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Risk factors for injury in men´s professional football
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis includes four papers based on three different prospective cohort studies on injury characteristics in men’s professional football. The same general methodology was used in all papers. Time-loss injuries and player individual exposure was registered for match and training separately. The general aim was to investigate potential internal and external risk factors for injury, with a focus on age, playing position, time in professional football, playing surface (artificial turf and natural grass), changes between surfaces and climate; and to evaluate the study methodology.

Paper I was based on data collected between 2001 and 2010 from 26 top professional clubs in Europe; the UCL injury study. In total, 6140 injuries and 797 389 hours of exposure were registered. A decreased general injury rate was observed for newcomers compared with established players (hazard ratio (HR), 0.77; 95% CI 0.61-0.99). Using goalkeepers as a reference, all outfield playing positions had significantly higher age-adjusted injury rates. Using players aged ≤ 21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30  years (HR, 1.44; 95% CI, 1.24-1.68).

Paper II and Paper III are based on data collected during two consecutive seasons, 2010 and 2011, in the Swedish and Norwegian male first leagues. In total, 2186 injuries and 367 490 hours of football exposure were recorded. No statistically significant differences were found in acute injury rates on artificial turf (AT) compared with natural grass (NG) during match play (rate ratio, 0.98, 99% CI 0.79-1.22) or training (rate ratio 1.14, 99% CI 0.86-1.50) when analysing at the individual player level. However, when analysing at the club level, clubs with AT installed at their home arena had a significantly higher acute training injury rate (rate ratio 1.31, 99% CI 1.04-1.63) and overuse injury rate (rate ratio 1.38, 99% CI 1.14-1.65) compared to clubs with NG installed at their home venue. No association was found between frequent surface shifts and subsequent overuse injury risk (risk ratio 1.01, 95% CI 0.91-1.12). Analyses on the total cohort showed no difference in injury rates between clubs in the two climate zones (total rate ratio 1.01, 95% CI 0.92-1.10).

Data included in Paper IV were collected during two consecutive seasons 2008 and 2009. During this period, two Norwegian elite football clubs were concurrently included in two research groups’ surveillance systems. The capture rate for match injuries was similar between the two audits, while the capture rate for training injuries was slightly higher with individual-based exposure recording. The inter-rater agreement in injury variable categorisations was in most aspects very high.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 94 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1445
Keyword [en]
Age, artificial turf, cohort study, elite, epidemiology, overuse injury, soccer, surface, sporting injuries, playing position
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-117170DOI: 10.3384/diss.diva-117170ISBN: 978-91-7519-126-3 (print)OAI: oai:DiVA.org:liu-117170DiVA: diva2:806627
Public defence
2015-05-29, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2015-04-21Bibliographically approved
List of papers
1. Lower Injury Rates for Newcomers to Professional Soccer: a Prospective Cohort Study over Nine Consecutive Seasons
Open this publication in new window or tab >>Lower Injury Rates for Newcomers to Professional Soccer: a Prospective Cohort Study over Nine Consecutive Seasons
2013 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 6, 1419-1425 p.Article in journal (Refereed) Published
Abstract [en]

Background: No study has investigated whether newcomers to professional soccer have a different injury rate than established players.                     

Purpose: The primary objective was to investigate whether being a newcomer to professional soccer influences injury rates. The secondary objective was to evaluate whether playing position and player age influence injury rates.                     

Study Design: Cohort study; Level of evidence, 2.                     

Methods: Twenty-six soccer clubs, with 1401 players, were followed prospectively over 9 consecutive seasons between 2001 and 2010. Club medical staff recorded time-loss injuries and soccer exposure on an individual level. Cox regression analyses were used to evaluate associations between time-loss injuries and time in professional soccer, playing position, and age.                     

Results: In total, 6140 injuries and 797,389 hours of exposure were registered. A decreased general injury rate was observed for newcomers (n = 116) compared with established players (n = 3091) (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.99). In contrast, newcomers had a higher rate of fractures (rate ratio [RR], 1.77; 95% CI, 1.05-2.97), especially stress-related bone injuries (RR, 2.68; 95% CI, 1.08-6.69). Using goalkeepers as a reference, all outfield playing positions had significantly higher adjusted injury rates: defenders with an HR of 1.91 (95% CI, 1.64-2.24), midfielders with an HR of 1.78 (95% CI, 1.53-2.07), and forwards with an HR of 1.82 (95% CI, 1.55-2.14). Using players aged ≤21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68).                     

Conclusion: Newcomers to professional soccer had a lower general injury rate than established players but a higher rate of stress-related bone injuries. Being a goalkeeper was associated with lower injury rates than all outfield playing positions. Injury rates increased with age, a pattern that persisted after adjusting for playing position and match exposure.

