Risk factors for football injuries in young players aged 7 to 12 years.

Football (soccer) is very popular among children. Little is known about risk factors for football injuries in children. The aim was to analyze potential injury risk factors in 7- to 12-year-old players. We collected prospective data in Switzerland and the Czech Republic over two seasons. Coaches reported exposure of players (in hours), absence, and injury data via an Internet-based registration system. We analyzed time-to-injury data with extended Cox models accounting for correlations on team- and intra-person levels. We analyzed injury risk in relation to age, sex, playing position, preferred foot, and regarding age-independent body height, body mass, and BMI. Further, we analyzed injury risk in relation to playing surface. In total, 6038 player seasons with 395 295 hours of football exposure were recorded and 417 injuries occurred. Injury risk increased by 46% (Hazard Ratio 1.46 [1.35; 1.58]; P < .001) per year of life. Left-footed players had a higher injury risk (Hazard Ratio 1.53 [1.07; 2.19]; P = .02) for training injuries compared to right-footed players. Injury risk was increased in age-adjusted taller players (higher percentile rank). Higher match-training ratios were associated with a lower risk of match injuries. Injury risk was increased on artificial turf (Rate Ratio 1.39 [1.12; 1.73]; P < .001) and lower during indoor sessions (Rate Ratio 0.68 [0.52; 0.88]; P < .001) compared to natural grass. Age is known as a risk factor in older players and was confirmed to be a risk factor in children's football. Playing surface and leg dominance have also been discussed previously as risk factors. Differences in injury risks in relation to sex should be investigated in the future.

Head injuries in children's football-results from two prospective cohort studies in four European countries.

Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7- to 12-year-old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow-up was retrieved from coaches, children and parents by phone. Thirty-nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player-seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children's football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput.

Health problems in former elite female football players: Prevalence and risk factors.

The aim of this study was to assess the prevalence of health problems and associated risk factors in former elite female football players. A cross-sectional research design was employed, using an online questionnaire on personal characteristics and health complaints during/after the career. One hundred fifty-two (response rate: 62.0%) former first German league players answered the survey. Around 70% described their current health as good or very good. Over half (57.9%) reported knee problems during the last 4 weeks while exercising and a third (33.6%) during normal daily activities. The second most common location for complaints was the head (53.3%). Almost one quarter (23.7%) of players suffered from osteoarthritis (OA). Regression analysis showed that OA in knee/ankle and physical complaints (PC) in knee/ankle/head were significantly predicted by number and severity of previous injuries (P < 0.05). Further, increases in age, training volume, and level of play were associated with an increased likelihood of presenting with OA (P < 0.05), but not PC. In conclusion, a football career may lead to specific long-term health problems in elite female players. Prevention strategies should focus on knee, ankle, and head injuries. Future studies are needed to clinically assess the prevalence rates of OA and possible neurocognitive changes.

Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports).

BACKGROUND: Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. OBJECTIVE: The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. METHODS: FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. RESULTS: Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. CONCLUSION: The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention.

MRI of the wrist is not recommended for age determination in female football players of U-16/U-17 competitions.

Age determination on magnetic resonance imaging (MRI) of the wrist is a reliable method in male football players to evaluate their eligibility to participate in Under 17 tournaments. MRI of the wrist was performed in 487 female volunteers aged 13-19 years from Brazil, Germany, Malaysia, and Tanzania, and in 139 female football players participating in Under-16 and Under-17 football tournaments. A previously validated method for grading fusion of the distal radial epiphysis in male adolescent was used. Moderate correlation of chronological age and epiphyseal fusion was found in the normative control group (r = .59) and weak correlation in female football players (r = .27). Complete fusion of the distal radial epiphysis was observed in two 15-year-old volunteers of the control group (1.7%) and in 17.6% (3 of 17) of 14-year-old football players. Up to 10.8% (47 of 437) in the control group and 14.4% (20 of 139) of the football players 17 years or younger had complete fused epiphysis. Because of earlier osseous maturity in female adolescents, the grade of fusion of the distal radial epiphysis on MRI is not recommended for pretournament age determination for the age of 17 and younger in female.

Executive summary: Football for health - prevention and treatment of non-communicable diseases across the lifespan through football.

