Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season

Abstract

The following possible risk factors for leg injuries in female soccer players were studied: age, anatomical alignment, generalized joint laxity, thigh muscle torque, muscle flexibility, ligamentous laxity of the knee and ankle joints, recent injuries, and duration of soccer exposure. A total of 146 players from 13 teams in the second and third Swedish divisions underwent clinical examination, isokinetic measurements of quadriceps and hamstring torques, and testing of postural sway of the legs. All soccer-related leg injuries resulting in absence from at least one scheduled practice session or game were recorded during one outdoor season (April-October). In 50 players there were 61 traumatic injuries, and 17 players sustained 19 overuse injuries. The overall injury incidence rate (traumatic and overuse) was 5.49/1000 h of soccer. Variables significantly increasing the risk of traumatic leg injuries included generalized joint laxity, low postural sway of the legs, hyperextension of the knee joint, and a low hamstring-to-quadriceps ratio during concentric action. Multivariate logistic regression showed hyperextension of the knee joint, a low postural sway, reduced H/Q ratio during concentric action, and a higher exposure to soccer to significantly increase the risk of traumatic leg injury. All five players who suffered an anterior cruciate ligament injury during the study period had a lower hamstring-to-quadriceps ratio during concentric action on the injured side than on their noninjured side.

Mapping current research trends on neuromuscular risk factors of non-contact ACL injury

“…Of the 4 prospective studies observing the neuromuscular markers of ACL injury, 3 evaluated muscular capacity (comprising of isokinetic knee strength and H/Q ratio) as risk factor of non-contact ACL injury (Myer, et al, 2009;Söderman, Alfredson, Pietilä, & Werner, 2001;Uhorchak, et al, 2003), and 1 study evaluated muscular activation patterns (Mette K. Zebis, Andersen, Bencke, Kjaer, & Aagaard, 2009) (see Table 4). …”

“…Soderman et al (Söderman, et al, 2001) found that an imbalance of the hamstrings to quadriceps ratio (H/Q ratio) between legs in female athletes was predictive of players who suffered an ACL injury, with a lower H/Q ratio on the side that would become injured (Söderman, et al, 2001). On the contrary, Uhorchak et al (Uhorchak, et al, 2003) did not find differences in H/Q ratios for males and females who go on to suffer ACL injury.…”

“…This systematic review found only four prospective studies of which three studies looked into muscular capacity (Myer, et al, 2009;Söderman, et al, 2001;Uhorchak, et al, 2003) and only one study into muscular activation patterns (Mette K. Zebis, et al, 2009). From the studied cohorts, there were only a small number of individuals who incurred an injury with injury rates ranging from 1.3% to 9.0%.…”

“…With low rates of injury, suggestions for future work have been that risk of ACL injury would need to be studied in substantially larger cohorts than typically done but the cost associated to that is simply too high. The relatively higher incidence of injury in females has led to most cohort studies only involving females (Myer, et al, 2009;Söderman, et al, 2001; Mette K. Zebis, et al, 2009). …”

“…Differences between injured and non-injured individuals were small, providing relatively low sensitivity and specificity of the measure to predict injury (Myer, et al, 2009;Söderman, et al, 2001;Uhorchak, et al, 2003;Mette K. Zebis, et al, 2009). The value of the risk factors for targeted screening with a focus on differentiating interventions based on risk is therefore limited.…”