Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men's professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22.

OBJECTIVES: To: (1) describe hamstring injury incidence and burden in male professional football players over 21 seasons (2001/02 to 2021/22); (2) analyse the time-trends of hamstring muscle injuries over the most recent eight seasons (2014/15 to 2021/22); and (3) describe hamstring injury location, mechanism and recurrence rate. METHODS: 3909 players from 54 teams (in 20 European countries) from 2001/02 to 2021/22 (21 consecutive seasons) were included. Team medical staff recorded individual player exposure and time-loss injuries. Time-trend analyses were performed with Poisson regression using generalised linear models. RESULTS: 2636 hamstring injuries represented 19% of all reported injuries, with the proportion of all injuries increasing from 12% during the first season to 24% in the most recent season. During that same period, the percentage of all injury absence days caused by hamstring injuries increased from 10% to 20%. Between 2014/15 and 2021/22, training hamstring injury incidence increased (6.7% annually, 95% CI 1.7% to 12.5%) as did burden (9.0% annually, 95% CI 1.2% to 18.3%). During those years, the match hamstring injury incidence also increased (3.9% annually, 95% CI 0.1% to 7.9%) and with the same trend (not statistically significant) for match hamstring injury burden (6.2% annually, 95% CI -0.5% to 15.0%). CONCLUSIONS: Hamstring injury proportions-in number of injuries and total absence days-doubled during the 21-year period of study. During the last eight seasons, hamstring injury rates have increased both in training and match play.

Elite football teams that do not have a winter break lose on average 303 player-days more per season to injuries than those teams that do: a comparison among 35 professional European teams.

OBJECTIVE: To compare injury rates among professional men's football teams that have a winter break in their league season schedule with corresponding rates in teams that do not. METHODS: 56 football teams from 15 European countries were prospectively followed for seven seasons (2010/2011-2016/2017)-a total of 155 team-seasons. Individual training, match exposure and time-loss injuries were registered. Four different injury rates were analysed over four periods within the season, and linear regression was performed on team-level data to analyse the effect of winter break on each of the injury rates. Crude analyses and analyses adjusted for climatic region were performed. RESULTS: 9660 injuries were reported during 1 447 011 exposure hours. English teams had no winter break scheduled in the season calendar: the other European teams had a mean winter break scheduled for 10.0 days. Teams without a winter break lost on average 303 days more per season due to injuries than teams with a winter break during the whole season (p<0.001). The results were similar across the three periods August-December (p=0.013), January-March (p<0.001) and April-May (p=0.050). Teams without a winter break also had a higher incidence of severe injuries than teams with a winter break during the whole season (2.1 severe injuries more per season for teams without a winter break, p=0.002), as well as during the period January-March (p=0.003). A winter break was not associated with higher team training attendance or team match availability. Climatic region was also associated with injury rates. CONCLUSIONS: The absence of a scheduled winter break was associated with a higher injury burden, both before and during the two periods following the time that many European teams take a winter break. Teams without a winter break (English clubs) had a higher incidence of severe injuries following the time of the year that other teams (other European clubs) had their scheduled break.

Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs.

OBJECTIVES: We investigated medical staff interpretations and descriptions of internal communication quality in elite football teams to determine whether internal communication was correlated with injuries and/or player availability at training and matches. METHODS: Medical staff from 36 elite football clubs across 17 European countries produced 77 reports at four postseason meetings to provide their perceptions of internal communications in their teams. They also recorded data on individual players' exposure to football and time-loss injuries. RESULTS: The injury burden and incidence of severe injuries were significantly higher in teams with low quality of communication between the head coach/manager and the medical team (scores of 1-2 on a 5-point Likert scale) compared with teams with moderate or high-quality scores (scores of 3-5; p=0.008 for both). Teams with low scores had 4%-5% lower training attendance (76% vs 83%, p=0.001) and less availability at matches (82% vs 88%, p=0.004) compared with teams with moderate or high communication quality scores. CONCLUSIONS: The quality of internal communication within a team was correlated with injury rates, training attendance and match availability.

Relationships between fatty infiltration in the thigh and calf in women with knee osteoarthritis.

