The perception of injury risk and prevention among football players: A systematic review

Introduction

In football (soccer), given the popularity of the sport, the large number of players and the levels of competition, injuries are frequent (1).

Overall, the incidence of injuries in professional football players is 8.1 injuries/1,000 h of exposure for male players (2), and 6.1 injuries/1,000 h of exposure for female players (3). At the amateur level, generally, the incidence is 12.5/1,000 h of exposure (4). For both groups and competitive levels, the incidence of injuries is higher in matches than in training sessions, and lower extremity injuries have the highest incidence rates (2–4). Also, most time-loss injuries in professional football players led to an absence of up to four weeks (5).

With such numbers, football-related injuries may have a major negative impact on physical, mental and financial burden on the players and their clubs. For example, the mean cost of an injured player in a professional team has been reported for 500.000€/month (6). Also, injuries may have a significant impact on socioeconomic systems worldwide (7), thus requiring socio-ecological perspectives that consider the specific contexts and integrate comprehensive analyses at multiple levels (8).

There is a growing call to advance the translation of evidence-based sports injury prevention programs into sustained use in practice. Studies suggest that successful incidents with risk-taking may clue to a reduction in injury risk perception in sports. Conversely, an overestimation of the risk may increase the risk of injury due to the inability to make no-risk decisions (9). To implement effective and meaningful interventions toward injury risk and prevention, it is essential to acknowledge the players' perspectives on this topic.

Thus, the present systematic review aims to provide an overview of football players' perceptions, beliefs, attitudes, and knowledge regarding injury risk and prevention, based on epidemiological definitions.

Methods

We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria (PRISMA) to conduct this systematic review (10). The PRISMA 2020 checklist is available for further consultation in Supplementary Material S1. The protocol has been registered in PROSPERO (reference number CRD42021270395).

Eligibility criteria

Studies were considered eligible considering the following inclusion criteria: (i) the participants were male or female football (i.e., soccer) players; (ii) the intervention included any form of football practice as competitive or amateur; and (ii) outcome measures included perceptions, beliefs, attitudes, or knowledge towards injury risk and prevention.

Articles were excluded according to the following criteria: studies not in humans or other agents involved in sports such as coaches, medical or science departments; type of studies such as editorials, comments, case reports, guidelines, reviews or conference abstracts; studies that did not apply only to football but rather other sports, including studies with other football codes; studies that did not guide or have the primary outcome of interest.

Information sources

An electronic search was conducted in PubMed, Scopus, Web of Science and APA PsychINFO, from inception until July 2022, to identify articles assessing the perception of injury risk and injury prevention among football players.

Search strategy

For database search, we used the following keywords: (“injury risk” OR “injury prevention”) AND (perception OR beliefs OR knowledge OR attitude) AND (football OR soccer). We did not apply limits to the search. The full search strategy is available in Supplementary Material S2.

Selection process

According to predefined steps, two authors (BCM and AB) independently reviewed the search results and screened publications retrieved from databases. First, articles were screened by the information outlined in the title and abstract. Then, articles potentially relevant were retrieved for full-text reading and determined eligibility for the review. Disagreements between authors were solved by consensus.

Data collection process

Two authors (BCM and AB) independently evaluated each selected article to extract information from the eligible studies. Data were compared and discussed in case of discrepancies. If necessary, the study authors were contacted to provide further explanation.

Data items

From the eligible studies, data were extracted regarding (1) study characteristics (first author, year of publication, country, objectives, design, instrument of data collection); (2) study participants (including age, sex, level of competition); (3) team type; and (4) outcomes (perceptions, attitudes, beliefs and knowledge about injury risk and prevention strategies).

Risk of bias assessment

To assess the risk of bias, two researchers (BCM and AB) independently applied the Joanna Briggs Institute (JBI) critical appraisal checklist according to the study design: randomized controlled trial (RCT) (11), cohort (12), cross-sectional (12), and qualitative and mixed methods' studies (13). If disagreements occurred, authors discussed them until they reached a consensus.

Synthesis methods

We conducted a narrative synthesis of included studies. We analysed and computed the outcomes of interest concerning football players' perceptions, beliefs, knowledge and attitudes about injury risk and injury prevention for each study.

Results

Study selection

A total of 800 references were identified in the initial search from electronic databases search. After removing duplicated studies (n = 313), 487 studies remained. In step 1, 444 articles were excluded, and 43 studies were eligible for full-text reading, from which 29 were removed. Thus, 14 studies were included for qualitative synthesis (Figure 1).

