Latest research in football - week 40 - 2017

#1 Professional football players at risk for non-acute groin injuries during the first half of the season: A prospective cohort study in The Netherlands
Reference: J Back Musculoskelet Rehabil. 2017 Sep 15. doi: 10.3233/BMR-150427. [Epub ahead of print]
Authors: Gouttebarge V, Veenstra E, Goedegebuure S, Frings-Dresen M, Kuijer P
Summary: The purpose was to study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands. Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012-2013 season. A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%). A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment.


#2 Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome
Reference: Eur J Radiol. 2017 Sep;94:46-52. doi: 10.1016/j.ejrad.2017.07.009. Epub 2017 Jul 19.
Authors: Gaudino F, Spira D, Bangert Y, Ott H, Beomonte Zobel B, Kauczor HU, Weber MA
Summary: Osteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome. All professional football players (23 males, 1 female; mean age: 21±3.7years; range: 16-30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale. For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated. Among all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p=0.042 and p=0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean=4.77±1.63 in the group with partial recovery vs. mean=2.86±0.45 in the group with complete recovery; p=0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months. Edema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.


#3 Applying graphs and complex networks to football metric interpretation
Reference: Hum Mov Sci. 2017 Sep 20. pii: S0167-9457(17)30628-0. doi: 10.1016/j.humov.2017.08.022. [Epub ahead of print]
Authors: Arriaza-Ardiles E, Martin-Gonzalez JM, Zuniga MD, Sanchez-Flores J, de Saa Y, Garcia-Manso JM
Summary: This work presents a methodology for analysing the interactions between players in a football team, from the point of view of graph theory and complex networks. We model the complex network of passing interactions between players of a same team in 32 official matches of the Liga de Fútbol Profesional (Spain), using a passing/reception graph. This methodology allows us to understand the play structure of the team, by analysing the offensive phases of game-play. We utilise two different strategies for characterising the contribution of the players to the team: the clustering coefficient, and centrality metrics (closeness and betweenness). We show the application of this methodology by analyzing the performance of a professional Spanish team according to these metrics and the distribution of passing/reception in the field. Keeping in mind the dynamic nature of collective sports, in the future we will incorporate metrics which allows us to analyse the performance of the team also according to the circumstances of game-play and to different contextual variables such as, the utilisation of the field space, the time, and the ball, according to specific tactical situations.


#4 Mental Fatigue and Spatial References Impair Soccer Players' Physical and Tactical Performances
Reference: Front Psychol. 2017 Sep 21;8:1645. doi: 10.3389/fpsyg.2017.01645. eCollection 2017.
Authors: Coutinho D, Gonçalves B, Travassos B, Wong DP, Coutts AJ, Sampaio JE
Summary: This study examined the effects of mental fatigue and additional corridor and pitch sector lines on players' physical and tactical performances during soccer small-sided games. Twelve youth players performed four Gk+6vs6+Gk small-sided games. Prior to the game, one team performed a motor coordination task to induce mental fatigue, while the other one performed a control task. A repeated measures design allowed to compare players' performances across four conditions: (a) with mental fatigue against opponents without mental fatigue in a normal pitch (MEN), (b) with mental fatigue on a pitch with additional reference lines (#MEN); (c) without mental fatigue against mentally fatigued opponents on a normal pitch (CTR); and (d) without mental fatigue on a pitch with reference lines (#CTR). Player's physical performance was assessed by the distance covered per minute and the number of accelerations and decelerations (0.5-3.0 m/s2; > -3.0 m/s2). Positional data was used to determine individual (spatial exploration index, time synchronized in longitudinal and lateral directions) and team-related variables (length, width, speed of dispersion and contraction). Unclear effects were found for the physical activity measures in most of the conditions. There was a small decrease in time spent laterally synchronized and a moderate decrease in the contraction speed when MEN compared to the CTR. Also, there was a small decrease in the time spent longitudinally synchronized during the #MEN condition compared to MEN. The results showed that mental fatigue affects the ability to use environmental information and players' positioning, while the additional reference lines may have enhanced the use of less relevant information to guide their actions during the #MEN condition. Overall, coaches could manipulate the mental fatigue and reference lines to induce variability and adaptation in young soccer players' behavior.


