Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies.

This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women's Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club's international players' lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player's injury resilience in professional women footballers.

Supporting athletes during a challenging situation: recommendations from a global insight of COVID-19 home-based training experience.

BACKGROUND: For athletes, overcoming obstacles in challenging situations like pandemic home training is crucial. Strategies and approaches in this context are not well-documented. Our study aims to investigate such a scenario from a performance standpoint, based on a major global crisis: the COVID-19 pandemic and lockdown. METHODS: This cross-sectional study surveyed athletes without disabilities using online questionnaires (35 languages) from May to July 2020. Questions included aspects of alternative routines, training monitoring, recovery, sleep patterns, injury occurrence/prevention based on structured answers, and an open-ended question on lockdown training experiences. RESULTS: Of the 11,762 athletes from 142 countries, 63% were male, including at World-Class, International, National, State and Recreational levels. During lockdown, 25% athletes used innovative or modern ways to maintain or improve fitness e.g., virtual reality and tracking devices (favoring World-Class level, 30%). Many athletes, regardless of gender (43%) watched video competitions to improve/maintain their mental skills and performance [World-Class (47%) and International (51%)]. Contact frequency between athletes and their coaches was mainly at least once a week (36%), more among higher-level (World-Class/International) than lower-level athletes (27 vs. 16%). Higher-level athletes (≥ 54%) monitored training load and were assisted by their coaches (21%). During lockdown, stretching (67%) was considered one of the primary means of recovery, especially for higher-level athletes (> 70%). Compared to pre-lockdown, about two-thirds of athletes reported "normal" or "improved" sleep quality and quantity, suggesting a low sleep quality pre-lockdown. On average, 40% utilized injury prevention exercises (at least) once a week [World-Class (51%) and International (39%)]. Most injury occurrences during lockdown involved the knee (18%), ankle (16%), and back (9%). Four key themes emerged regarding lockdown experiences: remote training adaptation (e.g., shifting training focus), training creativity (e.g., using household items), performance enhancement opportunities (e.g., refocusing neglected aspects), and mental and motivation challenges. CONCLUSIONS: Both male and female athletes, particularly those of higher levels, displayed some adaptalibity during the COVID-19 lockdown, employing innovative approaches and technology for training. Many athletes implemented load monitoring, recovery, and attentive of injury prevention, while optimizing their sleep quality and quantity. Athletes demonstrated their abilities to navigate challenges, and utilized different coping strategies in response to the lockdown's constraints.

Fractures in professional footballers: 7-years data from 106 team seasons in the Middle East.

Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional footballers and information on fracture treatment is scarce. The aim of this study is to describe the epidemiology of fractures across seven seasons in Qatar Stars League (QSL) footballers. A prospective study of fractures in professional male footballers over 7 consecutive seasons (2013 to 2020), involving 3255 players and 106 team' seasons. Time loss and injuries and illnesses were recorded using standardised digital tools in accordance with international consensus procedures. Fractures were recorded according to onset mechanism, location, diagnoses, treatment and return to play. A total of 108 players sustained fractures during 638,247 hours of player exposure (88.9% training and 11.1% matches), representing 2.7% of all time-loss injuries. The incidence was 0.17 fractures per 1000 h of exposure (match and training incidence of 0.9 and 0.07 fractures / 1000 h, respectively), equivalent to an average of one fracture per team per season. Fractures mostly occurred in the feet (28.2%), hands (21.1%), shoulders (11.3%) and head (i.e., face) (9.9%). Mean (median) absence was 71 (47 days), with 4.6% refractures. Only 34.3% of the fractures required surgery and nearly all players (98.1%) returned to play at the professional level. Almost all professional football players with fractures return to play at the same competitive level after an average of 10 weeks of absence (mean absence was 71 ± 81 (median: 47, Inter Quartile Range [14-93]) days). One in ten continue to play with symptoms and one in twenty may refracture. Long-term effects of fractures are still unknown.

Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study.

