Soccer is the most popular sport worldwide, with about 200 million players, both professionals and amateurs. Because of its popularity, it has been often proposed to be able to prevent or cure health problems around the world. Although participation in football leads to significant physical benefits such as improving well-being, extending life expectancy and reducing the likelihood of several major non-communicable diseases, the possibility to incur in soccer injuries must be considered. On average, an elite football player suffers from 1.5–7.6 injuries each 1,000 hours of training and 12–35 injuries each 1000 hours of match. Several risk factors for soccer injuries have been described. The most important of them are the level of play (the risk appears to be higher in professional than amateur players); the exercise load; and the standard of training. The injury prevention program “The 11”, developed with the support of the Federation Internationale de Football Association (FIFA), aims to reduce the impact of intrinsic injury risk factors in soccer, and it has been validated in that sport. A successive modified version of “The 11” (“The 11+”) has been also shown to be effective in preventing injuries in young female soccer players. The FIFA 11+ provided more than 40% of reduction of the risk of injury. Several factors can be related to the risk of injury during sport. Therefore different exercises or factors might have been responsible for efficacy of the FIFA 11+ to prevent injuries. Several improvements have been surely achieved in the last ten years, but further investigation is needed to improve the benefits of playing soccer on human health.
soccer; football; injuries; anterior cruciate ligament; muscle injuries; platelet rich plasma; players
Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football.
Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months). The main outcome measure was an injury surveillance with a missed match injury definition.
After 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051) and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051). The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025). There was no significant difference for weeks missed due to hamstring injury (4 v14, χ2:1.12, p = 0.29) and lower-limb muscle strains (4 v 21, χ2:2.66, p = 0.10). A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, χ2:6.70, p = 0.01).
This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management.
The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12608000533392).
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 U-tests 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.
Cognitive-behavioral training together with biofeedback training seems to be an effective strategy to decrease the occurrence of injuries.
More intervention studies should be conducted applying existing biofeedback methodology, especially in the injury preventive area.
Future research should develop a bio-psychological injury model aimed at predicting injury occurrence which describes the physiological stress responses and how they can be measured in more detail.
Coping skills; elite sport; psychological injury prevention; psychological stress; soccer
To evaluate the effectiveness of a preseason physical training programme that taught landing and falling skills in improving landing skills technique and preventing injury in junior elite Australian football players.
723 male players who participated in an under 18 elite competition were studied prospectively in a non‐randomised controlled trial over two consecutive football seasons. There were 114 players in the intervention group and 609 control players. The eight session intervention programme taught players six landing, falling, and recovery skills, which were considered fundamental for safe landing in Australian football. Landing skills taught in these sessions were rated for competence by independent and blinded assessors at baseline and mid‐season.
Evaluation of landing skills found no significant differences between the groups at baseline. Evaluation after the intervention revealed overall improvement in landing skills, but significantly greater improvement in the intervention group (z = −7.92, p = 0.001). Players in the intervention group were significantly less likely (relative rate 0.72, 95% confidence interval 0.52 to 0.98) to sustain an injury during the season than the control group. In particular, the time to sustaining a landing injury was significantly less for the intervention group (relative rate 0.40, 95% confidence interval 0.17 to 0.92) compared with the control group.
Landing and falling ability can be taught to junior elite Australian football players. Players in the intervention group were protected against injury, particularly injuries related to landing and falls.
injury; Australian football; prevention; intervention; landing
Hip abduction weakness has never been documented on a population basis as a common finding in a healthy group of athletes and would not normally be found in an elite adolescent athlete. This study aimed to show that hip abduction weakness not only occurs in this group but also is common and easy to correct with an unsupervised home based program.
A prospective sports team cohort based study was performed with thirty elite adolescent under-17 Australian Rules Footballers in the Australian Institute of Sport/Australian Football League Under-17 training academy. The players had their hip abduction performance assessed and were then instructed in a hip abduction muscle training exercise. This was performed on a daily basis for two months and then they were reassessed.
The results showed 14 of 28 athletes who completed the protocol had marked weakness or a side-to-side difference of more than 25% at baseline.