#5 Exercise physiology and nutritional perspectives of elite soccer refereeing
Reference: Scand J Med Sci Sports. 2017 Oct 5. doi: 10.1111/sms.12989. [Epub ahead of print]
Authors: Schenk K, Bizzini M, Gatterer H
Summary: Referees are an integral part of soccer and their performance is fundamental for regular match flow, irrespective of the competition level or age classes. So far, scientific interest was mainly limited to aspects of exercise physiology and match performance of soccer referees, whereas recommendations for nutrition were adopted from active professional soccer. In contrast to elite soccer players most referees are non-professional and engaged in different occupations. Furthermore, elite referees and soccer players differ in regard to age, body composition, aerobic capacity and training load. Thus, referees' caloric needs and recommended daily carbohydrate intake may generally be lower compared to active soccer players, with higher intakes limited to periods of increased training load and match days or for referees engaged in physical demanding occupations. With respect to fluid intake, pre-match and in-match hydration strategies generally valid in sports are recommended also for referees to avoid cognitive and physical performance loss, especially when officiating in extreme climates and altitude. In contrast to elite soccer, professional assistance concerning nutrition and training is rarely available for national elite referees of most countries. Therefore, special attention on education about adequate nutrition and fluid intake, about the dietary prevention of deficiencies (iron in female referees, vitamin D irrespective of sex and age) and basic precautions for travels abroad is warranted. In conclusion, the simple adoption of nutritional considerations from active soccer for referees may not be appropriate. Recommendations should respect gender differences, population specific physical characteristics and demands just as well as individual characteristics and special needs.


#6 A rare case of localised pigmented villonodular synovitis in the knee of a 24-year-old female soccer player: diagnosis, management and summary of tenosynovial giant cell tumours
Reference: BMJ Case Rep. 2017 Oct 4;2017. pii: bcr-2017-219549. doi: 10.1136/bcr-2017-219549.
Authors: Falster C, Stockmann Poulsen S, Joergensen U
Summary: Localised pigmented villonodular synovitis (PVNS) of the knee is a rare diagnosis, with clinical signs and symptoms mimicking meniscal damage or other common knee injuries.We report the case of a 24-year-old female soccer player, seeking treatment after 7 months of persisting knee pain. Additionally, we present an overview of tenosynovial giant cell tumours.On examination, the patient was found to have tenderness in the medial joint space of the knee. MRI revealed a heterogeneous formation in the central part of the knee. The formation was completely enucleated arthroscopically, histological analyses confirmed the diagnosis of localised PVNS. The patient was subsequently free of symptoms with no signs of recurrence on MRI and had resumed soccer practice at the 1-year follow-up appointment.


