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      Higher age and present injury at the start of the season are risk factors for in-season injury in amateur male and female football players—a prospective cohort study

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          Abstract

          Purpose

          To describe the injury prevalence, injury pattern, and potential baseline risk factors for injuries in male and female adolescent and adult amateur football players.

          Methods

          This prospective study followed adolescent and adult amateur football players over one season March–October 2020. The study was completed by 462 players (130 men, age 20.0 ± 5.7, 14–46 years) who answered a baseline survey and a weekly web survey during the season. A total of 1456 weekly surveys were registered from males and 5041 from females. Injuries were recorded with the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O2). Potential baseline risk factors (age, performance of strength/conditioning training, participation in other sports, perceived importance of sporting success, self-rated training and match load, perceived balance between training/match load and recovery, previous/present injury at start of season, and injury beliefs) and their association with injury were analysed with Poisson regressions within each sex.

          Results

          Males reported 95 injuries (262 injury weeks, weekly prevalence 18.0% (95% CI 16.1–20.1)) and females 350 injuries (1206 injury weeks, weekly prevalence 23.9% (95% CI 22.8–25.1)). Gradual-onset injuries accounted for 57% of the injuries in males and 66% in females. For males, substantial injuries were most common in the hip/groin (weekly prevalence 3.8%), ankle (2.1%), posterior thigh (2.0%), and knee (2.0%); and for females, in the knee (4.3%), ankle (2.5%), and lower leg/Achilles tendon (2.0%). Significant risk factors for injury were higher age (rate ratio males 1.05 per year increase (95% CI 1.02–1.08), females 1.03 (95% CI 1.01–1.05)), and present injury at baseline (males 1.92 (95% CI 1.27–2.89), females 1.58 (95% CI 1.19–2.09)).

          Conclusion

          At any given week, almost one in five male and one in four female amateur football players reported new or ongoing injuries. Hip/groin injuries were more frequent in males, while female players had a higher prevalence of knee injuries. Older players and those with an existing injury at the start of the season were more prone to new injury during the season. Rehabilitation of pre-season injury and complaints are key to reduce the injury burden in amateur football.

          Level of evidence

          Level II.

          Trial registration number NCT04272047, Clinical trials

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00167-023-07517-6.

          Related collections

          Most cited references43

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          International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS))

          Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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            Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons.

            Previous injury is often proposed to be a risk factor for football injury, but most studies rely on players reporting their own medical history and are thus potentially subject to recall bias. Little is known about the natural variation in injury pattern between seasons. To study whether prospectively recorded injuries during one season are associated with injuries sustained during the following season, and to compare injury risk and injury pattern between consecutive seasons. The medical staffs of 12 elite Swedish male football teams prospectively recorded individual exposure and time loss injuries over two full consecutive seasons (2001 and 2002). A multivariate model was used to determine the relation between previous injury, anthropometric data, and the risk of injury. The training and match injury incidences were similar between seasons (5.1 v 5.3 injuries/1000 training hours and 25.9 v 22.7/1000 match hours), but analysis of injury severity and injury patterns showed variations between seasons. Players who were injured in the 2001 season were at greater risk of any injury in the following season compared with non-injured players (hazard ratio 2.7; 95% confidence interval 1.7 to 4.3, p<0.0001). Players with a previous hamstring injury, groin injury, and knee joint trauma were two to three times more likely to suffer an identical injury in the following season, whereas no such relation was found for ankle sprain. Age was not associated with an increased injury risk. This study confirmed previous results showing that previous injury is an important risk factor for football injury. Overall injury incidences were similar between consecutive seasons, indicating that an injury surveillance study covering one full season can provide a reasonable overview of the injury problem among elite football players in a specific environment. However, a prolonged study period is recommended for analyses of specific injury patterns.
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              Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept

              Injury prediction is one of the most challenging issues in sports and a key component for injury prevention. Sports injuries aetiology investigations have assumed a reductionist view in which a phenomenon has been simplified into units and analysed as the sum of its basic parts and causality has been seen in a linear and unidirectional way. This reductionist approach relies on correlation and regression analyses and, despite the vast effort to predict sports injuries, it has been limited in its ability to successfully identify predictive factors. The majority of human health conditions are complex. In this sense, the multifactorial complex nature of sports injuries arises not from the linear interaction between isolated and predictive factors, but from the complex interaction among a web of determinants. Thus, the aim of this conceptual paper was to propose a complex system model for sports injuries and to demonstrate how the implementation of complex system thinking may allow us to better address the complex nature of the sports injuries aetiology. According to this model, we should identify features that are hallmarks of complex systems, such as the pattern of relationships (interactions) among determinants, the regularities (profiles) that simultaneously characterise and constrain the phenomenon and the emerging pattern that arises from the complex web of determinants. In sports practice, this emerging pattern may be related to injury occurrence or adaptation. This novel view of preventive intervention relies on the identification of regularities or risk profile, moving from risk factors to risk pattern recognition.
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                Author and article information

                Contributors
                sofi.sonesson@liu.se
                hanna.lindblom@liu.se
                martin.hagglund@liu.se
                Journal
                Knee Surg Sports Traumatol Arthrosc
                Knee Surg Sports Traumatol Arthrosc
                Knee Surgery, Sports Traumatology, Arthroscopy
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0942-2056
                1433-7347
                5 August 2023
                5 August 2023
                2023
                : 31
                : 10
                : 4618-4630
                Affiliations
                [1 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, , Linköping University, ; 581 83 Linköping, Sweden
                [2 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Sport Without Injury ProgrammE (SWIPE), Department of Health, Medicine and Caring Sciences, , Linköping University, ; Linköping, Sweden
                Author information
                http://orcid.org/0000-0001-8670-5666
                http://orcid.org/0000-0002-1533-6872
                http://orcid.org/0000-0002-6883-1471
                Article
                7517
                10.1007/s00167-023-07517-6
                10471640
                37542529
                3cf0441c-4c23-42d8-bf59-20e840dcaa95
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 March 2023
                : 14 July 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;
                Award ID: 2018-03135
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100016670, Region Östergötland;
                Award ID: 922771
                Award Recipient :
                Funded by: Linköping University
                Categories
                Sports Medicine
                Custom metadata
                © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2023

                Surgery
                sports,injury,epidemiology,knee injuries,hip/groin injuries
                Surgery
                sports, injury, epidemiology, knee injuries, hip/groin injuries

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