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Ucl injury study brusells 2014 05-01

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JanEkstrand

The Football Research Group at Linköping University studied injuries in the UEFA Champions League over 13 seasons from 2001-2014. They collected data from over 100 teams across 18 countries and 18,000 injuries. Their studies found that hamstring, adductor, quadriceps and calf muscle injuries were most common, accounting for over 90% of injuries. MRI imaging was valuable in grading hamstring injuries and prognosticating return to play times, with more severe injuries indicated by MRI features like edema and architectural distortion linked to longer lay-offs. While overall injury rates have not decreased, ligament injuries have reduced by 31% from 2001-2012. Keeping star players available and avoiding overuse through fixture congestion are keys to team performance and

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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 Injuriesper1,000hours 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 Injuries/1000matchhours 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 Injuries/1000h 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 Incidence/1000hofmatchplay 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 Injuries/1000hoursofexposure
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) CoachTeam drCEO 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
Ucl injury study brusells 2014 05-01
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
Ucl injury study brusells 2014 05-01
0 10 20 30 40 50 60 Normal MRI Grade 1 Grade 2 Grade 3 Daysofabsence 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

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Ucl injury study brusells 2014 05-01

  • 1. 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
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. UEFA Elite Club Injury study report: 35 pages Ekstrand et al. 2014
  • 7. UEFA Elite Club Injury study report: 35 pages http://www.uefa.org/protecting-the-game/medical/index.html Ekstrand et al. 2014
  • 9. 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
  • 10. 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
  • 11. Injury risk varies with match result 22 23 24 25 26 27 28 29 30 Won Draw Lost Injuriesper1,000hours 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
  • 12. 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 Injuries/1000matchhours More important match-more injuries Ekstrand et al. 2014
  • 13. When can he play? In 15 +/-3 days Ekstrand et al. 2014
  • 14. 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
  • 15. 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
  • 16. Playing too many matches affect injury risk and performance Ekstrand et al. IOC World Conference, Monaco, April 2014
  • 17. Playing too many matches affect muscle injury rates-fatigue? Ekstrand et al. IOC World Conference, Monaco, April 2014
  • 18. 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 Injuries/1000h 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
  • 19. 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 Incidence/1000hofmatchplay Training Match Ekstrand et al. IOC World Conference, Monaco, April 2014 11 seasons (Champions League study)
  • 20. 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 Injuries/1000hoursofexposure
  • 21. 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
  • 22. 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:
  • 23. 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
  • 24. Injury prevention The key to prevention is team work (coaching staff, medical staff and management staff) CoachTeam drCEO Ekstrand et al. 2014
  • 25. Information on injury study found on UEFA.com: http://www.uefa.com/trainingground/medical/index.htm
  • 27. Return to play after muscle injuries in football players Anna Hallén Football Research Group Linköping Brussels , April 2014
  • 29. 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%
  • 30. 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
  • 31. 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
  • 32. 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
  • 33. 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
  • 35. 0 10 20 30 40 50 60 Normal MRI Grade 1 Grade 2 Grade 3 Daysofabsence 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
  • 36. MRI and Ultrasound are valuable for prognosticating RTP Radiological grading associated with lay-off times after injury. Take home message:
  • 37. 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