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Ekstrand, Jan
Publications (10 of 74) Show all publications
Ekstrand, J., Lundqvist, D., Lagerbäck, L., Vouillamoz, M., Papadimitiou, N. & Karlsson, J. (2018). Is there a correlation between coaches leadership styles and injuries in elite football teams?: A study of 36 elite teams in 17 countries. British Journal of Sports Medicine, 52(8), 527-531
Open this publication in new window or tab >>Is there a correlation between coaches leadership styles and injuries in elite football teams?: A study of 36 elite teams in 17 countries
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2018 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 8, p. 527-531Article in journal (Refereed) Published
Abstract [en]

Background Do coaches’ leadership styles affect injury rates and the availability of players in professional football? Certain types of leadership behaviour may cause stress and have a negative impact on players’ health and well-being.

Aim To investigate the transformational leadership styles of head coaches in elite men’s football and to evaluate the correlation between leadership styles, injury rates and players’ availability.

Methods Medical staff from 36 elite football clubs in 17 European countries produced 77 reports at four postseason meetings with a view to assessing their perception of the type of leadership exhibited by the head coaches of their respective teams using the Global Transformational Leadership scale. At the same time, they also recorded details of individual players’ exposure to football and time-loss injuries.

Results There was a negative correlation between the overall level of transformational leadership and the incidence of severe injuries (rho=−0.248; n=77; p=0.030); high levels of transformational leadership were associated with smaller numbers of severe injuries. Global Transformational Leadership only explained 6% of variation in the incidence of severe injuries (r2=0.062). The incidence of severe injuries was lower at clubs where coaches communicated a clear and positive vision, supported staff members and gave players encouragement and recognition. Players’ attendance rates at training were higher in teams where coaches gave encouragement and recognition to staff members, encouraged innovative thinking, fostered trust and cooperation and acted as role models.

Conclusions There is an association between injury rates and players’ availability and the leadership style of the head coach.

Place, publisher, year, edition, pages
London, United Kingdom: BMJ Publishing Group Ltd, 2018
Keywords
soccer; injury; football; behaviour; psychology
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-147566 (URN)10.1136/bjsports-2017-098001 (DOI)000429732700012 ()29056596 (PubMedID)2-s2.0-85044864140 (Scopus ID)
Note

Funding Agencies|UEFA; Swedish Football Association; Swedish Research Council for Sport Science

Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-13Bibliographically approved
Waldén, M., Hägglund, M., Bengtsson, H. & Ekstrand, J. (2018). Perspectives in football medicine. Der Unfallchirurg (Berlin. Print), 121(6), 470-474
Open this publication in new window or tab >>Perspectives in football medicine
2018 (English)In: Der Unfallchirurg (Berlin. Print), ISSN 0177-5537, E-ISSN 1433-044X, Vol. 121, no 6, p. 470-474Article in journal (Refereed) Published
Abstract [en]

The high injury rate among mens professional football players is well-known. Therefore, the Union of European Football Associations (UEFA) launched an injury study already in 2001. This study, the UEFA Elite Club Injury Study (ECIS), currently includes data from a total of 51 clubs from 18 European countries with more than 14,000 registered injuries. With the 21(st) World Cup (WC) in Russia just around the corner, we have from our study identified a higher match injury rate and a higher proportion of severe injuries in the European Championships compared to the preceding club competitive seasons. Moreover, we have also recently showed that the muscle injury rate is higher when players are given a recovery window of five days or less between two matches. Considering the congested match schedule of the upcoming WC, it is therefore likely that injuries and fatigue once again will be a topic of discussion this summer.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Research; UEFA; Injury; Epidemiology; Prevention
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-149373 (URN)10.1007/s00113-018-0496-5 (DOI)000434044100011 ()29651514 (PubMedID)
Available from: 2018-07-02 Created: 2018-07-02 Last updated: 2018-08-10
Waldén, M., Hägglund, M., Magnusson, H. & Ekstrand, J. (2016). ACL injuries in mens professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. British Journal of Sports Medicine, 50(12), 744-750
Open this publication in new window or tab >>ACL injuries in mens professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture
2016 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 744-750Article in journal (Refereed) Published
Abstract [en]

