Kazuyuki Kanosue, Tetsuya Ogawa, Mako Fukano and Toru Fukubayashi (eds.)Sports Injuries and Prevention10.1007/978-4-431-55318-2_10

10. Injury Rate of Soccer Players and the Efficacy of the FIFA 11 + Program

Yasuaki Saho¹

(1)

Department of Sports and Medical Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan

Yasuaki Saho

Email: y-saho@main.teikyo-u.ac.jp

Abstract

Soccer is the most popular sport in the world. There are more than 265 million soccer players worldwide (in 2006, http://www.fifa.com/worldfootball/bigcount/). In particular, youth and female players are increasing. In the 2008 Beijing Olympics and the 2012 London Olympics, soccer was categorized among the higher injury risk sports (Junge et al., Am J Sports Med 37(11):2165–2172, 2009; Engebretsen et al., Br J Sports Med 47(7):407–414, 2013). Injuries affect team performance negatively and exact high medical and social costs. In soccer, about 70 % of all injuries occur in the lower extremities (Dvorak et al., Br J Sports Med 45(8):626–630, 2011; Theron et al., Clin J Sport Med 23(5):379–383, 2013). The most commonly injured body parts are the thigh, ankle, lower leg and knee, and the most common types of acute injuries are contusions, ligament sprains, and muscle strains (Dvorak et al., Br J Sports Med 45(8):626–630, 2011; Theron et al., Clin J Sport Med 23(5):379–383, 2013; Dvorak et al., Br J Sports Med 41(9):578–581, 2007). Therefore a soccer-specific injury prevention plan was needed. The Federation Internationale de Football Association (FIFA) Medical and Research Center (F-MARC) developed “The 11” and then the “FIFA 11 +”, soccer specific injury prevention programs designed to reduce soccer injuries and promote soccer as a health-enhancing leisure activity. In this chapter, the epidemiology of soccer injuries and the efficacy of the “The 11” and “FIFA 11 +” are covered.

Keywords

SoccerInjury preventionEpidemiology

10.1 Characteristics of Soccer Injury

10.1.1 Injury Rate of Soccer Players

Recently, the establishment of an injury surveillance system was suggested (Fuller et al. 2006). This system was created and has been used in soccer (football) tournaments and the Olympic games (Junge et al. 2004a, b, c, 2009; Dvorak et al. 2007, 2010; Junge and Dvorak 2007, 2013; Engebretsen et al. 2010). Since this system’s inception, the use of this system has received much attention and has created a greater awareness about soccer injuries. Information on injuries has been augmented on many fronts including the injured body part, type of injury, diagnosis, severity, circumstance (non-contact, contact or foul play), and the nature of the exposures in both soccer training and matches. The system’s guidelines recommend that injury incidence be expressed as the number of injuries per 1,000 athlete exposure hours.

The epidemiology of soccer injuries has been investigated in several studies.

Soccer is one of the highest injury risk sports. In the 2008 Olympic Games, Junge et al. (2009) reported injuries by all sports. The results of this study indicated that the incidence of injuries was highest in soccer, taekwondo, hockey, handball, and boxing. The results were almost the same for the 2012 Olympic Games (Engebretsen et al. 2013). Hootman et al. (2007) reported on the epidemiology of collegiate injuries over a 16 year period. The injury rate was highest for men’s football, followed by men’s wrestling, men’s soccer and then women’s soccer (soccer was highest of the women’s sports).

The characteristics of soccer injuries are relatively similar across various studies, although there are some differences. The majority of soccer injuries affect the lower extremities, and account for about 70 % of all injuries (Junge et al. 2006; Junge and Dvorak 2007, 2013; Theron et al. 2013). The most frequently injured body parts are the thigh, ankle, lower leg and knee. The most frequent types of injuries are contusions, ligament sprains, and muscle strains (Junge et al. 2006; Junge and Dvorak 2007, 2013; Ekstrand et al. 2011; Walden et al. 2005). The most frequent diagnoses were thigh and lower leg contusion, ankle sprain, and thigh muscle strain. The most common injury mechanism involved contact with another player, and almost half of the contact injuries were caused foul play in a match (Junge and Dvorak 2007, 2013). Injury incidence is higher in matches than in training (Ekstrand et al. 2011; Walden et al. 2005; Hagglund et al. 2009).

In the FIFA World Cup matches, the over-all injury rate was 2.7 injuries per match or 81.0 injuries per 1,000 match hours in 2002 (Korea/Japan Venue), 2.3 or 68.7 in 2006 (German Venue), and 2.0 or 61.1 in 2010 (South African Venue) (Dvorak et al. 2007, 2010; Junge et al. 2004a). The time-loss injury rate was 1.7 injuries per match or 50.7 injuries per 1,000 match hours in 2002 (Korea/Japan Venue), 1.5 or 49.5 in 2006 (German Venue), and 1.3 or 40.1 in 2010 (South African Venue). A third of the injuries involved no absence, while a third to a half of the injuries involved a 1–3 day player loss during the tournament.

In a different international tournament that was monitored, the incidence of time-loss injuries was 41.6 per 1,000 match hours (Hagglund et al. 2009). The incidence of time-loss injuries is lower for matches between professional clubs than for matches of international tournaments. The rate of time-loss injuries for the 11 top clubs in several European countries was 30.5 per 1,000 match hours (Walden et al. 2005). Ekstrand et al. (2011) examined the 23 of the European professional football teams over 7 seasons. The incidence of time-loss injuries was 27.5 per 1,000 match hours. The incident rate differed between countries (Walden et al. 2005). Thus, several factors such as region and match style (international tournament or professional club match) influence injury risk.

