Original ResearchStrategies for injury prevention in Brazilian football: Perceptions of physiotherapists and practices of premier league teams
Introduction
There are currently more than 65,000 registered and active professional football (soccer) athletes worldwide (FIFPro World Players Union, 2013). In elite clubs from Union of European Football Associations (UEFA), athletes sustain approximately 28 injuries per 1000 h of exposure in matches (Ekstrand, Hagglund, & Walden, 2011); while premier league teams in Asia and South America sustain around 22 and 43 injuries per 1000 playing hours, respectively (Aoki et al., 2012, Reis et al., 2015). These injuries adversely affect success in competitions (Hägglund et al., 2013a, Hägglund et al., 2013b), and negatively impact the clubs' finances (Ekstrand, 2013). They can also adversely affect athletes' health and careers, since approximately 47% of professional football players are forced to leave the sport due to injuries (Drawer & Fuller, 2001). Therefore, it is imperative that injury prevention become a priority of elite football clubs.
Scientific literature has shown that properly planned and implemented prevention programs are able to reduce the incidence of non-contact injuries in football (Hides and Stanton, 2014, Mohammadi, 2007, Petersen et al., 2011, Silvers-Granelli et al., 2015, Soligard et al., 2008). However, typical injuries sustained by football players, such as hamstring strains (Ekstrand, Waldén, & Hägglund, 2016) and anterior cruciate ligament (ACL) ruptures (Waldén, Hägglund, Magnusson, & Ekstrand, 2016), have not declined since the beginning of this century in elite football. Therefore, an old issue remains under discussion: does sports-science research influence practice?
McCall and colleagues conducted a series of studies aiming to reduce the gap between what is evidenced by science and what is done in practice. First, they interview members of the sport science staff, physiotherapists or medical doctors of 44 premier league teams from various countries, and provided an overview on the practitioners perceptions and the preventative strategies for non-contact injuries employed by clubs (McCall et al., 2014). A similar study design was performed with all 32 national teams participating in the 2014 FIFA World Cup (McCall et al., 2015b). Then they systematically reviewed the scientific evidence that underpins the main injury prevention strategies adopted by premier league teams (McCall et al., 2015a), and concluded that most of the perceptions and practices of practitioners remains with a low level of evidence and low graded recommendation.
South American countries have a long tradition in football, including three former world champions (Brazil, 5 times; Argentina, twice; and Uruguay, twice). In the football clubs’ scenario, South America presents highly competitive continental cups (e.g., Libertadores de America Cup) and national championships (e.g., Brazilian Premier League). However, a single South American club (CA Boca Juniors, Argentina) was assessed by McCall et al. (2014). Thus, there is a lack in the literature regarding the injury prevention strategies adopted by South American football clubs, including Brazilian teams. The aim of our study therefore was to describe the physiotherapists perceptions and the current practices for injury prevention within Brazilian premier league football teams.
Section snippets
Study design
A cross-sectional observational study design was used. Physiotherapists from participating football clubs answered questions from a structured questionnaire about their perceptions and the teams’ current injury prevention practices. This project was approved by the institutional ethics committee, and all clubs provided written informed consent.
Participants
All 20 football clubs of the first division of the 2015 Brazilian Championship were invited to participate in this study. Two teams did not respond to
Number of matches
In the 2015 season, teams played an average of 65.44 ± 4.53 official competition matches, ranging from 57 to 74 (Table 1).
Preseason duration
Most teams had a preseason that was 14–30 days long, one club had a 9-day preseason due to participation in a preliminary round for the Libertadores de America Cup, while another started the State Championship with a secondary team and thus had a 60-day preseason (Fig. 1). Therefore, preseason lasted 23.19 ± 11.93 days (n = 16) or 21.93 ± 6.21 when the two outliers were
Discussion
Our study investigated the injury prevention perceptions of physiotherapists and current practices in 16 of 20 clubs engaged in the 2015 Brazilian premier league. We compared what is actually done for injury prevention in elite Brazilian football teams with what is recommended by scientific literature, and with what is practiced by elite clubs from developed countries (McCall et al., 2014).
Conclusions
Our findings demonstrated that physiotherapists are active in all phases of injury prevention programs in Brazilian elite football. In their opinion, the most important risk factors for non-contact injuries are previous injury, muscle imbalance and fatigue. Clubs usually perform biochemical markers, isokinetic dynamometry, questionnaires, FMS and fleximetry as identification tools for injury risk. Prevention programs usually comprise traditional strength training, functional training, trunk
Acknowledgements
The authors would like to thank: Sociedade Nacional de Fisioterapia Esportiva (SONAFE-Brazil) for their help to contacting the clubs' medical staff; all clubs who agreed to participate in the study; and the physiotherapists who took the time to answer the survey.
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