Background Studies investigating the development of ACL injuries over time in football are scarce and more data on what happens before and after return to play (RTP) are needed. Aim To investigate (1) time trends in ACL injury rates, (2) complication rates before return to match play following ACL reconstruction, and (3) the influence of ACL injury on the subsequent playing career in male professional football players. Methods 78 clubs were followed between 2001 and 2015. Time trend in ACL injury rate was analysed using linear regression. ACL-injured players were monitored until RTP and tracked for 3 years after RTP. Results We recorded 157 ACL injuries, 140 total and 17 partial ruptures, with a non-significant average annual increase in the ACL injury rate by 6% (R-2=0.13, b=0.059, 95% CI -0.04 to 0.15, p=0.20). The match ACL injury rate was 20-fold higher than the training injury rate (0.340 vs 0.017 per 1000 h). 138 players (98.6%) with a total rupture underwent ACL reconstruction; all 134 players with RTP data (4 players still under rehabilitation) were able to return to training, but 9 of them (6.7%) suffered complications before their first match appearance (5 reruptures and 4 other knee surgeries). The median layoff after ACL reconstruction was 6.6 months to training and 7.4 months to match play. We report 3-year follow-up data for 106 players in total; 91 players (85.8%) were still playing football and 60 of 93 players (65%) with ACL reconstruction for a total rupture played at the same level. Conclusions The ACL injury rate has not declined during the 2000s and the rerupture rate before return to match play was 4%. The RTP rate within a year after ACL reconstruction was very high, but only two-thirds competed at the highest level 3 years later.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-129482 (URN)10.1136/bjsports-2015-095952 (DOI)000376762000010 ()27034129 (PubMedID)
Note

Funding Agencies|UEFA; Swedish Football Association; Football Association Premier League Limited; Swedish National Centre for Research in Sports

Available from: 2016-06-21 Created: 2016-06-20 Last updated: 2017-11-28
Gouttebarge, V., Aoki, H., Ekstrand, J., Verhagen, E. A. & Kerkhoffs, G. M. (2016). Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?. Knee Surgery, Sports Traumatology, Arthroscopy, 24(12), 3934-3942
Open this publication in new window or tab >>Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?
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2016 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 12, p. 3934-3942Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers.

METHODS: Cross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players' unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales.

RESULTS: A total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries.

CONCLUSION: It can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries.

LEVEL OF EVIDENCE: III.

National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-125547 (URN)10.1007/s00167-015-3729-y (DOI)000389607500032 ()26233596 (PubMedID)
Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2017-11-30
Ekstrand, J. (2016). Editorial Material: Preventing injuries in professional football: thinking bigger and working together in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 12, pp 709-+. British Journal of Sports Medicine, 50(12), 709-710
Open this publication in new window or tab >>Editorial Material: Preventing injuries in professional football: thinking bigger and working together in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 12, pp 709-+
2016 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 709-710Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-129477 (URN)10.1136/bjsports-2016-096333 (DOI)000376762000003 ()27121295 (PubMedID)
Available from: 2016-06-21 Created: 2016-06-20 Last updated: 2017-11-28
Larsson, D., Ekstrand, J. & Karlsson, M. K. (2016). Fracture epidemiology in male elite football players from 2001 to 2013: How long will this fracture keep me out?. British Journal of Sports Medicine, 50(12), 759-763
Open this publication in new window or tab >>Fracture epidemiology in male elite football players from 2001 to 2013: How long will this fracture keep me out?
2016 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 759-763Article in journal (Refereed) Published
Abstract [en]

Background Determining fracture risk and rehabilitation periods after specific fractures in professional football is essential for team planning. Aim To identify fracture epidemiology and absences after different types of fractures in male professional football players. Methods 2439 players from 41 professional male teams in 10 countries were followed prospectively from 2001 to 2013. Team medical staff registered fractures, absences after fractures and player exposure. Results 364 fractures were recorded, with an incidence of 0.27/1000 h of exposure (95% CI 0.25 to 0.30). The incidence of traumatic fractures was 0.25 (0.22 to 0.27) and that of stress fractures was 0.03 (0.02 to 0.04). 45% of traumatic fractures and 86% of stress fractures affected the lower extremities. Absence after a fracture was 32 days (1-278) (median (range)), compared to that after a traumatic fracture of 30 days (1-278) and a stress fracture of 65 days (6-168) (pamp;lt;0.001). Annual fracture incidence was stable during the study period (R-2=0.051, b=-0.011 (95% CI -0.043 to 0.021)). Young players had a relative risk of 10.9 (3.3 to 35.6) of sustaining stress fractures compared to old players (pamp;lt;0.01). The fracture incidence did not differ between individuals in different playing positions (p=0.10). Summary A male professional football team can expect 1 to 2 fractures per season. There are more traumatic fractures than stress fractures; while most fractures affect the lower extremities, stress fractures yield longer absences than traumatic fractures and young players have more stress fractures than old players. There is no difference in risk among players at different playing positions.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-129484 (URN)10.1136/bjsports-2015-095838 (DOI)000376762000012 ()27015852 (PubMedID)
Note

