epidemiologia urazów u ilkarzy.pdf

Epidemiology of football

related injuries part I

Epidemiologia urazów

w piÆce noºnej czæ¥ì I

Grzegorz Adamczyk, £ukasz Luboiñski

Carolina Medical Center, Warszawa

Summary

Football (soccer) is one of the most popular sports

in the world. Currently FIFA unifies 203 national

associations and represents about 200 million active

players, of which about 40 million are women. The

incidence of football injuries is estimated to be

10 35 per 1000 game hours. One athlete plays on

average 100 hours of football per year (from 50 ho-

urs per player of a local team, up to 500 hours per

player for a professional team). So every player will

have minimum one performance-limiting injury per

year.

High-velocity trauma and direct contact between

sportsmen have made of football a kind of a combat

sport, connecting both the consequences of chronic

overuse and acute injuries. National Athletic Injury

Registration System (NAIRS) in the USA precise

The reportable injury is one that limits athletic

participation for at least one day after the day of on-

set.

The review of literature suggests the following:

the data of all studies are similar,

the majority of injuries in prospective studies in-

volve the lower extremity (75,4 93%), in retrospec-

tive studies (64% -86,8%),

head/spine/trunk injuries occur more often than

upper extremity injuries.

Data from prospective studies indicate, that the

most frequently injured in the lower extremity were

the ankle (17,0 26%), and knee (17 23%). In yo-

uth players the most affected by the injury was the

lower extremity (61 89%), followed by the

head/trunk/spine (9,7 24,8%) and the upper extre-

mity (4,0 24,8%). The highest percentage consid-

ers ankle 16,4 to 41,2%. The most common types

of injuries are contusions, sprains and strains.

In majority of studies the incidence has been calcu-

lated in between 12 to 35 injury per 1000 hours of

outdoor games for adult male players and 1,5 to 7,6

injuries per 1000 hours of practice. In indoor foot-

ball players, the incidence of injury seems to be

higher.

The risk of injury in professional football is about

1000 times higher than that observed in other indus-

trial occupations generally regarded as high risk (con-

struction and mining 0,02 injuries/1000 hours).

About 60 74% of contusion are due to physical con-

tact between players. In the 1994 World Cup, 29% of

all injuries resulted from foul play as judged by the

referees. In a regular season in England only 18%

of injuries was caused by foul, 86% out of them by an

opponent, so in 14% of cases a fouling player contu-

sed himself, in 41% were caused by direct contact.

Foul by opponents therefore represents only 10% of

all injuries, indicating that, in general, violation by

players do not represent a major case of injury.

In 49% of cases, when contusion was the cause of

the end of the career, knee injuries, mainly anterior

cruciate ligaments and menisci were responsible.

Conclusions:

1. The overall level of injury to professional footbal-

lers is about 1000 times higher than that found in

industrial occupations more traditionally regarded

as a high risk.

2. Fatal injuries are extremely rare.

3. Only 12% of injuries involves a breach of the

laws of game, however this ratio reaches a 29% in

a high-level competition

4. High level of muscle strains observed during

training increases an importance of implementing

effective fitness in training programs.

5. The number of reinjuries suggests, that rehabili-

tation programs in clubs are inadequate.

6. Playing professional football can impact on the

health.

7. In 49% of cases, when contusion was the cause of

the end of the career, knee injuries, mainly anterior

cruciate ligaments and menisci, were responsible.

[Acta Clinica 2002 3:236-250]

Key words: Football, soccer, epidemiology, injuries

236 Jesieñ 2002

Epidemiology of football

Streszczenie

PiÆka noºna jest jednym z najpopularniejszych, je¥li

nie najpopularniejszym sportem na ¥wiecie. FIFA

jednoczy 203 organizacje narodowe i zrzesza ponad

200 milionów zarejestrowanych graczy, w tym 40

mln kobiet.

