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 O2 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°], 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.
1. Arnason A, Gudmundsson A, Dahl HA, et al: Soccer injuries in Iceland. Scand J Med Sci Sports6: 40-45, 1996
2.
2. Arnheim DD: The foot, ankle, and lower leg: Acute injuries, in Arnheim DD (ed): Modern Principles of Athletic Training. St. Louis, Times Mirror/Mosby College, 1989, pp 490-537
4. Baumhauer JF, Alosa DM, Renstrom AF, et al: A prospective study of ankle injury risk factors. Am J Sports Med23: 564-570, 1995
5.
5. Bjordal JM, Arnly F, Hannestad B, et al: Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med25: 341-345, 1997
6.
6. Boden BP, Kirkendall DT, Garrett WE Jr: Concussion incidence in elite college soccer players. Am J Sports Med26: 238-241, 1998
7.
7. Bosco C, Belli A, Astrua M, et al: A dynamometer for evaluation of dynamic muscle work. Eur J Appl Physiol Occup Physiol70: 379-386, 1995
8.
8. Brynhildsen J, Ekstrand J, Jeppsson A, et al: Previous injuries and persisting symptoms in female soccer players. Int J Sports Med11: 489-492, 1990
9.
9. Caraffa A, Cerulli G, Projetti M, et al: Prevention of anterior cruciate ligament injuries in soccer: A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc4: 19-21, 1996
10.
10. Chomiak J, Junge A, Peterson L, et al: Severe injuries in football players: Influencing factors. Am J Sports Med28: S58-S68, 2000
11.
11. de Loes M: Epidemiology of sports injuries in the Swiss organization “Youth and Sports” 1987-1989: Injuries, exposure and risks of main diagnoses. Int J Sports Med16: 134-138, 1995
12.
12. Dvorak J, Junge A, Chomiak J, et al: Risk factor analysis for injuries in football players: Possibilities for a prevention program. Am J Sports Med28: S69-S74, 2000
13.
13. Ekstrand J, Gillquist J: The frequency of muscle tightness and injuries in soccer players. Am J Sports Med10: 75-78, 1982
14.
14. Ekstrand J, Gillquist J: Soccer injuries and their mechanisms: A prospective study. Med Sci Sports Exerc15: 267-270, 1983
15.
15. Ekstrand J, Gillquist J: The avoidability of soccer injuries. Int J Sports Med4: 124-128, 1983
16.
16. Ekstrand J, Gillquist J, Liljedahl SO: Prevention of soccer injuries: Supervision by doctor and physiotherapist. Am J Sports Med11: 116-120, 1983
17.
17. Ekstrand J, Gillquist J, Moller M, et al: Incidence of soccer injuries and their relation to training and team success. Am J Sports Med11: 63-67, 1983
18.
18. Ekstrand J, Hilding J: The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports9: 98-103, 1999
19.
19. Ekstrand J, Tropp H: The incidence of ankle sprains in soccer. Foot Ankle11: 41-44, 1990
20.
20. Ekstrand J, Wiktorsson M, Oberg B, et al: Lower extremity goniometric measurements: A study to determine their reliability. Arch Phys Med Rehabil63: 171-175, 1982
21.
21. Engstrom B, Forssblad M, Johansson C, et al: Does a major knee injury definitely sideline an elite soccer player?Am J Sports Med18: 101-105, 1990
22.
22. Fredriksen H, Dagfinrud H, Jacobsen V, et al: Passive knee extension test to measure hamstring muscle tightness. Scand J Med Sci Sports7: 279-282, 1997
23.
23. Friedlander AL, Block JE, Byl NN, et al: Isokinetic limb and trunk muscle performance testing: Short-term reliability. JOSPT14: 220-224, 1991
24.
24. Gauffin H, Tropp H, Odenrick P: Effect of ankle disk training on postural control in patients with functional instability of the ankle joint. Int J Sports Med9: 141-144, 1988
25.
25. Golding LA, Myers CR, Sinning WE: The YMCA physical fitness test battery, in Golding LA, Myers CR, Sinning WE (eds): Y’s Way to Physical Fitness: The Complete Guide to Fitness Testing and Instruction. Leeds, Human Kinetics, 1989, pp 61-138
26.
26. Hawkins RD, Fuller CW: A preliminary assessment of professional footballers’ awareness of injury prevention strategies. Br J Sports Med32: 140-143, 1998
27.
27. Hawkins RD, Fuller CW: A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med33: 196-203, 1999
28.
