Heading Frequency and Risk of Cognitive Impairment in Retired Male Professional Soccer Players.

Importance: Although professional soccer players appear to be at higher risk of neurodegenerative disease, the reason remains unknown. Objective: To examine whether heading frequency is associated with risk of cognitive impairment in retired professional soccer players. Design, Setting, and Participants: A UK nationwide cross-sectional study was conducted between August 15, 2020, and December 31, 2021, in 459 retired male professional soccer players older than 45 years and registered with the Professional Footballers' Association or a League Club Players' Association. Exposure: Data on heading frequency in 3 bands-0 to 5, 6 to 15, and more than 15 times per match or training session and other soccer-specific risk factors, such as player position and concussion-were collected through a self-reported questionnaire. Main Outcomes and Measures: Cognitive impairment was defined using the Telephone Interview for Cognitive Status-modified as scores of less than or equal to 21. Hopkins Verbal Learning Test, verbal fluency, and independent activities of daily living were also assessed. Test Your Memory and physician-diagnosed dementia/Alzheimer disease were self-reported via the questionnaire. Adjusted odds ratios (AORs) with 95% CIs were calculated. Results: Of 468 retired male professional soccer players who completed questionnaires (mean [SD] age, 63.68 [10.48]; body mass index, 27.22 [2.89]), 459 reported heading frequency: 114 headed 0 to 5 times, 185 headed 6 to 15 times, 160 headed more than 15 times per match, and 125 headed 0 to 5 times, 174 headed 6 to 15 times, and 160 headed more than 15 times per training session during their careers. The prevalence of cognitive impairment was 9.78% (0-5 times), 14.78% (6-15 times), and 15.20% (>15 times) per match (P = .51). Compared with players reporting 0 to 5 headers per match, the AORs were 2.71 (95% CI, 0.89-8.25) for players reporting 6 to 15 headers per match and 3.53 (95% CI, 1.13-11.04) for players reporting more than 15 headers per match (P = .03 for trend). Corresponding AORs for heading frequency per training session were 2.38 (95% CI, 0.82-6.95) for those reporting 6 to 15, and 3.40 (95% CI, 1.13-10.23) for those reporting more than 15 in comparison with those who reported 0 to 5 (P = .03 for trend). Concussion involving memory loss was also associated with a greater risk of cognitive impairment (AOR, 3.16; 95% CI, 1.08-9.22). Similar results were observed with other cognitive tests and self-reported physician-diagnosed dementia/Alzheimer disease. Conclusions and Relevance: The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life. Further study is needed to establish the upper threshold for heading frequency to mitigate this risk.

Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players: A Cross Sectional Comparative Study.

BACKGROUND: Previous studies based on death certificates have found professional soccer players were more likely to die with neurodegenerative diseases, including dementia. Therefore, this study aimed to investigate whether retired professional male soccer players would perform worse on cognitive tests and be more likely to self-report dementia diagnosis than general population control men. METHODS: A cross-sectional comparative study was conducted between August 2020 and October 2021 in the United Kingdom (UK). Professional soccer players were recruited through different soccer clubs in England, and general population control men were recruited from the East Midlands in the UK. We obtained self-reported postal questionnaire data on dementia and other neurodegenerative diseases, comorbidities and risk factors from 468 soccer players and 619 general population controls. Of these, 326 soccer players and 395 general population controls underwent telephone assessment for cognitive function. RESULTS: Retired soccer players were approximately twice as likely to score below established dementia screening cut-off scores on the Hopkins Verbal Learning Test (OR 2.06, 95%CI 1.11-3.83) and Verbal Fluency (OR 1.78, 95% CI 1.18-2.68), but not the Test Your Memory, modified Telephone Interview for Cognitive Status, and Instrumental Activities of Daily Living. Analyses were adjusted for age, education, hearing loss, body mass index, stroke, circulatory problems in the legs and concussion. While retired soccer players were younger, had fewer cardiovascular diseases and other morbidities and reported healthier lifestyles, 2.8% of retired soccer players reported medically diagnosed dementia and other neurodegenerative disease compared to 0.9% of controls (OR = 3.46, 95% CI 1.25-9.63) after adjustment for age and possible confounders. CONCLUSIONS: UK male retired soccer players had a higher risk of performing below established cut-off scores of dementia screening tests and were more likely to self-report medically diagnosed dementia and neurodegenerative diseases, despite having better overall physical health and fewer dementia risk factors. Further study is needed to determine specific soccer-related risk factors.

