Epidemiology of injuries in professional football: a systematic review and meta-analysis.

OBJECTIVE: We performed a systematic review and meta-analysis of epidemiological data of injuries in professional male football. METHOD: Forty-four studies have reported the incidence of injuries in football. Two reviewers independently extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement and Newcastle Ottawa Scale. Studies were combined in a pooled analysis using a Poisson random effects regression model. RESULTS: The overall incidence of injuries in professional male football players was 8.1 injuries/1000 hours of exposure. Match injury incidence (36 injuries/1000 hours of exposure) was almost 10 times higher than training injury incidence rate (3.7 injuries/1000 hours of exposure). Lower extremity injuries had the highest incidence rates (6.8 injuries/1000 hours of exposure). The most common types of injuries were muscle/tendon (4.6 injuries/1000 hours of exposure), which were frequently associated with traumatic incidents. Minor injuries (1-3 days of time loss) were the most common. The incidence rate of injuries in the top 5 European professional leagues was not different to that of the professional leagues in other countries (6.8 vs 7.6 injuries/1000 hours of exposure, respectively). CONCLUSIONS: Professional male football players have a substantial risk of sustaining injuries, especially during matches.

Electromyographic and Kinematic Analysis of the Flexion-Rotation Trunk Test.

García-Vaquero, MP, Ruiz-Pérez, I, Barbado, D, and Vera-Garcia, FJ. Electromyographic and kinematic analysis of the flexion-rotation trunk test. J Strength Cond Res 34(12): 3386-3394, 2020-Although most trunk endurance field protocols are performed in the sagittal or frontal planes, the flexion-rotation trunk (FRT) test combines trunk flexion with rotation, which may be relevant to rotation-related sports. The aim of this study was to describe the trunk and hip muscle activation and fatigue and the range of hip flexion of this test. Twenty-seven physically active males and females performed the FRT test after a period of practice. Electromyographic (EMG) signals were bilaterally collected from the rectus abdominis (RA), internal oblique (IO), and rectus femoris (RF), and hip flexion amplitude was measured using a biaxial electrogoniometer. Because the fast Fourier transform algorithm requires stationary EMG signals, subjects performed a 6-second isometric trunk flexion-rotation repetition just before and just after the test execution (preexecution and postexecution repetitions, respectively). Rectus abdominis showed the highest mean activation levels (approximately 30% maximal voluntary isometric contractions [MVC]) in the preexecution repetition, followed by IO (approximately 20% MVC). Also, the mean power frequency (MPF) significantly decreased from the pre-execution to the postexecution repetition for RA and IO, which shows abdominal muscle fatigue. Although each trunk flexion-rotation repetition involved an average 8-14° hip flexion, the RF activation was lower than 10% MVC, and no significant MPF reduction (i.e., no muscle fatigue) was observed for this muscle. In addition, significant negative correlations were found between the FRT test scores and the normalized EMG amplitudes of RF. Based on these results, the FRT test seems a valid field protocol to assess abdominal muscle endurance in trunk flexion-rotation exertions.

The influence of a badminton competition with two matches in a day on muscle damage and physical performance in elite junior badminton players.

To investigate the effects of a badminton competition with 2 matches in a day on hip strength and range of motion (ROM) and exercise-induced muscle damage in elite junior badminton players. Twenty players (age: 17±0.8 years; body mass: 62.9±6.5 kg, height: 173.8±8.9 cm) participated in this study. Passive hip internal (IR) and external rotation (ER), abduction (ABD) and adduction (ADD) hip ROM, isometric hip ADD and ABD muscle strength, countermovement vertical jump (CMJ) height and blood creatine kinase concentration (CK) were measured before and after a badminton competition during an international tournament. Blood samples were collected 24 h after the end of the last match. Compared to baseline values, hip IR and ER ROM were significantly decreased at post-competition in the dominant (IR=-9.0%; p=0.007 and ER=-15.2%; p=0.002) and non-dominant limbs (IR=-9.08%; p=0.004 and ER=-19.4%; p<0.001). In contrast, hip ADD (13.5%; p<0.001) and ABD (14.6%; p<0.001) strength increased significantly after the competition in the dominant limb and ABD strength increased significantly in the non-dominant limb (9.2%; p=0.001). From baseline values, CK increased after the competition (430.1%) and values remained elevated over baseline values 24 h later (160.4%). Although hip muscle strength increased, a badminton competition with two consecutive matches reduced hip ROM and increased blood CK concentration. This study suggests the necessity of investigating recovery strategies after a badminton competition to return hip ROM to basal values before the next day of the competition.

A Preventive Model for Hamstring Injuries in Professional Soccer: Learning Algorithms.