Two months later ten players recorded an improvement of ≥ 80% in their recorded scores. The mean muscle performance on the right side improved from 151 Newton (N) to 202 N (p<0.001) while on the left, the recorded results improved from 158 N to 223 N (p<0.001).
The baseline values show widespread profound deficiencies in hip abduction performance not previously reported. Very large performance increases can be achieved, unsupervised, in a short period of time to potentially allow large clinically significant gains. This assessment should be an integral part of preparticipation screening and assessed in those with lower limb injuries. This particular exercise should be used clinically and more research is needed to determine its injury prevention and performance enhancement implications.
Objectives: To describe the safety attitudes and beliefs of junior (aged 16–18 years) Australian football players.
Setting: Six Victorian Football League Under 18 (VFL U18) clubs in Victoria, Australia.
Methods: Cross sectional survey. Altogether 103 players completed a self report questionnaire about their safety beliefs and perceptions of support when injured, across three contexts in which they played: VFL U18 club, local club, and school.
Results: Although only 6% believed it was safe to play with injuries, 58% were willing to risk doing so. This increased to almost 80% when players perceived that their chances of being selected to play for a senior elite team would be adversely affected if they did not play. There were significant differences in the perceived level of support for injured players and in the ranking of safety as a high priority across the three settings. In general, the VFL U18 clubs were perceived as providing good support for injured players and giving a high priority to safety issues, but local clubs and particularly schools were perceived to address these issues less well.
Conclusions: Junior Australian football players have certain beliefs and perceptions in relation to injury risk that have the potential to increase injuries. These negative beliefs need to be addressed in any comprehensive injury prevention strategy aimed at these players.
Low back pain in junior Australian Rules footballers has not been investigated despite findings that back pain is more prevalent, severe and frequent in senior footballers than non-athletic controls and findings that adolescent back pain is a strong predictor for adult back pain. The aim of this study was to determine the prevalence, intensity, quality and frequency of low back pain in junior Australian Rules footballers and a control group and to compare this data between groups.
A cross-sectional survey of male non-elite junior (n = 60) and elite junior players (n = 102) was conducted along with a convenience sample of non-footballers (school children) (n = 100). Subjects completed a self-reported questionnaire on low back pain incorporating the Quadruple Visual Analogue Scale and McGill Pain Questionnaire (short form), along with additional questions adapted from an Australian epidemiological study. Linear Mixed Model (Residual Maximum Likelihood) methods were used to compare differences between groups. Log-linear models were used in the analysis of contingency tables.
For current, average and best low back pain levels, elite junior players had higher pain levels (p < 0.001), with no difference noted between non-elite juniors and controls for average and best low back pain. For low back pain at worst, there were significant differences in the mean pain scores. The difference between elite juniors and non-elite juniors (p = 0.040) and between elite juniors and controls (p < 0.001) was significant, but not between non-elite juniors and controls. The chance of suffering low back pain increases from 45% for controls, through 55% for non-elite juniors to 66.7% for elite juniors. The chance that a pain sufferer experiences chronic pain is 16% for controls and 41% for non-elite junior and elite junior players. Elite junior players experienced low back pain more frequently (p = 0.002), with no difference in frequency noted between non-elite juniors and controls. Over 25% of elite junior and non-elite junior players reported that back pain impacted their performance some of the time or greater.
This study demonstrated that when compared with non-elite junior players and non-footballers of a similar age, elite junior players experience back pain more severely and frequently and have higher prevalence and chronicity rates.
Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs consume alcohol at levels above that of communities generally. Despite the potential benefits of interventions to address alcohol consumption in sporting clubs, there have been no randomised controlled trials to test the effectiveness of these interventions. The aim of this study is to examine the effectiveness of a comprehensive accreditation intervention with community football clubs (Rugby League, Rugby Union, soccer/association football and Australian Rules football) in reducing excessive alcohol consumption by club members.
