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  • 1.
    Apelqvist, Anna
    et al.
    Department of Orthopedics, Hässleholm-Kristianstad, Hässleholm Hospital, .
    Waldén, Markus
    Hässleholm Hospital.
    Larsson, Gert-Uno
    Hässleholm Hospital.
    Atroshi, Isam
    Hässleholm Hospital.
    Pneumatic wound compression after hip fracture surgery did not reduce postoperative blood transfusion: A randomized controlled trial involving 292 fractures.2009In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 80, no 1, p. 26-31Article in journal (Refereed)
    Abstract [en]

    Pneumatic wound compression does not reduce the need for transfusion after hip fracture surgery.

  • 2.
    Asker, Martin
    et al.
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Holm, Lena W.
    Karolinska Inst, Sweden.
    Kallberg, Henrik
    Publ Hlth Agcy Sweden, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Kristianstad Ystad Hosp, Sweden.
    Skillgate, Eva
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 7, p. 1892-1900Article in journal (Refereed)
    Abstract [en]

    Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. II.

  • 3.
    Atroshi, Isam
    et al.
    Department Orthoped, Sweden; Ystad Hospital, Sweden; Lund University, Sweden.
    Nordenskjold, Jesper
    Department Orthoped, Sweden; Ystad Hospital, Sweden; Lund University, Sweden.
    Lauritzson, Anna
    Department Orthoped, Sweden; Ystad Hospital, Sweden.
    Ahlgren, Eva
    Department Orthoped, Sweden; Ystad Hospital, Sweden.
    Waldau, Johanna
    Department Orthoped, Sweden; Ystad Hospital, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department Orthoped, Sweden; Ystad Hospital, Sweden.
    Collagenase treatment of Dupuytrens contracture using a modified injection method2015In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, no 3, p. 310-315Article in journal (Refereed)
    Abstract [en]

    Background and purpose - Treatment of Dupuytrens contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of greater than= 20 degrees in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was less than= 5 mm in 30 hands and greater than 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59 degrees (SD 26) as opposed to 32 degrees (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of greater than= 75 degrees. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55 degrees (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.

  • 4.
    Atroshi, Isam
    et al.
    Hässleholm Hospital, Sweden; Lund University, Sweden .
    Strandberg, Emelie
    Hässleholm Hospital, Sweden.
    Lauritzson, Anna
    Hässleholm Hospital, Sweden.
    Ahlgren, Eva
    Hässleholm Hospital, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Hässleholm Hospital, Sweden.
    Costs for collagenase injections compared with fasciectomy in the treatment of Dupuytren's contracture: a retrospective cohort study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1, p. e004166-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To compare collagenase injections and surgery (fasciectomy) for Dupuytren's contracture (DC) regarding actual total direct treatment costs and short-term outcomes.

    DESIGN:

    Retrospective cohort study.

    SETTING:

    Orthopaedic department of a regional hospital in Sweden.

    PARTICIPANTS:

    Patients aged 65 years or older with previously untreated DC of 30° or greater in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the small, ring or middle finger. The collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre. The controls were 16 patients randomly selected among those operated on with fasciectomy at the same centre during the preceding 3 years.

    INTERVENTIONS:

    Treatment with collagenase was given during two standard outpatient clinic visits (injection of 0.9 mg, distributed at multiple sites in a palpable cord, and next-day finger extension under local anaesthesia) followed by night-time splinting. Fasciectomy was carried out in the operating room (day surgery) under general or regional anaesthesia using standard technique, followed by therapy and splinting.

    PRIMARY AND SECONDARY OUTCOME MEASURES:

    Actual total direct costs (salaries of all medical personnel involved in care, medications, materials and other relevant costs), and total MCP and PIP extension deficit (degrees) measured by hand therapists at 6-12 weeks after the treatment.

    RESULTS:

    Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy. Total treatment cost for collagenase injection was US$1418.04 and for fasciectomy US$2102.56. The post-treatment median (IQR) total extension deficit was 10 (0-30) for the collagenase group and 10 (0-34) for the fasciectomy group.

    CONCLUSIONS:

    Treatment of DC with one collagenase injection costs 33% less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture.

  • 5.
    Bengtsson, Hakan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 7, p. 1505-1510Article in journal (Refereed)
    Abstract [en]

    Background: Player activities in soccer matches are influenced by the match result and match venue. It is not known whether injury rates are influenced by these factors. Purpose: To investigate whether there are associations between injury rates and the match result, venue, and type of competition in male soccer. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six professional clubs from 10 countries were followed prospectively during 9 seasons (2001-2002 to 2009-2010). All matches, and injuries occurring in these matches, were registered by the teams medical staff. An injury was registered if it resulted in player absence from training or matches. Information about match result, venue, and type of competition for all reported matches was gathered by the authors from online databases. Injury rates in matches with varying match characteristics were compared by use of generalized estimating equations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 2738 injuries during 6010 matches were registered. There were no associations between odds of 1 injury occurrence and match result or type of competition, whereas the odds were decreased in matches played away compared with home matches (OR, 0.89; 95% CI, 0.80-0.99). The odds of 2 or more injury occurrences in a match were increased in matches resulting in a draw (OR, 1.39; 95% CI, 1.15-1.69) or loss (OR, 1.66; 95% CI, 1.38-1.98) compared with matches won and were decreased in other cup matches compared with league matches (OR, 0.57; 95% CI, 0.39-0.84) and in matches played away compared with home matches (OR, 0.70; 95% CI, 0.60-0.82). Finally, injuries with more than 1 weeks absence occurred more frequently in Champions League matches compared with league matches both for matches with 1 injury (OR, 1.26; 95% CI, 1.09-1.45) and matches with 2 or more injuries (OR, 1.57; 95% CI, 1.13-2.20). Conclusion: The odds of 2 or more injury occurrences in professional soccer were higher in matches resulting in a loss or a draw compared with a win, whereas the odds of injury occurrences were lower in matches played away compared with home matches. The rate of moderate and severe injuries increased with the importance of the match.