Keyword
age; soccer; playing position; risk factor
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103813 (URN)10.1177/0363546513485358 (DOI)000330523500026 ()
Available from: 2014-01-28 Created: 2014-01-28 Last updated: 2017-12-06
2. The Nordic Football Injury Audit: higher injury rates for professional football clubs with third-generation artificial turf at their home venue
Open this publication in new window or tab >>The Nordic Football Injury Audit: higher injury rates for professional football clubs with third-generation artificial turf at their home venue
Show others...
2013 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, 775-781 p.Article in journal (Refereed) Published
Abstract [en]

Background Previously, no difference in acute injury rate has been found when playing football on artificial turf (AT) compared with natural grass (NG).

Aim To compare acute injury rates in professional football played on AT and NG at the individual player level; and to compare, at club level, acute and overuse injury rates between clubs that have AT at their home venue (AT clubs) and clubs that have NG (NG clubs).

Methods 32 clubs (AT, n=11; NG, n=21) in the male Swedish and Norwegian premier leagues were followed prospectively during the 2010 and 2011 seasons. Injury rate was expressed as the number of time loss injuries/1000 h and compared with rate ratio (RR) and 99% CI.

Results No statistically significant differences were found in acute injury rates on AT compared with NG during match play (RR 0.98, 99% CI 0.79 to 1.22) or training (RR 1.14, 99% CI 0.86 to 1.50) when analysing at the individual player level. When analysing at the club level, however, AT clubs had a significantly higher acute training injury rate (RR 1.31, 99% CI 1.04 to 1.63) and overuse injury rate (RR 1.38, 99% CI 1.14 to 1.65) compared with NG clubs.

Conclusions At the individual player level, no significant differences were found in acute injury rates when playing on AT compared with NG. However, clubs with AT at their home venue had higher rates of acute training injuries and overuse injuries compared with clubs that played home matches on NG.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2013
Keyword
Ankle injuries, Epidemiology, Lower extremity injuries, Soccer, Sporting injuries
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97450 (URN)10.1136/bjsports-2013-092266 (DOI)000322868800017 ()
Note

Funding Agencies|Swedish National Centre for Research in Sports||Swedish Football Association||Praktikertjanst AB||County Council of Ostergotland||Royal Norwegian Ministry of Culture and Church Affairs||South-Eastern Norway Regional Health Authority||International Olympic Committee||Norwegian Olympic Committee & Confederation of Sport||Norsk Tipping AS||

Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06Bibliographically approved
3. No association between surface shifts and time-loss overuse injury risk in male professional football: a prospective cohort study
Open this publication in new window or tab >>No association between surface shifts and time-loss overuse injury risk in male professional football: a prospective cohort study
Show others...
2016 (English)In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 19, no 3, 218-221 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate frequent surface shifts, match play on an unaccustomed surface, and climate type as potential risk factors for injury in Scandinavian male professional football.

Design: Prospective cohort study.

Methods: 32 clubs from two climate zones, warm temperate (n=19) and snow climates (n=13), were followed during seasons 2010 and 2011. The association between number of surface shifts during fivematch sequences and subsequent overuse injury risk was evaluated with generalized estimating equations. Injury rate was expressed as time loss injuries/1000 hours, and compared between groups with a rate ratio and 95% confidence interval (CI).

Results: No association was found between the number of surface shifts and subsequent overuse injury risk (risk ratio 1.01, 95% CI 0.91-1.12). Grass clubs (grass installed at home venue) had a lower match injury rate when playing away matches on artificial turf vs. away matches on grass (rate ratio 0.66, 95% CI 0.40-0.89). Analyses on the total cohort showed no difference in injury rates between clubs in the two climate zones, but sub-analyses revealed that grass clubs from the snow climate zone had lower training and match injury rates than grass clubs from the warm temperate zone (rate ratio 0.69, 95% CI 0.55-0.87).

Conclusions: No influence on injury risk was seen from frequent surface shifts or from playing matches on an unaccustomed surface. Climate type at club home venue had minimal influence on injury rates.

Keyword
Epidemiology, Lower extremity, Soccer, Surface, Surveillance
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Sciences
Identifiers
urn:nbn:se:liu:diva-117166 (URN)10.1016/j.jsams.2015.06.001 (DOI)000371445600006 ()
Note

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

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Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2017-12-04Bibliographically approved
4. Injuries in male professional football: a prospective comparison between individual and team-based exposure registration
Open this publication in new window or tab >>Injuries in male professional football: a prospective comparison between individual and team-based exposure registration
Show others...
2016 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 10, 1225-1232 p.Article 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
Keyword
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

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