Athletic Injuries in Soccer:
Three Year Study of a Greek Professional Team
Papacostas
M.., Pafis G., Bikos Ch., Porfiriadou A.,
Physical
Education and Sport Science,
Alexander
Technological Institute of Thessaloniki, Physiotherapy dept.
INTRODUCTION
Soccer is considered by many to be the most
popular game all over the world and is played by at least 40 million
people1.
Because of
its popularity, the epidemiology of soccer injury has been studied
extensively. In many European countries, injuries sustained from the
game account for about 40% of all sports related trauma2
The ultimate goal of sports medicine is the
prevention of injury. Preventive medicine is best approached by the
best analysis of the epidemiology of disease of injury 3.
In the case of sport injury, the agent (immediate causative factor),
the host (the athlete sustaining the injury) and the environment
(situation of conditions may predispose or inhibit the injury) have
been analyzed3.
Likewise, soccer is the most popular sport in
Greece involving a great number of participants all over Greece.
In addition, in the last decade the game has rapidly increased in
popularity
among Greek athletes4. On
the other hand, there are a lack of similar research evidence
involved the Greek professional soccer players, which necessitates the
present study.
The purpose of this study was to record the acute injuries and the
overuse syndromes in a professional Greek soccer team over three
years, in order to study the incidence and injury rate in relation to
exposure in games and practices.
MATERIALS AND METHOD
105 (35X3 years) Greek professional soccer players of a Greek soccer
team, participating in the Greek League, were observed on a daily basis
for
three years (preseason period July – August, game
period September –May ). The age, experience distribution
and anthropometric characteristics of the participants were recorded
(Table 1).
Table
1. Age, experience distribution and anthropometric
characteristics
-
|
1st year
|
2nd year
|
3rd year
|
Participants |
35
|
35
|
35
|
Age |
25,3 (±5,1)
|
26.1 (±6,2)
|
27.8 (±3,7)
|
Years playing
soccer |
12 (±3,4)
|
12 (±6)
|
15 (± 5)
|
Body weight |
79,6 (±8)
|
77,6 ±5)
|
76,8 (±6,3)
|
Height |
1,83 (±0,07)
|
1,84 (±0,09)
|
1,81 (±0,06)
|
Fat percentage % |
11,9 (±5)
|
11,6 (±3)
|
10,2 (±7)
|
Two orthopedic surgeons, a physiotherapist and two
athletic trainers comprised the “injury assessment” team.
Before the start of the preseason period: a general preventative
assessment took place for each participant.
b. Personal interviews (questionnaire
involved questions about health problems, previous and past
musculoskeletal injuries) for each player was recorded. During the year
the practice and the game were recorded, and personal
consultations by the authors twice a week to register any injury
occurring during scheduled games or practices which caused the player
to miss the next game or practice session 5.
The external risk factor, the agents, the characteristics, the
anatomical location, and the time (practice or game) of the muscle-
skeletal injuries were recorded. In continuance the “rehabilitation
team” planned the rehabilitation program for each injured player.
Injury was defined as “any mishap occurring
during scheduled games or practices that cause a player to miss a
subsequent game or practice session 3.
Injuries were classified into three grades of severity: minor
(absence from training or games less than 1 week), moderate (absence
from training or games 1 week to 1 month), major (absence from
training or games more than 1 month). Several other research studies
have adopted
the same classification 5,6,7,8. Injury rate was defined as injuries per 1000 hours of
playing time (whether practice or game)9
From this study we excluded the goalkeepers because according to
analogous research studies they reveal different rates of injuries10.
The statistical test used was the
non-parametric x2
and the level of statistical significant was P<0,05 .
RESULTS
Distinction
between injuries occurring during practice and games.
A total of one hundred one injuries were
recorded. Of all injuries 12 (23,5%) occurred
during the game and 39 during practice (76,5 %) (Table 2).
