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. 2005 Aug;39(Suppl 1):i3–i9. doi: 10.1136/bjsm.2005.018937

A six year prospective study of the incidence and causes of head and neck injuries in international football

C Fuller, A Junge, J Dvorak
PMCID: PMC1765312  PMID: 16046353

Abstract

Objective: To identify those risk factors that have the greatest impact on the incidence of head and neck injuries in international football.

Method: A case–control study of players sustaining head and neck injuries during 20 FIFA tournaments (men and women) from 1998 to 2004. Video recordings of incidents were used to identify a range of parameters associated with the incidents. Team physicians provided medical reports describing the nature of each injury. χ2 tests (p⩽0.01) and 95% confidence intervals were used to assess differences in distribution and incidence of injury, respectively.

Results: In total, 248 head and neck injuries were recorded of which 163 were identified and analysed on video sequences. The commonest injuries were contusions (53%), lacerations (20%), and concussions (11%). The incidence of all head and neck injuries was 12.5/1000 player hours (men 12.8, women 11.5) and 3.7 for lost-time injuries (men 3.5, women 4.1). The commonest causes of injury involved aerial challenges (55%) and the use of the upper extremity (33%) or head (30%). The unfair use of the upper extremity was significantly more likely to cause an injury than any other player action. Only one injury (a neck muscle strain) occurred as a result of heading the ball throughout the 20 tournaments equivalent to 0.05 injuries/1000 player hours.

Conclusions: Players' actions most likely to cause a head or neck injury were the use of the upper extremity or the head but in the majority of cases these challenges were deemed to be fair and within the laws of the game.

