Preseason Strength Training Can Reduce Injury Rates in Soccer Players

[Guest guest]

Preseason Strength Training Can Reduce Injury Rates in Soccer Players

Taken from:

http://www.nsca-lift.org/Perform/article.asp?ArticleID=105

Researchers at the Department of Sport and Health Science at the

Karolinska Institutet in Stockholm, Sweden recently examined the

effects of a preseason strength training program on the occurrence

and severity of hamstring injuries in elite male soccer players.

Thirty soccer players from the best premier-league division teams in

Sweden were divided into two groups.

One group performed eccentric exercises specifically designed for the

hamstring 2 times per week for a period of 10 weeks, while the second

group performed no special hamstring training. The occurrence of

hamstring injuries in the hamstring-training group was 36.7% lower

than in the group that performed no hamstring training. The hamstring-

training group also experienced significantly greater gains in

strength and speed than the non-training groups. The researchers

concluded that the inclusion of hamstring exercises that

eccentrically load the hamstrings is beneficial from a performance

enhancement and injury prevention perspective for soccer player.

Askling C, Karlsson J, Thorstensson A. (2003). Hamstring injury

occurrence in elite soccer players after preseason strength training

with eccentric overload. Scandinavian Journal of Medicine & Science

in Sports, 13(4):244 – 250.

---------

Carruthers

Wakefield, UK

[Guest guest]

,

I am not sure how to take this headline.

On one hand I am encouraged to see that finally there is some research being

done in the field of strength training for soccer players. But on the other hand

I am a little frustrated that it has taken till 2003 for us to figure out that

strength training, albeit only " eccentric exercise specifically designed for the

hamstrings " whatever they might be, can help reduce the risk of injury.

As I have stated before soccer is the largest professional sport in the world.

It is a multi-billion dollar/ pound whatever currency you like industry. But it

is still living in the dark ages. I have seen High School soccer teams here in

the US engage in more progressive weight training programs than Professional

outfits in Europe.

There is a high need for a much more in-depth approach to training our soccer

players. One only has to look at the rate of injury in the English Premiership

again this season. As a Liverpool fan (and one not ashamed to say it) I have

seen a team disseminated by injury. Owen has not played a single season

of his career intact and he is still only 24.

Much more needs to be done, and quickly. Attitudes must change, it's as simple

as that.

But then again even with a fully fit and healthy squad I'm not sure the Pool

could catch Arsenal or Utd. But here's hoping.

Condron

NYC, NY

carruthersjam wrote:

Preseason Strength Training Can Reduce Injury Rates in Soccer Players

Taken from:

http://www.nsca-lift.org/Perform/article.asp?ArticleID=105

Researchers at the Department of Sport and Health Science at the

Karolinska Institutet in Stockholm, Sweden recently examined the

effects of a preseason strength training program on the occurrence

and severity of hamstring injuries in elite male soccer players.

Thirty soccer players from the best premier-league division teams in

Sweden were divided into two groups.

One group performed eccentric exercises specifically designed for the

hamstring 2 times per week for a period of 10 weeks, while the second

group performed no special hamstring training. The occurrence of

hamstring injuries in the hamstring-training group was 36.7% lower

than in the group that performed no hamstring training. The hamstring-

training group also experienced significantly greater gains in

strength and speed than the non-training groups. The researchers

concluded that the inclusion of hamstring exercises that

eccentrically load the hamstrings is beneficial from a performance

enhancement and injury prevention perspective for soccer player.

Askling C, Karlsson J, Thorstensson A. (2003). Hamstring injury

occurrence in elite soccer players after preseason strength training

with eccentric overload. Scandinavian Journal of Medicine & Science

in Sports, 13(4):244 – 250.

---------

Carruthers

Wakefield, UK

[Guest guest]

Regarding the comments on injury rates in soccer players, I believe this is

true in several professional and amateur leagues. It appears that the

higher the level of play (if it is truly higher) the number of injuries

increase, and in many cases, performance levels decrease. A good example is

basketball. Teams now score much less than they did 5 to 10 years ago. It

is not due to better defenses.