Why Median Severity and Ordinal Scale Severity Values should not be used for Injury Burden Results: A Critical Review.

Injury burden is a composite measure of injury incidence and mean severity; this parameter has been reported as an output measure from injury surveillance studies in rugby for over 20 years. The benefits of reporting injury burden results have, more recently, been recognised in other sports. This wider use of injury burden as an output measure from injury surveillance studies has, however, highlighted misunderstandings about how to calculate, present and interpret injury burden data. The aim of this critical review is to explain why median severity and ordinal severity scales should not be used to calculate and report injury burden results in injury surveillance studies. Equations are presented to show how injury burden results should be calculated, and graphs and tables are presented to explain the errors that are introduced when median severity and ordinal scales of severity are used instead of mean severity. This critical review is intended to highlight the correct procedures for calculating, reporting and interpreting injury burden results in order to avoid incorrect results, conclusions and injury prevention recommendations being published.

Epidemiology of gradual-onset knee injuries in team ball-sports: A systematic review with meta-analysis of prevalence, incidence, and burden by sex, sport, age, and participation level.

OBJECTIVES: To systematically evaluate the literature and estimate the prevalence, incidence, and burden of gradual-onset knee injuries in team ball-sports. DESIGN: Systematic review with meta-analysis. METHODS: Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, SPORTDiscus, SCOPUS) were searched from inception to June 2021. Cohort studies of team ball-sports reporting the number of gradual-onset knee injuries were included. Study quality was assessed using a modified Newcastle-Ottawa scale. Studies were pooled using a Freeman-Tukey Double arcsine transformation (prevalence) and a Poisson random effects regression model (incidence, burden). RESULTS: Forty-nine studies that captured gradual-onset knee injuries (unclassified, patellofemoral pain, tendinopathies, and iliotibial band friction syndrome) across 15 team ball-sports were included. For unclassified gradual-onset knee injuries, prevalence was 4 % (95 % Confidence Interval (CI) 2 % to 7 %, I2 = 96 %), incidence was 0.32 per 1000 player-hours (95 % CI 0.25 to 0.43, I2 = 88 %), and burden was 3.24 days lost per 1000 player-hours (95 % CI 1.95 to 5.37, I2 = 99 %). For patellofemoral pain, prevalence was 6 % (95 % CI 1 % to 13 %, I2 = 93 %), and incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.12, I2 = 67 %). For tendinopathies, prevalence was 1 % (95 % CI 0 % to 2 %, I2 = 68 %), incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.11, I2 = 76 %), and burden was 2.14 days lost per 1000 player-hours (95 % CI 1.23 to 3.71, I2 = 92 %). CONCLUSIONS: Estimates of prevalence, incidence and burden generated from this systematic review quantify the extent of gradual-onset knee injuries in team ball-sports. Further research is required to assess whether age, sport, and participation level are predictors of gradual-onset knee injuries.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type.

BACKGROUND: Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. OBJECTIVE: To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports. METHODS: Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included. RESULTS: Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48-62, I2 = 82%; females: 63%, 95% CI 53-71, I2 = 84%; males: 50%, 95% CI 42-58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05-0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03-0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10-0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03-0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32-0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15-0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02-0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01-0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high. CONCLUSION: This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Foot and ankle Osteoarthritis and Cognitive impairment in retired UK Soccer players (FOCUS): protocol for a cross-sectional comparative study with general population controls.

INTRODUCTION: Professional footballers commonly experience sports-related injury and repetitive microtrauma to the foot and ankle, placing them at risk of subsequent chronic pain and osteoarthritis (OA) of the foot and ankle. Similarly, repeated heading of the ball, head/neck injuries and concussion have been implicated in later development of neurodegenerative diseases such as dementia. A recent retrospective study found that death from neurodegenerative diseases was higher among former professional soccer players compared with age matched controls. However, well-designed lifetime studies are still needed to provide evidence regarding the prevalence of these conditions and their associated risk factors in retired professional football players compared with the general male population. OBJECTIVES: To determine whether former professional male footballers have a higher prevalence than the general male population of: (1) foot/ankle pain and radiographic OA; and (2) cognitive and motor impairments associated with dementia and Parkinson's disease. Secondary objectives are to identify specific football-related risk factors such as head impact/concussion for neurodegenerative conditions and foot/ankle injuries for chronic foot/ankle pain and OA. METHODS AND ANALYSIS: This is a cross-sectional, comparative study involving a questionnaire survey with subsamples of responders being assessed for cognitive function by telephone assessment, and foot/ankle OA by radiographic examination. A sample of 900 adult, male, ex professional footballers will be recruited and compared with a control group of 1100 age-matched general population men between 40 and 100 years old. Prevalence will be estimated per group. Poisson regression will be performed to determine prevalence ratio between the populations and logistic regression will be used to examine risk factors associated with each condition in footballers. ETHICS AND DISSEMINATION: This study was approved by the East Midlands-Leicester Central Research Ethics Committee on 23 January 2020 (REC ref: 19/EM/0354). The study results will be disseminated at national and international meetings and submitted for peer-review publication.

