Orthopaedic researchers use database to study soccer injuries worldwide

Soccer injury risk is declining, but researchers call for stricter rules to reduce dangerous play.

INNSBRUCK, Austria — The incidence of some soccer injuries has decreased in the last two decades, but injury exposure remains high for professional players.

Scandinavian orthopaedic researchers are advocating better referee training and stricter penalties to reduce or eliminate some injuries.

Jan Eckstrand, MD, and Roald Bahr, MD, PhD, of Oslo, Norway, discussed their findings at the 12th ESSKA Congress. In their study, they reviewed cases entered into a new database involving 62 teams from 50 countries, which tracks injury rates and types.

“If we look at the [regular soccer] season, it’s about the same length [each year],” Eckstrand said. “The total risk of injury is six injuries per 1000 hours of exposure. However, there is a great difference between training and matches. The risk of injury in matches is 8 times higher than in training.”

Eckstrand cited a myth that soccer injury risk is consistent from year to year. Injury risk has declined over the years; the risk this season was 65% of the injury risk in 2000. However, the risk of training injuries was about the same this season as last.

Most common injuries

The most commonly treated soccer injuries, at least on the professional level, are thigh, knee and ankle injuries. Muscle and tendon injuries comprise about one-fourth of all injuries, Eckstrand said.

The incidence of ankle sprains has dropped sharply since 1992, when they averaged 10 per team each season, Eckstrand said. Metatarsal fractures are more common today, causing a mean absence of 76 days.

Bahr showed how specialists analyze game videos to identify injury “mechanisms,” or very specific movements that may cause injuries. Traditional data collection and keen analysis of game videos can help identify how and when injuries occur, he said.

“Duels,” or contests for ball possession, cause most soccer injuries, Bahr said. Studying 406 incidents from the Norwegian Super League, Bahr and his colleagues saw that the referees did not call penalties in 60% of foul play incidents.

A panel of three referees reviewed the game videos and mostly agreed with the match referees, Bahr said.

He pointed out that the match referees controlled athletes' behavior by handing out 90% of yellow and red cards for “bad mouthing” referees, delaying the game or standing too close to a free kick, but very few cards were given for situations involving a high injury risk.

Late tackles

Most ankle injuries resulted from tackles, 60% of which were late tackles, or those that occurred after a player released the ball, Bahr said. He showed a video in which a late tackle took place on the inside of the leg, making the recipient’s foot invert and bear the player’s full weight, resulting in a ligament tear.

Head-to-head contact caused 30% of head injuries, while hand and elbow contact with the head caused the other 40% of head injuries. However, fewer than 40% of elbow-to-head incidents generated penalties, he said.

Current international soccer rules are too “general” and do not address certain situations, Bahr said. He suggested improved referee training and stiffer penalties, such as a 10-minute expulsion for specific incidents of foul play.

Editors note: This article is taken from the July/August 2006 issue of Orthopaedics Today International, page 8.

For more information:
Eckstrand J, Bahr R. Preventing soccer injuries. Symposium #20. Presented at the 12th ESSKA Congress and 5th World Congress on Sports Trauma. May 23-27, 2006. Innsbruck, Austria.