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Australian football: injury profile at the community level.

Successful injury prevention relies on injury surveillance to establish the extent of the problem, to monitor injury patterns and to evaluate prevention strategies. Despite the popularity of participation in Australian football at the community level, few injury surveillance studies have been published describing the pattern of injuries at this level of participation. In contrast, ongoing injury surveillance at the elite-level is well established. Reliance on injury data from the elite-level of Australian football to guide injury prevention at the community level may not be appropriate due to differences across the levels with respect to exposure, fitness and skill level. Therefore, specific injury surveillance at the community level of Australian football is warranted. This study describes the epidemiology of community level Australian football injuries. Injury surveillance was undertaken in five amateur Australian football clubs over the 1999 season. The 320 participating players sustained 421 injuries over the season. The overall rate of injury was 27 injuries per 1000 player hours. Injuries were most commonly sustained at the start of the season and during the second quarter of match participation. Hamstring muscle strains were the most common injury sustained, followed by thigh haematomas and lateral ligament sprains of the ankle. The injury surveillance system used in this study was well accepted by the clubs and provides detailed data for the prioritisation of future injury prevention research at the community level of Australian football.

Adolescent↗

Major injuries in Norwegian football.

All Norwegian football players are insurance covered and most of the severe injuries occurring in Norwegian football are therefore reported to the Norwegian Football Association. Based on these reports a survey of major injuries in Norwegian football in the period 1970-1974 is given. This study has already led to recommendations to the Football Association in order to reduce the number of severe injuries. A more extensive registration form is now used which probably will give more and better information about injuries in Norwegian football in the future.

Adolescent↗

Drug use in English professional football.

OBJECTIVES: To examine several issues related to drug use in English professional football. More particularly the project sought to gather data on: players' use of permitted supplements (mineral and vitamin pills and creatine); whether they sought advice, and if so from whom, about their use of supplements; their experience of and attitudes towards drug testing; their views on the extent of the use of banned performance enhancing and recreational drugs in football; and their personal knowledge of players who used such drugs. METHODS: With the cooperation of the Professional Footballers Association (PFA), reply paid postal questionnaires were delivered to the home addresses of all 2863 members of the PFA. A total of 706 questionnaires were returned, a response rate of just under 25%. RESULTS: Many players use supplements, although almost one in five players does so without seeking qualified professional advice from anyone within the club. Blood tests are rarely used to monitor the health of players. One third of players had not been tested for drugs within the preceding two years, and 60% felt that they were unlikely to be tested in the next year. The use of performance enhancing drugs appears to be rare, although recreational drugs are commonly used by professional footballers: 6% of respondents indicated that they personally knew players who used performance enhancing drugs, and 45% of players knew players who used recreational drugs. CONCLUSIONS: There is a need to ensure that footballers are given appropriate advice about the use of supplements in order to minimise the risk of using supplements that may be contaminated with banned substances. Footballers are tested for drugs less often than many other elite athletes. This needs to be addressed. The relatively high level of recreational drug use is not reflected in the number of positive tests. This suggests that many players who use recreational drugs avoid detection. It also raises doubts about the ability of the drug testing programme to detect the use of performance enhancing drugs.

Adolescent↗

A comparison of the physiological profiles of elite Gaelic footballers, hurlers, and soccer players.

BACKGROUND: Gaelic football, soccer, and hurling are prominent field games in Ireland and involve participants undertaking a variety of playing tasks and skills which place various physiological demands on the participants. The aim of this study was to evaluate and compare the mid-season physiological profiles of elite players. METHODS: Physiological assessment was carried out on 29 inter-county Gaelic footballers, 30 inter-county hurlers, and 21 League of Ireland soccer players. RESULTS: Significant differences were reported for % body fat (p<0.05), aerobic capacity (p<0.05), flexibility (p<0.05), upper body strength (p<0.05), upper body strength endurance (p<0.05), abdominal endurance (p<0.05), and speed endurance (p<0.05), while there were no differences recorded for height, weight, or speed levels. A relatively heterogeneous body size is evident for all three sports. Soccer players had lower body fat levels, greater aerobic capacity, greater strength endurance, and greater flexibility compared to both Gaelic footballers and hurlers, possibly due to specific training and conditioning programmes or physical adaptation to match play The greater strength of both Gaelic footballers and hurlers and the superior speed endurance levels of Gaelic footballers also reflect the physical nature of the sports. Similar speed levels amongst all three sports reflect the importance of speed for performance. CONCLUSIONS: The various physiological attributes for Gaelic football, soccer, and hurling reflect the physical requirements for success and participation in each of these field games.

