Injury and illness epidemiology in professional Asian football: lower general incidence and burden but higher ACL and hamstring injury burden compared with Europe.

BACKGROUND: While football injury and illness epidemiology surveillance at professional club level in Europe is available, epidemiological data from other continents are lacking. PURPOSE: Investigating injury and illness epidemiology in professional Asian football. STUDY DESIGN: Descriptive prospective study. METHODS: Professional teams from the Asian Football Confederation (AFC) league were followed prospectively for three consecutive AFC seasons (2017 through 2019, 13 teams per season, 322 team months). Time-loss injuries and illnesses in addition to individual match and training exposure were recorded using standardised digital tools in accordance with international consensus procedures. RESULTS: In total, 232 665 hours of exposure (88.6% training and 11.4% matches) and 1159 injuries were recorded; 496 (42.8%) occurred during matches, 610 (52.6%) during training; 32 (2.8%) were reported as 'not applicable' and for 21 injuries (1.8%) information was missing. Injury incidence was significantly greater during match play (19.2±8.6 injuries per 1000 hours) than training (2.8±1.4, p<0.0001), resulting in a low overall incidence of 5.1±2.2.The injury burden for match injuries was greater than from training injuries (456±336 days per 1000 hours vs 54±34 days, p<0.0001). The two specific injuries causing the greatest burden were complete ACL ruptures (0.14 injuries (95% CI 0.9 to 0.19) and 29.8 days lost (29.1 to 30.5) per 1000 hours) and hamstring strains (0.86 injuries (0.74 to 0.99) and 17.5 days (17.0 to 18.1) lost per 1000 hours).Reinjuries constituted 9.9% of all injuries. Index injuries caused 22.6±40.8 days of absence compared with 25.1±39 for reinjuries (p=0.62). The 175 illnesses recorded resulted in 1.4±2.9 days of time loss per team per month. CONCLUSION: Professional Asian football is characterised by an overall injury incidence similar to that reported from Europe, but with a high rate of ACL ruptures and hamstring injury, warranting further investigations.

How does sleep help recovery from exercise-induced muscle injuries?

OBJECTIVES: Athletes and military personnel may experience sleep disturbances due to conditions of training and competitions or military missions/field operations. The risk of muscle injuries is greater for them when sleep duration decreases, and training load increases simultaneously, which can be exacerbated by fatigue. Accumulating evidence demonstrates that sleep extension improved performance, pain sensitivity and GH/IGF-I anabolic responses, which may be beneficial in accelerating recovery from muscle injuries. DESIGN & METHODS: This narrative review describes the importance of sleep for the recovery/prevention of exercise-induced muscle injuries and provides perspectives on the transferability of currently available scientific evidence to the field. RESULTS: The first part presents the role of sleep and its interaction with the circadian system for the regulation of hormonal and immune responses, and provides information on sleep in athletes and soldiers and its relationship to injury risk. The second part is an overview of muscle injuries in sport and presents the different phases of muscle regeneration and repair, i.e. degeneration, inflammation, regeneration, remodeling and maturation. Part three provides information on the deleterious effects of sleep deprivation on muscle tissue and biological responses, and on the benefits of sleep interventions. Sleep extension could potentially help and/or prevent recovery from exercise-induced muscle-injuries through increasing local IGF-I and controlling local inflammation. CONCLUSIONS: Although the science of sleep applied to sport is still an emerging field, the current scientific literature shows many potential physiological pathways between sleep and exercise-related muscle injuries. More direct studies are needed to establish clear guidelines for medical personnel and coaches.

Return to football training and competition after lockdown caused by the COVID-19 pandemic: medical recommendations.

The lockdown caused by the COVID-19 pandemic represents a great unknown regarding the physiological changes induced in elite football players. Although it will differ from country to country, the return to sport for professional football players will follow a forced lockdown never experienced and longer than the normal annual season break. Moreover, in addition to an obvious decrease in performance, the lockdown will possibly lead to an increase of the injury risk. In fact, preseason is always a period with a specific football injury epidemiology, with an increase in the incidence and prevalence of overuse injuries. Therefore, it seems appropriate to recommend that specific training and injury prevention programmes be developed, with careful load monitoring. Training sessions should include specific aerobic, resistance, speed and flexibility training programmes. The aerobic, resistance and speed training should respect some specific phases based on the progressiveness of the training load and the consequent physiological adaptation response. These different phases, based on the current evidence found in the literature, are described in their practical details. Moreover, injury prevention exercises should be incorporated, especially focusing on overuse injuries such as tendon and muscle lesions. The aim of this paper is to provide practical recommendations for the preparation of training sessions for professional footballers returning to sport after the lockdown.

