I put some stuff on about tendinitis last week, which got me interested in researching professional football injuries a bit. Well, somebody said on another thread that there aren’t enough postings, so you’ve asked for it! The most comprehensive study I found (although not the largest study) was published in the British Journal of Sports Medicine in 1999 by Hawkins and Fuller.

Physios at four English League Clubs (don’t know which four) recorded all injuries in professional and youth players over the period 1994 to 1997. An injury was recorded if it prevented training or playing for at least one day. The observation period included 983 competitive matches and 2073 hours of team training.

There were 744 injuries recorded, an injury frequency rate (IFR) of 8.5 per 1000 hours. This is 1000 times higher than the IFR for industries defined as high risk for injuries. Over each season, 86% to 100% of all players at each club were injured at some stage.

The IFR during competitive matches was 27.7 per 1000 hours, for training 3.5 per 1000 hours played; 67% of all injuries occurred during competitive matches. Significantly more injuries occurred during the last 15-minute period of each half. Injuries to youth players increased after January each season, while injuries to professionals decreased gradually throughout the season. The rise in younger players was linked to overuse in competitive matches over a long season, whereas the professionals returned from their summer break relatively unfit but improved as the season went on.

Common injuries were categorised as strains (40%), sprains (20%) and bruises (20%). The site affected was recorded as thigh (23%), ankle (17%), knee (14%) and lower leg (13%). Significantly more injuries occurred to the dominant leg. Reinjuries accounted for 22% of the total.

Of the total injuries, 12% resulted from “infringements of the laws” (fouls, I guess), and overall 41% were the result of personal contact (leaving 59% not resulting from contact).

The main conclusions were: football clubs’ fitness programmes show weaknesses; insufficient attention is paid to warm-ups and cool-downs (now “warm-downs” in the jargon I think); young players get overused over the course of a whole season before physically mature; older players do not, but do allow their fitness to lapse significantly over the summer break.

Criticisms: it’s a well-designed prospective study (fairly good science) BUT only four clubs, how representative are they (what level do they play at?), and some of the attributed causes are just speculative. I thought it was interesting that 22% were repeat injuries. “Once damaged, never as good again” to some extent, but can’t help wondering if some of this is bringing players back too soon – which is where I came in…

I’ve got more stuff including the long-term effects of injuries if anybody is interested.

-- Anonymous, March 26, 2002

Answers

Agonised Professionals

-- Anonymous, March 26, 2002

I'm game, post away. :-)

Though, I assume NUFC wasn't one of the clubs studied as we seem to get more injuries as the season goes on, rather than less mentioned in the study. Or does that indicate our training regime/facilities might not be as good as others? ;-)

-- Anonymous, March 26, 2002

Bill - interesting stuff. Is there any data to indicate whether the incidence of injuries is increasing or decreasing?

-- Anonymous, March 26, 2002

OK Ciara, will get to work on it!

Clarky - there aren't any directly comparable previous studies. The authors note that the proportion of injuries causing absences of over four weeks (11%) was the same as a study reported in 1983. However, all injuries could be rising or falling without the proportion changing, and I think the earlier study was from Scandinavia. The average length of time lost through each injury was lower than previous reports, at 14.6 days compared with 19.9 days for one English club in 1989 and 27.1 days in a Scottish premier team in 1995. That worries me, though, because it reeks of my recurring theme of bringing players back earlier, rather than less severe injuries.

-- Anonymous, March 26, 2002

Bill - the reduction in time lost through injuries could also be related to the major improvement in surgical techniques - eg. key- hole surgery for cartilage removal - that has occurred since the 70's.

-- Anonymous, March 26, 2002

Interesting point Clarky. On balance, I think that the effect of keyhole surgery would be quite limited. The majority of these injuries will not require any kind of surgical intervention, so the overall length of time off will be dominated strongly by rehabilitation policies. Also, I'm not sure that I would expect an arthroscopic menisectomy (ooer missus) to reduce much the time taken to resume training: it allows earlier mobilisation because the joint capsule hasn't been laid open, but the factor dictating return to training should be when the knee itself is ready to take high impacts and stresses, which won't be much different if at all.

-- Anonymous, March 26, 2002

This is a report which is on the BBC Website dated 1999, on the longer term effects of injuries. I have tried to track down the original report, unsuccessfully.

Former footballers are much more likely to suffer from the painful disabling condition osteoarthritis than the general public, according to research. As many as 15% are registered disabled. Some also complain of dizziness and migraines which may be linked to constant heading of the ball. The research by the University of Coventry's Psychosocial Rheumatology found that 49% of current and former footballers have osteoathritis. The average age of onset was 40. In the general population, less than 10% of men aged 35 to 44 develop the disease. Its major symptoms are pain, stiffness, crackling and enlargement and deformities of the afflicted joint or joints.

Andy Turner, who led the research, said 284 footballers returned questionnaires about their health. Fifty-nine per cent of former players said they had received at least one steroid injection during their career. Most said they had been forced to play when they had not had enough time to recover from an injury. Some former players said they would not have done things any differently if they had known when they were playing that they would develop injuries. One said: "The state of my knees is definitely the result of my football career, particularly the fact that I was a defender, but, in no way, had I known then what the result of playing would be, would I have changed anything. "I loved my football. I am hoping that my forthcoming knee replacements will further extend my physical capabilities."