Methods and analysis
The study will be conducted in New South Wales, Australia, and employ a cluster randomised controlled trial design. Half of the football clubs recruited to the trial will be randomised to receive an intervention implemented over two and a half winter sporting seasons. The intervention is based on social ecology theory and is comprehensive in nature, containing multiple elements designed to decrease the supply of alcohol to intoxicated members, cease the provision of cheap and free alcohol, increase the availability and cost-attractiveness of non-alcoholic and low-alcoholic beverages, remove high alcohol drinks and cease drinking games. The intervention utilises a three-tiered accreditation framework designed to motivate intervention implementation. Football clubs in the control group will receive printed materials on topics unrelated to alcohol. Outcome data will be collected pre- and postintervention through cross-sectional telephone surveys of club members. The primary outcome measure will be alcohol consumption by club members at the club, assessed using a graduated frequency index and a seven day diary.
Ethics and dissemination
The study was approved by The University of Newcastle Human Research Ethics Committee (reference: H-2008-0432). Study findings will be disseminated widely through peer-reviewed publications and conference presentations.
Trial registration number
Australian New Zealand Clinical Trials Registry: ACTRN12609000224224.
This article describes the protocol for a cluster randomised controlled trial of an intervention to reduce alcohol consumption at community sports clubs.
Excessive alcohol consumption is particularly prevalent among people involved in sports, particularly team and contact sports.
There are currently no existing controlled trials testing the effectiveness of interventions to reduce excessive alcohol consumption in the sporting club setting.
The findings from this study will provide a basis for further research and potentially important findings for both policy makers and those implementing health promotion programmes in sporting clubs.
Strengths and limitations of this study
The study has a strong design incorporating random allocation, blinding of data collection staff and the use of dual, validated outcome measures.
The intervention is multifaceted and comprehensive, based on a strong theoretical framework (social ecology) and past research evidence.
Knee injuries are a major injury concern for Australian Football players and participants of many other sports worldwide. There is increasing evidence from laboratory and biomechanically focused studies about the likely benefit of targeted exercise programmes to prevent knee injuries. However, there have been few international studies that have evaluated the effectiveness of such programmes in the real-world context of community sport that have combined epidemiological, behavioural and biomechanical approaches.
To implement a fully piloted and tested exercise training intervention to reduce the number of football-related knee injuries. In so doing, to evaluate the intervention’s effectiveness in the real-world context of community football and to determine if the underlying neural and biomechanical training adaptations are associated with decreased risk of injury.
Adult players from community-level Australian Football clubs in two Australian states over the 2007–08 playing seasons.
A group-clustered randomised controlled trial with teams of players randomly allocated to either a coach-delivered targeted exercise programme or usual behaviour (control). Epidemiological component: field-based injury surveillance and monitoring of training/game exposures. Behavioural component: evaluation of player and coach attitudes, knowledge, behaviours and compliance, both before and after the intervention is implemented. Biomechanical component: biomechanical, game mobility and neuromuscular parameters assessed to determine the fundamental effect of training on these factors and injury risk.
The rate and severity of injury in the intervention group compared with the control group. Changes, if any, in behavioural components. Process evaluation: coach delivery factors and likely sustainability.
Children's exposure to unhealthy food marketing influences their food knowledge, preferences and consumption. Sport sponsorship by food companies is widespread and industry investment in this marketing is increasing. This study aimed to assess children's awareness of sport sponsors and their brand-related attitudes and purchasing intentions in response to this marketing.
Sports clubs known to have food sponsors and representing the most popular sports for Australian children across a range of demographic areas were recruited. Interview-based questionnaires were conducted at clubs with children aged 10-14 years (n = 103) to examine their recall of local sports club and elite sport sponsors, and their attitudes towards sponsors and sponsorship activities.
Most children (68%) could recall sponsors of their sports club, naming a median of two sponsors, including a median of one food company sponsor each. Almost half (47%) of children could recall any sponsors of their favourite elite sporting team. Children aged 10-11 years were more likely than older children to report that they thought about sponsors when buying something to eat or drink (P < 0.01); that they liked to return the favour to sponsors by buying their products (P < 0.01); and that sponsors were 'cool' (P = 0.02). Most children had received a voucher or certificate from a food or beverage company to reward sport performance (86% and 76%, respectively). Around one-third of children reported liking the company more after receiving these rewards.
