The USA Cup Soccer Tournament, divided into the USA Cup Weekend and the USA Cup, is a large annual youth tournament that often requires a team to play more than one game a day. The game durations are shortened from regulation time for each age group. Little is known about the rate of injury as the tournament progresses with respect to the effect of playing more than one game a day or several games in a short time span. Hence, there is a need for research into the affect of tournament scheduling on injury rates in the younger athletes. PURPOSE: To investigate the influence of multiple games on multiple days on tournament athlete injury rates. METHODS: All athletes seeking medical attention for an acute or acute on chronic game related tournament injury were surveyed by questionnaire immediately after registering for care at the on site medical facility. The survey questions were directed at the circumstances of each injury related to the timing of the injury with respect to the amount of soccer played by the injured participant. RESULTS: In the USA Cup Weekend, there were 4.06, 5.14, and 3.92 injuries /1000 PH on July 11th, 12th, and 13th respectively. There was no significant difference in the incidence of injuries for the games on the 2nd or 3rd day compared to the 1st day. The injury rates of first games compared to second games of the day showed no difference (p= 0.1259). In the Schwan's USA Cup, the injury rates were 5.65, 8.95, 7.83, 6.94, and 4.62 /1000 PH on July 15th, 16th, 17th, 18th, and 19th respectively. There were statistically significant differences in the incidence of injuries seen when comparing the 17th to the 15th (p= 0.02; incidence ratio= 1.38, 95% confidence interval= 1.05-1.82) and the 16th to the 15th (p= 0.0009; incidence ratio= 1.58, 95% confidence interval= 1.21-2.06). There was no significant difference on other days compared to the 15th. A linear test for trend from the 15th to the 19th was not significant (p= 0.0922). The injury rates of first games compared to second games of the day showed no difference (p= 0.38). CONCLUSION: The USA Cup format limiting teams to two games per day and decreasing the length of games in each game of the tournament outside of the finals provides adequate protection to participants from injury as a result of fatigue and overuse in the environment conditions that prevailed during the tournaments.
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