Time-loss injuries and illnesses at the FIFA world cup Qatar 2022.

The study aimed to analyse incidence and characteristics of time-loss injuries and illnesses during the FIFA World Cup Qatar 2022. Of 838 male football players, 705 consented to participate. Team medical staff reported 82 time-loss injuries, corresponding to an injury event incidence of 5.6 injuries/1000 h of total exposure (95%CI 4.5 to 7.0 injuries/1000 h), with a median of 2 time-loss injury events per team (IQR, 1 to 4.5, range 0-7). The total injury burden was 103 (95% CI 61 to 152) days per 1000 h. Muscle/tendon injuries had the highest incidence of tissue types (48 cases, 3.3/1000 h (95% CI 2.5 to 4.4), and hamstring muscle injuries were the most frequent diagnosis (16 cases, incidence 1.1/1000 h, 95% CI 0.6 to 1.8). Match injury event incidence was 20.6/1000 h (15.0 to 27.7) and training injury event incidence was 2.1/1000 h (1.4 to 3.1). The majority (52%) of sudden-onset injuries were non-contact injuries, 40% direct contact and 8% indirect contact. We recorded 15 time-loss illnesses, corresponding to an illness event incidence of 1.1 per 1000 competition days, (95% CI: 0.6 to 1.8), and illness burden of 2.1 (1.0 to 3.4) days lost per 1000 competition days. The most common illness was respiratory infection (12 cases, 80%). Match injury event incidence was the lowest in any FIFA World Cup since injuries have been monitored.

Obstacles and opportunities for injury prevention in professional football in Qatar: exploring the implementation reality.

Background: Research focusing on reducing the risk of injuries has increased over the last two decades showing that prevention implementation in real life is challenging. Objective: To explore the experience and opinions of professional football stakeholders regarding injuries, their prevention and the implementation of preventive measures. Design: Qualitative study. Setting: Technical and medical staff from Qatar's premier football league. Participants: 22 professionals from 6 teams. Main outcome: Semistructured interviews were transcribed verbatim and analysed using the thematic analysis method. Results: All the participants acknowledged the importance of injury prevention. They mentioned teamwork, trust and communication as critical factors for a successful injury prevention implementation. Teams' doctors see themselves mainly involved in the treatment and recovery process, and to a lesser degree, in the prevention process. Physiotherapists defined their primary responsibilities as screening for injury risk and providing individual exercises to players. The participants declared that the fitness coach is responsible for injury prevention implementation. All stakeholders reported that the fitness coach plays a vital role in communication by bridging the head coach and the medical staff. Stakeholders reported that the Qatari football league has a very particular context around the player, such as socioecological factors influencing injury prevention implementation. Conclusions: The fitness coach plays a vital role in the injury prevention implementation system, as one of the key actors for the process, as well as the bridge between the medical team and the head coach, resulting from their better communication with the head coaches. The findings support considering and understanding the contextual factors during the development of preventive strategies in football.

Training Practices of Football Players During the Early COVID-19 Lockdown Worldwide.

The COVID-19 lockdown challenged the training options of athletes worldwide, including players from the most popular sport globally, football/soccer. PURPOSE: The authors explored the training practices of football players worldwide during the COVID-19 lockdown. METHODS: Football players (N = 2482, 30% professional, 22% semipro, and 48% amateur) completed an online survey (May-July 2020) on their training practices before versus during lockdown (March-June 2020). Questions were related to training frequency and session duration, as well as training knowledge and attitudes. RESULTS: Before lockdown, more professional (87%) than semipro (67%) and amateur (65%) players trained ≥5 sessions/wk, but this proportion decreased during the lockdown to 55%, 35%, and 42%, respectively. Players (80%-87%) trained ≥60 minutes before lockdown, but this proportion decreased to 45% in professionals, 43% in amateurs, and 36% in semipros during lockdown. At home, more than two-thirds of players had training space (73%) and equipment (66%) for cardiorespiratory training, while availability of equipment for technical and strength training was <50% during lockdown. Interactions between coach/trainer and player were more frequent (ie, daily) among professional (27%) than amateur (11%) and semipro (17%) players. Training load monitoring, albeit limited, was mostly performed by fitness coaches, more so with professionals (35%) than amateurs (13%) and semipros (17%). The players' training knowledge and attitudes/beliefs toward training were relatively modest (50%-59%). CONCLUSION: COVID-19 lockdown negatively affected training practices of football players worldwide, especially amateurs and semipros, for example, in training frequency, duration, intensity, technical, recovery, and other fitness training and coaching-related aspects. During lockdown-like situations, players should be monitored closely and provided appropriate support to facilitate their training.