Children's high recall of food and beverage company sport sponsors and their positive attitudes towards these sponsors and their promotions is concerning as this is likely to be linked to children's food preferences and consumption. Limiting children's exposure to this marketing is an important initiative to improve children's nutrition.
Food; Beverages; Child; Marketing; Sport; Sponsorship
Objective: Head/orofacial (H/O) injuries are common in Australian rules football. Mouthguards are widely promoted to prevent these injuries, in spite of the lack of formal evidence for their effectiveness.
Design: The Australian football injury prevention project was a cluster randomized controlled trial to evaluate the effectiveness of mouthguards for preventing H/O injuries in these players.
Setting and subjects: Twenty three teams (301 players) were recruited from the largest community football league in Australia.
Intervention: Teams were randomly allocated to either the MG: custom made mouthguard or C: control (usual mouthguard behaviours) study arm.
Main outcome measures: All injuries, participation in training and games, and mouthguard use were monitored over the 2001 playing season. Injury rates were calculated as the number of injuries per 1000 person hours of playing time. Adjusted incidence rate ratios were obtained from Poisson regression models.
Results: Players in both study arms wore mouthguards, though it is unlikely that many controls wore custom made ones. Wearing rates were higher during games than training. The overall rate of H/O injury was 2.7 injuries per 1000 exposure hours. The rate of H/O injury was higher during games than training. The adjusted H/O injury incidence rate ratio was 0.56 (95% CI 0.32 to 0.97) for MG versus C during games and training, combined.
Conclusions: There was a significant protective effect of custom made mouthguards, relative to usual mouthguard use, during games. However, the control players still wore mouthguards throughout the majority of games and this could have diluted the effect.
Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.
A cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.
Members of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.
The findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.
Alcohol drinking; Sports; Public health
Background: There is a saying in sport that "injury is just part of the game". In other words, injury in sport is seen as inevitable.
Objective: To examine progress toward reaching the contrary position that "injury prevention is just part of the game".
Methods: The four steps of van Mechelen's "sequence of prevention" model provide a structure for examining progress.
Results: What is known about the size of the problem (step 1)? Most is known about more serious injuries and about injuries in élite and professional sport. Least is known about less serious injuries, injury in community level and amateur sport, and injury occurring in recreational activities. What is known about risk factors (step 2)? Despite calls for analytic studies since the early 1980s, few such studies have been reported in the literature. What is known about the effectiveness of preventive measures (step 3)? Few randomized controlled trials have been reported in the literature. Are there systems in place to monitor sports injury (step 4)? Examples are given of systems in North America, Europe, and Australasia.
Conclusions: With a few exceptions, progress has not gone beyond step 1 in van Mechelen's model. Challenges for the future include: deciding where research efforts should be placed, standardization of definitions and methods of data collection and reporting, identification of risk factors and mechanisms of injury, and the evaluation of interventions. Finally, if the field of sports injury prevention is to advance, multidisciplinary collaboration will be required, along with the involvement of the sports community.
OBJECTIVES: To study the ictal phenomenology, aetiology, and outcome of convulsions occurring within seconds of impact in violent collision sport. DESIGN: Retrospective identification of convulsions associated with concussive brain injury from case records from medical officers of football clubs over a 15 year period. SUBJECTS: Elite Australian rules and rugby league footballers. MAIN OUTCOME MEASURES: Neuroimaging studies, electroencephalography, neuropsychological test data, and statistics on performance in matches to determine presence of structural or functional brain injury. Clinical follow up and electroencephalography for evidence of epilepsy. RESULTS: Twenty two cases of concussive convulsions were identified with four events documented on television videotape. Convulsions began within 2 seconds of impact and comprised an initial period of tonic stiffening followed by myoclonic jerks of all limbs lasting up to 150 seconds. Some asymmetry in the convulsive manifestations was common, and recovery of consciousness was rapid. No structural or permanent brain injury was present on clinical assessment, neuropsychological testing, or neuroimaging studies. All players returned to elite competition within two weeks of the incident. Epilepsy did not develop in any player over a mean (range) follow up of 3.5 (1-13) years. CONCLUSIONS: These concussive or impact convulsions are probably a non-epileptic phenomenon, somewhat akin to convulsive syncope. The mechanism may be a transient traumatic functional decerebration. In concussive convulsions the outcome is universally good, antiepileptic treatment is not indicated, and prolonged absence from sport is unwarranted.
