SPORT CONGRESS BRUSSEL 2014-05-01 UEFA Champions League injury study

Prof. Jan Ekstrand, MD, PhD Anna Hallén PTI Football Research Group Football Research Group Linköping University, Sweden Linköping University, Sweden 1st Vice-Chairman UEFA Medical Committee Former elite player

www.footballresearchgroup.eu/

5/11/2014

3 injury studies:

UEFA Champions League (2001-)

English Premier League (2011-)

Scandinavian top divisions (2001-

Database:

>100 teams

18 countries

18.000 injuries

1.2 million trainings and

matches

13 seasons

Ekstrand et al. 2014

UEFA Elite Club Injury Study

95% of all teams that have reached the semi- finals of the UEFA Champions

League since season 2001-2002 have been submitting data to the study

UCL study season 2008/09

PSV Eindhoven

AFC AJAX

Club Brugge KV

RSV Anderlecht

FC Porto

SL Benfica

FC Braga

BV Borussia Dortmund

FC Bayern München

Schalke04

Bayer Leverkusen

Hamburger SV

Olympique Lyonnais

Olympique Marseille

Paris StGermain

LOSC

Real Madrid CF

FC Barcelona

Athletico Madrid

Real Sociedad

Inter

Juventus

AC Milan

SCC Napoli

AFC Fiorentina

Arsenal FC

Manchester United FC

Manchester City

Chelsea FC

Liverpool FC

Tottenham Hotspur

Newcastle FC

FC Shakhtar Donetsk

UCL Injury Study teams 2001-14 (top 50 UEFA Club ranking)

Olympiacos FC

Panathinaikos

UEFA Elite Club Injury study report: 35 pages

Ekstrand et al. 2014

UEFA Elite Club Injury study report: 35 pages http://www.uefa.org/protecting-the-game/medical/index.html

Ekstrand et al. 2014

Post season report

Ekstrand et al. 2014

UEFA Elite Club Injury Study- What have we achieved?

• Which injuries might a team expect to see

amongst their players?

• Why do the different types of injury

happen?

• How often can the team expect them to

occur?

• How can the team best plan for, and

manage these injuries?

Practical information helping football people

working on the field

Ekstrand et al. 2014

Team of 25-28 players

• 50 injuries per season

• 1.8 injury /player /

season

• 12% of the squad

unavailable due to

injury

Ekstrand J, Hägglund M, Waldén M.

Injury incidence and injury patterns

in professional football – the UEFA

injury study. Br J Sports Med 2011

Ekstrand et al. 2014

Injury risk varies with match result

22

23

24

25

26

27

28

29

30

Won Draw Lost

Inju

ries

per

1,0

00

ho

urs

Ekstrand J, Waldén M, Hägglund M. Risk for injury when playing in a national football team. Scand J Med Sci Sports 2004.

Eirale et al. Injury epidemiology in a national football team of the middle east. Scand J Med Sci Sports 2012

Injury risk varies with type of match

0

5

10

15

20

25

30

35

Training Friendly Domestic cup Europa

league

National

league

National

team

UCL

Inju

ries/

10

00

matc

h h

ou

rs

More important match-more injuries

Ekstrand et al. 2014

When can he play?

In 15 +/-3 days

Ekstrand et al. 2014

Rare injuries—We need to collect data together

Database:

>100 teams

18 countries

18.000 injuries

13 seasons

50 MT5 fractures

100 ACL injuries

Ekstrand et al. IOC World Conference, Monaco, April 2014

There is no major difference

in the overall injury risk

between playing on

artificial turf (football turf)

neither in training nor in

matches, neither in men nor

in women, and neither at

adult elite level nor at

amateur youth level

Ekstrand et al. 2006 and 2011,

Bjørneboe et a.l 2010,

Fuller et al. 2007,

Steffen et al. 2007,

Soligaard et al. 2010

How is the risk when playing on football turf compared to playing on natural grass?

Ekstrand et al. 2014

Playing too many matches affect injury risk and performance

Ekstrand et al. IOC World Conference, Monaco, April 2014

Playing too many matches affect muscle injury rates-fatigue?

Ekstrand et al. IOC World Conference, Monaco, April 2014

0,0

0,5

1,0

1,5

2,0

2,5

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12

Inju

ries/

10

00

h

Ligament injury

-31%

Waldén et al.

Time-trends and circumstances surrounding ankle injuries in men’s professional football: an 11-year follow-up of the UEFA Champions League

injury study. BJSM 2013

Ekstrand et al. IOC World Conference, Monaco, April 2014

Development of ligament injuries, UCL 2001-2012

The total injury risk has not changed on elite level!

