Latest research in football - week 9 - 2017

#1 Injuries of the obturator muscles in professional soccer players
Reference: Knee Surg Sports Traumatol Arthrosc. 2017 Feb 10. doi: 10.1007/s00167-017-4453-6. [Epub ahead of print]
Authors: Wong-On M, Turmo-Garuz A, Arriaza R, Gonzalez de Suso JM, Til-Perez L, Yanguas-Leite X, Diaz-Cueli D, Gasol-Santa X
Summary: Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players. Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible. Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5  ±  8.8 days. Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries.


#2 Torque-angle-velocity Relationships and Muscle Performance of Professional and Youth Soccer Players
Reference: Int J Sports Med. 2016 Nov;37(12):992-996. Epub 2016 Aug 1.
Authors: Mazuquin BF, Dela Bela LF, Pelegrinelli AR, Dias JM, Carregaro RL, Moura FA, Selfe J, Richards J, Brown LE, Cardoso JR
Summary: Soccer matches consist of a variety of different activities, including repeated sprints. Time to attain velocity (TTAV), load range (LR) and the torque-angle-velocity relationship (TAV3D) represent an important measurement of muscle performance, however there are few related studies. The aim of this study was to compare these outcomes between soccer players of different age category. 17 professional (PRO) and 17 under-17 (U17) soccer players were assessed for concentric knee flexion/extension at 60, 120 and 300°/s. For the extensor muscles, differences were found in favor of the U17 group for TTAV and LR outcomes at 120°/s, however, the PRO group maintained higher torques in both movement directions in comparison to the U17 in TAV3D evaluation. These results suggest that muscle performance of the PRO group is more efficient than the U17 group.


#3 What's in a game? A systems approach to enhancing performance analysis in football
Reference: PLoS One. 2017 Feb 17;12(2):e0172565. doi: 10.1371/journal.pone.0172565. eCollection 2017.
Authors: McLean S, Salmon PM, Gorman AD, Read GJ, Solomon C
Download link: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0172565&type=printable
Summary: Performance analysis (PA) in football is considered to be an integral component of understanding the requirements for optimal performance. Despite vast amounts of research in this area key gaps remain, including what comprises PA in football, and methods to minimise research-practitioner gaps. The aim of this study was to develop a model of the football match system in order to better describe and understand the components of football performance. Such a model could inform the design of new PA methods. Eight elite level football Subject Method Experts (SME's) participated in two workshops to develop a systems model of the football match system. The model was developed using a first-of-its-kind application of Cognitive Work Analysis (CWA) in football. CWA has been used in many other non-sporting domains to analyse and understand complex systems. Using CWA, a model of the football match 'system' was developed. The model enabled identification of several PA measures not currently utilised, including communication between team members, adaptability of teams, playing at the appropriate tempo, as well as attacking and defending related measures.The results indicate that football is characteristic of a complex sociotechnical system, and revealed potential new and unique PA measures regarded as important by SME's, yet not currently measured. Importantly, these results have identified a gap between the current PA research and the information that is meaningful to football coaches and practitioners.


#4 Football APP based on smart phone with FES in drop-foot rehabilitation
Reference: Technol Health Care. 2016 Feb 3. doi: 10.3233/THC-160730. [Epub ahead of print]
Authors: Ciou SH, Hwang YS, Chen CC, Luh JJ, Chen SC, Chen YL
Summary: Long-term, sustained progress is necessary in drop foot rehabilitation. The necessary inconvenient body training movements, the return trips to the hospital and repetitive boring training using functional electrical simulation (FES) often results in the patient suspending their training. The patient's drop foot rehabilitation will not progress if training is suspended. A fast spread, highly portable drop foot rehabilitation training device based on the smart phone is presented. This device is combined with a self-made football APP and feedback controlled FES. The drop foot patient can easily engage in long term rehabilitation training that is more convenient and interesting. An interactive game is established on the smart phone with the Android system using the originally built-in wireless communications. The ankle angle information is detected by an external portable device as the game input signal. The electrical stimulation command to the external device is supplemented with FES simulation for inadequate ankle efforts. After six-weeks training using six cases, the results indicated that this training device showed significant performance improvement (p< 0.05) in the patient's ankle dorsiflexion strength, ankle dorsiflexion angle, control timing and Timed Up and Go. Preliminary results show that this training device provides significant positive help to drop foot patients. Moreover, this device is based on existing and universally popular mobile processing, which can be rapidly promoted. The responses of clinical cases also show this system is easy to operate, convenient and entertaining. All of these features can improve the patient's willingness to engage in long term rehabilitation.