Medical recommendations for home-confined footballers' training during the COVID-19 pandemic: from evidence to practical application.

In early 2020, the world is facing a global emergency called COVID-19. Many professional footballers around the world are home confined. The maintenance of physical capacity is a fundamental requirement for the athlete, so the training sessions must be adapted to this unique situation. Specific recommendations must be followed concerning the type of training, its intensity, the precautions that have to be followed to avoid the possibility of contagion, and the restrictions in accordance with the presence of any symptoms. This article analyses the available scientific evidence in order to recommend a practical approach.

Larger strength losses and muscle activation deficits in plantar flexors induced by backward downhill in reference to distance-matched forward uphill treadmill walk.

We tested the hypothesis that backward downhill walking (eccentric component) impairs both voluntary activation and muscle contractile properties in the plantar flexors and delays recovery as compared to a gradient and distance-matched uphill walk. Fourteen males performed two 30-min walking exercises (velocity: 1 m/ s; grade: 25%; load: 12% of body weight), one downhill (DW) and one uphill (UP), in a counterbalanced order, separated by 6 weeks. Neuromuscular test sessions were performed before, after, 24-, 48- and 72-h post-exercise, including motor nerve stimulations during brief (5 s) and sustained (1 min) maximal isometric voluntary contractions of the plantar flexors. DW (-18.1 ± 11.1%, P < .001), but not UP (-6.0 ± 7.7%, P =.15), decreased torque production during brief contractions for at least three days post-exercise (P < .05). Voluntary activation during brief contractions decreased after DW (P < .05), but not UP, and recovered by 24 h. Both UP (-9.3 ± 9.0%, P = .024) and DW (-25.6 ± 10.3%, P < .001) decreased torque production during sustained contractions but voluntary activation (P = .001) was lower in DW than UP. Peak twitch torque and maximum rates of torque development and relaxation were equally reduced after UP and DW (P < .05), and recovered by 24 h. DW induced an increase in muscle soreness with peak values observed 48 h post-walking (P < .001), whereas post-UP exercise changes were non-significant (all P > .05). Using a direct comparison, the capacity to drive the plantar flexors during sustained contractions remains sub-optimal during the three-day recovery period in response to non-exhaustive, downhill backward walking in reference to an uphill exercise matched for distance covered.

Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial.

BACKGROUND: To evaluate the efficacy of a single platelet-rich plasma (PRP) injection in reducing the return to sport duration in male athletes, following an acute hamstring injury. METHODS: A randomised, three-arm (double-blind for the injection arms), parallel-group trial, in which 90 professional athletes with MRI positive hamstring injuries were randomised to injection with PRP-intervention, platelet-poor plasma (PPP-control) or no injection. All received an intensive standardised rehabilitation programme. The primary outcome measure was time to return to play, with secondary measures including reinjury rate after 2 and 6 months. RESULTS: The adjusted HR for the PRP group compared with the PPP group was 2.29 (95% CI 1.30 to 4.04) p=0.004; for the PRP group compared with the no injection group 1.48 (95% CI 0.869 to 2.520) p=0.15, and for the PPP group compared with the no injection group 1.57 (95% CI 0.88 to -2.80) p=0.13. The adjusted difference for time to return to sports between the PRP and PPP groups was -5.7 days (95% CI -10.1 to -1.4) p=0.01; between the PRP and no injection groups -2.9 days (95% CI -7.2 to 1.4) p=0.189 and between the PPP and no injection groups 2.8 days (95% CI -1.6 to 7.2) p=0.210. There was no significant difference for the secondary outcome measures. No adverse effects were reported. CONCLUSIONS: Our findings indicate that there is no benefit of a single PRP injection over intensive rehabilitation in athletes who have sustained acute, MRI positive hamstring injuries. Intensive physiotherapy led rehabilitation remains the primary means of ensuring an optimal return to sport following muscle injury. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01812564.

