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PubMed2003

Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001.

The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity. The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8/1000 h-1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8/1000 h of football, in both seasons. A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.

Adult↗
PubMed2006

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.

BACKGROUND: Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries; this has made interstudy comparisons difficult. PROCEDURE: An Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology, and implementation was discussed by members of the group during a 2-day meeting. After this meeting, iterative draft statements were prepared and circulated to the members of the group for comment before the final consensus statement was produced. RESULTS: Definitions of injury, recurrent injury, severity, and training and match exposures in football, together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. CONCLUSIONS: The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.

Athletic Injuries↗
PubMed2004

The globalization of football: a study in the glocalization of the 'serious life'.

Sport, in particular football, constitutes one of the most dynamic, sociologically illuminating domains of globalization. This paper examines the globalization of football with particular reference to Robertson's theorizations of global processes. We examine football's cultural globalization through the concept of 'glocalization', which highlights the interdependence of local and global processes within the game's identities and institutions. We address economic globalization in football by considering the world's leading clubs as 'glocal' transnational corporations. We assess the political globalization of football with reference to the possible enhancement of democracy within the game's international governance. We conclude by affirming the utility of sport in advancing our empirical and theoretical understanding of globalization processes.

Commerce↗
PubMed2006

High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury.

BACKGROUND: Anterior cruciate ligament (ACL) injury is a severe event for a footballer, but it is unclear if the knee injury rate is higher on returning to football after ACL injury. OBJECTIVE: To study the risk of knee injury in elite footballers with a history of ACL injury compared with those without. METHOD: The Swedish male professional league (310 players) was studied during 2001. Players with a history of ACL injury at the study start were identified. Exposure to football and all time loss injuries during the season were recorded prospectively. RESULTS: Twenty four players (8%) had a history of 28 ACL injuries in 27 knees (one rerupture). These players had a higher incidence of new knee injury of any type than the players without ACL injury (mean (SD) 4.2 (3.7) v 1.0 (0.7) injuries per 1000 hours, p = 0.02). The risk of suffering a knee overuse injury was significantly higher regardless of whether the player (relative risk 4.8, 95% confidence interval 2.0 to 11.2) or the knee (relative risk 7.9, 95% confidence interval 3.4 to 18.5) was used as the unit of analysis. No interactive effects of age or any other anthropometric data were seen. CONCLUSION: The risk of new knee injury, especially overuse injury, was significantly increased on return to elite football after ACL injury regardless of whether the player or the knee was used as the unit of analysis.

Adult↗
PubMed1997

Drug doping in senior Australian rules football: a survey for frequency.

OBJECTIVES: To determine by survey whether the frequency of use of performance enhancing drugs (drug doping) is significant in elite players of Australian Rules football, and to compare this frequency with that in other competitions. METHODS: Randomised unannounced prospective urine testing during the period 1990-95 of players from the Australian Football League out of competition, in competition matches, and in finals matches; testing was performed according to Olympic International Committee protocols and standards. The players' identities and clubs were unknown during testing. RESULTS: Of 900 random urine tests, no positive results were obtained for anabolic steroids, diuretics, caffeine, or peptide hormones. Five positive results (0.6%) were obtained-for pseudoephedrine in two instances, and for probenecid, methoxyphenamine, and dextropropoxyphene in one instance each. Each were inadvertent medical doping and declared before testing. CONCLUSIONS: Drug doping is not a problem in the Australian Football League. This is probably because no doping method is considered to be of value to Australian Rules football, because an educational programme is run by football authorities, and because random during season and out of season testing for drugs occurs.

Anabolic Agents↗
PubMed2003

A matter of life and death: population mortality and football results.

OBJECTIVES: To determine whether football results are associated with mortality from circulatory disease. DESIGN: Retrospective study, comparing mortality on days of football matches between 18 August 1994 and 28 December 1999 with the results of the football matches. SETTING: Newcastle and North Tyneside, Sunderland, Tees, and Leeds Health Authority areas of England. SUBJECTS: All persons resident in Newcastle and North Tyneside, Sunderland, Tees, and Leeds Health Authority areas of England. MAIN OUTCOME MEASURES: Mortality attributable to acute myocardial infarction and stroke. RESULTS: On days when the local professional football team lost at home, mortality attributable to acute myocardial infarction and stroke increased significantly in men (relative risk 1.28, 95% confidence intervals 1.11 to 1.47). No increase was observed in women. CONCLUSIONS: Results achieved by the local professional football team are associated systematically with circulatory disease death rates over a five year period in men, but not women.