28. Hawkins RD, Hulse MA, Wilkinson C, et al: The association football medical research programme: An audit of injuries in professional football. Br J Sports Med35: 43-47, 2001
29.
29. Holme E, Magnusson SP, Becher K, et al: The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports9: 104-109, 1999
31. Inklaar H, Bol E, Schmikli SL, et al: Injuries in male soccer players: team risk analysis. Int J Sports Med17: 229-234, 1996
32.
32. Jackson AS, Pollock ML: Generalized equations for predicting body density of men. Br J Nutr40: 497-504, 1978
33.
33. Jackson AS, Pollock ML: Practical assessment of body composition. Physician Sports Med13: 76-80, 1985
34.
34. Jarvinen TA, Kaariainen M, Jarvinen M, et al: Muscle strain injuries. Curr Opin Rheumatol12: 155-161, 2000
35.
35. Karlsson J, Peterson L, Andreasson G, et al: The unstable ankle: A combined EMG and biomechanical modeling study. Int J Sport Biomech8: 129-144, 1992
36.
36. Konradsen L, Olesen S, Hansen HM: Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. Am J Sports Med26: 72-77, 1998
37.
37. Konradsen L, Ravn JB: Prolonged peroneal reaction time in ankle instability. Int J Sports Med12: 290-292, 1991
38.
38. Lewin G: The incidence of injury in an English professional soccer club during one competitive season. Physiotherapy75: 601-605, 1989
39.
39. Luthje P, Nurmi I, Kataja M, et al: Epidemiology and traumatology of injuries in elite soccer: A prospective study in Finland. Scand J Med Sci Sports6: 180-185, 1996
40.
40. Magee DJ: Knee, in Magee DJ (ed): Orthopedic Physical Assessment. Philadelphia, WBSaunders, 1992, pp 372-477
41.
41. McGregor JC, Rae A: A review of injuries to professional footballers in a premier football team (1990-93). Scott Med J40: 16-18, 1995
42.
42. Meeuwisse WH: Assessing causation in sport injury: A multifactorial model. Clin J Sport Med4: 166-170, 1994
43.
43. Nielsen AB, Yde J: Epidemiology and traumatology of injuries in soccer. Am J Sports Med17: 803-807, 1989
44.
44. Noonan TJ, Garrett WE Jr: Injuries at the myotendinous junction. Clin Sports Med11: 783-806, 1992
45.
45. Orchard J: Is there a relationship between ground and climatic conditions and injuries in football?Sports Med32: 419-432, 2002
46.
46. Orchard J, Marsden J, Lord S, et al: Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med25: 81-85, 1997
47.
47. Ostenberg A, Roos H: Injury risk factors in female European football: A prospective study of 123 players during one season. Scand J Med Sci Sports10: 279-285, 2000
48.
48. Scholander PF: Analyzer for accurate estimation of respiratory gases in one-half cubic centimeter samples. J Biol Chem167: 1-15, 1947
49.
49. Siri WE: The gross composition of the body, in Lawrence JH, Tobias CA (eds): Advances in Biological and Medical Physics IV. New York, Academic Press, 1956, pp 239-280
50.
50. Taimela S, Osterman L, Kujala U, et al: Motor ability and personality with reference to soccer injuries. J Sports Med Phys Fitness30: 194-201, 1990
51.
51. Tropp H, Ekstrand J, Gillquist J: Stabilometry in functional instability of the ankle and its value in predicting injury. Med Sci Sports Exerc16: 64-66, 1984
52.
52. Tropp H, Ekstrand J, Gillquist J: Stabilometry in functional instability of the ankle and its value in predicting injury. Med Sci Sports Exerc16: 64-66, 1984
53.
53. Tropp H, Odenrick P, Gillquist J: Stabilometry recordings in functional and mechanical instability of the ankle joint. Int J Sports Med6: 180-182, 1985
54.
54. Tyler TF, Nicholas SJ, Campbell RJ, et al: The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med29: 124-128, 2001
55.
55. Watson AW: Sports injuries related to flexibility, posture, acceleration, clinical defects, and previous injury, in high-level players of body contact sports. Int J Sports Med22: 222-225, 2001
56.
56. Wester JU, Jespersen SM, Nielsen KD, et al: Wobble board training after partial sprains of the lateral ligaments of the ankle: A prospective randomized study. J Orthop Sports Phys Ther23: 332-336, 1996
57.
57. Wikstrom J, Andersson C: A prospective study of injuries in licensed floorball players. Scand J Med Sci Sports7: 38-42, 1997
