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Football for Health 20 Years of F-MARC Research and Education 1994 - 2014

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Football for Health 20 Years of F-MARC Research and Education 1994 - 2014 F-MARC - Football for Health 20 years of F-MARC Research and Education 1994 - 2014 Editors: )HŔ´#UNŔ¨J Astrid Junge TABLE OF CONTENTS | FOOTBALL MEDICINE PROJECTS Table of Contents Preface 1 Executive Summary 2 2 Epidemiology of Football Injury 4 2.1 Review of Literature 4 2.1.1 Football Injuries before 2000 4 2.1.2 Football Injuries in Children and Adolescent Players 6 2.2 Definitions of Injuries and Assessment Methods 8 2.2.1 Influence of Definition and Data Collection on Injury Incidence 8 2.2.2 Consensus on the Injury Definition and Data Collection Procedures 10 2.2.3 Injury Surveillance in Multi-Sport Events 12 2.3 Injuries during the Football Season 14 2.3.1 Injuries of Male Players of Different Age and Skill Level 14 2.3.2 Severe Injuries of Male Players 16 2.3.3 Injuries of Female Players of the German National League 18 2.3.4 Injuries in the Tunisian Professional Leagues 20 2.3.5 Injuries in the Congo National Football League 22 2.4 Injuries during Football Competitions 24 2.4.1 Injuries during FIFA Competitions 1998 - 2001 24 2.4.2 Injuries during the 2002 FIFA World Cup Korea/Japan™ 26 2.4.3 Injuries during the 2006 FIFA World Cup Germany™ 28 2.4.4 Injuries of Female Players in Top-Level International Competitions 30 2.4.5 Injuries during the FIFA Futsal World Cups 2004 and 2008 32 2.4.6 Injuries and Illnesses at the 2010 FIFA World Cup South Africa™ 34 2.4.7 Injury Surveillance in World Football Tournaments 1998-2012 36 2.5 Risk Factors and Injury Causation 38 2.5.1 Risk Factors of Injuries in Different Ages and Skill Level 38 2.5.2 Risk Factors for Injuries in Elite Female Football Players 40 2.5.3 Tackling Situations of Male Players during FIFA Competitions 42 2.5.4 Video Analysis of Ankle Injuries 44 2.5.5 Causation of Injuries in Elite Female Players 46 2.5.6 Tackling Situations of Female Players in Top-Level Competitions 48 2.5.7 Refereeing in Injury Situations 50 2.5.8 Risk of Injury on Artificial Turf 52 2.5.9 Influence of Match Events on Injury Incidence during FIFA World Cups™ 54 2.6 Head Injuries 56 2.6.1 Head and Neck Injuries during FIFA Competitions 56 2.6.2 Biomechanical Aspects of Head Injuries 58 2.6.3 Biomechanical Analysis of Head Impacts 60 2.6.4 Biomechanical Analysis of Ball Properties 62 2.6.5 Biomechanical Analysis of Headgear 64 FOOTBALL MEDICINE PROJECTS | TABLE OF CONTENTS 2.6.6 S-100 Beta Serum Levels after Controlled Heading 66 2.6.7 Serum Levels of S-100 Beta after Minor Head Trauma 68 2.6.8 The Value of Neuropsychological Testing after Head Injuries 70 2.6.9 Effects of Heading Exposure and Previous Concussions 72 2.6.10 Do Minor Head Impacts in Football Cause Concussive Injury? 74 2.7 Injuries of Referees and Assistant Referees 76 2.7.1 Injuries in FIFA Competitions 76 2.7.2 Injuries of Referees at All Levels of Play in Switzerland 78 2.8 Injuries in Other Sports 80 2.8.1 Comparison of Injuries in Football and in Rugby 80 2.8.2 Injuries during the Olympic Games in Athens 2004 82 2.8.3 Handball Injuries during Major International Competitions 84 2.8.4 Sports Injury during the 11th IAAF World Championships 86 2.8.5 Injuries during the 2008 Olympic Games in Beijing 88 2.8.6 Sports Injuries and Illnesses during the 2009 FINA World Championships 90 2.8.7 Sports Injuries and Illnesses during the 2010 Winter Olympic Games 92 2.8.8 Sports Injuries and Illnesses during the 2012 Summer Olympic Games in London 94 2.8.9 Injuries in 13 International Athletics Championships 96 3 Prevention of Football Injury 98 3.1 Review of Literature 98 3.2 Development of Prevention Programmes 100 3.2.1 “The 11” – A Prevention Programme for Amateur Players 100 3.2.2 “FIFA 11+” A Complete Warm-Up Programme 102 3.2.3 “FIFA 11+ for Referees” 104 3.2.4 “FIFA 11+ Kids” 106 3.2.5 Enforcement of the Laws of the Game 108 3.3 Evaluation of the Effects of Prevention Programmes 110 3.3.1 Prevention of Injuries in Male Youth Amateur Players 110 3.3.2 Prevention of ACL Ruptures in Female Players 112 3.3.3 Prevention of Injuries in Female Adolescent Amateur Players 114 3.3.4 Importance of Compliance with Preventive Programmes 116 3.3.5 Effects of Different Implementations Strategies and Compliance with “FIFA 11+” 118 3.3.6 Benefits of High Adherence with regard to Performance and Injury Risk 120 3.3.7 Physiological and Performance Effects of “FIFA 11+” 122 3.3.8 Prevention of Injuries in Male Amateur Players 124 3.4 Implementation