In regard to soccer, I will plug my book here (Women's Soccer: Using Science

to Improve Speed). The exercises and technique analysis in this book, which

applies to men and women equally, have been very beneficial in not only

improving performance but also in decreasing the number of injuries.

~~~~~~~~~~~~~~~~~~~~~~

Yessis, Ph.D

President, Sports Training, Inc.

www.dryessis.com

PO Box 460429

Escondido, CA 92046

~~~~~~~~~~~~~~~~~~~

Message: 3

Date: Tue, 23 Dec 2003 11:34:08 -0800 (PST)

Subject: Re: Preseason Strength Training Can Reduce Injury Rates in Soccer

Players

,

I am not sure how to take this headline.

On one hand I am encouraged to see that finally there is some research being

done in the field of strength training for soccer players. But on the other

hand I am a little frustrated that it has taken till 2003 for us to figure

out that strength training, albeit only " eccentric exercise specifically

designed for the hamstrings " whatever they might be, can help reduce the

risk of injury.

As I have stated before soccer is the largest professional sport in the

world. It is a multi-billion dollar/ pound whatever currency you like

industry. But it is still living in the dark ages. I have seen High School

soccer teams here in the US engage in more progressive weight training

programs than Professional outfits in Europe.

There is a high need for a much more in-depth approach to training our

soccer players. One only has to look at the rate of injury in the English

Premiership again this season. As a Liverpool fan (and one not ashamed to

say it) I have seen a team disseminated by injury. Owen has not

played a single season of his career intact and he is still only 24.

Much more needs to be done, and quickly. Attitudes must change, it's as

simple as that.

But then again even with a fully fit and healthy squad I'm not sure the Pool

could catch Arsenal or Utd. But here's hoping.

Condron

NYC, NY

[Guest guest]

*** Thanks for this report Dr. Yessis but I would really appreciate any

scientific evidence / references of studies done that suggest or attempt

to prove that preseason / modified in-season strength training is

beneficial in preventing injuries. This would be very beneficial for me

in my attempts to convince insurance companies involved with some of my

patients.

Thanks in advance for any references.***

Dr. Yessis wrote:

" Regarding the comments on injury rates in soccer players, I believe this

is true in several professional and amateur leagues. It appears that

the higher the level of play (if it is truly higher) the number of

injuries increase, and in many cases, performance levels decrease. A

good example is basketball. Teams now score much less than they did 5

to 10 years ago. It is not due to better defenses.

In regard to soccer, I will plug my book here (Women's Soccer: Using

Science to Improve Speed). The exercises and technique analysis in this

book, which applies to men and women equally, have been very beneficial

in not only improving performance but also in decreasing the number of

injuries. "

Blaine Mackie P.T.

Saskatoon Canada

[Guest guest]

<<<Thanks for this report Dr. Yessis but I would really appreciate

any scientific evidence / references of studies done that suggest or

attempt to prove that preseason / modified in-season strength

training is beneficial in preventing injuries. This would be very

beneficial for me in my attempts to convince insurance companies

involved with some of my patients.>>>

***The following may be useful:

--------

Preseason Strength Training Can Reduce Injury Rates in Soccer Players

Taken from:

http://www.nsca-lift.org/Perform/article.asp?ArticleID=105

Researchers at the Department of Sport and Health Science at the

Karolinska Institutet in Stockholm, Sweden recently examined the

effects of a preseason strength training program on the occurrence

and severity of hamstring injuries in elite male soccer players.

Thirty soccer players from the best premier-league division teams in

Sweden were divided into two groups.

One group performed eccentric exercises specifically designed for the

hamstring 2 times per week for a period of 10 weeks, while the second

group performed no special hamstring training. The occurrence of

hamstring injuries in the hamstring-training group was 36.7% lower

than in the group that performed no hamstring training. The hamstring-

training group also experienced significantly greater gains in

strength and speed than the non-training groups. The researchers

concluded that the inclusion of hamstring exercises that

eccentrically load the hamstrings is beneficial from a performance

enhancement and injury prevention perspective for soccer player.

Askling C, Karlsson J, Thorstensson A. (2003). Hamstring injury

occurrence in elite soccer players after preseason strength training

with eccentric overload. Scandinavian Journal of Medicine & Science

in Sports, 13(4):244 – 250.