BACKGROUND: In individuals with knee osteoarthritis (OA), fatty infiltration into thigh muscle is associated with poor physical performance and strength. However, it is not known whether this also occurs in the calf and if this impacts physical function. AIMS: We investigated the relationships between volumes of intramuscular fat (intraMF), intermuscular fat (IMF), subcutaneous fat (SCF), lean muscle and muscle adiposity, in the thighs compared to the calves of women with knee OA. METHODS: MRI scans of the thigh and calf were acquired from 20 women over 55 years with knee OA (3.0T Discovery MR750, GE Healthcare). Axial IDEAL (iterative decomposition of water and fat with echo asymmetry and least-squares estimation) fat-separated images were segmented to quantify intraMF, IMF, SCF and lean muscle volumes (SliceOmatic 5.0, Tomovision). Correlation and linear regression analyses were run. RESULTS: We found a positive relationship between thigh and calf intraMF (R 2 = 0.592; B = 5.49; p = 0.001), muscle adiposity (R 2 = 0.539; B = 0.567; p = 0.001), and SCF volume (R 2 = 0.699; B = 12.847; p = 0.001), controlling for waist-to-hip ratio. Relationships between thigh and calf IMF (R 2 = 0.239; B = 7.743; p = 0.061), lean muscle (R 2 = 0.245; B = 4.149; p = 0.047) and combined intraMF and IMF volume (R 2 = 0.242; B = 6.162; p = 0.044) were not significant. DISCUSSION: Although a correlation exists between thigh and calf muscle adiposity, intraMF and SCF, this does not hold true for IMF or lean muscle. A greater amount of intraMF infiltration occurs in the thigh compared to the calf of women with knee OA. CONCLUSION: The calf and thigh may both be involved in pathologic changes in muscle composition in knee OA.

Quantifying fat and lean muscle in the lower legs of women with knee osteoarthritis using two different MRI systems.

Decreased muscle mass and increased fat mass are commonly seen in the thighs of individuals with knee osteoarthritis (OA). Despite the role of calf muscles in activities of daily living and knee mechanics, little work has investigated calf changes in knee OA. Unlike the thigh, muscle and fat in the lower leg can be imaged using a peripheral magnetic resonance imaging (MRI) scanner. We aimed to assess agreement between subcutaneous fat, intermuscular fat (IMF), intramuscular fat (intraMF), and lean muscle volumes acquired using a peripheral 1.0T as compared to a reference whole-body 3.0T MRI scanner. A calf MRI scan from each scanner was acquired from twenty women >55 years with knee OA. The different tissues were segmented on each of ten axial slices for every participant using SliceOmatic 5.0 (Tomovision, Magog, QC). Tissue volumes were determined for each outcome. Agreement between tissue volumes from the two scanners was assessed using intraclass correlation (ICC(2,1)) coefficients, standard error, and Bland-Altman plots. Agreement between tissue volumes was strong to very strong, with ICCs ranging from 0.842 to 0.991 for all outcomes. However, wide confidence intervals for IMF and intraMF suggest there is less confidence in agreement with segmentation of images from the 1.0T scanner generally underestimating fat volume relative to the 3.0T scanner. The 3.0T's superior between-tissue contrast likely resulted in more accurate segmentation of IMF and intraMF compared to the 1.0T scanner. Comparisons of tissue volume between studies using different scanners/sequences should be interpreted cautiously.

Hydrogen Sulfide Treatment Mitigates Renal Allograft Ischemia-Reperfusion Injury during Cold Storage and Improves Early Transplant Kidney Function and Survival Following Allogeneic Renal Transplantation.