  • 6.
    Bjorneboe, John
    et al.
    Norwegian School Sport Science, Norway.
    Kristensson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bengtsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ronsen, Ola
    Aker Solut, Norway.
    Einar Andersen, Thor
    Norwegian School Sport Science, Norway.
    Role of illness in male professional football: not a major contributor to time loss2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 11, p. 699-702Article in journal (Refereed)
    Abstract [en]

    Background There are limited data on the nature, type and incidence of illness in football. Previous studies indicate that gastrointestinal and respiratory tract illnesses are most common. Aim To describe the incidence and burden of illness in male professional football. Methods Over the 4-year study period, 2011-2014, 73 professional football teams in Europe participated, with a total of 1 261 367 player-days recorded. All time-loss illnesses were recorded by the medical staff of each club. A recordable illness episode was any physical or psychological symptom (not related to injury) that resulted in the player being unable to participate fully in training or match play. Results A total of 1914 illness episodes were recorded. The illness incidence was 1.5 per 1000 player-days, meaning that, on average, a player experienced an illness episode every second season, with a median of 3 days absence per illness episode. Severe illness (absence amp;gt;4 weeks) constituted 2% of all illnesses. Respiratory tract illness was the most common (58%), followed by gastrointestinal illness (38%). Respiratory tract illness, gastrointestinal illness and cardiovascular illness caused the highest illness burden. Conclusions The illness incidence among male professional football players is low compared with the injury incidence. We found that the highest illness burden was caused by illness to the respiratory tract, gastrointestinal tract and cardiovascular system.

  • 7.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Healy, Jeremiah C
    University of London Imperial Coll Science Technology and Med.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lee, Justin C
    University of London Imperial Coll Science Technology and Med.
    English, Bryan
    University of London.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play2012In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 46, no 2, p. 112-117Article in journal (Refereed)
    Abstract [en]

    Background Hamstring injury is the single most common injury in professional football. MRI is commonly used to confirm the diagnosis and provide a prognosis of lay-off time. less thanbrgreater than less thanbrgreater thanObjective To evaluate the use of MRI as a prognostic tool for lay-off after hamstring injuries in professional football players and to study the association between MRI findings and injury circumstances. less thanbrgreater than less thanbrgreater thanMethods Prospective cohort study where 23 European professional teams, were followed between 2007 and 2011. Team medical staffs recorded individual player exposure and time-loss injuries. Radiological grading was performed using a modified Peetrons classification into four grades where grades 2 and 3 represent fibre disruption. less thanbrgreater than less thanbrgreater thanResults In total, 516 hamstring injuries occurred and 58% of these were examined by MRI. Thirteen per cent were grade 0 injuries, 57% grade 1, 27% of grade 2 and 3% of grade 3. Grade 0 and 1 injuries accounted for 56% (2141/3830 days) of the total lay-off. The layoff time differed between all four radiological grades of injury (8 +/- 3, 17 +/- 10, 22 +/- 11 and 73 +/- 60 days, p andlt; 0.0001). Eighty-three per cent of injuries affected the biceps femoris while 11% and 5% occurred to the semimembranosus and semitendinosus, respectively. Re-injuries (N=34/207) constituted 16% of injuries. All re-injuries occurred to the biceps femoris. less thanbrgreater than less thanbrgreater thanConclusion MRI can be helpful in verifying the diagnosis of a hamstring injury and to prognosticate layoff time. Radiological grading is associated with lay-off times after injury. Seventy per cent of hamstring injuries seen in professional football are of radiological grade 0 or 1, meaning no signs of fibre disruption on MRI, but still cause the majority of absence days.

  • 8.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Tornqvist, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bengtsson, Håkan
    Linköping University, Department of Electrical Engineering, Electronic Devices. Linköping University, The Institute of Technology.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Upper extremity injuries in male elite football players2013In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 21, no 7, p. 1626-1632Article in journal (Refereed)
    Abstract [en]

    To investigate the epidemiology of upper extremity injuries in male elite football players and to describe their characteristics, incidence and lay-off times. less thanbrgreater than less thanbrgreater thanBetween 2001 and 2011, 57 male European elite football teams (2,914 players and 6,215 player seasons) were followed prospectively. Time-loss injuries and exposure to training and matches were recorded on individual basis. less thanbrgreater than less thanbrgreater thanIn total, 11,750 injuries were recorded, 355 (3 %) of those affected the upper extremities giving an incidence of 0.23 injuries/1,000 h of football. The incidence in match play was almost 7 times higher than in training (0.83 vs. 0.12 injuries/1,000 h, rate ratio 6.7, 95 % confidence interval 5.5-8.3). As much as 32 % of traumatic match injuries occurred as a result of foul play situations. Goalkeepers had a significantly higher incidence of upper extremity injuries compared to outfield players (0.80 vs. 0.16 injuries/1,000 h, rate ratio 5.0, 95 % confidence interval 4.0-6.2). The average absence due to an upper extremity injury was 23 +/- A 34 days. less thanbrgreater than less thanbrgreater thanUpper extremity injuries are uncommon among male elite football players. Goalkeepers, however, are prone to upper extremity injury, with a five times higher incidence compared to outfield players. less thanbrgreater than less thanbrgreater thanII.

