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Psychosocial predictors and psychological prevention of soccer injuries: A systematic review and meta-analysis of the literature
Abstract
Objectives: To examine (a) the relationships between the psychosocial risk factors and injury rates and (b) the effects of psychological-based prevention interventions on the injury risk of soccer players.
Design: Scholarly electronic databases (PubMed/MEDLINE, Google Scholar, Scopus) were searched on 1 January 2017, complemented by manual searches of bibliographies.
Setting: Systematic review and meta-analysis.
Participants: We identified 13 eligible studies, including a total of 1,149 injured soccer players aged between 14 and 36 years.
Main Outcome Measures: Psychosocial risk factors, psychological-based prevention interventions and injury risk in soccer players.
Results: Personality traits, such as trait anxiety and perceived mastery climate, along with a history of stressors, like negative-life-event stress or high level of life stress, daily hassle, and previous injury, are the main predictors of injury rates among soccer players. Also, from injury prevention studies, it has been shown that psychological-based interventions reduce injury rates (effect size = 0.96; 95% CI 0.34-1.58; p = 0.002) in senior soccer players.
Conclusions: Practitioners need to ensure injured soccer players are psychologically and socially ready to play. They should also employ psychological-based interventions (i.e., mindfulness, imagery, self-talk, stress management, relaxation, goal setting) when designing injury prevention programs.
... 15 This result is important, as the increased risk of MSK in athletes with elevated anxiety and depression is well established, indicating that baseline or preinjury measures are critical to consider. 16,17 Although the exact mechanism linking anxiety and depression to MSK are not fully explained, decreased concentration or attention and insufficient apprehension about threatening stimuli have been proposed. 16,17 Increased anxiety-and depression-related symptoms have been described for a month or longer postconcussion 3,14 ; thus, it is possible that athletes are returning to participation despite both persistent neurophysiological deficits and increased anxiety and depressive symptoms. ...
... 16,17 Although the exact mechanism linking anxiety and depression to MSK are not fully explained, decreased concentration or attention and insufficient apprehension about threatening stimuli have been proposed. 16,17 Increased anxiety-and depression-related symptoms have been described for a month or longer postconcussion 3,14 ; thus, it is possible that athletes are returning to participation despite both persistent neurophysiological deficits and increased anxiety and depressive symptoms. 8 Clinically feasible measures, such as brief questionnaires, can be used by athletic trainers (ATs) to obtain an initial mental health screening and may serve as important screening tools. ...
... The HADS is a reliable and valid 14-item self-reported questionnaire designed to assess anxiety (7 items) and depression (7 items). 20 Each item is scored from 0 to 3, and the separate anxiety and depression outcomes are continuous and categorized as normal (0-7), mild (8-10), moderate (11)(12)(13)(14), or severe (15)(16)(17)(18)(19)(20)(21). 20 The SWLS is a valid and reliable 5-item self-reported questionnaire using a 7-point Likert scale, with higher values reflecting better life satisfaction, and has appropriate psychometrics. ...
Objective
To assess the association between the Brief Symptom Inventory 18 (BSI-18) response at post-concussion return to play (RTP) and subsequent lower extremity musculoskeletal injury (LE-MSI).
Background
Concussion evaluation includes a multifaceted neurologic assessment at baseline and post-injury. Despite emotional sequelae after concussion, psychological assessments have received limited attention thus athletes may RTP despite persistent psychological distress post-concussion. Recent evidence has suggested an ∼2x elevated rate of post-concussion LE-MSI in collegiate athletes; however there is limited understanding of potential mechanisms. As psychological distress has been associated with MSI, the purpose of this study was to assess BSI-18 as a potential predictor of subsequent MSI.
Design/Methods
This analysis utilized a cross-sectional design of 67 NCAA intercollegiate students-athletes with a diagnosed concussion (59.7% female, age: 19.7 ± 1.4 years). Participants completed the BSI-18, an 18-item questionnaire based on a 5-point Likert scale (0–4) used to measure psychological distress at the RTP clinical time-point. Outcome measures were the Global Severity Index (GSI) which is the total score of symptoms (0–72) with higher scores representing greater psychological distress and subsequent MSI (yes or no) collected retrospectively through an electronic medical record in the year following diagnosed concussion. Binary logistic regression was used to assess the predictive capabilities of BSI-18 GSI and subsequent LE-MSI.
Results
The BSI-18 GSI did not significantly predict subsequent LE-MSI ( p = 0.095, Exp(B) = 2.436, Nagelkerke R2 = 0.181).
Conclusions
The BSI-18 GSI at RTP did not predict post-concussion subsequent LE-MSI. While the underlying mechanism for post-concussion MSI remains to be fully elucidated, results suggest that psychological health, as measured by the BSI-18 GSI, at RTP is not associated with subsequent LE-MSI. If MSI risk can be predicted then targeted, established, and clinically feasible injury prevention programs can be implemented to reduce injury risk.
... 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 ...
... Before being injured, 80% of them had recently encountered life events or life stressors. This confirmed the importance of this psychological risk factor for sports (10,11) and soccer (16) injuries, and also specifically for HSI. Previous injuries, already identified as a risk factor for HSI (6) and sports injury (10,11,18,19), were also confirmed in this study. ...
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.
... Motor performance assessment was included because our MSI-prevention program was designed to correct potential deficits in biomechanics and physical fitness. Psychosocial assessment was included because it has been reported that emotional problems and stress contribute to MSI risk and should be considered when planning preventive measures [33,34]. We hypothesized that our program might increase confidence through better movement control, and decrease potential musculoskeletal discomfort, which in turn could improve emotional and social well-being. ...
... In this study we did not find any effect of the exercise-based injury-prevention program on psychosocial status. Previous research has shown that implementing psychological interventions to reduce stress and anxiety reduces injury incidence [34,35]. Based on this, one should consider designing an injury-prevention program that has both psychological and physical components in order to address potential deficits in biomechanics and also possible mental problems. ...
Background and Objectives: Musculoskeletal injuries are a major health hazard among military personnel. Previous research has proposed several exercise-based strategies for prevention. The purpose of this study was to investigate the effect of an exercise-based injury-prevention program on the incidence of musculoskeletal injury, motor performance and psychosocial status. Materials and Methods: Thirty-six Estonian Military Academy cadets were randomly assigned into either an intervention or control group. The intervention group followed a neuromuscular exercise-based injury-prevention warm-up program, three times per week for 6 months. The control group continued with the usual warm-up. The main outcome measure was injury incidence during the study period. Additionally, evaluation of isokinetic lower-extremity strength, postural sway, physical fitness and psychosocial status was included pre- and post-intervention. Results: During the 6-month study period, the musculoskeletal injury incidence was 43% in the intervention group and 54% in the control group (RR = 0.8; 95% CI = 0.41 to 1.99). The noted 20% risk reduction was not statistically significant (p = 0.59). Furthermore, there were no statistically significant differences between the intervention and control group in motor performance or psychosocial status measures. Conclusions: In conclusion, no effect of the exercise-based injury-prevention program on injury risk, motor performance or psychosocial status could be detected.
... In patients following lower-extremity injury, fear of movement (kinesiophobia), poor psychological readiness, and poor self-reported function were found to be interrelated. 12 While psychological readiness and self-reported function may contribute to injury risk in MSK conditions, psychological factors such as kinesiophobia have yet to be explored in relation to MSK injuries following return to play from a diagnosed SC. 13,14 Psychological readiness has been positively associated with successful return to play following MSK injury. 15 Factors within the construct of psychological readiness such as fear, are important to consider following injuries, including SC, as they may directly impact subsequent injury risk. ...
... 15 Factors within the construct of psychological readiness such as fear, are important to consider following injuries, including SC, as they may directly impact subsequent injury risk. [13][14][15] The objective of this study was to compare Tampa Scale of Kinesiophobia (TSK) scores of college athletes who were and were not diagnosed with an acute MSK injury within 180 days of return to play following a diagnosed SC. We hypothesized that college athletes who sustained a MSK injury following a diagnosed SC would self-report higher TSK scores than a matched comparison group. ...
Context:
Athletes with a history of sport concussion (SC) have an increased risk of musculoskeletal injury (MSK); however, the underlying mechanisms have yet to be determined. The purpose of our study was to evaluate kinesiophobia in college athletes with or without a time-loss MSK within 180 days of unrestricted return to play following a SC.
Design:
This was a retrospective cohort study within a sports medicine facility.
Methods:
Participants were eligible if they were diagnosed with a SC, completed the Tampa Scale of Kinesiophobia (TSK), and completed an unrestricted return to play. Fifty-six college athletes (40 men and 16 women) with an average age of 19.5 (1.25) years, height of 183.5 (10.45) cm, and mass of 94.72 (24.65) kg, were included in the study. MSK participants were matched to non-MSK participants 1:1. Demographic and TSK outcome scores were compared using independent t tests. The proportion of participants in each group who scored above the clinical threshold (TSK ≥ 37) was compared using a chi-square analysis. Alpha was set at α = .05.
Results:
The MSK group (31.2 [6.30]) reported similar TSK scores to the matched group (28.9 [3.34]; t54 = 1.70, P = .10, d = 0.45 [-0.08 to 0.97]). A greater proportion of athletes who were diagnosed with an MSK-reported scores above the cutoff (χ2[1] = 6.49, P = .01).
Conclusions:
Athletes diagnosed with SC had similar kinesiophobia values regardless of MSK status. However, a higher proportion of athletes with a time-loss MSK injury reported a TSK score greater than the clinical cutoff. Our results suggest that factors such as kinesiophobia should be considered following a SC.
... En España, hay más de 900.000 licencias federativas de fútbol según los datos publicados por el Consejo Superior de Deportes en 2016, suponiendo un aumento de más del 10% respecto a los valores establecidos en 2011. Este incremento en la práctica futbolística se ve reflejado también en un aumento de las lesiones sufridas por los jóvenes jugadores en etapas de formación, pues el deporte además de tener grandes beneficios sobre la salud, conlleva unas grandes exigencias físicas, técnicas, tácticas, psicológicas y fisiológicas (Slimani et al., 2017). ...
... El principal objetivo del presente estudio fue diseñar un programa preventivo contextualizado en un equipo de jóvenes deportistas, para paliar la gran ratio lesional registrada en el fútbol (Arnason et al., 2004;Ekstrand et al., 2004;Hägglund et al., 2003;Hootman et al., 2007;Morgan & Oberlander, 2001;Pérez-Pemán & Casajús-Mallén, 2013;Waldén et al., 2005;Yoon et al., 2004) derivada de sus exigencias físicas, técnicas, tácticas, psicológicas y fisiológicas (Slimani et al., 2017) Realizando una búsqueda exhaustiva de los protocolos de prevención de lesiones aplicadas al fútbol en jóvenes deportistas, se observó que cada protocolo se divide en unos contenidos diferentes a pesar de que hay algunos que guardan una estrecha relación. El protocolo "FIFA 11+" se divide en los siguientes contenidos: (1) ejercicios de carrera, (2) ejercicios de fuerza, pliometría y equilibrio (con 3 niveles de progresión), y (3) ejercicios de carrera. ...
El fútbol es un deporte altamente lesivo debido a diversos factores. La lesión disminuye el rendimiento no solo del jugador sino también del equipo, lo que crea la necesidad de establecer programas preventivos para paliar, en la medida de lo posible, la tasa lesional. El objetivo del presente estudio fue diseñar un programa preventivo contextualizado y analizar la reducción lesional derivada de su implementación en jóvenes futbolistas. La muestra estuvo compuesta por 20 futbolistas de la categoría juvenil del Fútbol Club Cartagena, con una media de 6 horas de entrenamiento semanal. Tras una breve valoración inicial, llevaron a cabo un nuevo protocolo de prevención con diferentes ejercicios agrupados en 2 niveles de dificultad. Se realizó un análisis descriptivo de cada una de las variables cuantitativas. Los resultados muestran una disminución del 65% del número total lesiones, entre temporadas, y en gran medida de las graves. La tasa de reducción lesiva obtenida está por encima de diferentes estudios que analizan la eficacia en diversos programas preventivos. Un programa de entrenamiento preventivo basado en la contextualización de los participantes ha resultado en una reducción de la tasa lesiva. Los entrenadores y profesionales del deporte disponen de una herramienta para disminuir el riesgo de lesión.
... 4,6,21, 79,119,192,238 There is limited low-quality research demonstrating that other exercise and psychological-based interventions are effective at reducing soccer-related injuries. 43,64,123,182,211,243 Several systematic reviews have found injury prevention programs tailored toward hockey, 45 volleyball, 120 basketball, 121 tackle collision sports, 202 and sport climbing and bouldering 260 to be effective at reducing musculoskeletal injuries in general. ...
... The remaining 50.2% did not pool data mainly because of considerable heterogeneity among included studies. Finally, this review was limited to a qualitative summary of the literature since there was too much heterogeneity between studies to warrant any pooled data **References 4, 6, 21, 43, 64,79,119,123,182,192,211,238,243 analyses. However, strengths of this study include performing a thorough literature search in accordance with PRISMA and performing a thorough review of study quality and risk for bias using the AMSTAR-2. ...
Background
A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.
Purpose
To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.
Study Design
Systematic review; Level of evidence, 4.
Methods
We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).
Results
A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.
Conclusion
This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
... Moreover, Golby and Sheard [30] showed the progressive evolution of attention control at different sport practice stages, establishing this ability as a key differentiator of success factors between high performance sport athletes and regular ones. In the same line, previous studies have confirmed that it is essential to use mental attention strategies in the football training context in order to achieve high levels of competition success [36,41], as well as that attention control and mental toughness are key in sports injury prevention [55,56]. In addition, injuries should not only be considered as physical ailments that are influenced by mental strength, but good psychological health guarantees a decrease in the perceived pain, as psychological complaints may influence in the same way as a muscle strain. ...
... Attending to the visual and image control variable, U19 seemed to reach higher levels of achievement in this parameter, maintaining a similar good level in the later stages. Along these lines, the importance of this skill in football has also been reflected in previous studies, where the improvement of the visual-spatial control capacity in a game can be a determining factor in the competitive outcome, especially in high performance sport [54,56]. The same interpretation can be made for the motivational level variable, since the best results were achieved by U19 with a positive progression from the lower age category up to this U19 category. ...