Cause of Death↗
PubMedDate not supplied

Risk factors for injuries in football.

BACKGROUND: The injury risk in football is high, but little is known about causes of injury. PURPOSE: To identify risk factors for football injuries using a multivariate model. STUDY DESIGN: Prospective cohort study. METHODS: Participants were 306 male football players from the two highest divisions in Iceland. Before the 1999 football season started, the following factors were examined: height, weight, body composition, flexibility, leg extension power, jump height, peak O(2) uptake, joint stability, and history of previous injury. Injuries and player exposure were recorded throughout the competitive season. RESULTS: Older players were at higher risk of injury in general (odds ratio [OR] = 1.1 per year, P = 0.05). For hamstring strains, the significant risk factors were age (OR = 1.4 [1 year], P < 0.001) and previous hamstring strains (OR = 11.6, P <0.001). For groin strains, the predictor risk factors were previous groin strains (OR = 7.3, P = 0.001) and decreased range of motion in hip abduction (OR = 0.9 [1 degrees ], P = 0.05). Previous injury was also identified as a risk factor for knee (OR = 4.6) and ankle sprains (OR = 5.3). CONCLUSIONS: Age and previous injury were identified as the main risk factors for injury among elite football players from Iceland.

Adolescent↗
PubMed1995

Lack of evidence for significant hepatitis B transmission in Australian Rules footballers.

OBJECTIVE: To determine the prevalence of markers of past hepatitis B infection among participants in Australian Rules football, to estimate the potential exposure of Australians to hepatitis B virus (HBV) in contact sport. DESIGN AND SETTING: A point prevalence survey for antibody to hepatitis B surface antigen (anti-HBs) and core antigen (anti-HBc), supported by a questionnaire used to determine the history of risk and exposure, in South Australian National Football League (SANFL) players supervised at club level by general practitioners and sports medicine specialists. PARTICIPANTS: Of 245 players from seven clubs, 49 were excluded from the study because they had been previously vaccinated. Of 196 eligible participants, 117 submitted blood samples and, of these, 85 returned questionnaires. RESULTS: One player was positive for anti-HBc (a prevalence rate of 0.85%). This individual and three anti-HBc-negative players were positive for anti-HBs in the absence of a history of vaccination. We could not ascertain whether these additional three players had been previously infected, or vaccinated without this fact having been recorded on the questionnaires. No single behavioural factor correlated with positive anti-HBs results. CONCLUSIONS: The prevalence of markers of past hepatitis B infection in SANFL football players was no different to that in blood donors of the same age group from the same city. There was no evidence for any additional HBV transmission due to participation in football over that in the blood donor population. Vaccination of footballers and people engaged in similar sports is of benefit in conferring protection on the individual, but would be unlikely to make a significant public health impact on community rates of HBV infection.

Adolescent↗
PubMed2004

Splenic Artery Avulsion in a High School Football Player: A Case Report.

OBJECTIVE: To present the case of a high school football player who sustained avulsion of 2 branches of the splenic artery from his spleen as he was tackled and landed on the football. BACKGROUND: A high school football player was tackled and fell onto the football, left side first. He was examined by a certified athletic trainer and an internist. On evaluation, he had a positive Kehr sign, exquisite left upper abdominal quadrant tenderness, and complaint of nausea. He also exhibited signs of the onset of shock, including diaphoresis, a rapid pulse, and hypotension. He was immediately transported by ambulance to the local emergency facility. DIFFERENTIAL DIAGNOSIS: Splenic rupture, splenic laceration, splenic artery avulsion, or ruptured viscus. TREATMENT: Emergency surgery was performed, with removal of 2800 mL of blood and ligation of the 2 arterial branches avulsed from the spleen. The patient fully recovered within 6 weeks and was cleared to resume all sports activities. UNIQUENESS: Injury to the spleen in football is a known yet very uncommon injury. Even more unusual is the avulsion of splenic artery branches from the spleen. CONCLUSIONS: It is critical that athletic trainers and team physicians have an understanding of the mechanisms, signs, and symptoms of splenic injury. Because the spleen is a highly vascular organ, severe hemorrhage can be fatal in just minutes if not recognized and appropriately treated.