Translation, Cross-Cultural Adaptation, and Validation of the Persian Version of Thailand Physical Activity Children Survey Questionnaire.

Background: According to the importance of physical activity in the child's physical and mental development and cognitive health, developing a valid, reliable, and comprehensive assessment tool for children's physical activity is mandated. The purpose of this study is the translation, cross-cultural adaptation, and validation of the Persian version of the Thailand Physical Activity Children Survey questionnaire to measure the level of physical activity in children aged between 6-9 years in Iran. Methods: This study consisted of three stages, first, the questionnaire translation into Persian language and modification of the sections according to the Iranian culture, then the evaluation of the questionnaire via a pilot study, and finally, assessing the reliability and validity of the tool. Participants of the pilot study were 250 healthy children, aged 6 to 9 years, meeting eligibility criteria, recruited through a stratified cluster sampling method from schools across Tehran. Results: The Persian version of the questionnaire demonstrated an acceptable content validity (Content Validity Index between 0.88-1). The test-retest reliability reported the Intra-Class Correlation coefficient in the acceptable range in all sections (between 0.71-1). Cronbach's alpha was reported 0.993, which indicated excellent internal consistency. Conclusions: According to the acceptable validity and reliability of the Persian version of the Thailand Physical Activity Children Survey for children aged 6-9 years, it is recommended in research and surveillance studies to determine the level of physical activity of children of that age group in Iran.

Conceptualization and development of a questionnaire to determine physical activity barriers.

PURPOSE: Considering the role of physical activity on public health and the high prevalence of physical inactivity worldwide, determining physical activity barriers is critical and will be a road map for future planning. This study aimed to develop a comprehensive questionnaire to determine physical activity barriers. METHODS: By reviewing previous studies, the main domains of the questionnaire were established. A physical activity expert interviewed 20 individuals aged 18 to 65 years. The results were evaluated by an expert panel for a content validity index. Face validity, test-retest reliability, and internal consistency were established on 204 individuals. RESULTS: The content validity index in all items was within the acceptable range (>0.85). Face validity was appropriate, and the misunderstanding index was < 20% in all items. Test-retest reliability in the final questionnaire in all items based on Cohen's kappa was > 0.20, indicating fair agreement. Internal consistency with Cronbach's alpha of 0.63 was within the acceptable range. CONCLUSION: The study revealed that the newly designed survey is valid, accurate, and reliable. The use of this comprehensive tool by policymakers would help them properly identify the perceived barriers, and thus perform better physical activity interventions as promotional health programs.

Lockdown Duration and Training Intensity Affect Sleep Behavior in an International Sample of 1,454 Elite Athletes.

Objective: To investigate the effect of 1) lockdown duration and 2) training intensity on sleep quality and insomnia symptoms in elite athletes. Methods: 1,454 elite athletes (24.1 ± 6.7 years; 42% female; 41% individual sports) from 40 countries answered a retrospective, cross-sectional, web-based questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: 1) Pittsburgh sleep quality index (PSQI); 2) Insomnia severity index (ISI); bespoke questions about 3) napping; and 4) training behaviors. The association between dependent (PSQI and ISI) and independent variables (sleep, napping and training behaviors) was determined with multiple regression and is reported as semi-partial correlation coefficient squared (in percentage). Results: 15% of the sample spent < 1 month, 27% spent 1-2 months and 58% spent > 2 months in lockdown. 29% self-reported maintaining the same training intensity during-lockdown whilst 71% reduced training intensity. PSQI (4.1 ± 2.4 to 5.8 ± 3.1; mean difference (MD): 1.7; 95% confidence interval of the difference (95% CI): 1.6-1.9) and ISI (5.1 ± 4.7 to 7.7 ± 6.4; MD: 2.6; 95% CI: 2.3-2.9) scores were higher during-compared to pre-lockdown, associated (all p < 0.001) with longer sleep onset latency (PSQI: 28%; ISI: 23%), later bedtime (PSQI: 13%; ISI: 14%) and later preferred time of day to train (PSQI: 9%; ISI: 5%) during-lockdown. Those who reduced training intensity during-lockdown showed higher PSQI (p < 0.001; MD: 1.25; 95% CI: 0.87-1.63) and ISI (p < 0.001; MD: 2.5; 95% CI: 1.72-3.27) scores compared to those who maintained training intensity. Although PSQI score was not affected by the lockdown duration, ISI score was higher in athletes who spent > 2 months confined compared to those who spent < 1 month (p < 0.001; MD: 1.28; 95% CI: 0.26-2.3). Conclusion: Reducing training intensity during the COVID-19-induced lockdown was associated with lower sleep quality and higher insomnia severity in elite athletes. Lockdown duration had further disrupting effects on elite athletes' sleep behavior. These findings could be of relevance in future lockdown or lockdown-like situations (e.g., prolonged illness, injury, and quarantine after international travel).

