On average, a professional football team made up of 25 players experiences 50 injuries over a season, so each player can get injured twice a year.¹ One of the main training objectives is players’ availability to work out and compete. Financial loss and negative effects caused by injuries can unfold into a negative scenario or even lead to losing a game or a championship.^2,3,4

In spite of all the measures implemented by professional clubs to avoid injuries and get their athletes back to the field as soon as possible, the injury rate in football is still high. A recent publication reviewed research aimed to quantify the injury incidence in professional football.⁵ Conclusions are drawn from a review of 44 research articles meeting the following criteria: (i) injuries had to be based on players’ time out of play; (ii) participants had to be professional players; (iii) articles had to be published in English and in a journal including a peer review system before March 2018 and (iv) articles had to show the players’ injury or prevalence rates. The following databases were used: PubMed, Scopus, Excerpta Medica Database (EMBASE), Allied and Complementary Medicine Database (AMED), Google Scholar and the Cochrane Library.

The review results suggest some really remarkable conclusions:

• Injury rate in professional football is 8.1 injuries/1000 hours of exposure. Game injury incidence (36 injuries/1000 hours of exposure) is almost 10 times higher than training injury incidence rate (3.7 injuries/1000 hours of exposure).
• Lower extremity injuries have the highest incidence rates (6.8 injuries/1000 hours of exposure) compared to other parts of the body. The trunk is the second part of the body experiencing the most injuries (0.4 injuries/1000 hours of exposure), whereas upper limbs ranked third (0.3 injuries/1000 hours of exposure). On the other hand, the head and the neck present the lowest injury incidence rate (0.2 injuries/1000 hours of exposure).
• With regard to lower limb injuries, from the most to the least important parts, the worst-affected ones are: thigh (1.8 injuries/1000 hours of exposure), knee (1.2 injuries/1000 hours of exposure), ankle (1.1 injuries/1000 hours of exposure), hip/groin (0.9 injuries/1000 hours of exposure), lower part of the leg/the Achilles tendon (0.8 injuries/1000 hours of exposure) and feet/toes (0.4 injuries/1000 hours of exposure).
• The most common injury is that of muscle/tendon (4.6 injuries/1000 hours of exposure), followed by bruises (1.4 injuries/1000 hours of exposure), other unspecified injuries (0.6 injuries/1000 hours of exposure), joints and ligaments (0.4 injuries/1000 hours of exposure), bone fracture and stress injuries (0.2 injuries/1000 hours of exposure), lacerations (0.05 injuries/1000 hours of exposure) and central/peripheral nervous system injuries (0.04 injuries/1000 hours of exposure).
• Injuries causing 1-3 days of time loss are the most common (3.1 injuries/1000 hours of exposure), followed by moderate injuries (8-28 days, 2.0 injuries/1000 hours of exposure), minor injuries (4-7 days, 1.7 injuries/1000 hours of exposure) and severe injuries (more than 28 days, 0.8 injuries/1000 hours of exposure).
• Injury incidence rate of the 5 main European leagues (the Premier League in England, Serie A in Italy, Bundesliga in Germany, Ligue 1 in France, and La Liga in Spain) is not different from other professional leagues’ rate in other countries (7.6 v. 6.8 injuries/1000 hours of exposure, respectively). In descending order, the average injury incidence rate in training and competition are the following: games of the 5 main leagues: 35.5; games of other professional leagues: 31.9; training sessions of other professional leagues: 3.9 and training sessions of the 5 main leagues: 3.6.
• The new injury incidence rate is higher than recurrent ones (7.0 and 1.3 injuries/1000 hours of exposure, respectively).
• The injury incidence rate of international tournaments in which teams take part is higher than that of national competitions (9.8 v. 7.5 injuries/1000 hours of exposure). In more detail, the injury incidence rate is the following: international games (41.1 injuries/1000 hours of exposure), national games (32.3 injuries/1000 hours of exposure), national training sessions (3.8 injuries/1000 hours of exposure) and international training sessions (3.5 injuries/1000 hours of exposure).

Carlos Lago Peñas

References:

¹ Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 2011;45:553–8.

² Hägglund M, Waldén M, Magnusson H, et al. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA champions League injury study. Br J Sports Med 2013;47:738-42. 3

³ Eirale C, Tol JL, Farooq A, et al. Low injury rate strongly correlates with team success in Qatari professional football. Br J Sports Med 2013;47:807-8.

⁴ Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br J Sports Med 2013;47:723-4. Feeley BT, Agel J, LaPrade RF. When is it too early for single sport specialization? Am J Sports Med. 2016;44(1):234-241.

⁵ López-Valenciano A, Ruiz-Pérez I, García-Gómez A, et al. Epidemiology of injuries in professional football: a systematic review and meta-analysis. Br J Sports Med 2020;54:711-718.