Risk of injuries is also influenced by the score. Ryynanen et al. (2013) reported that players on winning teams had a higher risk of suffering injury than did players on a drawing or losing team in the FIFA World Cup. They surmised that the reason for the above results was that the winning team adopted a more defensive strategy and tried to simply maintain ball possession in order to control the game. The losing team, however, needed to be more aggressive in order to steal the ball. This lead to a more risky situation for the winning team, as they had to endure aggressive attacks.

The relationship between match results and injury incidence is somewhat confused. Ekstrand et al. (2004) found a higher injury incidence for matches lost as compared to matches won or drawn in by a national soccer team. A study by Bengtsson et al. (2013) reported similar results for professional clubs in that injury occurrence in a match that was lost or drawn was higher than for matches that were won. On the other hand, Hagglund et al. (2009) reported that there was no difference in the injury incidence rate for matches that were lost, won or drawn.

10.1.2 Injury Rate of Junior Soccer Players

There are about 22 million youth soccer players in the world (Big count 2006). The number of youth soccer players increased by 7 % during the period from 2000 to 2006.

Fauda et al. (2013) summarized soccer injuries in children and adolescent players. In their report, training injury incidence was nearly constant in adolescent players, and ranged from 1 to 5 injuries per 1,000 training hours. Match injury incidence tended to increase with age and ranged from 15 to 20 injuries per 1,000 match hours.

For adolescents, the likelihood of injury varies according to form level, age, and sex. Petersen et al. (2000) and Junge et al. (2002) report that low level youth players have more than twice the injury incidence level as compared with high level youth players. Overall, the incidence of injury in youth football increases with age (Schmidt-Olsen et al. 1991).

Thus older soccer players have a higher injury incidence as compared to younger soccer players (Peterson et al. 2000; Schmidt-Olsen et al. 1991; Inklaar et al. 1996), and the incidence of injury increases with each year/grade of school (Malina et al. 2006). A study by Hagglund et al. (2009) on the epidemiology of injuries in European soccer showed a tendency toward increased match injury incidence with increased age in male tournaments.

The injury rate of youth soccer players is different from that of professional players. Schmidt-Olsen et al. (1991) suggest that adolescent players incur fewer injuries than senior players because of better flexibility, as well as having less weight and moving slower during collisions.

The study also reported that 14 % of the adolescent had back pain trouble.

10.1.3 Injury Rate of the Female Soccer Players

Injury rates for female soccer players have been reported in several studies. Junge and Dvorak (2013) reported the incidence of injuries during international top-level tournaments from 1998 to 2012. In women, the average incidence of time-loss injury was 1.0 per match in the FIFA World Cups, 1.0 per match in the Olympic Games, and 1.0 per match in the FIFA U19/U20 World Cup and 0.7 per match in the FIFA U17 World Cup. The incidence of time-loss injuries was similar for males and females in the same type of tournament, except for the FIFA World Cup. The average number of injuries increased from 1.28 in the FIFA Women’s World cup 1999 to 2.34 in 2007 and from 2.13 in the Olympic Games of 2000 to 2.88 in 2008. The authors felt that the increase in injury incidence was due to an increasingly physical style of play. This interpretation was supported by data which indicated that while the non-contact injury incidence remained constant, contact injuries showed an increased incidence. This is a further indication that injury incidence is affected by playing style and the type of tournament.

Injury incidence in adolescent female players varied from 8.3 to 23.3 injuries per 1,000 match hours and from 1.1 to 4.6 injuries in training hours in a prospective study (Emery et al. 2005; Le Gall et al. 2008; Soderman et al. 2001; Faude et al. 2005; Steffen et al. 2007).

For female players, skilled players have a greater risk of injury. Soligard et al. (2010a) reported that highly skilled female soccer players (players with a high level of technical and tactical training and good physiological abilities) had a higher incidence of injury than lower skilled players. However, as mentioned above, a previous study suggested that low-level male players had a higher risk of injury. More studies are needed to examine the reason for this discrepancy.

Injury incidence in adolescent female players is different from that of male players (Le Gall et al. 2008). Gall documented injuries sustained by elite French female soccer players between 15 and 19 years of age, over the course of 8 seasons. The risk of injuries was lower in the U19 categories than in the U15 categories and overall, injury rate decreased with age. A study of Emery et al. (2005) supported these results that incidence of time-loss injuries in U18 was lower compared to that in U16.

10.2 Efficacy of the FIFA 11 + Program

10.2.1 FIFA “The 11” and “11 +”

In 2003 The Federation Internationale de Football Association (FIFA) Medical and Research Center (F-MARC) developed “The 11”, a soccer-specific injury prevention program. This program has ten exercises and a section on the spirit of fair play. Junge et al. (2011)noted the effectiveness of this program for reducing the incidence of soccer injuries (11.5 % fewer match injuries and 25.3 % fewer training injuries) and its cost effectiveness. However, some studies questioned the value of this program on the physical performance of the players (Steffen et al. 2008a; Kilding et al. 2008). Problems included a low rate of compliance and a negative impression by some of the players toward the program (Kilding et al. 2008; Steffen et al. 2008b). Since then, F-MARC developed a more comprehensive program, the “11 +”. The 11+ is a warm-up program which takes about 20 min to complete. The 11+ has 3 parts and involves 15 exercises. This program involves a progression through three levels. A video of the exercises and an accompanying manual for the 11+ can be downloaded without cost at the FIFA 11+ website (http://f-marc.com/11plus/). A summary of the 11+ program is mentioned below: