INJURY PREVENTION FOOTBALL
Human risk factors The rate of injury in football depends on several human factors &#x2013; age, level of competition, position on the field, setting, location of injury, time of injury and gender (Table 1). These injuries most commonly involve the lower extremities and are usually graded mild to moderate sprains, strains or contusions (15,16). In a study analysing the injury rates of professional male football athletes in the USA, Morgan et al. (17) found an overall injury rate of 6.2 injuries per 1000 hours of participation. Interestingly, these rates were strikingly different when the data was stratified for games and practices: it was 2.9 injuries per 1000 hours of practice compared to 35.3 injuries per 1000 hours of game-play. The authors also noted that 77% (197 of 256) of injuries involved the lower extremity, most frequently affecting the knee (n = 54) and ankle (n = 46) (17). There is a considerable body of research on some of these factors, as described below.
Gender The National Collegiate Athletic Association (NCAA) recorded injury rates for male and female collegiate football players over the course of 15 years. In one study (18) the injury rate in males alone was four times higher during game-playing than practising (18.75 vs 4.34 injuries per 1000 athlete exposures (AE); rate ratio, RR = 4.3; 95% CI = 4.2&#x2013;4.5). In both situations, more than two-thirds of the injuries were to the lower extremities, followed by the head and neck during games and the trunk and back in practice. Player-to-player contact was the primary cause of injuries during games in this study; most injuries during practice sessions occurred without direct contact with the injured body part. Ankle ligament sprains were most common during both practices and games, and internal derangements of the knee were the most common severe injury (severe is defined as at least 10 days of time loss) (18). Conversely, among female collegiate players, the injury rate
was more than three times higher in games than in practices (16.44 vs 5.23 injuries per 1000 AE; RR = 3.2; 95% CI = 3.1&#x2013;3.4; P< 0.01). The injury rate during preseason practice sessions
was more than three times greater than sessions that were in-season (9.52 vs 2.91 injuries per 1000 AE; RR = 3.3; 95% CI = 3.1&#x2013;3.5; P< 0.01). Approximately 70% of both game and practice injuries affected the lower extremities in females. Ankle ligament sprains (18.3%), knee internal derangements (15.9%), concussions (8.6%), and leg contusions (8.3%) accounted for most of the game injuries reported. However, upper leg muscle-tendon strains (21.3%), ankle ligament sprains (15.3%), internal derangements of the knee (7.7%) and pelvis and hip muscle strains (7.6%) accounted for most of the practice injuries. In these women, player-to-player contact accounted for approximately 54% of the game injuries but less than 20% of all practice injuries. The majority of practice injuries involved non-contact mechanisms (19). In a professional analysis of women&#x2019;s football-related injuries, Junge et al. (20) recorded the injuries in seven international football tournaments. A total of 387 injuries were reported during 174 games. This equates to 67.4 injuries per 1000 player hours (95% CI 60.7&#x2013;74.1) or 2.2 injuries per match (95% CI 2.0&#x2013;2.4). Most of the injuries were caused by contact with another player (84%; 317 of 378), similar to the game data recorded at the NCAA. The injuries frequently involved the lower extremity (n = 248; 65%), followed by the head and neck (n = 67; 18%), trunk (n = 83; 9%) and upper extremity (n = 32; 8%). Contusions (n = 166; 45%) were the most frequent type of injury, followed by sprains or ligament rupture (n = 96; 26%) and strains or muscle-fibre ruptures (n = 31; 8%). The most common diagnosis was an ankle sprain. On average, one injury per match (95%; CI 0.8&#x2013;1.2) was expected to result in absence from a game or from training. The injury rate in top-level women&#x2019;s tournaments was similar that for match injuries in elite male and female players, but the diagnoses and mechanisms of injury among the females differed substantially from those previously reported in male football players (20).
Player position With respect to player position, time of injury and the frequency of injury, Bailey et al. (21) found that strikers and defenders were injured most often, especially if they were playing in amateur leagues. With respect to position on the field, eight (54%) injuries occurred in midfielders, three (20%) each in forward and defence players, and one (7%) in a goalkeeper. The median age of the injured players was 22 years, with a range of 20&#x2013;35 years (21).
Timing of injury
The time at which the injury occurred during the game was statistically significant. The investigators (21) noted that most occurred in the fourth quarter (five injuries), followed by the first (four injuries) and third (four injuries) quarters of the match. These findings reinforce the hypothesis that neuromuscular
FEMALE FOOTBALLERS BUT EVIDENCE SUGGESTS THAT A PREVENTION PROGRAMME WILL DECREASE THEIR INCIDENCE
ACL INJURIES ARE NOT UNCOMMON IN MALE AND
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