Soccer Injuries.pdf

I NJURY C LINIC

Sports Med 2004; 34 (13): 929-938

0112-1642/04/0013-0929/$31.00/0

Soccer Injuries

A Review on Incidence and Prevention

Astrid Junge and Jiri Dvorak

FIFA Medical Assessment and Research Centre (F-MARC) and Schulthess Clinic,

Zurich, Switzerland

Contents

Abstract ....................................................................................929

1. Incidence of Soccer Injury ................................................................930

2. Characteristics and Causes of Soccer Injuries ...............................................930

3. Possibilities for Preventing Soccer Injury .....................................................933

4. Studies on Prevention of Soccer Injuries ....................................................933

4.1 Prevention of Soccer Injuries in General ................................................933

4.2 Prevention of Knee Injuries ............................................................935

4.3 Prevention of Ankle Sprains ...........................................................936

5. Conclusions .............................................................................936

Abstract

Several investigators have studied the incidence and causes of soccer injuries

in male professional players; however, epidemiological data on injuries in female

soccer players are limited. From the data presented, it can be estimated that,

on average, every elite male soccer player incurs approximately one

performance-limiting injury each year. Nine studies on the prevention of soccer

injuries were found in the literature. There is some evidence that multi-modal

intervention programmes result in a general reduction in injuries. Ankle sprains

can be prevented by external ankle supports and proprioceptive/coordination

training, especially in athletes with previous ankle sprains. With regard to severe

knee injuries, the results of prevention studies are partly inconclusive; however,

training of neuromuscular and proprioceptive performance as well as improve-

ment of jumping and landing technique seem to decrease the incidence of anterior

cruciate ligament injuries in female athletes. Prevention programmes are likely to

be more effective in groups with an increased risk of injury. More methodologi-

cally well-designed studies are required to evaluate the effects of specific preven-

tive interventions.

Soccer, or football as it is officially called by the stantially depending on the definition of injury, the

Federation International de Football Association characteristics of the investigated players and the

(FIFA), is the most popular sport in the world with research design. [1,2] The methodological problems

approximately 200 000 professional and 240 million associated with sports injury research have been

amateur players. The incidence of soccer injury has described in detail by Finch, [3] Junge and Dvorak [4]

been investigated in several studies and varies sub- and Noyes et al. [5]

930

Junge & Dvorak

Several investigators have described risk factors every elite male soccer player incurs approximately

for soccer injuries and discussed possibilities for one performance-limiting injury each year. [1,33]

prevention, [6-9] but only a few have investigated the Only a few studies have analysed the incidence of

actual effectiveness of preventive interven- injuries in female soccer players. [44,45,47,50] Because

tions. [10-19] However, methodologically sound stud- of the limited database and methodological

ies of injury prevention programmes are rare in all problems such as differences in the definition of

types of sport. [20] injury, study design and characteristics of players, it

A theoretical framework for the prevention of cannot be deduced whether the overall incidence of

sports injury [21] proposes a four-step series (figure injury differs between male and female players.

1):

Two studies that analysed injuries during soccer

•

step 1: establishing the extent of the sports injury tournaments reported a higher incidence in men than

problem;

in women. [26,51] However, some types of injury, such

as anterior cruciate ligament (ACL) injuries, are

•

step 2: establishing the aetiology and mecha-

nisms of injuries;

more frequent in female than male athletes. [52,53]

•

step 3: introducing preventive measures;

For youth players, the incidence of injuries seems

•

step 4: assessing the effectiveness of the preven- to increase with age; [24,37,47-49,54] the 17- to 18-year-

tive interventions by repeating step 1.

old age group appears to have a similar or even

higher incidence of injuries than adults. [24,37] The

The present review on incidence and prevention of

soccer injuries is structured following this sequence.

same observation was reported in a survey of inju-

ries during 12 international tournaments for players

1. Incidence of Soccer Injury

of different age- and skill-level. [26]

