Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data.

PURPOSE: Psychological factors have shown to be predictors of injury in professional football. However, it seems that this is a two-way relationship, as severe musculoskeletal time-loss injuries have shown to be associated with the onset of symptoms of common mental disorders (CMD). There is no longitudinal study performed exploring this interaction between symptoms of CMD and injuries. The purpose of this study was to explore the interaction between severe musculoskeletal time-loss injuries and symptoms of CMD in professional football players over a 12-month period. METHODS: Players were recruited by their national players' unions in five European countries. Symptoms of CMD included in the study were related to distress, anxiety/depression, sleep disturbance and adverse alcohol use. RESULTS: A total of 384 professional football players were enrolled in the study, of whom 262 (68%) completed the 12-month follow-up period. The mean age of the participants at baseline was 27 ± 5 years, and they had played professional football for 8 ± 5 years on average. Symptoms of CMD at baseline were not associated with the onset of severe musculoskeletal time-loss injuries during the follow-up period with relative risks (and 95% CI) ranging from 0.6 (0.3-1.0) to 1.0 (0.5-2.2). In contrast, severe musculoskeletal time-loss injuries reported at baseline were associated with the onset of symptoms of CMD during the follow-up period with relative risks ranging from 1.8 (0.8-3.7) to 6.9 (4.0-11.9). CONCLUSION: No relationship was found between symptoms of CMD and the onset of severe musculoskeletal time-loss injuries. However, professional football players who suffered from severe musculoskeletal time-loss injuries are likely to develop subsequent symptoms of CMD. This study emphasizes the need for an interdisciplinary medical approach, which not only focuses on the physical but also on the mental health of professional football players. An early identification of players at risk of symptoms of CMD, such as those suffering from severe musculoskeletal injuries, creates the opportunity for an interdisciplinary clinical medical team to treat the players timely and adequately. LEVEL OF EVIDENCE: Prospective cohort study, Level II.

Mental and psychosocial health among current and former professional footballers.

BACKGROUND: In common with elite athletes from other sport disciplines, severe or recurrent injuries in professional footballers are considered to be major physical and psychosocial stressors, which may predispose to mental health problems during and after their career. AIMS: To determine the prevalence of mental health problems and psychosocial difficulties in current and former professional footballers, and to explore the association between psychosocial stressors and the health conditions studied. METHODS: Based on validated scales, a paper and electronic questionnaire was developed for current and former professional footballers and distributed by the World Footballers' Union (FIFPro) and players' unions in six countries. Prevalence was calculated and cross-sectional analyses were conducted. RESULTS: The response rate was 29% with 253 responses available for analysis. The prevalence of mental health complaints ranged from 5% (burnout) to 26% (anxiety/depression) in 149 current players and from 16% (burnout) to 39% (anxiety/depression) in 104 former footballers. The prevalence of psychosocial problems ranged from 3% (low self-esteem) to 26% (adverse nutrition behaviour) in current players and from 5% (low self-esteem) to 42% (adverse nutrition behaviour) in former footballers. In both current and former players, mental health problems were significantly associated with low social support (odds ratio [OR] = 1.1) and recent life events (OR = 1.4-1.6). In former players, previous surgery was significantly associated with smoking (OR = 1.9). CONCLUSIONS: The prevalence of mental health problems and/or psychosocial difficulties in current and former professional footballers was found to be high. The presence of mental health problems was associated with low social support and recent life events.

Medical examinations undertaken by Dutch professional football clubs.

BACKGROUND: During their career, professional football players undergo periodic medical examinations intended to screen and monitor their fitness and health. In the Netherlands, information about the content of these examinations is lacking and it is not known whether they comply with current Dutch occupational medicine guidelines. AIMS: To explore the content of medical examinations undertaken in Dutch professional football clubs, and assess whether they comply with current Dutch occupational medicine guidelines. METHODS: An observational study conducted among physicians working for all clubs in the Dutch first- and second-tier professional football leagues, using an electronic questionnaire. RESULTS: Cardiovascular assessment based on different instruments was used in all clubs and respiratory assessment based on different instruments was used in most (87%). Other assessments such as mental health (7%), neurological (27%) or urinary (22%) assessments were only undertaken in some clubs. Seven out of the 26 clubs met some of the relevant aspects of current Dutch occupational medicine guidelines. CONCLUSIONS: The medical examinations currently undertaken in Dutch professional football clubs are diverse in nature and not consistent from one club to another. Only a limited number of clubs meet Dutch guidelines for periodic medical examinations of workers.