Sixty-eight per cent of former players with osteoarthritis said they had problems walking and 61% had difficulty performing tasks such as washing, dressing and housework. Eighty-nine per cent said they were in moderate to extreme pain. A quarter suffered from depression. Sixteen per cent said their injuries had affected their work prospects, leading to early retirement or working fewer hours. Several ex-players said they now suffered from constant migraines, feelings of dizziness or memory problems.

Some said they felt this was the result of constantly heading a football during their career. Mr Turner said: "It is easy to diminish the problems reported by the respondents as a price worth paying for the glamour, fame and riches, but only about 800 of the UK's 2,600 professional players earn their living in the Premiership. "In the lower divisions, many players earn little more than the spectators." He added that increasing demands on footballers in terms of greater competition and pressure for a quick return after injury could mean disability and pain were likely to remain a major feature of life after football.

The Football Association (FA) is conducting research into long-term injuries. Its medical committee is looking into head injuries as part of a 10-year study. And a two-year research project which consists of an audit of all injuries suffered by professional players is due to finish at the end of this season. The results will be published once they have been collated. They will form the basis of recommendations to all involved in football. Richard Hawkins, a sports scientist at the FA, said there was no conclusive proof that heading the ball led to memory or migraine problems. But it was difficult to prove injuries were related directly to football unless accurate medical records were kept. "If we track them throughout their professional career and they develop problems these can be related back to the injuries they sustained on the pitch," he said. He added that treatments used to kill pain were no longer as disabling as those used 20 years ago, such as cortisone. And players were less likely to be forced to play on with an injury. This was because coaches were now more aware of the long-term effects. Their training courses now include issues such as nutrition and health. However, he admitted some players and coaches might feel under pressure to return to football before their injury had properly healed.

Comments: difficult to be sure without access to the original report, but this seems a much poorer quality piece of research. Specifically, 284 footballers returned questionnaires, but how many were sent out (response rates of under 70% or so raise serious issues of how representative the responders were, particularly since those with problems to report may be more likely to return questionnaires). If response rates were low, they should have tried to analyse some non-responders to see if they were different. Also the sampling frame isn’t specified (how did they define who was eligible to be sent questionnaires), nor the method of sampling (did everybody receive a questionnaire, if not how did they decide). Oh, I could go on (I thought you bliddy were, Ed).

Still, the numbers are rather high, and I don’t find the bit about coaches understanding better the effects of bringing [players back early at all convincing. Where’s the evidence?

-- Anonymous, March 26, 2002

Thanks for that lot Dr Bill. Some interesting stuff, although like so many such studies, it does serve to whet the appetite for yet more data. Wouldn't it be great to know these figures, particularly IFR's and average recovery time, for the Toon in comparison to other clubs? (Even as we speak I can picture Softie tearing out yet more hair as a few extra columns are added to the database....)

I wonder if the business of the average recovery time being reduced would be due to improved medication for pain killing, reduction of inflammation and the like. I was intrigued by Mika's response to your previous post on this issue, when he said he just took an injection and the inflammation was gone. I think this would also go along with your idea that whilst the player can be rushed back in this way, the healing process has not completed which will contribute to the re- injury problem and to the problems suffered by footballers in later life.

I was very interested to read that these ex-players seemed to have no regret about the way they played the game and would not alter the past even knowing what future problems it would bring on for them. They loved their game and their lives would presumably have been poorer without the excitement of the game and the duress they subjected their bodies to.

-- Anonymous, March 26, 2002

Significantly more injuries occurred during the last 15-minute period of each half....... Wonder if we can use this study to persuade Uncle Bobby to use his subs a bit earlier????

-- Anonymous, March 27, 2002

Jonno,

re the NSAID drugs, they do not even need to be injected, but can be taken orally (as I do). As I said in the earlier thread, they work like magic. I have arthritis in my knee and ankle, and when I get painful inflammation due to exercise or injury the drug takes care of it in 24 to 48 hours. The damage of course remains, but the inflammation, and with that most of the pain, is gone. A short period of rest after medication and you're ready hurt yourself again.

My GP tells me that there are no serious side-effects to these drugs, and they are not opiates or anything so I can go on with your life while taking them. Very popular among older atheletes I'm told.

-- Anonymous, March 27, 2002

I can go on with MY life, that is, not yours Jonno.

-- Anonymous, March 27, 2002

Well Mika - I'm sure you could make a better job of it! :-)

So Mika, presumably you are able to return to competition before the rest period required to fully heal any damage. Thereby possibly storing up greater problems for the future?

BTW Mika - that volleyball website was interesting. When is your next participation in a major event? Perhaps you can keep us posted and we can look out for it. Only if you're likely to win though - we're all glory hunters on here. ;-)

-- Anonymous, March 27, 2002

I can pretty much keep up with light training and even play in matches while taking these drugs. So far, my GP hasn't been worried about my condition, as long as the medication works and I don't have to take it all the time. In the longer run problems may arise, but I'm told I shouldn't worry about them now when things are under control. His approach could be different though if I was a 20-yr old pacy striker, and not 30-yr old crocked setter.

I haven't had too many problems this season, and I'm looking forward to defending our silver medal in the the World Champs in Egypt in September. I'm going to our first national training camp tomorrow (and missing the toffees match sorry to say). Happy to keep you guys posted on developments, when they arise.

-- Anonymous, March 27, 2002

Yes do that Mika. Give us something to shout about if the lads let us down! Enjoy the training camp and we'll do our best against Everton in your absence. :-)

-- Anonymous, March 27, 2002