In reviewing the literature on the exposure-relat-

2. Characteristics and Causes of

ed incidence of soccer injuries, the majority of stud-

Soccer Injuries

ies focus on adult male professional players during

the year (see table I). The highest incidences of

injury were reported for players in the professional

Excellent information on the characteristics and

league of the US [22] and the national division league

causes of soccer injuries in male professional soccer

of Iceland, [23] whilst the lowest incidences were for

players has been presented by Hawkins et al. [33] who

Dutch [24] and Danish [25] low-level players. The inci-

analysed a total of 6030 injuries in 91 English pro-

dence of match injuries is, on average, 4–6 times

fessional soccer clubs. There are little epidemiologi-

higher than the incidence of injuries that occur dur-

cal data available regarding injuries to female play-

ing training sessions. Some investigators have

ers. [44,45,47] Summarising the literature, soccer inju-

analysed the incidence of match injuries based only

ries predominately affect the ankle, knee joints and

on reports [26-29] from team physicians or physiother-

the muscles of the thigh and calf. The most common

apists or from video recordings. [27,30-32] From the

data presented, it can be estimated that, on average,

types of injuries are sprains, strains and contusions.

The majority of soccer injuries are caused by

trauma; between 9% [23] and 34% [25] of all injuries

during the season are classified as overuse injuries.

An important cause of soccer injuries is contact with

another player and 12% [38] to 28% [55] of all injuries

are attributed to foul play. During a major interna-

tional tournament this proportion is even

higher. [26,56] The percentage of non-contact injuries

varies from 26% [39] to 59%. [38] Non-contact injuries

occur mainly during running and turning. [33,38]

(1) Establishing the extent

of the sports injury problem

(2) Establishing the aetiology

and mechanisms of injuries

(4) Assessing the effectiveness

of the preventive interventions

by repeating step 1

(3) Introducing

preventive measures

Fig. 1. Sequence of prevention (reproduced from van Mechelen et

al., [21] with permission).

Sports Med 2004; 34 (13)

Table I. Incidence of injury in soccer players during a year or season

Study

Country

No. of

Skill level

Age (y)

Study period

Injuries per 1000 hours

players

match

match and training

training

Male players

Arnason et al. [34]

Iceland

306

National elite, first league

16–38

1 season (May–Sep 1999)

24.6

2.1

Ekstrand et al. [35]

Sweden

1 team Senior national team

1991–97

30.3

6.5

H agglund et al. [36]

Sweden

310

National top division

17–38

1 season (Jan–Oct 2001)

25.9

5.2

Morgan and

237

Major league soccer (professional)

18–38

1 season (Mar–Oct 1996)

35.5

2.9

Oberlander [22]

Peterson et al. [37]

Czech Republic 21

1st, 2nd national league

>18

18.9

3rd national league

10.2

Amateur teams

21.6

Local teams

29.7

Hawkins and Fuller [38]

108

Premier, 1st, 2nd professional league

3 seasons (Nov 1994–May 1997)

25.9

3.4

Arnason et al. [23]

Iceland

National division league

18–34

1 season (May–Sep 1991)

34.8

5.9

Inklaar et al. [24]

The

Non-professional

19–60

1 season (Feb–Jun 1987)

Netherlands

101

High level

21.7

144

Low level

11.7

L uthje et al. [39]

Finland

263

Highest national league

17–35

1 season (May–Oct 1993)

16.6

1.5

Poulsen et al. [40]

Denmark

Division 1 (high)

21–28

1986

19.8

4.1

Series 3 and 5 (low)

24–30

20.7

5.7

Engstr om et al. [41]

Sweden

1st, 2nd division, semi-professional

24 (mean) 1 season

Ekstrand and Tropp [42]

Sweden

135

Division 1 (high)

17–38

21.8

4.6

180

Division 2

18.7

5.1

180

Division 4

16.9

7.6

Ekstrand et al. [43]

144

Division 6 (low)

1980

14.6

7.5

Nielsen and Yde [25]

Denmark

2nd division (high)

>18

1 season

18.5

2.3

Series (low)

Jan–Nov 1986

11.9

5.6

Table I. Contd

Study

Country

No. of

Skill level

Age (y)

Study period

Injuries per 1000 hours

players

match

match and training

training

Female players

Ostenberg and Roos [44]

Sweden

123

Senior players, different skill level

14–39

1 season (1996)

14.3

3.7

Engstr om et al. [45]

Sweden

Premier, 2nd division

16–28

Youth/adolescent

Junge et al. [46]

New Zealand

145

Schoolboy

14–18

Mar–Aug 2001

16.2

3.7

Junge et al. [15]