Within the determining factors of psychological performance, mental toughness is considered a multidimensional factor, comprising cognitive, affective, and behavioural components together with self-confidence, which is related to success in sports performance as well as psychological health and well-being. The aim of this study was to analyse the relationship between different factors composing mental toughness and age categories in young football players, in order to determine the presence of specific psychological skills in their formative progression. A total of 118 male players (16.91 ± 2.42 years old) completed the Spanish version by Cernuda (1988) of the original Psychological Performance Inventory (PPI) by Loher (1982, 1986). The results indicated significant differences in four variables (negative energy control, attention control, visual and image control, motivational level) on three different age categories, where the U19 category showed the best results for all the variables, decreasing afterwards in the semi-professional category. Significant correlations were established between mental toughness variables and age categories, where the age category variable was significantly correlated in a positive way with attention control, visual and image control, and motivational level. In the same line, the variable self-confidence correlated positively with negative energy control, attention control, motivational level, attention control, and positive energy. The assessment of psychological variables such as mental toughness, taking into account the formative stage, may be helpful for both coaches and players when selecting adequate mental skill training for improving competitive performance and sporting success, as well as for positive and healthy psychological development and well-being.
... Such injuries have numerous individual, social and economic consequences [7][8][9] . Injury prevention programs (IPPs) targeting sport injuries should be applied early in a sport career to maximize its effectiveness 5,10 . ...
... The occasional existing evidence in sports injury prevention research suggests that injury prevention interventions lack region-, level-and genderindependent wide-spread dissemination and integration [14][15][16][17][18] . The reason behind this could be that clinicians and practitioners are repeatedly confronted with barriers 4 4 hampering proper organization of IPPs 19 , such as absence of a theoretical background 20 , scarce evidence about specific implementation strategies 21 or even cultural and social barriers that could vary between different regions and countries 2,3,7,22 . However, it is striking that hardly any research is available concerning professionals organize and implement their IPPs. ...
Objective
To identify the role of sports physical therapists (PT) in the injury prevention process and to compare the structure of preventive programs and associated (organization) policies applied in athletic organizations and sports teams of varying gender and level world-wide.
Design: cross-sectional study.
Setting
LimeSurvey platform.
Participants
Sports PT working with athletes invited through the International Federation of Sports Physical Therapy.
Main outcome measures
Sports injury prevention program (IPP) structure and implementation.
Results
414 participants fully participate in this survey study. Athlete's injury history (68.84%), the most common injuries within the sport modality (67.87%) and athlete's preseason screening results (64.01%) were most frequently used to customize IPPs. Warm-up (70.04%) and individually PT-guided exercise-therapy (70.04%) were the preferred methods to organize the prevention routine. The main barrier for IPP implementation was lack of time within the athlete's weekly training schedule (66.66%). The majority of the participants (72.84%) reported to evaluate the perception of IPP's effect by comparing current and preceding seasons' injury occurrences.
Conclusion
These survey results are the first identifying contemporary sports injury prevention organization and implementation policies on an international level. This information might support the sports PT community in improving and standardizing IPP (implementation) strategies worldwide.
... Negative life stress may influence the risk of sustaining an injury in soccer players. 44 The SSP personality trait adventure seeking (avoiding routine and needing change and action) could be associated with risk behavior and playing style. In addition, high ACL-RSI, which was also included in the risk profile, could indicate high-risk appraisal. ...
... Stressors, such as daily hassles, negative life events, or a high level of life stress, should also be monitored over time. 44 Our analyses showed that patient-reported outcomes of knee function and knee-related QoL were not included as factors in any risk profile for a second ACL injury, which is in agreement with Paterno et al. 37 However, patientreported outcomes are important to evaluate clinical progress during rehabilitation as well as in return-to-sport criteria because of the association with return-to sport outcome. 29 Other factors that were not included in a risk profile for a second ACL injury in the CART analysis were level of play and time between injury and ACLR. ...
Background
The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex.
Purpose
To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis.
Study Design
Cohort study; Level of evidence, 2.
Methods
A total of 117 active female soccer players (mean ± SD age, 20 ± 2 years) were included. Athletes were enrolled 19 ± 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed.
Results
A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non–ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (>916 cm) with more side difference in ankle dorsiflexion ROM (>–2.5°) and more knee valgus collapse in the nonreconstructed knee (>−1.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury.
Conclusion
The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.
... The findings indicated that female and individual sports athletes presented higher general sports anxiety (Correia& Rosado, 2019). Therefore, it is essential to demonstrate that soccer is different from other team sports when comparing social, economic, and political aspects (Benjamin et al., 2020;Slimani et al., 2018); this already shows an impact on anxiety, especially in international players. This anxiety is evident in the current moment of the COVID-19 pandemic, and it could increase injuries and comorbidities (Franco, Lantin, Dekeuleneer, Bongaerts, &Tecco, 2018;Kilic et al., 2017;Slimani et al., 2018;Valovich McLeod & Register-Mihalik, 2011). ...
... Therefore, it is essential to demonstrate that soccer is different from other team sports when comparing social, economic, and political aspects (Benjamin et al., 2020;Slimani et al., 2018); this already shows an impact on anxiety, especially in international players. This anxiety is evident in the current moment of the COVID-19 pandemic, and it could increase injuries and comorbidities (Franco, Lantin, Dekeuleneer, Bongaerts, &Tecco, 2018;Kilic et al., 2017;Slimani et al., 2018;Valovich McLeod & Register-Mihalik, 2011). Diagnosed comorbidity was verified in preceding reports for ...
This study aims to verify associated factors with trait and state anxiety in professional soccer teams during the COVID-19 epidemic. The sample was composed of 529 athletes, coaches, and professional soccer teams' physical trainers during the COVID-19 epidemic. From this amount, 214 were classified with trait-anxiety, and 315 were classified with state-anxiety using the State-Trait Anxiety Inventory (STAI). This study is an epidemiological and cross-sectional study. We applied an observational method, and we performed a remote measurement. The measurement was made via online questionnaires in male and female individuals working on soccer teams (soccer professionals or athletes) who could be affected by anxiety during social isolation in the COVID-19 epidemic. Each questionnaire was composed of sociodemographic questions, self-perceived performance, and State-Trait Anxiety Inventory (STAI). Descriptive data are presented as percentage/absolute frequency. Factor analysis was used to reduce many variables into fewer factors of each anxiety group (state and trait) to verify which variables are associated with the COVID-19 pandemic anxiety state, p≤.05. Factor analysis of the trait anxiety group indicated a significant correlation (p≤ 0001). The trait anxiety group's components correlated 0.43 and 0.84, while the state anxiety demonstrated a correlation between 0.52 and 0.996. The present results highlight the importance of cognitive behavior therapy for professional soccer teams. Its core is cognitive restructuring using the ABC model (antecedents-behavior-consequences). Mental errors and maladaptive behaviors are identified and worked upon considering sociodemographic factors such as gender and schooling levels.
... Some well-documented psychological and health-related risk factors for sport injuries were also not tested as predictors (e.g. anxiety traits, avoiding-performance goals, poor coping strategies, neuroticism, perfectionistic strivings, strong athletic identity, persistence through pain, perceived vulnerability, and inappropriate food intake) [19,[22][23][24]. Therefore, one might contemplate whether incorporating a more concise yet pertinent selection of predictors from a broader spectrum of categories into a predictive model could enhance the preseason identification of soccer players vulnerable to HSI. ...
Objective
Reducing the incidence of hamstring strain injuries (HSIs) is a priority for soccer clubs. However, robust multifactorial predictive models are lacking and potential predictors such as sprint kinematics, performance fatigability, and psychological variables have been overlooked. Thus, the aim of this study was to develop a preliminary parsimonious multifactorial model to predict players at risk of HSI through preseason screening.
Materials and Method
Psychological, physiological, kinematic, performance fatigability and health-related variables were collected for 120 regional and national soccer players during the 2022 preseason. HSIs were prospectively recorded over the entire soccer season. After variable selection, logistic regressions with the Wald backward stepwise method were used to refine the model. The predictive abilities of the model and of the individual variables were determined using the area under the receiver operating characteristic curve (AUC).
Results
Twenty-nine players sustained an HSI during the follow-up period. The final model included eight variables: age, sex, HSI history, knee flexor performance fatigability, sprint performance (best sprint time and maximal theoretical velocity V0), perceived vulnerability to injury, and subjective norms in soccer. While its model was preliminary, it showed good fit indices and strong predictive performance (true positive rate: 79%, AUC = .82). None of the variables evaluated independently demonstrated satisfactory performance in predicting HSI (AUC≤.65).
Conclusion
Using a multidisciplinary approach and measurements of only a few variables during preseason screening, the current model tends to demonstrate high accuracy in identifying soccer players at risk of HSI.
... Psychosocial factors, such as fear and avoidance and kinesiophobia, have been associated with pain, especially chronic pain, but there is still a need to investigate the association between pain and psychosocial factors 11 . Studies involving soccer players have shown that psychosocial factors can increase injury risk, injury recurrence or delay in sports returning [12][13][14] . ...
... Psychosocial factors, such as fear and avoidance and kinesiophobia, have been associated with pain, especially chronic pain, but there is still a need to investigate the association between pain and psychosocial factors 11 . Studies involving soccer players have shown that psychosocial factors can increase injury risk, injury recurrence or delay in sports returning [12][13][14] . ...
... 40 Among young athletes, many studies have found an association between insufficient sleep or psychological distress, and an increased risk of any kind of injury. 29,35,47,52 However, the term "injury" is often explained as pain with reduced training volume, difficulties participating in normal training or competition, and reduced performance. 9 Our outcome is not injury but moderate or severe back pain for any reason, making it difficult to compare our findings with studies of sports injuries in the back. ...
Background
There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This study aimed to investigate the association between psychological distress, skipped meals, and insufficient sleep, and the occurrence of back pain among adolescent female soccer players.
Hypothesis
Psychological distress, skipped meals, and insufficient sleep are associated with the occurrence of back pain.
Study Design
Cohort study.
Level of Evidence
Level 3.
Methods
Swedish adolescent female soccer players aged 12 to 17 years, without back pain at baseline, were included. The exposures psychological distress, skipped meals, and insufficient sleep were assessed at baseline. The players were followed for 1 year with a weekly web-based survey, where back pain intensity was measured on a numeric rating scale (NRS) ranging from 0 to 10. The outcome back pain was defined as reporting low back pain and/or upper back/neck pain intensity of ≥4 on the NRS. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard rate ratio (HRR) with 95% CI for the association between each exposure and the outcome back pain, adjusted for age at baseline and parents’ education.
Results
In total, 351 players were included, and 141 players reported back pain at some point during the 1-year follow-up. The adjusted HRR for back pain was 1.79 (95% CI, 1.11-2.91) for insufficient sleep, 1.45 (95% CI, 0.97-2.17) for psychological distress, and 0.98 (95% CI, 0.61-1.59) for skipped meals.
Conclusion
Insufficient sleep and psychological distress are associated with the occurrence of back pain among female adolescent soccer players.
Clinical Relevance
Our results contribute to the understanding of what may influence the occurrence of back pain in adolescence, offering potential strategies for the prevention of back pain in adolescent female soccer players.
... Despite the publications regarding the psychological consequences of injuries, little research has evaluated gender differences in previously injured athletes regarding reinjury worry, confidence, and attention before returning to competition. Examining these psychological traits is crucial, as they have a significant role in the rehabilitation of a sport injury [19]. While re-injury worry, confidence, and attention are linked to the quality and effectiveness of the rehabilitation program, no previous studies have investigated any differences between male and female athletes. ...
Introduction: A sport injury is an unfortunate event that can significantly impact the injured athletes’ psychology. There have been no studies examining gender differences in the psychological state after a sport-related musculoskeletal injury. Τhe aims of the current study were to (a) investigate the relationship between re-injury worry levels, confidence, and attention in the injured athletes who followed a rehabilitation program in order to return to competition, and (b) compare differences in these psychological factors between male and female athletes. Methods: A cross-sectional research design was used. A total of 60 athletes (30 men and 30 women) volunteered to participate, aged 25.50 ± 5.25 years old, all of whom had experienced a musculoskeletal injury within the past year. Three validated questionnaires, i.e., the Causes of Re-Injury Worry Questionnaire, the Sport Confidence Questionnaire of Rehabilitated Athletes Returning to Competition, and the Attention Questionnaire of Rehabilitated Athletes Returning to Competition, were completed by the participants on their first competitive game after their rehabilitation program. Results: All of the athletes experienced average levels of re-injury worry due to their opponents’ ability and distraction attention, and high levels of confidence and functional attention. Many factors from the questionnaires were correlated with each other. Men experienced lower levels of re-injury worry due to rehabilitation compared to the women athletes (U = 329.00, p < 0.05), and women exhibited higher “Re-injury Worry due to Opponent’s Ability” compared to the men athletes (U = 292.00, p < 0.01). Conclusions: A strong relationship was found between re-injury worry, confidence, and attention, with few gender differences. Since there is no previous research examining re-injury worry, confidence, and attention between men and women, future research with larger and more homogeneous samples is needed to confirm the present results.
... Injury may affect the imagery ability due to negative consequences such as fear of re-injury, anxiety, and depression. To reduce these effects, psychological skills such as imagery and awareness are recommended (32,33). In our study, external visual imagery ability was higher in athletes with a history of injury. ...
Purpose: The aim of this study was to examine the relationships between elite athletes' imagery abilities and their body awareness, plank stance duration, psychological and social skills. Material and Methods: The study included 53 healthy elite athletes (female:32, male:21). The imagery abilities of the athletes were evaluated using the Movement Imagery Questionnaire-3. A Body Awareness Questionnaire was used for body awareness assessment. Plank stance duration, psychological and social skill levels were evaluated using Sport Specific Core Muscle Strength and Stability Plank Test, Athletic Psychological Skills Inventory and Social Skills Inventory, respectively. Results: External and kinesthetic imagery was found to correlate with body awareness (r=0.33, p=0.02; r=0.39, p
... In addition to anatomical and physiological factors, psychosocial factors have received increased attention in recent years. Personality attributes, such as trait anxiety, and a history of stressors, like high level of life stress or fear/anxiety associated with a previous injury, are positively correlated with injury rates, and psychological and social readiness for play may affect the risk of injuries in football players [32]. Perception of injury risk may be associated with risk-taking behaviour [8], which needs to be considered and taken into account in injury prevention [38]. ...
Purpose
To describe the injury prevalence, injury pattern, and potential baseline risk factors for injuries in male and female adolescent and adult amateur football players.