Mastering the Topic, the Message, and the Delivery: Leveraging the Social Marketing Mix to Better Implement Sports Injury Prevention Programs.

SYNOPSIS: Social marketing is successful at tackling global health threats and social change but has not been fully explored in sports injury prevention contexts. The social marketing mix (product, price, place, and promotion) can help create exercise-based injury prevention programs with high-value propositions that will be relevant to their implementation (adoption, adherence, maintenance). To improve the real-world effectiveness of injury prevention programs, we share steps that researchers and sports administrators can take tomorrow to leverage the social marketing mix to encourage downstream consumers, such as coaches, clinicians, parents, and athletes, to implement injury prevention programs. J Orthop Sports Phys Ther 2022;52(2):55-59. doi:10.2519/jospt.2022.10839.

Risk Factors for Knee Osteoarthritis in Retired Professional Footballers: A Cross-Sectional Study.

OBJECTIVE: To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers. DESIGN: This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders. SETTINGS AND PARTICIPANTS: Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs. ASSESSMENT OF RISK FACTORS: Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire. MAIN OUTCOME MEASURES: Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs). RESULTS: Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes. CONCLUSION: This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement.

Eight-season epidemiological study of match injuries in women's international rugby sevens.

This study aimed to describe anthropometry and incidence, nature and causes of match injuries in women's international rugby sevens and to compare these with results reported previously for men's international rugby sevens. The study comprised an 8-season, prospective study of World Rugby's women's Sevens World Series. Over the eight seasons, the overall incidence of injury was 105.6 (95% CI: 96.0 to 116.3) injuries/1000 player-match-hours with a mean injury severity of 53.4 (95% CI: 46.9 to 59.9) days-absence. There were no statistically significant trends for backs or forwards in the incidence (backs: p = 0.470; forwards: p = 0.242) or mean severity (backs: p = 0.098; forwards: p = 0.544) of injuries sustained over the 8-season period. Head/face (20.8%), knee (19.7%), ankle (11.3%) and shoulder/clavicle (8.4%) were the most common injury locations while ligament sprain (31.7%), concussion (15.6%), haematoma/bruise (11.5%) and fracture (11.5%) were the most common types of injury sustained. Being-tackled (35.4%), tackling (26.3%), collisions (13.8%) and rucks (8.8%) were the match events responsible for most injuries. The study indicates that injury burden in women's international rugby sevens (5,640 days-absence/1000 player-match-hours; 95% CI: 5,123 to 6,209) is similar to that reported previously for men's international rugby sevens (5,263 days-absence/1000 player-match-hours; 95% CI: 5,000 to 5,540).

The epidemiology of kicking injuries in professional Rugby Union: A 15-season prospective study.

PURPOSE: While kicking in Rugby Union can be influential to match outcome, the epidemiology of kicking injuries remains unknown. This study therefore aimed to investigate the epidemiology of injuries attributed to kicking in professional rugby, including playing position-specific effects and differences in kicking volumes and kick types. METHODS: Fifteen seasons of injury surveillance data and two seasons of match kicking characteristics from professional rugby players were analyzed. Incidence, propensity, and severity of kicking-related injuries were calculated together with the locations and types of these injuries. Position-related differences in match kicking types and volumes were also established. RESULTS: Seventy-seven match and 55 training acute-onset kicking injuries were identified. The match kicking injury incidence for backs was 1.4/1000 player-match-hours. Across all playing positions, the propensity for match kicking injury was 0.57 injuries/1000 kicks. Fly-halves sustained the greatest proportion of match kicking injuries (47%) and performed the greatest proportion of match kicks (46%); an average propensity for match kicking injury (0.58/1000 kicks). Scrum-halves executed 27% of match-related kicks but had a very low propensity for match kicking injury (0.17/1000 kicks). All other positional groups executed a small proportion of match-related kicks but a high propensity for match kicking injury. Ninety-two percent of match kicking injuries occurred in the pelvis or lower limb, with the majority sustained by the kicking limb. 21% of all match kicking injuries were associated with the rectus femoris muscle. CONCLUSION: Match kicking profiles and kicking injuries sustained are position-dependent, which provides valuable insight for developing player-specific conditioning and rehabilitation protocols.

