MEDICINE Matters MARCH 2006 – No.12 IN THIS ISSUE REAPING THE HARVEST THE STATE OF THE PITCH CANNABIS AND SPORT FIT TO MANAGE? BRUCOSPORT CONGRESS IN BRUGES PUBLISHED BY UEFA’S FOOTBALL DEVELOPMENT DIVISION EDITORIAL BY DR URS VOGEL FOUR-GONE It doesn’t feel as though almost four years have passed since we sat down to discuss the aftermath of the FIFA World Cup – and, in the case of some of the pre-tournament favourites, it amounted to something more akin to a post-mortem. Many star players were reported to have under-performed and a high percentage of European failures to live up to expectations were put down to mental and physical fatigue. There was a great deal of talk about excessive workloads. Four seasons later, we are once to harmonise methodologies is UEFA-HIGUERAS again watching attentively as another step in the right direc- Dr Urs Vogel, Chairman of the UEFA Medical Committee. players prepare for the FIFA tion, as it will permit other stu- World Cup in a year which also dies to be correlated with our includes the African Cup of own. Much of this issue of Medi- Nations. But there have been cine Matters is devoted to mat- changes. UEFA, for example, has ters related to injury studies – lightened the UEFA Champions and we make no apology for that. League burden by removing a group phase. FIFA has insisted Detecting ‘patterns’ in a short that the final whistle be blown time-span is, scientifically, risky. on all domestic competitions in But some interesting talking good time for players to prepare points have already emerged. COVER for the finals in Germany. Overall, the incidence of injury Andriy Shevchenko takes the ball past Greek defender Ioannis Goumas among the clubs involved in our in Ukraine’s 1-0 win in Athens During the same four-year study has fallen in the last four en route to their first-ever FIFA World period, UEFA’s injury studies have years. But is it a coincidence, Cup final, this summer’s tournament to be played in Germany from 9 June gathered momentum and a for example, that the significant to 9 July 2006. From a medical point valuable databank has not only decreases have occurred in the of view, the tournament will also offer an exceptional learning experience. been established but is also be- 2002/03 and 2004/05 seasons? PHOTO: FOTO-NET ing put to good use. The move In other words, after the FIFA MEDICINE MATTERS/2 The wise use of substitutes has become an important tactic in modern football. GETTY IMAGES CONCLUSIONS World Cup and the UEFA Euro- But only time – and continued After the tournament in Ger- pean Championship, when one research – will determine whether many, will we express the same would instinctively suspect that we are winning the crusade to concerns as we did in 2002? the incidence of injury would rise. reduce the risk of injury. In a sense, Four years have gone by and we Could the possible explanation the two World Cups will provide may be able to start drawing be that, while we are monitoring interesting points of reference. conclusions. the top stars’ ability to cope with the physical and psychological burdens of major tournaments, the rest of the professional work- force is finally able to benefit from a decent rest? What’s more, attitudes have changed as a result of injury studies which have undoubtedly increased awareness of the medical issues to be addressed. Reliable data about injury risks during pre-season training have given coaches food for thought. Four years ago, ‘rotation’ was not a frequently used word in the footballing lexicon. But there have now been significant moves in terms of designing and util- ising squads with a view to dis- IMAGES BARON/BONGARTS/GETTY The new UEFA Champions League format has taken some tributing workloads on a more of the pressure off the players. Here, Ze Roberto in Bayern Munich’s equitable basis. UEFA Champions League tie against Club Brugge. MEDICINE MATTERS/3 REAPING THE HARVEST UEFA’s injury studies have been a recurrent theme in Medicine Matters and the state of play is that one of the fundamental aims of the project is now beginning to be achieved. The study was not conceived as an esoteric incidence of injury in domestic compilation of figures. The objective was – and is – competitions. to provide feedback to team doctors which can enhance their efforts to prevent injuries. A case in point is Turkey, where Professor Mehmet Binnet, a mem- ber of UEFA’s Medical Committee, initiated the country’s first injury study along with Dr Onur Polat, Some of the top clubs involved It has never been Medicine Mat- his fellow chairman of the Turkish in UEFA’s project have now been ters’ policy to ‘name names’ but FA’s Medical Committee. monitored over a period of four full the much-publicised case of Michael seasons – which means that the Owen’s fifth metatarsal fracture The pioneering study embraced database has now become a valuable prompted the English media to 406 footballers enrolled in 15 clubs tool and that answers can now be question his presence in this sum- belonging to the Turkcell Premier provided to some of the most fre- mer’s FIFA World Cup. UEFA’s data- League. Data were collected ac- quently asked questions. Clubs and base included details of 19 such cording to UEFA norms over a football organisations often ask, injuries, which allowed a mean ab- period covering 9,190 hours (820 for instance, whether the risk of sence of 76 days to be established. match hours and 8,370 training injury in the top-level game has The evidence also suggested that hours). During this time-span, team increased. There is now enough solid surgery signified a lower risk of doctors recorded and reported evidence to respond that it has not – re-injury. UEFA could therefore 330 injuries at a mean of one injury and that it has even decreased. offer reassuring data to the player, per 27.85 hours. his club and his national association. The ongoing project now features Processing the data revealed signifi- visits by UEFA’s research team to In other words, the seeds sown over cant trends. 142 injuries (43%) oc- the clubs which have participated in the last four years are beginning to curred during the 820 match hours, the study, with a view to establishing produce a harvest. Continued feed- while 188 (57%) corresponded to how to develop the research and back will, we hope, allow physicians injuries sustained during training. what further elements could produc- to advance still further in the cru- When compared with similar stud- tively be incorporated into the moni- sade to prevent injuries, to avoid ies, the salient feature was the toring programme. burn-out syndromes, and to estab- high incidence of injuries during lish viable balances between work training. At the end of each season, there and recovery periods during long is direct feedback to the clubs in the and demanding campaigns. Further analysis uncovered other form of a detailed résumé of their significant trends. ‘Contact injuries’ own results, along with mean figures resulting from tackles or collisions from other teams, enabling compar- RESEARCH = accounted for 30.72%. The remain- isons to be made. Clubs and national VALUABLE EVIDENCE ing 69.28% were non-contact associations are aware that UEFA injuries. The figures suggested to can now provide reliable data and, Harmonising methodologies has the researchers that non-contact for instance, the Italians are keen enabled studies of injury patterns injuries had increased in relation to receive figures related to non- to be effectively interlocked and for to previous seasons and that the contact muscular injuries, while the valid comparisons to be made. At high ratio of non-contact injuries English have expressed more interest the same time, UEFA’s injury study represented a strong indicator of in issues such as groin injuries or has helped to promote individual physical overuse and/or return to the effects of a winter break on the studies within national associations activity before recovery had been incidence of injury. where there is concern about the completed. MEDICINE MATTERS/4 Several injuries occur during training. EMPICS The study also grouped figures grammes and a review of entire 495 match hours and 899 training according to geographical areas, training cultures. Clubs were urged hours. Sixteen players sustained providing further food for thought. to check whether specific endurance 17 injuries during the tournament, The teams based in the Marmara re- and elasticity routines were being only two of which were in training gion (broadly speaking, the western implemented and the importance and only three of the match injuries seaboard facing Greece) recorded of adequate warm-up and warm- were due to foul play. that 45.45% of the injuries regis- down procedures was underlined. tered during the season were of the The high ratio of non-contact mus- All but one of the injuries occurred non-contact type. Of the injuries af- cular injuries suggested a need to during the first week of the twelve- fecting teams in the more northerly upgrade preventive measures. day tournament. Only one was Black Sea region, 68.25% were non- classed as ‘major’ while five were contact. And in the central Anato- At the same time, analysis of injury ‘moderate’ (1-4 weeks). lian area, the incidence of non-con- patterns revealed one fact that could tact injuries peaked at no less than be the starting point for debate. Non-contact injuries accounted 94.12%.