FIGURE 1

Figure 1. PRISMA 2020 flow diagram of included studies.

Study characteristics

Studies included were conducted in Qatar (14), Canada (15, 16), Norway (17), United Kingdom (18, 19), Germany (20, 21), United States of America (22), Ireland (23), Brazil (24), Brunei (25), Austria (26), and Hong Kong Special Administrative Region of the People's Republic of China (27) (Table 1).

TABLE 1

Table 1. Characteristics of included studies.

All studies were published in English between 1998 and 2022. Regarding the study design, eight studies were cross-sectional (14, 15, 19, 21, 23–25, 27), two were cluster-randomized controlled trials (16, 17), two were cohort (20, 22), one was qualitative (18), and one used mixed methods (26). The sample sizes ranged from 30 to 1,129 participants. The participants’ age ranged from 11 to 40 years old. The studies comprised elite and professional players (14, 17–20, 24, 26, 27), youth and amateur players (15, 16, 22, 23, 25), and one study involved both competitive levels (21). Five studies included both genders (17, 18, 22, 25, 27), four studies were conducted on female players (14–16, 23), and five studies involved male players (19–21, 24, 26) (Table 1).

Seven studies used a questionnaire (15, 16, 18–20, 24, 25), five studies used a survey (14, 17, 21, 23, 27), one study used a scale to analyse the perception of injury risk and injury prevention among football players (22), and one study used semi-structured interviews and focus groups (26) (Table 2).

TABLE 2

Table 2. Findings of included studies.

Risk of bias in studies

The included studies presented several methodological limitations. In RCT studies (11), the most common issues identified were the lack of information on randomization, allocation concealment and blinding. In cohort studies (12), most of the concerns were related to the report of factors and strategies to deal with confounding, the follow-up of participants and statistical analysis. In cross-sectional studies (12), the majority of issues identified were linked to the report of factors and strategies to deal with confounding, and the validity of the instruments used to measure the outcomes. In qualitative (13) and mixed-methods studies (13), studies lacked the statement of the influence of the researcher on the research. The assessment of the risk of bias in the studies is available in Supplementary Material S3. There was an agreement between authors when assessing the risk of bias.

Results of individual studies

The detailed findings regarding the perceptions, beliefs, attitudes and knowledge of injury risk and prevention among football players are described in Table 2.

Gender differences

Deeming to the perceptions between genders, McKay et al. (16) reported that 27.8% of female players believe that male and female soccer players have the same overall risk of injury. On the other hand, Kontos et al. (22) reported that boys (11–14 years) described significantly higher levels of risk-taking and lower levels of perceived risk than girls (Table 2).

Injury risk factors

Concerning the perceptions about injury risk, most football players agreed that their risk of sustaining an injury was moderate to high and players expected to sustain at least one injury during the following season (14, 15, 17). Most football players believed injuries are a severe problem (20). Regarding overuse injuries, half of the players considered to be at high risk, and 10% of the players thought football players have an increased risk of illnesses (17). Considering injury severity, 50% and 40% of the players believed fractures and concussions to be very serious injuries, respectively (15). Also, Kontos et al. (22) noted that lower levels of perceived risk increased injury risk.

Intrinsic factors

The most frequently cited intrinsic injury risk factors were poor muscle strength (14, 24), lack of physical fitness (20, 25) and fatigue (21, 23) (Table 3). In the study of Alahmad et al. (23), joint mobility and menstrual regulation were not reasons to increase the risk of injuries in female athletes.

TABLE 3

Table 3. Summary of injury risk and prevention factors.

Extrinsic factors

The most commonly mentioned extrinsic injury risk factors for injury risk were excessive training (24), the type or condition of a playing surface and specifically the artificial surface (14, 18) (Table 3). Concerning the equipment, the study of Hawkins (19) found that in training, 51 players (out of 55) never wore shin pads, even though 30 of these players agreed that wearing shin pads reduced the risk of a lower leg injury.

Injury prevention factors

Despite players knowing that the risk of injury was high, their beliefs surrounding the perception of injury prevention and actual practices were low (14, 15). Players seem to be interested in injury prevention strategies and consider them very important (20, 21).