Risk and consequences of osteoarthritis after a professional football career: a systematic review of the recent literature.

BACKGROUND: The aim of the present study was to assess whether previous injury is a risk determinant for knee and ankle osteoarthritis (OA) in former professional football players and to explore OA-related activity and work limitations. METHODS: To retrieve the relevant recent literature, the Medline, Embase and Sportdiscus databases were systematically searched for studies published from January 2000 to May 2012. Included studies must be primary studies that are written in English, Dutch, French or German and involve former professional football players; injury had to be studied as an independent variable; and knee/ankle OA, work participation or limited activities had to be described as an outcome. The data from included studies were extracted using a standardised extraction form, and the methodological quality was assessed. RESULTS: No studies were retrieved about injury as a risk determinant for knee/ankle OA in former professional football players. Four studies about OA-related activity and work limitations were included (three of high and one of moderate methodological quality). Up to 17% of former professional football players with knee/ankle OA reported suffering from joint pain and discomfort during activities such as squatting, walking and climbing stairs. Former professional football players with knee/ankle OA reported that their conditions were very painful, chronically painful and affected their daily lives, while 28% reported work-related limitations. CONCLUSION: Knee and ankle OA in former professional football players causes joint pain and discomfort that has negative consequences for daily life and work activities. An OA health examination programs should be developed to empower the sustainable health and functioning of professional football players.

Pain, impairment, medication use and health-related quality of life of retired professional rugby players.

Background: Rugby is a physically demanding sport with a high injury rate. Professional male rugby players have a notably greater risk of sustaining injuries that require hospitalisation or surgery than male athletes from non-contact sports. Retired elite male rugby players experience physical and mental health conditions as well as varying levels of pain, negatively impacting their quality of life. Retired rugby players could use medication or substances as a coping mechanism to deal with chronic pain and a lower quality of life. However, research is scarce on how retired rugby players manage pain and how this affects their quality of life. Objectives: This study aimed to understand joint pain and impairment, mental and physical quality of life, and pain medication use in retired professional male rugby players. Methods: A cross-sectional study was conducted using a questionnaire completed by retired professional male rugby players. Joint pain and impairment were explored through three questions, health-related quality of life was assessed through the PROMIS-GH, and medication use was explored through 12 questions. Results: Retired rugby players (N=142) reported higher scores than matched controls (N=49) for joint pain and impairment, including significantly higher scores for joint impairments for activities of daily living (p=0.047). The global mental health scores of retired rugby players were significantly lower compared to matched controls (p=0.043) and the global physical health scores were also lower in retired rugby players. Most retired rugby players reported not using prescription pain medication (75%) or over-the-counter pain medication (56%). Conclusion: Professional rugby careers have a considerable impact on the joint health and overall well-being of retired players, resulting in unique challenges. The findings of this study emphasise the need for specific after-career support for challenges faced by retired rugby players.

Headers and concussions in elite female and male football: a pilot study.

Background: Heading is a risk factor for neurogenerative disease in football. However, the exposure to heading in elite football training is understudied. Objectives: The primary purpose of this study was to determine the exposure to headers in elite men's and women's football and to describe the effects of the headers on ocular markers. Methods: Exposure to headers was observed over three days of women's and men's football. The number of headers at each session was determined through video analysis, and the G-force was determined via an impact tracker. Ocular markers were assessed at the start and end of the three days, and the results were compared to determine if there were any changes. Self-reported exposure to heading was recorded after each session and compared to the number of headers observed through video analysis, to assess the validity of players' self-reporting. Results: Female players made an average of 11 headers per player per session. Ninety percent of the headers were below 10G, and none were above 80G. Male players made an average of three headers per player per session, with 74% of the headers recording a G-force above 10G and 3% above 80G. No meaningful changes were observed post-session in the ocular markers, and no concussions were observed. Neither cohort was able to accurately self-report exposure to headers. Conclusion: Longitudinal studies should be designed and conducted across different levels of play in both women and men's football as a prerequisite to develop evidence-based measures to prevent or mitigate the potential risks associated with headers and concussions in elite football.