Adult↗

Long term health impact of playing professional football in the United Kingdom.

OBJECTIVE: To describe the long term impact of football on the health related quality of life (HRQL) of former professional footballers in the United Kingdom. METHOD: A cross sectional survey gathered data from 284 former professional players. Respondents reported medical treatments, osteoarthritis (OA) diagnosis, other morbidity, disability status, and work related disability since their football career. The EuroQol (EQ-5D) and global health rating scales were selected to assess HRQL. RESULTS: Medical treatment for football related injuries was a common feature, as was OA, with the knee being the most commonly affected joint. Respondents with OA reported poorer HRQL compared with those without OA. As with medical treatments and problems on each of the five EQ-5D dimensions (pain, mobility, usual activities, anxiety/depression, self care), frequency of disability and work related disability were higher among respondents with OA than those without. CONCLUSION: This exploratory study suggests that playing professional football can impact on the health of United Kingdom footballers in later life. The development of OA was associated with poorer outcomes on all aspects of HRQL.

Athletic Injuries↗

Evaluating the level of injury in English professional football using a risk based assessment process.

OBJECTIVES: To show how epidemiological data can be presented and analysed in frequency based and risk based formats and how risk based information can simplify management decisions on injury prevention strategies in professional football. METHODS: The club physiotherapists at four English professional football clubs prospectively recorded players' injuries over the period November 1994 to May 1997. The nature, location, and mechanism of each injury and the specific numbers of days that players were unavailable to train or play as a result of injuries were recorded. The rates of injury were evaluated on a risk matrix using the number of days and the estimated costs of absence as measures of injury consequences. RESULTS: There was a significant difference in the time lost through injury as a function of injury severity (p<0.001). Slight and minor injuries accounted for 51% of all injuries but represented only 17% of the risk from injury, whereas major injuries accounted for only 12% of the number of injuries and 47% of the risk. Player to player contact injuries accounted for 39% of the risk of injury, and football specific activities accounted for 47% of the risk. The risks of acute injury in professional football were three orders of magnitude greater than those in the construction, manufacturing, and service sectors of industry. CONCLUSIONS: The risks associated with minor, moderate, and major acute injuries and osteoarthritis in lower limb joints of professional footballers were found to be unacceptable when evaluated against work based risk criteria used by the Health and Safety Executive. All stakeholders within professional football were shown to have an important contribution to make in reducing the overall level of risk to players through the provision of risk prevention strategies.

England↗

Football boot insoles and sensitivity to extent of ankle inversion movement.

BACKGROUND: The capacity of the plantar sole of the foot to convey information about foot position is reduced by conventional smooth boot insoles, compared with barefoot surface contact. OBJECTIVE: To test the hypothesis that movement discrimination may be restored by inserting textured replacement insoles, achieved by changing footwear conditions and measuring the accuracy of judgments of the extent of ankle inversion movement. METHODS: An automated testing device, the ankle movement extent discrimination apparatus (AMEDA), developed to assess active ankle function in weight bearing without a balance demand, was used to test the effects of sole inserts in soccer boots. Seventeen elite soccer players, the members of the 2000 Australian Women's soccer squad (34 ankles), took part in the study. Subjects were randomly allocated to start testing in: bare feet, their own football boots, own football boot and replacement insole, and on the left or right side. Subjects underwent six 50 trial blocks, in which they completed all footwear conditions. The sole inserts were cut to size for each foot from textured rubber "finger profile" sheeting. RESULTS: Movement discrimination scores were significantly worse when subjects wore their football boots and socks, compared with barefoot data collected at the same time. The substitution of textured insoles for conventional smooth insoles in the football boots was found to restore movement discrimination to barefoot levels. CONCLUSIONS: The lower active movement discrimination scores of athletes when wearing football boots with smooth insoles suggest that the insole is one aspect of football boot and sport shoe design that could be modified to provide the sensory feedback needed for accurate foot positioning.