The association of environmental heat stress with performance: analysis of the 2014 FIFA World Cup Brazil.

OBJECTIVE: The 2014 FIFA World Cup Brazil included 64 matches in temperate to tropical environmental conditions. We analysed performance data in relation to the environmental conditions to identify potential association. METHODS: Wet-bulb globe temperature (WBGT) parameters were obtained at the centre of the field 1 h before the start of play. Environmental stress was estimated (low, moderate and high) for each match using WBGT and relative humidity. Various physical and technical performance indices were recorded during each match (average of both teams). RESULTS: Over the 64 matches, 28 were played under low, 20 under moderate and 16 under high environmental stress. There was no difference in actual playing time (p=0.517), total distance covered (p=0.491), number of goals scored (p=0.485) and number of cards (p=0.618) between the matches played under different environmental stress categories. The number of sprints was lower in high than in moderate or low environmental stress (-10%, p<0.05) but peak speed was unaffected. The distance covered at high intensity was also lower under high (24.8±2.8 m/min/player) than low environmental stress (26.9±2.3 m/min/player, p=0.02). Number of passes was not different but the rate of successful passes was higher under high (76.8±4.4%) than low (73.6±10.8%) environmental stress (p=0.031). CONCLUSIONS: Top-level players seem to modulate their activity pattern during matches in a hot and humid environment (ie, less high-intensity but more low-intensity running and successful passes) to preserve the global match characteristics (ie, similar actual playing time, total distance covered, peak running speed and goals scored).

Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia.

BACKGROUND: The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion. DESIGN: To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme. METHODS: A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination. RESULTS: To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47% saving), with the cost per diagnosis reduced to US$43,113. CONCLUSIONS: Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.

Exercise and the platelet activator calcium chloride both influence the growth factor content of platelet-rich plasma (PRP): overlooked biochemical factors that could influence PRP treatment.

BACKGROUND: There is strong evidence that exercise affects platelet haemostasis factors, but this potential effect on growth factor concentrations in platelet-rich plasma (PRP) has never been studied. In addition, there is a paucity of studies focusing on the effects of activating agents used in conjunction with PRP. The first aim of this study was to evaluate the effect of exercise on platelet and platelet-derived growth factors (PDGF)-AB, hepatocyte growth factor (HGF), insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) concentrations in PRP. The second aim was to study the effect of the activating agent calcium chloride (CaCl2) on growth factor concentration in relation to different exercise states. METHODS: Controlled laboratory study. Ten healthy participants performed 1 h of submaximal exercise with blood being withdrawn immediately pre, post and 18 h following. PRP was prepared in each condition in both an activated CaCl2 and non-activated form. Concentrations of PDGF-AB, HGF, IGF-1 and VEGF were evaluated using standard ELISA systems. RESULTS: Exercise had no significant effect on platelet concentration, but significantly suppressed both VEGF and PDGF-AB concentrations. Exercise state had no significant effect on IGF-1 or HGF concentration. Activation with CaCl2 resulted in a significant increase in PDGF-AB and IGF-1 concentrations, unchanged VEGF and significantly reduced HGF concentrations. CONCLUSIONS: Exercise significantly impacts on PDGFs in PRP with significantly reduced concentrations of VEGF and PDFG-AB. Furthermore, the activation of PRP with CaCl2 results in a differentiated GF release from platelets. These relevant factors can potentially influence outcome in daily clinical practice and are recommended to be accounted for in future study design.

Concussion surveillance: do low concussion rates in the Qatar Professional Football League reflect a true difference or emphasize challenges in knowledge translation?

OBJECTIVE: To investigate concussion epidemiology in the first football (soccer) division of Qatar. DESIGN: Prospective cohort study. SETTING: Professional First Division Football League of Qatar. PARTICIPANTS: All first team players were included at the beginning of each season. INTERVENTIONS: Daily collection of training and match exposure from August 2008 until April 2012 by club medical staff. Head injuries during training and match play were recorded on standardized injury cards. MAIN OUTCOME MEASURES: Injury incidence was calculated as number of injuries per hour exposed to risk and expressed as rate per 1000 hours. RESULTS: The incidence of concussions in professional club football in Qatar is 0.016 (0.000-0.033) per 1000 hours of exposure. CONCLUSIONS: The concussion incidence is only 25% of that in the previous European studies using the same time loss injury definition. This raises the possibility that concussions are underreported. Further research is necessary. In the meantime, concussion education of players, club medical, and support staff is warranted, in keeping with the Zurich concussion consensus call for the need for an increase in knowledge translation.