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Selected References

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  1. Andersen T. E., Arnason A., Engebretsen L., Bahr R. Mechanisms of head injuries in elite football. Br J Sports Med. 2004 Dec;38(6):690–696. doi: 10.1136/bjsm.2003.009357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Andersen T. E., Larsen Ø, Tenga A., Engebretsen L., Bahr R. Football incident analysis: a new video based method to describe injury mechanisms in professional football. Br J Sports Med. 2003 Jun;37(3):226–232. doi: 10.1136/bjsm.37.3.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Andersen Thor Einar, Floerenes Tonje Waale, Arnason Arni, Bahr Roald. Video analysis of the mechanisms for ankle injuries in football. Am J Sports Med. 2004 Jan-Feb;32(1 Suppl):69S–79S. doi: 10.1177/0363546503262023. [DOI] [PubMed] [Google Scholar]
  4. Aubry M., Cantu R., Dvorak J., Graf-Baumann T., Johnston K., Kelly J., Lovell M., McCrory P., Meeuwisse W., Schamasch P. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Br J Sports Med. 2002 Feb;36(1):6–10. doi: 10.1136/bjsm.36.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Barnes B. C., Cooper L., Kirkendall D. T., McDermott T. P., Jordan B. D., Garrett W. E., Jr Concussion history in elite male and female soccer players. Am J Sports Med. 1998 May-Jun;26(3):433–438. doi: 10.1177/03635465980260031601. [DOI] [PubMed] [Google Scholar]
  6. Boden B. P., Kirkendall D. T., Garrett W. E., Jr Concussion incidence in elite college soccer players. Am J Sports Med. 1998 Mar-Apr;26(2):238–241. doi: 10.1177/03635465980260021301. [DOI] [PubMed] [Google Scholar]
  7. Cantu R. C. Head injuries in sport. Br J Sports Med. 1996 Dec;30(4):289–296. doi: 10.1136/bjsm.30.4.289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Collie A., Darby D., Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med. 2001 Oct;35(5):297–302. doi: 10.1136/bjsm.35.5.297. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Delaney J. Scott, Lacroix Vincent J., Leclerc Suzanne, Johnston Karen M. Concussions among university football and soccer players. Clin J Sport Med. 2002 Nov;12(6):331–338. doi: 10.1097/00042752-200211000-00003. [DOI] [PubMed] [Google Scholar]
  10. Dvorak J., Junge A. Football injuries and physical symptoms. A review of the literature. Am J Sports Med. 2000;28(5 Suppl):S3–S9. doi: 10.1177/28.suppl_5.s-3. [DOI] [PubMed] [Google Scholar]
  11. Ettlinger C. F., Johnson R. J., Shealy J. E. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med. 1995 Sep-Oct;23(5):531–537. doi: 10.1177/036354659502300503. [DOI] [PubMed] [Google Scholar]
  12. Fuller C. W., Junge A., Dvorak Jiri. An assessment of football referees' decisions in incidents leading to player injuries. Am J Sports Med. 2004 Jan-Feb;32(1 Suppl):17S–22S. doi: 10.1177/0363546503261249. [DOI] [PubMed] [Google Scholar]
  13. Fuller C. W., Smith G. L., Junge A., Dvorak Jiri. An assessment of player error as an injury causation factor in international football. Am J Sports Med. 2004 Jan-Feb;32(1 Suppl):28S–35S. doi: 10.1177/0363546503261247. [DOI] [PubMed] [Google Scholar]
  14. Fuller C. W., Smith G. L., Junge A., Dvorak Jiri. The influence of tackle parameters on the propensity for injury in international football. Am J Sports Med. 2004 Jan-Feb;32(1 Suppl):43S–53S. doi: 10.1177/0363546503261248. [DOI] [PubMed] [Google Scholar]
  15. Giza Eric, Fuller Colin, Junge Astrid, Dvorak Jiri. Mechanisms of foot and ankle injuries in soccer. Am J Sports Med. 2003 Jul-Aug;31(4):550–554. doi: 10.1177/03635465030310041201. [DOI] [PubMed] [Google Scholar]
  16. Guskiewicz Kevin M., Marshall Stephen W., Broglio Steven P., Cantu Robert C., Kirkendall Donald T. No evidence of impaired neurocognitive performance in collegiate soccer players. Am J Sports Med. 2002 Mar-Apr;30(2):157–162. doi: 10.1177/03635465020300020201. [DOI] [PubMed] [Google Scholar]
  17. Hawkins R. D., Fuller C. W. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med. 1999 Jun;33(3):196–203. doi: 10.1136/bjsm.33.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hawkins R. D., Fuller C. W. An examination of the frequency and severity of injuries and incidents at three levels of professional football. Br J Sports Med. 1998 Dec;32(4):326–332. doi: 10.1136/bjsm.32.4.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hawkins R. D., Fuller C. W. Risk assessment in professional football: an examination of accidents and incidents in the 1994 World Cup finals. Br J Sports Med. 1996 Jun;30(2):165–170. doi: 10.1136/bjsm.30.2.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Johnston K. M., McCrory P., Mohtadi N. G., Meeuwisse W. Evidence-Based review of sport-related concussion: clinical science. Clin J Sport Med. 2001 Jul;11(3):150–159. doi: 10.1097/00042752-200107000-00005. [DOI] [PubMed] [Google Scholar]
  21. Junge Astrid, Dvorak Jiri, Graf-Baumann Toni, Peterson Lars. Football injuries during FIFA tournaments and the Olympic Games, 1998-2001: development and implementation of an injury-reporting system. Am J Sports Med. 2004 Jan-Feb;32(1 Suppl):80S–89S. doi: 10.1177/0363546503261245. [DOI] [PubMed] [Google Scholar]
  22. Kirkendall D. T., Jordan S. E., Garrett W. E. Heading and head injuries in soccer. Sports Med. 2001;31(5):369–386. doi: 10.2165/00007256-200131050-00006. [DOI] [PubMed] [Google Scholar]
  23. Matser J. T., Kessels A. G., Jordan B. D., Lezak M. D., Troost J. Chronic traumatic brain injury in professional soccer players. Neurology. 1998 Sep;51(3):791–796. doi: 10.1212/wnl.51.3.791. [DOI] [PubMed] [Google Scholar]
  24. McCrory P. R., Bladin P. F., Berkovic S. F. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ. 1997 Jan 18;314(7075):171–174. doi: 10.1136/bmj.314.7075.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. McCrory Paul R. Brain injury and heading in soccer. BMJ. 2003 Aug 16;327(7411):351–352. doi: 10.1136/bmj.327.7411.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Putukian M., Echemendia R. J., Mackin S. The acute neuropsychological effects of heading in soccer: a pilot study. Clin J Sport Med. 2000 Apr;10(2):104–109. doi: 10.1097/00042752-200004000-00004. [DOI] [PubMed] [Google Scholar]
  27. Putukian Margot. Heading in soccer: is it safe? Curr Sports Med Rep. 2004 Feb;3(1):9–14. doi: 10.1249/00149619-200402000-00003. [DOI] [PubMed] [Google Scholar]
  28. Rahnama N., Reilly T., Lees A. Injury risk associated with playing actions during competitive soccer. Br J Sports Med. 2002 Oct;36(5):354–359. doi: 10.1136/bjsm.36.5.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tysvaer A. T. Head and neck injuries in soccer. Impact of minor trauma. Sports Med. 1992 Sep;14(3):200–213. doi: 10.2165/00007256-199214030-00006. [DOI] [PubMed] [Google Scholar]
  30. Wilson B. D., Quarrie K. L., Milburn P. D., Chalmers D. J. The nature and circumstances of tackle injuries in rugby union. J Sci Med Sport. 1999 Jun;2(2):153–162. doi: 10.1016/s1440-2440(99)80195-9. [DOI] [PubMed] [Google Scholar]
  31. Wojtys E. M., Hovda D., Landry G., Boland A., Lovell M., McCrea M., Minkoff J. Current concepts. Concussion in sports. Am J Sports Med. 1999 Sep-Oct;27(5):676–687. doi: 10.1177/03635465990270052401. [DOI] [PubMed] [Google Scholar]

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