Adult↗

Video analysis of the mechanisms for ankle injuries in football.

BACKGROUND: Although ankle sprains are frequent in football, little is known about their mechanisms. PURPOSE: To describe the injury mechanisms for ankle injuries in male elite football. STUDY DESIGN: Prospective cohort study. METHODS: Videotapes and injury information were collected for 313 of 409 matches from Norwegian and Icelandic elite football during the 1999 to 2000 seasons. Video recordings of incidents that resulted in ankle injuries were analyzed and cross-referenced with injury reports from the team medical staff. RESULTS: A total 46 acute ankle injuries were reported to have occurred, that is, 4.5 injuries per 1000 match hours. Of these, 26 (57%) were identified on the videotapes. Two mechanisms thought to be specific to football were found: 1) player-to-player contact with impact by an opponent on the medial aspect of the leg just before or at foot strike, resulting in a laterally directed force causing the player to land with the ankle in a vulnerable, inverted position; and 2) forced plantar flexion where the injured player hit the opponent's foot when attempting to shoot or clear the ball. CONCLUSIONS: Systematic video analysis provides detailed information on the mechanisms for ankle injuries in football-for lateral ligament sprains and for the condition dubbed "footballer's ankle."

Adult↗

Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance imaging findings and athlete outcome.

BACKGROUND: Groin pain and tenderness are common in athletes from a variety of codes of football, but little attention has been directed to the influence of magnetic resonance imaging and such clinical findings on athlete participation. HYPOTHESIS: Preseason groin pain, tenderness, and magnetic resonance imaging findings such as pubic bone marrow edema are associated with restricted training capacity and missed games. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Fifty-two Australian footballers in the national competition were recruited. Preseason groin pain and focal tenderness were recorded, and magnetic resonance imaging of the groin was performed within 1 week of examination. Training restriction and games missed owing to groin pain were documented during the subsequent season. RESULTS: Magnetic resonance imaging showed pubic bone marrow edema in 19 of 52 (37%) footballers and linear parasymphyseal T2 hyperintensity in 16 of 52 (31%) footballers. Groin pain restricted training during the season in 22 of 52 (42%) footballers, and 9 of 52 (17%) footballers missed at least 1 game. Preseason pain (P = .0004), pubic bone tenderness (P = .02), and linear parasymphyseal T2 hyperintensity (P = .01) were associated with restricted training capacity during the subsequent season. Preseason groin pain (P = .03) was associated with missed games, but magnetic resonance imaging findings were not. CONCLUSION: Preseason pubic bone marrow edema, groin pain, and linear parasymphyseal T2 hyperintensity were associated with training restriction, but only preseason groin pain was associated with missed games.

Adolescent↗

Can watching football be a component of developing a state of mental health for men?

Football supporters, by and large, continue to have a negative image and be presented in a very destructive way by the media generally. This has been reflected academically by the fact that much of the research that has been done into football and football fans has focused on negative aspects of small numbers of supporters' behaviours such as hooliganism and racism. This paper describes a two stage study exploring some of the more positive effects noted during studies with football fans from Mansfield Town, a team currently in the third division of the English Football League. The study explores the perceived benefits to mental health for fans gained from the supporting experience in such areas as stress relief, catharsis and the development of good parent-child relationships. Discussion takes place around the paradox that some of the behaviours described by supporters as beneficial and done in 'the spirit of carnival' may challenge liberal beliefs and be viewed as antisocial and offensive. The key feature in health promotional terms is the overwhelming view of fans that the 'carnivalesque' behaviours stay in the football ground where such behaviours are viewed as acceptable and socially sanctioned.