Ekstrand J, et al.

British Journal of Sports Medicine (BJSM) football issue Aug 2013

0

5

10

15

20

25

30

35

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12

Incid

en

ce/

10

00

h o

f m

atc

hp

lay

Training

Match

Ekstrand et al. IOC World Conference, Monaco, April 2014

11 seasons (Champions League study)

The injury risk has not changed on elite level!

Traditional preventive methods without effect?

Ekstrand et al. 2014

Hamstring muscle injury. UCL 2001-2011

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12

Inju

ries/

10

00

ho

urs

of

ex

po

sure

Ekstrand et al. 2014

How can medical staff get attention from coaches and CEOs?

Transform medical info to tactical info

• Injuries are negatively correlated to performance

• Injuries cost money

Key players on pitch

Injuries are correlated to performance

• Improved performance in the domestic

league play.

• Improved performance in international

European cups.

Hägglund et al.

Br J Sports Med 2013;47:12 738-742

Ekstrand et al. IOC World Conference, Monaco, April 2014

Low injury rates associated with:

Ekstrand: Keeping your top players on the pitch: the key to football medicine at a professional level. BJSM August 2013

Economical Impact

IF PLAYER INJURED 1 MONTH COST FOR THE CLUB = €580.000

Injury prevention

The key to prevention is team work

(coaching staff, medical staff and management staff)

Coach Team dr CEO

Ekstrand et al. 2014

Information on injury study found on UEFA.com:

http://www.uefa.com/trainingground/medical/index.htm

Ekstrand et al. 2014

Return to play after muscle injuries in football players

Anna Hallén Football Research Group

Linköping

Brussels , April 2014

Incidence of muscle injuries in Champions League teams across eleven seasons

95% of injuries affect

4 muscle groups

Quadriceps 17%

Hamstrings 37%

Calf 13%

Hip/groin 28%

Location N Mean ± SD % Re-injuries

Hamstrings 1922 18 ± 19 16

Adductors 1190 15 ± 22 16

Quadriceps 781 19 ± 22 15

Calves 652 18 ± 16 13

Location not predictive for absence

Many sorts of injuries within same location = large variation

UEFA Champions League Injury Study 2001-2013

Arsenal

Manchester United

Manchester City

Chelsea

Liverpool

Tottenham Hotspur

FC Porto

SL Benfica

Real Madrid

Barcelona

Atheltico Madrid

Glasgow Celtic

Paris St.Germain

Olympique Marseille

FC Shakhtar Donetsk

BV Borussia Dortmund

FC Bayern München

Bayer Leverkusen

Juventus FC

AC Milan

SCC Napoli

FC Internazionale

RSV Anderlecht

Club Brugge KV

AFC AJAX

PSV Eindhoven

FC Copenhagen Olympiacos Galatasaray Steua Bukarest

Examination of hamstring injuries:

100% clinical examination as basis

86% MRI or US or both

14% only clinical examination

Oedema,

No architectural distortion

Partial

rupture

Total

rupture

Normal

MRI

Peetrons, P. Eur Radiology (2002) 12: 35-43

Ekstrand et al. 2014

Grading by imaging

Oedema,

No architectural

distortion

Partial

rupture

Total

rupture

70%

No rupture

Cause > 50%

of absence

in a club

Normal

MRI

Ekstrand et al. 2012.

Hamstring muscle injuries in professional football –association of injury. MRI. Br J Sp Med

Hamstring injuries

0

10

20

30

40

50

60

Normal MRI Grade 1 Grade 2 Grade 3

Days o

f ab

sen

ce

Absence (days)

Ekstrand et al. 2012.

Hamstring muscle injuries in professional football –association of injury by MRI. Br J Sp Med

Severity of hamstring injuries

MRI and Ultrasound are valuable for

prognosticating RTP

Radiological grading associated with lay-off

times after injury.

Take home message:

Jan Ekstrand (MD, PhD) Henrik Magnusson (MSc, statistician)

Martin Hägglund (PT, PhD) Håkan Bengtsson (PT)

Markus Waldén (MD, PhD) Mariann Knudsen (PT)

Jon Karlsson (MD, PhD) Christoffer Thomeé (Data analyst)

Anna Nordström (MD, PhD) Anna Hallén (PTI)

Karolina Kristenson (MD, PhD student)

Matilda Lundblad (MD, PhD student)

Website: footballresearchgroup.eu

Twitter: @frgsweden