PURPOSE: Ischemia-reperfusion injury is unavoidable during organ transplantation. Prolonged ischemia-reperfusion injury is detrimental to short-term and long-term graft function and survival. H2S is a recently characterized, endogenously produced gaseous molecule with important physiological roles that has been shown to be cytoprotective during tissue ischemia-reperfusion injury. The current study aimed to determine whether H2S could mitigate cold renal ischemia-reperfusion injury in the clinically relevant context of allogeneic renal transplantation. MATERIALS AND METHODS: Following bilateral native nephrectomy Lewis rats underwent renal transplantation with kidneys from Brown Norway donor rats that were flushed with cold (4C) standard University of Wisconsin preservation solution (University of Wisconsin preservation solution group) or cold University of Wisconsin preservation solution plus 150 µM NaHS (H2S group) solution. Kidneys were stored for 6 hours at 4C in the same solution. Recipient animals were monitored for 14 days or until sacrifice using metabolic cages to assess various parameters of renal graft function. RESULTS: H2S treatment improved early allograft survival and function, and decreased early levels of necrosis, apoptosis and Kim-1 compared to University of Wisconsin preservation solution alone. H2S treatment did not affect allograft rejection. Rather, it modulated the early allograft transcriptome to decrease the expression of renal injury, coagulation and cellular stress response genes, and increase the expression of cellular proliferation and Ifn-γ induced genes compared to University of Wisconsin preservation solution alone. CONCLUSIONS: To our knowledge our findings are the first to show that H2S protects donor kidneys against cold ischemia-reperfusion injury in the context of allogeneic renal transplantation. This potentially represents a novel cost-effective therapeutic solution to mitigate ischemia-reperfusion injury and improve the clinical outcomes of renal transplantation.

Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues.

PURPOSE: To systematically review the scientific level of evidence for the 'Top 3' risk factors, screening tests and preventative exercises identified by a previously published survey of 44 premier league football (soccer) teams. Also, to provide an overall scientific level of evidence and graded recommendation based on the current research literature. METHODS: A systematic literature search (Pubmed [MEDLINE], SportDiscus, PEDRO and Cochrane databases). The quality of the articles was assessed and a level of evidence (1++ to 4) was assigned. Level 1++ corresponded to the highest level of evidence available and 4, the lowest. A graded recommendation (A: strong, B: moderate, C: weak, D: insufficient evidence to assign a specific recommendation) for use in the practical setting was given. RESULTS: Fourteen studies were analysed. The overall level of evidence for the risk factors previous injury, fatigue and muscle imbalance were 2++, 4 and 'inconclusive', respectively. The graded recommendation for functional movement screen, psychological questionnaire and isokinetic muscle testing were all 'D'. Hamstring eccentric had a weak graded 'C' recommendation, and eccentric exercise for other body parts was 'D'. Balance/proprioception exercise to reduce ankle and knee sprain injury was assigned a graded recommendation 'D'. CONCLUSIONS: The majority of perceptions and practices of premier league teams have a low level of evidence and low graded recommendation. This does not imply that these perceptions and practices are not important or not valid, as it may simply be that they are yet to be sufficiently validated or refuted by research.

Injury prevention strategies at the FIFA 2014 World Cup: perceptions and practices of the physicians from the 32 participating national teams.

PURPOSE: The available scientific research regarding injury prevention practices in international football is sparse. The purpose of this study was to quantify current practice with regard to (1) injury prevention of top-level footballers competing in an international tournament, and (2) determine the main challenges and issues faced by practitioners in these national teams. METHODS: A survey was administered to physicians of the 32 competing national teams at the FIFA 2014 World Cup. The survey included 4 sections regarding perceptions and practices concerning non-contact injuries: (1) risk factors, (2) screening tests and monitoring tools, (3) preventative strategies and (4) reflection on their experience at the World Cup. RESULTS: Following responses from all teams (100%), the present study revealed the most important intrinsic (previous injury, accumulated fatigue, agonist:antagonist muscle imbalance) and extrinsic (reduced recovery time, training load prior to and during World Cup, congested fixtures) risk factors during the FIFA 2014 World Cup. The 5 most commonly used tests for risk factors were: flexibility, fitness, joint mobility, balance and strength; monitoring tools commonly used were: medical screen, minutes/matches played, subjective and objective wellness, heart rate and biochemical markers. The 5 most important preventative exercises were: flexibility, core, combined contractions, balance and eccentric. CONCLUSIONS: The present study showed that many of the National football (soccer) teams' injury prevention perceptions and practices follow a coherent approach. There remains, however, a lack of consistent research findings to support some of these perceptions and practices.

Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues.

PURPOSE: Little is known about injury prevention practices in professional football clubs. The purpose of this study was therefore to determine the current perceptions and practices of premier league football clubs internationally concerning risk factors, testing and preventative exercises for non-contact injuries. METHODS: A survey was administered to 93 premier league football clubs internationally. The survey included four sections: (1) persons involved in the injury prevention programme: position, quantity, role, qualification; (2) perceptions regarding non-contact injury risk factors; (3) tests used to identify non-contact injury risk and (4) non-contact injury prevention exercises used, their perceived effectiveness and implementation strategies. RESULTS: 44 surveys were successfully returned (47%). The position of physiotherapist was the most represented position in the injury prevention programme. The top five perceived risk factors in rank order were previous injury, fatigue, muscle imbalance, fitness and movement efficiency. The five most commonly used tests to identify injury risk (in rank order) were functional movement screen, questionnaire, isokinetic dynamometry, physical tests and flexibility. The top five exercises used by clubs were (also in rank order) eccentric exercise, balance/proprioception, hamstring eccentric, core stability and, sharing the fifth position, Nordic hamstring and gluteus activation. CONCLUSIONS: The survey revealed the most common perceptions and practices of premier league football clubs internationally regarding risk factors, testing and preventative exercises. The findings can enable reduction of the gap between research and practice.

The generalization-across-dimensions model applied to conditional temporal discrimination.

Can simple choice conditional-discrimination choice be accounted for by recent quantitative models of combined stimulus and reinforcer control? In Experiment 1, two sets of five blackout durations, one using shorter intervals and one using longer intervals, conditionally signaled which subsequent choice response might provide food. In seven conditions, the distribution of blackout durations across the sets was varied. An updated version of the generalization-across-dimensions model nicely described the way that choice changed across durations. In Experiment 2, just two blackout durations acted as the conditional stimuli and the durations were varied over 10 conditions. The parameters of the model obtained in Experiment 1 failed adequately to predict choice in Experiment 2, but the model again fitted the data nicely. The failure to predict the Experiment 2 data from the Experiment 1 parameters occurred because in Experiment 1 differential control by reinforcer locations progressively decreased with blackout durations, whereas in Experiment 2 this control remained constant. These experiments extend the ability of the model to describe data from procedures based on concurrent schedules in which reinforcer ratios reverse at fixed times to those from conditional-discrimination procedures. Further research is needed to understand why control by reinforcer location differed between the two experiments.

Aversive control versus stimulus control by punishment.

Estes (1944) reported that adding electric shock punishment to extinction hastened response suppression but that responding increased when shock was removed. This result contributed to a view that reinforcement and punishment are asymmetrical processes because punishment has only indirect and temporary suppressive effects. Azrin and Holz (1966) suggested the result might be interpreted instead as shock serving as a discriminative stimulus for the absence of reinforcement. Here, to further examine potential stimulus control by punishment in a similar preparation, two groups of rats initially responded for food plus punishment and a third group for food alone. Reinforcement was then removed for all groups for the remaining three phases. With P and N denoting punishment and no punishment, the four phases for the three groups were: P-P-N-N, P-N-P-N, and N-P-N-N. We found some evidence for stimulus control by shock deliveries for group N-P-N-N (as suggested by Azrin and Holz), but all other changes in responding appeared due to introduction or removal of the aversive properties of shock. Although punishment may indeed have temporary effects under many circumstances, we argue that the view that this implies asymmetrical reinforcement and punishment processes was based on the flawed assumption that reinforcement has direct strengthening effects.

Detrimental effects of prolonged warm renal ischaemia-reperfusion injury are abrogated by supplemental hydrogen sulphide: an analysis using real-time intravital microscopy and polymerase chain reaction.