International sports bodies should protect the health of their athletes, and injury surveillance is an important pre-requisite for injury prevention. The Fédération International de Football Association (FIFA) has systematically surveyed all football injuries in their tournaments since 1998.
Analysis of the incidence, characteristics and changes of football injury during international top-level tournaments 1998–2012.
All newly incurred football injuries during the FIFA tournaments and the Olympic Games were reported by the team physicians on a standardised injury report form after each match. The average response rate was 92%.
A total of 3944 injuries were reported from 1546 matches, equivalent to 2.6 injuries per match. The majority of injuries (80%) was caused by contact with another player, compared with 47% of contact injuries by foul play. The most frequently injured body parts were the ankle (19%), lower leg (16%) and head/neck (15%). Contusions (55%) were the most common type of injury, followed by sprains (17%) and strains (10%). On average, 1.1 injuries per match were expected to result in absence from a match or training. The incidence of time-loss injuries was highest in the FIFA World Cups and lowest in the FIFA U17 Women's World Cups. The injury rates in the various types of FIFA World Cups had different trends over the past 14 years.
Changes in the incidence of injuries in top-level tournaments might be influenced by the playing style, refereeing, extent and intensity of match play. Strict application of the Laws of the Games is an important means of injury prevention.
Soccer; Epidemiology; Sporting injuries; Injury Prevention
Background and aims
Approximately 16% of all sports injuries in the Netherlands are caused by outdoor soccer. A cluster-randomised controlled trial has been designed to investigate the effectiveness and cost-effectiveness of an injury prevention programme (‘The11’) for male amateur soccer players. The injury prevention programme The11, developed with the support of the World Football Association FIFA, aims to reduce the impact of intrinsic injury risk factors in soccer.
Teams playing at first-class amateur level in two districts in the Netherlands are participating in the study. Teams in the intervention group were instructed to apply The11 during each practice session throughout the 2009–10 season. All participants of the control group continued their practice sessions as usual. All soccer-related injuries and related costs for each team were systematically reported online by a member of the medical staff. Player exposure to practice sessions and matches was reported weekly by the coaches. Also the use of The11 during the season after the intervention season will be monitored.
Our hypothesis is that integrating the The11 exercises in the warm-up for each practice session is effective in terms of injury incidence, injury severity, healthcare use, and its associated costs and/or absenteeism. Prevention of soccer injuries is expected to be beneficial to adult soccer players, soccer clubs, the Royal Dutch Football Association (KNVB), health insurance companies and society.
Soccer; injuries; prevention; effectiveness; cost-effectiveness; economics; methods; program; sports
There is little literature describing the use of manual therapy performed on athletes. It was our purpose to document the usage of a sports chiropractic manual therapy intervention within a RCT by identifying the type, amount, frequency, location and reason for treatment provided. This information is useful for the uptake of the intervention into clinical settings and to allow clinicians to better understand a role that sports chiropractors offer.
All treatment rendered to 29 semi-elite Australian Rules footballers in the sports chiropractic intervention group of an 8 month RCT investigating hamstring and lower-limb injury prevention was recorded. Treatment was pragmatically and individually determined and could consist of high-velocity, low-amplitude (HVLA) manipulation, mobilization and/or supporting soft tissue therapies. Descriptive statistics recorded the treatment rendered for symptomatic or asymptomatic benefit, delivered to joint or soft tissue structures and categorized into body regions. For the joint therapy, it was recorded whether treatment consisted of HVLA manipulation, HVLA manipulation and mobilization, or mobilization only. Breakdown of the HVLA technique was performed.
