likely mechanisms of injury or various patterns of pain that these athletes exhibit. The authors believe that the concept of a "pubic joint" or "pubic dynamic complex" is fundamental to understanding the anatomy and pertinent pathophysiology in these patients. Many injuries can now be treated successfully. Some of the injuries require surgery and others do not. In most cases, decisions regarding treatment and timing for return to full play require proper identification of the problems and consideration of a wide variety of medical, social, and business factors.
All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P<0.001). However, no difference was found in the incidence of severe injury (absence >4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.
Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the ‘sequence of prevention’. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step.
In this review some aspects of the first and second step of the sequence of prevention are discussed.
The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of ‘sports injury’ and ‘sports participation’.
The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample.
Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the ‘sequence of prevention’ the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model. The most commonly applied model is a stress/capacity model in which internal (personal) and external (environmental) aetiological factors are identified. In this model stress and capacity must be in balance and preventative measures must be designed to achieve or maintain this balance. However, merely to establish the aetiological factors is not enough; the mechanism by which sports injuries occur must also be identified. Athletes are in constant interaction with their environment and aetiological factors must be approached from this point of view. In a second, more dynamic, conceptual model on the aetiology of sports injuries, the importance of the determinants of sports behaviour, as well as the interaction between the various aetiological factors, is discussed. Whether or not a sports injury results from sports behaviour largely depends on the extent to which ‘prevention’ is incorporated in the determinants of sports behaviour. The drawback of both conceptual models is the fact that neither of them incorporate a time perspective. They can therefore not be applied to research on the aetiology of overuse injuries. In this perspective the application of a stress/strain/capacity model can be useful. This is a more dynamic and time-based 3-phase sequential model in which behaviour, amongst other aetiological factors, plays an important role. In this model an athlete is seen as an active manipulator of stress by whom the amount of strain evoked by sports participation can be altered, thereby influencing the capacity to perform in a certain sports situation, but also influencing the risk to sustain a sports injury, either acute or long term.
Finally, despite the importance of the model of choice in studying the aetiology of sports injuries one should realise that again the choice of research design influences the outcome of such research. Case series usually give no information on the underlying population at risk, so they are of no value in drawing valid conclusions on the risk factors of injuries. Only by relating the injuries to corresponding population denominators can one estimate injury rates and identify important risk factors and high risk sportspeople. As in research on sports injury incidence; research on risk factors should be undertaken on groups that are homogeneous with regard to age, sex, level of competition and type of sport.
To determine the prevalence of radiographic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury.
Female soccer players who sustained an ACL injury 12 years earlier were examined with standardized weight-bearing knee radiography and 2 self-administered patient questionnaires, the Knee Injury and Osteoarthritis Outcome Score questionnaire and the Short Form 36-item health survey. Joint space narrowing and osteophytes were graded according to the radiographic atlas of the Osteoarthritis Research Society International. The cutoff value to define radiographic knee OA approximated a Kellgren/Lawrence grade of 2.
Of the available cohort of 103 female soccer players, 84 (82%) answered the questionnaires and 67 (65%) consented to undergo knee radiography. The mean age at assessment was 31 years (range 26-40 years) and mean body mass index was 23 kg/m2 (range 18-40 kg/m2). Fifty-five women (82%) had radiographic changes in their index knee, and 34 (51%) fulfilled the criterion for radiographic knee OA. Of the subjects answering the questionnaires, 63 (75%) reported having symptoms affecting their knee-related quality of life, and 28 (42%) were considered to have symptomatic radiographic knee OA. Slightly more than 60% of the players had undergone reconstructive surgery of the ACL. Using multivariate analyses, surgical reconstruction was found to have no significant influence on knee symptoms.
A very high prevalence of radiographic knee OA, pain, and functional limitations was observed in young women who sustained an ACL tear during soccer play 12 years earlier. These findings constitute a strong rationale to direct increased efforts toward prevention and better treatment of knee injury.
The injury data from the first two seasons of the Women's United Soccer Association (WUSA) were analysed to determine the injury incidence, anatomic location of injuries, and relation of player position.
Injury data on 202 players from eight teams during the first two seasons of the WUSA were prospectively collected and analysed.