----------------

Typical Soccer Injuries and the Reason They Occur (Prof. Angel

Spassov)

http://www.coachsos.com/typicalinjury_spassov.html

Coach Spassov explains the professional approach to soccer injuries

based on the ideas of world-renowned conditioning coaches, medical

doctors, and physiotherapists in Europe and South America.

Considering its popularity, soccer is far ahead than any other

sports. There are about 300 million people playing soccer worldwide.

Germany alone has 6 million people involved in organized soccer and

this number constantly increases, especially after adding of the

women's soccer competitions on the highest level - World Cups and

Olympic games.

The advantages of soccer over other sports are pretty much obvious.

Some of them are the simple rules and equipment, team spirit,

excitement, no special requirements for the size of the body. A well-

prepared soccer player has an advantage over other athletes by the

versatility of the development of the physical qualities - speed,

endurance, agility, strength and flexibility.

That's why soccer is a wonderful way to shape the body for male and

female athletes of all ages. There are some concerns about a large

number of women and girls, getting involved in the sport of soccer

lately, especially for overloading of their inner organs, because of

the high endurance requirement. Research undoubtedly proves that such

statement is ungrounded since endurance is the physical quality women

are the closest to men, which is largely illustrated by the success

of female athletes in events like long distance and marathon.

At the same time we need to admit that soccer is a tough sports

event. That's why it is understandable that a number of soccer-

specific injuries are, unfortunately, a part of the player's life.

There are players who practice 2-3 times a week and then play 20-30

games a year. And, of course, there are the professionals who

practice every day, sometimes twice a day, and then play about 100

games a year. For all of them that process is not injury-free.

The point is that a large number of injuries could be limited if the

player is well prepared for the requirements of the game. In soccer,

95% of the injuries are a consequence of not enough high-level

preparation for practice and games. All different sports have

specific injuries and soccer is no exception to the rule. Due to the

nature of the game it is obvious that the major pressure is on the

lower extremities.

E. Doyzer has documented thousands of injuries with high-level soccer

players in Germany, and came to a conclusion that the distribution on

the different parts of the body is as follows........

----------------------

Pre-season injuries blight soccer performance

23:01 25 November 02

http://www.newscientist.com/news/news.jsp?id=ns99993104

Four out of 10 professional soccer players in England get injured

even before the season starts. The shock finding indicates that

changes should be made to pitches and player preparation, says the

research team. The results emerged from injury data submitted by 91

of England's 92 professional club teams over the two seasons from

July 1997 to May 1999. One fifth of the 6030 injuries recorded

happened during pre-season training - the six weeks when players gear

up for a new season. Although most pre-season injuries were

relatively minor, they kept players sidelined for an average of three

weeks. " Prevention of pre-season injury is important to ensure

availability of players for the commencement of the season and to

decrease the risk of injury later, " says the team, led by Alan Hodson.

The team warns that players are hit by a " quadruple whammy " when they

return to training after a short vacation.

First, they are out of condition and so are more likely to strain

themselves. Second, the sheer intensity of the training - especially

running - makes overstrain more likely. Third, the ground is hard and

dry, which increases jarring of limbs. Finally, they wear boots or

trainers that might not fit properly or suit the dry conditions.

Muscle strains were the most common pre-season injuries, accounting

for more than one third of the toll. Most were strains to the rectus

femoris, a quadriceps muscle in the thigh essential for kicking. This

muscle was injured twice as frequently in pre-season training. Almost

a third of all injuries to the Achilles tendon in the ankle were also

inflicted pre-season.

------------

Br J Sports Med 2001 Feb;35(1):43-7

The association football medical research programme: an audit of

injuries in professional football.

Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M.

OBJECTIVES: To undertake a prospective epidemiological study of the

injuries sustained in English professional football over two

competitive seasons.

METHODS: Player injuries were annotated by club medical staff at 91

professional football clubs. A specific injury audit questionnaire

was used together with a weekly form that documented each club's

current injury status.