However, for example, a study of McKay et al. (15) showed that, besides the expectation to reduce the injury risk with the FIFA 11 + program, players reported a limited intention to use it. Having enough time, making the programme a routine, and having someone taking responsibility for leading the prevention programme were facilitators perceived as necessary for players (15). Moreover, 60% of the players reported poor team support of the program, finding the programme too complex, and scheduling changes by club officials, soccer federations and team staff as key barriers to the injury prevention program's implementation (15, 19, 26) (Table 2).

Intrinsic factors

Motivation (14), diet control (24) and knowledge about the cause of injury (23) were the intrinsic aspects identified to injury prevention (Table 3).

Extrinsic factors

The most frequent players' features for preventing injuries were a warm-up (16, 19, 23–25), strength and conditioning training (19, 24, 25, 27), and workload monitoring (17, 24, 26) (Table 3).

Discussion

In the present systematic review, we summarized the evidence regarding football players' perceptions, beliefs, attitudes and knowledge toward injury risk and prevention. The injury risk is multifactorial: it entangles a match between the intrinsic and extrinsic factors. On this road, we should be aware of biomechanical, anatomical, hormonal, physiological, psychological, social, and neuromuscular factors that involve and evolves the athlete (28). Therefore, it is urgent to reflect that intrinsic and extrinsic risk factors should be studied and monitored by the technical and medical teams.

Verhagen et al. (29), explain the leadership and communication to enhance health and performance in elite sports: a multidisciplinary team is required to follow the road around all of these factors that are perceived by the athlete as the risk of injury.

Lack of muscle regeneration, densely packed games in a season, inadequate workload management, and inadequate warm-up were commonly cited extrinsic risk factors for injury (16, 17, 19, 21, 23, 24). Players perceived artificial turf or uneven terrains as a possible extrinsic factor for injury, and players considered wearing shinpads to reduce the risk of injury (15, 19, 20, 22). Since the extrinsic factors were important perceived risk factors for injury, they can be monitored during the season. These factors could be used in athlete screening to target preventive interventions (30).

Overall, one of the most frequently cited intrinsic injury risk factors was poor muscle strength (14, 24), despite the already known evidence of the effectiveness of neuromuscular training strategies in reducing injury in football players (31). For example, one study conducted in female football players showed that a 15-minute neuromuscular exercise programme reduced the rate of ACL injuries, severe knee injuries and overall injuries (32).

In this systematic review, female players reported significantly lower levels of risk-taking and higher levels of perceived risk than male players. Nevertheless, gender-related risk factors show female populations to have a higher predisposition to ACL injury than males (33). However, there are no evidence-based guidelines around hormonal regulation and the injury risk for female athletes for practitioners to apply (34, 35). Particularly, in the area of injury risk, further studies are needed.

However, the lack of uptake and current maintenance of such programs is an ongoing concern. For instance, high compliance with the 11+, an injury prevention programme developed by FIFA targeting to reduce the sway of intrinsic injury risk factors in football, led to decreases in injury rates and time loss in football players (36). Also, players with high compliance with neuromuscular training programs significantly reduced ACL injury rates compared with players with low compliance (37). This highlights the importance of consistency and compliance with injury prevention training.

In this study, although most studies reveal that football players have the perception of their higher injury risk, their motivation and attitude to pursue prevention programs were limited. Lack of personal, coach and team motivation were cited as the main reasons for that (15).

Currently, significant deterioration in team and player compliance may occur throughout the season (31, 38). If injury awareness was given a similar weighting in elite sports as in any other highly physical occupation, the potential benefits and long-term health improvement could be significant (39). Therefore, the focus on implementation is critical to influencing knowledge, behaviour change, and sustainability of evidence-informed injury prevention practice. In future dissemination of injury prevention programs, players' reluctance to sustain exercise protocols should be addressed as a potential barrier to implementation (40).

Van der Horst et al. (41) studied the key issues in motivating football players to adhere to the Nordic hamstring training programme to decrease the risk of hamstring injuries. The issues were knowledge of the programme and personal motivation. Coaches and medical departments also cited personal enthusiasm and consensus with team staff to encourage adherence to the programme (41).

Moreover, the main enablers for players to implement a load management approach were scientific evidence for improved performance (88%) and mitigation of injuries and illnesses (84%), and a positive attitude of the coach towards it (86%) (17). This aligns with Andersson et al. (37), which established a link between player motivation and coach motivation.