Methods
This prospective study followed adolescent and adult amateur football players over one season March–October 2020. The study was completed by 462 players (130 men, age 20.0 ± 5.7, 14–46 years) who answered a baseline survey and a weekly web survey during the season. A total of 1456 weekly surveys were registered from males and 5041 from females. Injuries were recorded with the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O2). Potential baseline risk factors (age, performance of strength/conditioning training, participation in other sports, perceived importance of sporting success, self-rated training and match load, perceived balance between training/match load and recovery, previous/present injury at start of season, and injury beliefs) and their association with injury were analysed with Poisson regressions within each sex.
Results
Males reported 95 injuries (262 injury weeks, weekly prevalence 18.0% (95% CI 16.1–20.1)) and females 350 injuries (1206 injury weeks, weekly prevalence 23.9% (95% CI 22.8–25.1)). Gradual-onset injuries accounted for 57% of the injuries in males and 66% in females. For males, substantial injuries were most common in the hip/groin (weekly prevalence 3.8%), ankle (2.1%), posterior thigh (2.0%), and knee (2.0%); and for females, in the knee (4.3%), ankle (2.5%), and lower leg/Achilles tendon (2.0%). Significant risk factors for injury were higher age (rate ratio males 1.05 per year increase (95% CI 1.02–1.08), females 1.03 (95% CI 1.01–1.05)), and present injury at baseline (males 1.92 (95% CI 1.27–2.89), females 1.58 (95% CI 1.19–2.09)).
Conclusion
At any given week, almost one in five male and one in four female amateur football players reported new or ongoing injuries. Hip/groin injuries were more frequent in males, while female players had a higher prevalence of knee injuries. Older players and those with an existing injury at the start of the season were more prone to new injury during the season. Rehabilitation of pre-season injury and complaints are key to reduce the injury burden in amateur football.
Level of evidence
Level II.
Trial registration number NCT04272047, Clinical trials
... 56 Techniques such as goal setting, positive self-talk, imagery, relaxation, mindfulness, and cognitive-behavioral biofeedback contribute positively to injury prevention, physical recovery from injury, and improved levels of self-confidence, and decreased cognitive and physical anxiety. 57 The replication of this study in several national championships is considered necessary with the aim of determining psychological predictors of sports injuries in this sport, which have not been found in the scientific literature to date. This would allow the systematization of the knowledge obtained to guide the primary and secondary psychological prevention of injuries in these athletes, integrating into current preventive strategies to form a true comprehensive care, moving towards the biopsychosocial model in the professional practice of medical doctors, psychologists, and physiotherapists. ...
Introduction: the systematic analysis of the relationships between relevant psychological variables for sports performance and injuries is essential to contribute to their prevention in specific sports.
Material and methods: a descriptive-correlational and cross-sectional study was carried out in the first category women's national softball championship in Cuba. 88 athletes participated with an average chronological age of 22.91 (SD=6.13) and a sports experience of 10.83 years (SD=4.92). A specific questionnaire, the Competitive Sport Anxiety Inventory and the Psychological Inventory of Sport Execution was applied. Descriptive statistics and Kendall's Tau_b nonpara-metric correlation coefficient was used for data analysis.
Results: A high injury load was verified with a low perception of the role of psychological factors in its etiology, as well as a notable occurrence of new injuries with negative emotional repercussions. Negative correlations of self-confidence, negative coping control, visual-imaginative control , positive coping control, and attitude control with history of injuries were obtained. The high anxiety showed significant relationships with previous injuries and new injuries during the analyzed competition.
Conclusions: the findings are especially congruent with previous results in elite softball players, although new and greater relationships between variables were determined. All this means that stimulating psychological skills to control anxiety in competition could contribute to the prevention of injuries. However, longitudinal analyzes are required to confirm the predictive role of these variables before proposing psychological interventions in this regard.
... Soccer is a physically as well as mentally demanding activity [1]. The interaction of a soccer player with their sport environment leads to many factors such as stress, cognitive load, or concentration that contribute to sport outcomes [2]. Despite the notable advances in technology or statistics to the quantification of physical efforts in soccer training and game scenarios [3], human factors continue to influence the outcomes [4]. ...
The present study examined the effects of stressful constraints during soccer trainings on psychological skill development and internal load when compared with control (nonstressful) trainings. A total of 51 elite male youth soccer players (27 in the experimental group, M = 16.54 years; 24 in the control group, M = 15.44 years) participated in the study. In a 12-week longitudinal survey, team resilience, using the Spanish version of the Characteristics of Resilience in Sports Teams Inventory, and anxiety, using the Sport Anxiety Scale, were measured at baseline (after 4 weeks of regular trainings), postprotocol (after 4 weeks of control or experimental trainings), and follow-up (after 4 weeks of regular trainings). Results show that, when compared with the control group, a program with stressful constraints helped young soccer players to develop better psychological skills: specifically, increased ability to cope with impairments in resilience (both resilience characteristics and team vulnerability under pressure; p < 0.001). Increases in anxiety (p = 0.06) and decreases in preoccupation (p < 0.001) and lack of concentration (p < 0.001) were also observed. The adaptation of human behavior to specific trainings may explain these results. In conclusion, the regular exposure of young soccer players to stressful situations during trainings shows benefits for their psychological skill development in soccer. Then, benefits on internal load were also observed.
... 4 Sin lugar a dudas, las presiones recibidas y los factores psicosociales aumentan la probabilidad de padecer lesiones en nuestros deportistas. 5 Conocer nuestra población y la incidencia de lesiones nos permite establecer estrategias preventivas y así disminuir las tasas de lesiones, los costos en salud, las pérdidas de tiempo deportivo y los daños permanentes en los jugadores. 4 Hasta el momento no existen suficientes datos epidemiológicos publicados sobre lesiones ...
Objetivo:
Describir la prevalencia, incidencia, gravedad y el correspondiente impacto lesional de nuestra población, así como establecer una diferenciación entre el periodo del año, puestos y las situaciones en las que se producen las lesiones en un equipo de fútbol.
Materiales y método:
Estudio observacional, descriptivo, retrospectivo y longitudinal de un equipo de la tercera categoría profesional del fútbol argentino durante dos temporadas (junio 2018 a mayo 2019 y junio 2019 a mayo 2020).
Resultados:
De 66 jugadores, 53 informaron al menos una lesión, lo que resultó en una prevalencia de lesiones del 80,3% en el período de 2 temporadas. En total se registraron 139 lesiones, de las cuales 54 (38,8%) se produjeron durante los partidos y 85 (61,2%) durante los entrenamientos. Se registró una tasa de incidencia de lesiones de 53,6/1000 horas-partido-jugador y de 3,8/1000 horas-entrenamiento-jugador. La tasa de incidencia global fue de 6,0/1000 horas-jugador. La entidad más frecuente fue la lesión muscular estructural del bíceps femoral, con un total de 16 lesiones, seguida del esguince lateral de tobillo con 13 jugadores afectados.
Conclusión:
La prevalencia de lesión fue de 80,3%, dentro de ella la lesión estructural del bíceps femoral, el esguince lateral de tobillo, las lesiones funcionales de los isquiotibiales fueron las de mayor incidencia en nuestra población, seguidas de las lesiones funcionales y estructurales de los aductores. Sin embargo, las lesiones del LCA fueron las que causaron mayor impacto lesional.
... Furthermore, athletes who return to their preinjury levels have a greater chance of reinjuring their ACL than those who do not return (Webster et al., 2014;Grindem et al., 2016). Along with the physical changes associated with the transition between the state of injury and health, athletes also experience psychosocial changes (Slimani et al., 2018). Common feelings experienced by these athletes include fear of reinjury and losses of identity, support, or motivation, all of which might persist through RTS or even cause the termination of their sports career (Nyland et al., 2002;Kvist et al., 2005;Ristolainen et al., 2012). ...
Background
An injury followed by surgery poses many challenges to an athlete, one of which is rehabilitation, with the goal of returning to sport. While total restoration of physical abilities is a primary goal for most athletes, psychosocial factors also play an important role in the success of an athlete's return to sport (RTS). The purpose of this review was to examine the effectiveness of exercise and psychosocial interventions on RTS rates, which might be one of the most important outcomes for elite athletes.
Methods
To carry out this review, PubMed, SAGE Journals, Web of Science, SPORTDiscus, ScienceDirect, and Google Scholar databases were searched from inception to July 2022. The inclusion criteria consisted exercise or psychosocial intervention for athletes after anterior cruciate ligament reconstruction (ACLR), with reporting RTS rates as an outcome.
Results
From 1032 identified articles, four reports (N = 130) met inclusion criteria, all of which examined the recovery after ACLR. The mean MINORS score for the included studies was 16.3 ± 6.1, of which non-comparative studies scored 11.0 ± 1.4, while comparative studies scored 21.5 ± 0.7. There were consistent findings for benefits of exercise and psychosocial interventions on RTS rates. Return to preinjury rates in the reviewed studies vary between 63 and 95% with lower % observed in female athletes and with shorter follow-up. Interventional studies reporting RTS rates with a larger sample size and longer follow-up are needed.
Conclusion
Physical and psychological function, as well as social support can be influenced by appropriate interventions, indicating future work on rehabilitation programs for return to preinjury might consider taking the holistic approach addressing those.
... Fourth, HSI are complex and multifactorial in nature 15 , and our findings provide only a biomechanical view on the structural and functional properties of the involved muscle groups. The physical demands of a male football match are distinct from those found in a women's match [35], while genetics [36], psychological factors [37], the workload [38], and even the coach's leadership style [39] may also affect the injury rates. Therefore, other factors should be investigated Content courtesy of Springer Nature, terms of use apply. ...
Purpose
The purpose of this study was to assess if differences in hamstring strength, hamstring-to-quadriceps (H:Q) strength ratio, and biceps femoris long head (BFLH) fascicle length exist between male and female professional football (soccer) players.
Methods
One-hundred professional footballers participated in this cross-sectional study: 50 men and 50 women. Ultrasound images of BFLH muscle and isokinetic dynamometry tests were performed.
Results
Men were stronger than women for hamstring concentric (2.01 ± 0.21 Nm/kg vs. 1.55 ± 0.23 Nm/kg; p < 0.001; large effect size, 2.08) and eccentric (2.87 ± 0.45 Nm/kg vs. 2.39 ± 0.32 Nm/kg; p < 0.001; large effect size, 1.23) peak torques. There was no sex-related difference for H:Q conventional ratio (concentric/concentric; 0.55 ± 0.06 vs. 0.55 ± 0.07); but women presented greater H:Q functional ratio (eccentric/concentric; 0.78 ± 0.12 vs. 0.85 ± 0.09; p = 0.003; moderate effect size, 0.66). Men and women presented similar BFLH fascicle length: 0.24 ± 0.05 vs. 0.23 ± 0.05 (values normalized by muscle length).
Conclusions
Among the muscular factors assessed in this study, men presented stronger hamstring muscles, women presented greater H:Q functional ratio, and there was no sex-related differences for H:Q conventional ratio or BFLH fascicle length.
... A Previous study found that coping with adversity, freedom from worry, confidence and achievement motivation were all key mediators in the connection between negative affect and eating disorders symptoms [20]. According to preliminary research, psychological skills contribute to injury prevention, physical healing from injury, increased self-confidence, and reduced cognitive and physical anxiety [21]. The autonomous motivation was connected to improved coping among adolescent athletes when compared to managed motivation [11]. ...
... The previous argument about FIFA 11þ could also support the agreement on warm-up sessions delivered by the head or strength coach (Sadigursky et al., 2017). The majority of factors indicated by the participants for prevention implementation is supported by the literature: coach's support (Dejonghe et al., 2017), health professionals' engagement (Breslin et al., 2017), athletes' routine organization (Loose et al., 2018), education (Loose et al., 2018), prevention results dissemination (Bekker et al., 2017;McGlashan et al., 2018), infrastructure/space (Finch & Donaldson, 2010;Johansen et al., 2020), technology (Adesida et al., 2019;Li et al., 2016), psychological and mental factors (Slimani et al., 2018), sleep quality (Bonnar et al., 2018;Gupta et al., 2017), nutrition (Maughan et al., 2018), training load (Jones et al., 2017;Soligard et al., 2016), athletes' responsibility (Loose et al., 2018), governing bodies participation (Webborn, 2012) and work environment/ relationship between professionals (Webborn, 2012). Regarding the dissemination of injury prevention results from previous seasons to the athletes (injury risk, time loss, etc), no strong evidence is available to support the agreement established in the present study. ...
Objective
To provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports.
Design
Delphi.
Setting
LimeSurvey platform.
Participants
Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries.
Main outcome measures
Factors related to sports IPP planning, organization and implementation.
Results
We included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement).
Conclusion
Strong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.
... In fact, there are several factors related with the injuries' occurrence, such as biomedical, dispositional, nutritional, or postural ones [12], related to the field or pitch conditions, or with some psychosocial factors other than the practitioners themselves [13]. Another one of the aspects demonstrated in research conducted over recent decades is the role of psychological factors in the risk of athlete injuries [14][15][16][17][18]. The stress and injury model of Andersen and Williams [19,20] shows that stress is a key factor in the origin of injuries. ...
The main objective of this study is to extend the stress and injury model of Andersen and Williams to other “negative” psychological variables, such as anxiety and depression, encompassed in the conceptual model of Olmedilla and García-Mas. The relationship is studied of this psychological macro-variable with two other variables related to sports injuries: the search for social support and the search for connections between risk and the environment of athletes. A combination of classic methods and probabilistic approaches through Bayesian networks is used. The study samples comprised 455 traditional and indoor football players (323 male and 132 female) of an average age of 21.66 years (±4.46). An ad hoc questionnaire was used for the corresponding sociodemographic data and data relating to injuries. The variables measured were the emotional states of: stress, depression and anxiety, the attitude towards risk-taking in different areas, and the evaluation of the perception of social support. The results indicate that the probabilistic analysis conducted gives a boost to the classic model focused on stress, as well as the conceptual planning derived from the Global Model of Sports Injuries (GMSI), supporting the possibility of extending the stress model to other variables, such as anxiety and depression (“negative” triad).
... 65 Psychologically based interventions can significantly reduce injury rates and, along with mindfulness, have been recommended when designing injury prevention programs. 66 MABIs also have a positive influence on recovery time, stress, anxiety, performance, endurance, cognitive function, and risk of reinjury. 67 This may be due to psychological variables such as emotion regulation and attentional control. ...