Ten-season epidemiological study of match injuries in men's international rugby sevens.

The aim of this study was to describe the incidence, nature and causes of match injuries in men's international rugby sevens and to compare these to values for international rugby fifteens. The study comprised a 10-season, whole population, prospective study of the Sevens World Series. Over the ten seasons, the overall incidence of injury was 122.4 (95% CI = 116.3 to 128.9) injuries/1000 player-match-hours and the mean severity of injury was 43.0 (95% CI = 40.3 to 45.7) days-absence. There was an increasing trend in the incidence of injury over the ten-season period (slope = 5.3 injuries/1000 player-hours/season, R2 = 0.68, p = 0.003) but no trend in the mean severity of injury (slope = 0.02 days/season, R2 < 0.01, p = 0.971). Head/face (15.7%), knee (15.6%), ankle (15.4%) and shoulder/clavicle (11.9%) were the most common injury locations and ligament sprain (30.5%), muscle strain (16.4%), concussion (12.6%) and haematoma/bruise (10.6%) the most common types of injury sustained. Being-tackled (33.1%), tackling (23.4%), running (16.1%) and collisions (12.4%) were the most common events leading to injury. These results indicate that the burden of injury in international rugby sevens is two to three times higher than that reported for international rugby fifteens.

Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis.

BACKGROUND: The long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA). METHODS: This is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA). RESULTS: 44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40-2.34) and TKR (OR 2.21, 95% CI 1.43-3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85-2.01). Given, the association with KP and TKR, we found a significant dose-response relationship as the more injections a player received (by dose-response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01). CONCLUSION: On average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.

Patterns of training volume and injury risk in elite rugby union: An analysis of 1.5 million hours of training exposure over eleven seasons.

Rugby union is a popular team sport that demands high levels of physical fitness and skill. The study aim was to examine trends in training volume and its impact on injury incidence, severity and burden over an 11-season period in English professional rugby. Data were recorded from 2007/08 through 2017/18, capturing 1,501,606 h of training exposure and 3,782 training injuries. Players completed, on average, 6 h 48 minutes of weekly training (95% CI: 6 h 30 mins to 7 h 6 mins): this value remained stable over the 11 seasons. The mean incidence of training-related injuries was 2.6/1000 player-hours (95% CI: 2.4 to 2.8) with a mean severity rising from 17 days in 2007/08 to 37 days in 2017/18 (Change/season = 1.773, P <0.01). Rate of change in severity was dependent on training type, with conditioning (non-gym-based) responsible for the greatest increase (2.4 days/injury/season). As a result of increasing severity, injury burden rose from 51 days absence/1000 player-hours in 2007/08 to 106 days' absence/1000 player-hours in 2017/18. Despite the low incidence of injury in training compared to match-play, training accounted for 34% of all injuries. Future assessments of training intensity may lead to a greater understanding of the rise in injury severity.

Depressive symptoms and the general health of retired professional footballers compared with the general population in the UK: a case-control study.