RESULTS: A total of 6,030 injuries were reported over the two seasons

with an average of 1.3 injuries per player per season. The mean (SD)

number of days absent for each injury was 24.2 (40.2), with 78% of

the injuries leading to a minimum of one competitive match being

missed. The injury incidence varied throughout the season, with

training injuries peaking during July (p<0.05) and match injuries

peaking during August (p<0.05). Competition injuries represented 63%

of those reported, significantly (p<0.01) more of these injuries

occurring towards the end of both halves. Strains (37%) and sprains

(19%) were the major injury types, the lower extremity being the site

of 87% of the injuries reported. Most injury mechanisms were

classified as being non-contact (58%). Re-injuries accounted for 7%

of all injuries, 66% of these being classified as either a strain or

a sprain. The severity of re-injuries was greater than the initial

injury (p<0.01).

CONCLUSIONS: Professional football players are exposed to a high risk

of injury and there is a need to investigate ways of reducing this

risk. Areas that warrant attention include the training programmes

implemented by clubs during various stages of the season, the factors

contributing to the pattern of injuries during matches with respect

to time, and the rehabilitation protocols employed by clubs.

--------

Br J Sports Med 1999 Jun;33(3):196-203

A prospective epidemiological study of injuries in four English

professional football clubs.

Hawkins RD, Fuller CW.

OBJECTIVE: To define the causes of injuries to players in English

professional football during competition and training. METHOD: Lost

time injuries to professional and youth players were prospectively

recorded by physiotherapists at four English League clubs over the

period 1994 to 1997. Data recorded included information related to

the injury, date and place of occurrence, type of activity, and

extrinsic Playing factors.

RESULTS: In all, 67% of all injuries occurred during competition. The

overall injury frequency rate (IFR) was 8.5 injuries/1000 hours, with

the IFR during competitions (27.7) being significantly (p < 0.01)

higher than that during training (3.5). The IFRs for youth players

were found to increase over the second half of the season, whereas

they decreased for professional players. There were no significant

differences in IFRs for professional and youth players during

training. There were significantly (p < 0.01) injuries in competition

in the 15 minute periods at the end of each half. Strains (41%),

sprains (20%), and contusions (20%) represented the major types of

injury. The thigh (23%), the ankle (17%), knee (14%), and lower leg

(13%) represented the major locations of injury, with significantly

(p < 0.01) more injuries to the dominant body side. Reinjury counted

for 22% of all injuries. Only 12% of all injuries were caused by a

breach of the rules of football, although player to player contact

was involved in 41% of all injuries.

CONCLUSIONS: The overall level of injury to professional footballers

has been showed to be around 1000 times higher times higher than for

industrial occupations generally regarded as high risk. The high

level of muscle strains, in particular, indicates possible weakness

in fitness training programmes and use of warming up and cooling down

procedures by clubs and the need for benchmarking players' levels of

fitness and performance. Increasing levels of injury to youth players

as a season progresses emphasizes the importance of controlling the

exposure of young players to high levels of competition.

--------------

Med Sci Sports Exerc 1983;15(3):267-70

Soccer injuries and their mechanisms: a prospective study.

Ekstrand J, Gillquist J.

In order to study the incidence and mechanisms of injury in soccer

and to recommend prophylactic measures, 180 players in a senior male

soccer division were followed prospectively for 1 yr. Attendance

records for games and practice sessions were kept, and all injuries

were examined and treated by the same orthopaedic surgeon. One

hundred twenty-four players incurred 256 injuries, mostly sprains and

strains of the lower extremities. Of these, 62% were considered minor

with ankle sprains being the most common (17%), while 11% were

considered major with knee ligament sprains being the most frequent

(32%).

Overuse injuries were most frequent in the preseason training period.

Traumatic leg injuries involved players with inadequate or no shin

guards. Of the traumatic knee injuries, 11 of 18 (61%) occurred

during a collision; non-contact knee injuries were frequently seen in

those players with a history of knee injury and existing instability.

Study of injury sequence disclosed that a minor injury was often

followed within two months by a major one. In addition, with severe

injuries incurred during fouls, the individual causing the penalty

was injured. This prospective study suggested that those with knee

instability and those allowed to resume play with poorly

rehabilitated or clinically unhealed injuries are more apt to sustain

further injury. Some injuries can be avoided by using better

equipment and by observance of the rules.