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review.

OBJECTIVE: Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs? METHODS: A systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed. RESULTS: Of the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies. CONCLUSIONS: Strong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Osteoarthritic changes in the knees of recently retired male professional footballers: a pilot study.

Background: Knee osteoarthritis (OA) is common amongst retired male professional footballers. There is limited understanding with respect to the interplay between imaging findings, clinical presentation and patient-reported outcome measures (PROMs) in retired professional footballers with knee OA. Objectives: This pilot study aimed to evaluate the extent of radiological and clinical knee OA in a cohort of retired male professional footballers, and to explore the relationship between these findings and knee-related PROMs. Methods: Fifteen retired male professional footballers underwent knee radiographs and were surveyed on their history of clinical OA, severe knee injury and previous knee surgery. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess health outcomes, such as level of function and pain. Results: Radiological knee OA was diagnosed in six out of 15 participants. Seven of the participants had a clinical diagnosis of knee OA. Evidence of clinical and radiological OA was present amongst four participants. Radiological knee OA and clinical OA was significantly associated with a history of severe knee injury and previous knee surgery. Low correlations (ρ<-0.40) were found between knee OA severity and knee-related PROMs. Moderate correlation (ρ=-0.65) was found between clinical knee OA and KOOS-SP. Conclusion: Clinical knee OA correlates with PROMs amongst retired professional footballers but radiological OA does not. Further studies are required to understand the relationship between imaging findings, clinical presentation and PROMs amongst retired professional footballers with knee OA.

The congested International Match Calendar in football: views of 1055 professional male players.

BACKGROUND: The International Match Calendar congestion affects players recovery. The views of a worldwide cohort of professional football players is shared in this communication. METHODS: A cross-sectional observational study recruited players through Fédération Internationale des Associations de Footballeurs Professionnel's national members. An electronic survey was shared in English, French, Italian and Spanish with 1055 players consenting and completing it anonymously in November 2021. RESULTS: A total of 42% of respondents believe back-to-back matches should be limited to three. Most respondents (69%) felt off or in season breaks are infringed by clubs or national teams and 83% believe regulations should protect them. A total of 55% of players believed they sustained one or more injuries due to the overload and it has affected 52% of respondents' mental state. CONCLUSION: The congested International Match Calendar poses a risk to professional footballers physical and mental health. Poor recovery between matches may affect player availability and performance. Players should be represented by active players when International Match Calendar scheduling decisions are made. Administrators should seek medical guidance regarding the effects of overload on performance prior to making decisions. This study allows the opportunity for a larger national team player sample to be studied.

The effectiveness of an online intervention in stimulating injury-preventive behaviour in adult novice runners: Results of a randomised controlled trial.

Background: The online intervention Runfitcheck was developed to stimulate injury-preventive behaviour among adult novice runners. Objectives: This study evaluated the effectiveness of Runfitcheck on injury-preventive behaviour among adult novice runners. Methods: A randomised controlled trial was conducted among adult novice runners. The intervention group had access to the Runfitcheck intervention, the control group performed their running activities as usual. One, three, and five months after enrolment, participants reported retrospectively what they had done regarding injury-preventive behaviour (operationalised as (i) using a (personalised) training schedule; (ii) performing strength and technique exercises; and (iii) performing a warm-up routine prior to running). Relative Risks (RR) and 95% Confidence Interval (95%CI) were used to analyse behavioural change. Results: The intervention group (n=715) searched more often for information about a warm-up routine (RR 1.211; 95%CI 1.080-1.357), and added more often strength exercises to their warm-up routine (RR 1.228; 95%CI 1.092-1.380). The intervention group performed more often running technique exercises compared to the control group (n=696) (RR 1.134; 95%CI 1.015-1.267), but less often strength exercises (RR 0.865 (95%CI 0.752-0.995). Within the group of runners that did not perform any warm-up routine at enrolment (n=272), the intervention group started to perform a regular warm-up routine more often than the control group (RR 1.461; 95%CI 1.084-1.968). No significant results were found for using a training schedule. Conclusion: The online intervention Runfitcheck was effective in stimulating aspects of injury-preventive behaviour in adult novice runners, mostly related to a warm-up routine. Trial registration: NL6225, Registered April 24th 2007 - Retrospectively registered, https://www.trialregister.nl/trial/6225.