A total of 487 treatments were provided (mean 16.8 consultations/player) with 64% of treatment for asymptomatic benefit (73% joint therapies, 57% soft tissue therapies). Treatment was delivered to approximately 4 soft tissue and 4 joint regions each consultation. The most common asymptomatic regions treated with joint therapies were thoracic (22%), knee (20%), hip (19%), sacroiliac joint (13%) and lumbar (11%). For soft tissue therapies it was gluteal (22%), hip flexor (14%), knee (12%) and lumbar (11%). The most common symptomatic regions treated with joint therapies were lumbar (25%), thoracic (15%) and hip (14%). For soft tissue therapies it was gluteal (22%), lumbar (15%) and posterior thigh (8%). Of the joint therapy, 56% was HVLA manipulation only, 36% high-HVLA and mobilization and 9% mobilization only. Of the HVLA manipulation, 63% was manually performed and 37% mechanically assisted.
The intervention applied was multimodal and multi-regional. Most treatment was for asymptomatic benefit, particularly for joint based therapies, which consisted largely of HVLA manipulation techniques. Most treatment was applied to non-local hamstring structures, in particular the knee, hip, pelvis and spine.
Despite the growing popularity of women's football and the increasing number of female players, there has been little research on injuries sustained by female football players.
Analysis of the incidence, characteristics and circumstances of injury in elite female football players in top‐level international tournaments.
Injuries incurred in seven international football tournaments were analysed using an established injury report system. Doctors of all participating teams reported all injuries after each match on a standardised injury reporting form. The mean response rate was 95%.
387 injuries were reported from 174 matches, equivalent to an incidence of 67.4 injuries/1000 player hours (95% CI 60.7 to 74.1) or 2.2 injuries/match (95% CI 2.0 to 2.4). Most injuries (84%; 317/378) were caused by contact with another player. The injuries most commonly involved the lower extremity (n = 248; 65%), followed by injuries of the head and neck (n = 67, 18%), trunk (n = 33, 9%) and upper extremity (n = 32, 8%). Contusions (n = 166; 45%) were the most frequent type of injury, followed by sprains or ligament rupture (n = 96; 26%) and strains or muscle fibre ruptures (n = 31; 8%). The most common diagnosis was an ankle sprain. There were 7 ligament ruptures and 15 sprains of the knee. On average 1 injury/match (95% CI 0.8 to 1.2) was expected to result in absence from a match or training.
The injury rate in women's top‐level tournaments was within the range reported previously for match injuries in elite male and female players. However, the diagnoses and mechanisms of injury among the female players differed substantially from those previously reported in male football players.
The Orchard Sports Injury Classification System (OSICS) is one of the world’s most commonly used systems for coding injury diagnoses in sports injury surveillance systems. Its major strengths are that it has wide usage, has codes specific to sports medicine and that it is free to use. Literature searches and stakeholder consultations were made to assess the uptake of OSICS and to develop new versions. OSICS was commonly used in the sports of football (soccer), Australian football, rugby union, cricket and tennis. It is referenced in international papers in three sports and used in four commercially available computerised injury management systems. Suggested injury categories for the major sports are presented. New versions OSICS 9 (three digit codes) and OSICS 10.1 (four digit codes) are presented. OSICS is a potentially helpful component of a comprehensive sports injury surveillance system, but many other components are required. Choices made in developing these components should ideally be agreed upon by groups of researchers in consensus statements.
sports injury classification; epidemiology; surveillance; coding
To characterize the causes, effects, and risks associated with concussion in sports.
Concussion is an injury associated with sports and is most often identified with boxing, football, ice hockey, and the martial arts. In addition, recent research has shown that concussion occurs in many different sports. In the decade of the 1990s, concussion became a primary issue for discussion among the media, sports sponsors, sports medicine professionals, and athletes.
Concussion is an injury that results from a wide variety of mechanisms and has numerous signs and symptoms that are common to different types of injury. Continued improvement in prevention and management strategies for concussion requires a strong body of research from a variety of different disciplines. It is essential that research efforts focus on both prevention and management and that researchers and clinicians work closely toward their common goals.