  • 9.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology of Muscle Injuries in Professional Football (Soccer)2011In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 39, no 6, p. 1226-1232Article in journal (Refereed)
    Abstract [en]

    Background: Muscle injuries constitute a large percentage of all injuries in football.

    Purpose: To investigate the incidence and nature of muscle injuries in male professional footballers.

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

    Methods: Fifty-one football teams, comprising 2299 players, were followed prospectively during the years 2001 to 2009. Team medical staff recorded individual player exposure and time-loss injuries. The first-team squads of 24 clubs selected by the Union of European Football Associations as belonging to the best European teams, 15 teams of the Swedish First League, and another 15 European teams playing their home matches on artificial turf pitches were included. A muscle injury was defined as “a traumatic distraction or overuse injury to the muscle leading to a player being unable to fully participate in training or match play.”

    Results: In total, 2908 muscle injuries were registered. On average, a player sustained 0.6 muscle injuries per season. A squad of 25 players can thus expect about 15 muscle injuries per season. Muscle injuries constituted 31% of all injuries and caused 27% of the total injury absence. Ninety-two percent of all muscle injuries affected the 4 major muscle groups of the lower limbs: hamstrings (37%), adductors (23%), quadriceps (19%), and calf muscles (13%). Sixteen percent of the muscle injuries were reinjuries. These reinjuries caused significantly longer absences than did index injuries. The incidence of muscle injury increased with age. When separated into different muscle groups, however, an increased incidence with age was found only for calf muscle injuries and not for hamstring, quadriceps, or hip/groin strains.

    Conclusion: Muscle injuries are a substantial problem for players and their clubs. They constitute almost one third of all time-loss injuries in men’s professional football, and 92% of all injuries affect the 4 big muscle groups in the lower limbs.

  • 10.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injury incidence and injury patterns in professional football - the UEFA injury study2011In: British journal of sports medicine, ISSN 1473-0480, Vol. 45, no 7, p. 553-558Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the injury characteristics in professional football and to follow the variation of injury incidence during a match, during a season and over consecutive seasons. DESIGN: Prospective cohort study where teams were followed for seven consecutive seasons. Team medical staff recorded individual player exposure and time-loss injuries from 2001 to 2008. SETTING: European professional men's football. PARTICIPANTS: The first team squads of 23 teams selected by UEFA as belonging to the 50 best European teams. Main outcome measurement: Injury incidence. RESULTS: 4,483 injuries occurred during 566,000 hours of exposure, giving an injury incidence of 8.0 injuries/1,000 hours. The injury incidence during matches was higher than in training (27.5 v 4.1, p<0.0001). A player sustained on average 2.0 injuries per season and a team with typically 25 players can thus expect about 50 injuries each season. The single most common injury subtype was thigh strain, representing 17% of all injuries. Re-injuries constituted 12% of all injuries and they caused longer absences than non re-injuries (24 v 18 days, p<0.0001). The incidence of match injuries showed an increasing injury tendency over time in both the first and second halves (p<0.0001). Traumatic injuries and hamstring strains were more frequent during the competitive season, while overuse injuries were common during the pre-season. Training and match injury incidences were stable over the period with no significant differences between seasons. CONCLUSIONS: The training and match injury incidences were stable over seven seasons. The risk of injury increased with time in each half of matches.

  • 11.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A congested football calendar and the wellbeing of players: The correlation between exposure to match play for football players in European clubs during the months prior to the World Cup 2002 and the injuries and performance of these players during the World Cup2004In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, p. 493-497Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objectives: To investigate the correlation between exposure to match play for football players in European clubs during the months prior to the World Cup 2002 and the injuries and performance of these players during the World Cup.

    Methods: The team doctors at eleven of the best football clubs in Europe prospectively recorded player’s exposure and injuries during the 2001-2002 season (July 2001-May 2002). Sixty-five  players  participated in the World Cup in Korea/Japan (June 2002). During the World Cup, the clubs reported injuries sustained by these players, and their performance was evaluated by three international experts.

    Results: The number of  team matches during the season varied between 40 and 76 for the different countries involved. The individual player had a mean of 36 matches during the season. Top players played more matches, especially during the final period of the season. Players that participated in the World Cup (WC players) played more matches during the season compared to players who did not participate in the World Cup (46 vs 33 matches).

    WC players did not show an increased risk for injury during the season. Twenty-nine per cent of the WC players incurred injuries during the World Cup and 32% performed below their normal standard. The players who under-performed in the World Cup played more matches during the 10 weeks prior to the World Cup compared to those who performed better than expected (12.5 vs 9, p< 0.05). Twenty-three (60%) of the 38 players who had played more than 1 match/week prior to the World Cup incurred injuries or underperformed during the World Cup.

    Conclusions: There is a considerable variation in the number of matches played per season in European professional leagues. Top-level players are obliged to play many matches especially during the final period of the season.

  • 12.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. UEFA Medical Comm, Switzerland.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hamstring injuries have increased by 4% annually in mens professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 731-737Article in journal (Refereed)
    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.

  • 13.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Risk for injury when playing in a national football team.2004In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 14, no 1, p. 34-38Article in journal (Refereed)
    Abstract [en]

    The Swedish male senior national football team was followed prospectively between 1991 and 1997. During these 6 years, the team played 73 official matches and had three training camps. The senior author (J. E.) attended 57 of these matches and the three training camps and these matches and training camps, are included in the present study. Exposure to football was recorded individually for each player. The team physician examined all injuries. Total exposure was 7245 h (6235 training and 1010 match hours) and there were 71 injuries (40 training and 31 match injuries). Five (16%) of the match injuries were major, with more than 4 weeks of absence from football. The injury incidence during training was 6.5/1000 h and the injury risk during matchplay was 30.3/1000 h. A significantly higher injury incidence was found for matches lost compared to matches won or drawn (52.5 vs. 22.7/1000 h, P=0.026). No statistically significant difference for injury was found between competitive matches and friendly matches. No difference was found between home and away matches or matches on neutral ground. The risk for injury when playing in a national team compares with previously reported figures for professional football at a high level.