Sports career-related concussion and mental health symptoms in former elite athletes.

BACKGROUND: In elite sports, concussion is common and recurrent, especially in high-speed contact or collision sports such as american and australian football, ice hockey and rugby. Mental health symptoms (e.g., anxiety, depression, sleep disturbance) are often reported by former elite athletes, with prevalence ranging from 16% for distress to 26% for anxiety/depression. This article focuses on the potential relationship between sports career-related concussion and mental health symptoms in former elite athletes. METHOD: A narrative mini-review was based on the scientific literature. RESULTS: Some literature based on cross-sectional data suggests that sports career-related concussion might lead in the long term to mental health symptoms in former elite athletes. Retired professional American football players reporting three or more previous concussions were found to be three times more likely to be diagnosed with depression than those with no history of concussion. Former professional athletes from football, ice hockey and rugby who reported a history of six or more concussions were approximately up to five times more likely to report mental health symptoms. CONCLUSIONS: While longitudinal evidence about any causal relationship is lacking, the suggested relationship between sports career-related concussion and mental health symptoms in former elite athletes warrants the development of support measures for elite athletes transitioning out of sport, especially for those with a history of concussion.

Criterion-related validity of functional capacity evaluation lifting tests on future work disability risk and return to work in the construction industry.

OBJECTIVES: To assess the criterion-related validity of the five Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave due to musculoskeletal disorders (MSDs). METHODS: Six weeks, 6 months and 1 year after the first sick leave day due to MSDs, construction workers underwent two isometric and three dynamic EK FCE lifting tests, and completed the Instrument for Disability Risk (IDR) for future work disability risk. Concurrent and predictive validity were assessed by the associations between the scores of the EK FCE lifting tests and the IDR outcomes (Pearson Correlation coefficients (r) and associated proportions of variance (PV) and area under receiver operating characteristic curve (AUC)). Predictive validity of the EK FCE lifting tests on the total number of days on sick leave until full durable return to work (RTW) was also evaluated (Cox regression analysis). RESULTS: Concurrent validity with future work disability risk was poor for the two isometric EK FCE lifting tests (-0.15

Stimulating injury-preventive behaviour in sports: the systematic development of two interventions.

BACKGROUND: In addition to the beneficial health effects of being active, sports are also associated with a risk of sustaining injuries. To avoid the occurrence of sports injuries, preventive measures can be applied. The aim of the current article is to provide insight into the systematic developmental process of two evidence-based interventions designed to stimulate injury-preventive behaviour in runners and skiers, in which Intervention Mapping (IM) and Knowledge Transfer Scheme (KTS) are used as developmental protocols. However, the ultimate steps in the process are adjusted to meet requirements of the intervention and the target group. METHODS: Using a three-step process, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. Sports participants, sports experts and behaviour experts contributed throughout steps two and three of the developmental process. RESULTS: In step one we started with a problem statement in which we used information about the number and the burden of running-related and skiing-related injuries in the Netherlands. In step two, in-depth research was performed using four research strategies. During this step we tried to answer the following question: Which preventive measures or actions should be executed to prevent what injuries by whom, and how should we do that? A desk research/systematic review of the literature, expert meetings, target user surveys, and target user focus group meetings were conducted. In step three of product development, both interventions were developed. During the developmental process, co-creation sessions with target users were held. Before finalizing the interventions, pre-tests of the interventions were performed with target users. CONCLUSIONS: Through a three-step approach, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. To develop an intervention that fits the needs of the target population, and will be used by them, it is necessary to involve this population as soon and as much as possible. Several steps in the IM and KTS protocols have thus been adjusted in order to establish an optimal fit between intervention and target group.