Until the research community is able to provide sound recommendations for the prevention and management of the concussion, the care of the injured player falls squarely on the clinician. It is important for sports medicine professionals to continue to stay up to date on the advances in understanding concussions and how to care individually for each player who sustains a concussion.
mild traumatic brain injury; head injury; injury prevention
High school athletes sustain more than 1.4 million injuries annually. National high school sports injury surveillance forms the foundation for developing and evaluating preventive interventions to reduce injury rates. For national surveillance, individuals must report consistently and accurately with little one-on-one interaction with study staff.
To examine the feasibility of relying on high school coaches as data reporters in a national, Internet-based sports injury surveillance study, using the same methods that have already proven successful in the National High School Sports-Related Injury Surveillance Study, which calls on certified athletic trainers (ATs) as reporters.
Prospective injury surveillance study.
Eighteen United States high schools
Athletic trainers and varsity coaches for football, boys' and girls' soccer, and boys' and girls' basketball.
Main Outcome Measure(s):
Quantity and quality of exposure and injury reports.
All enrolled ATs participated, compared with only 43.0% of enrolled coaches. Participating ATs submitted 96.7% of expected exposure reports, whereas participating coaches submitted only 36.5%. All ATs reported athlete exposures correctly, compared with only 2 in 3 coaches. Participating ATs submitted 338 injury reports; participating coaches submitted only 55 (16.3% of the 338 submitted by ATs). Injury patterns differed between AT-submitted and coach-submitted injury reports, with ATs reporting a higher proportion of ankle injuries and coaches reporting a higher proportion of knee injuries. The reports submitted by ATs and coaches for the same injury had low agreement for diagnosis and time loss, with only 63.2% and 55.3% of pairs, respectively, providing the same response. The ATs lacked more responses for demographic questions, whereas coaches lacked more responses regarding the need for surgery.
Whenever possible, ATs should be the primary data reporters in large, national studies. In high schools without access to an AT, researchers must be willing to devote significant time and resources to achieving high participation and compliance from other reporters.
injury epidemiology; methodologies
Objective—To describe the trends in recreational sports injury in Perth, Western Australia.
Design—A prospective cohort study of sports injuries during the 1997 winter season (May to September).
Setting—Sample of Australian football, field hockey, basketball, and netball players from the Perth metropolitan area, Western Australia.
Methods—A cohort of sports participants was followed over the five month winter sports season. Before the season, participants completed a baseline questionnaire and during the season were interviewed every four weeks by telephone.
Results—Overall, 92% of participants (n = 1391) who completed a baseline questionnaire completed at least one follow up telephone interview. About half (51%) of the cohort sustained one or more injuries during the winter season accounting for a total of 1034 injuries. Most injuries were of moderate (58%, n = 598) or minor (40%, n = 412) severity, with only 3% (n = 24) requiring emergency department treatment or a hospital stay. The injury incidence rate was greatest for football (20.3/1000 hours of participation), similar for field hockey and basketball (15.2/1000 hours and 15.1/1000 hours respectively), and lowest for netball (12.1/1000 hours). The incidence of injury was greatest in the first four weeks of the season, and participants aged between 26 and 30 years had about a 55% greater risk of injury than those aged less than 18 years.
Conclusions—This is one of the first studies to show that recreational sports are safe. Although the likelihood of injury was greatest in the first month of the season, few injuries required admission to hospital or emergency department treatment. A greater emphasis on prevention in the early part of the season should help to reduce the elevated incidence of injury found at this time.
Key Words: injury incidence; prospective study; time at risk
Objective: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's football and identify potential areas for injury prevention initiatives.
Background: Football is a high-velocity collision sport in which injuries are expected. Football tends to have one of the highest injury rates in sports. Epidemiologic data helps certified athletic trainers and other clinicians identify injury trends and patterns to appropriately design and institute injury prevention protocols and then measure their effects.