UNLABELLED: What's known on the subject? and What does the study add? Hydrogen sulphide (H(2) S) has recently been classified as a member of the gasotransmitter family. Its physiological and pathophysiological effects are rapidly expanding with numerous studies highlighting the protective effects of H(2) S on ischaemia-reperfusion injury (IRI) in various organ systems, e.g. heart, liver, CNS and lungs. The mechanisms behind its protective effects reside in its vasodilatory, anti-inflammatory and anti-oxidant characteristics. These specific mechanistic profiles appear to be different across different tissues and models of IRI. We recently showed that supplementation of preservation solutions with H(2) S during periods of prolonged cold renal storage and subsequent renal transplantation leads to a massive and significant survival, functional and tissue protective advantage compared with storage in standard preservation solution alone. However, there have only been a few studies that have evaluated the effects of H(2) S against warm renal IRI; although these studies have focused primarily upon shorter periods of warm renal pedicle clamping, they have shown a clear survival benefit to H(2) S supplementation. The present study adds to the existing literature by evaluating the effects of H(2) S in a model of warm IRI with clinically relevant, prolonged warm ischaemia-reperfusion times (1 h ischaemia, 2 h reperfusion). We show an unprecedented view into real-time renal and hepatic perfusion with intravital microscopy throughout the reperfusion period. We show, for the first time, that supplemental H(2) S has multiple protective functions against the warm IRI-induced tissue damage, which may be clinically applicable to both donation after cardiac death models of renal transplantation, as well as to uro-oncological practices requiring surgical clamping of the renal pedicle, e.g. during a partial nephrectomy. OBJECTIVE: • To determine the protective role of supplemental hydrogen sulphide (H(2) S) in prolonged warm renal ischaemia-reperfusion injury (IRI) using real-time intravital microscopy (IVM). MATERIALS AND METHODS: • Uninephrectomised Lewis rats underwent 1 h of warm ischaemia and 2 h of reperfusion during intraperitoneal treatment with phosphate buffer saline (IRI, n = 10) or 150 µmol/L NaHS (IRI+H(2) S, n = 12) and were compared with sham-operated rats (n = 9). • Blood was collected for measurement of serum creatinine (Cr), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). • IVM was performed to assess renal and hepatic microcirculation. • Kidneys were sectioned for histology and real-time quantitative polymerase chain reaction for markers of inflammation. RESULTS: • The mean (sd) Cr concentration raised to 72.8(2.5) µmol/L after IRI from 11.0 (0.7) µmol/L (sham) but was partially inhibited with H(2) S to 62.8 (0.9) µmol/L (P < 0.05). • H(2) S supplementation during IRI increased renal capillary perfusion on IVM, and improved acute tubular necrosis and apoptotic scores on histology (P < 0.05). • Supplemental H(2) S decreased expression of the pro-inflammatory markers toll-like receptor 4, tumour necrosis factor α, interleukin 8, C-C chemokine receptor type 5, interferon γ and interleukin 2 (P < 0.05). • Distant organ (liver) dysfunction after renal IRI was limited with H(2) S supplementation: blunting of the ALT and AST surge, decreased hepatic sinusoidal vasodilation, and decreased leukocyte infiltration in post-sinusoidal venules (P < 0.05). • H(2) S supplementation directly inhibited interleukin 8-induced neutrophil chemotaxis in vitro (P < 0.05). CONCLUSIONS: • These findings are the first to show the real-time protective role of supplemental H(2) S in prolonged periods of warm renal IRI, perhaps acting by decreasing leukocyte migration and limiting inflammatory responses. • The protective effects of H(2) S suggest potential clinical applications in both donors after cardiac death models of renal transplantation and oncological practices requiring vascular clamping.

Modeling choice across time: Effects of response-reinforcer discriminability.

This experiment asks whether timing is affected by animals' discrimination of response-reinforcer contingencies, and if so, how this effect can be understood. Six pigeons were trained on a procedure in which concurrent-schedule reinforcer ratios between left and right keys changed at 30 s after the last reinforcer. One stimulus signaled a reinforcer-ratio reversal from 9:1 to 1:9 on that key, and the other stimulus signaled the inverse reversal, with the key on which these stimuli occurred randomized. Across conditions, the physical difference between the stimuli signaling the two responses was varied and the directional changes in the reinforcer ratio signaled by each stimulus were reversed. Choice changed appropriately across time when the two stimuli were discriminable, and points of subjective equality fell with decreasing stimulus difference. A model which assumed that reinforcers obtained in time bins were redistributed across other time bins according to ogivally changing standard deviations, and between response locations according to an ogivally changing redistribution measure, accounted well for the data. This model was shown to be preferable to one in which across-time redistributions were scalar, and across-location redistribution was constant. These results show the critical importance of stimulus-response-reinforcer discriminability to measures of timing.