This supplement contains 16 original articles describing how football conducted as small sided games affects fitness and health of untrained individuals across the lifespan. The intermittent nature of football and high exercise intensity result in a broad range of effects. The heart changes its structure and improves its function. Blood pressure is markedly reduced with the mean arterial blood pressure being lowered by ~10 mmHg for hypertensive men and women training 2-3 times/week for 12-26 weeks. Triglycerides and cholesterol are lowered and body fat declines, especially in middle-aged men and women with type 2 diabetes. Furthermore, muscle mass and bone mineral density increases in a number of participant groups, including 65-75-year-old men. The functional capacity is elevated with increases in VO2 max of 10-15%, and 50-100% improvements in the capacity to perform intermittent work within 16 weeks. These effects apply irrespective of whether the participants are young, overweight, elderly or suffering from a disease. The studies clearly show that the participants enjoy playing football and form special relationships with their team mates. Thus, football is a healthy activity, providing a unique opportunity to increase recruitment and adherence to physical activity in a hitherto underserved population, and to treat and rehabilitate patients with hypertension, type 2 diabetes and prostate cancer.

47,X,idic(Y),inv dup(Y): a non-mosaic case of a phenotypically normal boy with two different Y isochromosomes and neocentromere formation.

A de novo aberrant karyotype with 47 chromosomes including 2 different-sized markers was identified during prenatal diagnosis. Fluorescence in situ hybridization (FISH) with a Y painting probe tagged both marker chromosomes which were supposed to be isochromosomes of the short and the long arm, respectively. A normal boy was born in time who shows normal physical and mental development. To characterize both Y markers in detail, we postnatally FISH-mapped a panel of Y chromosomal probes including SHOX (PAR1), TSPY, DYZ3 (Y centromere), UTY, XKRY, CDY, RBMY, DAZ, DYZ1 (Yq12 heterochromatin), SYBL1 (PAR2), and the human telomeric sequence (TTAGGG)(n). The smaller Y marker turned out to be an isochromosome containing an inverted duplication of the entire short arm, the original Y centromere, and parts of the proximal long arm, including AZFa. The bigger Y marker was an isochromosome of the rest of the Y long arm. Despite a clearly visible primary constriction within one of the DAPI- and DYZ1-positive heterochromatic regions, hybridization of DYZ3 detected no Y-specific alphoid sequences in that constriction. Because of its stable mitotic distribution, a de novo formation of a neocentromere has to be assumed.

[Current concepts in the treatment of mallet fractures of the distal phalanx]. / Aktuelle Konzepte in der Therapie der dorsalen Endgliedbasisfraktur.

Articular fractures of the dorsal part of the distal phalanx may result in a painful dysfunction and a bothersome deformity of the distal interphalangeal joint. For this injury multiple treatment procedures exist. We performed a survey among German hand surgeons and a review of the literature in order to present current concepts of treatment and to verify the feasibility of a randomized trial. There is a tendency to prefer conservative treatment options. The indication for operative treatment depends on size and displacement of the articular fragment as well as on subluxation of the joint. Operative techniques vary widely and the comparability of their results is restricted. Complications more often occur after operative treatment. The type of injury and the individual demands of the patient are the most relevant factors for the choice of treatment. From the results of the survey and the review of the literature, a randomized trial of conservative and operative treatment has to be considered as a challenge.

Injuries of football referees: a representative survey of Swiss referees officiating at all levels of play.

The purpose of this study was to investigate the frequency and characteristics of injury and musculo-skeletal complaints in Swiss football referees of all levels. A representative sample of 489 Swiss referees was interviewed regarding their socio-demographic characteristics, refereeing qualifications, time spent in training and in matches, history of injuries and musculo-skeletal complaints caused by training or refereeing, and other medical problems. A total of 110 referees (22.5%) reported having suffered at least one injury related to officiating, and 126 referees (25.8%) at least one refereeing-related musculo-skeletal complaint. Thigh strains and ankle sprains were the most frequent injuries, with the most frequent locations of complaints being the knee and lower back. The incidence of match injuries in the last 12 months was on average 2.06 per 1000 match hours; the incidence of training injuries was substantially lower (0.09 per 1000 training hours). The injury rates were similar for referees officiating at an adult level, but lower at a junior level. In comparison with elite football referees, the incidence of training injuries and the prevalence of musculo-skeletal complaints were lower in amateur referees. Nevertheless, preventive programs are indicated for referees at all levels, especially when considering the length of a referee's career.