Table
2. Stratified injury rates
|
No of injuries |
% of total injuries |
Time of exposure |
No of injuries / 1000
h |
Game |
12 |
23,5 |
960 |
12,5 |
Practice |
39 |
76,5* |
10531 |
3,7 |
*
Statistically significant
Severity
of injury
The
severity of injuries is shown in Table 3 in terms of absence from the
game or practice after the injury. According to the results the rate
involving mild injuries was 54,9% (28 cases), moderate injuries was
35,2% (18 cases) and major injuries was 9,9% (5 cases).
Table
3. Severity of injuries
Severity of injuries
|
Weeks of absent
|
No of injuries
|
(%)
|
Minor
|
<1
|
28
|
54,9*
|
Moderate
|
1-4
|
18
|
35,2
|
Major
|
>4
|
5
|
9,9
|
*
Statistically significant
Location
of injury
The anatomic location and the type of injuries are
shown in Table 4. Of the 51 injuries, 44
cases involved the lower extremity (86,2%), 6 cases the torso (13,6%)
and 1 case the upper extremity (1,2%). More specifically, 58,8% (30
cases) involved knee and thigh injuries, 27,5% (14 cases) the ankle.
Table
4. Injuries anatomic location
-
Anatomic location
|
%
|
C.Spine-Thorax,
Back
|
1 (1,9%)
|
Lumbar spine
|
5 (9,9%)
|
Pelvis- hip
inguinal
|
-
|
Femur – Knee
|
30 (58,8%)*
|
Tibia – Ankle
– Foot
|
14 (27,5%)
|
Shoulder –
elbow
|
1 (1,9%)
|
Wrist - hand
|
-
|
*Statistical significant
Type
of injury
The
rate of lower extremity acute injuries (32 cases, 72,72%) was
significantly higher in comparison with the lower extremity overuse
syndromes (12 cases, 27,27%). Injury diagnosis refers to table 5.
Table
5. Injuries diagnosis
Acute injuries
|
Cases
|
Overuse syndrome
|
No of cases
|
Hamstring strains
|
8
|
Adductor-
abdominal
|
2
|
Ankle sprains
|
8
|
Hamstrings tent.
|
2
|
Adductors strains
|
7
|
Adductors tent.
|
5
|
Lumbar muscle
strain
|
3
|
Fibula
|
3
|
Meniscal rupture
Knee ligament
|
6
|
|
|
Higher rates of acute injuries (32%) were reported during September
(beginning of season) and during February through April higher
rates (85 %) of overuse syndromes were reported.
Discussion
Severity
of injury
Our
findings about the severity of injury are in agreement with current
research11
Among the first to address the issue of injury severity in three
categories based on the length of time lost from competition were
Engstrand et al12.
Sandelin et al13
who also chose to categorize injuries according the severity. However,
they did not include overuse syndrome, regardless of the length of
the players’ absence14.
Morgan11
included the overuse syndrome and he supported that minor
injuries occured more often. Our finding also supported the finding
that minor injuries occurred more often
than did moderate or major injuries.
Location
of injury:
The present study supports, as have others
6,11,15,16,18,19,
that most soccer – related injuries affect the lower extremities. Given
the demands of the game, it is obvious that the disproportionate
percentage of participants receiving lower extremity injuries is to be
expected. In the present study 86,2% of the injuries reported
involved the lower extremity. With regard to lower extremity injuries,
researchers have identified the knee and ankle as the most
frequently injured joints 7,11,13,15,16,17,20,21,.
Ankle injuries ranged from 16% to 31 % of the total, while knee
injuries ranged 14% to 34% of all injuries. Falling within these ranges
were our findings of 22% for ankle injuries and 19% for knee
injuries. Other investigations reported percentages varying from a
low of 68% for youth22
to a high of 95% for an adult group of mixed skill levels15
Distinction
between injuries occurring during practice and games.
Our findings that injuries occurred more often
during a game than during practice at a rate that proved to be
statistically significant is in step with Morgan's11
results. In their review of soccer injuries3,10,
supported the previous findings. In
contrast19
another 5 year follow up study, found that 47% (66 of 142) of injuries
occurred during games and 53% (76 of 142) were associated with
practice.
