Risk factor | Literature review (L)/research (R) study | Outcome | Action required |
---|---|---|---|
Intrinsic factors | |||
Participant related | |||
Age | Comparison of the incidence of injury for male amateur players as a function of age (R)23 | Incidence of injury increases with age and is highest among senior players | Develop techniques to determine the age of young players and monitor the age of players competing in age-restricted competitions |
Assess whether over-age players take part in age-restricted competitions (R)24 | Some evidence of overage players taking part in age-restricted competitions | ||
Drugs/medication | Excretion of nandrolone metabolites by amateur and professional players following exercise (R)25 | Variations in postactivity urine levels of some steroids in non-drug-taking players occur across ethnic groups; results indicate that individual steroid profiling should be considered. High usage of NSAIDs by players | Instigate drug-testing procedures in football to support WADA. Information to team physicians on the side effects of NSAIDs |
Steroid profiles in elite footballers (R)26 | |||
Evaluate the use of medication during competition (R)27 | |||
Gender | Comparison of incidence and severity of injury for international male and female players (R)28 | Incidence of injury is higher among male players than among female players but female players are significantly more likely to sustain ACL injuries than men | Develop a prevention programme to reduce the incidence of ACL injuries among female players |
Comparison of incidence and severity of injury for amateur male and female players (R)29 | |||
Medical history | Risk factor analysis (R)30 | Previous injury most important risk factor for injury. Players frequently returned to play while still feeling the effects of an injury. Players may have undiagnosed cardiovascular problems when playing high-level football | Review the best practice procedures and develop protocols to evaluate player's medical condition prior to FIFA tournaments |
Precompetition musculoskeletal evaluation (R)31 | |||
Precompetition cardiovascular assessment (R)32 | |||
Psycho-social | Impact of player behaviour on fair play (R)33 | A wide range of psychosocial factors impacted on players attitudes towards fair play | Review FIFA policy towards all aspects of ‘fair play’ |
Impact of psychological characteristics on fair play (R)34 | |||
Standard of play | Comparison of the incidence of injury at international men's tournaments (R)28 | For men, the incidence of injury at World Cups lower than the incidences of injury at <17 and <20 tournaments; for women, no clear trends | Develop an injury prevention programme for players of all skill levels. |
Comparison of the incidence of injury at international women's tournaments (R)28 | |||
Tackling | Comparison of risks associated with making different types of tackle by male players (R)35 | Video analysis of tackles showed that players making a tackle were more likely to be injured when tackles involved a clash of heads or were two-footed | Review the laws of the game |
Comparison of risks associated with making different types of tackle by female players (R)36 | |||
Extrinsic factors | |||
Facility-related | |||
Playing surface | Comparison of the incidence of injury among non-professional players on artificial turf and grass playing surfaces (R)29 | There were no significant differences in the overall incidence of injury for male and female footballers playing on artificial turf compared with natural grass | Maintain quality criteria for FIFA-approved artificial turf pitches |
Comparison of the incidence of injury among professional players on artificial turf and grass playing surfaces (R)37 | |||
Stadium design | Assess the environs of the playing area that may impact on a player's safety (R)38 | Hazardous situations and objects were found in the environs of the playing area | Produce stadium design guidelines |
Equipment-related | |||
Headgear/footballs | Biomechanical analysis of protection offered by headgear (R)39 | No evidence found that commercially available headgear provided a significant level of head protection to players Some evidence that reducing ball size and ball pressure could reduce impact forces during heading | Review technical specifications for water uptake of balls |
Biomechanical analysis of football properties (R)40 | |||
Environment-related | |||
Altitude | Effect of altitude on football performance (L)41 | Players from low altitude must acclimatise for 1–2 weeks before competing at high altitude to avoid adverse effects on performance | Develop a statement on playing football at altitude |
Preparations for playing football at altitude (L)42 | |||
Being tackled | Comparison of risks associated with different types of tackle on male players (R)35 | Video analysis of tackles showed that players being tackled were more likely to be injured when the tackles involved a clash of heads or were two-footed | Review the laws of the game and the punishments given against players causing severe injuries |
Comparison of risks associated with different types of tackle on female players (R)36 | |||
Playing position | Impact of playing position on the incidence of injury among male players (R)35 | No significant difference found in the incidence of injury as a function of playing position for men but forwards and defenders showed higher incidences of injury among female players | None required |
Impact of playing position on the incidence of injury among female players (R)43 | |||
Ramadan | Impact of Ramadan on physical and football performance (R)44 | Changes in sleep and nutrition patterns during Ramadan had no significant effects on physical performance | Provide advice on nutrition; recommendation that players ensure adequate sleep and nutrition during Ramadan |
Influence of Ramadan on physiological parameters (R)45 | |||
Refereeing | Assess referees' decision-making in player injury situations (R)46 | Current laws were adequate to protect players from injury but in matches referees were under pressure to make difficult decisions in high pressure situations and match referees often failed to punish players in incidents leading to injury | Review referees training programmes |
Stage in match | Effect of stage in match on the incidence of injury in men's football (R)47 | For men, there were significantly more injuries in the second half of matches than in the first half but for women there were no differences. Effects in the men's game may be caused by fatigue | Develop an injury prevention programme for players of all skill levels |
Effect of stage in match on the incidence of injury in women's football (R)36 | |||
Temperature | Playing football in hot environments (L)48 | High temperatures, especially when accompanied by high humidity, have an adverse effect on performance | Develop a statement on playing football in hot conditions |
Effect of heat on the physical activity of footballers (R)49 |
ACL, anterior cruciate ligament; FIFA, Fédération Internationale de Football Association; NSAIDs, non-steroidal anti-inflammatory drugs; WADA, World Anti-doping Agency.