Adolescent↗

Lipid peroxidation, erythrocyte superoxide-dismutase activity and trace metals in young male footballers.

Physical training is known to induce oxidative stress in individuals subjected to intense exercise. In this study, we investigated plasma malondialdehyde (MDA) levels and erythrocyte superoxide dismutase (SOD) activity of 25 young male footballers and a control group of similar age. Red blood cell (RBC) count, haemoglobin (Hb) and haematocrit (Hct) values, and copper (Cu) and zinc (Zn) levels were also examined. The maximal oxygen uptake (VO2max) of all subjects was determined in order to establish their functional capacity. The main finding of the present study was that plasma MDA levels, one of the most commonly used markers of lipid peroxidation, of this group of footballers aged under 21 decreased slightly when compared with those of the control group (p < 0.001). In contrast, erythrocyte SOD activity was higher in the footballer group than in the controls (p < 0.001). Footballers who are under regular training showed an improved antioxidant activity in comparison to sedentary controls. Plasma copper concentration, RBC count and Hb concentration of the footballer group were all significantly lower than those of the control group, (p < 0.001, p < 0.01, p < 0.01, respectively). Investigating the footballers' data with Spearman's correlation analyses, the correlation coefficients (r) between Zn/Cu ratio and SOD was positive (r=0.44; p < 0.05); and between VO2max and SOD (r=0.42; p < 0.05) were both positive. On the basis of statistical analysis, we suggest that regular exercise may be beneficial in cases of oxidative damage by reducing the amount of lipid peroxidation and increasing the activity of the antioxidant enzyme SOD.

Aged↗

Australian Rules football injuries in children and adolescents.

OBJECTIVE: To ascertain the incidence, severity, risk factors, and outcomes of injuries in children and adolescents playing Australian Rules football. DESIGN SETTING AND SUBJECTS: A prospective cohort study of football injuries in children and adolescents playing community football. We studied a stratified random sample of 54 teams and clinics (18 under-15 teams, 18 under-10 teams and 18 Vickick clinics for children under 10 years) from the Melbourne metropolitan area. Football exposure, injuries and associated risk factors were recorded for 1253 players during the 1992 football season. RESULTS: Vickick, a modified form of the game, had the lowest rates of injury for all levels of injury severity, with an overall rate of 3.49 injuries per 1000 player-hours. The rate in the under-10 age group was 2.4 times higher (95% confidence interval [CI], 1.5-3.8) than that in Vickick, and the under-15 rate was 1.2 times (95% CI, 0.9-1.6) that of the under-10s. The under-15 age group had significantly more injuries that led to use of health services than the under-10 and Vickick groups, with rates of 3.93 (95% CI, 2.9-4.9), 0.64 (95% CI, 0.2-1.4), and 0.33 (95% CI, 0.1-0.8) injuries per 1000 players-hours respectively. Injuries were largely to soft tissues (sprains 26%, haematomas 25%) and to the lower limb (43%). Very few serious injuries occurred (19 fractures and three injuries with loss of consciousness); nearly all of these were in the under-15s. Rule modifications in under-10 teams and clinics were associated with an injury rate of 5.8 injuries per 1000 player-hours (95% CI, 4.4-7.3) compared with 7.5 injuries per 1000 player-hours (95% CI, 5.2-9.8) when no modification was used. Alterations to the ruck contest, decreased contact, field size and player numbers were significantly associated with lower injury rates, while body size was not. Of the 30% of injuries resulting in a health service consultation, the most common health provider was a medical practitioner. Very few required expensive investigation or treatment. CONCLUSION: Injury rates were low in children under age 10, but higher in adolescents. Most injuries were minor, and did not result in a health professional consultation. Rule modifications were associated with substantially lower injury rates at the under-10 level, and should be promoted as a safe way to learn football skills.