  • 14.
    Hagglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Marcus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    UEFA injury study-an injury audit of European Championships 2006 to 20082009In: BRITISH JOURNAL OF SPORTS MEDICINE, ISSN 0306-3674, Vol. 43, no 7, p. 483-489Article in journal (Refereed)
    Abstract [en]

    Objective: To study the incidence and nature of injuries at European Championships, to compare training and match injury characteristics and to study differences in injury incidence between tournaments. Design: Team physicians prospectively recorded individual player exposure and time loss injuries during 12 European Championships (mens EURO n = 1, mens Under-21 n = 2, mens Under-19 n = 3, mens Under-17 n = 3, womens Under-19 n = 3) from 2006 to 2008. Setting: International football tournaments Participants: 1594 men and 433 women Main outcome measurement: Injury incidence Results: 224 injuries (45 training, 179 match play) were registered among 208 (10%) players. No differences in training injury incidence were seen between tournaments (range 1.3-3.9 injuries/1000 hours). The mens EURO had the highest match injury incidence (41.6 injuries/1000 hours) followed by the mens Under-21 tournaments (33.9). The lowest match injury incidence was seen in the womens Under-19 tournaments (20.5). Training injuries constituted 20% of all injuries and caused 26% of all match unavailability. A greater proportion of match injuries were due to trauma (83 vs 47%, p less than 0.001) and occurred from player contact (75 vs 48%, p = 0.018) compared to training injuries. A higher frequency of reinjury was found among training injuries than match injuries (20 vs 6%, p = 0.009). Conclusions: Match injury incidence increased with age, indicating greater risk with higher intensity of play. Training injury incidence was relatively low, but training injuries were responsible for a quarter of all match unavailability and may thus have a profound impact on team performance and should be the object of preventive measures.

  • 15.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Kristianstad Ystad Hosp, Dept Orthopaed, Hassleholm, Sweden.
    Risk factors for acute knee injury in female youth football.2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, p. 737-746Article in journal (Refereed)
    Abstract [en]

    Purpose: To prospectively evaluate risk factors for acute time-loss knee injury, in particular ACL injury, in female youth football players.andlt;br /andgt;Methods: Risk factors were studied in 4556 players aged 12-17 years from a randomised controlled trial during the 2009 season. Covariates were both intrinsic (body mass index, age, relative age effect, onset of menarche, previous acute knee injury or ACL injury, current knee complaints, and familial disposition of ACL injury) and extrinsic (no. of training sessions/week, no. of matches/week, match exposure ratio, match play with other teams, and artificial turf exposure). Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated from individual variable and multiple Cox regression analyses.andlt;br /andgt;Results: Ninety-six acute knee injuries were recorded, 21 of them ACL injuries. Multiple Cox regression showed a fourfold higher ACL injury rate for players with familial disposition of ACL injury (HR 3.57; 95 % CI 1.48-8.62). Significant predictor variables for acute knee injury were age andgt;14 years (HR 1.97; 95 % CI 1.30-2.97), knee complaints at the start of the season (HR 1.98; 95 % CI 1.30-3.02), and familial disposition of ACL injury (HR 1.96; 95 % CI 1.22-3.16). No differences in injury rates were seen when playing on artificial turf compared with natural grass.andlt;br /andgt;Conclusion: Female youth football players with a familial disposition of ACL injury had an increased risk of ACL injury and acute knee injury. Older players and those with knee complaints at pre-season were more at risk of acute knee injury. Although the predictive values were low, these factors could be used in athlete screening to target preventive interventions.andlt;br /andgt;Level Of Evidence: II.

  • 16.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Atroshi, Isam
    Hassleholm Hospital.
    Preventing knee injuries in adolescent female football players - design of a cluster randomized controlled trial [NCT00894595]2009In: BMC MUSCULOSKELETAL DISORDERS, ISSN 1471-2474, Vol. 10, no 75Article in journal (Refereed)
    Abstract [en]

    Background: Knee injuries in football are common regardless of age, gender or playing level, but adolescent females seem to have the highest risk. The consequences after severe knee injury, for example anterior cruciate ligament (ACL) injury, are well-known, but less is known about knee injury prevention. We have designed a cluster randomized controlled trial (RCT) to evaluate the effect of a warm-up program aimed at preventing acute knee injury in adolescent female football. Methods: In this cluster randomized trial 516 teams (309 clusters) in eight regional football districts in Sweden with female players aged 13-17 years were randomized into an intervention group (260 teams) or a control group (256 teams). The teams in the intervention group were instructed to do a structured warm-up program at two training sessions per week throughout the 2009 competitive season (April to October) and those in the control group were informed to train and play as usual. Sixty-eight sports physical therapists are assigned to the clubs to assist both groups in data collection and to examine the players acute knee injuries during the study period. Three different forms are used in the trial: (1) baseline player data form collected at the start of the trial, (2) computer-based registration form collected every month, on which one of the coaches/team leaders documents individual player exposure, and (3) injury report form on which the study therapists report acute knee injuries resulting in time loss from training or match play. The primary outcome is the incidence of ACL injury and the secondary outcomes are the incidence of any acute knee injury (except contusion) and incidence of severe knee injury (defined as injury resulting in absence of more than 4 weeks). Outcome measures are assessed after the end of the 2009 season. Discussion: Prevention of knee injury is beneficial for players, clubs, insurance companies, and society. If the warm-up program is proven to be effective in reducing the incidence of knee injury, it can have a major impact by reducing the future knee injury burden in female football as well as the negative long-term disabilities associated with knee injury.

