Injury incidence and risk factors in youth soccer players: a systematic literature review. Part I: epidemiological analysis

The analysis of the epidemiological data and the risk factors underlying injuries is crucial to promote prevention strategies in young soccer players. The objective of the present study was to perform a systematic literature review on the epidemiological data, described in the first part, and injury risk factors, presented in the second part. After electronic database searching, articles in line with the inclusion criteria were selected for the systematic review. Epidemiological data were extracted and discussed in this first part of the review. Data were grouped as follows: injury incidence, injury severity, and re-injury, injury types, injury mechanisms, and anatomical location. The principal findings of this first part of the review are as follows: (1) injury incidence is higher in older players and during matches than during training; (2) sex and maturity status may increase risk of injury; (3) male soccer players are more prone to muscle strains and ligament sprains while female players suffer more ligament sprains; (4) most injuries are located in the ankle and thigh in young male soccer players, and in the ankle and knee in female players; (5) severe injuries are less frequent but the incidence increases in older players. Re-injuries represent only a small percentage. Although soccer is considered a safe sport, many injuries are recorded in young soccer players every year. Injury predisposition changes in relation to age, sex, and biological age. Coaches and physical trainers should be aware of individual differences in order to promote prevention strategies and personalised training.     

The relationship between preseason range of motion and muscle strain injury in elite soccer players

The purpose of the study was to determine the influence of preseason lower-extremity range of motion (ROM) on the risk of muscle strain injury during a competitive season for elite soccer players. Thirty-six elite male soccer players (age, 25.6 +/- 4.7 years) had maximum static ROM for 6 movements of the lower extremity measured prior to the 2003-2004 English Premier League season. Player age, body size, dominant limb, and playing position were documented also. All lower-extremity muscle strain injuries were recorded prospectively during the competitive season, as was the total amount of time spent in training and games for each player. Soccer players sustaining a muscle strain injury in the hip flexors or knee flexors had lower preseason ROM (p < 0.05) in these muscle groups compared with uninjured players. Similar trends were observed for the remaining muscle groups, but all failed to reach statistical significance (p > 0.05). Most significantly, soccer players with lower preseason ROM in the hip flexors and knee flexors had a statistically higher risk for a muscle strain injury to these muscle groups during a competitive season. Age, body size, limb dominance, and playing position were not significant intrinsic risk factors for the development of muscle strain injuries. Screening of flexibility for soccer players should be conducted during preseason, and flexibility training should be prescribed to players with reduced ROM to lower the risk of developing a muscle strain injury.     

Neuromuscular training and the risk of leg injuries in female floorball players: cluster randomised controlled study

Objective To investigate whether a neuromuscular training programme is effective in preventing non-contact leg injuries in female floorball players.Design Cluster randomised controlled study.Setting 28 top level female floorball teams in Finland.Participants 457 players (mean age 24 years)—256 (14 teams) in the intervention group and 201 (14 teams) in the control group—followedup for one league season (six months).Intervention A neuromuscular training programme to enhance players’ motor skills and body control, as well as to activate and prepare their neuromuscular system for sports specific manoeuvres.Main outcome measure Acute non-contact injuries of the legs.Results During the season, 72 acute non-contact leg injuries occurred, 20 in the intervention group and 52 in the control group. The injury incidence per 1000 hours playing and practise in the intervention group was 0.65 (95% confidence interval 0.37 to 1.13) and in the control group was 2.08 (1.58 to 2.72). The risk of non-contact leg injury was 66% lower (adjusted incidence rate ratio 0.34, 95% confidence interval 0.20 to 0.57) in the intervention group.Conclusion A neuromuscular training programme was effective in preventing acute non-contact injuries of the legs in female floorball players. Neuromuscular training can be recommended in the weekly training of these athletes.Trial registration Current Controlled Trials ISRCTN26550281.     

The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis

In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3–1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1–1.4]) and hip/groin (RR 1.9 [95% CI 1.3–2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1–3.2]; youths RR 1.5 [95% CI 1.26–1.67]; professionals RR 1.3 [95% CI 1.14–1.46]). Both males (RR 1.5 [95% CI 1.33–1.68)] and females (RR 1.5 [95% CI 1.14–1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.     

Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial

Objective To investigate the effect of a structured warm-up programme designed to reduce the incidence of knee and ankle injuries in young people participating in sports.Design Cluster randomised controlled trial with clubs as the unit of randomisation.Setting 120 team handball clubs from central and eastern Norway (61 clubs in the intervention group, 59 in the control group) followed for one league season (eight months).Participants 1837 players aged 15-17 years; 958 players (808 female and 150 male) in the intervention group; 879 players (778 female and 101 male) in the control group.Intervention A structured warm-up programme to improve running, cutting, and landing technique as well as neuromuscular control, balance, and strength.Main outcome measure The rate of acute injuries to the knee or ankle.Results During the season, 129 acute knee or ankle injuries occurred, 81 injuries in the control group (0.9 (SE 0.09) injuries per 1000 player hours; 0.3 (SE 0.17) in training v 5.3 (SE 0.06) during matches) and 48 injuries in the intervention group (0.5 (SE 0.11) injuries per 1000 player hours; 0.2 (SE 0.18) in training v 2.5 (SE 0.06) during matches). Fewer injured players were in the intervention group than in the control group (46 (4.8%) v (76 (8.6%); relative risk intervention group v control group 0.53, 95% confidence interval 0.35 to 0.81).Conclusion A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.     

An integrated approach to change the outcome part II: targeted neuromuscular training techniques to reduce identified ACL injury risk factors

Prior reports indicate that female athletes who demonstrate high knee abduction moments (KAMs) during landing are more responsive to neuromuscular training designed to reduce KAM. Identification of female athletes who demonstrate high KAM, which accurately identifies those at risk for noncontact anterior cruciate ligament (ACL) injury, may be ideal for targeted neuromuscular training. Specific neuromuscular training targeted to the underlying biomechanical components that increase KAM may provide the most efficient and effective training strategy to reduce noncontact ACL injury risk. The purpose of the current commentary is to provide an integrative approach to identify and target mechanistic underpinnings to increased ACL injury in female athletes. Specific neuromuscular training techniques will be presented that address individual algorithm components related to high knee load landing patterns. If these integrated techniques are employed on a widespread basis, prevention strategies for noncontact ACL injury among young female athletes may prove both more effective and efficient.     

Plasma amino acids and sports injuries

Summary. The aim of this study was to explore the relationship between changes in plasma amino acids and the incidence of sports injuries during a soccer season. Fourteen plasma amino acids were assayed at monthly intervals in 12 young soccer players during a whole soccer season. Based on the number and severity of injuries the soccer players were divided into an injury-prone and a non-injury-prone group. The mean plasma level of the amino acid glycine was significantly lower (P=0.009) in the injury-prone group than the other group, while the mean plasma levels of tyrosine, tryptophan and lysine were higher in the injury-prone group during this period (P<0.05). However there were no significant differences in the calculated plasma tryptophan and tyrosine/large neutral amino acids ratios. Significant linear time trends were observed for taurine, ornithine, lysine and the tryptophan/large neutral amino acids ratio.These results indicate that the plasma concentrations of glycine and to a lesser extent those of tyrosine, tryptophan and lysine may be promising peripheral markers for injury-proneness in young soccer players. Whether a role for glycine substitution will be indicative to reduce the occurrence of sports injuries will need to be investigated in future studies.     

Analysis of Jumping-Landing Manoeuvers after Different Speed Performances in Soccer Players

PurposeRunning at high speed and sudden change in direction or activity stresses the knee. Surprisingly, not many studies have investigated the effects of sprinting on knee’s kinetics and kinematics of soccer players. Hence, this study is aimed to investigate indices of injury risk factors of jumping-landing maneuvers performed immediately after sprinting in male soccer players.MethodsTwenty-three collegiate male soccer players (22.1±1.7 years) were tested in four conditions; vertical jump (VJ), vertical jump immediately after slow running (VJSR), vertical jump immediately after sprinting (VJFR) and double horizontal jump immediately after sprinting (HJFR). The kinematics and kinetics data were measured using Vicon motion analyzer (100Hz) and two Kistler force platforms (1000Hz), respectively.ResultsFor knee flexion joint angle, (p = 0.014, η = 0.15) and knee valgus moment (p = 0.001, η = 0.71) differences between condition in the landing phase were found. For knee valgus joint angle, a main effect between legs in the jumping phase was found (p = 0.006, η = 0.31), which suggests bilateral deficit existed between the right and left lower limbs.ConclusionIn brief, the important findings were greater knee valgus moment and less knee flexion joint angle proceeding sprint (HJFR & VJFR) rather than no sprint condition (VJ) present an increased risk for knee injuries. These results seem to suggest that running and sudden subsequent jumping-landing activity experienced during playing soccer may negatively change the knee valgus moment. Thus, sprinting preceding a jump task may increase knee risk factors such as moment and knee flexion joint angle.     