#5 A comparison of injuries in elite male and female football players: A 5-Season prospective study
Reference: Scand J Med Sci Sports. 2017 Feb 16. doi: 10.1111/sms.12860. [Epub ahead of print]
Authors: Larruskain J, Lekue JA, Diaz N, Odriozola A, Gil SM
Summary: The aim was to compare the epidemiology of injuries between elite male and female football players from the same club. Injuries and individual exposure time in a male team and a female team, both playing in the Spanish first division, were prospectively recorded by the club's medical staff for five seasons (2010-2015) following the FIFA consensus statement. Total, training and match exposure hours per player-season were 20% higher for men compared to women (P < 0.01). Total, training and match injury incidence were 30-40% higher in men (P ≤ 0.04) mainly due to a 4.82 [95% confidence interval (CI) 2.30-10.08] times higher incidence of contusions, as there were no differences in the incidence of muscle and joint/ligament injuries (P ≥ 0.44). The total number of absence days was 21% larger in women owing to a 5.36 (95% CI 1.11-25.79) times higher incidence of severe knee and ankle ligament injuries. Hamstring strains and pubalgia cases were 1.93 (95% CI 1.16-3.20) and 11.10 (95% CI 1.48-83.44) times more frequent in men, respectively; whereas quadriceps strains, anterior cruciate ligament ruptures and ankle syndesmosis injuries were 2.25 (95% CI 1.22-4.17), 4.59 (95% CI 0.93-22.76) and 5.36 (95% CI 1.11-25.79) times more common in women, respectively. In conclusion, prevention strategies should be tailored to the needs of male and female football players, with men more predisposed to hamstring strains and hip/groin injuries, and women to quadriceps strains and severe knee and ankle ligament injuries.


#6 Hip strength and range of motion: Normal values from a professional football league
Reference: J Sci Med Sport. 2016 Aug 23. pii: S1440-2440(16)30106-2. doi: 10.1016/j.jsams.2016.05.010. [Epub ahead of print]
Authors: Mosler AB, Crossley KM, Thorborg K, Whiteley RJ, Weir A, Serner A, Holmich P
Summary: The objective of the study was to determine the normal profiles for hip strength and range of motion (ROM) in a professional football league in Qatar, and examine the effect of leg dominance, age, past history of injury, and ethnicity on these profiles. Participants included 394 asymptomatic, male professional football players, aged 18-40 years. Strength was measured using a hand held dynamometer with an eccentric test in side-lying for hip adduction and abduction, and the squeeze test in supine with 45° hip flexion. Range of motion measures included: hip internal and external rotation in 90° flexion, hip IR in prone, bent knee fall out and hip abduction in side-lying. Demographic information was collected and the effect on the profiles was analysed using linear mixed models with repeated measures. Strength values (mean±SD) were: adduction=3.0±0.6Nm/kg, abduction=2.6±0.4Nm/kg, adduction/abduction ratio=1.2±0.2, Squeeze test=3.6±0.8N/kg. Range of motion values: internal rotation in flexion=32±8°, external rotation=38±8°, internal rotation in prone=38±8°, bent knee fall out=13±4.4cm, abduction in side-lying=50±7.3°. Leg dominance had no clinically relevant effect on these profiles. Multivariate analysis demonstrated that age had a minor influence on squeeze strength (-0.03N/kg/year), external rotation (-0.30°/year) and abduction range (-0.19°/year) but past history of injury, and ethnicity did not. Normal values are documented for hip strength and range of motion that can be used as reference profiles in the clinical assessment, screening, and management of professional football players. Leg dominance, recent past injury history and ethnicity do not need to be accounted for when using these profiles for comparison purposes.


#7 One ACL injury is enough! Focus on female football players
Reference: Br J Sports Med. 2017 Feb 9. pii: bjsports-2016-097179. doi: 10.1136/bjsports-2016-097179. [Epub ahead of print]
Authors: Faltstrom A


#8 Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries
Reference: Knee Surg Sports Traumatol Arthrosc. 2017 Feb 8. doi: 10.1007/s00167-017-4431-z. [Epub ahead of print]
Authors: Krutsch V, Gesslein M, Loose O, Weber J, Nerlich M, Gaensslen A, Bonkowsky V, Krutsch W
Summary: The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury. In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population. The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected. In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms.