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Epidemiology and prevention of football injuries
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-6883-1471
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to study the incidence, severity and pattern of injury in male and female elite football players; to study time trends in injury risk; to identify risk factors for injury; and to test the effectiveness of an intervention programme aimed at preventing re-injury.

All studies followed a prospective design using standardised definitions and data collection forms. Individual training and match exposure was registered for all players participating. Time loss injuries were documented by each team’s medical staff.

The amount of training increased by 68% between the 1982 and 2001 Swedish top male division seasons, reflecting the shift from semi-professionalism to full professionalism. No difference in injury incidence or injury severity was found between seasons. The injury incidence was 4.6 vs. 5.2/1000 training hours and 20.6 vs. 25.9/1000 match hours. The incidence of severe injury (absence >4 weeks) was 0.8/1000 hours in both seasons.

The Swedish and Danish top male divisions were followed during the spring season of 2001. A higher risk for training injury (11.8 vs. 6.0/1000 hours, p<0.01) and severe injury (1.8 vs. 0.7/1000 hours, p=0.002) was observed among the Danish players. Re-injury accounted for 30% and 24% of injuries in Denmark and Sweden respectively.

The Swedish top male division was studied over two consecutive seasons, 2001 and 2002, and comparison of training and match injury incidences between seasons showed similar results. Players who were injured in the 2001 season were at greater risk for injury in the following season compared to non-injured players (relative risk 2.7; 95% CI 1.7-4.3). Players with a previous hamstring injury, groin injury and knee joint trauma were two to three times more likely to suffer an identical injury to the same limb in the following season, but no such relationship was found for ankle sprain. Age was not associated with an increased injury risk.

The effectiveness of a coach-controlled rehabilitation programme on the rate of re-injury was studied in a randomised controlled trial at amateur male level. In the control group, 23 of 79 injured players suffered a recurrence during the season compared to 10 of 90 players in the intervention group. There was a 75% lower re-injury risk in the intervention group for lower limb injuries (relative risk 0.25; 95% CI 0.11-0.57). The preventive effect was greatest during the first weeks after return to play.

Both the male and female Swedish top divisions were followed during the 2005 season. Male elite players had a higher risk for training injury (4.7 vs. 3.8/1000 hours, p<0.05) and match injury (28.1 vs. 16.1/1000 hours, p<0.001) than women. However, no difference was observed in the rate of severe injury (0.7/1000 hours in both groups). The thigh was the most common site of injury in both men and women, while injury to the hip/groin was more frequent in men and to the knee in women. Knee sprain accounted for 31% and 37% of the time lost from training and match play in men and women respectively.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle , 2007.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 988
Keyword [en]
Football, Injury prevention, Incidence, Re-injury, Rehabilitation, Elite
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-8500ISBN: 978-91-85715-51-0 (print)OAI: oai:DiVA.org:liu-8500DiVA: diva2:23280
Public defence
2007-03-30, Aulan, Hälsans Hus, Universitetssjukhuset, Linköping, 13:00 (English)
Opponent
Supervisors
Note
Serienumret i serien Linköping University medical dissertation är fel. Det korrkta numret är 988. The serial number in the series Linköping University medical dissertation is incorrect. The correct number is 988.Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2013-09-04
List of papers
1. Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001
Open this publication in new window or tab >>Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001
2003 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 13, no 6, 364-370 p.Article in journal (Refereed) Published
Abstract [en]

The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity.

The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/ 1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8 1000 h−1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8 /1000 h of football, in both seasons.

A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.

Keyword
sports injuries, soccer injuries, incidence, epidemiology, prospective study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14339 (URN)10.1046/j.1600-0838.2003.00327.x (DOI)
Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-11
2. Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions
Open this publication in new window or tab >>Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions
2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 1, 21-28 p.Article in journal (Refereed) Published
Abstract [en]

The Danish and Swedish male top football divisions were studied prospectively from January to June 2001. Exposure to football and injury incidence, severity and distribution were compared between the countries.

Swedish players had greater exposure to training (171 vs. 123 h per season, P<0.001), whereas exposure to matches did not differ between the countries. There was a higher risk for injury during training in Denmark than in Sweden (11.8 vs. 6.0 per 1000 h, P<0.01), whereas for match play there was no difference (28.2 vs. 26.2 per 1000 h). The risk for incurring a major injury (absence from football more than 4 weeks) was greater in Denmark (1.8 vs. 0.7 per 1000 h, P=0.002). The distribution of injuries according to type and location was similar in both countries. Of all injuries in Denmark and Sweden, overuse injury accounted for 39% and 38% (NS), and re-injury for 30% and 24% (P=0.032), respectively.

The greater training exposure and the long pre-season period in Sweden may explain some of the reported differences.

Keyword
sports injuries, soccer, incidence, epidemiology, re-injury
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14340 (URN)10.1111/j.1600-0838.2004.00395.x (DOI)
Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-06
3. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons
Open this publication in new window or tab >>Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons
2006 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, 767-772 p.Article in journal (Refereed) Published
Abstract [en]

Background: Previous injury is often proposed to be a risk factorfor football injury, but most studies rely on players reportingtheir own medical history and are thus potentially subject torecall bias. Little is known about the natural variation ininjury pattern between seasons.

Objectives: To study whether prospectively recorded injuriesduring one season are associated with injuries sustained duringthe following season, and to compare injury risk and injurypattern between consecutive seasons.

Methods: The medical staffs of 12 elite Swedish male footballteams prospectively recorded individual exposure and time lossinjuries over two full consecutive seasons (2001 and 2002).A multivariate model was used to determine the relation betweenprevious injury, anthropometric data, and the risk of injury.

Results: The training and match injury incidences were similarbetween seasons (5.1 v 5.3 injuries/1000 training hours and25.9 v 22.7/1000 match hours), but analysis of injury severityand injury patterns showed variations between seasons. Playerswho were injured in the 2001 season were at greater risk ofany injury in the following season compared with non-injuredplayers (hazard ratio 2.7; 95% confidence interval 1.7 to 4.3,p<0.0001). Players with a previous hamstring injury, groininjury, and knee joint trauma were two to three times more likelyto suffer an identical injury in the following season, whereasno such relation was found for ankle sprain. Age was not associatedwith an increased injury risk.

Conclusions: This study confirmed previous results showing thatprevious injury is an important risk factor for football injury.Overall injury incidences were similar between consecutive seasons,indicating that an injury surveillance study covering one fullseason can provide a reasonable overview of the injury problemamong elite football players in a specific environment. However,a prolonged study period is recommended for analyses of specificinjury patterns.

Keyword
risk factor; injury; re-injury; football; soccer; multivariate model
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14341 (URN)10.1136/bjsm.2006.026609 (DOI)
Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-05
4. Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial
Open this publication in new window or tab >>Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial
2007 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 35, no 9, 1433-1442 p.Article in journal (Refereed) Published
Abstract [en]

Background: Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury.

Hypothesis: The rate of reinjury is reduced using a coach-controlled rehabilitation program.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups.

Results: There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.16–0.72, P = .0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11–0.57, P < .001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%).

Conclusion: The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.

Keyword
soccer, football, recurrent injury, prevention, rehabilitation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14342 (URN)10.1177/0363546507300063 (DOI)
Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-06
5. Injuries among male and female elite football players
Open this publication in new window or tab >>Injuries among male and female elite football players
(English)Manuscript (Other (popular science, discussion, etc.))
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14343 (URN)
Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2013-09-04

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