Injuries In Soccer Players Research Articles

Response to acute concussive injury in soccer players: is gender a modifying factor?

Several studies have suggested a gender difference in response to sports-related concussion (SRC). The Concussion in Sport group did not include gender as a modifying factor in SRC, concluding that the evidence at that point was equivocal. In the present study the authors endeavored to assess acute neurocognitive and symptom responses to an SRC in equivalent cohorts of male and female soccer players. The authors hypothesized that female athletes would experience greater levels of acute symptoms and neurocognitive impairment than males. Baseline symptom and neurocognitive scores were determined in 40 male and 40 female soccer players by using the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) scale prior to any SRC. After sustaining an SRC, each athlete completed postconcussion ImPACT tests and was carefully matched on a wide array of biopsychosocial variables. Baseline symptom and neurocognitive test scores were compared, and their acute symptoms and neurocognitive responses to concussive injury were assessed. Specific a priori hypotheses about differences between males and females at baseline and at postconcussion measurements of verbal and visual memory ImPACT scores were evaluated according to simple main effects of the gender variable and according to baseline-to-postconcussion main effect and interaction of 2 × 2 split-plot ANOVA. Neither the interaction nor the main effects nor the simple main effects for either ImPACT variable were found to be statistically significant. Exploratory ANOVAs applied to the remaining ImPACT variables of visualmotor speed, reaction time, impulse control, and symptom total scores revealed only a single statistically significant baseline-to-postconcussion main effect for the symptom total. The results failed to replicate prior findings of gender-specific baseline neurocognitive differences in verbal and visual memory. The findings also indicated no differential gender-based acute response to concussion (symptoms or neurocognitive scores) among high school soccer players. The implications of these findings for the inclusion of gender as a modifying factor in this tightly matched cohort are addressed. Potential explanations for the null findings are discussed.

Return to Play and Future ACL Injury Risk After ACL Reconstruction in Soccer Athletes From the Multicenter Orthopaedic Outcomes Network (MOON) Group

Background: There is limited information on outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACLR) in soccer athletes. Purpose: The purpose of this study was to (1) test the hypotheses that player sex, side of injury, and graft choice do not influence RTP and (2) define the risk for future ACL injury in soccer players after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Soccer players in a prospective cohort were contacted to determine RTP after ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant), and incidence of subsequent ACL surgery was recorded. Results: Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACLR returned to soccer. At average follow-up of 7.0 years, 36% were still playing, a significant decrease compared with initial RTP (P < .0001). Based on multivariate analysis, older athletes (P = .006) and females (P = .037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% vs 5.5%, P = .03). Soccer athletes who underwent ACLR on their nondominant limb had a higher future rate of contralateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (P = .03). Conclusion: Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer after ACLR declines over time. ACLR on the nondominant limb potentially places the dominant limb at risk for future ACL injury.

Risk Factors for Hamstring Injuries in Male Soccer Players: A Systematic Review of Prospective Studies

Hamstring injuries are common injuries in soccer players. In view of the high incidence and the serious consequences, identifying risk factors related to hamstring injuries is essential. The aim of this systematic review was therefore to identify risk factors for hamstring injuries in male adult soccer players. PubMed, Embase/Medline, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus were systematically searched, and prospective studies investigating risk factors for hamstring injuries in adult male soccer players were included. The methodological quality of the included articles was assessed using a standardized set of predefined criteria. Seven of the 11 studies identified, involving a total of 1775 players and 344 hamstring injuries, met the inclusion criteria. All but one of the included studies met at least five of nine methodological criteria, causing them to be qualified as 'high quality'. The included studies used univariate as well as multivariate analyses to identify risk factors for hamstring injury. The results from the multivariate analyses suggest that previous hamstring injury is most strongly related to hamstring injury. Conflicting evidence is found for age and hamstring length or flexibility as risk factors for the occurrence of hamstring injuries.