Mianem urazu sportowego okre¥la siæ wszystkie

uszkodzenia tkanek dokonujåce siæ w czasie trenin-

gu sportowego lub gry. Najczæ¥ciej stosowanym kry-

terium uznania urazu sportowego jest konieczno¥ì

zrezygnowania z minimum jednego dnia treningu

lub gry. Koncepcja urazu sportowego róºni siæ od

standardowej, gdyº ludzie nie trenujåcy wyczynowo

uznawani så za zdrowych, gdy mogå wykonywaì

bez przeszkód swoje codzienne obowiåzki. Sporto-

wiec musi byì zdolny do gry czy treningu na naj-

wyºszym poziomie.

DokÆadna liczba urazów sportowych jest czæsto

trudna do oceny, gdyº nierzadko zaleºy od wielu

czynników, takich jak: motywacja, odnotowanie

urazu przez lekarza ekipy (je¥li taki w ogóle jest),

stopnia ¥wiadomo¥ci gracza i trenera. Prawdopo-

dobnie wiele wypadków nie jest w ogóle odnotowy-

wanych, gdy gracz obawia siæ, ºe zostanie uznany

za nie w peÆni sprawnego, odsuniæty od gry, itp.

Narodowy System Rejestrujåcy Urazy Sportowe

w USA (NAIRS) uznaje za uraz odnotowany uraz,

który ogranicza moºliwo¥ì treningu lub gry przez

minimum 1 nastæpujåcy dzieñ i dzieli je na lekkie

(1 7 dni), umiarkowane (8 21) i powaºne (ponad

21 dni).

Rada Europy zaproponowaÆa definicjæ urazu sporto-

wego jako wynik uczestniczenia w zajæciach sporto-

wych majåcy jednå lub wiæcej z powyºszych kon-

sekwencji:

zmniejszenie intensywno¥ci aktywno¥ci spor-

towych,

potrzeba zasiægniæcia opinii medycznej lub le-

czenia,

niekorzystne skutki finansowe lub ekonomiczne.

Czæsto¥ì urazów sportowych bardzo wzrasta,

w 1975 roku 5% kontuzji leczonych w oddziaÆach

urazowych w Anglii to byÆy wypadki sportowe,

w 1990 juº 17% (a tylko 7% urazy komunikacyjne),

a w roku 2000 2328%. W Europie 50 60% urazów

sportowych i 3,5 10% urazów leczonych w szpita-

lach, to skutki gry w piÆkæ noºnå.

Czæsto¥ì wystæpowania jest definiowana jako liczba

nowych kontuzji w jednostce czasu, powinna uwzgl-

ædniaì czas ekspozycji zawodnika na græ kontaktowå

i czas spædzony na treningach. Czæsto¥ì wypadków

w piÆce noºnej wynosi 12 35 urazów na 1000 go-

dzin gry i 1,5 do 7,6 urazów na 1000 godzin trenin-

gów, w Anglii przeciætnie 8,7 urazu na 1000 godzin

zajæì. Kobiety ulegajå relatywnie czæ¥ciej urazom niº

mæºczyªni. Wiækszo¥ì kontuzji piÆkarskich wymaga

mniej niº 1 tydzieñ leczenia. Najczæ¥ciej dÆugiego le-

czenia wymagajå naciågniæcia miæ¥ni i skræcenia sta-

wów. W ciågu 6 sezonów w USA zanotowano tylko

4 ciæºkie urazy, ani jednego ze skutkiem ¥miertel-

nym. Najczæstszym typem urazu så skræcenia sta-

wów, gÆównie skokowego (27,6 35% kontuzji) i na-

ciågniæcia miæ¥ni (10 47%). 75,4% do 93% urazów

sportowych dotyczy koñczyn dolnych, w 17 26%

stawu skokowego, 17 23% stawu kolanowego.

W 63 do 91% do urazów dochodzi w czasie gry, tyl-

ko 9 do 37% kontuzji, gÆównie o charakterze prze-

wlekÆym przytrafia siæ w czasie treningów.