:
One in 5 adults in the United States live with a mental illness, and many more struggle with stress-related chronic illnesses. Physical therapists often see the physical effects that stress has on the body, but there is an underutilization of evidence-based stress management strategies with patients and clients. Mindfulness-and-acceptance-based interventions (MABIs) constitute a family of methods that emphasize present-moment awareness, nonjudgment, and values-based living. They operate by teaching patients to cope with stressful thoughts, emotions, and physical sensations. MABIs are associated with improved health outcomes in areas commonly seen in physical therapist practice, including health promotion, physical function, injury prevention, pain management, immune function, and noncommunicable diseases. The purpose of this Perspective article is to (1) describe MABIs, (2) discuss the relevance of MABIs to physical therapist practice, (3) discuss the positive impact of MABIs for pain, sports, immune function, physical and mental health promotion and wellness, and (4) identify MABI outcome measures related to health behavior change. It is time.
Impact:
Contemporary practice requires that physical therapists manage patient care by addressing both the mind and body. Given the existing research on MABIs, it is time to translate the evidence into minimum accreditable standards for health promotion and prevention of chronic, noncommunicable disease. This approach would have far-reaching benefits for individuals, family units, communities, and society as a whole.
... Considering that the above-cited psychopathologies could negatively impact elite athletes' performance and mental health 4 . As well as the interpersonal relationship with coaches and leaders 15 , and the coping abilities managed by athletes can protect from the negative effects caused by stress 21 . It is also known that, to date, no study has sought to analyze the responses of the relationships between these variables as a function of the time of the season in athletes in career transition. ...
Aims: The present study investigated the quality of coach-athlete relationship (CAR) and coping as associated factors stress, anxiety, burnout, and depression symptoms of soccer players in the transition to professional. Equations, Pearson's Correlation, and Linear Multiple Regression (p < 0.05). Results: Our findings show that from the beginning to the end of the season, CAR and coping strategies were predictors of psychic occurrences. For CAR, the symptoms of anxiety associated with self-confidence and stress symptoms were predicted by Proximity and Com-plementarity, respectively. As for coping strategies, only the symptoms of stress were predicted by the dimension of facing adversity. Conclusion: From the beginning to the end of the season, the magnitude of the predicting factors over some psychopathologies is enhanced in youth soccer players going through a career transition stage.
... • The focus of our search was for studies examining the use of psychological intervention programs to reduce sports-related injuries among athletes. • The search returned 6 possible papers: 2 systematic reviews that did not conduct an associated meta-analysis, 7,10 one systematic review with a meta-analysis, 11 2 meta-analyses, 2,3 and one randomized control trial. 12 We narrowed our appraisal to 2 studies: Gledhill procedures to identify at-risk profiles using questionnaires to measure a combination of personality, general life stress, competition anxiety, coping resources, and injury history. ...
Clinical Scenario : Injury prevention programs are becoming standard practice for reducing sports-related injuries, but most programs focus on musculoskeletal elements. Psychological factors can be strong predictors of sports-related injuries and there is recent evidence that suggests psychological interventions can be effective at reducing injury risk. It is unclear if injury prevention programs that focus on psychological factors are an important inclusion for athletic trainers/therapists. Athletes can be exposed to different psychological factors based on sport type including team or individual sports, which can increase their risk of injury. While psychological interventions can reduce injuries by addressing psychological symptoms, it is unclear if the interventions are effective for at-risk athletes in addition to athletes who are not suffering from any psychological factors. Currently, there are no guidelines or recommendations for athletic trainers/therapists to address psychological factors with the purpose of injury prevention. Clinical Question : Are psychological intervention programs effective in reducing sports-related injury risk and are they clinically relevant to athletic trainers/therapists for implementation in all settings? Summary of Findings : The authors searched the literature for studies investigating the use of psychological intervention programs to reduce sports-related injuries in an athletic population. The search returned 6 possible papers (2 systematic reviews without meta-analysis, 1 systematic review with a meta-analysis, 2 meta-analyses, and 1 randomized control trial not included in the systematic reviews). The authors narrowed our appraisal to one systematic review and one randomized controlled trial. The review contained all the studies from the previous review papers including 3 studies which performed screening procedures. The collection of evidence demonstrates positive effects associated with implementing psychological intervention techniques to reduce sports injury rates in all athletes; at-risk athletes, not at-risk athletes, and individual and team-sport athletes. Bottom Line : There is sufficient evidence supporting the use of a psychological-based intervention by athletic trainers/therapists to effectively reduce the number of injury occurrences in the athletic population. Direct comparisons of effectiveness between team and individual sports was not conducted in the research, but a substantial representation of both sport types existed. The current evidence includes a variety of athletic populations, at-risk and not at-risk, different sport types, and competition levels. Athletic trainers/therapists should consider the integration of psychological disciplines in current injury prevention practices to address the psychological concerns which put athletes at additional risk for injury. Strength of Recommendation : Grade B evidence exists to support the use of psychological intervention strategies in a well-developed injury prevention plan. Sports medicine practitioners can help athletes reduce stress, increase mindfulness, and be more aware of mental health practices which helps reduce injury risk.
... Slimani et al. showed that psychosocial factors might be directly related to increased rates of injuries in soccer players. More specifically, personality traits (such as stress and perception) and exposure to stressor factors (high level of daily stress, daily fatigue, and previous injuries) are directly related to most injuries [18]. ...
Soccer is one of the most popular sport, with many describing it as the "king of sports." In recent years, increased global participation in soccer has led to an inevitable increase in injury rates, especially in the lower extremities. Consequently, there is an increase in the epidemiology of soccer injuries, both in professionals and amateur athletes. The cause of an injury is multifactorial and depends on psychosocial, predisposing, intrinsic, and extrinsic factors. Also, contact with another player and non-contact injuries seem to be the most widespread mechanisms of injuries. The most common injuries recorded in soccer are ankle sprains and hamstrings injuries. More specifically, many studies have shown a correlation between the previous injury in lower extremities, weakness of abductors muscle, and psychosocial factors with the ankle sprain. Additionally, according to study results, injuries in adult men, adolescent men, and women during a match are higher than injuries during training. This narrative review aims to record the epidemiology of ankle injuries, risk factors, and the relationship between circadian rhythm, sleep, and injuries.
... perceived mastery, and experienced stress are the main predictors of injury rates among soccer players (Slimani et al., 2018). However, psychologically based interventions may significantly reduce injury rates. ...
Problem Statement and Approach: Although balance skills and personality have been explored in the field of sports science, little is known about the relationship between the two factors. This study aims to investigate the association of postural balance with traits of personality and temperament. Materials and Methods: There were 73 participants in the cross-sectional study between ages 16 and 30 years (M = 21.29, SD = 2.47), and 59% were men. Three samples of participants consisted of Elite Athletes (EA, n = 17, 23.29%) in track and field from the Polish National Team, Football Players (FP, n = 32, 43.84%), and the Control Sample (CS, n = 24, 32.88%). Postural control was assessed on a force platform with a sampling frequency of 100 Hz, whereas personality and temperament were measured using the NEO-FFI and FCB-TI. Results: The EA and CS groups were more stable in the medial-lateral (ML) direction than in the FP group. In the anterior-posterior (AP) direction, the athletes from the EA group were more stable than the CS group. Openness to experience and emotional reactivity were associated with centre of pressure (COP) parameters. Discussion: The results of this study showed that EA and CS showed better stability than footballers in both the ML and AP directions. This study indicates that emotional reactivity as a temperamental trait is associated with postural stability. Among the big five traits of personality, openness solely was found to be related to postural balance skills. Openness is strongly linked with intelligence, which is determined by the efficiency and reliability of the central nervous system and the speed of a neural impulse. Additionally, plasticity as a trait includes openness and extraversion (low emotional reactivity) and may explain the relationship of both personality and temperament traits with balance skills. Conclusions: Openness to experience and emotional reactivity can be explained by postural balance skills. Further research should examine the association of balance skills with plasticity and intelligence. The present research may provide useful clues for sport selection and rehabilitation of sport injuries. Development of openness should be supported in team and individual sports that require excellent balance skills, such as track and field, artistic gymnastics, ice skating, and sky jumping.
... Over the last four decades sport-related injuries have received increased research attention (Ivarsson et al., 2017) in response to the high incidence (Rosa et al., 2014;Sheu et al., 2016) and associated undesirable physical and psychological effects (Leddy et al., 1994;Brewer, 2012). Multiple psychological (Slimani et al., 2018), anatomical (Murphy et al., 2003), biomechanical (Neely, 1998;Hughes, 2014), and environmental (Meeuwisse et al., 2007) factors have been associated with sports injury occurrence and several models of injury causation have been proposed that highlight the multifactorial nature of injury occurrence (Meeuwisse et al., 2007;Kumar, 2001;Wiese-Bjornstal, 2009), of which one of the most widely cited was developed by Andersen and Williams (1988) and Williams and Andersen (1998). Williams and Andersen's (1998) stress-injury model proposed that when faced with a potentially stressful athletic situation, an athlete's personality traits (e.g., hardiness, locus of control, and competitive trait anxiety), history of stressors (e.g., major life events and previous injuries) and coping resources (e.g., general coping behaviours) contribute to the injury response, either interactively or in isolation. ...
This paper adopts a novel, interdisciplinary approach to explore the relationship between stress-related psychosocial factors, physiological markers and occurrence of injury in athletes using a repeated measures prospective design. At four data collection time-points, across 1-year of a total 2-year data collection period, athletes completed measures of major life events, the reinforcement sensitivity theory personality questionnaire, muscle stiffness, heart rate variability and postural stability, and reported any injuries they had sustained since the last data collection. Two Bayesian networks were used to examine the relationships between variables and model the changes between data collection points in the study. Findings revealed muscle stiffness to have the strongest relationship with injury occurrence, with high levels of stiffness increasing the probability of sustaining an injury. Negative life events did not increase the probability of injury occurrence at any single time-point; however, when examining changes between time points, increases in negative life events did increase the probability of injury. In addition, the combination of increases in negative life events and muscle stiffness resulted in the greatest probability of sustaining an injury. Findings demonstrated the importance of both an interdisciplinary approach and a repeated measures design to furthering our understanding of the relationship between stress-related markers and injury occurrence.
... Moreover, athletes have training sessions twice a day during the competitive season and take part in national and international championships (Slimani et al., 2018b). This hard and demanding training schedule and tournaments involve great developed physical, mental, and physiological factors (Slimani et al., 2018a;Degens et al., 2019). A well-developed aerobic fitness is essential for soccer players to maintain repetitive high-intensity actions within a soccer match, to accelerate the recovery process, and to maintain their physical condition at an optimum level during the entire season (Orntoft et al., 2016;Michailidis et al., 2020). ...
The present study aimed to verify the quarantine’s effects during a serious viral outbreak on the cardiovascular and performance associated with the Yo-Yo test in a sample of professional soccer players. 20 high-level soccer players (n = 20; age: 26 ± 4 years-old; weight: 76.85 ± 6.7 kg; height: 179 ± 6 cm) participated in this study. The intermittent Yo-Yo test was performed pre- and post- COVID-19 quarantine in a random order. During each test, the soccer players’ running performance outcomes were monitored using a portable 5-Hz GPS with a 100 Hz accelerometer and a paired t-test was conducted at a p-value of ≤ 0.05. The main results demonstrated significant differences between pre- versus post-COVID-19 quarantine in the following variables: relative distance (161.7 ± 5.9 > 141.1 ± 33.8 m/min), maximal speed (18.7 ± 0.9 > 18.2 ± 0.6 km/h), acceleration (60 ± 20 frequency > 52 ± 16 frequency), deceleration (34 ± 13 frequency > 27 ± 6 frequency), sprints > 19 km/h [0.8 (0.2;3)% >0.5 (0;0.5)%], and in high intensity running distance [16.48 (2.68;41.64)m > 0.827 (0.164;3.0)m]. We concluded that COVID-19-related restrictions and quarantine COVID-19 demonstrated adverse effects on professional soccer players’ Yo-Yo tests performance.
... Risk factors and injury rates are affected by different considerations: psychosocial, 24 psychological, 25,26 biomechanical, 27 field surfaces [28][29][30] and physical exercise. 31 Some injury prevention programmes have been effective in reducing the incidence of injuries [32][33][34][35][36][37][38][39][40][41] and decreasing healthcare costs among football players. ...
Background
Football is the most practised sport in the world and is associated with the risk of injuries in the players. Some studies have been published that identify injury prevention programmes, but there is no review of the full body of evidence on injury prevention programmes for use by football coaches. The aim of this article was to carry out a systematic review of published studies on injury prevention programmes for adult male footballers, identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies.
Methods
PubMed and EMBASE databases were used to identify relevant published articles using the following keywords: ‘soccer’, ‘injury’, and ‘prevention’.
Results
A total of 2512 studies were identified initially, but only 11 studies met the inclusion criteria, and their outcomes are presented. Results revealed that injury prevention programmes in football have focused on strength training, proprioceptive training, multicomponent programmes (balance, core stability, functional strength and mobility) and warm-up programmes.
Conclusion
Based on results from the studies analysed, football players can lower the incidence of match and training injuries by participating in dynamic warm-up programmes that include preventive exercises before games or during training sessions, and by adding strength, balance and mobility training to the training sessions.
... 6,7 This might negatively influence subsequent performance along injury occurrence. 8 Training and coaching staff may anticipate short-term match congestion by squad rotation management. 9 Furthermore, training sessions in between can be adjusted in load by decreasing frequency, intensity, or duration. ...
In elite basketball, players are exposed to intensified competition periods when participating in both national and international competitions. How coaches manage training between matches and in reference to match scheduling for a full season is not yet known.
Purpose:
First, to compare load during short-term match congestion (ie, ≥2-match weeks) with regular competition (ie, 1-match weeks) in elite male professional basketball players. Second, to determine changes in well-being, recovery, neuromuscular performance, and injuries and illnesses between short-term match congestion and regular competition.
Methods:
Sixteen basketball players (age 24.8 [2.0] y, height 195.8 [7.5] cm, weight 94.8 [14.0] kg, body fat 11.9% [5.0%], VO2max 51.9 [5.3] mL·kg-1·min-1) were monitored during a full season. Session rating of perceived exertion (s-RPE) was obtained, and load was calculated (s-RPE × duration) for each training session or match. Perceived well-being (fatigue, sleep quality, general muscle soreness, stress levels, and mood) and total quality of recovery were assessed each training day. Countermovement jump height was measured, and a list of injuries and illnesses was collected weekly using the adapted Oslo Sports Trauma Research Center Questionnaire on Health Problems.