Funding Agencies|UEFA; Swedish Football Association; Football Association Premier League Limited; Swedish National Centre for Research in Sports

Available from: 2016-06-21 Created: 2016-06-20 Last updated: 2017-11-28
Ekstrand, J., Waldén, M. & Hägglund, M. (2016). Hamstring injuries have increased by 4% annually in mens professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. British Journal of Sports Medicine, 50(12), 731-737
Open this publication in new window or tab >>Hamstring injuries have increased by 4% annually in mens professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study
2016 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 731-737Article in journal (Refereed) Published
Abstract [en]

Background There are limited data on hamstring injury rates over time in football. Aim To analyse time trends in hamstring injury rates in male professional footballers over 13 consecutive seasons and to distinguish the relative contribution of training and match injuries. Methods 36 clubs from 12 European countries were followed between 2001 and 2014. Team medical staff recorded individual player exposure and time-loss injuries. Injuries per 1000 h were compared as a rate ratio (RR) with 95% CI. Injury burden was the number of lay off days per 1000 h. Seasonal trend for injury was analysed using linear regression. Results A total of 1614 hamstring injuries were recorded; 22% of players sustained at least one hamstring injury during a season. The overall hamstring injury rate over the 13-year period was 1.20 injuries per 1000 h; the match injury rate (4.77) being 9 times higher than the training injury rate (0.51; RR 9.4; 95% CI 8.5 to 10.4). The time-trend analysis showed an annual average 2.3% year on year increase in the total hamstring injury rate over the 13-year period (R-2=0.431, b=0.023, 95% CI 0.006 to 0.041, p=0.015). This increase over time was most pronounced for training injuries-these increased by 4.0% per year (R-2=0.450, b=0.040, 95% CI 0.011 to 0.070, p=0.012). The average hamstring injury burden was 19.7 days per 1000 h (annual average increase 4.1%) (R-2=0.437, b=0.041, 95% CI 0.010 to 0.072, p=0.014). Conclusions Training-related hamstring injury rates have increased substantially since 2001 but match-related injury rates have remained stable. The challenge is for clubs to reduce training-related hamstring injury rates without impairing match performance.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-129480 (URN)10.1136/bjsports-2015-095359 (DOI)000376762000008 ()26746908 (PubMedID)
Note

Funding Agencies|UEFA; Swedish Football Association; Football Association Premier League Limited; Swedish National Centre for Research in Sports

Available from: 2016-06-21 Created: 2016-06-20 Last updated: 2017-11-28
Kristenson, K., Bjørneboe, J., Waldén, M., Andersen, T. E., Ekstrand, J. & Hägglund, M. (2016). Injuries in male professional football: a prospective comparison between individual and team-based exposure registration. Scandinavian Journal of Medicine and Science in Sports, 26(10), 1225-1232
Open this publication in new window or tab >>Injuries in male professional football: a prospective comparison between individual and team-based exposure registration
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2016 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 10, p. 1225-1232Article in journal (Refereed) Published
Abstract [en]

Methodological considerations of football injury epidemiology have only scarcely been described. The aim of this study was to evaluate the inter-rater agreement in injury capture rate and injury categorisation for data registered in two different prospective injury surveillance audits studying the same two Norwegian male professional football clubs for two consecutive seasons, 2008-2009. One audit used team-based exposure (TBE) recording and the other individual-based exposure (IBE). The number of injuries recorded and corresponding injury rates (injuries/1000 h exposure) were compared between audits. Cohen’s Kappa and Prevalence Adjusted Bias Adjusted Kappa (PABAK) coefficients were calculated for injury variables. Of 323 injuries included, the IBE audit captured 318 (overall capture rate 98.5%, training 98.9%, match 97.8%) and the TBE audit 303 injuries (overall capture rate 93.8%, training 91.4%, match 97.1%). Agreement analysis showed Kappa and PABAK coefficients regarded as almost perfect (> 0.81) for 8 of 9 injury variables, and substantial (ƙ 0.75) for the variable injury severity. In conclusion, the capture rate for training injuries was slightly higher with individual-based exposure recording, and inter-agreement in injury categorisation was very high.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
Elite, epidemiology, methodology, reliability, soccer, validity
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Sciences
Identifiers
urn:nbn:se:liu:diva-117169 (URN)10.1111/sms.12551 (DOI)000386937200011 ()26376838 (PubMedID)
Note