Journal Article↗
PubMed1999

A reconditioning program to lower the recurrence rate of brachial plexus neurapraxia in collegiate football players.

OBJECTIVE: To present clinical techniques for managing class I brachial plexus neurapraxia (BPN) in collegiate football players. BACKGROUND: During a football career, up to 50% of college football players develop BPN. It is difficult to return the player to practice and competition without many recurrences during the same season. Postseason reconditioning programs may improve the outcome by allowing the injured nerves a chance to heal adequately. Flexibility and strength of the neck and shoulder girdle are the focus of this proposed postseason BPN reconditioning program. This clinical technique is designed to reduce or eliminate inflammation, weakness, and hypomobility that contribute to reinjury of the brachial plexus and the resulting class I BPN. DESCRIPTION: After the football season, the team physician performs a mandatory follow-up examination. Any pathology that may be exacerbated is ruled out before beginning this program. Conservative management is prescribed during the first 4 weeks postseason. Then an 8-week period of aggressive reconditioning is initiated. Players begin manual resistance and Nautilus neck machine exercises 3 times per week. A cervical spine mobilization and modified shoulder resistance program is performed 2 days per week. Subsequently, players proceed with modification of the general neck and shoulder program used by the rest of the squad. Shoulder pad and neck orthoses selection should be reviewed to ensure that the best protection against reinjury is used when the athlete returns to play. To minimize any chance of recurrence, a progressive pattern of gradually increasing collision work is employed after the athlete is cleared by the physician. CLINICAL ADVANTAGES: Postseason observation of players after 1 year should reveal decreased recurrence of brachial plexus injury. The reconditioning program format, together with protective equipment considerations, may have a significant effect in reducing or eliminating the recurrence of BPN in football players.

Journal Article↗
PubMed2003

Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.

CONTEXT: Approximately 300 000 sport-related concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury. OBJECTIVE: To estimate the incidence of concussion and time to recovery after concussion in collegiate football players. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999, 2000, and 2001 on a variety of measures and followed up prospectively to ascertain concussion occurrence. Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season. MAIN OUTCOME MEASURES: Incidence of concussion and repeat concussion; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons. RESULTS: During follow-up of 4251 player-seasons, 184 players (6.3%) had a concussion, and 12 (6.5%) of these players had a repeat concussion within the same season. There was an association between reported number of previous concussions and likelihood of incident concussion. Players reporting a history of 3 or more previous concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident concussion than players with no concussion history. Headache was the most commonly reported symptom at the time of injury (85.2%), and mean overall symptom duration was 82 hours. Slowed recovery was associated with a history of multiple previous concussions (30.0% of those with > or =3 previous concussions had symptoms lasting >1 week compared with 14.6% of those with 1 previous concussion). Of the 12 incident within-season repeat concussions, 11 (91.7%) occurred within 10 days of the first injury, and 9 (75.0%) occurred within 7 days of the first injury. CONCLUSIONS: Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history; 1 in 15 players with a concussion may have additional concussions in the same playing season; and previous concussions may be associated with slower recovery of neurological function.

Adolescent↗
PubMed1993

[American football in Germany--aspects of trauma surgery].

While football injuries in the USA are well documented and thoroughly studied, informations on injuries caused by this spreading sport in Germany are not available. For this reason the Berufsgenossenschaftliche Unfallklinik in Frankfurt conducted a prospective study to register all injuries in major league football in southern Germany in 1991. In 49 games that were evaluated we found 281 minor injuries, mainly skin lesions and concussions of extremities. In addition 33 significant injuries were registered, amongst them 30% injuries of knee ligaments. The only severe injury was an abdominal hit causing a intrahepatic hematoma. The results of our study are comparable to the injury risks found in US college football as well as to those found in German statistics on soccer and hockey. Although no fatal injuries in our study were registered, this should not lead to neglecting the potential risks in football.

