Elsevier

Physical Therapy in Sport

Volume 32, July 2018, Pages 308-322
Physical Therapy in Sport

Literature Review
The “sequence of prevention” for musculoskeletal injuries among adult recreational footballers: A systematic review of the scientific literature

https://doi.org/10.1016/j.ptsp.2018.01.007Get rights and content

Highlights

  • Ankle, knee, groin and hamstring injuries are common in recreational adult football.

  • Musculoskeletal injuries in recreational adult football are associated with previous injury and match exposure.

  • The FIFA11 + injury prevention programme and the Nordic Hamstring Exercise (NHE) are effective programmes in order to prevent ankle, knee and hamstring injuries.

Abstract

Objective

To gather epidemiological information related to all steps of Van Mechelen's “sequence of prevention” for musculoskeletal injuries among adult recreational football players.

Methods

A systematic review of the scientific literature was conducted in Medline via Pubmed. Therefore, two highly sensitive search strategies based on three groups of keywords (and related search terms) were used.

Results

In total, 33 relevant original studies were included in our systematic review. The results of our systematic review showed that the incidence of musculoskeletal injuries among recreational adult football players ranged from 9.6 to 15.8 injuries per 1000 exposure hours. These injuries are especially located in the ankle, knee, groin and hamstring, being associated with previous injury and match exposure. The FIFA11 + injury prevention programme and the Nordic Hamstring Exercise (NHE) were found to be effective for the reduction or prevention of musculoskeletal injuries among adult recreational football players.

Conclusions

Our systematic review showed that musculoskeletal injuries are common among recreational adult football players, while effective preventive programmes are available. Further studies should focus on the identification and understanding of the key factors responsible for the optimal adoption, implementation and maintenance of these measures.

Introduction

Football (also referred to as ‘soccer’) is the most popular sport in the world, being played in more than 200 countries by nearly 400 million people. While its physical and psychosocial health benefits have been recently established, recreational football is also known for its risk for musculoskeletal injuries (Bangsbo et al., 2015, Dvorak and Junge, 2015). The incidence of football injuries among recreational players is estimated at up to 10 injuries per 1000 football hours, being more likely to be located in the lower limbs and to occur during competition (van Beijsterveldt, Stubbe, Schmikli, van de Port, & Backx, 2015; Inklaar, 1994). Because these injuries can lead to high (direct and indirect) costs for society, increased attention is being paid to injury prevention in football (Bizzini & Dvorak, 2015).

When it comes to sport injury prevention, van Mechelen's “sequence of prevention” has been recognized as the most influential model in the past 25 years (van Mechelen, 2017, van Mechelen et al., 1992). Van Mechelen's “sequence of prevention” relies on four sequential steps, from establishing the incidence, severity and aetiology of musculoskeletal injuries (steps 1 and 2) to the development and evaluation of preventive interventions (steps 3 and 4) (van Mechelen et al., 1992). These four steps of van Mechelen's “sequence of prevention” are essential for a successful implementation of interventions aiming to reduce or prevent the occurrence of musculoskeletal injuries in sports. Currently, no systematic overview exists that presents the scientific evidence related to all the steps of van Mechelen's “sequence of prevention” for musculoskeletal injuries among recreational football players. Such an overview would provide the football community with the available epidemiological knowledge and the available interventions related to injury prevention in recreational football, as well as point out the empirical information that still needs to be gathered.

Consequently, the objective of this study was to gather epidemiological information in order to answer the following four research questions: 1) What are the most common musculoskeletal injuries occurring among adult recreational football players?; 2) What are the risk factors and mechanisms of these most common musculoskeletal injuries among adult recreational football players?; 3) What are the available primary preventive interventions to prevent these most common musculoskeletal injuries among adult recreational football players?; 4) What is the effectiveness of the available primary preventive interventions on the reduction or prevention of musculoskeletal injuries among adult recreational football players?

Section snippets

Methods

A systematic review of the scientific literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Moher et al., 2009).

Search strategies

A total of 703 potentially relevant citations were retrieved from the literature search in Medline: 587 citations for our first and second research question, and 116 citations for our third and fourth research question. After applying the inclusion criteria to the titles and abstracts, only 64 potentially relevant studies were included for the full text review. From those potentially relevant studies, 31 studies were excluded for various reasons (not an original study; inappropriate study

Discussion

This study aimed to present an overview from the scientific literature on the most common musculoskeletal injuries and its football-specific risk factors among adult recreational football players, as well as to give an insight into the effect of available primary preventive interventions. The results of our systematic review (based on studies with low risk of bias) show that especially ankle, knee, groin and hamstring injuries occur among adult recreational football players, being principally

Conflict of interest

None.

Funding statement

No funding.

Ethical statement

No human participants (systematic literature review).

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      Interestingly, almost half of the sample also reported considering time-loss comparison between seasons. Existing literature indeed indicates that injury incidence is commonly used to analyse prevention program perceived effect, which is in favour of our results (Ageberg et al., 2019; Al Attar et al., 2016; Kilic et al., 2018; Taylor et al., 2015; Thorborg et al., 2017). However, time-loss, which is a measure of injury severity, is not usually adopted as an epidemiological measure to indicate effectiveness, despite being indicated by Van Mechelen's sequence of prevention (Andrade et al., 2020; Bleakley et al., 2011; López-Valenciano et al., 2020; van Mechelen et al., 1992).

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