Hamstring strain injury (HSI) is one of the most prevalent and severe injury in professional soccer. The purpose was to analyze and compare the predictive ability of a range of machine learning techniques to select the best performing injury risk factor model to identify professional soccer players at high risk of HSIs. A total of 96 male professional soccer players underwent a pre-season screening evaluation that included a large number of individual, psychological and neuromuscular measurements. Injury surveillance was prospectively employed to capture all the HSI occurring in the 2013/2014 season. There were 18 HSIs. Injury distribution was 55.6% dominant leg and 44.4% non-dominant leg. The model generated by the SmooteBoostM1 technique with a cost-sensitive ADTree as the base classifier reported the best evaluation criteria (area under the receiver operating characteristic curve score=0.837, true positive rate=77.8%, true negative rate=83.8%) and hence was considered the best for predicting HSI. The prediction model showed moderate to high accuracy for identifying professional soccer players at risk of HSI during pre-season screenings. Therefore, the model developed might help coaches, physical trainers and medical practitioners in the decision-making process for injury prevention.

Incidence, burden, and pattern of injuries in Spanish male youth soccer players: A prospective cohort study.

OBJECTIVES: To explore the incidence, burden, and pattern of injuries in Spanish male youth soccer players during a 9-month competitive season (from September to May-June). DESIGN: Prospective cohort study. PARTICIPANTS: 314 young (10-19 years) soccer players. MAIN OUTCOME MEASURES: Incidence, burden, location, type, severity, mechanism, and circumstance of injuries, as well as potential differences by tactical position, month of the year, age group, and maturity status. RESULTS: A total of 146 time-loss injuries were sustained by 101 different players. This resulted in an overall injury incidence of 3.1 injuries per 1000 h, a training injury incidence of 1.8 injuries per 1000 h, and a match injury incidence of 11.2 injuries per 1000 h. The probability of injury over the season was 34%. Most of the injuries affected the lower extremity and were classified as muscle/tendon injuries, with hamstring muscle injuries representing the most burdensome diagnosis. The incidence of injuries increased with age and maturation, but a heightened risk of overuse injuries during periods around peak height velocity was also identified. CONCLUSIONS: These findings suggest a need for implementing specific injury prevention measures. Due to the high burden shown, these measures should mainly focus on reducing the number and severity of hamstring muscle injuries.

Epidemiology of injuries in elite male and female futsal: a systematic review and meta-analysis.

The main purpose of this study was to conduct a systematic review and meta-analysis quantifying the incidence of injuries in futsal players. A systematic search was conducted using MEDLINE, PubMed, Web of Science and Scopus databases and subsequently, six studies (14 cohorts) were selected. Separate meta-analyses for male and female players were conducted using a Poisson random-effect regression model approach. The overall and match incidence rates in elite male futsal players were 6.8 (95% CI = 0.0-15.2) and 44.9 (95% CI = 17.2-72.6) injuries/1000 hours of exposure. Pooled training injury rate in male players was not calculated due to the lack of studies reporting training injuries in this cohort. For females, an overall, training and match incidence rates of 5.3 (95% CI = 3.5-7), 5.1 (95% CI = 2.7-7.6) and 10.3 (95% CI = 0.6-20.1) injuries/1000 hours of exposure were reported. In males, match incidence rate in International tournaments was 8.5 times higher than in national leagues (77.2 [95% CI = 60.0-94.5] vs 9.1 [95% CI = 0.0-19.3] for international tournaments and national leagues, respectively). Elite male and female futsal players are exposed to a substantial risk of sustaining injuries, especially during matches.

Comprehensive Lower Extremities Joints Range of Motion Profile in Futsal Players.

The purposes of this study were to describe the lower extremities joints range of motion (ROM) profile using a comprehensive approach in futsal players and to examine potential player position (goalkeepers vs. outfield players), competitive level (first [top] division vs. second division), number of playing years, sex (males vs. females), and bilateral (dominant limb vs. non-dominant limb) differences. A total of 72 male and 67 female elite futsal players from 11 clubs were measured of passive hip (flexion with knee flexed [HF KF ] and extended [HF KE ], extension [HE], abduction [HA], external [HER], and internal [HIR] rotation), knee (flexion [KF]) and ankle (dorsiflexion with knee flexed [ADF KF ] and extended [ADF KE ]) ROMs. Bayesian inferences exploring differences between player position, competitive level, sex and limb were made. A Bayesian correlation analysis was conducted to explore the influence of playing years on joints ROMs. The results showed no significant player position or competitive level related differences in any average ROM score. However, statistically significant sex-related differences were documented whereby female players reported higher hip and knee joints ROM average values than their male counterparts. Especially relevant were the proportions of males (72%) and players from teams engaged in the second division (61%) displaying limited HF KE ROMs. Likewise, around 35% of all players showed restricted ADF KF ROMs. In addition, approximately 21, 18, 22, and 25% of the futsal players were identified as having bilateral asymmetries (≥8°) for HA, HIR, HER, and KF ROMs, respectively. Finally, Bayesian correlation analysis did not report any significant association between years of playing futsal and ROM measures (all r values < 0.34). The implications that these restricted HF KE and ADF KF ROMs and bilateral asymmetries in hip (abduction, internal and external rotation) and knee (flexion) ROMs caused by the practice of futsal may have on physical performance and injury risk warrant future research.

