Physical Training Mar 2009
Our Sponsor, SDKsupplies

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.


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.


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






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)


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 .


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














* 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


Overuse syndrome

No of cases

Hamstring strains


Adductor- abdominal


Ankle sprains


Hamstrings tent.


Adductors strains


Adductors tent.


Lumbar muscle strain




Meniscal rupture

Knee ligament


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.


Severity of injury

Our findings about the severity of injury are in agreement with current research
11 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.

  1. Kristian H 1992, Statistics on the 150 national associations of FIFA, FIFA News 235:528,1982
  2. Hoy K et al European soccer injuries a prospective epidemiologic study and socioeconomic study Am J Sports Med 20:318, 1992)
  3. Nicholas J, Hershman E “The Lower extremity & Spine The CV Mosby Company, St Louis, 1990 pp1510-1511”
  4. GSF News Greek Soccer Federation 2000 Athens, Greece
  5. de Loes M Medical treatment and costs of sports related injuries in a total population. Int J Sports Med 11:66-72, 1990
  6. Ekstrand J, Gilliquist J: Soccer injuries and their mechanisms. A prospective study. Med Sci Sports Exerc 15: 267-270, 1983
  7. 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
  8. Ekstrand J, Tropp H: The incidence of ankle sprains in soccer Foot Ankle 11 : 41-44, 1990
  9. van Galen W, Diederisk J. Sportblessures breed uitgemeten, Uitg. De Vrieseborch, Haarlem, 1990
  10. Inklaar H : Soccer injuries. Sports Med 18(1):55-73, 1994
  11. Morgan B.: An examination of injuries in major league soccer: The inaugural season
  12. Ekstrand J: Incidence of soccer injuries and their relation to training and team success. Am J Sports Med 11 (2): 63, 1983
  13. Sandelin j, Santavirta S, Kiviluoto O: Acute soccer injuries in Finland in 1980. Br J Sports Med 19: 30-33, 1985
  14. 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
  15. 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
  16. Ekstrand J, Gilliquist J:The avoidavility of soccer injuries. Int Sport Med 4: 124-128, 1983
  17. Pardon TD: Lower extremities are site of most soccer injuries. Physician Sportsmed 5(6): 42-48, 1977
  18. Ekstrand J, Gilliquist J: The frequency of muscle tightness and injuries in soccer players. Am J Sports Med 10:75, 1982
  19. van Mechelen A, Hlobil H, Kemper H: Incidence, Severity, Aetiology and Prevention of Sports Injuries. Sports Med 14(2): 82-99, 1992
  20. Engstrom B, Johansson C, Tornkwist H: Soccer injuries among elite female players. Am J Sports Med 19: 372-375, 1991
  21. Albert M: Descriptive three year data study of outdoor and indoor professional soccer injuries. Athletic Training 18: 218-220, 1983
  22. Nielsen AB, Yde J: Epidemiology and traumatology of injuries in soccer. Am J Sports Med 17: 803-807, 1989
  23. 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
  24. 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

Our Sponsor, SDKsupplies
Physical Training