Type
of injury and injury diagnosis
Overuse syndrome consistently accounts for about 27,27% of all injuries
and they occur mostly in training camp or at the
end of a season. Nicholas 3 found
35% of all injuries involved chronic injuries. Our findings support those by
other
investigations of overuse syndrome incidence that, at the professional
level, Soccer is
not as high as in other sports14,20,21,22.
Overall, despite the increased participation in
sports in the last decade there has been no associated increase in
the pattern of incidence of soccer injuries 23,24,25
In
conclusion the incidence and injury (acute and chronic) rate in
relation to exposure in games and practices involving Greek soccer
players are similar to other European countries such as the UK, Denmark
and Sweden amongst others.
REFERENCES
- Kristian H 1992, Statistics on the 150 national associations of
FIFA, FIFA News 235:528,1982
- Hoy K et al European soccer injuries a prospective epidemiologic
study and socioeconomic study Am J Sports Med 20:318, 1992)
- Nicholas J, Hershman E “The Lower extremity & Spine The CV
Mosby Company, St Louis, 1990 pp1510-1511”
- GSF News Greek Soccer Federation 2000 Athens, Greece
- de Loes M Medical treatment and costs of sports related injuries
in a total population. Int J Sports Med 11:66-72, 1990
- Ekstrand J, Gilliquist J: Soccer injuries and their mechanisms.
A prospective study. Med Sci Sports Exerc 15: 267-270, 1983
- Ekstrand J, Gilliquist J, Moller M et al: Incidence of soccer
injuries and their relation to training and team success. Am J Sports
Med 11: 63-67, 1983
- Ekstrand J, Tropp H: The incidence of ankle sprains in soccer
Foot Ankle 11 : 41-44, 1990
- van Galen W, Diederisk J. Sportblessures breed uitgemeten, Uitg.
De Vrieseborch, Haarlem, 1990
- Inklaar H : Soccer injuries. Sports Med 18(1):55-73, 1994
- Morgan B.: An examination of injuries in major league soccer:
The inaugural season
- Ekstrand J: Incidence of soccer injuries and their relation to
training and team success. Am J Sports Med 11 (2): 63, 1983
- Sandelin j, Santavirta S, Kiviluoto O: Acute soccer injuries in
Finland in 1980. Br J Sports Med 19: 30-33, 1985
- Engstorm B, Forssblad M, Johansson C et al: Does a major Knee
injury definitely sideline an elite soccer player± Am J Sports
Med 18: 101-105, 1990
- Poulsen TD, Freund KG, Madsen F, et al: Injuries in high-skilled
and low-skilled soccer: A prospective study. Br J Sports Med 25:
151-153, 1991
- Ekstrand J, Gilliquist J:The avoidavility of soccer injuries.
Int Sport Med 4: 124-128, 1983
- Pardon TD: Lower extremities are site of most soccer injuries.
Physician Sportsmed 5(6): 42-48, 1977
- Ekstrand J, Gilliquist J: The frequency of muscle tightness and
injuries in soccer players. Am J Sports Med 10:75, 1982
- van Mechelen A, Hlobil H, Kemper H: Incidence, Severity,
Aetiology and Prevention of Sports Injuries. Sports Med 14(2): 82-99,
1992
- Engstrom B, Johansson C, Tornkwist H: Soccer injuries among
elite female players. Am J Sports Med 19: 372-375, 1991
- Albert M: Descriptive three year data study of outdoor and
indoor professional soccer injuries. Athletic Training 18: 218-220, 1983
- Nielsen AB, Yde J: Epidemiology and traumatology of injuries in
soccer. Am J Sports Med 17: 803-807, 1989
- Hawkins RD, Hulse MA,
Wilkinson C, Hodson A, Gibson M.Br The
association football medical research programme: an audit of injuries
in professional football. J Sports Med, Feb 2001
- Peterson L, Junge A,
Chomiak J, Graf-Baumann T, Dvorak J Incidence of football injuries and
complaints in different age groups and skill-level groups..Am J Sports Med, 2000