#7 Genetic Variants and Hamstring Injury in Soccer: an Association and Validation Study
Reference: Med Sci Sports Exerc. 2017 Oct 2. doi: 10.1249/MSS.0000000000001434. [Epub ahead of print]
Authors: Larruskain J, Celorrio D, Barrio I, Odriozola A, Gil SM, Fernandez-Lopez JR, Nozal R, Ortuzar I, Lekue JA, Aznar JM.
Summary: The purpose was to investigate the association of candidate single nucleotide polymorphisms (SNPs) with non-contact hamstring muscle injuries in elite soccer players, and to create and validate a model to assess the risk of hamstring injury. 107 elite male outfield players were prospectively followed for 6 seasons. Players were genotyped for 37 SNPs previously investigated in relation to musculoskeletal injuries. The association of SNPs, previous injury, age, level of play, position and anthropometric data with 129 hamstring injuries (413 observations) was investigated in the discovery phase (2010-2015), and a multivariable Cox-frailty model was created using forward selection. The model's discriminative ability was tested in the validation phase (2015-2016, 31 injuries, 98 observations) using Harrell's C index. Five SNPs were found to be significantly associated with hamstring injury in a multivariable model, MMP3 (Matrix metalloproteinase-3) rs679620 (A vs. G, hazard ratio (HR)=2.06, 95% confidence interval (CI)=1.51-2.81), TNC (Tenascin-C) rs2104772 (A vs. T, HR=1.65, 95% CI=1.17-2.32), IL6 (Interleukin-6) rs1800795 (GG vs. GC+CC, HR=1.68, 95% CI=1.11-2.53), NOS3 (Nitric oxide synthase-3) rs1799983 (G vs. T, HR=1.35, 95% CI=1.01-1.79), and HIF1A (Hypoxia-inducible factor-1α) rs11549465 (CC vs. CT, HR=2.08, 95% CI=1.00-4.29). Age also entered the model (≥24 vs. <24 years, HR=2.10, 95% CI=1.29-3.42). The model showed acceptable discrimination in the discovery phase (C index=0.74), but not in the validation phase (C index=0.52). Genetic variants appear to be involved in the etiology of hamstring injuries, but were not found to have predictive value by themselves. Further research, increasing the number of genetic variants and including environmental factors in complex multifactorial risk models is necessary.


#8 Prevalence of femoroacetabular impingement morphology in asymptomatic youth soccer players: magnetic resonance imaging study with clinical correlation
Reference: Rev Bras Ortop. 2017 Jun 24;52(Suppl 1):14-20. doi: 10.1016/j.rboe.2017.06.005. eCollection 2017.
Authors: Yepez AK, Abreu M, Germani B, Galia CR
Download link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620002/pdf/main.pdf
Summary: The purpose was to determine the prevalence of femoroacetabular impingement morphology (FAIM), cam- or pincer-type, by magnetic resonance imaging (MRI) in asymptomatic adolescent soccer players, and to evaluate the possible correlation between alterations on MRI and clinical examination findings. A cross-sectional study was conducted to determine the prevalence of FAIM in asymptomatic youth soccer players aged 13-18 years. A total of 112 hips in 56 players (mean age 15.3 years) were evaluated by MRI. Images were examined by two musculoskeletal radiologists for signs of FAIM. Cam-type (impingement) deformity was diagnosed by alpha angle ≥55° or head-neck offset <7 mm. Pincer-type (impingement) deformity was diagnosed by center-edge angle (CEA) ≥35° or acetabular index ≤0°. Other MRI changes, characteristic of FAIM, were observed. Clinical examination was performed to determine the range of motion (ROM) of the hips. In addition, specific tests for anterolateral and posteroinferior impingement were performed. The prevalence of MRI findings consistent with FAIM among this young population was 84.8% (95/112). The alpha angle was ≥55° in 77.7% (87/112) of hips, while the CEA was altered in 10.7% (12/112) of hips. Qualitative MRI findings consistent with FAIM were highly prevalent, and included loss of sphericity of the femoral head (77%), osseous bump (44%), femoral neck edema (21%), and acetabular osteitis (9%). The anterior impingement test was positive in 15% of the hips evaluated. Youth soccer players have a high prevalence of FAIM as diagnosed by MRI. There is no correlation between physical examination findings and MRI evidence of FAIM in this population.