Incidence, aetiology and prevention of musculoskeletal injuries in volleyball: A systematic review of the literature.

Currently, there is no overview of the incidence and (volleyball-specific) risk factors of musculoskeletal injuries among volleyball players, nor any insight into the effect of preventive measures on the incidence of injuries in volleyball. This study aimed to review systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures of volleyball injuries. To this end, a highly sensitive search strategy was built based on two groups of keywords (and their synonyms). Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports and sports medicine literature) via EBSCOhost. The results showed that ankle, knee and shoulder injuries are the most common injuries sustained while playing volleyball. Results are presented separately for acute and overuse injuries, as well as for contact and non-contact injuries. Measures to prevent musculoskeletal injuries, anterior knee injuries and ankle injuries were identified in the scientific literature. These preventive measures were found to have a significant effect on decreasing the occurrence of volleyball injuries (for instance on ankle injuries with a reduction from 0.9 to 0.5 injuries per 1000 player hours). Our systematic review showed that musculoskeletal injuries are common among volleyball players, while effective preventive measures remain scarce. Further epidemiological studies should focus on other specific injuries besides knee and ankle injuries, and should also report their prevalence and not only the incidence. Additionally, high-quality studies on the aetiology and prevention of shoulder injuries are lacking and should be a focus of future studies.

Mortality in international professional football (soccer): a descriptive study.

The objective of this study was to describe the characteristics of mortalities from 2007 to 2013 in active (during career) and recently retired (post career) professional footballers. An observational prospective study was conducted. From 2007, the World Footballers' Union (FIFPro) and its related national footballers' unions (more than 70 countries distributed across all continents) collected descriptive data (football-related, cause, etc.) on mortality of active (during career) and recently retired (postcareer before reaching 45 years of age) professional footballers by means of several official sources. A total of 214 deaths were recorded among active and recently retired professional footballers, leading to an overall mortality rate of 0.47 per 1000 footballers per year. Of the 214 deaths, 183 were recorded among active players and 31 among recently retired players. Among the active players, 17% of the fatalities were related to football participation. Disease was the leading cause of death among professional footballers (55%), of which up to 33% accounted for suspected cardiac pathology. Accidents accounted for 25% of the overall deaths, and suicide for 11%. From 2007 to 2013, 214 deaths were recorded among active (during career) and recently retired (post career) professional footballers. Leading cause of death was disease (55%), one third of which were accounted for by suspected cardiac pathology, while accidents accounted for 25% of all deaths, and suicide for 11%. Attention to the predictive validity and application of heart-related precompetition medical assessment should be given, and mental health support should be developed and implemented both during and after a professional football career to prevent potential suicidal behaviors.

Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers.

OBJECTIVE: The objective of this study was to determine the prevalence of symptoms related to mental disorders (distress, anxiety/depression, sleep disturbance, adverse alcohol behaviour, adverse smoking behaviour, adverse nutrition behaviour) among retired professional footballers, and to explore their associations with stressors i.e. determinants such as severe injury, surgery, life events and career dissatisfaction. METHOD: Cross--sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study among retired male professional footballers. Based on validated questionnaires to assess both stressors and symptoms related to mental disorders, an electronic questionnaire was set up and distributed by players' unions in 11 countries across three continents. RESULTS: Prevalence of symptoms related to mental disorders among 219 retired professional footballers ranged from 11% for adverse smoking behaviour and 18% for distress, to 35% for anxiety/depression and 65% for adverse nutrition behaviour. Especially life events that occurred in the previous six months was positively associated with distress (OR=1.3; 95%CI 1.0--1.6), anxiety/depression (OR=1.6; 95%CI 1.2--2.1), sleeping disturbance (OR=1.3; 95%CI 1.1--1.7) and adverse nutrition behaviour (OR=1.4; 95%CI 1.0--1.8). CONCLUSIONS: A high prevalence of symptoms related to mental disorders was found among retired professional footballers, confirming a previous study in a similar study population. Relationships were established between symptoms of mental disorders and severe injuries, recently occurred life events, and career dissatisfaction.