Long-term musculoskeletal and cardiac health effects of recreational football and running for premenopausal women.

We examined long-term musculoskeletal and cardiac adaptations elicited by recreational football (FG, n=9) and running (RG, n=10) in untrained premenopausal women in comparison with a control group (CG, n=9). Training was performed for 16 months ( approximately 2 weekly 1-h sessions). For FG, right and left ventricular end-diastolic diameters were increased by 24% and 5% (P<0.05), respectively, after 16 months. Right ventricular systolic function measured by tricuspid annular plane systolic excursion (TAPSE) increased (P<0.05) in FG after 4 months and further (P<0.05) after 16 months (15% and 32%, respectively). In RG and CG, cardiac structure, E/A and TAPSE remained unchanged. For FG, whole-body bone mineral density (BMD) was 2.3% and 1.3% higher (P<0.05) after 16 months, than after 4 and 0 months, respectively, with no changes for RG and CG. FG demonstrated substantial improvements (P<0.05) in fast (27% and 16%) and slow (16% and 17%) eccentric muscle strength and rapid force capacity (Imp30ms: 66% and 65%) after 16 months compared with 4 and 0 months, with RG improving Imp30ms by 64% and 46%. In conclusion, long-term recreational football improved muscle function, postural balance and BMD in adult women with a potential favorable influence on the risk of falls and fractures. Moreover, football training induced consistent cardiac adaptations, which may have implications for long-term cardiovascular health.

Beneficial effects of recreational football on the cardiovascular risk profile in untrained premenopausal women.

The present study examined the cardiovascular health effects of 16 weeks of recreational football training in untrained premenopausal women in comparison with continuous running training. Fifty healthy women were matched and randomized to a football (FG, n=25) or a running (RG, n=25) group and compared with a control group with no physical training (CO, n=15). Training was performed for 1 h twice a week. After 16 weeks, systolic and diastolic blood pressure was reduced (P<0.05) in FG (7+/-2 and 4+/-1 mmHg) and systolic blood pressure was lowered (P<0.05) in RG (6+/-2 mmHg). After 16 weeks, resting heart rate was lowered (P<0.05) by 5+/-1 bpm both in FG and RG, and maximal oxygen uptake was elevated (P<0.05) by 15% in FG and by 10% in RG (5.0+/-0.7 and 3.6+/-0.6 mL/min/kg, respectively). Total fat mass decreased (P<0.05) by 1.4+/-0.3 kg in FG and by 1.1+/-0.3 kg in RG. After 16 weeks, pulse pressure wave augmentation index (-0.9+/-2.5 vs 4.2+/-2.4%), skeletal muscle capillarization (2.44+/-0.15 vs 2.07+/-0.05 cap/fib) and low-density lipoprotein/high-density lipoprotein cholesterol ratio were improved (P<0.05) in FG, but not altered in RG. No changes were observed in CO. In conclusion, regular recreational football training has significant favorable effects on the cardiovascular risk profile in untrained premenopausal women and is at the least as efficient as continuous running.

Football as a treatment for hypertension in untrained 30-55-year-old men: a prospective randomized study.

The present study investigated whether football has favorable effects in the treatment of mild-to-moderate arterial hypertension in untrained middle-aged men. Twenty-five untrained males aged 31-54 year with mild-to-moderate hypertension were randomized to a football training group (FTG, two 1-h sessions per week) and a control group receiving physician-guided traditional recommendations on cardiovascular risk factor modification (doctoral advice group, DAG). After 3 months, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lowered (P<0.05) by 12 +/- 3 and 7 +/- 1 mmHg in FTG, respectively, whereas no significant changes were observed for DAG, with the 3 months values being lower (P<0.05) in FTG than DAG (SBP: 138 +/- 2 vs 148 +/- 2 mmHg; DBP: 84 +/- 2 vs 92 +/- 2 mmHg). The resting heart rate was lowered (P<0.05) by 12 +/- 2 b.p.m. in FTG after 3 months (67 +/- 3 vs 79 +/- 3 b.p.m.), whereas no change was observed for DAG. After 3 months, FTG had higher (P<0.05) VO(2max) (8 +/- 2%; 35.0 +/- 1.6 vs 32.5 +/- 1.3 mL/min/kg) and lower (P<0.05) fat mass (1.7 +/- 0.6 kg), whereas no change was observed for DAG. In conclusion, football training is an attractive non-pharmacological supplement to the treatment of mild-to-moderate arterial hypertension in untrained middle-aged men.

