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Epidemiology of injuries in elite football
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to study the injury characteristics in elite football, and risk factors for injury with special emphasis on anterior cruciate ligament injury. All five papers followed a prospective design using a standardised methodology. Individual training and match exposure was recorded for all players participating as well as all injuries resulting in time loss. Severe injury was defined as absence from play longer than 4 weeks.

In Paper I, all 14 teams in the Swedish men’s elite league were studied during the 2001 season. In this paper, all tissue damage regardless of subsequent time loss was also recorded. There were no differences in injury incidence between the two injury definitions during match play (27.2 vs. 25.9 injuries per 1000 hours, p=0.66) or training (5.7 vs. 5.2 injuries per 1000 hours, p=0.65). Significantly higher injury incidences for training injury, overuse injury and re-injury were found during the pre-season compared to the competitive season. Thigh strain was the single most common injury (14%).

In Paper II, 8% of all players in the Swedish men’s elite league 2001 had a history of previous ACL injury at the start of the study period. These players had a higher incidence of new knee injury during the season than players without previous ACL injury (4.2 vs. 1.0 injuries per 1000 hours, p=0.02). The higher incidence of new knee injury was seen both when using the player (relative risk 3.4, 95% CI 1.8-6.3) and the knee (relative risk 4.5, 95% CI 2.3-8.8) as the unit of analysis.

In Paper III, eleven clubs in the men’s elite leagues of five European countries were studied during the 2001-2002 season. The incidence of match injury was higher for the English and Dutch teams compared to the Mediterranean teams (41.8 vs. 24.0 injuries per 1000 hours, p=0.008) as well as the incidence of severe injury (2.0 vs. 1.1 injuries per 1000 hours, p=0.04). Players having international duty had a higher match exposure (42 vs. 28 matches, p<0.001), but a tendency to a lower training injury incidence (4.1 vs. 6.2 injuries per 1000 hours, p=0.051). Thigh strain was the most common injury (16%) with posterior strains being more frequent than anterior ones (67 vs. 36, p<0.0001).

In Paper IV, the national teams of all 32 countries that qualified for the men’s European Championship 2004, the women’s European Championship 2005 and the men’s Under-19 European Championship 2005 were studied during the tournaments. There were no differences in match and training injury incidences between the championships. Teams eliminated after the group stage in the women’s championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 hours, p=0.02). Non-contact mechanisms were ascribed for 41% of the match injuries and these injuries were more common in the second half.

In Paper V, all 12 clubs in the Swedish women’s elite league and 11 of 14 clubs in the men’s elite league were studied during the 2005 season. The prevalence of a history of previous ACL injury at the start of the study was three times higher among the female players (15% vs. 5%, p=0.0002). During the season, 16 new ACL injuries were recorded. There was a tendency to a lower mean age at injury among the women (20 vs. 24 years, p=0.069). Adjusted for age, no gender-related difference in the incidence of ACL injury was seen (relative risk 0.99, 95% CI 0.37-2.6). Age was associated with ACL injury incidence in women where the risk decreased by 24% for each year increase in age (relative risk 0.76, 95% CI 0.59-0.96).

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle , 2007. , 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 993
Keyword [en]
Elite, epidemiology, football, injuries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-8623ISBN: 978-91-85715-30-5 (print)OAI: oai:DiVA.org:liu-8623DiVA: diva2:23371
Public defence
2007-05-04, Aulan, Hälsans hus, Universitetssjukhuset, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2007-04-05 Created: 2007-04-05 Last updated: 2013-04-03
List of papers
1. Injuries in Swedish elite football - a prospective study on injury definitions, risk for injury and injury pattern during 2001
Open this publication in new window or tab >>Injuries in Swedish elite football - a prospective study on injury definitions, risk for injury and injury pattern during 2001
2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 2, 118-125 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to study the risk for injury and injury pattern in Swedish male elite football and to compare two different injury definitions. A prospective cohort study was conducted during 2001 on all 14 teams (310 players) in the Swedish top division. Injuries and individual exposure were recorded. Injury was defined as time-lost injury (715 injuries) and for comparison as tissue injury (765 injuries). No significant difference in the risk for injury between tissue injuries and time-lost injuries was found during matches (27.2 vs. 25.9 injuries per 1000 match hours, P=0.66) or training sessions (5.7 vs. 5.2 injuries per 1000 training hours, P=0.65). The risk for injury during training was significantly higher during the pre-season compared with the competitive season (P=0.01).

Thigh strain was the single most common injury (14%). Knee sprain was the most common major injury (absence >4 weeks). Overuse injuries and re-injuries were frequent and constituted 37% and 22% of all injuries. Re-injuries caused significantly longer absence than their corresponding initial injuries (P=0.02). The risk for re-injury (P=0.02) and overuse injury (P<0.01) was significantly higher during the pre-season compared with the competitive season.

Keyword
definition, epidemiology, incidence, soccer, sports injuries
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14381 (URN)10.1111/j.1600-0838.2004.00393.x (DOI)
Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
2. High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury
Open this publication in new window or tab >>High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury
2006 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, no 2, 158-162 p.Article in journal (Refereed) Published
Abstract [en]

Background: Anterior cruciate ligament (ACL) injury is a severeevent for a footballer, but it is unclear if the knee injuryrate is higher on returning to football after ACL injury.

