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.

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