Retrospective injury epidemiology of one hundred one competitive Oceania power lifters: the effects of age, body mass, competitive standard, and gender

The injury epidemiology of competitive power lifters was investigated to provide a basis for injury prevention initiatives in power lifting. Self-reported retrospective injury data for 1 year and selected biographical and training information were obtained via a 4-page injury survey from 82 men and 19 women of varying ages (Open and Masters), body masses (lightweight and heavyweight), and competitive standards (national and international). Injury was defined as any physical damage to the body that caused the lifter to miss or modify one or more training sessions or miss a competition. A total of 118 injuries, which equated to 1.2 +/- 1.1 injuries per lifter per year and 4.4 +/- 4.8 injuries per 1,000 hours of training, were reported. The most commonly injured body regions were the shoulder (36%), lower back (24%), elbow (11%), and knee (9%). More injuries appeared to be of a sudden (acute) (59%) rather than gradual (chronic) nature (41%). National competitors had a significantly greater rate of injury (5.8 +/- 4.9 per 1,000 hours) than international competitors (3.6 +/- 3.6 per 1,000 hours). The relative proportion of injuries at some body regions varied significantly as a function of competitive standard and gender. No significant differences in injury profile were seen between Open and Masters or between lightweight and heavyweight lifters. Power lifting appears to have a moderately low risk of injury, regardless of the lifter's age, body mass, competitive standard, or gender, compared with other sports. Future research should utilize a prospective cohort or case-controlled design to examine the effect of a range of other intrinsic and extrinsic factors on injury epidemiology and to assess the effects of various intervention strategies.     

Biomechanical assessment of the effects of significant hamstring injury: an isokinetic study

Soccer players may develop recurrent hamstring injuries. This may be due to inadequate rehabilitation or to recurrent injury. In addition, following injury, the hamstring muscular complex may be permanently damaged, resulting in decreased strength, and increased likelihood of recurrent injury. Fourteen professional soccer players were assessed by clinical examination and by isokinetic testing with a Cybex II machine. Seven had suffered moderate or major hamstring injuries in the past year. There were seven controls. None of the hamstring group were currently suffering from an acute hamstring injury. The results of the two groups were compared. There were no differences in the mean results. This pilot study suggests that no permanent functional damage occurs to the muscular complex after moderate or major hamstring injuries after correct treatment. However, further research is required to confirm this.     

The Effects of Injury Preventive Warm-Up Programs on Knee Strength Ratio in Young Male Professional Soccer Players

Purpose

We aimed to investigate the effect of FIFA 11+ (11+) and HarmoKnee injury preventive warm-up programs on conventional strength ratio (CSR), dynamic control ratio (DCR) and fast/slow speed ratio (FSR) in young male professional soccer players. These ratios are related to the risk of injury to the knee in soccer players.

Methods

Thirty-six players were divided into 3 groups; FIFA 11+, HarmoKnee and control (n = 12 per group). These exercises were performed 3 times per week for 2 months (24 sessions). The CSR, DCR and FSR were measured before and after the intervention.

Results

After training, the CSR and DCR of knee muscles in both groups were found to be lower than the published normal values (0.61, 0.72, and 0.78 during 60°.s⁻¹, 180°.s⁻¹ and 300°.s⁻¹, respectively). The CSR (60°.s⁻¹) increased by 8% and FSR in the quadriceps of the non-dominant leg by 8% in the 11+. Meanwhile, the DCR in the dominant and non-dominant legs were reduced by 40% and 30% respectively in the 11+. The CSR (60°.s⁻¹) in the non-dominant leg showed significant differences between the 11+, HarmoKnee and control groups (p = 0.02). As for the DCR analysis between groups, there were significant differences in the non-dominant leg between both programs with the control group (p = 0.04). For FSR no significant changes were found between groups.

Conclusions

It can be concluded that the 11+ improved CSR and FSR, but the HarmoKnee program did not demonstrate improvement. We suggest adding more training elements to the HarmoKnee program that aimed to enhance hamstring strength (CSR, DCR and FSR). Professional soccer players have higher predisposition of getting knee injuries because hamstring to quadriceps ratio were found to be lower than the average values. It seems that the 11+ have potentials to improve CSR and FSR as well as prevent knee injuries in soccer players.     