Intrinsic Risk Factors of Noncontact Ankle Sprains in Soccer

Background: Ankle sprain is an extremely common injury in soccer players. Despite extensive research, the intrinsic cause of this injury under noncontact conditions remains unclear. Purpose: To identify intrinsic risk factors for noncontact ankle sprains in professional soccer players. Study Design: Cohort study; Level of evidence, 2 Methods: One hundred professional soccer players were assessed in the preseason for potential risk factors of noncontact ankle sprains. The assessment included (A) ankle joint asymmetries (right-left) in isokinetic muscle strength, flexibility, proprioception, and stability; (B) somatometric asymmetries; (C) previous injuries; and (D) lateral dominance traits. Noncontact ankle sprains were prospectively recorded and diagnosed for a full competition period (10 months). Results: Seventeen of the players sustained at least 1 noncontact ankle sprain. Logistic regression revealed that players with (A) eccentric isokinetic ankle flexion strength asymmetries (odds ratio [OR] = 8.88; 95% confidence interval [CI], 1.95-40.36, P = .005), (B) increased body mass index (OR = 8.16; 95% CI, 1.42-46.63, P = .018), and (C) increased body weight (OR = 5.72; 95% CI, 1.37-23.95, P = .017 ) each had a significantly higher risk of a noncontact ankle sprain. A trend for younger players (OR = 0.28; 95% CI, 0.061-1.24, P = .092) and for players with ankle laxity asymmetries (OR = 3.38; 95% CI, 0.82-14.00, P = .093) to be at greater risk for ankle sprain was also apparent to the limit of statistical significance (.05 < P < .10). Conclusion: Functional strength asymmetries of the ankle flexors and increased body mass index and body weight raise the propensity for ankle sprains in professional soccer players. Age and asymmetries in ankle laxity are potential factors worth revisiting, as there was an indication for younger players and players with ankle instability to be at higher risk for ankle injury. Proper preseason evaluation may improve prevention strategies for this type of injury in soccer.

Post-training consumption of wheat gluten hydrolysate suppresses the delayed onset of muscle injury in soccer players

Wheat gluten hydrolysate (WGH) is reported to suppress the muscle injuries associated with exercise in long distance running and weight training. In the present study, we investigated the effects of WGH consumption on suppression of muscle injury after soccer training in a double-blind crossover study. Immediately after a mini soccer game, six soccer players consumed 18.0 g of WGH, and muscle injury was investigated using serum creatine kinase (CK) as an indicator. The results showed a significant increase in serum CK from immediately after exercise to 12 h after exercise stress (p<0.05) in the placebo group, while serum CK decreased during this same time period in the WGH group, and the difference between the two groups was significant. This suggests that WGH consumption suppresses delayed-onset muscle injury after exercise in soccer.

Eccentric hamstring muscle training can prevent hamstring injuries in soccer players

Does eccentric muscle training of hamstring muscles reduce the rate of hamstring injuries in male soccer players? Cluster randomised, controlled trial with concealed allocation. The 5 top men's soccer divisions in Denmark. First team squad soccer players from teams in the top 5 national soccer divisions were included. Players who joined a team after the start of the trial were excluded. Randomisation of 54 teams allocated 26 to the intervention group and 28 to a control group. Both groups followed their usual training program. In addition, the intervention group completed 27 sessions of the eccentric hamstring muscle training in a 10-week period during the midseason break, and once a week in the second half of the season. The hamstring exercise (the Nordic curl) involves the player using hamstrings to resist forward falling of the trunk from a kneeling position. Players completed 2-3 sets of 5-12 repetitions of the exercise for 1-3 sessions per week. The primary outcome was the number of overall, new, and recurrent acute hamstring injuries during one full soccer season. A hamstring injury was defined as any acute physical complaint in the region of the posterior thigh sustained during a soccer match or training. Recurrence of an injury already reported in the trial period was not included to avoid recording the same injury more than once. 50 teams with 942 players completed the study. At the end of the season, there had been 15 hamstring injuries (12 new, 3 recurrent) in the eccentric hamstring exercise group and 52 injuries (32 new, 20 recurrent) in the control group. The number needed to treat (NNT) to prevent 1 hamstring injury (new or recurrent) was 13 (95% CI 9 to 23). The NNT to prevent 1 new injury was 25 (95% CI 15 to 72) and the NNT for recurrent injury was 3 (95% CI 2 to 6). Apart from short term muscle soreness no adverse events were reported in the exercise group. An eccentric strengthening exercise program for the hamstring muscles that can be performed during training can help prevent hamstring injuries in soccer players.