------------

Int J Sports Med 1996 Apr;17(3):229-34 Related Articles, Links

Injuries in male soccer players: team risk analysis.

Inklaar H, Bol E, Schmikli SL, Mosterd WL.

Selection may be responsible for different characteristics of

subgroups (teams) of soccer players resulting in different risks of

injury and different injury patterns. In the present study injury

rates of teams were analysed with respect to the factors age and

level of play. In two Dutch non-professional soccer clubs 477 male

players, active in teams of different age groups and at different

levels of play, were prospectively followed during the second half of

the 1986/1987 competitive season.

Teams in the 17/18 years age group showed the highest incidence of

injury per 1000 players hours in games. At a high level of play teams

have a significantly (p < 0.01) higher risk of injury than teams at a

low level of play. This difference is noticed within every age group

with exception of the 15/16 years age group. At a high level of play

teams of senior players have significantly (p < 0.005) more prevalent

injuries than teams of junior players. Senior players, active at a

high level of play, have significantly (p < 0.05) more overuse

injuries than senior players of a low level of play. At a high level

of play significantly (p < 0.05) more upper leg injuries are

reported. In the total population of soccer players relatively more

sprains are located in the ankle joint and relatively more strains

are located on the upper leg.

It is concluded that prevention of soccer injuries primarily should

be aimed at teams and their environment and not at the individual

soccer player.

--------------

Am J Sports Med 1991 Jul-Aug;19(4):372-5

Soccer injuries among elite female players.

Engstrom B, Johansson C, Tornkvist H.

Injuries occurring in two female elite soccer teams were recorded

during 1 year. Of 41 players, 33 (80%) sustained 78 injuries. The

incidence of injury during games was 24/1000 hours, while the

incidence during training was 7/1000 hours. The majority (88%) of

injuries were localized to the lower extremities, with equal

occurrence in the left and right legs.

Forty-nine percent of the injuries occurred in the knee or ankle.

Most of the injuries were minor (49%), while 36% were moderate and

15% were major. Of the major injuries (N = 12), 10 were due to trauma

and 7 (58%) were knee ligament or meniscal tears. Overuse injuries

constituted 28% of all injuries and occurred mainly during preseason

training and at the beginning and end of the competitive season.

Traumatic injuries (72%) occurred mainly during games with a

predominance at the beginning of the competitive season. Almost 80%

of the traumatic injuries occurred during physical contact with an

opponent. Extrinsic factors such as weather, playing surface,

temperature, or the position of the player within the team did not

influence the injury rate. We conclude that female elite soccer

players sustain a high incidence of injury. Few injuries were major,

but 17% of the players sustained a major knee injury during the year.

-----------

Am J Sports Med 1989 Nov-Dec;17(6):803-7

Epidemiology and traumatology of injuries in soccer.

Nielsen AB, Yde J.

A prospective investigation of soccer injuries among 123 players

participating at various competition levels was undertaken in a

Danish soccer club. The injury incidence during games was highest at

division level (18.5/1000 hours) and lowest at series level

(11.9/1000 hours), whereas the distribution of the incidences during

practice was reversed. The youth section (16 to 18 years) had

incidences that could be compared to the highest senior level.

The lower extremity was involved in 84% of the injuries, including

34% of overuse injuries. Ankle sprains were most common (36%) and

equally found at all levels, whereas half of all overuse injuries

were seen among division players. Contact injuries during tackling

occurred most often in lower series and youths (45%). Players

participating at high levels had only 30% of the injuries during

tackling and 54% during running. More than half of 20 knee injuries

were caused by tackling. Thirty-five percent of injured players were

absent from soccer for more than 1 month; 28% had complaints 12

months after the end of the season with knee injuries the most

serious. The study shows that the injury incidence, the pattern of

injury, and the traumatology varied between players participating at

different levels of soccer competition.

--------------

Am J Sports Med 2000 Sep-Oct;28(5):659-62

Avoidance of soccer injuries with preseason conditioning.

Heidt RS Jr, Sweeterman LM, Carlonas RL, Traub JA, Tekulve FX.