At the time for thesis presentation publication was in status: Manuscript

Funding agencies: Union of European Football Associations; Swedish Football Association; Football Association Premier League Limited; Swedish National Centre for Research in Sports; County Council of Ostergotland; Royal Norwegian Ministry of Culture and Church Affairs; Sou

Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2017-12-04Bibliographically approved
McCall, A., Dupont, G. & Ekstrand, J. (2016). Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams head medical officers. British Journal of Sports Medicine, 50(12), 725-730
Open this publication in new window or tab >>Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams head medical officers
2016 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 725-730Article in journal (Refereed) Published
Abstract [en]

Purpose (1) To quantify current practice at the most elite level of professional club football in Europe with regard to injury prevention strategy; (2) to describe player adherence and coach compliance to the overall injury prevention programme. Methods A structured online survey was administered to the Head medical officers of 34 elite European teams currently participating in the UEFA Elite Club Injury Study. The survey had 4 sections; (1) risk factors for injury, (2) assessment and monitoring of injury risk, (3) prevention strategies and (4) coach compliance and player adherence to the injury prevention process. Results 33 (97%) Medical officers of the teams responded. The most important perceived injury risk factor was previous injury. Four of the top 6 risk factors physical fitness, accumulated fatigue, reduced recovery time between matches and training load-were related to player workload. The top 3 preventative exercises were eccentric, balance/proprioception and core training. Regarding monitoring, the top 3 tools implemented were measurement of workload, subjective wellness and a general medical screen. The subjectively rated level of coach compliance in UEFA teams was perceived as high, while the player adherence varied from none at all to perfect. Summary and conclusion Medical officers place importance on workload-related variables as risk factors for injury in elite European football players. A lack of consistently high player adherence may limit the effects of contemporary injury prevention programmes in elite European footballers.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-129479 (URN)10.1136/bjsports-2015-095259 (DOI)000376762000007 ()26795611 (PubMedID)
Available from: 2016-06-21 Created: 2016-06-20 Last updated: 2017-11-28
Hägglund, M., Waldén, M. & Ekstrand, J. (2016). Injury recurrence is lower at the highest professional football level than at national and amateur levels: does sports medicine and sports physiotherapy deliver?. British Journal of Sports Medicine, 50(12), 751-758
Open this publication in new window or tab >>Injury recurrence is lower at the highest professional football level than at national and amateur levels: does sports medicine and sports physiotherapy deliver?
2016 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 751-758Article in journal (Refereed) Published
Abstract [en]

Background Previous injury is a well-documented risk factor for football injury. The time trends and patterns of recurrent injuries at different playing levels are not clear. Aim To compare recurrent injury proportions, incidences and patterns between different football playing levels, and to study time trends in recurrent injury incidence. Methods Time-loss injuries were collected from injury surveillance of 43 top-level European professional teams (240 team-seasons), 19 Swedish premier division teams (82 team-seasons) and 10 Swedish amateur teams (10 team-seasons). Recurrent injury was defined as an injury of the same type and at the same site as an index injury within the preceding year, with injury amp;lt;2 months defined as an early recurrence, and amp;gt;2 months as a delayed recurrence. Seasonal trend for recurrent injury incidence, expressed as the average annual percentage of change, was analysed using linear regression. Results 13 050 injuries were included, 2449 (18.8%) being recurrent injuries, with 1944 early (14.9%) and 505 delayed recurrences (3.9%). Recurrence proportions were highest in the second half of the competitive season for all cohorts. Recurrence proportions differed between playing levels, with 35.1% in the amateur cohort, 25.0% in the Swedish elite cohort and 16.6% in the European cohort (chi(2) overall effect, pamp;lt;0.001). A decreasing trend was observed in recurrent injury incidence in the European cohort, a -2.9% average annual change over the 14-year study period (95% CI -5.4% to -0.4%, p=0.026). Similarly, a decreasing tendency was also seen in the Swedish premier division. Conclusions Recurrence proportions showed an inverse relationship with playing level, and recurrent injury incidence has decreased over the past decade.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-129483 (URN)10.1136/bjsports-2015-095951 (DOI)000376762000011 ()27015858 (PubMedID)
Note

Funding Agencies|UEFA; Swedish Football Association; Football Association Premier League Limited; Swedish National Centre for Research in Sports

Available from: 2016-06-21 Created: 2016-06-20 Last updated: 2017-11-28
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