Ramadan Observance Exacerbated the Negative Effects of COVID-19 Lockdown on Sleep and Training Behaviors: A International Survey on 1,681 Muslim Athletes.

Objective: Disrupted sleep and training behaviors in athletes have been reported during the COVID-19 pandemic. We aimed at investigating the combined effects of Ramadan observance and COVID-19 related lockdown in Muslim athletes. Methods: From an international sample of athletes (n = 3,911), 1,681 Muslim athletes (from 44 countries; 25.1 ± 8.7 years, 38% females, 41% elite, 51% team sport athletes) answered a retrospective, cross-sectional questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: (i) Pittsburgh sleep quality index (PSQI); (ii) insomnia severity index (ISI); (iii) bespoke questions about training, napping, and eating behaviors, and (iv) questions related to training and sleep behaviors during-lockdown and Ramadan compared to lockdown outside of Ramadan. The survey was disseminated predominately through social media, opening 8 July and closing 30 September 2020. Results: The lockdown reduced sleep quality and increased insomnia severity (both p < 0.001). Compared to non-Muslim (n = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both p < 0.001), but not pre-lockdown (p > 0.05). Muslim athletes reported longer (p < 0.001; d = 0.29) and later (p < 0.001; d = 0.14) daytime naps, and an increase in late-night meals (p < 0.001; d = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ2 = 222.6; p < 0.001) and training volume (χ2 = 342.4; p < 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes. Conclusion: Muslim athletes reported lower sleep quality and higher insomnia severity during- compared to pre-lockdown, and this was exacerbated by Ramadan observance. Therefore, further attention to Muslim athletes is warranted when a circadian disrupter (e.g., lockdown) occurs during Ramadan.

Is there a relationship between lower-extremity injuries and foot postures in professional football players? A prospective cohort study.

BACKGROUND: Lower extremity injuries are an ongoing concern for professional football players. This study aims to evaluate the relationship between foot posture and lower extremity injuries in professional football players. METHOD: In this prospective cohort study, 420 male players of the Iran Premium football league were evaluated during the 2015-2016 season. The players were assessed for their foot types based on optical and static foot scans and foot posture index (FPI). The trained club physicians recorded all injuries during the season. RESULT: The analyzed data of 244 players showed the highest rate of lower extremity injury in hamstrings, ankle, and groin, respectively. These injuries led to 46% of time loss. The probability of hamstrings injuries was higher among pronated players based on static, optic, FPI, and visual examination, 2.1, 1.8, 1.8, and 2.3, respectively. Medial Collateral Ligament (MCL) injuries were associated with subtalar joint abnormality defined by visual observation. An increased relative risk of leading-to-absence injuries among the flat foot group was significant based on optic scanning, FPI, and visual observation. CONCLUSION: Abnormal foot postures in professional football players may increase the risk of hamstring and MCL injuries and time loss due to lower extremity injuries.

COVID-19 Lockdowns: A Worldwide Survey of Circadian Rhythms and Sleep Quality in 3911 Athletes from 49 Countries, with Data-Driven Recommendations.