Though injury prevention programs might be effective, there is a need to ensure the real vision of all stakeholders for failing to adhere to them. Players reported their motivation and the cooperation of the coach as facilitators (14, 15).

Therefore, if players have a high interest in injury prevention (22, 23, 25, 27) and firm beliefs about the warm-up (18, 21, 36, 38), workload management (19, 38), flexibility training (19, 24) and strength training (19, 24, 27) as well as diet (38), a multidisciplinary team can address the need of the injury prevention programs.

However, there is still a lack of knowledge regarding the quantity and quality of coach-led injury prevention plans and the relative impact on players' performance. Therefore, injury prevention efforts need to be built around athletes' behaviours to be effective. Consequently, there is a need to know and understand more about the behavioural aspects related to injury occurrence.

Also, it is vital to identify reasons and perceptions for increasing adherence to injury prevention programs in real-world settings by including the limitations and barriers throw players' vision. It is now understood that sports injury interventions will not have a significant public health impact if they are not widely accepted and adopted by all stakeholders (42). Moreover, real-world implementation of injury prevention interventions and evaluation of their effectiveness needs to consider the wide-ranging environmental context in which they are introduced.

The most frequently quoted injury risk issue was the lack of muscle regeneration with a short break between matches and a high number of matches in a season (22, 38). Though, players strongly believed that workload management could support reducing injury risk.

Alongside the lack of medical support (22, 36), it's important to reflect on the periods of over-scheduling during the season, in which the player's training load increases, cutting player recovery time. Furthermore, all stakeholders should help in the schedule and consider the moments of injury risk reduction, as well as awareness about the management of training conditions, such as artificial turf and field conditions, since they were perceived as a common cause of injuries (16, 20).

Concerning the agenda, players described scheduling changes as a significant hurdle for the injury prevention session (15, 17, 19, 26). Although at the same time, the agenda is problematic for the strength and conditioning training programs, the planning and integration of soccer practices that could promote injury prevention, such as small-sided games, is a worthwhile opportunity (43).

Implications for practice

Sports injuries can result in significant setbacks, pain, social isolation, depression, disability and loss of income being some of them (44). It can also predispose athletes to degenerative disorders, such as osteoarthritis (44). A preventive approach is paramount, and exercise can be an effective tool to prevent sports-related injuries. Thus, the factors hindering athletes' injury awareness from achieving occupational health standards can be discussed from organizational, societal and individual safety management perspectives (45). Multi-level engagement strategies are required to maximize athlete adherence to the programs. Hence, future studies should focus on enhancing performance programs to catch athletes' engagement in prevention strategies.

There is also a lack of studies regarding the epidemiology of football-related injuries, especially in women's football, and at both professional and amateur levels. Specific evidence is necessary to investigate at these levels, such as intrinsic (e.g., hormonal regulation, motivation for prevention programs' implementation) and extrinsic factors (e.g., climate, playing position, periods of fixed match congestion, number of matches and breaks per season), with the multiple stakeholders involved in football, so that the effectiveness of interventions can be tested.

The evidence regarding the use of preventive programs and measures are still scarce, therefore no definite conclusions for football stakeholders (e.g., coaches, medical or science departments) can be made. However, low levels of perceived risk may increase injury risk (22). Therefore, studies are needed to design and implement behavioural interventions to educate players, coaches, and other stakeholders about injury risk, aiming to explain the risks and consequences of injuries, and elucidate long-term costs for health and socio-economic systems.

Limitations

There were small sample sizes across studies, the geographical areas of the studies were limited, the participants included in the studies were generally young, and studies with both sex (17, 18, 22, 25) did not include representative samples of both sexes, thus affecting the generalization of the findings.

Some of the questionnaires were not available in the athlete's native language and did not include open questions about their opinions. Also, in some studies, the questionnaires were completed in a team setting and might have been subject to social desirability bias in the team ambience.

Official medical records did not back up most studies about injury risk, and retrospective study designs may have increased the bias regarding the assessment of accurate injury history.

Moreover, a limitation of the current review is the possibility of a high risk of bias, as assessed in the JBI critical appraisal checklists, with studies lacking essential items of the studies’ methodology, and therefore results should be interpreted with caution.