Objective: To study the risk of knee injury in elite footballerswith a history of ACL injury compared with those without.

Method: The Swedish male professional league (310 players) wasstudied during 2001. Players with a history of ACL injury atthe study start were identified. Exposure to football and alltime loss injuries during the season were recorded prospectively.

Results: Twenty four players (8%) had a history of 28 ACL injuriesin 27 knees (one rerupture). These players had a higher incidenceof new knee injury of any type than the players without ACLinjury (mean (SD) 4.2 (3.7) v 1.0 (0.7) injuries per 1000 hours,p = 0.02). The risk of suffering a knee overuse injury wassignificantly higher regardless of whether the player (relativerisk 4.8, 95% confidence interval 2.0 to 11.2) or the knee (relativerisk 7.9, 95% confidence interval 3.4 to 18.5) was used as theunit of analysis. No interactive effects of age or any otheranthropometric data were seen.

Conclusion: The risk of new knee injury, especially overuseinjury, was significantly increased on return to elite footballafter ACL injury regardless of whether the player or the kneewas used as the unit of analysis.

Keyword
football; injury incidence; knee; prevalence; anterior cruciate ligament
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14382 (URN)10.1136/bjsm.2005.021055 (DOI)
Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
3. UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season
Open this publication in new window or tab >>UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season
2005 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 39, no 8, 542-546 p.Article in journal (Refereed) Published
Abstract [en]

Background: No previous study on adult football involving severaldifferent countries has investigated the incidence and patternof injuries at the highest club competitive level.

Objective: To investigate the risk exposure, risk of injury,and injury pattern of footballers involved in UEFA ChampionsLeague and international matches during a full football season.

Method: Eleven top clubs (266 players) in five European countrieswere followed prospectively throughout the season of 2001–2002.Time-lost injuries and individual exposure times were recordedduring all club and national team training sessions and matches.

Results: A total of 658 injuries were recorded. The mean (SD)injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5(11.0) injuries per 1000 match hours and 5.8 (2.1) injuriesper 1000 training hours). The risk of match injury was significantlyhigher in the English and Dutch teams than in the teams fromFrance, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per1000 hours; p = 0.008). Major injuries (absence >4 weeks)constituted 15% of all injuries, and the risk of major injurywas also significantly higher among the English and Dutch teams(p = 0.04). National team players had a higher match exposure,with a tendency towards a lower training injury incidence thanthe rest of the players (p = 0.051). Thigh strain was themost common injury (16%), with posterior strains being significantlymore common than anterior ones (67 v 36; p<0.0001).

Conclusions: The risk of injury in European professional footballis high. The most common injury is the thigh strain typicallyinvolving the hamstrings. The results suggest that regionaldifferences may influence injury epidemiology and traumatology,but the factors involved are unclear. National team playershave a higher match exposure, but no higher risk of injury thanother top level players.

Keyword
elite; epidemiology; injury incidence; professional; football; soccer
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14383 (URN)10.1136/bjsm.2004.014571 (DOI)
Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
4. Football injuries during European Championships 2004-2005
Open this publication in new window or tab >>Football injuries during European Championships 2004-2005
2007 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, no 9, 1155-1162 p.Article in journal (Refereed) Published
Abstract [en]

The risk of injury in football is high, but few studies have compared men's and women's football injuries. The purpose of this prospective study was to analyse the exposure and injury characteristics of European Championships in football and to compare data for men, women and male youth players. The national teams of all 32 countries (672 players) that qualified to the men's European Championship 2004, the women's European Championship 2005 and the men's Under-19 European Championship 2005 were studied. Individual training and match exposure was documented during the tournaments as well as time loss injuries. The overall injury incidence was 14 times higher during match play than during training (34.6 vs. 2.4 injuries per 1000 h, P < 0.0001). There were no differences in match and training injury incidences between the championships. Teams eliminated in the women's championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 h, P = 0.02). Non-contact mechanisms were ascribed for 41% of the match injuries. One-fifth of all injuries were severe with absence from play longer than 4 weeks. In conclusion, injury incidences during the European Championships studied were very similar and it seems thus that the risk of injury in international football is at least not higher in women than in men. The teams eliminated in the women's championship had a significantly higher match injury incidence than the teams going to the final stage. Finally, the high frequency of non-contact injury is worrying from a prevention perspective and should be addressed in future studies.

Keyword
Athletic injuries, Epidemiology, Football, Incidence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14384 (URN)10.1007/s00167-007-0290-3 (DOI)
Available from: 2013-04-03 Created: 2007-04-05 Last updated: 2013-09-04Bibliographically approved
5. Anterior cruciate ligament injury in elite football: a prospective three-cohort study.
Open this publication in new window or tab >>Anterior cruciate ligament injury in elite football: a prospective three-cohort study.
2011 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, 11-19 p.Article in journal (Refereed) Published
Abstract [en]

Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.

Place, publisher, year, edition, pages
Springer, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-64457 (URN)10.1007/s00167-010-1170-9 (DOI)000286529200003 ()20532869 (PubMedID)
Note

Titled "Anterior cruciate ligament injuries in elite football: the influence of gender and age" in while in manuscript.

Available from: 2011-01-25 Created: 2011-01-25 Last updated: 2017-12-11

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