UEFA Injury Audits in

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• UEFA Injury Audits in
• Elite Professional Football

International Sports Medicine Science
Performande conference Leeds, July 2010
Professor Jan Ekstrand Football Research
Group Linköping University, Sweden
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UEFA Medical Committee
The international football organisations such as
FIFA and UEFA and the national FAs are concerned
about the injury risk in football Research
aiming to increase the safety
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Football as an occupation

• Injury risk at top level 6-9 injuries/1000H of
  exposure

• Defined as absence from training or matches (work
  !)
• Compare with a factory
• 25 workers each week 6-9 workers injured at
  work, causing absence from their workplace

Tremendous occupational hazard
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PREVENTION
Van Mechelen et al. 1987
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PREVENTION
Injury study
Van Mechelen et al. 1987
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Instrument to study the injury risk

• A problem with comparisons between different
  studies of sports injuries is the inconsistent
  manner in which injury is defined and information
  collected and recorded

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Consensus (football)
Consensus statement on injury definitions and
data collection procedures in studies of
football (soccer) injuries Colin W Fuller, J
Ekstrand, Astrid Junge, T E Andersen, Roald Bahr,
Jiri Dvorak, M Hagglund, Paul McCrory, W H
Meeuwisse Br J Sp Med Am J Sp Med Scand J Sp
Med Clinical Orthopedics
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• Injury studies
• UEFA Champions League study
• Artificial turf
• Tournaments
• Superleagues Sweden-Denmark

• Database75 teams18 countries12.000
  injuries10 seasons

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UCL study season 2008/09
UCL teams 2009-2010

• Real Madrid CF
• FC Barcelona

• BV Borussia Dortmund
• Hamburger SV
• FC Bayern München

• Olympique Lyonnais

• Inter
• Juventus
• AC Milan
• AFC Fiorentina

Arsenal FC Manchester United FC Chelsea
FC Liverpool FC

• PSV Eindhoven
• AFC AJAX

• Club Brugge KV
• RSV Anderlecht

• FC Porto
• SL Benfica

FC Shakhtar Donetsk
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Validity meeting 2001
Methods for epidemiological study of injuries too
professional football players Developing the
UEFA model Martin Hägglund, M Waldén, R Bahr, J
Ekstrand Br J Sp Med 2005, 340-346
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Study design

• All players in the A-team
• All training sessions
• All matches (including matches with national
  teams)
• Rehab until clearance from medical team
• Injury absence from full participation in
  training or match (time loss)

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How to achieve

• Participation
• Validity
• Reliability
• Compliance

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Participation and validity Meetings- network
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Participation Visit to teams
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Reliability a manual !
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Reliability fictive examples
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Reliability a controller !
Contact person in club
Controller
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-1-2
Database
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Compliance Feedback to clubs
Reports at end of season in season
Postseason
1st quarter
Halfseason
3rd quarter
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Compliance meaningful data
What significance could this be to the manager?
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Compliance
Search of excellence
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players absent key figure for performance
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players absent key figure for performance
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players absent key figure for performance
lt10 is excellent
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players absent key figure for performance
gt15 you need to analyze !
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Research questions and answers

• How many injuries per season in a team?
• Correlation injuries and performance?
• Most common injuries? Absence times?
• Has the injury risk increased?
• Does climate affect injury risk?
• How common are re-injuries?
• Hamstring injuries- when play? MRI as a
  prognosticating tool?

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Team of 25 players
50 injuries/ season

• 50 minor (absence less than a week)
• 8-9 severe (absence more than a month)

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Severe injuries (absence gt 1 month)
are negatively correlated to performance
2001
Nr of Severe injuries

Swedish Super League
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Major injuries and absence of players (UCL
injury study)
Team Nr major inj Absence/injury Total absence of exposure Players absent
Mean 9 77 693 10 2



Players sidelined due to major injuries limit the
possibility of optimal performance for the team
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Major injuries and absence of players (UCL injury
study)
Team Nr major inj Absence/injury Total absence of exposure Players absent
Mean 9 77 693 10 2
X 01-02 16 81 1303 20 5
Y 05-06 17 65 1109 20 5