Adult↗
PubMed2003

Conservative treatment for rugby football players with an acute isolated posterior cruciate ligament injury.

We investigated the outcome of the conservative treatment from the point of athletic performance for rugby football players with an acute isolated PCL injury. The subjects were sixteen competitive rugby football players, with an average age of 21 years. After exercise consisting of quadriceps muscle strengthening and range of knee motion, the players were allowed to return to sports activity when swelling and pain disappeared. At one year after the injury, the period of return to pre-injury level and the self-evaluation for eleven performances during rugby football were surveyed by a questionnaire. Each performance of the athletic skills was rated as normal, nearly normal, abnormal or severely abnormal. Fourteen players (88%) returned to their pre-injury level. The time to return to pre-injury level ranged from one to seven months, with a mean of three months. High-speed running was the most affected skill (9 out of 14, 64%). These results showed that performance of athletic skills was apparently affected in rugby football players with an acute isolated PCL injury though the conservative treatment was effective

Adolescent↗
PubMed2006

A comparison of paediatric soccer, gaelic football and rugby injuries presenting to an emergency department in Ireland.

OBJECTIVES: Children presenting with sport related injuries (SRIs) as a result of soccer, rugby and gaelic football are frequently seen in an emergency medicine (EM) setting in Ireland. A comparison of the demographics of injuries in these three sports has however not previously been performed. The purpose of this study was to provide up-to-date data on the nature of these SRIs. METHOD: Data was collected retrospectively on all children (<17 years of age), injured in these three sports, presenting to an emergency medicine department over 6 months, and was entered into a database for analysis. RESULTS: Retrospective analysis was performed on 23,000 charts, and 409 SRIs were identified over a 6-month period. None of the children reported using any form of protective gear, and 27% reported a previous presentation to the emergency department with a SRI. Most injuries were as a result of soccer (56%), with 24% occurring in gaelic football, and 20% occurring in rugby. The predominant mechanism of injury was different in each sport, in soccer-falls (38%), in gaelic football-collisions with objects (balls) (37%), and in rugby-collision with persons (55%). Although the predominant type of injury in soccer and gaelic football was a fracture, accounting for 50% and 42% of injuries, respectively, in rugby however, skin/soft tissue injuries presented more commonly, accounting for 44% of injuries. When the general site of injury was investigated, the upper limb accounted for the majority of SRIs in each sport. In the management of SRIs, oral analgesics were prescribed in 50%, however, it was observed that no use was made of topical, intramuscular or rectal analgesic routes of administration. In addition it was observed that RICE/general injury advice was given in only 27%, physiotherapy was requested in 2%, and no injury prevention advice was given to any child. Overall, 8% required admission. CONCLUSIONS: The data provided from this study may raise awareness of the nature of SRIs affecting children in each of these three sports, and may be useful in formulating much needed injury prevention strategies.

Adolescent↗
PubMed1997

Prevalence of acne keloidalis nuchae in football players.

BACKGROUND: Acne mechanica (AM) is common in football players. Severe cases of nuchal AM may precede acne keloidalis nuchae (AKN). Factors that may be associated with the progression of nuchal AM to AKN are unknown. The prevalence of AKN in football players has not been reported. OBJECTIVE: We investigated the frequency of nuchal AM and AKN within a susceptible population and attempted to identify factors that may be associated with AKN. METHODS: Four hundred fifty-three high school, collegiate, and professional football players were examined for the presence of nuchal AM or AKN. Those with positive findings completed a questionnaire regarding their disease. RESULTS: Nuchal AM was more prevalent in high school players (15.5%) than older players (1.2%). AKN was more frequent in players beyond the high school level and was found exclusively in blacks. AKN was not associated with a positive family history of AKN nor a positive personal or family history of keloid formation. CONCLUSION: AKN occurs almost exclusively in blacks. The level of football play may be associated with the development of AKN. Positive family history of AKN and positive family or personal history of keloids is not associated with AKN development.

