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Foul play is associated with injury incidence: an epidemiological study of three FIFA World Cups (2002–2010)
  1. Jaakko Ryynänen1,2,
  2. Astrid Junge3,
  3. Jiri Dvorak3,4,
  4. Lars Peterson2,4,
  5. Hannu Kautiainen5,6,
  6. Jón Karlsson2,
  7. Mats Börjesson7,8
  1. 1Faculty of Medicine, University of Helsinki, Helsinki, Finland
  2. 2Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
  3. 3FIFA Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland
  4. 4Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
  5. 5Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
  6. 6Department of General Practice, University of Helsinki, Helsinki, Finland
  7. 7Swedish School of Sport and Health Sciences, Stockholm, Sweden
  8. 8Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Jaakko Ryynänen, Tarkk'ampujankatu 4 A 10, 00140 Helsinki, Finland; jaakko.ryynanen{at}


Background Foul play has been considered as one of the most important known extrinsic risk factors for injuries in football.

Aims To compare the incidence and characteristics of foul play injuries and non-foul injuries.

Methods Team physicians’ postmatch injury reports and official match statistics were obtained from all matches of the 2002, 2006 and 2010 Fédération Internationale de Football Association World Cups.

Results The number of injuries was associated with the number of fouls in a match. The incidence of foul play injuries (20.6/1000 match-hours, 95% CI 17.3 to 24.4) was significantly lower than that of non-foul injuries (42.6, 37.7 to 47.9), which also applied to all playing positions. The causation of injury (foul/non-foul), match period and teams’ drawing/losing/winning status were associated with the injury incidence. The interactions between the causation of injury (foul/non-foul) and match time, as well as the teams’ drawing/losing/winning status or playing position were not statistically significant. The median (IQR) days of absence resulting from foul play injuries were significantly shorter than that of non-foul injuries. The lower leg and ankle were more common locations for foul play injuries than for non-foul injuries, whereas the opposite was observed for thigh injuries. Contusions were a more common type of foul play injuries than non-foul injuries, while the opposite was found for muscle strains/ruptures/tears.

Conclusions The numbers of injuries and fouls in a match were significantly associated. No significant differences in the variation of foul play and non-foul injury incidences regarding match period, teams’ current winning/drawing/losing status and playing position were observed, suggesting that foul play injuries and non-foul injuries may share similar underlying risk factors.

  • Sporting Injuries
  • Soccer
  • Epidemiology

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