  • 17.
    Hägglund, Martin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Waldén, Markus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bahr, R
    Sports and psysical education Norwegian university, Oslo.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Methods for epidemiological study of injuries to prfessional football players: developing the UEFA model2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, p. 340-346Article in journal (Refereed)
  • 18.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 20012003In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 13, no 6, p. 364-370Article in journal (Refereed)
    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.

  • 19.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injuries among male and female elite football players2009In: SCANDINAVIAN JOURNAL OF MEDICINE and SCIENCE IN SPORTS, ISSN 0905-7188, Vol. 19, no 6, p. 819-827Article in journal (Refereed)
    Abstract [en]

    All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P andlt; 0.001). However, no difference was found in the incidence of severe injury (absence andgt; 4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.

  • 20.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injuries among male and female elite football playersManuscript (Other (popular science, discussion, etc.))
  • 21.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions2005In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 1, p. 21-28Article in journal (Refereed)
    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.

  • 22.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Injury recurrence is lower at the highest professional football level than at national and amateur levels: does sports medicine and sports physiotherapy deliver?2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 751-758Article in journal (Refereed)
    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.

  • 23.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial2007In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 35, no 9, p. 1433-1442Article in journal (Refereed)
    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.

  • 24.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons2006In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, p. 767-772Article in journal (Refereed)
    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.

  • 25.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Risk Factors for Lower Extremity Muscle Injury in Professional Soccer: The UEFA Injury Study2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 2, p. 327-335Article in journal (Refereed)
    Abstract [en]

    Background: Muscle injury is the most common injury type in professional soccer players. Despite this, risk factors for common lower extremity injuries remain elusive.

    Purpose: To evaluate the effects of various player- and match-related risk factors on the occurrence of lower extremity muscle injury in male professional soccer.

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

    Methods: Between 2001 and 2010, 26 soccer clubs (1401 players) from 10 European countries participated in the study. Individual player exposure and time loss muscle injuries in the lower extremity were registered prospectively by the club medical staffs during 9 consecutive seasons. Hazard ratios (HRs) were calculated for player-related factors from simple and multiple Cox regression, and odds ratios (ORs) were calculated for match-related variables from simple and multiple logistic regression, presented with 95% confidence intervals (CIs).

    Results: There were 2123 muscle injuries documented in the major lower extremity muscle groups: adductors (n = 523), hamstrings (n = 900), quadriceps (n = 394), and calf (n = 306). Injuries to the adductors (56%; P = .015) and quadriceps (63%; P< .001) were more frequent in the kicking leg. Multiple analysis indicated that having a previous identical injury in the preceding season increased injury rates significantly for adductor (HR, 1.40; 95% CI, 1.00-1.96), hamstring (HR, 1.40; 95% CI, 1.12-1.75), quadriceps (HR, 3.10; 95% CI, 2.21-4.36), and calf injuries (HR, 2.33; 95% CI, 1.52-3.57). Older players (above mean age) had an almost 2-fold increased rate of calf injury (HR, 1.93; 95% CI, 1.38-2.71), but no association was found in other muscle groups. Goalkeepers had reduced injury rates in all 4 muscle groups. Match play on away ground was associated with reduced rates of adductor (OR, 0.56; 95% CI, 0.43-0.73) and hamstring injuries (OR, 0.76; 95% CI, 0.63-0.92). Quadriceps injuries were more frequent during preseason, whereas adductor, hamstring, and calf injury rates increased during the competitive season.

    Conclusion: Intrinsic factors found to increase muscle injury rates in professional soccer were previous injury, older age, and kicking leg. Injury rates varied during different parts of the season and also depending on match location.

  • 26.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Thomee, R.
    Gothenburg University, Sweden.
    Should patients reach certain knee function benchmarks before anterior cruciate ligament reconstruction? Does intense prehabilitation before anterior cruciate ligament reconstruction influence outcome and return to sports?2015In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, no 22, p. 1423-1424Article in journal (Other academic)
    Abstract [en]

    n/a

  • 27.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Til, Lluis
    FC Barcelona, Olympic Training Center, Sant Cugat del Vallès, Barcelona, Spain.
    Pruna, Ricard
    FC Barcelona, Barcelona, Spain.
    The importance of epidemiological research in sports medicine2010In: Apunts Med Esport, ISSN 1886-6581, Vol. 45, no 166, p. 57-59Article in journal (Refereed)
  • 28.
    Kragh, Annika M
    et al.
    Hassleholm Hospital.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Apelqvist, Anna
    Hassleholm Hospital.
    Wagner, Philippe
    Lund University.
    Atroshi, Isam
    Hassleholm Hospital.
    Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study2011In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 12, no 254Article in journal (Refereed)
    Abstract [en]

    Background: Hip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and first-year all-cause mortality. less thanbrgreater than less thanbrgreater thanMethods: An observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation) participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (andgt;= 50 years) of whom 118 (46%) were using LdAA (defined as andlt;= 320 mg daily) preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease. less thanbrgreater than less thanbrgreater thanResults: Blood transfusions were given postoperatively to 74 (62.7%) LdAA-treated and 76 (54%) non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3). First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR) was 2.35 (95% CI 1.23 to 4.49). The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88). Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03). less thanbrgreater than less thanbrgreater thanConclusions: In patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric or subtrochanteric treated with internal fixation) preoperative use of low-dose acetylsalicylic acid was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.