Acute responses of soccer match play on hip strength and flexibility measures: potential measure of injury risk.

Regular measurements of groin risk factors may offer a preventive measure against injury. Therefore, the aim of this study was to (1) determine minimal detectable change (MDC) and reliability of hip flexibility and strength measures and to (2) identify the effect soccer match play load has on these measures. Reliability was determined for bent knee fall out test, hip abduction and adduction (hand-held dynamometry (HHD)) in 20 trained youth male soccer players. Reliability was evaluated with the intra-class correlation coefficient (ICC[2,1]), 95% confidence intervals (CI). Hip strength and flexibility measures were taken before and after an international friendly match. Intra-rater reliability ICC ranges were bent knee fall out (0.75-0.90), abduction (0.83-0.90) and adduction (0.72-0.96). Inter-rater ICCs (95% CI) were bent knee fall out test [0.75 (0.39-0.90) right, 0.71 (0.27-0.89) left hip]; abduction [0.80 (0.50-0.92) right, 0.81 (0.53-0.92) left hip] and adduction [0.72 (0.31-0.89) right, 0.70 (0.26-0.88) left hip]. MDCs were as low as 20.7% of the mean for hip flexibility and 12.5% for strength. In conclusion, HHD and the bent knee fall out test are reliable tools to measure changes in hip strength and flexibility. Finally, a threshold may exist in which match play load negatively impacts hip flexibility.

ECG and morphologic adaptations in Arabic athletes: are the European Society of Cardiology's recommendations for the interpretation of the 12-lead ECG appropriate for this ethnicity?

AIMS: To examine the cardiac structure and function of Arabic athletes and to establish if the European Society of Cardiology (ESC) guidelines for the interpretation of an athlete's ECG are applicable to this ethnicity. METHODS: 600 high-level Arabic, 415 Black African, 160 Caucasian male athletes (exercising ≥6 h/week) and 201 Arabic controls presented for ECG and echocardiographic screening. RESULTS: 9 athletes (0.7%) were identified with a cardiac pathology associated with sudden cardiac death. Two Arabics (0.3%) and five Black Africans (1.2%) were diagnosed with hypertrophic cardiomyopathy; a prevalence four times greater in Black African compared to Arabic athletes. Arabic athletes had significantly greater (p<0.05) left ventricular (LV) end-diastolic diameters, maximal LV wall thicknesses and LV mass compared with controls; yet were significantly smaller than Black African and Caucasian athletes. The percentage of athletes demonstrating LV hypertrophy (≥12 mm) was comparable between Arabic, Black African and Caucasian populations (0.5%, 0.5% and 0.6%, respectively). There was no difference in the frequency of an uncommon and training-unrelated ECG between Arabic and Caucasian. However, Black Africans demonstrated a significantly greater prevalence than Arabic and Caucasian athletes (20% vs 8.4% and 6.9%, p<0.001); specifically more right/left atrial enlargement and T wave inversion. CONCLUSIONS: Arabic athletes present significantly smaller cardiac dimensions than Black African and Caucasian athletes. There was no significant difference between the frequency of an uncommon and training-unrelated ECG between Arabic and Caucasian athletes. Therefore, the use of ESC guidelines for the interpretation of an athlete's ECG is clinically relevant and acceptable for use within Arabic athletes.

Different injury pattern in goalkeepers compared to field players: a three-year epidemiological study of professional football.