Still poorly adopted in male professional football: but teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries - a retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020-2021 season.

Objectives: The primary objective was to study the adoption of the NHE programme in European football teams in the 2020/21 season and to compare it to the previous study. A second objective was to compare hamstring injury rates between teams that used the NHE programme in the team training and teams that used the NHE only for players with previous or current hamstring injuries. Methods: Data about the implementation of the NHE programme and injury rates were included for 17 teams participating in the Elite Club Injury Study during the 2020/2021 season. Results: One team (6%) used the full original NHE programme, and another four teams used it for all or most players in the team (team training group, n=5). Eleven teams used NHE only for players with a previous or current hamstring injury (individual training group), and one team did not use NHE. The team training group had fewer hamstring injuries (5 vs 11 per team, p=0.008) and a lower injury burden (12 vs 35 lay-off days per 1000 hours, p=0.003) than the individual training group. Conclusion: Similar to previous reports, low adoption of the NHE programme was seen in the 2020/2021 season. The low adoption rate (13%) relates to the number of teams fully or partly using NHE programmes. Teams that used NHE for the whole team or most players had a lower hamstring injury burden than teams that used NHE only for individual players.

Influence of the COVID-19 Lockdown and Restart on the Injury Incidence and Injury Burden in Men's Professional Football Leagues in 2020: The UEFA Elite Club Injury Study.

BACKGROUND: Studies on football and the coronavirus disease 2019 (COVID-19) have mainly focused on the lockdown consequences for player fitness, the resumption of football training, and how to safely restart the league play, but injury data are scarce. OBJECTIVE: To describe the injury incidence and injury burden in men's professional football teams during the pandemic year of 2020. METHODS: Nineteen teams in 12 countries prospectively registered data on player-exposure and time-loss injuries throughout 2020. All major football leagues were paused as a direct response to the pandemic in March 2020 and were thereafter completely cancelled or restarted after a lockdown interval of at least two months. Historical data from 43 teams in the same cohort during the five preceding years (2015-2019) were used as reference. Between-season and within-season comparisons were made for injury incidence (number of injuries per 1000 h) and injury burden (number of absence days per 1000 h) with 95% confidence intervals and interquartile ranges. RESULTS: There was no increased match injury incidence or injury burden following the restart in 2020 compared with other time periods of 2020 and the corresponding periods 2015-2019. There was an increased training injury incidence and injury burden immediately during the lockdown in 2020, and they remained elevated also following the restart, being higher in 2020 compared with 2015-2019, respectively. The injury characteristics during the first months of the new 2020/21 season (August/September-December) were similar between the five teams that cancelled their 2019/20 season in March 2020 and the 14 teams that restarted their season in May/June 2020. CONCLUSIONS: There was no increased match injury incidence or injury burden following the COVID-19 lockdown and restart of the football season in 2020, but training injury incidence and injury burden were elevated and higher than in 2015-2019.

Concurrent schedules: How responses per reinforcer affects estimates of sensitivity to reinforcement.

Conventionally, when choice is measured under concurrent schedules, all responses are included. However, the class of all responses consists of 2 sub-classes which are discriminable by their properties: Reinforced responses always equal obtained reinforcers, while unreinforced responses are free to vary. As a result, the inclusion of reinforced responses in choice measures results in sensitivity values in generalized matching that are biased toward larger values, and this bias becomes extreme in some combinations of overall response and reinforcer rates. Different ways of varying concurrent-schedule values also affect estimated sensitivity and the linearity between choice based on all responses and reinforcer ratios. To avoid spurious results and comparisons, and as a matter of good practice, generalized-matching fits and measures should be done using only unreinforced responses.