Conclusion

In conclusion, this systematic review explored football players' perceptions of injury risk and prevention. Most football players agreed that their risk of injury is high and that prevention strategies are important, still, they do not intend to use some of these strategies. It is crucial to acknowledge perceived injury risk factors, namely low muscle strength, lack of physical fitness, fatigue, excessive training and type and condition of surfaces, as well as injury prevention factors, such as the warm-up, workload monitoring and strength and conditioning training.

A better understanding of how the coach and medical departments match with players' perceptions may help inform delivery strategies, leading to better compliance with injury prevention programs. In addition, there is a need to alter the perceptions through education, rule changes, economic measures, and changes in the governance of the sport. Questioning more stakeholders and policymakers can shed light on such potential interventions.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s.

Author contributions

BCM and JB: conceptualization. BCM: writing—original draft preparation. BCM and AB: methodology. BCM and AB: formal analysis. BCM and AB: interpretation of data for the work. CB, JPM, PF and JB: writing—review and editing and supervision. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fspor.2022.1018752/full#supplementary-material.

References

1. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. (2011) 45(7):553–8. doi: 10.1136/bjsm.2009.060582

PubMed Abstract | CrossRef Full Text | Google Scholar

2. López-Valenciano A, Ruiz-Pérez I, Garcia-Gómez A, Vera-Garcia FJ, De Ste Croix M, Myer GD, et al. Epidemiology of injuries in professional football: a systematic review and meta-analysis. Br J Sports Med. (2020) 54(12):711–8. doi: 10.1136/bjsports-2018-099577

CrossRef Full Text | Google Scholar

3. López-Valenciano A, Raya-González J, Garcia-Gómez JA, Aparicio-Sarmiento A, Sainz de Baranda P, De Ste Croix M, et al. Injury Profile in Women's Football: a Systematic Review and Meta-Analysis. Sports Med. (2021) 51(3):423–42. doi: 10.1007/s40279-020-01401-w

CrossRef Full Text | Google Scholar

4. Szymski D, Krutsch V, Achenbach L, Gerling S, Pfeifer C, Alt V, et al. Epidemiological analysis of injury occurrence and current prevention strategies on international amateur football level during the UEFA Regions Cup 2019. Arch Ortho Trauma Surg. (2022) 142(2):271–80. doi: 10.1007/s00402-021-03861-9

CrossRef Full Text | Google Scholar

5. Ekstrand J, Krutsch W, Spreco A, van Zoest W, Roberts C, Meyer T, et al. Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study. Br J Sports Med. (2020) 54(7):421–6. doi: 10.1136/bjsports-2019-100666

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br J Sports Med. (2013) 47(12):723. doi: 10.1136/bjsports-2013-092771

CrossRef Full Text | Google Scholar

7. Prieto-González P, Martínez-Castillo JL, Fernández-Galván LM, Casado A, Soporki S, Sánchez-Infante J. Epidemiology of Sports-Related Injuries and Associated Risk Factors in Adolescent Athletes: an Injury Surveillance. Int J Environ Res Public Health. (2021) 18(9):4857. doi: 10.3390/ijerph18094857

CrossRef Full Text | Google Scholar

8. Bolling C, van Mechelen W, Pasman HR, Verhagen E. Context Matters: revisiting the First Step of the “Sequence of Prevention” of Sports Injuries. Sports Med. (2018) 48(10):2227–34. doi: 10.1007/s40279-018-0953-x

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Horvath P, Zuckerman M. Sensation seeking, risk appraisal, and risky behavior. Pers Individ Differ. (1993) 14(1):41–52. doi: 10.1016/0191-8869(93)90173-Z

CrossRef Full Text | Google Scholar

10. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. (2021) 372:n160. doi: 10.1136/bmj.n160

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L Chapter 3: systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. JBI Manual for evidence synthesis. JBI. (2020). doi: 10.46658/JBIMES-20-04. https://synthesismanual.jbi.global2020

12. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: systematic reviews of etiology and risk. In: Aromataris E, Munn Z, editors. JBI Manual for evidence synthesis. JBI. (2020). doi: 10.46658/JBIMES-20-08. https://synthesismanual.jbi.global2020

13. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. (2015) 13(3):179–87. doi: 10.1097/XEB.0000000000000062

PubMed Abstract | CrossRef Full Text | Google Scholar

14. Geertsema C, Geertsema L, Farooq A, Harøy J, Oester C, Weber A, et al. Injury prevention knowledge, beliefs and strategies in elite female footballers at the FIFA Women's World Cup France 2019. Br J Sports Med. (2021) 55(14):801–6. doi: 10.1136/bjsports-2020-103131