OkoÆo 86% do 100% zawodników jest kontuzjowa-

nych w trakcie sezonu. W 64 meczach Pucharu

ÿwiata 2002, stwierdzono 2,7 kontuzji na mecz, 37%

byÆo spowodowanych przez faule, 36% bezpo¥rednie

starcie pomiædzy zawodnikami bez zÆamania zasad

gry, 27% bez styczno¥ci z innym zawodnikiem.

Spo¥ród urazów, które powodowaÆy zakoñczenie

kariery 49% to urazy kolan, gÆównie uszkodzenia

wiæzadeÆ krzyºowych i Æåkotek.

Urazy sportowe majå czæsto odlegÆe konsekwencje

w Szwecji spo¥ród 180 zbadanych zawodników

13,3% 28,9% miaÆo niestabilno¥ì stawu skokowego,

9,3% 17,2% zespóÆ bólowy po przebytych skræce-

niach, 7,3% 14,4% niestabilno¥ì stawu kolanowego.

Choroba zwyrodnieniowa stawu kolanowego w po-

pulacji Szwecji w 40 roku ºycia rozpoznawana jest

u 1,6% ludzi, 4,2% byÆych graczy amatorów i 15,5%

byÆych piÆkarzy wyczynowych.

Czynnikami sprzyjajåcymi urazom så: wiek,

uprzednie, nie wyleczone urazy, szczególnie naciåg-

niæcia miæ¥ni, czas ekspozycji na græ kontaktowå,

zaniedbania w przygotowaniu ogólno sprawno¥cio-

wym, szczególnie w aspekcie niedostatecznego roz-

ciågniæcia i elastyczno¥ci miæ¥ni. Ocenia siæ, ºe za

42% kontuzji odpowiedzialne jest niedostateczne

przygotowanie do sezonu.

Wnioski:

1. CaÆkowita liczba urazów w profesjonalnym fut-

bolu jest okoÆo 1000 wiæksza niº np. w górnictwie,

2. Urazy ciæºkie stanowiå niezwykÆå rzadko¥ì,

3. Tylko okoÆo 12% urazów jest skutkiem fauli, acz-

kolwiek w zawodach o wysokiej randze ich czæsto¥ì

ro¥nie do 29%,

4. Wysoka czæsto¥ì naciågniæì i zerwañ miæ¥ni do-

wodzi konieczno¥ci wprowadzenia do procesu tre-

ningowego znacznie wiækszej ilo¥ci ìwiczeñ typu

stretchingu,

5. Wysoka czæsto¥ì ponownych urazów w tej samej

okolicy dowodzi, ºe programy diagnostyki urazów,

ich leczenie i rehabilitacja dotychczas realizowane

w klubach wymagajå korekty,

6. Gra w piÆkæ noºnå moºe mieì znaczåcy wpÆyw

na stan zdrowia po zaprzestaniu treningów.

7. Spo¥ród urazów, które powodowaÆy zakoñczenie

kariery, 49% to urazy kolan, gÆównie uszkodzenia

wiæzadeÆ krzyºowych i Æåkotek.

[Acta Clinica 2002 3:236-250]

SÆowa kluczowe: piÆka noºna, urazy, epidemiologia

Tom 2, Numer 3 237

Acta Clinica

Introduction

It is evident that sport, as well as

health-giving aspect, may present a danger

to health in the form of accidents and inju-

ries. High-velocity trauma and direct con-

tact between sportsmen have made of foot-

ball a kind of a combat sport, connecting

both the consequences of chronic overuse

and acute injuries.

Definitions: Sport injury is a collecti-

ve name for all types of damage received in

the course of sporting activities. Incidence

is defined as the number of new sports in-

juries occurring during a period of time in

a particular group of sportsmen.

Sport injury may be defined in different

ways. In majority of studies the definition

is confined to injuries treated at a medical

casualty or other medical department (28).

In some studies, a sports injury is defined

as one received during sporting activities

for which an insurance claim is submitted

(15). The most common criterion in the

definition of an injury is an absence from

training or a game followed by the need for

medical treatment and the diagnosis of an-

atomic tissue damage (7, 24, 28). This cri-

terion may be misleading, because absence

from game is influenced by a strong subjec-

tive component, frequency of the games,

availability of medical treatment, importan-

ce of a player to the team and the expected

outcome of the game.