Adolescent↗

Beyond the racist/hooligan couplet: race, social theory and football culture.

This paper draws on recent research to explore the changing cultures of racism in English football. Starting from a critical analysis of key themes in the literature on football it seeks to show that existing analytical frameworks need to be reworked if they are going to adequately account for the complex forms through which racism is expressed in contemporary football cultures. In the course of this analysis we question some of the ways in which the issue of racism in football is collapsed into broader accounts of 'hooliganism' and other forms of violence among football fans. From this starting point the paper draws on some elements of our empirical research in order to outline an alternative way of framing the issues of racism and multicultrralism in football.

Black People↗

Injury profile of amateur Australian rules footballers.

Australian Rules Football is played by numerous young Australians throughout winter each year. There have been a number of studies on professional and semi-professional footballers, establishing the nature and frequency of injuries within this football code. Medical cover of an amateur football club over the 1993 season allowed detailed recording of injuries over this period. The data collected revealed a markedly different injury profile to that seen previously. The injury rate in this study was 96 per 1000 player hours. The most common injury was concussion (15%), with hand fractures next most frequent (13.5%). The lower limb was the most common site of injury, with head and neck second and upper limb third. Injuries with an overuse component were seen less commonly in the amateur group while traumatic injuries were more frequent. The time allocated by amateur footballers to their sport is less than professional players, quite aside from the difference in skill level attained. Overuse injuries may be correspondingly much less frequent on a time basis alone. The increased incidence of traumatic injuries is postulated to be a manifestation of both less well developed skills and possibly less available and effective preventative measures such as ankle strapping and tape supplies. Considering the large number of young people playing amateur football and the significant time and cost of what are often relatively minor injuries, more work is required to establish what injuries are most common, and importantly, what measures can be taken to decrease their incidence.

Athletic Injuries↗

Concussion in professional football: location and direction of helmet impacts-Part 2.

OBJECTIVE: National Football League game video was analyzed for the typical locations of severe helmet impacts in professional football. By use of selected cases that were reconstructed in laboratory tests and reported previously, the magnitude and direction of force causing concussion was determined for these locations. METHODS: Multiple video views were obtained for 182 severe helmet impacts that occurred between 1996 and 2001. From a top view, the helmet was divided into 45-degree quadrants with 0 degrees eyes forward. From a side view, it was divided into seven equal levels, four (+Q1 to +Q4) above the head center of gravity and three below (-Q1 to -Q3). The initial helmet contact was located in these regions. Thirty-one impacts were reconstructed with helmeted Hybrid III dummies involving 25 concussions. Measurement of head translational and rotational acceleration was used to determine the average and +/-1 standard deviation in responses, with impacts reflected to the right side. RESULTS: From video, the majority (71%) of impact is to the helmet shell primarily from a striking player's helmet, arm, or shoulder pad to the side (45-135 degrees) or from ground contact to the back (135-180 degrees). Most impacts were high on the helmet at +Q2 to +Q4. The remainder (29%) were primarily from helmet contact on the facemask at an oblique frontal angle (0-45 degrees) and -Q3 to +Q1 height. From reconstructions, concussion occurred with the lowest peak head acceleration in facemask impacts at 78 +/- 18 g versus an average 107 to 117 g for impacts on other quadrants (t = 2.90, P < 0.005). There was a significantly higher head acceleration for concussed versus nonconcussed players (t = 2.85, P < 0.05). The vector of peak force was essentially horizontal for facemask impacts and downward at 12 to 27 degrees for impacts to the helmet side and back. Concussion in professional football involves four typical conditions, as follows: A, 0- to 45-degree quadrant, -Q3 to +Q3 level, peak force 49 +/- 18 degrees from front and horizontal; B, 45- to 90-degree quadrant, -Q2 to +Q3 level, peak force 73 +/- 12 degrees and horizontal; C, 90- to 135-degree quadrant, +Q1 to +Q4 level, peak force 97 +/- 9 degrees and 12 degrees downward; and D, 135- to 180-degree quadrant, +Q1 to +Q4 level, peak force 157 +/- 1 degrees and 27 degrees downward. Concussed players averaged 3.6 +/- 2.7 initial signs and symptoms. The most common were headaches, dizziness, immediate recall problems, and difficulty with information processing. CONCLUSION: The location, direction, and severity of helmet impacts causing concussion in the National Football League have been defined from analysis of game video and laboratory reconstruction. These conditions define the circumstances in which helmets need to reduce head injury risks in professional football.

