The risk of injury in football is high. A professional football team with 25 players suffers in average 50 injuries during a season. The injury rate is 8.1 injuries/1000 hours of exposition with a ten-time higher incidence in games compared to what happens in training sessions.

Apart from scientific evidence and clinical experience, the success of injury prevention and injury recovery programs has a lot to do with the players and coaches’ beliefs and expectations. When scientific evidence agrees with the athlete’s beliefs, it is relatively easy to avoid or present a new approach. However, in other opportunities, the perception of players and coaches might differ from scientific evidence which normally supports the intervention routines. Thus, it is very important to understand which factors influence athletes and coaches to accept, adopt, and comply with the elements of the intervention. Adherence to the training proposals is higher when the athletes believe in what they do. We already know that a high prevention program compliance leads to a lower probability of injury.

How do players and coaches perceive the risk of injury?

Some recent researches have studied the perception of football players and coaches on the factors that can lead to an injury and the prevention and recovery strategies. Some interesting conclusion were drawn from them:

1. Coaches and players are convinced that injuries are a serious problem that, in general, can be avoided by implementing special prevention and recovery programs.

2.  Players and coaches have different opinions about when to return to play after an injury. While players want to decide on their own (81%), coaches of teams rely on physicians as the main character (84%) to take a decision. Sometimes, both groups take decisions against the physician’s recommendation (64% and 87% respectively). Curiously, 29% of players and 71% of coaches observed relapses after not following the physician’s recommendation on not to return to play. In this sense, it was demonstrated that internal communication in high performance football teams is quite important. It also proved how it is correlated to injuries and the player’s availability to train and compete. Creating a good working environment in the club, asking about and showing interest in other people’s work and designing internal communication protocols (channels, meeting calendars, location in the week, reports to be presented, …) to promote positive interaction between the coaching staff members and the players are highly recommended actions.

3. According to players, four out of the five main risk factors that lead to injuries are related to fatigue: poor rest/sleep, little recovery between games, too many games and excessive training. The most significant factor was related to lower levels of strength. However, football players did not consider the history of injuries and the age as key elements leading to injuries.

4. Almost all players and coaches surveyed stated that injury prevention is important or very important and most of them stated that they felt well-informed about the topic.

5. According to players, the most important factor to ensure the effectiveness of injury prevention and recovery programs was related to the monitoring of load in the training session and the competition. Warm-up routines, lumbopelvic stabilization, proprioceptive and functional training, diet control and flexibility work were the other factors considered as very important. Nevertheless, rotations in games were not considered as an important aspect to prevent injuries.

To sum up, the perception of players partially agrees with the existing scientific evidence. The proposal of an injury prevention and recovery program based exclusively on scientific evidence will possibly be rejected by some players posing a risk for their success. To be precise, the aspects related to participation in the game (when to return to play after an injury and the implementation of rotations in games) seem to be the two aspects that can lead to most of the problems a player can face. The medical team and coaches should know the perceptions and beliefs of their athletes. Since they can be influenced by what football players have learnt from the medical team/coach, it is recommended to propose formative activities that enable the development of their beliefs based on the solid and scientific information that can facilitate the prevention programs compliance. When the scientific evidence is solid, but the athlete does not believe in what they will do, patience is needed. When appropriate, it is recommended to talk about the archetypes of athletes who adopt interventions based on science.

References:

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.

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

Silvers-Granelli H, Mandelbaum B, Adeniji O, Insler S, Bizzini M, Pohlig R, Junge A, Snyder-Mackler L, Dvorak J. 2015. Efficacy of the FIFA 11+ injury prevention program in the collegiate male soccer player. Am J Sports Med. 43(11):2628–2637.

Liporaci R, Yoshimura S, Manfredini B. 2021. Perceptions of Professional Football Players on Injury Risk Factors and Prevention Strategies. Sci Med Football. Ahead of print.

Loose O, Achenbach L, Fellner B, Lehmann J, Jansen P, Nerlich M, Angele P, Krutsch W. 2018. Injury prevention and return to play strategies in elite football: no consent between players and team coaches. Arch Orthop Trauma Surg. 138(7):985–992.

Zech A, Wellmann K. 2017. Perceptions of football players regarding injury risk factors and prevention strategies. PloS One. 12(5): e0176829.

Ekstrand J, Lundqvist D, Davison M, et al. Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. Br J Sports Med 2019; 53: 304-308.