PubMed Abstract | CrossRef Full Text | Google Scholar

15. McKay CD, Merrett CK, Emery CA. Predictors of FIFA 11 + implementation intention in female adolescent soccer: an application of the health action process approach (HAPA) model. Int J Environ Res Public Health. (2016) 13(7):657. doi: 10.3390/ijerph13070657

PubMed Abstract | CrossRef Full Text | Google Scholar

16. McKay CD, Steffen K, Romiti M, Finch CF, Emery CA. The effect of coach and player injury knowledge, attitudes and beliefs on adherence to the FIFA 11 + programme in female youth soccer. Br J Sports Med. (2014) 48(17):1281–6. doi: 10.1136/bjsports-2014-093543

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Dalen-Lorentsen T, Ranvik A, Bjørneboe J, Clarsen B, Andersen TE. Facilitators and barriers for implementation of a load management intervention in football. BMJ Open Sport Exerc Med. (2021) 7(2):e001046. doi: 10.1136/bmjsem-2021-001046

PubMed Abstract | CrossRef Full Text | Google Scholar

18. Mears AC, Osei-Owusu P, Harland AR, Owen A, Roberts JR. Perceived links between playing surfaces and injury: a worldwide study of elite association football players. Sports Med - Open. (2018) 4(1):4. doi: 10.1186/s40798-018-0155-y

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Hawkins RD. A preliminary assessment of professional footballers’ awareness of injury prevention strategies. Br J Sports Med. (1998) 32(2):140–3. doi: 10.1136/bjsm.32.2.140

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Loose O, Achenbach L, Fellner B, Lehmann J, Jansen P, Nerlich M, et al. Injury prevention and return to play strategies in elite football: no consent between players and team coaches. Arch Orthop Trauma Surg. (2018) 138(7):985–92. doi: 10.1007/s00402-018-2937-6

PubMed Abstract | CrossRef Full Text | Google Scholar

21. Zech A, Wellmann K. Perceptions of football players regarding injury risk factors and prevention strategies. PLos ONE. (2017) 12(5):e0176829. doi: 10.1371/journal.pone.0176829

PubMed Abstract | CrossRef Full Text | Google Scholar

22. Kontos AP. Perceived Risk, Risk Taking, Estimation of Ability and Injury Among Adolescent Sport Participants. J Pediatr Psychol. (2004) 29(6):447–55. doi: 10.1093/jpepsy/jsh048

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Alahmad TA, Tierney AC, Cahalan RM, Almaflehi NS, Clifford AM. Injury risk profile of amateur Irish women soccer players and players’ opinions on risk factors and prevention strategies. Phys Ther Sport. (2021) 50:184–94. doi: 10.1016/j.ptsp.2021.05.008

PubMed Abstract | CrossRef Full Text | Google Scholar

24. Liporaci RF, Yoshimura S, Baroni BM. Perceptions of Professional Football Players on Injury Risk Factors and Prevention Strategies. Sci Med Football. (2021) 5(2):148–52. doi: 10.1080/24733938.2021.1937689

CrossRef Full Text | Google Scholar

25. Som MAHHM, Vasanthi RK, Subramaniam A, Nadzalan Ali M. Knowledge, attitudes and practices of injury prevention towards lateral ankle sprain among amateur football players in Brunei. Pedag Phys Cult Sports. (2022) 26(2):111–7. doi: 10.15561/26649837.2022.0205

CrossRef Full Text | Google Scholar

26. O'Brien J, Santner E, Kröll J. Moving Beyond One-Size-Fits-All Approaches to Injury Prevention: evaluating How Tailored Injury Prevention Programs Are Developed and Implemented in Academy Soccer. J Orthop Sports Phys Ther. (2021) 51(9):432–9. doi: 10.2519/jospt.2021.10513

CrossRef Full Text | Google Scholar

27. Weldon A, Wong ST, Mateus N, Duncan MJ, Clarke ND, Pears M, et al. The strength and conditioning practices and perspectives of soccer coaches and players. Int J Sports Sci Coach. (2022) 17(4):742–60. doi: 10.1177/17479541211072242

CrossRef Full Text | Google Scholar

28. Kolokotsios S, Drousia G, Koukoulithras I, Plexousakis M. Ankle Injuries in Soccer Players: a Narrative Review. Cureus. (2021) 13(8):e17228. doi: 10.7759/cureus.17228

