'More than likely the men come first. That's just very frustrating'. A qualitative exploration of contextual factors affecting the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club football in Ireland.

OBJECTIVES: The aim of our study was to explore the contextual factors that affect the implementation of football injury prevention initiatives and the provision of effective injury management in the Irish Women's National League (WNL). METHODS: We used a criterion-based purposive sampling approach to recruit coaches (n=7), players (n=17) and medical personnel (n=8) representing eight of the nine clubs in the WNL to participate in one-to-one semistructured interviews. Our study was located within an interpretivist, constructivist research paradigm. The interview data were analysed using reflexive thematic analysis. RESULTS: The participants identified academic and work pressures, financial challenges, conflict with college football, inadequate facilities and gender inequity as being barriers to the implementation of injury prevention initiatives and the provision of effective injury management. Financial constraints within clubs were perceived to limit the provision of medical care and strength and conditioning (S&C) support and this was deemed to be associated with a heightened risk of injuries. CONCLUSION: Specific contextual factors were identified which curtail the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club football in Ireland. Gender inequity was identified as one of the factors impacting the availability of high-quality medical care, S&C support, as well as access to training and match facilities. Our results provide new insights that could be used to inform the design and implementation of injury prevention and management initiatives for women football players in Ireland.

Injury incidence rates in women's football: a systematic review and meta-analysis of prospective injury surveillance studies.

OBJECTIVE: To review the literature to establish overall, match and training injury incidence rates (IIRs) in senior (≥18 years of age) women's football (amateur club, elite club and international). DESIGN: Systematic review and meta-analysis of overall, match and training IIRs in senior women's football, stratified by injury location, type and severity. DATA SOURCES: MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO and Web of Science were searched from earliest record to July 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: (1) football players participating in a senior women's football league (amateur club or elite club) or a senior women's international football tournament; (2) the study had to report IIRs or provide sufficient data from which this outcome metric could be calculated through standardised equations; (3) a full-text article published in a peer-reviewed journal before July 2021; (4) a prospective injury surveillance study and (5) case reports on single teams were ineligible. RESULTS: 17 articles met the inclusion criteria; amateur club (n=2), elite club (n=10), international (n=5). Overall, match and training 'time-loss' IIRs are similar between senior women's elite club football and international football. 'Time-loss' training IIRs in senior women's elite club football and international football are approximately 6-7 times lower than their equivalent match IIRs. Overall 'time-loss' IIRs stratified by injury type in women's elite club football were 2.70/1000 hours (95% CI 1.12 to 6.50) for muscle and tendon, 2.62/1000 hours (95% CI 1.26 to 5.46) for joint and ligaments, and 0.76/1000 hours (95% CI 0.55 to 1.03) for contusions. Due to the differences in injury definitions, it was not possible to aggregate IIRs for amateur club football. CONCLUSION: Lower limb injuries incurred during matches are a substantial problem in senior women's football. The prevention of lower limb joint, ligament, muscle and tendon injuries should be a central focus of injury prevention interventions in senior women's amateur club, elite club and international football. PROSPERO REGISTRATION NUMBER: CRD42020162895.

The selection advantages associated with advanced biological maturation vary according to playing position in national-level youth soccer.

This study investigated the extent to which biological maturation selection biases existed according to playing position in national-level youth soccer. A total of 159 players from the U13 to U16 age groups in the Football Association of Ireland's national talent pathway and international representative squads had their relative biological maturity status assessed using the Khamis-Roche method for the percentage of predicted adult height at the time of observation. Players were categorised as goalkeeper (GK), central defender (CD), full-back (FB), centre defensive midfielder (CDM), centre midfielder (CM), centre attacking midfielder (CAM), wide midfielder (WM) or centre forward (CF). A series of one-sampled means t-tests were used to examine the degree to which biological maturation selection biases existed across playing positions. A non-parametric Kruskal-Wallis test was used to evaluate inter-positional differences. A small to very large selection bias in favour of early maturing players existed for GK (D = 0.7), CD (D = 1.65), FB (D = 0.49), CM (D = 0.62), WM (D = 0.78), and CF (D = 0.76) (p < 0.05). Maturational selection biases did not exist for CDM or CAM. Moreover, CD were significantly more advanced in maturation compared to FB, CDM and CAM (p < 0.05). This study supports the contention that maturation selection biases exist in youth soccer, but the magnitude of this bias is highly dependent upon playing position. The very strong maturity selection biases at the national level evidenced in this investigation highlight the need for Football Associations to explore strategies, such as futures programmes, to help to retain talented, yet late maturing athletes.