Acne Keloid↗
PubMed2003

Echocardiographic characteristics of professional football players.

OBJECTIVES: We examined the echocardiographic characteristics of highly trained American football players. BACKGROUND: Intense physical training is associated with morphologic and physiologic cardiac changes often referred to as the "athlete's heart." Echocardiographic features peculiar to elite football players have not been described. METHODS: We studied cardiac morphology and function as assessed by rest and stress echocardiography in 156 asymptomatic National Football League players. Resting and stress ejection fraction (EF), wall thickness, and diastolic left ventricular internal diameter (LVID) were measured. Left ventricular (LV) mass was calculated, as was relative wall thickness (RWT) defined as septal and posterior wall thickness divided by LVID. Control data were obtained from published studies. RESULTS: The mean LVID (53 +/- 0.5 mm) and maximal wall thickness (11.2 +/- 0.2 mm) were increased over normal reported control subjects. There was a correlation between LVID and body weight (p = 0.01) and body surface area (BSA) (p = 0.01). The average LVID indexed to BSA was 23 +/- 2 mm/M(2). There was also a correlation between maximal wall thickness and body weight (p = 0.01) and BSA (p = 0.01). The average wall thickness indexed to BSA was 5.05 +/- 0.88 mm/M(2). Of the players, 23% had evidence of LV hypertrophy. Two players had an increased septal-to-posterior-wall-thickness ratio (> or =1.3), although no player had an outflow gradient. The RWT for the players was 0.424 (+/- 0.1). The mean resting EF was 58% (+/- 4.4%), and every player undergoing exercise testing had an appropriate hyperdynamic response in cardiac function. CONCLUSIONS: Both wall thickness and LVID of elite American football players are increased and correlate with body size. There is a high RWT, reflecting an emphasis on strength training. The LV EF was normal and not supranormal, as is sometimes believed. Regardless of the resting EF, all players had hyperdynamic cardiac responses with exercise.

Adult↗
PubMed2004

Impact energy attentuation of protective football headgear against a yielding surface.

There is no standard test to assess the ability of soft headgear to prevent the likelihood of head injuries in the Australian football codes. Therefore the impact energy attenuation of protective football headgear was assessed using a yielding artificial headform and impact surface to characterise the impact scenario. Seven soft football headgear of varying mass, materials and thickness were dropped from a height to generate impact energy of 56 J. The headgear were tested for a number of different impact locations. Accelerometers within the headform monitored the impact mechanics. A Head Injury Criterion (HIC) of 1000 was selected as the injury threshold. Reliability data, collected one week apart, revealed that the results were highly reproducible. Although several of the headgear generated HIC values about 1000 for the various impact locations, only one of the headgear, that with the greatest thickness (15 mm) generated a HIC score below 1000 for impacts to the side and front of the headgear. There was a significant correlation between headgear thickness and HIC scores. It was concluded that all but one of the commercially available soft football headgear tested provided inadequate impact energy attenuation due to the limited amount of padding. It is postulated that the padding material of the headgear would need to be at least 15 mm thick to offer adequate protection.

Equipment Design↗
PubMed2004

Do community football players wear allocated protective equipment? Descriptive results from a randomised controlled trial.

Before protective equipment can be adopted as an effective sports safety intervention, its protective effects in reducing the incidence and severity of injury need to be demonstrated, Importantly, it also needs to be well accepted by the players. The Australian Football Injury Prevention Project (AFIPP) was a large scale community-based randomised controlled trial to assess the effectiveness of headgear and mouthguards in preventing head/neck/dental injuries in Australian Football. A subcomponent of this study was to assess the extent to which community football players complied with the requirement to wear protective headgear and/or mouthguards, as this equipment is not compulsory in this sport. Three hundred and one community football players from 23 teams were randomly allocated to one of three protective equipment intervention arms or one control arm. Protective equipment usage was measured by a primary data collector at each training and game session during the 2001 playing season. Mouthguard use was higher than headgear use, with the highest usage for both being measured during games rather than training. Although many players use mouthguards, particularly in games, most do not wear headgear. Given the low adoption of headgear, other strategies to prevent head injuries need further investigation.

Football↗