Time of day affects heart rate recovery and variability after maximal exercise in pre-hypertensive men

ABSTRACT

Previous literature suggests that human behaviour and physiology are somehow altered by the moon-cycle, with particular emphasis on poorer sleep quality and increased aggressive behaviour during full moon. The latter variables can negatively impact athletes’ recovery and increase the likelihood of injury resulting from collision with another athlete. Therefore, the current study aimed to investigate the association between the lunar cycle and injury risk in professional football players (soccer). We monitored injuries and player exposure in the premier professional league in Qatar during four consecutive seasons (2013–2014 through 2016–2017). Acute (sudden-onset traumatic) injuries (n = 1184; 587 from contact with another player and 597 without player contact) recorded during matches and training were classified according to the lunar cycle characteristics on the date of injury: (i) moon illumination, (ii) lunar distance from earth and (iii) tidal coefficient, acquired from the lunar calendar and tide tables. We used a Poisson regression model to examine the relationship between injury risk and lunar cycle characteristics. We did not detect any association between injury risk and moon illumination, earth-to-moon distance or tidal coefficient, not for all acute injuries, nor for contact and non-contact injuries when examined separately. The findings suggest that the full moon or new moon or the gravitational pull have no effect on football injuries. Thus, organisers need not consult moon or tide tables when planning future event schedules.     

Intercondylar notch width and inner angle of lateral femoral condyle as the risk factors for anterior cruciate ligament injury in female handball players in Herzegovina

The principal purpose of this prospective study was to examine intercondylar notch size and the value of inner angle of lateral femoral condyle as the risk factors for noncontact anterior cruciate ligament ACL injury and than to correlate them to the physical values of the athletes such as body mass index (BMI), hight, wight, etc. There are indentified two type of risk factors, external include shoes-surface interaction, type of playing surface, weather conditions and internal include anatomic, neuromuscular, biomechanical and hormonal factors that may predispose female athlets to noncontact injury of ACL. Among anatomic factors, intercondylar notch stenosis and larger inner angle of lateral condyle of femur as the factors which can cause impigement of ACL, were related to an increased risk of injury of ACL. In this study were included 51 female athlete. In the study group there were 24 female handball players with ACL tear and in control group there were 27 female handball players without any type of injury of the knee, who are practicing handball on a daily basis for at least for two years. In the first step, were gathered clinical data performed by orthopaedic surgeon. In the second step, the femoral notch width and the inner angle of lateral condyle of femur were measured on coronal MR-images. Study has shown that value of inner angle of lateral condyle of femur was significantly higher in athletes with ACL tear compared to those without. Value of width of intercondylar notch was statisticaly smaller in athletes with ACL tear, compared to those without. In the conclusion the inner angle of lateral femoral condyle is better predicting factor for ACL tear in young female handball players compared to intercondylar notch width.     

Balance index score as a predictive factor for lower sports results or anterior cruciate ligament knee injuries in Croatian female athletes--preliminary study

Female athletes participating in high-risk sports suffer anterior cruciate ligament (ACL) knee injury at a 4- to 6-fold greater rate than do male athletes. ACL injuries result either from contact mechanisms or from certain unexplained non-contact mechanisms occurring during daily professional sports activities. The occurrence of non-contact injuries points to the existence of certain factors intrinsic to the knee that can lead to ACL rupture. When knee joint movement overcomes the static and the dynamic constraint systems, non-contact ACL injury may occur. Certain recent results suggest that balance and neuromuscular control play a central role in knee joint stability, protection and prevention of ACL injuries. The purpose of this study is to evaluate balance neuromuscular skills in healthy Croatian female athletes by measuring their balance index score, as well as to estimate a possible correlation between their balance index score and balance effectiveness. This study is conducted in an effort to reduce the risk of future injuries and thus prevent female athletes from withdrawing from sports prematurely. We analysed fifty-two female athletes in the high-risk sports of handball and volleyball, measuring for their static and dynamic balance index scores, using the Sport KAT 2000 testing system. This method may be used to monitor balance and coordination systems and may help to develop simpler measurements of neuromuscular control, which can be used to estimate risk predictors in athletes who withdraw from sports due to lower sports results or ruptured anterior cruciate ligament and to direct female athletes to more effective, targeted preventive interventions. The tested Croatian female athletes with lower sports results and ACL knee injury incurred after the testing were found to have a higher balance index score compared to healthy athletes. We therefore suggest that a higher balance index score can be used as an effective risk predictor for lower sports results and lesser sports motivation, anterior cruciate ligament injury and the ultimate decision to withdraw from active participation in sports. If the balance testing results prove to be effective in predicting the occurrence of ligament injuries during future sports activities, we suggest that prophylactic training programs be introduced during athlete training, since the prevention of an initial injury will be more effective than prevention of injury recurrence.     