Biological Repair of Knee Injuries in Soccer Players

Biological Repair of Knee Injuries in Soccer Players

Eccentric hip adduction and abduction strength in elite soccer players and matched controls: a cross-sectional study

BackgroundEccentric hip adduction and abduction strength plays an important role in the treatment and prevention of groin injuries in soccer players. Lower extremity strength deficits of less than 10% on...

Hip Adductors' Strength, Flexibility, and Injury Risk

The hip adductor muscle group plays an important role in both movement and stability at the hip joint in many athletic pursuits. Injury to this muscle group has been reported in a number of sports, among them, ice hockey, soccer, Australian football, and swimming. The identification of muscle characteristics that predispose a muscle to injury is an important step in developing conditioning programs to reduce injury risk. Muscle strength and range of motion are 2 parameters that may influence injury risk. The aim of this review was to examine the relationship between hip adductors' strength, flexibility, and injury risk. Strength testing has involved isokinetic or hand-held dynamometry. Flexibility has usually been assessed by goniometry during maximal hip abduction. An association has been reported between adductor strength deficits and injury for ice hockey players. Low adductor flexibility has also been identified as a risk factor for injury in soccer players. An intervention program that strengthened the hip adductors had some success in reducing injury risk for ice hockey players. There is some low- to moderate-level evidence from cohort studies to suggest that flexibility and strength are related to injury risk in particular sports and that an intervention program may be effective in reducing injury risk. Higher level evidence from randomized controlled trials is required to firmly establish the link between hip adductor flexibility, strength, and injury.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer, which has served as the strong impetus to conduct research that focuses to determine the risk factors for injury, and more importantly, to identify and teach techniques to reduce this injury in the sport. This research emphasis has afforded a rapid influx of literature aimed to report the effects of neuromuscular training on the risk factors and the incidence of non-contact ACL injury in high-risk soccer populations. The purpose of the current review is to sequence the most recent literature relating the effects of prevention programs that were developed to alter risk factors associated with non-contact ACL injuries and to reduce the rate of non-contact ACL injuries in soccer players. To date there is no standardized intervention program established for soccer to prevent non-contact ACL injuries. Multi-component programs show better results than single-component preventive programs to reduce the risk and incidence of non-contact ACL injuries in soccer players. Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injury. Compliance may in fact be the limiting factor to the overall success of ACL injury interventions targeted to soccer players regardless of gender. Thus, interventional research must also consider techniques to improve compliance especially at the elite levels which will likely influence trickle down effects to sub-elite levels. Future research is also needed for male soccer athletes to help determine the most effective intervention to reduce the non-contact ACL injury risk factors and to prevent non-contact ACL injuries.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.

Prevenção de lesões do ligamento cruzado anterior em futebolistas

A lesão do joelho é a mais comum entre as lesões graves apresentadas por futebolistas, destacando-se o ligamento cruzado anterior como um dos ligamentos do joelho mais frequentemente lesados. Assim, a prevenção de lesões do ligamento cruzado anterior em futebolistas deve ser encarada como uma preocupação constante para todos os agentes ligados à modalidade, independentemente do nível competitivo, idade e sexo dos praticantes. OBJETIVOS: O objetivo deste trabalho é a análise da importância do trabalho de prevenção de lesões do LCA em futebolistas que possa ser incorporado no treino de futebol. METODOLOGIA: A metodologia utilizada neste trabalho foi uma revisão da literatura. CONCLUSÕES: Propõe-se um programa de prevenção de lesões do ligamento cruzado anterior em futebolistas, com três sessões de treino semanais, englobando treino neuromuscular e treino proprioceptivo.

