Do Sports-related Concussions Induce Subsequent Injuries in Elite Male Football Players?

To assess the players' risk of a subsequent injury after sustaining concussive injuries and their return-to-competition in German professional men's football. A prospective injury database in the 1st Bundesliga was created encompassing 7 seasons (2014/15-2020/21). Cox proportional hazard model analyzed whether a concussive injury increased the risk of a subsequent injury in the first year after the index injury. 6,651 injuries were reported (n=182 concussive injuries). The incidence rate was 0.15 (95% CI 0.13-0.17) per 1000 football hours. A concussive injury was associated with only a slightly numerical higher risk of 7% (HR=1.07, 95% CI 0.78-1.47) in the subsequent year after the injury compared to a randomly selected non-concussive injury, but the effect was not significant. The risk was higher after 6-12 months post-SRC reaching 70% (HR=1.70, 95% CI 1.15-2.52). For 0-3 months (HR=0.76, 95% CI 0.48-1.20) and 3-6 months (HR=0.97, 95% CI 0.62-1.50) the injury risk was lower. The present data do not confirm previously published investigations about an increased injury risk after SRC. Contrasting effects of lower hazard ratios were found early after SRC, followed by an increase after 6-12 months. Further research should look into compliance rates with regards to return-to-competition protocols.

No increased injury incidence in the German Bundesliga after the SARS-CoV-2 virus lockdown.

INTRODUCTION: The coronavirus lockdown in 2020 resulted in a worldwide suspension of professional sports. The first major professional football league to restart after the lockdown was the German Bundesliga. This study investigates whether the injury incidence increased after the restart of the season with only 9 days of regular preparation time and without any friendly matches in comparison to three control periods. MATERIALS AND METHODS: In a prospective cohort study, injury analysis (at least 1 day of absence from official football matches or training sessions) of the German Bundesliga registry was standardised according to Hägglund et al. (Br J Sports Med 39:340-346, 2005) and Fuller et al. (Clin J Sports Med 16:97-106, 2006) for data collection and to previous publications for the validated use of media sources for injury registration. The study period after the lockdown in May and June of the 2019-2020 season was compared to three control periods: the period directly before the lockdown, the beginning of the 2019-2020 season and the 2018-2019 season final. RESULTS: The nine match days after the restart of the 2019-2020 season showed an overall injury incidence of 4.9 per 1000 h football. This rate was significantly lower than that of the previous season final (9 last match days, overall injury incidence: 6.9 per 1000 h football; p < 0.001) and not increased compared to the rates after the summer break (9 match days; incidence: 5.5/1000 h, p > 0.05) or the winter break (8 match days; incidence: 5.6/1000 h, p > 0.05). CONCLUSION: The period after the unexpected break in the 2019-2020 season due to the coronavirus lockdown and the rapid return to competition showed no increase in the injury rate compared to the pre-lockdown period and a lower injury rate than in the previous season final. The unintentional mid-season rest with its potential for physical recovery and individual fitness training seems to have had a positive effect on injury occurrence.

Epidemiology of Football Injuries of the German Bundesliga: A Media-Based, Prospective Analysis over 7 Consecutive Seasons.

BACKGROUND: This study describes the implementation of a standardised, prospective injury database covering the entire 1st male German football league ("Bundesliga") based on publicly available media data. For the first time, various media sources were used simultaneously as the external validity of media-generated data was low in the past compared to data obtained by way of the "gold standard", i.e. by the teams' medical staffs. METHODS: The study covers 7 consecutive seasons (2014/15-2020/21). The primary data source was the online version of the sport-specific journal "kicker Sportmagazin™" complemented by further publicly available media data. Injury data collection followed the Fuller consensus statement on football injury studies. RESULTS: During the 7 seasons, 6653 injuries occurred, thereof 3821 in training and 2832 in matches. The injury incidence rates (IRs) per 1000 football hours were 5.5 [95% CI 5.3-5.6], 25.9 [25.0-26.9] per 1000 match, and 3.4 [3.3-3.6] per 1000 training hours. Twenty-four per cent of the injuries (n = 1569, IR 1.3 [1.2-1.4]) affected the thigh, 15% (n = 1023, IR 0.8 [0.8-0.9]) the knee, and 13% (n = 856, IR 0.7 [0.7-0.8]) the ankle. Muscle/tendon injuries contributed 49% (n = 3288, IR 2.7 [2.6-2.8]), joint/ligament injuries 17% (n = 1152, IR 0.9 [0.9-1.0]), and contusions 13% (n = 855, IR 0.7 [0.7-0.8]). Compared to studies using injury reports from the clubs' medical staff, media data revealed similar proportional distributions of the injuries, but the IRs tended towards the lower end. Obtaining specific locations or diagnosis especially with regard to minor injuries is difficult. CONCLUSIONS: Media data are convenient for investigating the quantity of injuries of an entire league, for identifying injuries for further subanalysis, and for analysing complex injuries. Future studies will focus on the identification of inter- and intraseasonal trends, players' individual injury histories, and risk factors for subsequent injuries. Furthermore, these data will be used in a complex system approach for developing a clinical decision support system, e.g. for return to play decisions.