The effect of a preseason conditioning program was studied to

evaluate its influence on the occurrence and severity of soccer

injuries. Three hundred female soccer players (ages 14 to 18 years)

were studied over a 1-year period. Forty-two of these players

participated in a 7-week training program before the start of the

season. The type, mechanism, and severity of the injury, when the

injury occurred, the number of games or practices missed, and type of

shoe worn were recorded.

All injuries occurred in the lower extremities, with 61.2% occurring

at the knee and ankle. Student's t-test evaluations revealed that the

trained group experienced a significantly lower incidence of injury

than the untrained group (P = 0.0085). Although not statistically

significant, the trained group also had a lower percentage (2.4%) of

anterior cruciate ligament injuries compared with the untrained group

(3.1%). These results suggest that this type of conditioning has a

significant influence on lowering the incidence of injury in female

adolescent soccer players.

---------------

Am J Sports Med 2003 Jan-Feb;31(1):41-6

Muscle flexibility as a risk factor for developing muscle injuries in

male professional soccer players. A prospective study.

Witvrouw E, Danneels L, Asselman P, D'Have T, Cambier D.

BACKGROUND: Muscular tightness is frequently postulated as an

intrinsic risk factor for the development of a muscle injury.

However, very little prospective data exist to prove this.

HYPOTHESIS: Increased muscle tightness identifies a soccer player at

risk for a subsequent musculoskeletal lesion. STUDY DESIGN:

Prospective cohort study.

METHODS: We examined 146 male professional soccer players before the

1999-2000 Belgian soccer competition. None of the players had a

history of muscle injury in the lower extremities in the previous 2

years. The flexibility of the hamstring, quadriceps, adductor, and

calf muscles of these players was measured goniometrically before the

start of the season. All of the examined players were monitored

throughout the season to register subsequent injuries.

RESULTS: Players with a hamstring (N = 31) or quadriceps (N = 13)

muscle injury were found to have significantly lower flexibility in

these muscles before their injury compared with the uninjured group.

No significant differences in muscle flexibility were found between

players who sustained an adductor muscle injury (N = 13) or a calf

muscle injury (N = 10) and the uninjured group.

CONCLUSIONS: These results indicate that soccer players with an

increased tightness of the hamstring or quadriceps muscles have a

statistically higher risk for a subsequent musculoskeletal lesion.

CLINICAL SIGNIFICANCE: Preseason hamstring and quadriceps muscle

flexibility testing can identify male soccer players at risk of

developing hamstring and quadriceps muscle injuries.

-------------

Am J Sports Med 2002 Sep-Oct;30(5):652-9

Prevention of soccer injuries: a prospective intervention study in

youth amateur players.

Junge A, Rosch D, L, Graf-Baumann T, Dvorak J.

BACKGROUND: Risk factors for soccer injuries and possibilities for

prevention have been discussed by several authors, but only a few

have investigated the effectiveness of preventive interventions.

PURPOSE: The aim of the present study was to evaluate the effects of

a prevention program on the incidence of soccer injuries in male

youth amateur players.

STUDY DESIGN: Prospective controlled intervention study. METHODS:

Seven soccer teams took part in a prevention program that focused on

education and supervision of coaches and players, while seven other

teams were instructed to train and play soccer as usual. Over 1 year

all injuries were documented weekly by physicians. Complete weekly

injury reports were available for 194 players.

RESULTS: The incidence of injury per 1000 hours of training and

playing soccer was 6.7 in the intervention group and 8.5 in the

control group, which equates to 21% fewer injuries in the

intervention group. The greatest effects were observed for mild

injuries, overuse injuries, and injuries incurred during training.

The prevention program had greater effects in low-skill than in high-

skill teams.

CONCLUSIONS: The incidence of soccer injuries can be reduced by

preventive interventions, especially in low skill level youth teams.

Coaches and players need better education regarding injury prevention

strategies and should include such interventions as part of their

regular training.

-------------

Am J Sports Med 1983 Mar-Apr;11(2):63-7

Incidence of soccer injuries and their relation to training and team

success.

Ekstrand J, Gillquist J, Moller M, Oberg B, Liljedahl SO.

......The incidence of injury was higher at training camps.