Switzerland

High-level male youth

14–19

1999–2000

18.7

4.1

Low-level male youth

21.7

8.2

S oderman et al. [47]

Sweden

Female adolescent

14–15

Apr–Oct 96

5.1

15–16

7.6

16–17

9.0

17–19

5.2

Petersen et al. [37]

Czech Republic 70

High-level male youth

14–16

15.8

Low-level male youth

14–16

37.8

High-level male youth

16–18

18.9

Low-level male youth

16–18

42.5

Inklaar et al. [24]

The

Male adolescent

13–14

Feb–Jun 1987

12.8

Netherlands

15–16

16.1

17–18

28.3

Schmidt-Olsen et al. [48]

Denmark

247

Male adolescent

12–13

3.4

112

14–15

3.8

137

16–17

4.0

Yde and Nielsen [49]

Denmark

152

Male adolescent

6–18

Feb–Oct 1986

5.6

Nielsen and Yde [25]

Denmark

Male youth

16–18

Jan–Nov 1986

14.4

3.6

Soccer Injuries: Incidence and Prevention

933

Table II. The ‘SportSmart’ programme of the New Zealand Accident Compensation Corporation (reproduced from New Zealand Accident

Compensation Corporation, [57] with permission)

Point

Action

1. Screening

Assessing health and fitness before playing identifies injury risk

2. Warm-up, cool down and stretch

The right preparation for mind and body makes for a better performance. Cooling down

helps your body to recover and is a good time to work on flexibility

3. Physical conditioning

Staying in condition means playing to your maximum potential

4. Technique

Know how to play it safe with good technique

5. Fair play

Good sport is about positive attitude – playing fair and enjoying the game

6. Protective equipment

Protect yourself against injury by using the right equipment

7. Hydration and nutrition

Eating the right food and drinking adequate fluid helps maintain health and sports

performance

8. Injury reporting

Gathering information about injuries and monitoring how and when they occur help in

injury prevention – and improve the game for everyone

9. Environment

It is not only the weather that counts – safe surroundings means safer play

10. Injury management

Getting the right treatment sooner means less pain and a faster recovery

Approximately 20–25% of all injuries are re-

4. Studies on Prevention of

injuries of the same type and location. [23,25,38] The

Soccer Injuries

importance of previous injuries and inadequate re-

habilitation as risk factors for future injury has been

Preventive programmes generally focus either on

described by Dvorak et al., [6] Inklaar, [8] Hawkins et

the reduction of all injuries associated with a given

al. [33] and Arnason et al. [34]

sport or on a particular type of injury that is extreme-

ly severe or frequent. With respect to soccer, three

Because of the limited information on injuries in

studies have focused on the prevention of injuries in

female soccer players, it cannot be stated as yet

general [12,13,15] and seven others have evaluated the

whether or not the characteristics and causes of

prevention of specific types of injury, namely ankle

injuries vary substantially from those previously

sprains, [17-19] severe injuries of the knee [11,14,16,17] and

reported for male players.

hamstring strains [10] (table III).

3. Possibilities for Preventing

4.1 Prevention of Soccer Injuries in General

Soccer Injury

Several authors have discussed possibilities for

About 20 years ago, Ekstrand et al. [12] evaluated

an injury prevention programme in male senior divi-

sion players. Six out of 12 teams were randomised

prevention of a soccer injury such as:

into an intervention group. The prevention pro-

•

warm-up with more emphasis on stretching;

gramme included: the correction of training; provi-

•

regular cool-down;

sion of shin guards and during winter training spe-

•

adequate rehabilitation with sufficient recovery

cial training shoes; prophylactic ankle taping in

time;

players with clinical instability or history of previ-

•

proprioceptive training;

ous strain; controlled rehabilitation; exclusion of

• protective equipment; players with serious knee instability; information

• good playing field conditions; about the importance of disciplined play and the

• adherence to the existing rules. [15] increased risk of injury at training camps; and cor-

These topics are closely related to the 10-point rection and supervision of doctors and physiother-

action plan to avoid sports injury proposed by the apists. During the 6-month follow-up period, the

SportSmart programme of the New Zealand Acci- players in the intervention group sustained 75%

dent Compensation Corporation (table II). [57]

fewer injuries than those in the control group.

Sports Med 2004; 34 (13)

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