Elsevier

Physical Therapy in Sport

Volume 28, November 2017, Pages 1-8
Physical Therapy in Sport

Original Research
Strategies for injury prevention in Brazilian football: Perceptions of physiotherapists and practices of premier league teams

https://doi.org/10.1016/j.ptsp.2017.07.004Get rights and content

Highlights

  • Brazilian physiotherapists usually are active in all phases of the prevention program.

  • Previous injury, muscle imbalance and fatigue are considered the main injury risk factors.

  • Biochemical markers are widely used for to detect athlete's injury risk.

  • Strengthening and proprioception exercises are the main preventive strategies.

  • Most teams have used adaptations of the “FIFA 11+” for injury prevention.

Abstract

Objectives

To describe the physiotherapists perceptions and the current practices for injury prevention in elite football (soccer) clubs in Brazil.

Design

Cross-sectional study.

Setting

Group of Science in Sports & Exercise, Federal University of Healthy Sciences of Porto Alegre (Brazil).

Participants

16 of the 20 football clubs involved in the Brazilian premier league 2015.

Main outcome measures

Physiotherapists answered a structured questionnaire.

Results

Most physiotherapists (∼88%) were active in design, testing and application of prevention programs. Previous injury, muscle imbalance, fatigue, hydration, fitness, diet, sleep/rest and age were considered “very important” or “important” injury risk factors by all respondents. The methods most commonly used to detect athletes’ injury risk were: monitoring of biochemical markers (100% of teams), isokinetic dynamometry (81%), questionnaires (75%), functional movement screen (56%), fleximetry (56%) and horizontal jump tests (50%). All clubs used strength training, functional training, core exercises and balance/proprioception exercises in their injury prevention program; and Nordic hamstring exercise and other eccentric exercises were used by 94% of clubs. “FIFA 11+” prevention program was adapted by 88% of clubs.

Conclusion

Physiotherapists perceptions and current practices of injury prevention within Brazilian elite football clubs were similar to those employed in developed countries. There remains a gap between clinical practice and scientific evidence in high performance football.

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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