Study of the Fatigue Curve in Quadriceps and Hamstrings of Soccer Players During Isokinetic Endurance Testing

Many studies have presented regression models of quadriceps (Q) muscle strength loss with fatigue development. Paradoxically, the hamstrings (H), which are the principal site of muscle injury in soccer players, have received little attention, and no regression model has been established. This study investigated strength loss in the Q and H to establish a regression model using the lowest number of flexions-extensions during isokinetic endurance testing. Twenty-four semiprofessional soccer players performed 50 flexion-extension movements at 180 degrees x s(-1) on an isokinetic dynamometer. The theoretical equations were calculated from the first 10, first 15, first 20, and first 25 contractions for each muscle group by several regression models (linear, quadratic, cubic). The linear model was the best fit to this exercise protocol to describe the strength loss in both muscle groups. The quadratic model was the best fit to predict the changes in the H/Q ratio. This study showed that a regression model can be established for both muscle groups. A minimum of 20 extensions and 15 flexions was needed to establish a linear model that represented strength loss in, respectively, Q and H. A minimum of 25 flexions-extensions was needed with the quadratic model to accurately determine the decrease in the H/Q ratio. Isokinetic endurance testing can be carried out with only 25 flexions-extensions. This reduction should facilitate the implementation of this protocol. Regular evaluation would contribute to the efforts to prevent muscle injury during competitive sports activity.

Preventing Lower Limb Injuries in Soccer Players

Preventing Lower Limb Injuries in Soccer Players

The unreamed intramedullary tibial nail in tibial shaft fractures of soccer players: a prospective study.

Lower leg fractures are common and complex injuries in soccer players. Twenty-five mainly recreational soccer players who sustained a tibial shaft fracture were treated with the AO-UTN (Unreamed Tibial Nail). This prospective series included 25 males with a mean age of 28.1 years. These patients were prospectively followed for a mean period of 4.7 years. Clinical and radiographic data was collected. In addition, 20 patients completed an outcomes based questionnaire. In all but one case, the mechanism of injury was a contact with an opposing player. Shin guards provided little prevention against these fractures. The majority of these tibial shaft fractures were consistent with a short oblique or transverse fracture pattern. All fractures were stabilized with the UTN on the day of injury. Four patients had concurrent compartment syndromes and underwent a fasciotomy. Average time until bony consolidation was 11.3 weeks. No patients returned to competitive soccer activities earlier than five months after the initial injury (average 9.5). Only 11 out of 20 soccer players returned to the same level of sporting activity. Six patients never returned to playing soccer again after this injury, even without complications. The fracture of the tibial shaft in soccer players is a severe injury that can be treated safely with the UTN without major complications, but nevertheless only 50% of a mainly-recreational playing population return to the same competitive level as before the injury.

Proprioceptive training and prevention of anterior cruciate ligament injuries in soccer.

This commentary describes a program developed to help reduce the incidence of anterior cruciate ligament injuries in soccer players. The basic principles underlying the injury prevention protocol are described with respect to the proprioceptive control mechanisms at the knee joint. This is followed by a detailed description of the program.

Lifetime musculoskeletal symptoms and injuries among former elite male athletes.

