Monday, August 26, 2013

Women’s College Soccer Injuries – Part 2: Causes, Situations and Positions

Last week, we reviewed a study that compared injuries sustained by female collegiate players on artificial turf and natural grass. As part of that study, a wealth of data was collected on the causes and situations surrounding injuries to these players. In Part 2 of this analysis, we set aside the grass-turf debate and focus on how injuries occur. The results provide some insight into risky situations and risky behaviors that lead to injuries.

One of the key variables recorded was the position each player was playing at the time of injury (see the pie cart at right). Central midfielders were the most often injured, accounting for 26.1% of the injuries. Forwards / strikers were next with 19.8% and outside backs third with 18.5%. The least injured position was goalkeeper (9.7%). We do have to consider that that only two goalkeepers play each match (1 per side) compared to four players at the other positions. When this is taken into account, goalkeepers are the second most often injured plays on the pitch.

The bar graph on the left side of the second figure shows the situations that lead to each injury. About 40% of all injuries were due to player-to-player collisions. It’s not surprising that the most common was a tackle from the side or from behind. This situation alone accounted for 17.2% of all injuries. Most coaches and players would agree that a sliding tackle for the side or behind is one of, if not the most dangerous plays. And previous research studies support this idea. This has lead FIFA to encourage stricter interpretation of the Laws of the Game pertaining to tackles. However, there is some debate as to whether this has been effective. Researchers with the FIFA Medical Assessment and Research Center (F-MARC) found that referees may be hesitant to sanction a slide tackle unless and injury occurs. This raises the possibility that that referees may not distinguish tackles with the potential for injury (careless, reckless or dangerous) from those that are lower-risk (Tscholl et al., 2007). They also point out that nearly 1/3 of injuries sustained during a sliding tackle occurred after the ball had been played and that these situations were less likely to be cautioned that when contact with the player was made first.

From a coaching perspective, there is little doubt that discouraging these types of tackles could reduce to rate of injuries sustained during training and matches. This is especially true for younger players who may not execute proper tackles or be able to defend themselves against a challenge from behind or the side.

Impact of landing on the field was the second most often injury cause (14.3%) followed non-contact cutting, jumping and sprinting was third (10.1%). Many of these types of injuries might be prevented with an injury prevention program such as the FIFA 11+ or other neuromuscular training routine. Studies have shown that neuromuscular training that involve strengthening, flexibility, balance and agility can significantly reduce the risk of non-contact knee and ankle injuries.

Surprisingly, less than 1% of the injuries were heat-related (perhaps because college soccer is played in the fall – see Part 1).

The circumstances during the match when injuries occurred are shown in the bar graph on the right side of the figure. Appling high pressure during a defensive situation resulted in the greatest percentage of injuries (23.4%) with offensive direct play causing with second most (20.5%). When injuries were classified according to offensive or defensive situations, offensive possession / direct play accounted for slightly more injuries than defensive pressure (45.7 vs 43.7%). Set pieces accounted for relatively few injuries (7.2%).

Many of these results support the findings of earlier studies and they confirm what many have long thought. Most injuries occur due to player-to-player contact and many of these involve foul play or dangerous situations such as tackles from the side / behind. What this study adds is information on playing position and match circumstances leading to injury in the women’s collegiate game. It also emphasizes the need for focused technical and physical training programs designed to reduce the risk of injury.

Meyers MC (2013) Incidence, mechanisms and severity of match related injuries on FieldTurf and Natural Grass. A 5-year prospective study. American Journal of Sports Medicine, doi:10.1177/0363546513498994.

Tscholl P, O'Riordan D, Fuller CW, Dvorak J, Junge A (2007) Tackle mechanisms and match characteristics in women's elite football tournaments. British Journal of Sports Medicine, 41, Suppl 1: i15-i19.