Executive summary: the health and fitness benefits of regular participation in small-sided football games.

The present special issue of Scandinavian Journal of Medicine & Science in Sports deals with health and fitness benefits of regular participation in small-sided football games. One review article and 13 original articles were the result of a 2-year multi-center study in Copenhagen and Zurich and include studies of different age groups analyzed from a physiological, medical, social and psychological perspective. The main groups investigated were middle-aged, former untrained, healthy men and women who were followed for up to 16 months. In addition, elderly, children and hypertensive patients were studied. A summary and interpretations of the main findings divided into an analysis of the physical demands during training of various groups and the effect of a period of training on performance, muscle adaptations and health profile follow. In addition, social and psychological effects on participation in recreational football are considered, the comparison of football training and endurance running is summarized and the effects of football practice on the elderly and children and youngsters are presented.

Effects of a 12-week intervention period with football and running for habitually active men with mild hypertension.

The present study examined the effect of football (F, n=15) training on the health profile of habitually active 25-45-year-old men with mild hypertension and compared it with running (R, n=15) training and no additional activity (controls, C, n=17). The participants in F and R completed a 1-h training session 2.4 times/week for 12 weeks. Systolic and diastolic blood pressure decreased in all groups but the decrease in diastolic blood pressure in F (-9 +/- 5 (+/- SD) mmHg) was higher than that in C (-4 +/- 6 mmHg). F was as effective as R in decreasing body mass (-1.6 +/- 1.8 vs-1.5 +/- 2.1 kg) and total fat mass (-2.0 +/- 1.5 vs -1.6 +/- 1.5 kg) and in increasing supine heart rate variability, whereas no changes were detected for C. Maximal stroke volume improved in F (+13.1%) as well as in R (+10.1%) compared with C (-4.9%). Total cholesterol decreased in F (5.8 +/- 1.2 to 5.5 +/- 0.9 mmol/L) but was not altered in R and C. We conclude that football training, consisting of high-intensity intermittent exercise, results in positive effects on blood pressure, body composition, stroke volume and supine heart rate variability, and elicits at least the same cardiovascular health benefits as continuous running exercise in habitually active men with mild hypertension.

Football to tackle overweight in children.

The present study aimed at analyzing the efficacy of a 6-month football training program compared with a standard exercise program on health and fitness parameters in overweight children. The study design was a 6-month, two-arm, parallel-group randomized trial. Twenty-two overweight children were randomly assigned to two groups (age=10.8+/-1.2 years, height=1.56+/-0.08 m, weight= 65.1+/-11.4 kg). One group conducted a football training program, and the other group an established standard sports program. Both interventions took place three times per week from mid-May to mid-November. Before, after 3 months and after the training period, comprehensive testing was conducted: anthropometric characteristics, cycling ergometry, psychometric monitoring as well as several motor ability tests. Maximal performance capacity increased and submaximal heart rate during cycling ergometry decreased significantly. Several motor skills as well as self-esteem also improved considerably. Body composition and other psychometric variables remained nearly unchanged. No relevant differences were observed between both exercise programs. It can be concluded that a 6-month football training is as efficacious in improving the physical capacity, health-related fitness parameters and self-esteem of overweight children as a standard exercise program. These results provide further evidence that playing football has significant health effects.

Cardiac findings in the precompetition medical assessment of football players participating in the 2009 African Under-17 Championships in Algeria.