Results:
Total load (training sessions and matches; P < .001) and training load (P < .001) were significantly lower for ≥2-match weeks. Significantly higher well-being (P = .01) and less fatigue (P = .001) were found during ≥2-match weeks compared with 1-match weeks.
Conclusion:
Total load and training load were lower during short-term match congestion compared with regular competition. Furthermore, better well-being and less fatigue were demonstrated within short-term match congestion. This might indicate that coaches tend to overcompensate training load in intensified competition.
Marcello Cesa-Bianchi (1926-2018) negli anni Cinquanta realizzò il progetto del primo servizio psicologico in una squadra di calcio in Italia: l'A. C. Milan.Dopo il Campionato del Mondo di calcio del 1958, l'esperienza brasiliana promosse l'istituzione di un supporto psicologico per le squadrea nazionali di calcio. Il servizio psicologico dell'A. C. Milan aprì la strada allo sviluppo delle ricerche di psicologia dello sport nello specifico campo in Italia. Gli autori analizzano questa esperienza pionieristica sulla scorta di nuova documentazione.
The aims of this study were: 1) to describe the total muscular injuries, and specifically HSIs, and their corresponding missed matches; 2) to analyse their economic impact; and 3) to estimate the loss of incomes due to TV rights, in first division clubs from LaLigaTM depending on the expected and actual ranking position during the 2018/2019 season. To do that, a cross-sectional study for season 18/19 and for all players of the 20 Spanish professional football clubs was performed. The economic impact of injuries was estimated considering the missed matches and salary cost of all players and the audio-visual income loss was estimated considering the Spanish Royal Decree of Law (RDL 5/2015). The high number of muscular (270) and hamstring injuries (57) implies a high cost for professional first division football clubs, specifically € 365,811 per month for the former and € 47,388 per month for the latter. In addition, reaching a worse than expected position in LaLigaTM ranking involved a loss of 45,2 million € in TV rights incomes. The high cost of muscle injuries in first division teams justifies the need for multidisciplinary teams that are capable of reducing the number of injuries as well as recovery times.
The study aimed to identify the level of mental alertness and risk-taking behavior among soccer players, and to identify the relationship between mental alertness and risk-taking behavior, and to identify the differences in mental alertness and risk-taking behavior in the light of the following demographic variables (training age, degree of injury severity, number of injury times, centers playing), and knowing the extent of the contribution of mental alertness and its relationship to risky behavior to predict sports injury in football youths, and the study used the descriptive approach, and the study population consisted of junior high-class clubs, and the sample included (300) youths, who were chosen in a simple random way, and the study was used in The tools are a measure of mental alertness (Johnson, et al, 2016), a measure of risk-taking behavior (Abdel-Fattah, Mahmoud, 2019), and a form for the player's primary data. There is an inverse (negative) statistically significant correlation between the total degree of mental alertness and risk-taking behavior and its dimensions. Mental alertness and risk-taking behavior according to the following variables (training age - playing position), and there are statistically significant differences in mental alertness according to the number of sports injuries in the past and current season and the severity of the injury in favor of the players whose number of injuries is from (1-3), and whose severity Their injury is light, and there are statistically significant differences in the risk-taking behavior according to the number of injury times for the two seasons and the severity of the injury in favor of the players whose number of times of injury is from (1-3) times and whose severity of injury is light, and since the higher the degrees of mental alertness among soccer players, this leads to The decrease in risk-taking behavior among young people, which is reflected in the reduction of sports injuries, so mental alertness predicted the risk-taking behavior, which was reflected in the decrease in the rate of sports injuries.
This clinical practice review describes the biological, biomechanical and behavioral rationale behind a return to sport bridge program used predominantly with non-elite, youth and adolescent high school and college athletes following anterior cruciate ligament (ACL) reconstruction. Post-physiotherapy, this program has produced outcomes that meet or exceed previous reports. With consideration for athletic identity and the Specific Adaptations to Imposed Demands (SAID) principle, the early program focus was on restoring non-impaired bilateral lower extremity joint mobility and bi-articular musculotendinous extensibility. Building on this foundation, movement training education, fundamental bilateral lower extremity strength and power, and motor learning was emphasized with use of external focus cues and ecological dynamics—social cognition considerations. Plyometric and agility tasks were integrated to enhance fast twitch muscle fiber recruitment, anaerobic metabolic energy system function, and fatigue resistance. The ultimate goal was to achieve the lower extremity neuromuscular control and activation responsiveness needed for bilateral dynamic knee joint stability. The rationale and conceptual basis of selected movement tasks and general philosophy of care concepts are described and discussed in detail. Based on the previously reported efficacy of this movement-based therapeutic exercise program we recommend that supplemental programs such as this become standard practice following release from post-surgical physiotherapy and before return to sports decision-making.
Objective:
To report the injury prevention programs utilized by top-level female footballers competing internationally.
Methods:
An online survey was administered to physicians of the 24 competing national teams at the 2019 FIFA Women's World Cup. The survey included 4 sections regarding perceptions and practices concerning non-contact injuries: (1) risk factors, (2) screening tests and monitoring tools, (3) preventative strategies and (4) reflection on their World Cup experience.
Results:
Following responses from 54% of teams, the most common injuries encountered included muscle strains, ankle sprains, and ACL ruptures. The study also revealed the most important injury risk factors during the FIFA 2019 World Cup. Intrinsic risk factors include accumulated fatigue, previous injury, and strength endurance. Extrinsic risk factors include reduced recovery time between matches, congested match schedule, and number of club team matches played. The 5 most used tests for risk factors were flexibility, joint mobility, fitness, balance, and strength. Monitoring tools commonly used were subjective wellness, heart rate, minutes/matches played, and daily medical screening. Specific strategies to limit risk of ACL injury included the FIFA 11+ program and proprioception training.
Conclusion:
The present study revealed multifactorial approaches to injury prevention strategies for women's national football teams at the FIFA 2019 World Cup. Challenges to injury prevention program implementation reflect time limitations, schedule uncertainties, and varying club team recommendations.
Level of evidence:
IV.
Objectives
The purpose of this prospective cohort study was to assess the associations between lower limb injuries in female team-sport athletes and a number of factors. The potential risk factors explored included: 1) lower limb strength; 2) history of life-event stress; 3) family history of ACL injuries; 4) menstrual history; and, 5) history of oral contraception use.
Methods
135 female athletes aged between 14 and 31 years (mean: 18.8 ± 3.6 years) from rugby union (n = 47), soccer (n = 72), and netball (n = 16) volunteered to participate in this study. Demographic, history of life-event stress, injury history and baseline data were obtained prior to the competitive season. The following strength measures were collected: isometric hip adductor and abductor strength, eccentric knee flexor strength and single leg jumping kinetics. Athletes were then followed for 12 months and all lower limb injuries sustained were recorded.
Results
109 athletes provided one-year follow-up injury data, of whom, 44 suffered at least one lower limb injury. All athletes who reported high scores for negative life-event stress sustained lower limb injury. Non-contact lower limb injury was positively associated with weak hip adductor strength (OR: 0.88; 95%CI: 0.78 - 0.98; p = 0.017), and between-limb adductor (OR: 5.65; 95%CI: 1.61 - 19.7.; p = 0.007) and abductor (OR: 1.95; 95%CI: 1.03 - 3.71; p = 0.039) strength asymmetries.
Conclusion
History of life event stress, hip adductor strength, and between-limb adductor and abductor strength asymmetries offer potential novel avenues for investigating injury risk factors in female athletes.
Oxidative stress is associated with playing soccer. The objective of the present report was to study the influence of different polyphenolic antioxidant-rich beverages in five-a-side/futsal players. The study was performed with a no supplemented control group (CG) and two supplemented groups with an almond-based beverage (AB) and the same beverage fortified with Lippia citriodora extract (AB + LE). At day 22, participants played a friendly futsal game. Blood extractions were performed at the beginning of intervention (day 1), before and after match (day 22) to determine oxidative stress markers and antioxidant enzyme activities in plasma, neutrophils and peripheral blood mononuclear cells (PBMCs). Malondialdehyde increased significantly in controls after the match in neutrophils, PBMCs and plasma compared to pre-match. Protein carbonyls also increased after the match in plasma in CG. In addition, malondialdehyde levels in neutrophils were significantly lower in the supplemented groups compared to controls. Post-match samples showed significant increases in neutrophil antioxidant activities in CG. Supplemented groups displayed variable results regarding neutrophil antioxidant activities, with superoxide dismutase activity significantly lower than in controls. Finally, post-match myeloperoxidase activity increased significantly in controls compared to pre-match and supplemented groups. In conclusion, polyphenolic antioxidant and anti-inflammatory supplements could be instrumental for optimal recovery after high intensity futsal games.
In this review, we examined the literature on psychological aspects among professional soccer players and discussed the research trends in this field. National and international databases were searched using terms such as “psychological and (soccer OR football) and professional” and 56 studies were selected. A total of 15 psychological aspects were extracted from the selected studies. In addition, an overview of the studies revealed that (1) most of the studies were conducted in Europe and targeted approximately one soccer team, (2) most of the studies were survey or observational studies and only a few were intervention studies, and (3) most of the research topics were related to players’ mental health, with many studies dealing with aspects such as stress and coping strategies. From study designs, it can be said that the research targeting professional soccer players is still in the stage of identifying the psychological aspects among the players and organizing these in terms of significance. In the future, it will be necessary to determine the significant psychological aspects through research and suggest and evaluate interventions for professional soccer players.
Context:
There is an elevated rate of post-concussion lower extremity musculoskeletal injury (LE MSK), however the underlying mechanism has not been elucidated. Existing approaches have investigated physical characteristics despite poorer mental health being a common post-concussion complaint and linked to musculoskeletal injuries.
Objective:
The purpose of this study was to investigate the role of mental health as a predictor of post-concussion subsequent LE MSK.
Design:
Case-Control Study.
Setting:
Intercollegiate Athletic Training Room.
Patients or other participants:
67 NCAA Division I student-athletes (N=39 Female) who were diagnosed with a sports-related concussion.
Main outcome measures:
The Brief Symptom Inventory-18 (BSI-18), the Hospital Anxiety and Depression Scale (HADS), and the Satisfaction with Life Scale (SWLS) measures were completed at baseline (pre-season) and on the day they were cleared for unrestricted return to participation (RTP) following a concussion. Two binary logistic regressions were used to predict post-concussion LE MSK within a year, one for the baseline time point and the second for RTP time point. A 2 (Group: LE MSK, No LE MSK) by 2 (Time: Baseline, RTP) repeated measures ANOVA compared performance between baseline and RTP.
Results:
There were 44 participants with subsequent LE MSK (65.7%). The only significant predictor of post-concussion LE MSK was SWLS at RTP (Exp(B): 0.64) indicating an increased (improved) SWLS was associated with lower LE MSK injury rate. There were no significant interactions between any of the mental health measures (p=0.105 - 0.885).
Conclusions:
There was limited associations for post-concussion LE MSK from commonly used measures of anxiety, depression, and satisfaction with life. Reported increased satisfaction with life was associated with decreased injury risk which warrants further attention. The results of this study suggest that these measures of anxiety, depression, and satisfaction with life have limited value for assisting sports medicine clinicians in determining which student-athletes are at elevated risk of post-concussion LE MSK.
Introduction:
The present systematic review aimed to compile the information available in the literature having to do with sport psychology regarding futsal and soccer players, in order to identify which psychological constructs are being investigated in these athletes and by means of which instruments and analysis techniques.
Method:
The search was carried out in the APA (PsycINFO), EBSCO (SportDiscus), PubMed, Web of Science, Scielo, Science Direct, Scopus, BVS and EMBASE databases, with the following descriptors: psychological construct; psychological factor; psychological variable; psychological phenomenon; soccer; futsal and athlete, in English, Spanish and Portuguese.
Results:
Initially, 66 studies met the established eligibility criteria. Of these, 46 studies were conducted with soccer players, 19 with futsal players and one with athletes who participate in both sports. The psychological constructs most studied in the soccer modality were anxiety, stress, motivation, coping, motivational climate, depression, self-efficacy and group cohesion. With regard to the futsal modality, the most studied psychological constructs were group cohesion, perfectionism, motivation, athlete satisfaction, leadership style, perceived parenting styles and burnout.
Conclusions:
Group cohesion was associated with several other psychological aspects of an individual nature, with cohesion being the construct of both modalities which is of the greatest interest to researchers possibly because it is a collective modality. It can be established that important psychological factors have not been studied in soccer and futsal modalities, especially among female athletes. Therefore, it is recommended that the research carried out with male athletes be extended to include female populations.
:
Explaining the onset and maintenance of pain can be challenging in many clinical presentations. Allostasis encompasses the mechanisms through which humans adapt to stressors to maintain physiological stability. Due to related neuro-endocrine-immune system effects, allostasis and allostatic load (the cumulative effects on the brain and body that develop through the maintenance of physiological stability) offer the potential to explain the development and maintenance of musculoskeletal pain in certain cases. This paper outlines the concept of allostatic load, highlights the evidence for allostatic load in musculoskeletal pain conditions to date, and discusses mechanisms through which allostatic load influences pain, with particular focus on hypothalamic-pituitary-adrenal axis and sympathetic nervous system function and central, brain-driven governance of these systems. Finally, through case examples, consideration is given as to how allostatic load can be integrated into clinical reasoning and how it can be used to help explain pain to individuals and guide clinical decision-making.
Impact:
Awareness of the concept of allostatic load, and subsequent assessment of physical and psychological stressors potentially contributing to allostatic load, may facilitate a broader understanding of the multidimensional presentations of many people with pain, both acute and persistent. This may facilitate discussion between clinicians and their patients regarding broader influences on their presentations and drive more targeted and inclusive pain management strategies.
Background: The aim of this study was to compare the psychological parameters in Coper individuals and people with chronic ankle instability (CAI).
Methods: This study was a cross-sectional and comparative study. Sixty elite athletes, from multiple athletic disciplines, who have suffered from lateral ankle sprains at least once in the last two years, were selected as research subjects and were divided into two groups: Copers (n = 30) and CAI (n = 30). Classification of CAI, and coper groups were done by AJFAT, CAIT and FAAM self-report questionnaires. Athletes' psychological characteristics were measured using the Ottawa Mental Skills Assessment Tool (OMSAT-3). Multivariate analysis of variance (MANOVA) and independent t-test were used to evaluate the differences between groups at a significance level of 0.05.
