Muscle injury rate in professional football is higher in matches played within 5 days since the previous match: a 14-year prospective study with more than 130 000 match observations.
Bengtsson H, Ekstrand J, Waldén M, Hägglund M. Br J Sports Med. 2018 Sep;52(17):1116-1122. doi: 10.1136/bjsports-2016-097399. Epub 2017 Nov 3.
Take Home Message: A professional athlete with 6 or 7 days rest between soccer matches may be less likely to have a muscular injury during a match than a player with 3 or fewer days between matches.
Numerous investigators have studied the possible relationship of the time between matches and injury rates in professional football (soccer). For example, prior researchers showed that if a team plays 2 matches within 4 days compared to 6 or more days they are more likely to have greater muscular injury rates. However, prior studies have small sample sizes or study teams instead of individuals, which can make interpreting the findings challenging. Hence, the authors analyzed the associations between match congestion and match injury rates at an individual player level in a large population of professional soccer players. The authors used data gathered through a prospective cohort study known as the UEFA Elite Club Injury Study. This study included data from 14 consecutive seasons of 57 professional European teams from 16 countries for a total of 2,672 players. A member of the technical staff recorded individual exposure for each match and all time-loss injuries, including information on the occurrence and diagnosis. The authors defined short-term match congestion as the number of days since the player’s last recorded match exposure. Long-term match congestion was defined as the total hours of match play that a player was exposed to during the prior 30 days. Injury rate was defined as number of injuries per 1000 hours of match exposure. This study included a total of 133,170 individual match observations, adding up to a total of 166,433 match hours. The authors found no relationship between total injury rates and short-term match congestion. However, when the authors looked specifically at muscular injuries they found that muscle injury rates were 21% lower with 6 days rest and 19% lower with 7-10 days, compared to 3 days between matches. Players with 4 or 5 days of rest had a similar risk of injury as those with had 3 or less days of rest. There was no consistent evidence of an association between long-term match congestion and overall or muscular injury rates.
Using a large sample size and individual player data, the authors found that short-term match congestion may be related to muscular injuries. This is important as more leagues are becoming aware of and making changes regarding training/playing load, with the goal of preventing injuries. A recent rule change has been suggested to allow at least 4 days to recover between matches. The authors note that from their findings, this rule change would have limited benefit since there was no difference between muscle injury rates among players with 3 to 5 days off. The authors acknowledge that overall, the individual player is still unlikely to suffer an injury in a congested match schedule. Even though this is true, untimely and possibly preventable injuries, can make a difference in a championship run for a team. The authors discuss planned player rotation strategies as a way to prevent injuries, but there are still limitations to the amount of substitutions available for each team. This is relevant to the debate on the need for substitution rule changes to allow for proper medical evaluation during injuries, such as with concussion, that don’t penalize teams for proper medical care. This study, although done in European soccer players, is also probably relevant to the discussion in the National Football League (American football) regarding player safety with adding more weekday games (such as Thursday Night Football). In conclusion, medical staff should advocate for strategies to promote longer rest intervals between matches to help reduce the risk of muscular injuries.
Questions for Discussion: What are your thoughts on how teams can balance competition, player safety, and increased financial incentives from more games? Should new substitution rules be allowed?
Written by: Kris Fayock, MD
Reviewed by: Jeffrey Driban
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