Epidemiology: The Most Frequent Lesions

Fig. 2.1

Incidence of injuries during training sessions and matches

During Euro 2004, the thigh was the most common injury location (22%) followed by the ankle (17%), lower leg (14%) and hip/groin (14%).

Sprains (ligament injury) were the most dominant type of injury at Euro 2008 (n = 16, 29%), and nine of these injuries comprised the ankle joint and seven the knee joint. The 15 muscle strain injuries mainly occurred in the thigh (n = 6), calf (n = 4) and groin (n = 2).

In terms of risk injury Euro 2004 had a rate of 9.0/1000h of exposure; during Euro 2008, the total risk of injury was 10.0/1000 h of exposure and during Euro 2012, the total risk of injury was 6.0/1000 h of exposure (4.2/1000 h in the Portuguese team).

In Euro 2012, the injury incidence was about 16 times higher during match play (41.8 injuries/1000 match hours) than during training (2.6 injuries/1000 training hours).

2.5 Clubs Competitions: The UEFA Champions League Injury Study

The UEFA Champions League represents the highest expression of club level football in the world. Since 2001, UEFA has implemented an injury survey among Champions League clubs [2], with the aim of reducing injuries, which, at this level, have a high sporting and economic impact. Prof Jan Ekstrand, one of the pioneers of football injury epidemiology, leads the group study for this project. The UEFA Champions League (UCL) injury study involves the most important clubs in European football from several countries and with different levels of competition success. Each day, injury data together with information on the football activity exposure of each player are collected by the medical staff of these clubs and sent to the group study. Feedback on the club’s injury profile is sent periodically by the study group to the club in order to improve specific prevention programmes. Until now, the results of this survey have been extensively published in the scientific literature [2, 3] and have helped to identify the most common injuries at that level of football as well as their specificity and fundamental characteristics, namely, the total injury risk in top-level club football in Europe (8.0/1000 h).

According to the UCL injury study, a professional football team can expect about 50 injuries that cause time loss from play each season, which equates to two injuries per player per season [3]. The impact of injuries on team performance can therefore be considerable as on average; 12% of the squad is unavailable due to injury at any point during the season. Most injuries occur during a match where there is a five times higher risk of injury compared with training. Data from the UEFA Champions League show that the risk of injury remained constant in the last decade (Fig. 2.1).

During a match, data show that injury incidence increases during the last part of each half (Fig. 2.2).

Fig. 2.2

Injury incidence during matches (courtesy of Waldén M et al. [2])

There is also evidence that overuse injuries have a higher incidence during the preseason (Fig. 2.3), while there are different trends of seasonality linked to different regions and their specific environmental conditions. In modern football, where a considerable amount of money is invested, this has a notable economic impact with some teams reportedly losing millions of euros due to injury [4]. These data suggest the importance of the medical staff, whose role in many clubs and federations is still undervalued.