Physical Training Mar 2009

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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 injuries^3,10, 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 sports^14,20,21,22.

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

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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

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