Injury Prevention in (Youth) Football (Soccer)

Abstract

Introduction: Playing football carries a significant risk of injury. Since injuries can negatively affect both health and performance, injury prevention is a priority. Aiming to reduce the number of football injuries, various multi-component exercise-based prevention programmes (IPPs) (e.g. FIFA® 11, FIFA® 11+, 11+ Kids, Prevent Injury and Enhance Performance (PEP), and HarmoKnee) were established and examined in studies. These studies focused either on children up to the age of 12 years or on ‘adults’. However, after the age of 14, no further distinctions were made, and players were generally grouped with adults. In the cluster RCTs where efficacy was investigated, the results were promising. A major challenge of all IPPs is their implementation and subsequent adherence in the field. The main intentions of this thesis were two-fold: firstly, to provide a detailed analysis of the efficacy of existing programmes, and secondly, to develop and evaluate a new IPP targeting a previously underrepresented group, youth players aged 13-19 years. This age group is distinct from both children and adults. It is crucial to address this age group separately, given their unique physical, developmental, and performance demands. Furthermore, the intention of the new programme was to increase its attractiveness and its wake the adherence to it. This cumulative thesis consists of three publications. Methods: A systematic review and meta-analysis of randomised and cluster-randomised controlled trials was conducted to investigate the efficacy of multi-component exercise-based IPPs on the overall number of injuries, body region-specific injuries, contact, and non-contact injuries. ii) The ‘FUNBALL’ programme was developed, and its efficacy was investigated through a two armed cluster-randomised controlled trial (cluster-RCT). 55 teams were randomly assigned to the intervention group (INT; 28 teams) and the control group (CON; 27 teams). The INT group performed the ‘FUNBALL’ programme after their usual warm-up at least twice per week. The CON group followed their usual training routine. The outcomes included the overall number of football-related injuries, region-specific injuries of the lower limbs (hip/groin, thigh, knee, lower leg, ankle, and foot), and injury severity. Study iii) entailed a detailed secondary analysis of the aforementioned study, and investigated the injuries within the control group. xii Results: i) Fifteen randomised and cluster-RCTs met the inclusion criteria and were incorporated into the analysis. Results from this study suggested uncertainty and inconclusiveness regarding the efficacy of multi-component exercise-based injury prevention programmes in football. The calculation of prediction intervals (PIs) resulted in a wide range of efficacy, varying from very protective to an increased risk of injury. ii) The ‘FUNBALL’ programme reduced the incidence of football-related injuries among male adolescent football players. Specifically, reduced the incidence of overall injuries (incidence rate ratio (IRR) 0.69), of thigh injuries (IRR 0.62), of moderate (time loss between 7 and 28 days) (IRR 0.65) and of severe injuries (time loss >28 days) (IRR 0.51). iii) The study's findings suggest a lower injury incidence in youth players compared to adults. Additionally, a higher injury incidence was observed in older age groups. Discussion: In contrast to several meta-analyses conducted previously to investigate the efficacy of multi-component exercise-based IPPs, the first study incorporated prediction intervals (PIs) into the analysis. The findings revealed a need for more cautious interpretation of their efficacy. The 'FUNBALL' programme emerged as an effective intervention that reduced injury incidence in youth football players. However, further investigation to determine whether this specificity enhances adherence compared to previous programs. The third study revealed a lower injury incidence in youth players compared to adults whereas injury locations were similar. The thigh, knee, and ankle were the most commonly injured body regions. Finally, the increase in injury incidence among older age groups can assist medical staff and coaches in anticipating injury types and locations.