Reliability, validity, and maturation-related differences of frontal and sagittal plane landing kinematic measures during drop jump and tuck jump screening tests in male youth soccer players.

OBJECTIVES: To determine the inter-rater and intra-rater reliability of frontal and sagittal plane landing kinematic measures during drop jump (DVJ) and tuck jump (TJA) tasks in male youth soccer players, to assess the concurrent validity between DVJ and TJA tests, and to evaluate the ability of both tasks to detect differences between players' stage of maturation. DESIGN: Cross-sectional study. PARTICIPANTS: 223 male youth soccer players. MAIN OUTCOME MEASURES: Frontal plane knee projection angles (FPPA), and hip (HF), knee (KF) and ankle (AF) flexion angles at initial contact (IC) and peak flexion (PF) (i.e., the deepest landing position) in the sagittal plane were assessed. RESULTS: Good-to-excellent inter- and intra-rater reliability (ICC > 0.75; TEMST < 0.3; CVTE < 5%) for the FPPA, HF and KF during DVJ and TJA tasks were found. A low concurrent validity between DVJ and TJA measures was reported. Differences by maturity status (BF10 > 10; error < 10; δ > 0.6) were only identified for the TJA. Pre-PHV group reported higher FPPA, HF-IC, HF-PF, and KF-IC values, as well as lower AF-IC than post-PHV. Pre-PHV also displayed greater HF-IC and KF-IC than circa-PHV group. CONCLUSIONS: Although both tests are reliable, the TJA might be viewed as a more informative tool given it shows greater FPPA and can also detect differences by maturity status.

A Field-Based Approach to Determine Soft Tissue Injury Risk in Elite Futsal Using Novel Machine Learning Techniques.

Lower extremity non-contact soft tissue (LE-ST) injuries are prevalent in elite futsal. The purpose of this study was to develop robust screening models based on pre-season measures obtained from questionnaires and field-based tests to prospectively predict LE-ST injuries after having applied a range of supervised Machine Learning techniques. One hundred and thirty-nine elite futsal players underwent a pre-season screening evaluation that included individual characteristics; measures related to sleep quality, athlete burnout, psychological characteristics related to sport performance and self-reported perception of chronic ankle instability. A number of neuromuscular performance measures obtained through three field-based tests [isometric hip strength, dynamic postural control (Y-Balance) and lower extremity joints range of motion (ROM-Sport battery)] were also recorded. Injury incidence was monitored over one competitive season. There were 25 LE-ST injuries. Only those groups of measures from two of the field-based tests (ROM-Sport battery and Y-Balance), as independent data sets, were able to build robust models [area under the receiver operating characteristic curve (AUC) score ≥0.7] to identify elite futsal players at risk of sustaining a LE-ST injury. Unlike the measures obtained from the five questionnaires selected, the neuromuscular performance measures did build robust prediction models (AUC score ≥0.7). The inclusion in the same data set of the measures recorded from all the questionnaires and field-based tests did not result in models with significantly higher performance scores. The model generated by the UnderBagging technique with a cost-sensitive SMO as the base classifier and using only four ROM measures reported the best prediction performance scores (AUC = 0.767, true positive rate = 65.9% and true negative rate = 62%). The models developed might help coaches, physical trainers and medical practitioners in the decision-making process for injury prevention in futsal.

Injury incidence, characteristics and burden among female sub-elite futsal players: a prospective study with three-year follow-up.

The main purpose of the current study was to analyze the injury incidence, characteristics and burden among sub-elite female futsal players. Individual exposure to match play and training, injury incidence and characteristics (player position, injury mechanism, type of injuries, severity of injuries, recurrent vs. new injuries, season variation of injury pattern) in a female futsal team were prospectively recorded for three consecutive seasons (2015-2018). Incidences were calculated per 1,000 h of exposure. A total of 30 injuries were reported during the three seasons within a total exposure of 4,446.1 h. The overall, match and training incidence of injuries were 6.7, 6.4 and 6.8 injuries/1,000 h of exposure, respectively. Most injuries had a non-contact mechanism (93%), with the lower extremity being the most frequently injured anatomical region (5.62 injuries/1,000 h of exposure). The most common type of injury was muscle/tendon (4.9 injuries/1,000 h of exposure) followed by joint (non-bone) and ligament (1.3 injuries/1,000 h of exposure). The injuries with the highest injury burden were those that occurred at the knee (31.9 days loss/1,000 h exposure), followed by quadriceps (15.3 day loss/1,000 h) and hamstring (14.4 day loss/1,000 h) strains. The first few weeks of competition after pre-season and soon after the Christmas break were the time points when most injuries occurred. These data indicate that sub-elite female futsal players are exposed to a substantial risk of sustaining an injury. To reduce overall injury burden, efforts should be directed toward the design, implementation and assessment of preventative measures that target the most common diagnoses, namely, muscle/tendon and ligament injuries.