OBJECTIVES: Goalkeepers have a specific physiological and biomechanical profile including hip loading with increased frontal plane kinetics and explosive side jumps. The aim of this study is to analyze the injury incidence in professional goalkeepers and to compare this with field players. DESIGN: Descriptive Epidemiology Study. METHODS: Prospective (3 seasons, 2008-2011) registration of injuries and exposure of first division professional footballers of Qatar. RESULTS: Of the 527 players, 49 were goalkeepers. Sixty-seven injuries occurred during 17.858 h of exposure. Goalkeepers had a lower total (p=0.01) and training (p=0.007) injury incidence than field players, while there was no injury difference during matches (p=0.279). Moreover, goalkeepers presented a lower incidence of injuries that were: non contact (p=0.002), traumatic (p<0.001), strains (p<0.001), thigh (p<0.001), and hamstring (p=0.038). Adductor strains were the most common subtype of injury for goalkeepers and this incidence was higher in goalkeepers than in field players (p=0.045). In goalkeepers, mean lay off time for adductor strains was 2.5 times longer than for hamstring strains. More than one third of the overuse injuries were hip and groin injuries. While the overall and lower body injury incidence in goalkeepers was lesser than in field players, upper body incidence was higher. CONCLUSIONS: Football goalkeepers have a peculiar injury epidemiology, possibly due to their specific physiological and biomechanical performance requirements. Goalkeepers are prone to acute adductor and overuse hip and groin injuries, while muscle strains, in particular located in the hamstrings, are lower compared with field players. Specific prevention program should be implemented in this category of footballers.

Vitamin D concentration in 342 professional football players and association with lower limb isokinetic function.

OBJECTIVES: This study aimed to evaluate both the epidemiology of Vitamin D deficiency in Qatar-based footballers originating from a variety of countries and the existence of any relationship between 25 hydroxy-cholecalciferol (25(OH)D) concentration and lower limb isokinetic performance (peak torque) in well trained professional football players. DESIGN: Cross-sectional clinical. METHODS: Three hundred and forty-two professional footballers based in Qatar were evaluated as part of their routine annual medical assessment. History, examination, blood tests and a lower limb isokinetic evaluation were performed. Association between 25(OH)D concentrations and lower limb isokinetic peak torque was assessed. RESULTS: Eighty four percent of players had 25(OH)D concentrations less than 30 ng/ml; 12% were severely deficient (<10 ng/ml) and there was a significant difference in 25(OH)D level depending on the country of origin of the player. Total body mass and lean mass was significantly higher in players with 25(OH)D levels greater than 20 ng/ml, when compared with the less than 10 ng/ml group. There was no consistent association found between lower limb isokinetic peak torque and 25(OH)D concentration. CONCLUSIONS: 25(OH)D deficiency is highly prevalent in Qatar based footballers. Severe 25(OH)D deficiency is associated with lower body mass, and lower lean mass, when compared with footballers with concentrations >20 ng/ml. Vitamin D deficiency was not shown to have a consistent association with lower limb isokinetic peak torque and both the clinical and performance related significance of this high prevalence of Vitamin D deficiency remains unclear.

Changes in circulating microRNAs levels with exercise modality.

Here, we studied muscle-specific and muscle-related miRNAs in plasma of exercising humans. Our aim was to determine whether they are affected by eccentric and/or concentric exercise modes and could be biomarkers of muscle injuries or possible signaling molecules. On two separate days, nine healthy subjects randomly performed two 30-min walking exercises, one downhill (high eccentric component) and one uphill (high concentric component). Perceived exertion and heart rate were higher during the uphill exercise, while subjective pain and ankle plantar flexor strength losses within the first 48-h were higher following the downhill exercise. Both exercises increased serum creatine kinase and myoglobin with no significant differences between conditions. Plasma levels of circulating miRNAs assessed before, immediately after, and at 2-, 6-, 24-, 48-, and 72-h recovery showed that 1) hsa-mir-1, 133a, 133b, and 208b were not affected by concentric exercise but significantly increased during early recovery of eccentric exercise (2 to 6 h); 2) hsa-mir-181b and 214 significantly and transiently increased immediately after the uphill, but not downhill, exercise. The muscle-specific hsa-mir-206 was not reliably quantified and cardiac-specific hsa-mir-208a remained undetectable. In conclusion, changes in circulating miRNAs were dependent on the exercise mode. Circulating muscle-specific miRNAs primarily responded to a downhill exercise (high eccentric component) and could potentially be alternative biomarkers of muscle damage. Two muscle-related miRNAs primarily responded to an uphill exercise (high exercise intensity), suggesting they could be markers or mediators of physiological adaptations.

Does Ramadan affect the risk of injury in professional football?