INTRODUCTION: Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. METHODS: In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad). RESULTS: There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12-30) days; II: 10 (95% CI: 7.3.1-13.4)]. Apophyseal injuries of the hip-pelvis resulted in the greatest burden [median: 13 (95% CI: 10-17); II: 2.5 (95% CI: 2.1-3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot-ankle (II: 2.4; 95% CI: 1.0-4.9), U-14 for knee (II: 4.5; 95% CI: 2.7-7.1), and U-17 for hip-pelvis (II: 6.4; 95% CI: 4.2-9.3). CONCLUSION: Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip-pelvic apophyseal injuries accounted for the largest injury burden.

Association of Skeletal Maturity and Injury Risk in Elite Youth Soccer Players: A 4-Season Prospective Study With Survival Analysis.

BACKGROUND: The association between injury risk and skeletal maturity in youth soccer has received little attention. PURPOSE: To prospectively investigate injury patterns and incidence in relation to skeletal maturity in elite youth academy soccer players and to determine the injury risks associated with the skeletal maturity status, both overall and to the lower limb apophysis. STUDY DESIGN: Descriptive epidemiology study. METHODS: All injuries that required medical attention and led to time loss were recorded prospectively during 4 consecutive seasons in 283 unique soccer players from U-13 (12 years of age) to U-19 (18 years). The skeletal age (SA) was assessed in 454 player-seasons using the Fels method, and skeletal maturity status (SA minus chronological age) was classified as follows: late, SA >1 year behind chronological age; normal, SA ±1 year of chronological age; early, SA >1 year ahead of chronological age; and mature, SA = 18 years. An adjusted Cox regression model was used to analyze the injury risk. RESULTS: A total of 1565 injuries were recorded; 60% were time-loss injuries, resulting in 17,772 days lost. Adjusted injury-free survival analysis showed a significantly greater hazard ratio (HR) for different status of skeletal maturity: early vs normal (HR = 1.26 [95% CI, 1.11-1.42]; P < .001) and early vs mature (HR = 1.35 [95% CI, 1.17-1.56]; P < .001). Players who were skeletally mature at the wrist had a substantially decreased risk of lower extremity apophyseal injuries (by 45%-61%) compared with late (P < .05), normal (P < .05), and early (P < .001) maturers. CONCLUSION: Musculoskeletal injury patterns and injury risks varied depending on the players' skeletal maturity status. Early maturers had the greatest overall adjusted injury risk. Players who were already skeletally mature at the wrist had the lowest risk of lower extremity apophyseal injuries but were still vulnerable for hip and pelvis apophyseal injuries.

Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years.

OBJECTIVE: Investigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons. METHODS: All injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups. RESULTS: A total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures. SUMMARY: At this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.

Injury patterns differ with age in male youth football: a four-season prospective study of 1111 time-loss injuries in an elite national academy.

OBJECTIVES: To describe age group patterns for injury incidence, severity and burden in elite male youth football. METHODS: Prospective cohort study capturing data on individual exposure and time-loss injuries from training and matches over four seasons (2016/2017 through 2019/2020) at a national football academy (U13-U18; age range: 11-18 years). Injury incidence was calculated as the number of injuries per 1000 hours, injury severity as the median number of days lost and injury burden as the number of days lost per 1000 hours. RESULTS: We included 301 players (591 player-seasons) and recorded 1111 time-loss injuries. Overall incidence was 12.0 per 1000 hours (95% CI 11.3 to 12.7) and burden was 255 days lost per 1000 hours (252 to 259). The mean incidence for overall injuries was higher in the older age groups (7.8 to 18.6 injuries per 1000 hours), while the greatest burden was observed in the U16 age group (425 days; 415 to 435). In older age groups, incidence and burden were higher for muscle injuries and lower for physis injuries. Incidence of joint sprains and bone stress injuries was greatest for players in the U16, U17 and U18 age groups, with the largest burden observed for U16 players. No clear age group trend was observed for fractures. CONCLUSION: Injury patterns differed with age; tailoring prevention programmes may be possible.

Involving research-invested clinicians in data collection affects injury incidence in youth football.

It is well established that differences in injury definition and recording methodology restrict comparisons between injury surveillance programmes. There is, however, little documentation of the variation that can exist between data recorders. The aim of this study was, therefore, to explore the effect on reported injuries when team recorders or supervisors are involved in research. Injury data collected prospectively over five seasons for the U16, U17, and U18 age groups in a youth football (soccer) academy were used to compare different recording settings based on the research involvement of the clinicians. A research-invested team physiotherapist reported an 8.8 times greater incidence (P < 0.001) of non-time-loss injuries and a 2.5 times greater incidence (P < 0.001) of minimal injuries (1-3 days lost) compared to a setting where neither the team physiotherapists nor the supervisor relied on the collected data for research purposes. When team physiotherapists were not invested in research themselves but were supervised by a researcher, the incidence of non-time-loss injuries and minimal injuries was 2.5 times (P < 0.001) and 2.0 times greater (P < 0.01) than in the non-invested setting, respectively. However, there were no differences between recording settings for overall incidence of time-loss injuries. The results from this study demonstrate that involving clinicians that are relying on the collected data for research purposes can significantly affect the reported rates of non-time-loss and minimal injuries. Time-loss injuries overall were not affected by research investment, and should therefore be preferred for comparisons between teams and seasons.

Beighton scoring of joint laxity and injury incidence in Middle Eastern male youth athletes: a cohort study.

OBJECTIVES: To examine the association between generalised joint laxity (GJL) and injury rates in Middle Eastern male youth athletes. DESIGN: Prospective observational study consisting of GJL screen and injury audit (season 2009/2010). SETTING: Aspire Sports Academy Doha, Qatar. PARTICIPANTS: A total of 226 adolescent male athletes (mean age: 14.2 years; SD: 1.7; range: 10-18) involved in 15 sporting activities were grouped into contact and non-contact sports. All available athletes were included in this study. OUTCOME MEASURES: A seasonal injury audit, athletes' anthropometric characteristics, for example, weight, height and body mass index and screen for GJL to determine Beighton Score (BS). RESULTS: The 226 athletes sustained 596 injuries and 75% reported at least one injury over a seasonal injury audit. Players in contact sports were injured more often than players in non-contact sports (more frequent injuries than injury-free time in contact sports; 127 days (95% CI 93 to 160) vs 176 days in non-contact sports (95% CI 118 to 234) (p<0.001). Survival analysis showed that gradient BS was not associated with injury HR=1.004 (95% CI 0.95 to 1.06) in the overall cohort. However, BS was associated with a greater injury risk in contact sports (HR: 1.29; 95% CI 1.05 to 1.59; p=0.015). CONCLUSION: Greater GJL, defined by gradient BS, plus involvement in contact sports together influence injury risk in youth athletes. Preseason documentation of GJL scoring should be considered specifically for contact sports as injury pre-emptive measure.

Reliability of a novel procedure to monitor the flexibility of lower limb muscle groups in highly-trained adolescent athletes.

OBJECTIVES: To evaluate the reliability level of an innovative method using a standardized stretch force to assess the flexibility of lower limb muscle groups in highly-trained adolescent athletes and to examine whether interchanging the examiners affects the reliability of the measures. DESIGN: Randomized test-retest study. SETTING AND PARTICIPANTS: In ten athletes, the flexibility of eight lower limb muscle groups was examined on two occasions on both sides and in two phases: a video capture by three distinct operators and an analysis by three distinct analysers. The reliability of the measures was assessed by the coefficient of variation (CV, 90% CI). Between-analysers and between-operators standardized differences (i.e., Cohen's d) were calculated. RESULTS: CV (%, 90% CI) were 8.3% (7.5; 9.3) for quadriceps, 3.3% (3.0; 3.7) for hamstrings, 7.2% (6.5-8.0) for adductors, 5.7% (5.1; 6.3) for gastrocnemius, 4.5% (4.0; 5.0) for soleus, 2.6% (2.3; 2.9) for hip flexors, 9.6% (8.6; 10.8) for hip medial rotators and 12.4% (12.2; 14.0) for hip lateral rotators. There was no substantial (i.e., Cohen's d < 0.2) difference in CV between all the possible operators/analysers combinations. CONCLUSION: This method has a moderate-to-good reliability level and is examiner-independent. It may be implemented in future injury prevention programs, in order to monitor the flexibility of highly-trained adolescent athletes.