OBJECTIVES: To determine the prevalence of depressive symptoms and general health of male ex-professional footballers compared with general population controls. METHODS: 572 retired professional footballers and 500 general population controls in the UK were assessed by postal questionnaire. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale and a threshold score of ≥11 was used to indicate probable caseness. General health was ascertained using the Short Form-12 Health Survey Questionnaire quality of life (QoL) tool; self-reported comorbidities, analgesic usage and body pain; and Index of Multiple Deprivation based on postcode data. Mood was assessed using the Positive and Negative Affect Scale and sleep using the Medical Outcome Survey. Linear regression analysis was used to determine adjusted relative risk with 95% CI and adjusted for age, body mass index, comorbidities, body pain and medication usage. RESULTS: The prevalence of depressive symptoms in retired professional footballers was 5.66% compared with 5.76% in the general population and anxiety prevalence was also comparable (12.01% vs 10.29%; all p>0.05). However, footballers had lower physical and mental component scores compared with controls (p<0.01). They also reported significantly more sleep problems, more negative mood profiles and more widespread body pain (adjusted relative risk (aRR) 1.88, 95% CI 1.15 to 3.09). They also reported greater pain medication usage compared with controls (aRR 1.54, 95% CI 1.26 to 1.89). However, compared with controls, they were 26% (95% CI 15% to 37%) less likely to report comorbidities, especially heart attacks (aRR 57%, 95% CI 27% to 74%) and diabetes (aRR 61%, 95% CI 37% to 76%). CONCLUSIONS: The prevalence of depressive symptoms and anxiety symptoms and probable caseness in ex-professional footballers is comparable with general population controls. However, ex-footballers reported lower health-related QoL, more widespread body pain and higher analgesic usage. Conversely, lower reporting of diabetes and heart attacks indicates potential long-term physical health benefits of professional football.

Guidelines for community-based injury surveillance in rugby union.

OBJECTIVES: The vast majority of rugby union ('rugby') participants are community-based players; however, the majority of injury surveillance studies reported relate to the elite, professional game. A potential reason for this dearth of studies could be the perceived difficulty of using the consensus statement for injury recording at the community level. The aim of this study was to identify areas where the consensus statement could be adapted for easier and more appropriate implementation within the community setting. DESIGN: Round-table discussion. METHODS: All community-based injury surveillance issues were discussed during a 2-day facilitated round-table meeting, by an 11-person working group consisting of researchers currently active in rugby-related injury surveillance, sports medicine and sports science issues. The outcomes from the meeting were summarised in a draft guidance document that was then subjected to an extensive iterative review prior to producing methodological recommendations. RESULTS: Each aspect of the rugby-specific consensus statement was reviewed to determine whether it was feasible to implement the standards required in the context of non-elite rugby and the resources available within in a community setting. Final recommendations are presented within a community-based injury report form. CONCLUSIONS: It is recommended that whenever possible the rugby-specific consensus statement for injury surveillance studies be used: this paper presents an adapted report form that can be used to record injury surveillance information in community rugby if suitable medical support is not available.

Assessing the Return on Investment of Injury Prevention Procedures in Professional Football.

INTRODUCTION: The aim of this study was to develop a quick and simple screening procedure for evaluating the return on investment provided by injury prevention programmes in professional football. Injury prevention in sport has usually been considered in isolation of other management responsibilities, and interventions are published irrespective of whether their impact is worthwhile and irrespective of the return on players' time investment in the programme. This approach is naive from a business perspective and is not an approach normally adopted by commercial organisations. METHODS: In professional football, the overwhelming cost associated with implementing an injury prevention programme is the players' time commitment, and the major benefit is the players' increased availability, achieved through the reduction in the number of injuries. A comparison of these time-based costs and benefits provides the basis for the evaluation process presented. RESULTS: Applying the evaluation process to a number of published injury prevention programmes recommended for football demonstrates that they are unlikely to provide an adequate return on investment. CONCLUSIONS: Researchers should focus on developing injury prevention programmes that provide an adequate return on players' time investment, otherwise there is no incentive for clubs to implement the programmes. Reporting that an injury prevention programme produces a statistically significant reduction in the incidence of injury, for example, is insufficient information. Injury prevention programmes should focus on 'at risk' players to increase the return on investment, and researchers should evaluate and report on the utility of prevention programmes within the intended sports setting.

Injury Risk (Burden), Risk Matrices and Risk Contours in Team Sports: A Review of Principles, Practices and Problems.

The aim of this review was to provide insights into and a critical assessment of injury burden, risk matrices and risk contours in the context of team sports. Injury burden is the product of injury incidence and mean severity, and is normally reported as days' absence/1000 player-hours. An important feature of injury burden is that equal values can reflect quite different numerical combinations of injury incidence and severity. The timeframe over which injury burden affects a team depends on the incidence and severity values of the injuries sustained. Injury burden is evaluated through the use of risk matrices and risk contours. The main benefits of using risk matrices, and the reasons for their widespread acceptance, are the minimal data inputs required, the ease of understanding the visual data presentation, the transparent nature of the evaluation criteria and the simplicity with which the conclusions can be communicated to stakeholders. Injury burden is most often used for the identification of injuries that cause the greatest loss of time for players, ranking the importance of injury risk factors and prioritising injury prevention plans. Although risk matrices are commonly used for evaluating risks during the risk assessment process, there is little evidence to demonstrate that they improve decision-making, as they have a number of limitations, including potential inconsistencies and discrepancies when evaluating and ranking risks. These limitations suggest that physicians, physiotherapists and sports scientists should only use injury burden, risk matrices and risk contours when they fully understand their strengths and weaknesses.