OBJECTIVE: To investigate whether fasting during Ramadan influences injury incidence in professional Muslim and non-Muslim footballers. DESIGN: Prospective cohort study. SETTING: Professional First Division League of Qatar. PARTICIPANTS: About 527 male football players (462 Muslim and 65 non-Muslim) from 7 league clubs (first year of data collection) and 8 clubs (second and third years). INTERVENTIONS: Daily collection of training and match exposure from August 2008 until April 2011 by club medical staff. Injuries during training and match play were recorded on standardized injury cards. MAIN OUTCOME MEASURES: Injury incidence was calculated as number of injuries per hour exposed to risk, and expressed as rate per 1000 hours. The probability of injury for different Arabic months between Muslims and non-Muslims was calculated using Generalized Estimating Equations (GEEs). RESULTS: There was no significant difference in total, match, and training injury incidence between the Ramadan and non-Ramadan periods. Non-Muslim footballers had a significantly higher injury incidence rate than Muslim footballers both during Ramadan (8.5 vs 4.0 injuries/1000 hours, P = 0.009) and non Ramadan (6.6 vs 4.9 injuries/1000 hours, P = 0.004) periods. The GEE analysis revealed that after adjusting for age and random factors (month and club), the probability of match injury among non-Muslims was the highest in Ramadan and the 2 consecutive following months (adjusted odds ratio of injury among non-Muslims compared with Muslims was 3.7 [95% confidence interval (CI), 1.7-7.9], P = 0.001 during Ramadan (ninth) month; 2.4 (95% CI, 1.1-4.9), P = 0.021 during 10th month; and 2.7 (95% CI, 1.2-5.8), P = 0.013 during 11th month). Finally, there was no change in injury patterns over the months of the Islamic calendar. CONCLUSIONS: Ramadan does not impact injury incidence for Muslim footballers in Qatar, suggesting the current adjustments and scheduling of football activities during Ramadan are sufficient. The increased match injury among non-Muslims during and 2 months post-Ramadan may suggest less effective coping strategies.

Low injury rate strongly correlates with team success in Qatari professional football.

BACKGROUND: Although the incidence of football injuries should relate to team success there is little empirical evidence. OBJECTIVE: We investigated the relationship between injury incidence and team success in Qatar first-division football clubs. METHODS: Using a prospective cohort study design, we captured exposure and injuries in Qatar male elite football for a season. Club performance was measured by total league points, ranking, goal scored, goals conceded and number of matches won, drawn or lost. RESULTS: Lower injury incidence was strongly correlated with team ranking position (r=0.929, p=0.003), more games won (r=0.883, p=0.008), more goals scored (r=0.893, p=0.007), greater goal difference (r=0.821, p=0.003) and total points (r=0.929, p=0.003). CONCLUSIONS: Lower incidence rate was strongly correlated with team success. Prevention of injuries may contribute to team success.

Epidemiology of football injuries in Asia: a prospective study in Qatar.

OBJECTIVES: To investigate the incidence, characteristics and patterns of football injuries at club level in Qatar. DESIGN: Prospective cohort study. METHODS: Data were prospectively collected from the first division football league clubs in Qatar, in accordance with the international consensus statement on football injury epidemiology. An injury was defined as any physical complaint sustained during football activity resulting in the inability to participate fully in the next training or match. Individual injuries and exposure of each player were recorded by the medical staff of each team over one season. RESULTS: A total of 217 injuries were recorded, with an injury rate during matches of 14.5/1000h (95% CI: 11.6-18.0) compared with 4.4/1000h during training sessions (95% CI: 3.7-5.2). More than one third of all injuries were muscle strains (36.4%). Hamstring strains (54.4% of all muscle strains) exhibited a higher incidence than all other injury types (p<0.001). The thigh was the most frequent injury location (41.9%, p<0.001). Reinjuries (15% of total injuries) were mainly comprised of muscle strains associated with a higher severity compared with new injuries. CONCLUSIONS: Despite the different environmental, social and cultural setting, our findings are comparable with previous data from European club football, confirming the previous finding at national team level that there are no regional peculiarities of football injuries in this part of the Asiatic continent. The relatively high overuse injury incidence rate and the high recurrence rate for (severe) thigh muscle strains, especially during games, warrants prevention strategies.