INJURY PREVENTION Head Neck/spine

Location of injuries Location of re-injuries 1997-98 2003-04 1997-98 2003-04 1.4 5.3

1.1 4.6

Shoulder joint 0.5 Upper limb Chest

Abdomen Hip

Groin

Lower limb Thigh Knee

Lower leg Calf

Ankle Foot Toe

2.3 1.1 1.4 2.0

10.0 88.1 22.3 16.8 4.5 9.1

17.1 5.4 1.0

1.4* 2.9 0.7 1.1 2.4 9.3

71.8** 23.3 17.8 4.3 7.6

17.3 5.1 0.4

1.7 5.7 0.3 2.0 1.3 1.3 1.8 9.4

87.9 24.3 14.3 4.0

10.2 17.7 5.0 1.1

1.5 5.5 1.3 2.9 1.1 1.5 2.1

10.9 87.4 23.4 16.3 4.1 9.4

18.0 3.9 0.3

*Significant difference between 1997-98 and 2003-04 sea- sons; p<0.01

** Significant difference between 1997-98 and 2003-04 sea- sons; p<0.001

Table 2: Location of injuries and re-injuries sustained during 1997-98 and 2003-04 seasons, expressed as a percentage of total injuries and total re- injuries sustained per season, respectively.

cies in the laws of the game may also need addressing to protect players from certain types of injuries (20,21,22).

Lower limb injuries significantly decreased in number in 2003-04 compared with 1997-98 (p<0.001; Table 2). Although this is encouraging, it remains clearly evident that this area needs to be addressed with regards to both intrinsic and extrinsic factors if injury incidence to this area is to be reduced further.

The percentage of re-injuries was not significantly different between seasons (8.4% vs. 6.4%; Table 2). This suggests that awareness needs to be increased concerning the need for adequate rehabilitation treatment and time following an injury to minimise the possibility of sustaining a subsequent injury (19).

Mechanism of injury Running was the most frequent mechanism of injury in both sea- sons, however significantly fewer injuries occurred as a result of running in 2003-04 than in 1997-98 (18.7% vs. 13.7%; p<0.01). This may suggest that clubs are employing improved screening methods and carefully tailored, individualised conditioning pro- grammes for their players. Conversely, it could be suspected that if the proportion of injuries sustained whilst running is reduced, then a concomitant decrease in the incidence of hamstring injuries might also be expected, however this was not the case.

The 2003-04 season also saw a significant decrease in the number of injuries occurring from collisions and being tackled compared with 1997-98 (p<0.001), possibly due to stricter punishment from

8

referees for foul tackles. The number of injuries as a result of being kicked (p<0.001), falling (p<0.05), and being hit by the ball (p<0.001) was significantly greater in 2003-04 compared with 1997-98 (Fig. 5). Whether or not these kicks were foul play in nature was not recorded, however it may be worth investigating because stricter punishment may be required if such foul play sig- nificantly influences the risk of injury to a player. Previous studies have investigated the role of foul play and rule violations on injury incidence (19), (20), (21), (22) however at present, injuries caused by players being kicked by opponents has not been investigated.

CONCLUSION In conclusion, a number of encouraging trends have been identified in the present study. Notably, the decrease in pre-season injuries recorded in 2003-04 compared with 1997-98 has contributed great- ly to increasing the number of players available for selection at the start of the competitive season. Specially tailored, individualised strength and conditioning programmes may further reduce the inci- dence of pre-season injuries in the future.

However, a number of key areas have been highlighted where fur- ther research may help decrease injury incidence in the future. Improving players’ endurance, introducing football specific activities at half time and utilising conditioning and nutritional interventions to delay the onset of fatigue may help to decrease the incidence of injuries in the second half of matches. Maintaining conditioning training throughout the competitive football season may help reduce the incidence of injury towards the end of the season, when the majority of cup finals, international tournaments and final league matches are played.

In light of the present findings, efforts should be made to decrease the incidence of re-injury. Whereas gaining complete control over injury occurrence is impossible, ensuring adequate rehabilitation treatment and time following an injury is within the club’s control, and may contribute largely to minimising a player’s risk of sustain- ing a re-injury in the future.

THE AUTHORS

Catrin Sheppard MSc, BSc, currently works for the Football Association as a research scientist in the Medical and Exercise Science Department. A graduate from Loughborough University, she gained her BSc (Hons) degree in Sport and Exercise Science in 2003, before completing her MSc Exercise Physiology degree in 2004, also at Loughborough University. Having gained the OCR Diploma in Sports Massage in 2005, she has also worked as a sports masseur to the England senior women’s football squad in the UEFA European

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Figure 5: Mechanism of injuries sustained in 1997-98 and 2003-04 seasons. Values shown are percentage of total injuries sustained in each season.