High-throughput screening for glutathione conjugates using stable-isotope labeling and negative electrospray ionization precursor-ion mass spectrometry.

RATIONALE: It has been proposed that the increase in the instances of idiosyncratic adverse drug reactions (IADRs) and black box warnings may be attributed to the occurrence of reactive metabolites. Consequently, a high-throughput screen for reactive metabolites formed from liver microsome extracts with added glutathione (GSH) was developed for use in the early stages of drug discovery. METHODS: To enhance sensitivity and specificity, as well as accelerate data processing, a mixture of a stable-isotope probe consisting of natural GSH (light GSH) and stable-isotope-labeled [(15) N,(13) C(2)] GSH (heavy GSH) at a ratio of 1:1 was used. Any metabolite that reacted with the GSH results in the formation of light and heavy GSH conjugates with a 3 Da difference. Employing a precursor-ion scan using negative ion electrospray ionization (ESI) corresponding to the expected fragments, signals with the appropriate ratio in the precursor ion scan are then further examined. RESULTS: The new method greatly simplifies data collection by assuming molecules containing GSH will fragment to form specific ions. As such, this approach accelerates data processing (and collection) at the risk of missing compounds that do not fragment as expected. The assay was validated with 33 diverse drugs known to form GSH conjugates, 5 drugs known to not form GSH adducts and over 100 samples containing components of the normal in vitro matrix. In all cases data collected matched the expected result. CONCLUSIONS: The observed sensitivity, specificity, and fast data processing make this assay an excellent fit for high-throughput screening of reactive metabolites in the early stages of drug discovery. This method is not intended to eliminate compounds or terminate their development. Instead, it is to bring forward molecules with one less liability and thus a greater probability of ultimate success.

Method for rapid metabolite profiling of drug candidates in fresh hepatocytes using liquid chromatography coupled with a hybrid quadrupole linear ion trap.

Rapid information on metabolic profiling is required to evaluate the structural liabilities of drug candidates in early drug discovery. In this study, a sensitive and rapid semi-quantitative method was developed to simultaneously monitor the drug candidate and metabolites as well as collect tandem mass (MS/MS) spectra for subsequent metabolite identification. The simultaneous semi-quantitation and identification of metabolites in fresh hepatocytes is achieved using high-performance liquid chromatography (HPLC) coupled with a hybrid quadrupole linear ion trap. The survey experiment consists of monitoring multiple-reaction monitoring (MRM) transitions for the internal standard, the parent, and 48 MRM transitions designed to cover the most common phase I and II biotransformations. An information-dependent acquisition (IDA) method was employed to trigger product ion scans above the MRM signal threshold. Three biotransformations of a lead compound have been identified through enhanced product ion scans and the respective MRM transitions of those metabolites were selected for semi-quantitation. Parent disappearance and formation of the metabolites as a function of incubation time in five different species were monitored by their respective MRM responses. The method provides the necessary sensitivity to detect minor metabolites in a relevant therapeutic concentration range. Enzymatic turnover of the parent and the metabolites in different species are revealed based on the different initial concentrations of the parent. This methodology integrates the parent disappearance, metabolite identification, and the formation of the metabolites along the time course using a single rapid LC/MS/MS analysis. This method can be used as a complementary tool to the conventional method of metabolic profiling. It provides a rapid and sensitive initial profile of the metabolism of potential structural series at the lead selection stage. The method can also be incorporated into the overall metabolite profiling scheme to evaluate the drug candidates in drug discovery.