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Verhagen E, Mellette J, Konin J, Scott R, Brito J, McCall A. Taking the lead towards healthy performance: the requirement of leadership to elevate the health and performance teams in elite sports. BMJ Open Sport Exerc Med. (2020) 6(1):e000834. doi: 10.1136/bmjsem-2020-000834

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Hägglund M, Waldén M. Risk factors for acute knee injury in female youth football. Knee Surg Sports Traumatol Arthrosc. (2016) 24(3):737–46. doi: 10.1007/s00167-015-3922-z

CrossRef Full Text | Google Scholar

31. Hägglund M, Atroshi I, Wagner P, Waldén M. Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT. Br J Sports Med. (2013) 47(15):974–9. doi: 10.1136/bjsports-2013-092644

CrossRef Full Text | Google Scholar

32. Wingfield K. Neuromuscular training to prevent knee injuries in adolescent female soccer players. Clin J Sport Med. (2013) 23(5):407–8. doi: 10.1097/01.jsm.0000433153.51313.6b

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Bisciotti GN, Chamari K, Cena E, Bisciotti A, Bisciotti A, Corsini A, et al. Anterior cruciate ligament injury risk factors in football. J Sports Med Phys Fitness. (2019) 59(10):1724–38. doi: 10.23736/S0022-4707.19.09563-X

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Hackney A, Constantini N. In: Constantini N, Hackney AC, editors. Endocrinology of physical activity and sport. NJ: Humana Totowa (2020). doi: 10.1007/978-1-62703-314-5

35. Elliott-Sale K, Hicks K. The exercising female: science and its application. In: Forsyth J, Roberts C-M, editors, Hormonal-based contraception and the exercising female. London: Routledge (2018). doi: 10.4324/9781351200271

36. FIFA. FIFA's medical assessment and research centre. In: F-MARC, editor. FIFA 11+: A complete warm-up program. Zürich: FIFA (2021), [August 2021]; Available from: https://www.f-marc.com/files/downloads/workbook/11plus_workbook_ptbr.pdf.

37. Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med. (2017) 51(14):1073–80. doi: 10.1136/bjsports-2016-096226

PubMed Abstract | CrossRef Full Text | Google Scholar

38. van Beijsterveldt AM, Krist MR, Schmikli SL, Stubbe JH, de Wit GA, Inklaar H, et al. Effectiveness and cost-effectiveness of an injury prevention programme for adult male amateur soccer players: design of a cluster-randomised controlled trial. Inj Prev. (2011) 17(1):e2. doi: 10.1136/ip.2010.027979

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Emery CA. Injury prevention in kids’ adventure and extreme sports: future directions. Res Sports Med. (2018) 26(sup1):199–211. doi: 10.1080/15438627.2018.1452239

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. (2015) 49(13):865–70. doi: 10.1136/bjsports-2015-094639

PubMed Abstract | CrossRef Full Text | Google Scholar

41. van der Horst N, Hoef SV, Otterloo PV, Klein M, Brink M, Backx F, et al. Effective But Not Adhered to: how Can We Improve Adherence to Evidence-Based Hamstring Injury Prevention in Amateur Football? Clin J Sport Med. (2021) 31(1):42–8. doi: 10.1097/JSM.0000000000000710

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Paul DJ, Bradley PS, Nassis GP. Factors affecting match running performance of elite soccer players: shedding some light on the complexity. Int J Sports Physiol Perform. (2015) 10(4):516–9. doi: 10.1123/ijspp.2015-0029

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Hammami A, Gabbett TJ, Slimani M, Bouhlel E. Does small-sided games training improve physical fitness and team-sport-specific skills? A systematic review and meta-analysis. J Sports Med Phys Fitness. (2018) 58(10):1446–55. doi: 10.23736/S0022-4707.17.07420-5

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Finnoff JT. Preventive exercise in sports. Pm r. (2012) 4(11):862–6. doi: 10.1016/j.pmrj.2012.08.005

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Chen YB, Buggy C, Kelly S. Winning at all costs: a review of risk-taking behaviour and sporting injury from an occupational safety and health perspective. Sports Med - Open. (2019) 5(1):15. doi: 10.1186/s40798-019-0189-9

PubMed Abstract | CrossRef Full Text | Google Scholar