Results: The results showed there was a significant difference between the two groups in Goal setting, Self-confidence, Commitment, Relaxation, Fear control and Coping with stress, Focusing, Refocusing, and Mental practice (P <0.05). And Coper athletes scored higher than ankle instability athletes. But there were no significant differences between the two groups in the following parameters: Inactivation, Imagery, and Competition planning skills (P <0.05).
Conclusion: The findings showed that athletes with CAI scored lower than Coper athletes on psychological exams. Given the importance of prioritizing the mental components of goal setting, imagery, relaxation, activation, and self-confidence, the design of the competition should be a priority for rehabilitation. Therefore, coaches and sports experts are recommended to focus and improve mental skills in athletes who suffer from sports injuries, to reduce the occurrence of repetitive sports injuries.
Background:
The aim of the present systematic review was to profile soccer players' anthropometric, physiological, and physical attributes relative to different competitive levels, playing positions and age groups.
Methods:
The systematic search was conducted using different databases and according to the Population/Intervention or Exposure/Comparison/Outcome(s) [PICO] criteria.
Results:
The present review shows that the somatotype characteristics, percentage (%) of body fat, maximal oxygen uptake (VO2max), repeated sprint ability (RSA), running speed, strength, and muscular power of the lower limbs were the most powerful discriminators between male soccer players of different competitive levels, playing positions, and age groups. Specifically, higher VO2max, muscle strength, muscular power (vertical jump height), running speed (10-30 m) and agility, and lower % of body fat were identified in elite soccer players (higher level) compared to all other competitive levels (i.e., lowerlevel: subelite, amateur, recreational). As for the competitive level differences, higher VO2max, mean anaerobic power, RSA and sprint performances (5 to 20 m), and lower % of body fat and lower limbs' explosive capabilities (countermovement jump (CMJ) and squat jump (SJ)) were found in outfielders (forwards, midfielders, and defenders) as compared to goalkeepers, from a very youth age (8 years old). Concerning age related performance, it appears that physical performance increased significantly with age.
Conclusions:
These data, together with the fact that each position, age category, and playing level has a different physiological background in male soccer players, demonstrate that training programs should be individualized to each position, playing level and age category, as is already done with goalkeepers.
The last three authors contributed equally to this work.
Soccer players are required to have well-developed physical, technical and cognitive abilities. The present systematic review, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, examined the effects of cognitive training strategies on motor and positive psychological skills development in soccer performance and identified the potential moderators of the “cognitive training-soccer performance” relationship. Thirteen databases were systematically searched using keywords related to psychological or cognitive training in soccer players. The review is based on 18 studies, employing 584 soccer players aged 7-39 years. Cognitive strategies, particularly imagery, appear to improve sports performance in soccer players. Regarding imagery, the combination of two different types of cognitive imagery training (i.e., cognitive general and cognitive specific) have a positive influence on soccer performance during training, whereas motivational imagery (i.e., motivational general-arousal, motivational general-mastery, and motivational specific) enhance competition performance. Younger soccer players employ cognitive general and cognitive specific imagery techniques to a greater extent than older soccer players. Combined cognitive training strategies were more beneficial than a single cognitive strategy relative to motor skills enhancement in elite (particularly midfielders) and amateur (i.e., when practicing complex and specific soccer skills in precompetitive period) soccer players. In conclusion, it appears that there are differences in cognitive/psychological training interventions, and their efficacy, according to whether they are directed towards training or competition, and the age, standard and playing position of the players.
Background
Several studies have suggested that psychosocial variables can increase the risk of becoming injured during sport participation.
Objectives
The main objectives of these meta-analyses were to examine (i) the effect sizes of relationships between the psychosocial variables (suggested as injury predictors in the model of stress and athletic injury) and injury rates, and (ii) the effects of psychological interventions aimed at reducing injury occurrence (prevention).
Methods
Electronic databases as well as specific sport and exercise psychology journals were searched. The literature review resulted in 48 published studies containing 161 effect sizes for injury prediction and seven effect sizes for injury prevention.
Results
The results showed that stress responses (r = 0.27, 80 % CI [0.20, 0.33]) and history of stressors (r = 0.13, 80 % CI [0.11, 0.15]) had the strongest associations with injury rates. Also, the results from the path analysis showed that the stress response mediated the relationship between history of stressors and injury rates. For injury prevention studies, all studies included (N = 7) showed decreased injury rates in the treatment groups compared to control groups.
Conclusion
The results support the model’s suggestion that psychosocial variables, as well as psychologically, based interventions, can influence injury risk among athletes.
Two interrelated studies examined the role psychological factors play in the prediction and prevention of sport related injury. Study 1 involved 470 rugby players who completed measures corresponding to variables in the revised Williams and Andersen (1998) stress and injury model at the beginning of the 2001 playing season. Prospective and objective data were obtained for both the number of injuries and the time missed. Results showed that social support, the type of coping, and previous injury interacted in a conjunctive fashion to maximize the relationship between life stress and injury. Study 2 examined the effectiveness of a cognitive behavioral stress management (CBSM) intervention in reducing injury among athletes from Study 1 who were identified as having an at-risk psychological profile for injury. Forty-eight players were randomly assigned to either a CBSM intervention or a no-contact control condition. Participants completed psychological measures of coping and competitive anxiety at the beginning and end of the 2002 rugby season. The assessment of injury was identical to that used in Study 1. Results showed that those in the intervention condition reported missing less time due to injury compared to their nonintervention counterparts. The intervention group also had an increase in coping resources and a decrease in worry following the program. Taken together, both studies underscore the importance of (a) psychosocial factors in identifying those athletes most vulnerable to injury and (b) cognitive behavioral stress management programs in reducing the vulnerability to injury.
The aim of this study was to examine the extent to which a mindfulness-based program could reduce the number of sports injuries in a sample of soccer players. A total of 41 junior elite soccer players were randomly assigned to the treatment or the attentional control group. The treatment group took part in a 7-session program based on the mindfulness, acceptance, and commitment (MAC) approach (Gardner & Moore, 2007). The attentional control group was offered 7 sessions of sport psychology presentations with a particular focus on soccer. There were no statistically significant differences in injury rates between the two groups (U (39) = 149.50, z = −1.77, p = .077), but there was a medium effect size (adjusted Cohen´s d = −0.59, approx. 80% CI for d = −0.37 – −0.74). Moreover, 67% of the players in the mindfulness group remained injury-free in comparison to 40% in the control group. This result suggests that an intervention program focusing on strategies for improving attention could decrease injury risk. Recommendations include applying mindfulness exercises in athletes’ daily training to help lower injury risk.
Hardly any sport practitioner would have finished his/her career without suffering at least one sport injury. Sport injury is a broadly spread out morbidity condition sustained as a result of an energy transfer when the specific tissue or organ is no longer able to resist the biomechanical forces that stress it. Traditionally, athlete has been viewed as a mere injury container and the injury itself as a broken piece that should be fixed up. Despite of such outlook, psychological research has shown athletes play an active role on the process of becoming injured and several psychosocial variables might influence on such. According to the seminal Andersen and Williams (1988, Williams and Andersen, 1998) model, the key psychological factor related to sport injury occurrence is the stress response. The present paper focuses on the preinjury phase, reviewing the concept of stress and analyzing the mechanisms involved in Corresponding author: Ass. Prof. Aurelio Olmedilla. Dpt. Personality, Assessment and
Successful training must involve overload, but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short-term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation’ not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirmor refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc., together with identification of initiating events or triggers. In this paper, we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted.
Aims: To examine the influence of motivational and instructional self-talk on balance test performance of knee injured active individuals with meniscectomy. Design: One between-groups factor with four levels (instructional, motivational, no self-talk, neutral self-talk) and one within-groups “time” factor with two levels (pre-test, post-test). Method: 35 men and 25 women physically active and knee injured following meniscectomy 6 months ago participated. After 2 days of familiarization, they completed four dynamic balance stability trials, spaced 3 min apart. After the first two trials (best value as pre-test score), the participants were randomly assigned to four groups: the motivational self-talk group, instructional self-talk group and control groups (no instruction and neutral self-talk). They repeated the two trials (best value as post-test score) expressing aloud the phrases assigned. Results: Analysis of variance repeated-measures and Sidak multiple comparisons tests were performed on the time variable to detect differences in each group for each time point (pre- and post-test). Statistical analysis showed that balance board time score increased significantly only for experimental groups after the intervention period and not for control groups, F(3,56) = 9.93, p < 0.05, η2 = 0.861 for time of keeping stability on the board. Conclusions: The findings of the present study indicate that injured active individuals with meniscectomy may enhance their balance test performance via the use of instructional and motivational self-talk.
The purpose of the current article was to perform a systematic review of 52 studies in which the drive for muscularity (DFM) has been measured. We included all the papers we found published from 2000 until May 2012. Variables most consistently related to DFM are (1) gender, with males reporting higher levels than females; (2) anxiety and body shame; (3) perceptions that the ideal physique involves high muscularity; (4) behaviours associated with increasing muscularity, including dietary manipulation and resistance training; and (5) the internalisation of a muscular physique as the standard to which to aspire. The DFM was inconsistently correlated with self-esteem, physical characteristics and actual-ideal discrepancies. Research has focused on white male students and been cross-sectional and descriptive. Further theory-driven work is needed with a wider range of populations to enhance the conceptualisation, measurement and understanding of the DFM.
Athletes participating in sport are exposed to a relatively high injury risk. Previous research has suggested that it could be possible to reduce sports injuries through psychological skills training. The purpose of this study was to examine the extent to which a cognitive behavioural biofeedback intervention could reduce the number of sports injuries in a sample of players in Swedish elite football high schools. Participants from four elite football high schools (16-19 years old) were divided into one experiment (n = 13) and one control group (n = 14). Participants were asked to complete three questionnaires to assess anxiety level (Sport Anxiety Scale), history of stressors (Life Event Scale for Collegiate Athletes) and coping skills (Athletic Coping Skills Inventory - 28) in a baseline measure. Mann-Whitney Utests showed no significant differences in pre-intervention scores based on the questionnaires. The experimental group participated in a nine-week intervention period consisting of seven sessions, including: somatic relaxation, thought stopping, emotions/problem focused coping, goal setting, biofeedback training as well as keeping a critical incident diary. A Mann-Whitney U test showed no significant difference between the control and experimental group U (n1 = 13, n2 = 14) = 51.00, p = 0.054. However, considering the small sample, the statistical power (0.05 for present study), to detect effects was low. The results of the study are discussed from a psychological perspective and proposals for future research are given.
Context
Prevention of a lower extremity sprain or strain requires some basis for predicting that an individual athlete will sustain such an injury unless a modifiable risk factor is addressed.
Objective
To assess the possible existence of an association between reaction time measured during completion of a computerized neurocognitive test battery and subsequent occurrence of a lower extremity sprain or strain.
Design
Prospective cohort study.
Setting
Preparticipation screening conducted in a computer laboratory on the day prior to initiation of preseason practice sessions.
Participants
76 NCAA Division I-FCS football players.
Main Outcome Measures
Lower extremity sprains and strains sustained between initiation of preseason practice sessions and the end of an 11-game season. Receiver operating characteristic analysis identified the optimal reaction time cut-point for discrimination between injured versus noninjured status. Stratified analyses were performed to evaluate any differential influence of reaction time on injury incidence between starters and nonstarters.
Results
A total of 29 lower extremity sprains and strains were sustained by 23 of the 76 players. A reaction time cut-point of ≥ .545 s provided good discrimination between injured and noninjured cases: 74% sensitivity, 51% specificity, relative risk = 2.17 (90% CI: 1.10, 4.30), and odds ratio = 2.94 (90% CI: 1.19, 7.25).
Conclusions
Neurocognitive reaction time appears to be an indicator of elevated risk for lower extremity sprains and strains among college football players, which may be modifiable through performance of exercises designed to accelerate neurocognitive processing of visual input.
Athletes participating in sport are exposed to a high injury risk. Previous research has found a great number of risk factors (both physiological and psychological) that could increase injury risk. One limitation in previous studies is that few have considered the complex interaction between psychological factors in their research design.
To study whether personality, stress, and coping predicted injury occurrence in an elite soccer population based on a hypothesized model.
Prospective.
56 (n = 38 male, n = 18 female) Swedish Premiere League soccer players were selected based on convenience sampling.
Participants completed 4 questionnaires including the Swedish Universities Scales of Personality, Life Events Survey for Collegiate Athletes, and Brief COPE during the initial questionnaire administration. Subsequent to the first meeting, participants also completed the Hassle and Uplift Scale5 once per wk for a 13-wk period throughout the competitive season.
A path analysis was conducted examining the influence of personality traits (ie, trait anxiety), state-level stressors (ie, negative-life-event stress and daily hassles), and coping on injury frequency.
Results of the path analysis indicated that trait anxiety, negative-life-event stress, and daily hassle were significant predictors of injury among professional soccer players, accounting for 24% of the variance.
The findings highlight the need for athletes, coaches, and medical practitioners to attempt to reduce state-level stressors, especially daily hassles, in minimizing injury risk. Educating and training athletes and coaches in proactive stress-management techniques appears warranted.
This study investigated the attitudes and perceptions of physiotherapists working in professional soccer toward sport psychology intervention in injury rehabilitation. The Physiotherapist and Sport Psychology Questionnaire (Hemmings & Povey, 2002) was distributed to all professional soccer clubs in England and Wales. Thirty‐nine of the questionnaires were returned fully completed. In addition to this, 10 of the 39 respondents participated in semi‐structured interviews designed to further examine attitudes and perceptions in this area. It was found that the physiotherapists believed that negative psychological reactions to sports injury were fairly commonplace, with stress/anxiety being the most commonly cited reaction. Fifty‐one percent of the physiotherapists reported having referred an athlete to a sport psychologist. The stigma associated with consulting a psychologist was found to be a barrier to referral. It was suggested that more education as to the role of sport psychology in injury rehabilitation is required, along with the development of a sport psychology referral network
Abstract We investigated the relationship between skill qualities and contact injury risk in professional rugby league players. Sixty-six professional rugby league players aged 23 ± 4 years (mean ± s) participated in this three-year prospective study. Players underwent assessments of tackling proficiency, dual-task draw-and-pass proficiency, reactive agility, pattern recall, and pattern prediction. The frailty model was applied to calculate the adjusted risk ratios of injury. When the players' age and playing position were adjusted in the frailty model, the risk ratios showed that reactive agility was a predictor for the risk of injury. Players with reactive agility decision times of >80 ms had a lower incidence (relative risk = 0.68, 95% CI 0.47-0.98, P = 0.04) of injuries than players with reactive agility decision times of ≤80 ms. Although there was no relationship between injury and the majority of skill qualities (P = 0.47-0.93), players with poor reactive agility performances (specifically longer decision times) had a lower risk of injury, suggesting that poor perceptual skill is protective against contact injuries in professional rugby league players. These players might inadvertently avoid the heavy collisions that result in injury, or at best result in partial contact that does not result in exposure to the full force of a tackle.