OBJECTIVES: To screen all players registered for the 8th CAF African Under-17 Championship for risk factors of sudden cardiac death. DESIGN: Standardised cardiac evaluation prior to the start of the competition. STUDY POPULATION: 155 male football players from all eight qualified teams; mean age 16.4 (SD 0.68) years (range 14 to 17). METHODS: The cardiac evaluation consisted of a medical history, clinical examination, 12-lead resting electrocardiogram (ECG) and echocardiography, and was performed by three experienced cardiologists using established guidelines. RESULTS: Nine (5.8%) players reported cardiac symptoms, and the clinical examination was abnormal in only two players with elevated blood pressure. A total of 40 players (25.8%) showed abnormal ECG patterns. None of the players with a positive ECG showed correlating echocardiographic findings. The echocardiogram of one player appeared highly suspicious for early-stage hypertrophic cardiomyopathy, and in another player the myocardium was suspicious for non-compaction cardiomyopathy, but both had normal ECGs. Thirteen (8.4%) players showed echocardiographic findings that needed further follow-up. The percentage of players with pathological ECG patterns and some abnormal echocardiographic measurements varied substantially between different ethnic groups. CONCLUSION: Cardiological screening for risk factors of sudden cardiac death of football players prior to an international competition proved feasible, and conduction by independent experts allowed high-quality standards and a consistent protocol for the examinations. Differences observed between ethnic groups indicate that guidelines for the analysis of ECGs and echocardiography might be adjusted to the target population.

Injuries and musculoskeletal complaints in referees and assistant referees selected for the 2006 FIFA World Cup: retrospective and prospective survey.

BACKGROUND: There is a considerable amount of scientific literature on football, but few studies have focused on referees, despite their key role in this sport. Existing studies focus on the physiological demands and training of referees. PURPOSE: To analyse injuries and musculoskeletal complaints in referees and assistant referees selected for the 2006 FIFA World Cup. STUDY DESIGN: Retrospective survey and prospective study. METHODS: During the preparation camps for the 2006 FIFA World Cup in Germany, all 123 referees pre-selected for the tournament completed a questionnaire on injuries and musculoskeletal complaints. During the tournament, the characteristics and consequences of all injuries and complaints incurred by the 63 officiating referees were documented. RESULTS: More than 40% of the referees reported having incurred an injury and more than 60% having had musculoskeletal complaints during their career. About 20% of the group reported having suffered from musculoskeletal complaints in the last match. During the World Cup, 14 referees (22%) incurred an injury and more than 30% had musculoskeletal complaints. This prospectively collected data showed an incidence of 20.8 injuries per 1000 match hours (95% CI: 4.17 to 37.4). The most common acute injuries were hamstring strains, calf strains, and ankle sprains, while the most frequent locations of complaints were the low back, hamstring and knee. CONCLUSION: Considering the injury profile, the prevalence of associated musculoskeletal complaints, and the high physiological demands of refereeing, it appears that injury prevention programmes should be developed and integrated into the fitness training routine of the referee.

Female soccer referees selected for the FIFA Women's World Cup 2007: survey of injuries and musculoskeletal problems.

BACKGROUND: Few studies have examined the physiology, training and more recently injury profile of the soccer referee, and these have involved almost exclusively male referees. PURPOSE: To analyse the frequency and characteristics of injuries and musculoskeletal problems in female referees selected for the FIFA Women's World Cup 2007. STUDY DESIGN: Retrospective and prospective descriptive epidemiological study. METHODS: During the preparation camps a few months before the FIFA Women's World Cup 2007, all 81 preselected female referees completed a questionnaire on injuries and musculoskeletal problems. During the final 32 matches of the tournament in China, all injuries, musculoskeletal problems and related treatment of the 36 officiating referees were documented. RESULTS: Almost 50% of the referees reported having incurred at least one injury during their career that had led to time loss from the game. In the previous 12 months, 13 (16%) referees reported having sustained an injury and 64 (79%) reported musculoskeletal problems related to refereeing. During the World Cup and 14 (39%) referees incurred an injury and 17 (33%) were treated for musculoskeletal problems. The commonest location of injuries and problems were hamstrings, quadriceps, calf and ankle. The prospectively collected data found an incidence of 34.7 match injuries per 1000 match hours (95% CI 4.2 to 65.1). CONCLUSION: Top-level female referees are exposed to an even greater risk of injury and/or musculoskeletal problems related to officiating than are male referees. Considering the growth of women's soccer, injury prevention programmes should be specifically developed for female referees.