of Prevention Programmes 126 3.4.1 Country-wide Campaign to Prevent Football Injuries in Switzerland 126 3.4.2 Country-wide Campaign to Prevent Football Injuries in New Zealand 128 3.4.3 From Development to Worldwide Dissemination 130 TABLE OF CONTENTS | FOOTBALL MEDICINE PROJECTS Table of Contents 4 Prevention of Sudden Cardiac Death 132 4.1 Pre-Competition Medical Assessment (PCMA) 132 4.1.1 PCMA at the 2006 FIFA World Cup™ 132 4.1.2 PCMA at the 8th African U-17 Championships 134 4.1.3 PCMA in International Football – Feasibility and Considerations 136 4.1.4 PCMA of Referees and Assistant Referees 138 4.2 Risk Factors and Management of Sudden Cardiac Arrest 140 4.2.1 Statement on Sudden Cardiac Death 140 4.2.2 Practical Management of Sudden Cardiac Arrest on the Field of Play 142 4.2.3 FIFA 11 Steps to Prevent Sudden Cardiac Death and the FIFA Medical Emergency Bag 144 4.2.4 Cardiac Findings and the Athlete’s Heart in African Adolescent Players 146 5 Other Recognised Matters 148 5.1 Assessment of Player Characteristics 148 5.1.1 Medical History and Physical Examination 148 5.1.2 Psychological Characteristics 150 5.1.3 Assessment of Performance 152 5.2 Ramadan and Football 154 5.2.1 Influence of Ramadan on Performance 154 5.2.2 Influence of Ramadan on Physiological and Performance Variables 156 5.2.3 Ramadan and Sports Performance 158 5.3 Use of Medication and Nutritional Supplements in FIFA Competitions 160 5.4 Age Determination using MRI 162 5.4.1 Developing a Methodology and Application in FIFA U-17 Competitions 162 5.4.2 Age Determination in U-20 Players 164 5.5. Cartilage Injury in the Football Player 166 6. Improving Standards of Care 168 6.1 Football Medicine Manual and Website 168 6.1.1 Football Medicine Manual 168 6.1.2 Emergency Medicine Manual 170 6.1.3 First Aid Manual 172 6.2 Consensus Statements and Recommendations 174 6.2.1 Recommendations for Diagnosis and Treatment of Concussion in Sport 174 6.2.2 Nutrition for Football 176 6.2.3 Medical Issues of the Female Football Player 178 6.2.4 Playing Football at Different High Altitudes 180 6.2.5 Playing Football in Hot Environments 182 FOOTBALL MEDICINE PROJECTS | TABLE OF CONTENTS 6.3 FIFA Regulations 184 6.3.1 Gender Verification Regulations 184 6.4 FIFA Medical Centres of Excellence 186 7 The Fight against Doping in Football 188 7.1 FIFA’s Approach to the Fight against Doping in Football 188 7.2 Comprehensive Information for Laymen 192 7.3 Research Projects 194 7.3.1 Nandrolone Excretion after Exercise 194 7.3.2 Testosterone Variability – the Influence of Ethnicity on Steroid Profiles of Football Players 196 7.3.3 Quantification of Clenbuterol at Trace Level in Human Urine 198 7.3.4 Profiling of Steroid Metabolites after Transdermal and Oral Administration of Testosterone 200 7.3.5 Influence of Multiple Injections of Human Chorionic Gonadotropin (hCG) on Urine and Serum Endogenous Steroids Concentrations 204 8 Football for Health 208 8.1 Prevention of Non-Communicable Diseases 208 8.1.1 Prevention of Risk Factors for Non-Communicable Diseases 208 8.1.2 Prevention and Treatment of Non-Communicable Diseases across the Lifespan 210 8.2 ”FIFA 11 for Health” 212 8.2.1 Development and Evaluation in Different Settings 212 8.2.2 Planning a Nationwide Implementation 214 8.2.3 Implementation in Five African Countries 216 8.2.4 FIFA in the Fight against Ebola 218 9 Bibliography 220 10 Supplements 236 10.1 Twenty years of the FIFA Medical and Research Centre (F-MARC): From “Medicine for Football” to “Football for Health” 244 11 Acknowledgement 246 FOOTBALL MEDICINE PROJECTS | PREFACE Preface Joseph S. Blatter Dr Michel D’Hooghe FIFA President Member of the FIFA Executive Committee Since 20 years the FIFA Medical Assessment and In my capacity as chairman of the FIFA Medical Com- Research Centre (F-MARC) has focussed on the most mittee, and together with members of our Medical important thing in sport and indeed in society – health. Committee, I wholeheartedly congratulate to F-MARC, Prof Jiří Dvořák (Chairman) and Prof Astrid Junge The presented publication recognise the achievements of (Head of Research) for presenting the update of all 369 the F-MARC since its establishment in 1994. Under the scientific publications related to football. This publica- leadership of chairman Professor Jiří Dvořák and head tion gives an unique opportunity to further develop the of research Professor Astrid Junge, F-MARC has con- spectacular evolution in the world of our sport for the ducted rigorous research studies that have benefited the good of more than 300 million football players.
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