Main Results: During the 16-year reporting period, about 19% of the Division I, II, and III NCAA institutions sponsoring football participated in the Injury Surveillance System. The results from the 16-year study period show little variation in the injury rates over time: games averaged 36 injuries per 1000 athlete-exposures (A-Es); fall practice, approximately 4 injuries per 1000 A-Es; and spring practice, about 10 injuries per 1000 A-Es. The game injury rate was more than 9 times higher than the in-season practice injury rate (35.90 versus 3.80 injuries per 1000 A-Es, rate ratio = 9.1, 95% confidence interval = 9.0, 9.2), and the spring practice injury rate was more than 2 times higher than the fall practice injury rate (9.62 versus 3.80 injuries per 1000 A-Es, rate ratio = 2.5, 95% confidence interval = 2.5, 2.6). The rate ratio for games versus fall practices was greatest for upper leg contusions (18.1 per 1000 A-Es), acromioclavicular joint sprains (14.0 per 1000 A-Es), knee internal derangements (13.4 per 1000 A-Es), ankle ligament sprains (12.0 per 1000 A-Es), and concussions (11.1 per 1000 A-Es).
Recommendations: Football is a complex sport that requires a range of skills performed by athletes with a wide variety of body shapes and types. Injury risks are greatest during games. Thus, injury prevention measures should focus on position-specific activities to reduce the injury rate. As equipment technology improves for the helmet, shoulder pads, and other protective devices, appropriate injury surveillance procedures should be performed to determine the effect of the new equipment on injury rates. A consistent evaluation of injury trends and patterns will assist decision makers in designing injury prevention techniques in areas that warrant the greatest attention and suggesting rule changes and modifications based on the data.
athletic injuries; injury prevention; concussions; knee injuries; ankle injuries; heat illness
Methods: During the preseason, 10 Australian football clubs volunteered 23 teams to participate in a protective equipment randomised controlled trial, the Australian Football Injury Prevention Project (AFIPP). All players from these teams were invited to participate. Players who did not agree to participate in AFIPP were surveyed about their reasons for non-involvement.
Results: 110 football players (response rate 63.6%) completed the non-responder survey and cited the two main reasons behind non-involvement in the project as "I did not know about the project" (39.4%) and "I was not at training when the research team visited" (36.5%).
Conclusions and implications: Preseason may not be the best time for maximal player recruitment in community based sports safety research. Enhanced communication between researchers and players at community level football clubs during the recruitment phase is likely to improve response rates.
Returning an athlete to play following a spinal or concussive injury remains a challenge for the health practitioner making the decision. Among the possible mechanisms responsible for such injuries in amateur football, the concept of “spearing” has attracted a great deal of attention in sport medicine.
The purpose of this paper is to present a review of the diagnosis and treatment of the potentially catastrophic neck and head injuries caused by spearing in Canadian amateur football and to suggest the role the chiropractic profession can have in their prevention. It proposes to follow the recommendations advocated by the National Capital Amateur Football Association (NCAFA) athletic trainers group, led by a chiropractor.
Information regarding the concepts and prevention of “spearing”, concussion and spinal injuries at the amateur football level in both the United States and Canada was obtained using the following computerized search methods: PubMed – MeSH (via the National Center for Biotechnology Information (NCBI); The Index to Chiropractic Literature (ICL); Google Scholar Beta. Recent (2005) information on sports related spinal injuries and concussion were obtained by attendance at the 2005 Sports Related Concussion and Spine Injury Conference. Foxborough, Massachusetts. From a total of 698 references, 63 were retained.
Literature search yields very little information regarding Canadian statistics for amateur football neck and head injuries. The author encourages such injury data collecting and proposes that original Canadian studies and statistical analyses be carried out, such as those from diverse sports groups in the United States and abroad.1, 2, 3 The NCAFA group of trainers recommends a changing of the rules for “spearing” within the league and advocates gathering of Canadian based sports injury statistics. It also recognizes the need for public presentations (of concussion/spinal injuries).5 This paper describes the different interpretations of spearing rules at American and Canadian football associations, both at the amateur and professional levels; it further shows that injury prevention in sports is an absolute necessity and that the chiropractic profession should play a role in its application. It is suggested that chiropractors, who often attend to athletes who sustained sport related neck and head injuries, ought to contribute in their prevention and treatment.
chiropractic; spearing; cervical injuries; concussion; amateur football; Canada; statistics; prevention; NCAFA