Correlation was noted between the design of the training and the

incidence of injuries. The duration of warming up seemed adequate,

but its content did not appear to be satisfactory from a clinical

point of view. Redesign of the warm-up with more emphasis on

flexibility and the addition of a cool-down is suggested to reduce

injuries.

-------------

Am J Sports Med 2000;28(5 Suppl):S69-74

Risk factor analysis for injuries in football players. Possibilities

for a prevention program.

Dvorak J, Junge A, Chomiak J, Graf-Baumann T, L, Rosch D,

Hodgson R.

Review of the literature shows that information concerning risk

factors for football injuries is incomplete and partly contradictory.

The aim of this study was to analyze the influence of medical

history, physical findings, football skills, and football

performance, as well as psychosocial characteristics on the

occurrence and severity of football injuries.

The prospective outline of the study was as follows: after a baseline

examination was performed to ascertain possible predictors of injury,

all players were followed up weekly for 1 year to register subsequent

injuries and complaints. Two hundred sixty-four of 398 players (67%)

had complete weekly follow-ups over 1 year. A majority of the players

(N = 216; 82%) were injured during the observation period. In

comparing injured and uninjured players, several differences were

observed. To create a multidimensional predictor score for football

injuries, 17 risk factors were selected.

These risk factors covered a wide spectrum, such as previous

injuries, acute complaints, inadequate rehabilitation, poor health

awareness, high life-event stress, playing characteristics, poor

reaction time, poor endurance, and insufficient preparation for

games. By summing up the individual risk factors, a predictive sum

was calculated for each player. The more risk factors present at the

baseline examination, the higher the probability of that player

incurring an injury in the ensuing year. Using two risk factors as

the cut-off score, more than 80% of the players were correctly

classified as to whether they went on to incur an injury. Based on

these findings, knowledge from the literature, and practical

experience, possibilities for a prevention program are suggested.

-----------

Orthop Clin North Am 2002 Oct;33(4):637-51

The female ACL: why is it more prone to injury?

Ireland ML.

Multiple factors are responsible for ACL tears. The key factor in the

gender discrepancy appears to be dynamic, not static, and proximal,

not distal. The factors involved in evaluating the female ACL are

multiple. However, it is the dynamic movement patterns ot hip and

knee position with increased flexion and a coordinated proximal

muscle firing pattern to keep the body in a safe landing position

that are the most critical factors. An ACL injury at an early age is

a life-changing event. We can very successfully reconstruct and

rehabilitate an ACL, but we cannot stop there. We must now go into

the prevention arena.

In the United States there is tremendous variation in the exposure

and acquisition of skills of physical activities in our youth. Today,

children are often playing inside, using computers and watching

television-missing out on the opportunity to learn safe movement

patterns. Therefore, physical movement classes should occur very

early in life, teaching children to land safely and in control,

similar to the cry of " get down, stay down " routinely heard during

youth soccer. Similarly, specific strength training programs can

address landing as well as foot movements during cutting in

basketball. Coaches should issue stern warnings when athletes

demonstrate a high-risk movement patterns such as one-leg landings,

out-of-control baseline landings, or straight-leg landings.

The warnings may serve to keep the athlete from " touching the hot

stove again " for fear of getting burned. No athlete feels she will be

the one to get injured. Therefore, prospective analysis is likely to

be received more warmly by the athletes if the program is presented

with an emphasis on performance improvement rather than injury

prevention. With increased participation in these programs, multiple-

center analysis will have the power necessary to determine which

factors significantly predispose athletes to ACL injury. The future

for injury prevention is bright. We must rise to the challenge.

---------------

Female Athletics: Are ACL Tears Preventable in the Female Athlete?

http://www.medscape.com/viewarticle/440052

Medscape Orthopaedics & Sports Medicine 6(2), 2002

Hewett[1] originally brought to our attention that the rate of

ACL injury can be reduced by a preseason jump-training program. This

program taught the female athletes how to land from a jump and

strengthened the quadriceps and hamstring muscle groups by plyometric

training.

The following article has reproduced the Hewett study findings and

confirmed that a conditioning program for soccer will reduce the rate

of ACL injury. The findings should be of interest to anyone who is

involved with young women in sports.

------------

Carruthers

Wakefield, UK