Injuries in elite-level women's football-a two-year prospective study in the Irish Women's National League.

We investigated the pattern of injuries in elite-level women's football in Ireland, during a two-season prospective injury surveillance study in the Women's National League (WNL). Seven out of the eight clubs (271 players) in the WNL were followed prospectively during the 2018 and 2019 seasons. The injury incidence rate in matches (19.2/1000 h) was 7.5 times higher than in training (2.5/1000 h). Players, on average, sustained 0.69 injuries per season (266 injuries/383 player seasons), which equates to 15 time-loss injuries per season for a squad of 22 players. The majority of the injuries sustained by players were lower extremity injuries (85%), of which, 46% had a non-contact injury mechanism. Muscle, ligament, and contusion injuries were the most common injury types, while the ankle, knee, and thigh were the most commonly injured body sites. The most common injuries sustained over the two seasons were lateral ankle sprains (13.9%), hamstring strains (12.4%), knee meniscus/cartilage injuries (7.5%), adductor strains (6%), quadriceps strains (4.5%), and ankle contusions (4.5%). The injuries with the highest injury burden were ACL injuries (59 days lost/1000 h), knee meniscus/cartilage injuries (23/1000 h), lateral ankle sprains (21/1000 h), hamstring strains (12/1000 h), MCL sprains (11/1000 h), and quadriceps strains (11/1000 h). There were 8 ACL tears documented over the 2 seasons, which accounted for 28% of all time lost to injury with a mean days lost per injury of 247. We recommend that clubs in the WNL in Ireland should implement injury risk mitigation strategies, with a particular focus on injuries with a high injury burden.

Players', Head Coaches', And Medical Personnels' Knowledge, Understandings and Perceptions of Injuries and Injury Prevention in Elite-Level Women's Football in Ireland.

BACKGROUND: To manage injuries effectively, players, head coaches, and medical personnel need to have excellent knowledge, attitudes, and behaviours in relation to the identification of risk factors for injuries, the implementation of injury prevention initiatives, as well as the implementation of effective injury management strategies. Understanding the injury context, whereby specific personal, environmental, and societal factors can influence the implementation of injury prevention initiatives and injury management strategies is critical to player welfare. To date, no qualitative research investigating the context of injuries, has been undertaken in elite-level women's football. The aim of our study was to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish Women's National League (WNL) to injury prevention and injury management. METHODS: We used qualitative research methods to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish WNL to injury prevention and injury management. Semi-structured interviews were undertaken with 17 players, 8 medical personnel, and 7 head coaches in the Irish WNL. The data were analysed using thematic analysis. Our study is located within an interpretivist, constructivist research paradigm. RESULTS: The participants had incomplete knowledge of common injuries in elite-level football, and many held beliefs about risk factors for injuries, such as menstrual cycle stage, which lacked evidence to support them. Jumping and landing exercises were commonly used to reduce the risk of injuries but evidence-based injury prevention exercises and programmes such as the Nordic hamstring curl, Copenhagen adduction exercise, and the FIFA 11+ were rarely mentioned. Overall, there was dissatisfaction amongst players with their medical care and strength and conditioning (S & C) support, with resultant inadequate communication between players, head coaches, and medical personnel. CONCLUSION: Poor quality and availability of medical care and S & C support were considered to be a major obstacle in the effective implementation of injury risk reduction strategies and successful return-to-sport practices. More original research is required in elite-level women's football to explore injury risk factors, injury prevention initiatives, and contextual return-to-sport strategies, so that players, head coaches, and medical personnel can use evidence that is both up-to-date and specific to their environment.

Quantification of internal and external training load during a training camp in senior international female footballers.

OBJECTIVE: This study aimed to quantify the internal and external training load profile of an international training camp and identify any differences between positional groups or starting status. METHODS: 18 players were sampled using a global positioning system (GPS) and internal training load (TL) via session rate of perceived exertion (RPE). RESULTS: Internal and external training load variation was present across all six individual training sessions. Results indicated match day -7 (MD-7), had significantly (P= 0.001) less training volume (3339.5 m) than all other training sessions. MD-5 and MD-2 were the most intense (387.5 and 201 m very high speed running (VHSR) and 187.5 and 49 m sprint distance (SPD) respectively in combination with large volume (5933.5 and 5151.5 m). Differences in playing position and starting status were observed in MD-2. Forwards (FW) covered significantly greater distances of VHSR (P= 0.008) and SPD (P= 0.008) in comparison to midfielders (MF) whilst starters reported significantly (P = 0.013) higher internal training loads (TL). CONCLUSION: This study provides the first report on training load in elite female footballers during an international training camp including a competitive fixture highlighting the undulation of training loads across the individual training sessions, playing positions and starting status.