  • 29.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping, Sweden.
    Bjørneboe, John
    Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping, Sweden.
    Andersen, Thor Einar
    Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping, Sweden.
    Injuries in male professional football: a prospective comparison between individual and team-based exposure registration2016In: 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)
    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.

  • 30.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bjørneboe, John
    Norwegian School Sport Science, Norway.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersen, Thor Einar
    Norwegian School Sport Science, Norway.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    The Nordic Football Injury Audit: higher injury rates for professional football clubs with third-generation artificial turf at their home venue2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 775-781Article in journal (Refereed)
    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.

  • 31.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bjørneboe, John
    Norwegian School Sport Science, Norway.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Andersen, Thor Einar
    Norwegian School Sport Science, Norway.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    No association between surface shifts and time-loss overuse injury risk in male professional football: a prospective cohort study2016In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 19, no 3, p. 218-221Article in journal (Refereed)
    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.

  • 32.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lower Injury Rates for Newcomers to Professional Soccer: a Prospective Cohort Study over Nine Consecutive Seasons2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 6, p. 1419-1425Article in journal (Refereed)
    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.

  • 33.
    Lindblom, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after a randomised controlled trial2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1425-1430Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Neuromuscular training (NMT) has been shown to reduce anterior cruciate ligament injury rates in highly structured clinical trials. However, there is a paucity of studies that evaluate implementation of NMT programmes in sports.

    AIM: To evaluate the implementation of an NMT programme in female adolescent football 3 years after a randomised controlled trial (RCT).

    METHODS: Cross-sectional follow-up after an RCT using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Sports Setting Matrix (RE-AIM SSM) framework. Questionnaires were sent to the Swedish Football Association (FA), to eight district FAs and coaches (n=303) that participated in the RCT in 2009, and coaches who did not participate in the RCT but were coaching female adolescent football teams during the 2012 season (n=496).

    RESULTS: Response rates were 100% among the FAs, 57% among trial coaches and 36% among currently active coaches. The reach of the intervention was high, 99% of trial coaches (control group) and 91% of current coaches were familiar with the programme. The adoption rate was 74% among current coaches, but programme modifications were common among coaches. No district FA had formal policies regarding implementation, and 87% of current coaches reported no club routines for programme use. Maintenance was fairly high; 82% of trial coaches from the intervention group and 68% from the control group still used the programme.

    CONCLUSIONS: Reach and adoption of the programme was high among coaches. However, this study identified low programme fidelity and lack of formal policies for its implementation and use in clubs and district FAs.

  • 34.
    Lindblom, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Department of Orthopaedics, Hässleholm-Kristianstad Hospitals.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Limited positive effects on jump-landing technique in girls but not in boys after 8 weeks of injury prevention exercise training in youth football2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate changes in jump-landing technique in football-playing boys and girls after 8 weeks of injury prevention training.

    METHODS: Four boys' and four girls' teams (mean age 14.1 ± 0.8 years) were instructed to use either the original Knee Control injury prevention exercise programme (IPEP) or a further developed IPEP, Knee Control + , at every training session for 8 weeks. Baseline and follow-up testing of jump-landing technique included drop vertical jumps (DVJ), assessed subjectively and with two-dimensional movement analysis, and tuck jump assessment (TJA).

    RESULTS: Only minor differences in intervention effects were seen between the two IPEPs, and results are therefore presented for both intervention groups combined. At baseline 30% of the boys showed good knee control during the DVJ, normalised knee separation distances of 77-96% (versus hip) and a median of 3 flaws during the TJA. Among girls, 22% showed good knee control, normalised knee separation distances of 67-86% and a median of 4 flaws during the TJA. At follow-up, boys and girls performed significantly more jumps during TJA. No changes in jump-landing technique were seen in boys, whereas girls improved their knee flexion angle at initial contact in the DVJ (mean change + 4.7°, p < 0.001, 95% CI 2.36-6.99, d = 0.7) and their TJA total score (- 1 point, p = 0.045, r = - 0.4).

    CONCLUSION: The study showed small positive effects on jump-landing technique in girls, but not in boys, after 8 weeks of injury prevention training.

    LEVEL OF EVIDENCE: Level II.

    TRIAL REGISTRATION: Clinical Trials gov identifier: NCT03251404.

  • 35.
    Lindblom, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    No effect on performance tests from a neuromuscular warm-up programme in youth female football: a randomised controlled trial2012In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 20, no 10, p. 2116-2123Article in journal (Refereed)
    Abstract [en]

    The objective of the present randomised controlled trial was to study the effect of a neuromuscular warm-up programme on performance tests in youth female football. less thanbrgreater than less thanbrgreater thanFour youth female football teams with players aged 12-16 years were randomised into an intervention group and control group. The intervention was a 15-min neuromuscular warm-up programme carried out twice a week during the 11-week study period. Baseline and follow-up measurements of performance were made indoors and included the star excursion balance test, a countermovement jump test, a triple-hop for distance test, a modified Illinois agility test, and 10- and 20-m sprint tests. less thanbrgreater than less thanbrgreater thanFifty-two players (intervention 28; control 24) took part in baseline measurements, and after dropout, 41 players (intervention 23; control 18) were included for analysis. Minor positive changes were seen in the control group compared to the intervention group for a sub-score of the star excursion balance test (P andlt; 0.05) and in the modified Illinois agility test (P andlt; 0.05). No improvement was seen in the intervention group from baseline to follow-up. less thanbrgreater than less thanbrgreater thanThe study showed that a neuromuscular warm-up programme carried out during 11 weeks did not improve performance in youth female football. This could indicate that the programme does not contain sufficient stimulus to improve performance. A low player attendance at training sessions, and low specificity between exercises in the warm-up programme and the evaluated performance tests may also contribute to the lack of effect. less thanbrgreater than less thanbrgreater thanI.

