Sports Medicine Research: In the Lab & In the Field: Careful: Injury Incidence Increases Following Red and Yellow Cards, Goals, and Injuries (Sports Med Res)
Thursday, October 24, 2013

Careful: Injury Incidence Increases Following Red and Yellow Cards, Goals, and Injuries

Increased risk of injury following red and yellow cards, injuries and goals in FIFA World Cups

Ryynänen J, Dvorak J, Peterson L, Kautiainen H, Karlsson J, Junge A, Börjesson M. Br J Sports Med. 2013, 47:970-973. Doi:10.1136/bjsports-2013-092676
http://bjsm.bmj.com/content/47/15/970.short

Take Home Message: Injury incidence increases in the 5 minute period following a potentially game-disruptive incident (red or yellow card, injury, or goal) compared with other match periods.

In light of the tremendous popularity of soccer and the desire to better understand the epidemiology of soccer injuries, the FIFA Medical Assessment and Research Center (F-MARC) developed and implemented an injury surveillance system that has been successfully implemented at all FIFA tournaments since 1998.  Evidence from sports psychology literature suggests that game events could change an athlete’s mentality, potentially increasing the risk of injury.  Therefore, the authors investigated the possible relationship between potentially game-disrupting incidents (PGDIs; red and yellow cards, goals, and injuries) and injuries in FIFA World Cups. In order to do so, they collected prospective injury surveillance data from the FIFA World Cups in 2002, 2006, and 2010 and match statistics from FIFA’s official website.  Matches were divided into (1) minutes played during the minutes of PGDIs or within the following 5 minutes and (2) other match periods.  On average, there were 9.5 PGDIs per match (most frequently a yellow card), and the injury incidence during or within 5 minutes of a PGDI was significantly higher compared with other match periods (Incidence rate ratio 1.42).  Furthermore, the frequency of PGDIs increased toward the end of each half.

Several factors, both intrinsic (related to individual nature of a player) and extrinsic (related to environmental variables), potentially increase injury risk in soccer.  Prior to this study, investigators had focused on foul play as an extrinsic risk factor for injuries.  The authors in this study demonstrate that injury incidence increases during the 5 minute period following PGDIs, suggesting the importance of other extrinsic risk factors for injury risk.  This would support recent sports psychology literature suggesting a detrimental effect of psychological stressors and situation-dependent emotional stress on concentration, awareness, and attitude.  In other words, it lends credence to the theory that PGDIs affect both players and teams at the strategic and psychological level, in turn leading to an increased injury risk.  Further research on this topic should include analysis of the effects of other potentially calming interruptions from the game (goal kicks, free kicks) on injury risk, types of injuries associated with PGDIs, and the role of individual factors included in the definition of PGDI.  Ultimately, awareness of increased injury risk following PGDIs may open opportunities for referees, players, and team management to prevent injury.

Questions for Discussion: What do you think are the most significant extrinsic variables of a soccer match that may increase injury risk?  Do you perform any stress relieving techniques with players for injury prevention?

Written by: Stuart D. Kinsella
Reviewed by:  Stephen Thomas

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Ryynänen J, Dvorak J, Peterson L, Kautiainen H, Karlsson J, Junge A, & Börjesson M (2013). Increased risk of injury following red and yellow cards, injuries and goals in FIFA World Cups. British Journal of Sports Medicine, 47 (15), 970-3 PMID: 23881892

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