If sports injuries are recorded only thro-

ugh medical channels, a large percentage of

serious, predominantly acute injuries will

be observed and less serious and/or overuse

injuries will not be recorded. On the other

hand many medical decisions are made by

a paramedical stuff. Often a special atmo-

sphere of no pain no game is created,

particularly among young sportsmen and

often a serious pain is neglected by a pla-

yer, who is afraid of opinion of being ap-

preciated as a weak or fragile person. An

observation of a bad medical practice or an

unfortunate course of injury or treatment of

a player provokes others to avoid a medical

stuff and a sensation that a need for opera-

tions might mean an end of a career is cre-

ated.

So a tip-of-the-iceberg phenomenon

is commonly described in epidemiological

research (28).

The definition of sport injury should be

based on a concept of health other than

that customary in standard medicine. In ev-

eryday life people are regarded as healthy if

they are able to do their daily works. A pla-

yer is not fully recovered unless he or she

can take part in his or her training, compe-

tition or match. National Athletic Injury

Registration System (NAIRS) in the USA

precise The reportable injury is one that

limits athletic participation for at least one

day after the day of onset (24). According

to the length of incapacitation NAIRS clas-

sifies injuries into minor (1 7 days),

moderately serious (8 21 days) and se-

rious (more than 21 days or permanent

damage).

Council of Europe proposed a defini-

tion of sport injury as a result of participa-

tion in sport with one or more of the follo-

wing consequences:

a reduction in the amount or level of

sports activity,

a need for (medical) advise or treat-

ment,

adverse social or economic effects

(29).

The overall data are somehow surpris-

ing. The representative nation wide study

in the Netherlands revealed, on a total pop-

ulation of about 15 million, an allover

sports incidence of 3,3 injuries per 1000

h spent on sports; 1,4 injuries per 1000

h spent on sports were medically treated.

That gave 2,7 millions contusions, 1,7 mil-

lions out of it were medically treated (28).

Theres an evident tendency of increas-

ing the percentage of sport-related injuries

238 Jesieñ 2002

Epidemiology of football

with time. In 1975 Williams estimated, that

5% of injuries treated at casualty depart-

ments in Great Britain were related to sport

(31). According to the Dutch Home Acci-

For this purpose injury incidence is ex-

pressed as the number of injuries per 1000

h of participation by many researchers (28,

19, 3).

(n sports injuries/year) x 10 4

Incidence =

(n participants) x (average h of sport participation) x (weeks of season/year)

dents Surveillance System a total of 32 276

were recorded by casualty departments of

hospitals participating in the study during

6 months of 1983 year. 28,6% were related

to sport, 14,9% to games, 0,7% to occupa-

tional activities and 9,1% to road accidents.

In 1990 de Loes reported 17% of sport-rela-

ted injuries, 26% happened at home, 19%

at work and 7% were traffic injuries, 31%

not defined (11).

Unfortunately soccer is among the hig-

hest risk sports. A report by the Dutch mi-

nistry of Health, Welfare and Cultural Af-

fairs expressed the risk of sports injuries

per 1000 practitioners of each sport the

highest risk was found in soccer (4,2%)

(28).

Van Galen and Diederics made a table

league taking into account time spent on

each sport and indoor soccer was ranked as

a first with 8,7 injuries per 1000 h (11). Out

of 945 registered injuries 30% were

self-treated, 24% by a ports first-aid atten-

dant, 29% by a GP and 9% by a hospital

first-aid ward.

Incidence can be defined as the number

of new sports injuries during a particular

period of time divided by the total number

of sports people at the start of the period

(population at risk). It gives as also an esti-

mation of risk. Multiplied by hundred may

be expressed in percents. (28). A very im-

portant factor is exposure to sport (the

number of hours during which the person

actually runs risk of being injured). It ma-

kes a great difference in between a profes-

sional player and an amateur, between dif-

ferent sports.