The Irish Football Player Pathway: Examining Stakeholder Coherence Throughout and Across the Player Development System.

Maximizing the efficiency of the player development system is a strategic priority for any professional football club or association. However, the successful development of a young footballer is largely dependent upon the roles and relationships of the different stakeholders invested in the developmental process. This study examined the level of horizontal (i.e., extent to which stakeholders across a pathway stage work with players in an agreed fashion to optimize their experience) and vertical (i.e., extent to which multiple stages of the pathway are coordinated and build chronologically from previous involvement toward long-term needs) stakeholder coherence throughout the Irish football player pathway following a restructuring of development policies and the implementation of a nationwide academy system between 2016 and 2020 under the Football Association of Ireland's (FAI) Player Development Plan. As a second aim, we explored each of the key stakeholders' alignment to academic talent development principles in order to provide practical recommendations for future player and coach development policies. Accordingly, a series of interviews were conducted with 31 key stakeholders currently engaged in the player pathway. These key stakeholders consisted of parents, coaches and members of the FAI as the National Governing Body for football in Ireland. Data were analyzed using Reflexive Thematic Analysis, with findings highlighting a lack of stakeholder coherence across the pathway, both vertically and horizontally. Stakeholders displayed inconsistency in their understanding of the purpose of the player pathway and its long-term strategic aims, as well as demonstrating poor and incohesive relationships with each of the different stakeholders. Moreover, talent development principles between the different stakeholders appeared well-understood overall, although the practical implementation of several of these principles in applied practice did not appear to exist. Results highlight the need for organizational intervention and structural change across the Irish player pathway to maximize long-term player development in the future. Practical implications for the FAI are discussed and recommendations are made to support optimal player development policies moving forward.

Premature Professionalisation or Early Engagement? Examining Practise in Football Player Pathways.

There is a growing debate, both in the academic and sporting worlds, about the most appropriate pathway for high potential young players in sport. In this regard, there has been a considerable focus on the age of selection into structured talent development pathways and the nature of the experience once players have been recruited. Given the economic and reputational currency associated with developing professional footballers in particular, it is unsurprising that professional football clubs continue to invest significant financial resources into their academy structures. Understandably, this recruitment policy has attracted substantial attention within the media and research community, with ethical concerns arising surrounding the impact early selection may have on the welfare and the experiences of the young players within the pathway. The aim of this perspective article was to critically consider the research underpinning the early engagement practises of football clubs and the extent to which, and how, the pathway can provide players with the most appropriate starting point for their development. This evidence points to the need to look beyond the prevalent 'early specialisation vs. diversification' debate in youth sport towards a consideration of an early engagement perspective that reflects the biopsychosocial influences on talent development and the socio-political environment that influences decisions. We provide practical recommendations focused on the quality of the early engagement experience.

Combination therapy in the Col1a2G610C mouse model of Osteogenesis Imperfecta reveals an additive effect of enhancing LRP5 signaling and inhibiting TGFß signaling on trabecular bone but not on cortical bone.

Enhancing LRP5 signaling and inhibiting TGFß signaling have each been reported to increase bone mass and improve bone strength in wild-type mice. Monotherapy targeting LRP5 signaling, or TGFß signaling, also improved bone properties in mouse models of Osteogenesis Imperfecta (OI). We investigated whether additive or synergistic increases in bone properties would be attained if enhanced LRP5 signaling was combined with TGFß inhibition. We crossed an Lrp5 high bone mass (HBM) allele (Lrp5A214V) into the Col1a2G610C/+ mouse model of OI. At 6-weeks-of-age we began treating mice with an antibody that inhibits TGFß1, ß2, and ß3 (mAb 1D11), or with an isotype-matched control antibody (mAb 13C4). At 12-weeks-old, we observed that combining enhanced LRP5 signaling with inhibited TGFß signaling produced an additive effect on femoral and vertebral trabecular bone volumes, but not on cortical bone volumes. Although enhanced LRP5 signaling increased femur strength in a 3-point bending assay in Col1a2G610C/+ mice, femur strength did not improve further with TGFß inhibition. Neither enhanced LRP5 signaling nor TGFß inhibition, alone or in combination, improved femur 3-point-bending post-yield displacement in Col1a2G610C/+ mice. These pre-clinical studies indicate combination therapies that target LRP5 and TGFß signaling should increase trabecular bone mass in patients with OI more than targeting either signaling pathway alone. Whether additive increases in trabecular bone mass will occur in, and clinically benefit, patients with OI needs to be determined.