  • 36.
    Nilsson, Michael
    et al.
    Football Research Group, Linköping, Sweden and Ängelholm Hospital, Sweden .
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Head and Neck Injuries in Professional Soccer2013In: Clinical Journal of Sports Medicine, ISSN 1050-642X, E-ISSN 1536-3724, Vol. 23, no 4, p. 255-260Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the rate of and risk factors for head and neck injury in male soccer.

    Design: Prospective cohort study.

    Setting: Professional soccer.

    Participants: Twenty-six European teams between 2001/2002 and 2009/2010.

    Assessment of Risk Factors: Simple and multiple risk factor analyses were evaluated using Cox regression for player-related variables and logistic regression for match-related variables.

    Main Outcome Measures: Injury rate (number of time loss injuries per 1000 hours).

    Results: A total of 136 head and neck injuries were recorded (2.2% of all injuries). The head and neck injury rate was 0.17 (0.06 concussions) per 1000 hours. There was a 20-fold higher rate of head and neck injury during match play compared with training (rate ratio [RR], 20.2; 95% confidence interval [CI], 13.3-30.6) and a 78-fold higher rate of concussions (RR, 78.5; 95% CI, 24.4-252.5). Mean layoff for concussion was 10.5 days, but 27% of the concussed players returned to play within 5 days. Defender was the only significant player-related risk factor for head and neck injuries in the multiple analysis (RR, 1.8; 95% CI, 1.0-3.1), whereas no significant variables were identified for concussions.

    Conclusions: Head and neck injuries were relatively uncommon in professional soccer. Defender was the playing position most at risk. More than one-quarter of the concussed players returned to play before what is recommended in the consensus statements by the major sports governing bodies.

  • 37.
    Orchard, John W
    et al.
    School of Public Health, University of Sydney, NSW, Australia.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Orchard, Jessica J
    School of Public Health, University of Sydney, NSW, Australia.
    Chivers, Ian
    Native Seeds, Cheltenham, VIC , Australia.
    Seward, Hugh
    Australian Football League Medical Officers Association, Melbourne, VIC , Australia.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Comparison of injury incidences between football teams playing in different climatic regions2013In: Open Access Journal of Sports Medicine, ISSN 1179-1543, E-ISSN 1179-1543, Vol. 4, p. 251-260Article in journal (Refereed)
    Abstract [en]

    Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999-2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01-1.10) with quadriceps strains (RR 1.32, 95% CI 1.10-1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16-1.74), and ankle sprains (RR 1.17, 95% CI 1.00-1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47-1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes.

  • 38.
    Thomee, R.
    et al.
    Gothenburg University, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Return to sports after anterior cruciate ligament injury: neither surgery nor rehabilitation alone guarantees success-it is much more complicated2015In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, no 22, p. 1422-1422Article in journal (Other academic)
    Abstract [en]

    n/a

  • 39.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology of injuries in elite football2007Doctoral 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).

    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, p. 118-125Article 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.

    Keywords
    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, p. 158-162Article 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.

    Keywords
    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, p. 542-546Article 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.

    Keywords
    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, p. 1155-1162Article 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.

    Keywords
    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: 2017-12-13Bibliographically 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, p. 11-19Article 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
  • 40.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Atroshi, Isam
    Hassleholm Kristianstad Ystad Hospital.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Wagner, Philippe
    Lund University.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial2012In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 344Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury in adolescent female football players. less thanbrgreater than less thanbrgreater thanDesign Stratified cluster randomised controlled trial with clubs as the unit of randomisation. less thanbrgreater than less thanbrgreater thanSetting 230 Swedish football clubs (121 in the intervention group, 109 in the control group) were followed for one season (2009, seven months). less thanbrgreater than less thanbrgreater thanParticipants 4564 players aged 12-17 years (2479 in the intervention group, 2085 in the control group) completed the study. Intervention 15 minute neuromuscular warm-up programme (targeting core stability, balance, and proper knee alignment) to be carried out twice a week throughout the season. less thanbrgreater than less thanbrgreater thanMain outcome measures The primary outcome was rate of anterior cruciate ligament injury; secondary outcomes were rates of severe knee injury (andgt;4 weeks absence) and any acute knee injury. less thanbrgreater than less thanbrgreater thanResults Seven players (0.28%) in the intervention group, and 14 (0.67%) in the control group had an anterior cruciate ligament injury. By Cox regression analysis according to intention to treat, a 64% reduction in the rate of anterior cruciate ligament injury was seen in the intervention group (rate ratio 0.36, 95% confidence interval 0.15 to 0.85). The absolute rate difference was -0.07 (95% confidence interval -0.13 to 0.001) per 1000 playing hours in favour of the intervention group. No significant rate reductions were seen for secondary outcomes. less thanbrgreater than less thanbrgreater thanConclusions A neuromuscular warm-up programme significantly reduced the rate of anterior cruciate ligament injury in adolescent female football players. However, the absolute rate difference did not reach statistical significance, possibly owing to the small number of events.

  • 41.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden .
    Atroshi, Isam
    Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm and Lund University, Sweden .
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Wagner, Philippe
    Lund University, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Republished research: Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial2012In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 46, no 13, p. 904-Article in journal (Refereed)
    Abstract [en]

    Study question Does a neuromuscular warm-up programme reduce the rate of anterior cruciate ligament injury in adolescent female football players? 

