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Football, or soccer, as it is called in North America, is the
most popular sport worldwide. There are currently about
200 million players, 40 million of whom are women. The
ever-increasing number of active players, leading in turn
to an increasing frequency of injury with resultant cost for
treatment and loss of playing time, makes evident the
need for an injury prevention program.
The Fédération Internationale de Football Association
(FIFA), as the governing body of football, realized the need
and decided to play an active role in developing and sup-
porting research on football. In 1994, following the
Initiative of J. S. Blatter, F-MARC (FIFA Medical
Assessment and Research Center) was established to
study in depth the aetiology and epidemiology of football-
related injuries and physical complaints.
In a first supplement in the American Journal of Sports
Medicine in 2000, the incidence of football-related injuries
and complaints was evaluated and factors such as physi-
cal performance, medical history, and pathologic findings,
as well as the influence of psychosocial characteristics on
the frequency and severity of injury, were analyzed to
develop, based on the analysis of risk factors and predic-
tors, a program of optimal training to reduce the incidence
of injury and somatic symptoms.
Based on the results and the analysis of multidimen-
sional predictors, F-MARC recommended a prevention
program, which was tested in a prospective controlled
study.1
The results of the prospective control trial showed that
the prevention program was effective in reducing injuries,
especially in low-skill teams. Coaches and players need
better education regarding injury prevention strategies
and should include interventions as a part of their regular
training program. However, football injuries can be pre-
vented only in part by intervention focused on players and
coaches. For the development and implementation of pre-
vention programs, the specific initial situation of the play-
ers and their environment should be considered, including
extrinsic risk factors such as quality of pitches and equip-
ment. Furthermore, important aspects in the prevention of
football injury concern also the laws of the game, their
observance, and, especially, the spirit of fair play; a broad-
er view and the involvement of other target groups (such
as referees and official representatives) would be desirable
to make football a healthier game.
FIFA, the world governing body of football, which cur-
rently unifies 204 national associations, has realized that
it is its responsibility to guarantee a smooth government
of the different competitions in the spirit of fair play in all
age groups and levels of play and for both sexes. Thus,
FIFA is also aware of its responsibility for the health of its
football players. The increasing number of games being
played annually at all levels is obviously accompanied by
a higher incidence of injuries and physical symptoms. It is
the aim of FIFA to ensure, based on the current body of
knowledge, that the increasing incidence of injury is
reduced and that acute injuries as well as secondary
degenerative changes are prevented.
It is unfortunately a well-established fact that the level
of risk in football per 1000 hours of exposure is signifi-
cantly higher than in industry or commerce. Therefore, the
sports-ruling body must assess the risks associated with
the sport and implement rules to reduce the risk to an
acceptable level. The rules must identify which playing
conditions and playing actions are acceptable and those
that are not. For players to accept the level of risk, they
must be aware of the risk involved with the game and also
have some basic understanding of the medical back-
ground. Furthermore, the football referees must effective-
ly implement the laws of the game.
This supplement of AJSM 2004 presents results from
large international football competitions for different occa-
sions and age groups, comparing tournaments for men and
women. The analysis of the incidence of injuries, on one
side, and the influence of different causation factors
including tackles on the propensity of injuries, on the other
side, offers scientific evidence to discuss the current laws
of the game and their interpretation with the
International Board.
In this respect, F-MARC has invited papers from
Norway analyzing the risk factors for injuries in profes-
sional football players from different perspectives but
reaching similar conclusions.
F-MARC, as an independent academic body, would like
to express their sincere thanks on behalf of recreational
and professional football players for supporting the differ-
ent studies aiming to reduce football-related injuries, par-
ticulary to the president, Mr J. S. Blatter. Also, thanks
belong to the chairman of FIFA Sports Medical
Committee, Dr. M. D’Hooghe-Belgium, and all members
(Prof. O’Hata, Japan; Dr. R. Gittens, Canada; Dr. A. Y.
Zerguini, Algeria; Dr. R. H. Madero, Argentina; Dr. Y. Yoon,
Korea; Dr. S. Kanangara, Australia; Prof. H. S. Abd El-
Rahman, Egypt; Dr. J. T. Babwah, Trinidad and Tobago;
DOCTYPE = EDITORIALEDITORIAL
3S
The American Journal of Sports Medicine, Vol. 32, No. 1 Suppl.
DOI: 10.1177/0363546503262283
© 2004 American Orthopaedic Society for Sports Medicine
Editorial
4S Editorial The American Journal of Sports Medicine
and Dr. G. Singh, Malaysia) for obtaining the data during
the different competitions and all team physicians offering
the medical data of their injured players.
F-MARC
FIFA Medical Assessment and Research Center
Professor Jiri Dvorak, Chairman, Switzerland and Czech
Republic
Dr. Astrid Junge, Germany
Professor Toni Graf-Baumann, Germany
Professor Lars Peterson, Sweden
REFERENCE
1. Junge A, Roesch D, Peterson L, Graf-Baumann T, Dvorak J:
Prevention of football injuries-a prospective intervention study in
youth amateur players. Am J Sports 30: 652-659, 2002