We studied the lifetime occurrence of musculoskeletal symptoms in former elite male athletes: 29 weight-lifters, 31 soccer players, 28 long-distance runners, and 29 shooters, 45-68 years of age. The proportion of subjects with monthly back pain during the past year was smaller among runners than among the other athletes, although not statistically significant. Monthly back pain was more common in weight-lifters with lifetime training hours above the median as compared with those below the median. The average intensity of the worst back pain during the past year was clearly higher in weight-lifters and soccer players, than in runners and shooters. Knee pain at least once a month during the past year was reported by 52% (CI 33-70%) of the soccer players, 31% (CI 15-51%) of the weight lifters, 21% (CI 8-41 %) of the runners, and 17% (CI 6-36%) of the shooters (p = 0.019). Soccer players had the highest number of sports-related knee injuries (p < 0.0001). Past knee injuries were associated with knee pain in later adulthood (p = 0.048). More runners reported having had hip pain episodes during their lifetime than other athletes, but no differences were found in the occurrence of hip pain during the past year. In conclusion, compared with shooters, athletes formerly exposed to heavy exercise did not report more frequent back pain during the past year, whereas a high intensity of back pain was typical of soccer players and weight-lifters. A predisposition to knee injuries in soccer players appears to increase the risk of future knee pain. Similarly, knee pain later in life seems to be more common in weight-lifters than in runners and shooters. Long-distance runners, on the other hand, are prone to an increased lifetime risk of hip pain.

POSTURE IN SOCCER PLAYERS 977

Soccer is the most popular team sport in the world. That game is played by both genders of different ages. Little information is available respect to postural deformities of soccer players and related injuries. Thus we evaluated posture in professional soccer players, in order to detected the frequency of postural alterations and related injuries. 87 males subjects (25 ± 5 years) underwent posture examination. They were evaluated for gravity center of body, thorax symmetry, spine, pelvis and lower extremities in the frontal, lateral and posterior planes and leg lenght. 85 subjects (97.7%) showed at least a postural defect. Of the total population, 64.3% had foot malalignment; 57.4% spine abnormalities and 35.6% had pelvic extremities disorders. 62 subjects (72.1%) had skin and nails foot alterations (calluses and fungal infection). In relation to posture, the most common observation was thoracic scoliosis (n = 33, 37.9%), followed by rearfoot valgus (n = 24, 27.5%) and midfoot pronation (n = 19, 21.8%). We conclude: 1) Our findings indicates a high prevalence of postural disorders; 2) The foot was the anatomical area with more abnormalities; 3) This high prevalence of alterations may represent and important risk factor for future injuries in soccer players.

Prevention of anterior cruciate ligament injuries in soccer

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained "normally" and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the proprioceptively trained group (P < 0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.

Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters.

To determine the relationship between different physical loading conditions and findings of knee osteoarthritis (OA). We selected 117 male former top-level athletes (age range 45-68 years) who had participated in sports activities with distinctly different loading conditions: 28 had been long-distance runners, 31 soccer players, 29 weight lifters, and 29 shooters. Histories of lifetime occupational and athletic knee loading, knee injuries, and knee symptoms were obtained, and subjects were examined clinically and radiographically for knee findings of OA. The prevalence of tibiofemoral or patellofemoral OA based on radiographic examination was 3% in shooters, 29% in soccer players, 31% in weight lifters, and 14% in runners (P = 0.016 between groups). Soccer players had the highest prevalence of tibiofemoral OA (26%), and weight lifters had the highest prevalence of patellofemoral OA (28%). Subjects with radiographically documented knee OA had more symptoms, clinical findings, and functional limitations than did subjects without knee OA. By stepwise logistic regression analysis, the risk for having knee OA was increased in subjects with previous knee injuries (odds ratio [OR] 4.73), high body mass index at the age of 20 (OR 1.76/unit of increasing body mass index), previous participation in heavy work (OR 1.08/work-year), kneeling or squatting work (OR 1.10/work-year), and in subjects participating in soccer (OR 5.21). Soccer players and weight lifters are at increased risk of developing premature knee OA. The increased risk is explained in part by knee injuries in soccer players and by high body mass in weight lifters.