#9 In-Season High-Intensity Interval Training Improves Conditioning In High School Soccer Players
Reference: Int J Exerc Sci. 2017 Sep 1;10(5):713-720. eCollection 2017.
Authors: Howard N, Stavrianeas S
Download link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609662/pdf/ijes-10-05-713.pdf
Summary: Soccer is characterized by high aerobic demands interspersed with frequent bursts of anaerobic activity. High-intensity interval training (HIIT) is considered a viable alternative to traditional endurance conditioning and offers the additional time-saving benefits of anaerobic training. We hypothesized that HIIT will compare favorably to traditional (aerobic-based) soccer conditioning over the course of a high school soccer season. Junior varsity soccer players were split into control (CON, n=16) and experimental (HIIT, n=16) groups for the 10-week study. The HIIT group performed 4-6 "all-out" sprints lasting 30s each, with 4.5 minute recovery, 3 times a week. The CON group performed endurance running for the same duration. The groups did not differ in any other aspect of their training. Participants completed the Yo-Yo intermittent recovery test level 1 (IR1), a 40-yard dash, vertical jump, Illinois agility test, and a sit-and-reach test, in two different testing sessions (pre/post season). Both HIIT and CON groups exhibited significant increase in IR1 test performance with time (741.6±307.6m vs. 1067.6±356.8m, p<.001 and 733.2±318.8m vs. 1165.2±252.8m, p<0.001 respectively), with no difference between groups. The CON group demonstrated a significant difference in the 40-yard dash over time (5.48±0.36s vs. 5.21±0.16s, p<0.004). While there was a difference in vertical jump between the pre and post tests for the HIIT group (42.20±7.04cm vs. 47.87±750cm respectively, p<0.019), no such effect was observed in the CON group. In contrast, there were differences in the agility test only for the CON group over time (16.67±0.76s vs. 16.15±0.49s, p<0.001). There were no differences in the flexibility test between groups. Our results indicate that HIIT offers similar endurance improvements to more traditional soccer training.

#10 Maturation-related adaptations in running speed in response to sprint training in youth soccer players
Reference: J Sci Med Sport. 2017 Sep 21. pii: S1440-2440(17)31058-7. doi: 10.1016/j.jsams.2017.09.012. [Epub ahead of print]
Authors: Moran J, Parry DA, Lewis I, Collison J, Rumpf MC, Sandercock GRH
Summary: This study investigated the effects of a previously recommended dose of sprint training (ST) in young male soccer players of differing maturity status. Male soccer players from two professional academies were divided into Pre-PHV (Training: n=12; Control: n=13) and Mid-PHV (Training: n=7; Control=10) groups. The training groups completed 16 sprints of 20m with 90s recovery, once per week. Between-group effect sizes (ES) were substantially larger in Pre-PHV (10m [1.54, CI: 0.74-2.23]; 20m [1.49, CI: 0.75-2.23]; 5-10-5 [0.92, CI: 0.23-1.61]) than in Mid-PHV (10m [-0.00, CI: -0.81 to 0.81]; 20m [-0.12, CI: -0.93 to 0.69]; 5-10-5 [-0.41, CI: -1.22 to 0.41]). Within-group effects demonstrated a similar, though less accentuated, trend which revealed ST to be effective in both Pre-PHV (10m [0.44, CI: -0.24 to 1.12]; 20m [0.45, CI: -0.23 to 1.13]; 5-10-5 [0.69, CI: 0.00-1.38]) and Mid-PHV (10m [0.51, CI: -0.38 to 1.40]; 20m [0.33, CI: -0.56 to 1.21]; 5-10-5 [0.43, CI: -0.46 to 1.32]). ST, in the amount of 16 sprints over 20m with a 90s rest, may be more effective in Pre-PHV youths than in Mid-PHV youths.