OBJECTIVE: In a convenience sample of athletes, we conducted a survey of COVID-19-mediated lockdown (termed 'lockdown' from this point forward) effects on: (i) circadian rhythms; (ii) sleep; (iii) eating; and (iv) training behaviors. METHODS: In total, 3911 athletes [mean age: 25.1 (range 18-61) years, 1764 female (45%), 2427 team-sport (63%) and 1442 elite (37%) athletes] from 49 countries completed a multilingual cross-sectional survey including the Pittsburgh Sleep Quality Index and Insomnia Severity Index questionnaires, alongside bespoke questions about napping, training, and nutrition behaviors. RESULTS: Pittsburgh Sleep Quality Index (4.3 ± 2.4 to 5.8 ± 3.1) and Insomnia Severity Index (4.8 ± 4.7 to 7.2 ± 6.4) scores increased from pre- to during lockdown (p < 0.001). Pittsburgh Sleep Quality Index was predominantly influenced by sleep-onset latency (p < 0.001; + 29.8%), sleep efficiency (p < 0.001; - 21.1%), and total sleep time (p < 0.001; - 20.1%), whilst Insomnia Severity Index was affected by sleep-onset latency (p < 0.001; + 21.4%), bedtime (p < 0.001; + 9.4%), and eating after midnight (p < 0.001; + 9.1%). During lockdown, athletes reported fewer training sessions per week (- 29.1%; d = 0.99). Athletes went to bed (+ 75 min; 5.4%; d = 1.14) and woke up (+ 150 min; 34.5%; d = 1.71) later during lockdown with an increased total sleep time (+ 48 min; 10.6%; d = 0.83). Lockdown-mediated circadian disruption had more deleterious effects on the sleep quality of individual-sport athletes compared with team-sport athletes (p < 0.001; d = 0.41), elite compared with non-elite athletes (p = 0.028; d = 0.44) and older compared with younger (p = 0.008; d = 0.46) athletes. CONCLUSIONS: These lockdown-induced behavioral changes reduced sleep quality and increased insomnia in athletes. Data-driven and evidence-based recommendations to counter these include, but are not limited to: (i) early outdoor training; (ii) regular meal scheduling (whilst avoiding meals prior to bedtime and caffeine in the evening) with appropriate composition; (iii) regular bedtimes and wake-up times; and (iv) avoidance of long and/or late naps.

SARS-CoV-2 serological assay and viral testing: a report of professional football setting.

PURPOSE OF THE STUDY: PCR is the current standard test for the diagnosis of SARS-CoV-2 infection. However, due to its limitations, serological testing is considered an alternative method for detecting SARS-CoV-2 exposure. In this study, we measured the level of SARS-CoV-2 IgM and IgG antibodies of male professional football players and compared the results with the standard PCR test to investigate the association between the two tests. STUDY DESIGN: Participants were male professional football players and team officials. Nasopharyngeal swabs and peripheral blood samples were collected for the PCR and serological tests, respectively. Also, previous records of COVID-19 testing and symptoms were gathered. Those with previous positive PCR tests who tested negative for the second time were considered to be recovered patients. RESULTS: Of the 1243 subjects, 222 (17.9%) were seropositive, while 29 (2.3%) tested positive for the SARS-CoV-2 PCR test. Sixty percent of symptomatic cases with a negative PCR were found to be seropositive. The mean level of IgM was significantly higher in PCR-positive and symptomatic subjects, whereas the recovered cases showed significantly higher levels of IgG. CONCLUSION: Our study revealed an inconsistency of results between the two tests; therefore, although application of serological assays alone seems insufficient in diagnosing COVID-19 disease, the findings are beneficial in the comprehension and the management of the disease.

A national and sub-national metaregression of the trend of insufficient physical activity among Iranian adults between 2001 and 2016.

Insufficient physical activity (IPA) caused approximately 5% of mortalities in 2017 in Iran, almost double its global average. Despite the relatively considerable burden, a knowledge gap exists regarding the trend of IPA in recent years. We described the trend of IPA prevalence utilizing the data from six rounds of STEPwise approach to risk factor Surveillance (STEPS) in Iran. We estimated the physical activity status of Iranian adults from 2006 to 2016 after adjusting for years of schooling, urbanization percentage, and wealth index. We used the spatiotemporal model to interpolate and extrapolate the IPA prevalence for the years in-between the series and from 2001 to 2006, respectively. We used the data of 177,910 participants from six STEPS surveys and found that the national prevalence of IPA had steadily increased over the course of 16 years and had almost doubled in this time period (23.1% in 2001 to 55.4% in 2016). The increase was persistent across all age and gender strata and in every province. Moreover, IPA was more prevalent among women than their male peers regardless of their age category or province of residence. The prevalence of IPA in Khuzestan (highest prevalence) was almost double compared to that in Lorestan (lowest prevalence) in 2016. The IPA prevalence increased considerably and almost doubled in 16 years among Iranian adults, particularly women. Policies need to target IPA as a high priority contributing to the burden of Non-communicable diseases.

Evaluation of Visual Skills in Soccer Referees and Assistant Referees.

Background: As a soccer referee or an assistant referee, having perfect visual skills is mandatory, which will help make quick and accurate decisions in the field of the play and during matches; however, this skill is not well studied among referrers. This study aimed to assess the visual skills of referees and assistant referees. Methods: Men's professional referees and assistant referees working for the Iran football federation were investigated in 2019. The visual skill investigation consists of the evaluation of static visual acuity, color vision, stereoacuity, intraocular pressure, confrontation test, and eye anatomical assessment with slit lamp. The statistical analysis was performed using the SPSS software Version 18. Results : In this study, 159 men's professional referees and assistant referees with a mean age of 35.52±5.39 were selected. The results of this study showed that 1.88% of the referees and assistant referees had color blindness dyschromatopsia) and 3.14% of them needed more follow-up examinations. The mean spherical equivalent of examined eyes was -0.42D in the right eye and -0.16 D in the left eye. Conclusion: Our results showed that referees and assistant referees both had some kind of visual skill deficiencies. As visual skills are among the fundamental skills for success in referees in dynamic sports such as soccer, all of them must undergo visual skill assessments during the precompetition period to avoid any errors in judgment due to visual disturbances.

Full duodenal rupture after direct abdominal trauma in soccer: a case report of an elite soccer player with follow up and return to play protocol.

Severe traumatic abdominal injuries and duodenal ruptures are relatively rare in soccer and can be easily missed and turn into a life-threatening condition. All team physicians need to be familiar with the warning sign in these situations. This report aims to report a case, discuss the diagnostic and treatment process and the return to play protocol.During a professional female soccer team training session, the injury occurred while the player's epigastrium was hit hardly by the opponent's knee. In the first evaluation, there was only mild epigastrium pain without any other sign. Eventually, pain exacerbated, nausea and vomiting were added. All the initial evaluation (Physical examination, abdominal X-ray, ultrasonography, blood tests) were normal. Eventually, she developed abdominal guarding and underwent abdominopelvic computed tomography with intravenous contrast where Duodenal rupture becomes evident. She underwent laparotomy and full duodenal repair and discharged from the hospital in good health.For the return to play determination in such injuries, the abdomen should not be imposed on any trauma for about 6 months, so while the player can start a self-training session firstly without a ball and then with a ball, she is not allowed to play or train with others for 6 months.

Intraosseous Lipoma of Calcaneus, Rare Cause of Chronic Calcaneal Pain: A Case Report.

Intraosseous lipoma is a rare, benign primary tumor occurring in the bone. Herein, we reported a 45-year-old man with chronic right posterior heel pain. In this study, the man was treated conservatively due to plantar fasciitis. During a one-month follow-up visit, the patient had no symptoms of relief in the right heel pain. Initially, calcaneal X-ray was taken, which revealed an expansile unicameral lytic lesion with central calcification on the right calcaneus. Moreover, computed tomography scan revealed an expansile lytic lesion on the right calcaneus. The diagnosis was confirmed as calcaneal lipoma in magnetic resonance imaging. The patient underwent curettage and autogenous iliac crest corticocancellous bone graft under general anesthesia. In a 3-month postoperative follow-up, the patient returned to full ambulation. Postoperative radiographs demonstrated continued remodeling and healing of the graft site. The purpose of this article was to increase awareness among clinicians about the existence of this rare cause of calcaneal pain.

Pelvic incidence and lumbar spine instability correlations in patients with chronic low back pain.

PURPOSE: Many factors such as lumbar instability and spinopelvic alignment are associated with low back pain. Our purpose was to analyze the pelvic incidence - one of spinopelvic alignment parameters- and spine instability correlations in patients with chronic low back pain. METHODS: Fifty-two patients suffering from chronic low back pain entered this case control study. Lateral spine radiography was taken from patients. pelvic incidence and L3, L4 and L5's vertebral body width were measured for all patients, and lumbar instability was evaluated in 3 different levels: L5-S1, L4-L5 and L3-L4. RESULTS: Thirty-two patients having lumbar instability formed group A and 20 patients without lumbar spine instability allocated to group B. Average age, mean weight, height, body mass index and mean vertebral width of both groups did not differ meaningfully. Pelvic incidence's mean amounts set to 53.9 in group B and 57.7 in group A without any significant difference; but pelvic incidence was significantly lower in patients with lumbar instability of L5-S1 origin (P=0.01). CONCLUSIONS: Overall, pelvic incidence did not differ between two groups. However, separate evaluation of each level revealed lumbar instability of L5-S1 segment to be associated with lower pelvic incidence.