Players sidelined due to major injuries limit the
possibility of optimal performance for the team
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Major injuries and absence of players (UCL injury
study)
Team Nr major inj Absence/injury Total absence of exposure Players absent
Mean 9 77 693 10 2
X 01-02 16 81 1303 20 5
Y 05-06 17 65 1109 20 5
Z 0 0 0 0 0
Players sidelined due to major injuries limit the
possibility of optimal performance for the team
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10 most common injuries
Diagnosis Absence (days)
Hamstring strain 10 16
Groin strain 9 13
Ankle sprain 7 12
Quadriceps strain 5 18
MCL tear 4 24
Thigh pain 4 6
Thigh contusion 4 5
Calf muscle strain 3 16
Achilles tendinopathy 3 19
Knee contusion 2 5
Ekstrand et al 2010
1 about 0.7 injury/team/season at elite level
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Severeinjuries
Diagnosis Absence (days)
ACL rupture 0.83 201
Achilles tendon rupture 0.01 169
Fracture tibia 0.06 113
MT 5 fracture 0.12 80
Ankle fracture 0.16 50
Lateral meniscus injury 0.87 46
Medial meniscus injury 0.59 40
Ekstrand et al 2010
1 about 0.7 injury/team/season at elite level
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9 seasons (Champions League study)
The match injury risk has not incresed!
!

• Injury risk in matches has not increased

Ekstrand J, Hägglund M, Waldén M. Injury
incidence and injury patterns in professional
football the UEFA injury study. Br J Sports
Med 2010 Epub ahead of print
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Climate affects injury risk?
Waldén M, Hägglund M, Ekstrand J. UEFA Champions
League study a prospective study of injuries in
professional football during the 2001-2002
season. Br J Sports Med 200539-8542-6.
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Ekstrand et al. 2009
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Injury risk vs geography
plt0.01
Ekstrand et al 2010
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Re-injuries
Definition injury of the same type, location and
side within 2 months previously
More resources in medical teams- Individual rehab
Better with an extra physio than a 29th player??
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Previous injury as a risk factor

• Players who are injured during a season have a
  higher risk of any injury in the following season
  compared to uninjured players
• The more injuries a player sustains during a
  season, the greater the risk for injury during
  the following season

Hägglund, Walden,Ekstrand Previous injury as a
risk factor for injury in elite football - a
prospective study over two consecutive seasons.
Br J Sports Med 200640 767-772
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Thigh muscle injuries- the most common at top
level !

• 10 per team / season
• 7 hamstrings
• 3 quadriceps

• Hamstring strain Sprinters injury
• (reflecting the speed and velocity of modern top
  football)

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Thigh muscle injury- MRI study

• Started season 2007-2008
• 20 teams
• 600 injuries
• 65 H
• 35 Q
• 50 MRI

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Independent radiologists
MRI
UCL study group
Dr Jerry Healy Dr Justin Lee
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Thigh muscle injury
Rectus femoris 86
MRI diagnosis
Biceps femoris 80
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Hamstring injuries - sprinting!
Hamstring injuries occur at matches ( 66) Speed!
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Severity of injury (H)
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Factors that determine absence
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Factors that determine absence
In 15 /-3 days
When can he play?

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PREVENTION
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Which factors influence the risk of injuries?
Player factors
Previous injuries Strength
Coordination Flexibility
Injury
Load Season planning Training dose Number of
matches Recovery/rest
Equipment Referee Rules
Club factors Club philosophy Playing
tactics Consistency Medical service

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Who controls the injury factors?
Medical team
Player factors Previous
injuries Strength
Coordination Flexibility
Load Season planning Training dose Number of
matches Recovery/rest
Injury
Equipment Referee Rules
Team/ coach
Associations FIFA/UEFA
Club factors Club
philosophy Playing tactics
Consistency Medical service
Club manager, board
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Communication medical team, coach and club manager
What significance could this be to the manager?
Club manager
Coach
Team dr
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The injury study is an important tool for me I
can see how the injury situation is in Shakhtar
compared to other teams I can evaluate our
injury preventive program in an objective way I
can see what is ok and what needs to be changed
Risk management tool
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Injury prevention-Take home message

• The key to prevention is team work (coaching
  staff, medical staff and management staff)

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Je vous remercie de votre attention !
Thank You!
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• 40 min excl QA