    Summary answer The neuromuscular warm-up programme reduced the overall rate of anterior cruciate ligament injury by 64%.

    What is known and what this paper adds Knee injuries are common in football regardless of the playing level, and adolescent female players are more susceptible to anterior cruciate ligament injury than their male counterparts. Almost two thirds of anterior cruciate ligament injuries in adolescent female football players can be prevented with a 15 minute neuromuscular warm-up programme.

  • 42.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Football injuries during European Championships 2004-20052007In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, no 9, p. 1155-1162Article in journal (Refereed)
    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.

  • 43.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury2006In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, no 2, p. 158-162Article in journal (Refereed)
    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.

  • 44.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injuries in Swedish elite football - a prospective study on injury definitions, risk for injury and injury pattern during 20012005In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 2, p. 118-125Article in journal (Refereed)
    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.

  • 45.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    The epidemiology of groin injury in senior football: a systematic review of prospective studies2015In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, no 12Article, review/survey (Refereed)
    Abstract [en]

    Background Groin injuries are troublesome in mens and womens football. Aim To review the literature on the epidemiology of groin injury in senior football and compare injury occurrence between sexes. Methods Studies were identified through a search of PubMed, EMBASE, CINAHL and Web of Science, in the reference lists of the selected articles and the authors bibliographies. The number of injuries, percentage of groin injury from all injuries and rate of groin injury per 1000 h were extracted. Exposure and injury data were aggregated across included studies and the absolute differences in groin injury proportion and rate of groin injury were compared between sexes. Risk of bias was assessed using a 5-item checklist. Results 34 articles met the study criteria and were included. The proportion of groin injury in club-seasonal football was 4-19% in men and 2-14% in women. Aggregated data analysis (29 studies) showed a higher relative proportion of groin injury in men than in women (12.8% vs 6.9%, absolute difference 5.9%, 95% CI 4.6% to 7.1%). The rate of groin injury varied from 0.2 to 2.1/1000 h in men and 0.1 to 0.6/1000 h in womens club football, and aggregated analysis (23 studies) showed a more than two-fold higher rate in men (0.83/1000 h vs 0.35/1000 h, rate ratio 2.4, 95% CI 2.0 to 2.9). High risk of bias was identified for participant selection (18 studies), exposure (17 studies) and precision estimate (16 studies). Conclusions Groin injuries are frequent in senior football and are more common in men than women. Future research needs to be of higher quality.

  • 46.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Time-trends and circumstances surrounding ankle injuries in men's professional football: an 11-year follow-up of the UEFA Champions League injury study2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 748-753Article in journal (Refereed)
    Abstract [en]

    Background Ankle injury is common in football, but the circumstances surrounding them are not well characterised.

    Aim To investigate the rates, especially time-trends, and circumstances of ankle injuries in male professional football.

    Methods 27 European clubs with 1743 players were followed prospectively between 2001/2002 and 2011/2012. Time loss injuries and individual-player exposure during training sessions and matches were recorded. Injury rate was defined as the number of injuries/1000 h.

    Results A total of 1080 ankle injuries were recorded (13% of all injuries) with lateral ligament ankle sprain being the most common injury subtype (51% of all ankle injuries). The rates of ankle injury and ankle sprain were 1/1000 h and 0.7/1000 h, respectively. The ankle sprain rate declined slightly over time during the 11-year study period (on average 3.1%/season) with a statistically significant seasonal trend (p=0.041). Foul play according to the referee was involved in 40% of the match-related ankle sprains. Syndesmotic sprains and ankle impingement were uncommon causes of time loss (3% each of all ankle injuries).

    Conclusions Lateral ligament ankle sprain constituted half of all ankle injuries in male professional football, whereas ankle impingement syndromes were uncommon. The ankle sprain rate decreased slightly over time, but many ankle sprains were associated with foul play. Our data extend the body of literature that provides football policy makers with a foundation to review existing rules and their enforcement.

  • 47.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season2005In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 39, no 8, p. 542-546Article in journal (Refereed)
    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.

  • 48.
    Waldén, Markus
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Hassleholm Kristianstad Ystad Hospital, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    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 rupture2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 744-750Article in journal (Refereed)
    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.

  • 49.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Magnusson, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Sports Medicine .
    Anterior cruciate ligament injury in elite football: a prospective three-cohort study.2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 11-19Article in journal (Refereed)
    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.

  • 50.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Orchard, J
    University of Sydney, Australia.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Regional differences in injury incidence in European professional football2013In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 23, no 4, p. 424-430Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate regional differences in injury incidence in men's professional football in Europe. A nine-season prospective cohort study was carried out between 2001–2002 and 2009–2010 involving 1357 players in 25 teams from nine countries. Teams were categorized into different regions according to the Köppen–Geiger climate classification system. Teams from the northern parts of Europe (n = 20) had higher incidences of injury overall [rate ratio 1.12, 95% confidence interval (CI) 1.06 to 1.20], training injury (rate ratio 1.16, 95% CI 1.05 to 1.27), and severe injury (rate ratio 1.29, 95% CI 1.10 to 1.52), all statistically significant, compared to teams from more southern parts (n  = 5). In contrast, the anterior cruciate ligament injury incidence was lower in the northern European teams with a statistically significant difference (rate ratio 0.43, 95% CI 0.25 to 0.77), especially for noncontact anterior cruciate ligament injury (rate ratio 0.19, 95% CI 0.09 to 0.39). In conclusion, this study suggests that there are regional differences in injury incidence of European professional football. However, further studies are needed to identify the underlying causes.

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