Eight-season epidemiological study of injuries in men's international Under-20 rugby tournaments.

The aim of this study was to define the incidence and nature of match injuries sustained in men's international under-20 rugby. The study comprised an 8-season prospective study of 16 international under-20 rugby tournaments. Procedures complied with the consensus statement for epidemiological studies in rugby. Outputs included players' mean age, stature and body mass and incidence, severity, location, type and cause of match injuries. The overall incidence of injury was 49.7 injuries/1000 player-match-hours (backs: 48.3; forwards: 50.9) with a mean severity of 32.2 days-absence (backs: 29.4; forwards: 34.4). There were no significant changes in incidence or severity of injury over the study period. Shoulder/clavicle (18.3%), head/face (16.4%), knee (13.7%) and ankle (13.7%) were the most common injury locations and ligament sprain (35.4%), haematoma/bruise (15.9%), concussion (12.5%) and muscle strain (11.2%) the most common types of injury. Being-tackled (29.2%), tackling (24.0%) and collisions (14.3%) were the most common events leading to injury. The results confirm that international under-20 rugby has a high incidence and severity of injury but the incidence is half that reported for senior international players. There was no significant change in the overall incidence of injury at the Under-20 level in the period 2008 to 2016.

"Recognize and Remove": A Universal Principle for the Management of Sports Injuries.

OBJECTIVE: To identify the locations and types of injury that result in players not being immediately removed from the field of play when injured and to quantify the magnitude of the situation. DESIGN: Prospective cohort epidemiological study with definitions and procedures compliant with the international consensus statement for studies in rugby. SETTING: Sevens World Series (SWS) (2008-2016) and Rugby World Cup (RWC) (2007, 2011, 2015). PARTICIPANTS: Players from 17 countries taking part in the SWS and 22 countries taking part in the RWC. MAIN OUTCOME MEASURES: Location, type, and mean severity of injury, period of match when the injury occurred and whether players were removed from the field of play when injured. RESULTS: Injured players (51.5%) in the SWS and 33.1% of injured players in the RWC were immediately removed from the field of play at the time of injury. The percentages of players immediately removed varied from 16.7% for hand fractures (severity: 71 days) to 96.7% for shoulder dislocations/subluxations (severity: 105 days) during the SWS and from 4.5% for shoulder ligament sprains (severity: 25 days) to 65.9% for concussions (severity: 9 days) during the RWC. The percentage of players immediately removed from play when injured was not related to the severity of the injury sustained. CONCLUSIONS: A high proportion of players continue to play (in the same game) after sustaining an injury although the likelihood of being removed from play is not dependent on injury severity.

Modelling injury-burden in rugby sevens.

OBJECTIVES: To develop a time-based model of injury-burden for international rugby sevens teams and to demonstrate its utility. DESIGN: Descriptive, cohort study. METHODS: Injury data recorded during seven seasons of the Sevens World Series were used to quantify the rate of injury and the rate at which injured players recovered from injury. An equation describing the rate at which injuries were sustained was combined with an equation for the rate at which injured players recovered from injury to produce a time-based equation for the injury-burden of rugby sevens players at any point in time during a season. RESULTS: The overall rates at which match and training injuries were sustained (incidence of injury) were 108.6 (95% confidence interval: 101.6-116.1) injuries/1000 player-match-hours and 0.91 (95% CI: 0.65-1.27) injuries/1000 player-training-hours, respectively. Injured players recovered from injury according to a first-order rate equation with a rate constant of 0.0257 days-1 calculated from the median severity of injuries sustained (27 days). The time-based injury-burden values predicted from the proposed kinetic model of injury-burden closely matched the values recorded in the Sevens World Series. CONCLUSIONS: For governing bodies in rugby, the proposed model provides a way to examine the consequences of changes in the number and timing of international rugby sevens tournaments. For individual teams, the model provides a means to forecast and manage the team's injury-burden as a function of the team's scheduled match and training loads throughout a season.