A total of 173 injuries occurred in 110 players with an overall injury incidence rate of 1.93 injuries per 1000 player hours. The incidence of injury during practice and games was 1.17 and 12.63 per 1000 player hours, respectively. Of the injuries 82% were acute and 16% were chronic. Most of the injuries (60%) were located in the lower extremities. Strains (30.7%), sprains (19.1%), contusions (16.2%), and fractures (11.6%) were the most common diagnoses and the knee (31.8%) and head (10.9%) were the most common sites of injury. Anterior cruciate ligament (ACL) injuries accounted for 4.6% of all injuries and the incidence of ACL tears was 0.09 per 1000 player hours (practice 0.04, game 0.90). Midfielders suffered the most injuries (p<0.007).
We conclude that the injury incidence in the WUSA is lower than the 6.2 injuries per 1000 player hours found in the corresponding male professional league (Major League Soccer); however, knee injuries predominate even in these elite female athletes.
The purpose of this study was to determine the effects of short-term (14-day) unilateral leg immobilization using a simple knee brace (60 degree flexion)- or crutch-mediated model on muscle function and morphology in men (M, n = 13) and women (W, n = 14). Isometric and isokinetic (concentric-slow, 0.52 rad/s and fast, 5.24 rad/s) knee extensor peak torque was determined at three time points (Pre, Day-2, and Day-14). At the same time points, magnetic resonance imaging was used to measure the cross-sectional area of the quadriceps femoris and dual-energy X-ray absorptiometry scanning was used to calculate leg lean mass. Muscle biopsies were taken from vastus lateralis at Pre and Day-14 for myosin ATPase and myosin heavy chain analysis. Women showed greater decreases (Pre vs. Day-14) compared with men in specific strength (N/cm2) for isometric [M = 3.1 +/- 13.3, W = 17.1 +/- 15.9%; P = 0.055 (mean +/- SD)] and concentric-slow (M = 4.7 +/- 11.3, W = 16.6 +/- 18.4%; P < 0.05) contractions. There were no immobilization-induced sex-specific differences in the decrease in quadriceps femoris cross-sectional area (M = 5.7 +/- 5.0, W = 5.9 +/- 5.2%) or leg lean mass (M = 3.7 +/- 4.2, W = 2.7 +/- 2.8%). There were no fiber-type transformations, and the decreases in type I (M = 4.8 +/- 5.0, W = 5.9 +/- 3.4%), IIa (M = 7.9 +/- 9.9, W = 8.8 +/- 8.0%), and IIx (M = 10.7 +/- 10.8, W = 10.8 +/- 12.1%) fiber areas were similar between sexes. These findings indicate that immobilization-induced loss of knee extensor muscle strength is greater in women compared with men despite a similar extent of atrophy at the myofiber and whole muscle levels after 14 days of unilateral leg immobilization. Furthermore, we have described an effective and safe knee immobilization method that results in reductions in quadriceps muscle strength and size.
The mechanism underlying gender disparity in anterior cruciate ligament injury risk is likely multifactorial in nature. Several theories have been proposed to explain the mechanisms underlying the gender difference in anterior cruciate ligament injury rates. These theories include the intrinsic variables of anatomical, hormonal, neuromuscular, and biomechanical differences between genders and extrinsic variables. Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals.
Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football injuries; this has made inter‐study comparisons difficult.
An Injury Consensus Group was established under the auspices of FIFA Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology and implementation was discussed by members of the group during a 2‐day meeting. Following this meeting, iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced.
Definitions of injury, recurrent injury, severity and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis and causation are proposed. Proforma for recording players' baseline information, injuries and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.
The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.
Although all injuries in sports are a concern for participants, head injuries are particularly troublesome because of the potential for long-term cognitive deficits. To prevent any specific injury, it is important to understand the basic frequency and incidence of injury and then the mechanism of injury. Once these are established, prevention programmes can be tested to see if the rate of injury changes. A primary problem with head injuries is recognising that the injury has occurred. Many athletes are not aware of the seriousness of concussive injury, thus this type of injury is probably under-reported. Once the diagnosis of a concussion is made, the next difficult decision is when to return a player to the game. These two management issues dominate the continuing development of understanding of concussive head injury. This paper explores the known gender differences between head injuries and highlights the areas that need to be considered in future research.
Understanding, “sports hernia” (athletic pubalgia): the anatomic and pathophysiologic basis for abdominal and groin pain in athletes
- Meyers