American Football
#1 National Football League Skilled and Unskilled Positions Vary in Opportunity and Yield in Return to Play After an Anterior Cruciate Ligament Injury
Reference: Orthop J Sports Med. 2017 Sep 21;5(9):2325967117729334. doi: 10.1177/2325967117729334. eCollection 2017 Sep.
Authors: Yang J, Hodax JD, Machan JT, Secrist ES, Durand WM, Owens BD, Eltorai AEM, Dodson CC
Summary: Anterior cruciate ligament (ACL) injuries pose a significant risk to the careers of players in the National Football League (NFL). The relationships between draft round and position on return to play (RTP) among NFL players are not well understood, and the ability to return to preinjury performance levels remains unknown for most positions. The purpose was to test for differences in RTP rates and changes in performance after an ACL injury by position and draft round. We hypothesized that skilled positions would return at a lower rate compared to unskilled positions. We further hypothesized that early draft-round status would relate to a greater rate of RTP and that skilled positions and a lower draft round would correlate with decreased performance for players who return to sport. Utilizing a previously established database of publicly available information regarding ACL tears among NFL players, athletes with ACL tears occurring between the 2010 and 2013 seasons were identified. Generalized linear models and Kaplan-Meier time-to-event models were used to test the study hypotheses. The overall RTP rate was 61.7%, with skilled players and unskilled players returning at rates of 64.1% and 60.4%, respectively (P = .74). Early draft-round players and unskilled late draft-round players had greater rates of RTP compared to skilled late draft-round players and both unskilled and skilled undrafted free agents (UDFAs). Skilled early draft-round players constituted the only cohort that played significantly fewer games after an injury. Unskilled UDFAs constituted the only cohort to show a significant increase in the number of games started and ratio of games started to games played, starting more games in which they played, after an injury. Early draft-round and unskilled players were more likely to return compared to their later draft-round and skilled peers. Skilled early draft-round players, who displayed relatively high rates of RTP, constituted the only cohort to show a decline in performance. Unskilled UDFAs, who exhibited relatively low rates of RTP, constituted the only cohort to show an increase in performance. The significant effect of draft round and position type on RTP may be caused by a combination of differences in talent levels and in opportunities given to returning to play.


#2 Recurrent Labral Tearing on Magnetic Resonance Imaging Is Not Predictive of Diminished Participation Among National Football League Athletes
Reference: Arthroscopy. 2017 Sep 30. pii: S0749-8063(17)30703-X. doi: 10.1016/j.arthro.2017.07.007. [Epub ahead of print]
Authors: Knapik DM, Gebhart JJ, Sheehan J, Tanenbaum JE, Salata MJ, Voos JE
Summary: The purpose was to investigate the prevalence of shoulder labral repair and utility of magnetic resonance imaging (MRI) in determining the risks of recurrent labral tearing and impact on future participation in the National Football League (NFL). Athletes invited to the NFL Combine between 2012 and 2015 were retrospectively reviewed. Athletes with a history of labral repair and MRI of the operative shoulder at the Combine were included in the study for further analysis, excluding athletes without a history of labral repair, labral repair without MRI at the Combine, additional procedure to the operative shoulder, or athletes still undergoing rehabilitation at the time of the Combine after labral repair. All MRIs were reviewed to determine initial labral repair location, the presence of recurrent tearing, and any concomitant shoulder pathology. Prospective information on future NFL participation in regard to draft status, games played, and games started in the athlete's first NFL season after the Combine was compared between athletes with a history of labral repair with and without recurrent tearing versus all other athletes participating in the Combine. A total of 132 (10.1%) athletes underwent 146 shoulder labral repair procedures before the NFL Combine, of whom 32% (n = 39 athletes, n = 46 shoulders) had recurrent labral tears on MRI. Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P = .048) and possess concomitant shoulder pathology (P < .001). Recurrent labral tearing was significantly more common in the posterior labrum in athletes with a history of posterior labral repairs (P = .032). Prospective participation in the NFL in terms of games played (P = .38) or started (P = .98) was not significantly reduced in athletes with a history of labral repair compared with those without repair. Participation was not diminished in athletes with recurrent labral tears compared with those with intact repairs or those with evidence of degenerative joint disease. Athletes invited to the NFL Scouting Combine with a history of bilateral repair, posterior labral repair, and concomitant shoulder pathology are at high risk of recurrent labral tearing on MRI. No significant reduction in NFL participation the year after the Combine was seen in athletes with a history of labral repair, recurrent labral tearing, or degenerative joint disease who were successfully drafted into the NFL. In athletes with a history of labral repair, assessment of labral integrity on MRI alone is not predictive of future short-term participation.