Purpose: This study examined the relationship between athletes' imagery use, perceived pain, overall lower limb functioning, and satisfaction in the context of injury rehabilitation. Methods: In this cross-sectional study, eighty-three injured athletes receiving physiotherapy for a lower limb injury completed a questionnaire package containing the Athletic Injury Imagery Questionnaire-2 (AIIQ-2), the Visual Analogue Scale (VAS) for pain, the Lower Extremity Functional Scale (LEFS), and questions concerning their use of imagery for pain management and satisfaction with rehabilitation. Main Findings: Based on their self-reported use of imagery to manage pain, athletes were divided into two groups: athletes who used imagery to manage pain (Pain Imagery Group; n = 35) and athletes who did not use imagery to manage pain (No Pain Imagery Group; n = 48). Athletes in the Pain Imagery Group did not differ in perceptions of pain or level of lower limb functioning compared to those in the No Pain Imagery Group (p > .05). However, athletes in the Pain Imagery Group employed signi cantly more cognitive, motivational and healing imagery and expressed signi cantly greater satisfaction with their rehabilitation (p < .05). Principal Conclusions: Athletes employ imagery for multiple purposes, such as pain management, outside training and competition settings. When athletes employ imagery for pain management they report increased satisfaction with their rehabilitation.
Elite youth soccer players have a relatively high risk for injuries and illnesses due to increased physical and psychosocial stress. The aim of this study is to investigate how measures to monitor stress and recovery, and its analysis, provide useful information for the prevention of injuries and illnesses in elite youth soccer players.
53 elite soccer players between 15 and 18 years of age participated in this study. To determine physical stress, soccer players registered training and match duration and session rating of perceived exertion for two competitive seasons by means of daily training logs. The Dutch version of the Recovery Stress Questionnaire for athletes (RESTQ-Sport) was administered monthly to assess the psychosocial stress-recovery state of players. The medical staff collected injury and illness data using the standardised Fédération Internationale de Football Association registration system. ORs and 95% CIs were calculated for injuries and illnesses using multinomial regression analyses. The independent measures were stress and recovery.
During the study period, 320 injuries and 82 illnesses occurred. Multinomial regression demonstrated that physical stress was related to both injury and illness (range OR 1.01 to 2.59). Psychosocial stress and recovery were related the occurrence of illness (range OR 0.56 to 2.27).
Injuries are related to physical stress. Physical stress and psychosocial stress and recovery are important in relation to illness. Individual monitoring of stress and recovery may provide useful information to prevent soccer players from injuries and illnesses.
The measurement of inflammation by biomarkers not only documents clinically relevant infections but also offers an important tool to pin point potentially harmful effects of chronic psychosocial stressors. This article focuses firstly on basic biology of inflammation and lists main biomarkers currently used in psycho-physiologic research. In the second part, the effects of the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system as pathways modulating stress-related inflammation are discussed. Furthermore, current evidence of how chronic psychosocial stressors are related to alterations in inflammatory activity is presented. In summary, job stress, low socioeconomic status, childhood adversities as well as life events, caregiver stress, and loneliness were all shown to exert effects on immunologic activity.
In contrast to the rich body of empirical studies investigating psychological factors in sport injury occurrence, there are few controlled intervention studies examining relationships among psychological risk variables, prevention treatments, and injury outcomes (Cupal, 1998). Moreover, little attention has been given to those brief interventions that occur frequently when working with athletes in the field, often referred as brief contact interventions (see Giges & Petitipas, 2000). In the field of clinical psychology, there has been interest and research in brief or focused interventions, especially in the cognitive-behavioral therapies, and particularly for clients diagnosed with anxiety and somatic disorders (Bergin & Garfield, 1994). Most brief therapies typically range from 5 to 15 sessions (Pinkerton & Rockwell, 1994) and are commonly organized with close spacing of initial sessions and gradually increasing inter-session intervals with a planned follow-up or booster session (Budman & Gurman, 1983). Such brief therapy models seem well-suited for sport interventions, and have been used, in various forms, in the past.
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 purpose of this study was to investigate the importance of subject-related risk factors for sports injuries, taking exposure time into account. At baseline in 182 healthy males and females (27 yr) the following subject-related risk factors were assessed: body mass index (BMI), maximal oxygen uptake (direct treadmill measurement), seven aspects of neuromotor fitness (MOPER fitness test), strength of the hamstring and quadriceps muscles (CYBEX), having sustained a sports injury in the 12 months preceding the baseline measurement ("previous injury"), and 16 psychological and psychosocial factors (measured with 8 standard, valid, and reliable questionnaires). For 1 yr, subjects were asked to make daily entries on a monthly log concerning all sports activities exceeding an intensity of 4 MET and all sustained sport injuries. Completed logs were returned by 139 subjects (75 males and 64 females). Fifty-one injuries were registered in 41 subjects. The overall incidence rate (IR) was 3.7 sports injuries per 1000 h of sports participation (95% confidence interval 2.8-4.9). For various subcategories, the following IR per 1000 h of sports participation were calculated: contact sports IR = 11.0 (95% CI 7.4-16.3); noncontact sports IR = 2.3% (95% CI 1.6-3.3); competition IR = 13.4 (95% CI 8.7-20.6); and training IR = 2.8 (95% CI 1.6-5.1). Data were analyzed by stepwise multiple logistic regression. The following five variables were independent and significant (P < 0.05) predictors of risk in sustaining a sport injury: dominance (odds ratio (OR) = 1.71; 95% CI = 1.44-2.03), vital exhaustion (OR = 1.85; CI = 1.22-2.86), stressful life events (OR = 1.84; 95% CI = 1.10-311); these ORs were calculated for an increase of 10% of the range of obtained scores, starting at minimum value. For total sporting time, the OR was calculated by taking the group with a total sporting time below the median (4050 h) as a reference (OR = 6.87; 95% CI = 2.09-22.55). For previous injury, subjects that had not sustained a sports injury in the 12 months preceding the baseline measurements served as a reference for the calculation of the OR (OR = 9.41; 95% CI = 2.80-31.58). These findings confirm that both exposure time and previous injury are more important predictors of sports injuries than psychological, psychosocial, physiological, and anthropometrical factors.
Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results.
A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3-12) and adolescents (ages 13-18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents.
About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children's physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents' physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise.
These consistently related variables should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.
Cognitive behavioral stress management (CBSM) has previously been found to reduce fatigue, depression, and cortisol response to heavy exercise training among competitive collegiate athletes and to speed physical and psychological recovery from surgery. Our study assessed the efficacy of a CBSM program to reduce the frequency of injury and illness among collegiate athletes in a randomized, single-blind, controlled clinical trial. Following assessment of baseline medical history, mood state, stress, cortisol, sleep, alcohol use, and exercise training, collegiate rowers were stratified by gender and competitive level and randomly assigned to either a control group or a CBSM group. Exercise training information and psychosocial assessments were repeated immediately following the intervention period, and health care providers who were blinded to participant assignment recorded the frequency of medical visits and the number of days injured or ill until the end of the season. Athletes randomly assigned to a CBSM group experienced significant reductions in the number of illness and injury days as compared to control group athletes. CBSM participants also had half the number of health service visits as did controls. The data suggest that a time-limited CBSM intervention designed specifically for an athlete population may be an effective prophylactic treatment to reduce the incidence of injury and illness among competitive collegiate athletes.
Different types of stressors are known to activate distinct neuronal circuits in the brain. Acute physiological stimuli that are life threatening and require immediate reactions lead to a rapid stimulation of brainstem and hypothalamus to activate efferent visceral pathways. In contrast, psychological stressors activate higher-order brain structures for further interpretations of the perceived endangerment. Common to the later multimodal stressors is that they need cortical processing and, depending on previous experience or ongoing activation, the information is assembled within limbic circuits connecting, e.g., the hippocampus, amygdala and prefrontal cortex to induce neuroendocrine and behavioral responses. In view of the fact that stressful life events often contribute to the etiology of psychopathologies such as depressive episodes, several animal models have been developed to study central nervous mechanisms that are induced by stress. The present review summarizes observations made in the tree shrew chronic psychosocial stress paradigm with particular focus on neurotransmitter systems and structural changes in limbic brain regions.
What are the best fuel foods for soccer players? What training regimen will best prepare young soccer players and improve their resistance to injuries? This book presents answers to these questions. It addresses: the physical and mental demands of the game, including the differences between boys' and girls' games and the differences in the levels of play in youth, college, and professional leagues; nutrition fundamentals, including food, drink, and vitamin supplements; physiology and training methods, with an emphasis on the basic elements of flexibility, speed, strength, and conditioning; and injury treatment and prevention. This guide to health and fitness for soccer players offers expert advice for soccer teams at all levels. The book discusses training practices, physical problems soccer players often encounter, and ways to treat and prevent injury. Topics covered include: important differences between boys' and girls' games; the best foods and fluids for maximum performance; the best training concepts; speed training tips; training considerations specific to female athletes; muscle soreness; treatment of head, knee, leg, ankle, foot, and other injuries; and when to return to play after an injury.
Overtraining Athletes: Personal Journeys in Sport seeks to communicate the complex subject of overtraining to help athletes, coaches, parents, and sport science professionals understand the dangers of overtraining and take steps toward prevention. Using history and research, current experts' perspectives, and athletes' personal experiences, Overtraining Athletes identifies forces that push athletes to overtrain by sharing the struggles of those athletes and the sport professionals who seek to help them. The text employs a nonlinear structure, allowing the flexibility to sample chapters from each of its four parts based on interest and level of knowledge about the topic. By presenting the phenomenon of overtraining from a variety of perspectives and with varying degrees of technicality, the book engages a wide range of readers while presenting significant research and studies in the area. Each of the four parts of the text displays a distinct method for discovering how overtraining affects athletes, coaches, parents, and professionals.
Editor's Note: PTJ's Editorial Board has adopted PRISMA to help PTJ better communicate research to physical therapists. For more, read Chris Maher's editorial starting on page 870.
Membership of the PRISMA Group is provided in the Acknowledgments.
This article has been reprinted with permission from the Annals of Internal Medicine from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. Available at: http://www.annals.org/cgi/content/full/151/4/264. The authors jointly hold copyright of this article. This article has also been published in PLoS Medicine, BMJ, Journal of Clinical Epidemiology, and Open Medicine.
Copyright © 2009 Moher et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives:
Several attempts to reduce the incidence of sport injuries using psychosocial interventions produced fruitful, although inconclusive results. This paper presents the effectiveness and implementation issues of a pilot 3-month stress-management and muscle relaxation program aimed at reducing sport injury incidence.
Design:
Pre-post treatment-non treatment group comparison.
Program administration:
The program was administered by a trained psychologist on a once-a-week, 1-h session basis.
Participants:
Seventy-four male soccer players from four National Youth league teams voluntarily participated. Teams were randomly assigned to either treatment/non-treatment group.
Measures:
Injury protocol, Self-monitoring cards, Athletes' satisfaction and commitment survey, Coaches' interview.
Results:
Group main effect and Time-Group interaction effect were both statistically significant, F(1,60) = 8.30, p = 0.005, η(2)p = 0.121, with the average number of injuries larger in the post-treatment phase of non-treatment group (p = 0.005, η(2)p = 0.077). There was a significant decrease in the average number of injuries for the intervention group before and after implementing the program (p < 0.001, η(2)p = 0.309).
Conclusions:
A controlled implementation of a psychosocial program was effective in reducing youth soccer sport injuries, with a high level of satisfaction and commitment from the athletes, as well as high acceptance from the coaches.
Women's soccer is now being played in all different cultures and is one of the fastest-growing female sports throughout the world. Furthermore, it is becoming professional in an increasing number of countries. The physical load for elite female players is high and, consequently, players complete demanding training schedules in order to optimally prepare for games. Moreover, the ability to run at high speeds during a game is vital for the match performance of successful elite players, and hence training must reflect this demand. A higher incidence of ACL injuries has been shown for female than for male players, especially in younger age groups, and highlights the importance of strength training, with correct technique and kneestability programmes in the early stages of development for female players. Additionally, female players are more prone to iron deficiency than are male players, and low iron status may affect a player's training response. It is important for female players to monitor their iron status regularly and to develop strategies to ensure an adequate intake of iron in the diet. The training response and injury incidents do not, in general, seem to be affected by the different phases of the menstrual cycle. Finally, while there is a plethora of research on elite male players, by comparison very few studies have been completed on female players. With the ever-increasing number of female players worldwide, and more demanding training and game loads for elite players, further research is warranted to investigate the match demands, as well as physical preparation and recovery strategies specific to female players at all levels of the game.
Psychological Predictors of Injury among Professional Soccer Players
Objectives: Numerous empirical studies suggest that specific psychological factors influence the frequency and severity of sport injuries. The main purpose of the present study is to outline the psychological factors, which predict increased injury vulnerability among professional male soccer players in Denmark. Based on the Stress-Injury Model by Williams & Anderson (1998) it is hypothesized that low coping resources, high competitive trait anxiety, and history of previous injuries would be positively related to an increased risk of injury occurrence and severity. Methods: The soccer players (N = 87) were asked to report history of previous injuries within the last 12 months. Furthermore, 2 questionnaires were used; Competitive Trait Anxiety Test, and Athletic Coping Skills Inventory - 28 (ACSI-28). Injuries were prospectively recorded throughout a period of approximately 3 months by the team's medical staff (doctors and physiotherapists). Results: Study findings clearly suggest that history of previous injury and coping with adversity are the best predictors of injury occurrence. These factors explained between 7 % and 11 % of the total variance of injury occurrence and days lost due to injury respectively. Furthermore, the same variables were found very successful in prediction injury occurrence. Conclusions: The findings support the suggestions that psychological factors can be utilized as a predictive measurement to sport injuries, which should be considered by coaches and medical staff in order to reduce vulnerability to injury.
IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
Purpose:
The objective was to evaluate the effect of a psychological group-based injury prevention, which was implemented throughout the first season, after the second season, in Swedish elite floorball teams (males and females). The secondary objective was to evaluate the effect of the intervention over the two consecutive floorball seasons as a whole.
Methods:
Twenty-three teams in the premier leagues for males and females volunteered and were allocated to an intervention group, n = 175 players, and a control group n = 171 players. The intervention group participated in psychological skills training during the first season. The control group did not receive any alternative treatment. Neither of the groups received any intervention during the second season. All injuries were registered and documented according to time-loss definition and classified into either traumatic or overuse injuries.
Results:
Ninety-three players (27 %) sustained 119 injuries during the second season. The intervention group 0.31 (95 % CI 0.22-0.39) and the control group 0.41 (95 % CI 0.29-0.53) injuries/player. The injury incidence decreased in the intervention group and was lower than the control group. The analysis showed no statistical differences when comparing the intervention group and the control group neither after the second season nor after the two seasons together, Cohen's d 0.2.
Conclusion:
This group-based training showed a small effect size after the second year resulting in fewer injuries, especially severe injuries, in the intervention group compared to the control group. It is, therefore, important not to overlook the potential of a group-based psychological injury prevention programme.
This study aims at setting up a psychological rehabilitation program for soccer players of anterior cruciate ligament (ACL) injury and to find out the impact of this program on self-confidence level and competition anxiety dimensions (cognitive -physical -confidence) to injured players. The researcher applied experimental method by using two groups (control and experimental).The sample included 8 of soccer players of (ACL) injury who were divided into two groups and he also used some tests to measure the functional state of injured knee to make sure of players' safety as control procedure, added to sports confidence test and competition anxiety state inventory. Most important results that the researcher could reach were that the proposed program impacted positively on improving self-confidence level, decreasing of cognitive and physical anxiety dimensions and increasing of confidence which is the positive dimension of sports competition anxiety.
To investigate by use of a latent growth curve analysis framework whether athletes' individual levels and changes in hassle and uplift levels over a 10-week period could predict injury outcome in an elite junior soccer population.
A prospective design with repeated measurement points.
Participants were 101 Swedish elite junior soccer players (67 males and 34 females). Ten sets of measures were taken on a weekly basis during which participants completed the Hassles and Uplifts Scale (HUS). Latent growth curve models were used to examine whether the level and change in psychological stress could predict the frequency of injury over the 10-week period.
The results show that injury occurrence was significantly associated with both the initial level of daily hassle and the change in daily hassle. High initial daily hassle levels and a smaller decrease in daily hassles were associated with injury occurrence. Moreover, injury occurrence was significantly associated with a greater decrease in daily uplift.
The findings highlight the importance of focusing on state variables using prospective designs and appropriate analysis of within-person change to detect complex and dynamic associations across time in injury-prediction research.
It is reported that between 65-91% of elite soccer players in Sweden have at least one injury per year. Several studies define different physiological and psychological factors affecting athletic injury-risk. A number of models contain proposals that specify relationships between psychological factors and an increased athletic injury-risk. Examples include Williams and Andersen's stress-injury model and Johnson and Ivarsson's empirical model of injury risk factors which proposes that factors such as trait anxiety and ineffective coping skills are influential. The purpose of this study was to examine the relationship between (a) personality factors, b) coping variables, and (c) stress and injury risk. Participants were 48 male soccer players from 3 Swedish teams ranging in age from 16 to 36 years (M = 22 years). Participants completed 5 questionnaires: Football Worry Scale, Swedish universities Scales of Personality, Life Events Survey for Collegiate Athletes, Daily Hassle Scale and Brief COPE. Information on injuries was collected by athletic trainers of the teams over 3-months. Results suggest injury was significantly predicted by 4 personality trait predictors: somatic trait anxiety, psychic trait anxiety, stress susceptibility, and trait irritability. Collectively, the predictors self-blame and acceptance could explain 14.6% of injury occurrence. More injuries were reported among players who score high in daily hassles. These results support previous findings. Recommendations are given for both the athletes and the trainers on working to prevent sport injuries.
To counter the narrow scope and atheoretical nature of early research, Andersen and Williams (1988) developed a multi-component theoretical model of stress and injury. The model proposes that athletes with a history of many stressors, personality characteristics that exacerbate the stress response, and few coping resources will. when placed in a stressful situation, be more likely to appraise the situation as stressful and to exhibit greater physiological activation and attentional disruptions. The severity of the resulting stress response is the mechanism proposed to cause the injury risk. The model also proposes interventions for reducing injury risk. For the last decade. this stress-injury model has helped to provide the impetus and theoretical base for much of the psychosocial injury research. The present article examines research support for the different components of the model. The article concludes with suggestions for potential changes to the model and future research needs.
Glass's estimator of effect size, the sample mean difference divided by the sample standard deviation, is studied in the context of an explicit statistical model. The exact distribution of Glass's estimator is obtained and the estimator is shown to have a small sample bias. The minimum variance unbiased estimator is obtained and shown to have uniformly smaller variance than Glass's (biased) estimator. Measurement error is shown to attenuate estimates of effect size and a correction is given. The effects of measurement invalidity are discussed. Expressions for weights that yield the most precise weighted estimate of effect size are also derived.
The purpose of this study was to review 500 dance injury reports submitted by 644 participating dancers over a two-year period to determine if patterns emerged that might shed light on behavior and/or work conditions linked with injury occurrence. Injury report forms that ascertained conditions surrounding the injury such as workload exposure, floor surface, costume, temperature, dieting behavior and menstrual status were collected by an on-site physical therapist from three different settings: a university conservatory; an urban, hospital-based outpatient orthopaedic clinic specialized in the evaluation and treatment of dance injuries; and a professional ballet company. The university and professional ballet dancers were screened at the beginning of the study for injury risks, including eating attitudes using the Eating Disorders Inventory 2 (EDI-2), and mood using the Profile of Mood States (POMS). Psychometric data from these screening inventories were evaluated by sub-groupings of dancers who had reported an injury during the subsequent study period and of those who had not. Fatigue was indicated as a significant injury factor in several data items, including injury form self-report, POMS scores, exposure hours on day of injury occurrence, time of injury, stage of season or semester, and work intensity at time of injury occurrence. EDI-2 scores for body dissatisfaction, drive for thinness, bulimic tendencies, and perfectionism were significantly higher in injured than in non-injured dancers. It is concluded that self-reports of fatigue, increased exposure to work, work of a highly intense or monotonous nature, and/or changes in mood or diet may provide strong clues to increased injury vulnerability.
This review describes the psychosocial factors that affect recovery following anterior cruciate ligament (ACL) injury and reconstructive surgery in athletes. A systematic search in literature with inclusion and exclusion criteria on PubMed, PsycINFO, and Embase was performed. Articles used in this review were divided in five different parts according to the biopsychosocial model of Wiese-Bjornstal, with the addition of intervention studies. The results showed that a high internal Health Locus of Control and a high self-efficacy were useful cognitive factors to facilitate the recovery. Athletes with a low level of fear of reinjury had the best knee outcome after the injury followed by a reconstruction. In addition, athletes who returned to sport had less fear of reinjury and were more experienced and established athletes compared with athletes who did not return to sport. Furthermore, researchers showed that there was a positive relation between goal setting and adherence, which in turn yielded a positive relation with the outcome of the rehabilitation of an ACL injury. There were several psychosocial interventions that appeared to be facilitating the rehabilitation process.
The mediating effect of peripheral narrowing in the negative life event stress (N-LES)/athletic injury relationship was investigated. LES and other psychosocial variables were measured, and peripheral vision was assessed in nonstressful (practice day) and stressful (game day) sport situations. Results showed that total LES, N-LES, and psychological coping skills significantly contributed to the prediction of the occurrence of athletic injury. Additionally, psychological coping skills buffered the N-LES/athletic injury relationship. Peripheral narrowing during stress significantly mediated 8.1% of the N-LES/athletic injury relationship. The findings support the predictions of the model of stress and injury, provide evidence for peripheral narrowing as a mechanism in the LES/athletic injury relationship, and suggest directions for future research examining mediating effects in the model of stress and injury. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proposes a framework for the prediction and prevention of stress-related injuries that includes cognitive, physiological, attentional, behavioral, intrapersonal, social, and stress history variables. Development of the model grew from a synthesis of the stress–illness, stress–accident, and stress–injury literatures. The model and its resulting hypotheses offer a framework for research into the nature of injury and reduction of injury risk. The model addresses possible mechanisms behind the stress–injury relationship and suggests interventions that may help diminish the likelihood of injury. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous researches have established models that specify psychological factors that could predict sport injuries. One example is Williams and Andersen's stress-injury model stressing factors such as anxiety, negative life stress and few coping resources. The purpose of the current study was to find psychological factors that could lead to an increased injury risk among junior soccer players, in addition to construct an empirical model of injury risk factors for soccer players. The participants were 108 male and female soccer players (m=17, 6) studying at soccer high schools in southwest Sweden. Five questionnaires were used, State Trait Anxiety Inventory, Sport Anxiety Scale, Life Events Survey for Collegiate Athletes, Athletic Coping Skills Inventory-28 and Swedish universities Scales of Personality. Injury record was collected by athletic trainers at the schools during a period of 8 months. The result suggested four significant predictors that together could explain 23% of injury occurrence. The main factors are life event stress, somatic trait anxiety, mistrust and ineffective coping. These findings partly support Williams and Andersen's stress-injury model and are organized into an empirical model. Recommendations are given to sport medicine teams and coaches concerning issues in sport injury prevention.
A formula is developed for the correlation between a ranking (possibly including ties) and a dichotomy, with limits which are always ±1. This formula is shown to be equivalent both to Kendall's and Spearman's.
A modified version of the Life Experiences Survey (LES) was used to examine the relationship between positive and negative life change and subsequent athletic injury among 104 collegiate varsity football players drawn from two teams. The findings from Team One indicated that players who incurred a significant time-loss injury had experienced greater negative--but not positive--life changes in the previous twelve months than noninjured players. Further, injured players tended to have higher object loss scores than noninjured players. No between-group differences were found for Team Two. Trait anxiety, competitive trait anxiety, and locus of control were examined as possible moderator variables in the life change--injury relationship, and were found to have no significant effects. While partially supporting past research, the findings indicate that more work on the stress--injury relationship is needed before life change measures can contribute to the assessment of athletes' injury potential.
To assess the risks to footballers' health and safety during competitive international matches, with identification of the most common causes of injury.
Videos of 44 of the 52 matches played during the 1994 World Cup finals staged in the USA were analysed. During each match, several relevant variables were recorded, including the number of fouls, injuries, treatments, times of incidents, identity of players treated or injured, and the injury mechanism. Additional information on players' injuries was obtained from the extensive media coverage of the event.
Only 29% of injuries resulted from foul play, whereas 71% of injuries to players occurred where no foul play was adjudged by the referee to have taken place (P < 0.01). Defenders were found to be proportionately subjected to a greater risk of injury than other players (P < 0.05). Fifteen per cent of all injuries were judged to be at least moderate, resulting in the player missing at least one match. Frequency of moderate injury was 1026 injuries per 100,000 hours played.
The major causes of injuries during international football matches were not found to be associated with foul play, as judged by the referees. However, in those cases where injuries occurred without a foul being committed, almost 50% involved player to player contact. This gives some cause for concern and is worth further investigation.
There is some evidence that, in humans and experimental animals, psychological stress may suppress or enhance immune functions, depending on the nature of the stressor and the immune variables under consideration. The possibility that psychological stress may affect the production of pro-inflammatory and immunoregulatory cytokines was investigated in 38 medical students, who had blood samplings a few weeks before and after as well as one day before an academic examination. Psychological stress significantly increased the stimulated production of tumour necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), IL-1 receptor antagonist (IL-1Ra), interferon gamma (IFN-gamma) and IL-10. Students with high stress perception during the stressful condition had a significantly higher production of TNF-alpha, IL-6, IL-1Ra and IFN-gamma than students with a low-stress perception. Students with a high anxiety response had a significantly higher production of IFN-gamma and a lower production of the negative immunoregulatory cytokines, IL-10 and IL-4, than students without anxiety. These findings suggest that, in humans, changes in the production of the pro-inflammatory cytokines, TNF-alpha, IL-6 and IFN-gamma, and negative immunoregulatory cytokines, IL-10 and IL-4, take part in the homeostatic responses to psychological stress and that stress-induced anxiety is related to a T-helper-1-like response.
The influence of psychological factors on sports injuries has been demonstrated in numerous empirical studies. Almost all investigations have been based on stress theory or a personality-profile approach. Although the majority of studies have employed different methods, the results are in general agreement that "life events" can influence the risk of injury in athletes. In this context, social support appears to have a buffering effect. According to existing results, the influence of stress-coping strategies is somewhat questionable. From the numerous psychological attributes that have been investigated in relation to sports injuries, only competitive anxiety has been shown to be associated with injury occurrence. A personality profile typical of the "injury-prone" athlete does not exist. However, several studies have shown a certain readiness to take risks (lack of caution, adventurous spirit) on the part of injured athletes. In this review, the current knowledge regarding the relationship between psychological factors and sports injuries is presented and a stress theory model is developed.
To undertake a prospective epidemiological study of the injuries sustained in English professional football over two competitive seasons.
Player injuries were annotated by club medical staff at 91 professional football clubs. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status.
A total of 6,030 injuries were reported over the two seasons with an average of 1.3 injuries per player per season. The mean (SD) number of days absent for each injury was 24.2 (40.2), with 78% of the injuries leading to a minimum of one competitive match being missed. The injury incidence varied throughout the season, with training injuries peaking during July (p<0.05) and match injuries peaking during August (p<0.05). Competition injuries represented 63% of those reported, significantly (p<0.01) more of these injuries occurring towards the end of both halves. Strains (37%) and sprains (19%) were the major injury types, the lower extremity being the site of 87% of the injuries reported. Most injury mechanisms were classified as being non-contact (58%). Re-injuries accounted for 7% of all injuries, 66% of these being classified as either a strain or a sprain. The severity of re-injuries was greater than the initial injury (p<0.01).
Professional football players are exposed to a high risk of injury and there is a need to investigate ways of reducing this risk. Areas that warrant attention include the training programmes implemented by clubs during various stages of the season, the factors contributing to the pattern of injuries during matches with respect to time, and the rehabilitation protocols employed by clubs.