Acceleration↗

Bone mineral density in female junior, senior and former football players.

The purpose of this study was to examine the bone mineral densities (BMD) of female junior and senior football (soccer) players with different training regimens and histories, female former football players, and their respective controls. Active junior (age 13-17 years, n = 62) and senior (age 18-28 years, n = 34) players, representing three teams with different levels of performance and training, were compared reciprocally and with matched controls (n = 90). Former players (age 34-84 years, n = 25) who had ended their careers on average 9.7 years previously and their matched controls (n = 57) were also studied. Body composition and total body, lumbar spine and proximal femur BMD were measured with dual-energy X-ray absorptiometry. Former players and their controls were asked in a questionnaire to specify their current level of physical activity. In a control for differences in age, weight and body mass index, football players had significantly greater BMD than controls at all sites measured. This difference appeared to be site-specific, with greater differences in BMD at the proximal femur sites (10.5-11.1%) than at the lumbar spine (4.8%) or for the total body (3.5%). Further, differences were greater for senior than for junior players. However, no BMD differences were found between teams representing different levels of performance and training. Female former football players had retained their proximal femur and total-body BMD advantage over controls. In conclusion, training in female football, which is an impact-loading activity, has a site-specific, positive effect on bone formation that is not increased over a certain level of physical activity. The BMD advantage attained appears to be preserved to some extent after the termination of the athlete's active career, which may have a positive effect on future fracture risk.

Absorptiometry, Photon↗

Effect of training on GH and IGF-1 responses to a submaximal exercise in football players.

To study the effects of regular football training on basal and exercise induced levels of growth hormone (GH) and insulin-like growth factor (IGF-1), 13 young football players were investigated by a submaximal exercise at the beginning of the sporting season in October (S1), at the middle of the season in January (S2) and at the end in May (S3). At each session, an exercise test on an ergogycle was performed for 25 min, beginning with an incremental exercise to reach 90% of theoretical maximal heart, which was maintained for the last 10 min of the test. Venous blood samples were collected at rest, at the end of the exercise and at 30 and 60 min during the recovery period. Plasma lactate and glucose concentrations increased during exercise with no difference found between sessions. GH level increased with exercise at each session but the response was significantly higher in S1 than in S2 and S3 (P<0.01). The GH area under the curve decreased significantly all along the football season (P<0.01); the IGF-1 level did not significantly change during exercise nor with training. Basal insulin-like growth factor binding protein-3 (IGFBP3) remained stable during the three sessions. Football training decreased significantly the exercise-stimulated GH levels all along the football season but did not have any significant effect on IGF-1 levels or on basal IGFBP3 levels.

Adaptation, Physiological↗

[Football, television and emergency services].

BACKGROUND: To know the influence of televised football on the use of emergency department (ED). PATIENTS AND METHODS: We assessed the number, demographic characteristics and acuity of patients attended during the broadcast of football matches played by FC Barcelona during Champions' League (n = 12), and they were compared with days without televised football (n = 12). RESULTS: Televised football was associated with a decrease in visits to ED (-18%; p = 0.002). Such a decrease was observed for all ED units, but only for traumatology unit reached statistical significance (-28%; p = 0.006). Decay of ED visits were mainly due to a decrease of low-acuity consults (-30%; p = 0.04). CONCLUSION: There is a significant decrease on ED use associated with televised football.

Adult↗