Development of anthropometric and physical performance profiles of young elite male soccer players: a longitudinal study

The purpose of the present longitudinal study was to explore distinctive anthropometric and physical performance characteristics of young soccer players between the age of 11 and 14 and to reveal the performance at the age of 11, which contributes to the later success. Male players of the best national male squads of the 'cadet league' (14 years of age; n = 26) were annually tested starting from the age of 11 for body size and composition, flexibility, power, coordination, and agility. Randomly selected untrained but physically active age-matched boys (n = 63) were also tested over 4 consecutive years. The results revealed no difference between 2 groups regarding the body size and composition (p > 0.05). The differences in flexibility emerged only at the later age, whereas the differences regarding the explosive power (as assessed by various jumps) were moderate and partly inconsistent. The most prominent advantage of the soccer players over the control subjects during the entire tested age period appeared to be movement agility and coordination (p < 0.01). Therefore, the explosive muscle power and, in particular, the agility and coordination characterize elite soccer players of 11-14 years of age but not the body size and body composition. In addition, the agility and coordination could be among the crucial factors of future success in 11-year-old players and, therefore, should be used for early selection.     

Rapid muscle activation changes across a competitive collegiate female soccer season

Objective:The purpose of this study was to examine the effects of a competitive soccer season on rapid activation properties of the knee extensors and flexors in Division II female soccer players.Methods:Eighteen collegiate female soccer players participated in the present study, however, due to injuries during the season a final sample of 16 players were included for study analysis. Participants performed two maximal voluntary isometric contractions (MVICs) of the knee extensors and flexors before, during, and at the end of a competitive college soccer season. Electromyography root mean square (EMG RMS; µV), rate of EMG rise (RER; %Peak EMG•s^-1), and electromechanical delay (EMD; ms) were examined on both legs for the knee extensors and flexors.Results:EMG RMS at early time intervals (0-50, 0-100, and 50-100 ms) and RER at 0-75 ms for the knee extensors and flexors significantly increased from the pre-season to the end of the season (P≤0.010-0.026, η²=0.36-0.81). EMD of the knee flexors significantly decreased at the mid-season and the end of the season compared to the pre-season (P<0.001, η²=0.95).Conclusions:These findings may have important implications for monitoring improvements on thigh neuromuscular activation and developing lower extremity injury prevention strategies during a competitive collegiate female soccer season.     

Training injuries in rugby league: an evaluation of skill-based conditioning games

This study investigated the site and nature of rugby league training injuries, and identified the training activities that were most likely to result in injury in rugby league players. The incidence of training injuries was prospectively studied in 60 semiprofessional rugby league players over 1 season. Injury data was collected from 72 training sessions, which included all preseason and in-season training sessions. Injuries were described according to site, type, and the training activity performed at the time of injury. The majority of injuries (90.9 per 1000 training hours, 37.5%) were sustained in traditional conditioning activities that involved no skill component (i.e., running without the ball). In contrast, the incidence of injuries sustained while participating in skill-based conditioning games (26.0 per 1000 training hours, 10.7%) was low. These results suggest that skill-based conditioning games offer a safe, effective method of conditioning for rugby league players.     

A review of machine learning applications in soccer with an emphasis on injury risk

This narrative review paper aimed to discuss the literature on machine learning applications in soccer with an emphasis on injury risk assessment. A secondary aim was to provide practical tips for the health and performance staff in soccer clubs on how machine learning can provide a competitive advantage. Performance analysis is the area with the majority of research so far. Other domains of soccer science and medicine with machine learning use are injury risk assessment, players’ workload and wellness monitoring, movement analysis, players’ career trajectory, club performance, and match attendance. Regarding injuries, which is a hot topic, machine learning does not seem to have a high predictive ability at the moment (models specificity ranged from 74.2%-97.7%. sensitivity from 15.2%-55.6% with area under the curve of 0.66–0.83). It seems, though, that machine learning can help to identify the early signs of elevated risk for a musculoskeletal injury. Future research should account for musculoskeletal injuries’ dynamic nature for machine learning to provide more meaningful results for practitioners in soccer.