Lindenfeld (18) proposed that the def-

inition of incidence should be sharpened

by using actual exposure time at risk ra-

ther then overall time spent on sports par-

ticipation. This is rather impossible to cal-

culate, however is probably true for top le-

vel football players, who participate much

more often in a game, exposed e.g. to bru-

tal fouls than others, who simply are in

training. In team sports (in contrast to in-

dividual sports) more injuries are sus-

tained during matches than during train-

ing (9).

In majority of studies the incidence has

been calculated in between 12 to 35 injury

per 1000 hours of outdoor games for adult

male players and 1,5 to 7,6 injuries per

1000 hours of practice. In indoor football

players, the incidence of injury seems to be

higher (7, 16, 13).

In England (12) the overall injury ratio

(IFR) was 8,5 injuries per 1000 h of com-

petition and training. The overall ratio cal-

culated for competition was 27,7 for profes-

sionals and 37,2 for youth players, mainly

in between 30 to 45 min of a match and in

between 60 90 min and for training 3,5

for professional and 4,1 for youth.

So the risk of injury in professional

football is about 1000 times higher than

that observed in other industrial occupa-

tions generally regarded as high risk (con-

struction and mining 0,02 injuries/1000

hours).

Overall injury frequency rate for youth

players were found to increase over the sec-

ond half of the season, whereas they de-

creased for professional players. This emp-

Tom 2, Numer 3 239

Acta Clinica

hasizes the importance of controlling the

exposure of young players to high levels of

competition (12)

Ekstrand (8) stated that overuse inju-

ries were most often seen during preseason

training and that adductor tenosinovitis

with Achilles tendinitis were the most com-

mon type of overuse injury among males,

shin splints and iliotibial tract tendinitis

among female players.

Complaints without injury: Peterson

(23) investigated 264 players from 8 differ-

ent age and level groups and 91% of them

suffered from complaints related to foot-

ball, but not caused by trauma or overuse.

Complaints were mainly located in the lo-

wer extremities and the lumbar spine.

Most of them disappeared in 1 week, but

15% of them were lasting for more than

4 weeks.

Table 1 b.

STUDY TYPE

USA

Nation

League men

1991 92

N-105

teams

Prospective

USA

Nation

League

women

1991 92

N-61 teams

Prospective

TIME LOSS (%)

Total number

of injuries

5179

2530

1 2 days

39,5

3 6 days

7 9 days

10 days

Time loss is an effective indicator of in-

jury severity, but its dependent on who ma-

kes the decision governing when the player

is able to return to competition and by what

criteria they make that judgement. Not al-

ways an athlete has the days off. So the data

are were difficult to interpret. The majority

of soccer injuries requires less than one we-

ek of time loss, however recent English data

(12) indicate 14,6 days of absence, 15,2 for

competition and 13,4 days for training.

Albert (1) in a study of 142 reportable

injuries in one season in professional soc-

cer, found that the predominant injuries

causing a time loss of one week or more

were strains and sprains. He recorded six

major injuries (out for more than 21 days)

with an average time loss of 36 weeks. The

overall average time loss per injury was

2,38 games and 8,59 practices.

Yde and Nielsen revealed similar dates

to college-age players and professionals. Of

the 24% injuries in time loss of 4 weeks or

more, four were fractures, seven were knee

injuries and five were ankle sprains (22).

In the six seasons of mens and women

soccer from 1986 to 1992, the NCAA Soc-

Severity of sport injuries:

Six factors must be taken under the

consideration: 1. Nature of sport injury, 2.

Duration and nature of treatment, 3. Spor-

ting time lost, 4. Working time lost, 5. Per-

manent damage, 6. Cost.

Time loss:

Table 1 a. Time loss according

to Larsson (16)

STUDY TYPE

Ekstrand

& Gillquist

1983

N- 180

Prospective

Nielsen

& Yde

1989

N-123

Prospective

TIME LOSS (%)

Total number

of injuries

256

109

< 1 week

1 week 1 month

> 1 month

240 Jesieñ 2002

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