Latest research in football - week 49 - 2022

As previous literature updates, I have performed a PubCrawler search looking for football articles in NCBI Medline (PubMed) and GenBank databases. 


Following studies were retrieved for this week:

#1 Effect of Playing Position on Return to Sport, Functional Outcomes, and Recurrence After Arthroscopic Bankart Repair in Soccer Players

Reference: Orthop J Sports Med. 2022 Nov 28;10(11):23259671221138106. doi: 10.1177/23259671221138106. eCollection 2022 Nov.

Authors: Ignacio Pasqualini, Luciano Andrés Rossi, Rodrigo Brandariz, Ignacio Tanoira, Nora Fuentes, Patrick J Denard, Maximiliano Ranalletta

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Summary: Little attention has been paid to playing position as a risk factor for recurrence after arthroscopic Bankart repair (ABR) in soccer players. The purpose was to compare return to sport, functional outcomes, and recurrence after ABR between goalkeepers and field position players in soccer. A retrospective comparative cohort study was performed in soccer players who underwent ABR between January 2017 and December 2019. The minimum clinical follow-up was 2 years. Functional outcomes included the Rowe score, visual analog scale (VAS) for pain, and shoulder-dependent sports ability measured with the Athletic Shoulder Outcome Scoring System (ASOSS). The difference between the post- and preoperative scores was calculated; rate and level of return to sport, recurrent instability, and revisions were also evaluated according to position played. A total of 70 position players and 11 goalkeepers met the study criteria. Postoperative functional outcomes were significantly improved in both groups as compared with baseline (P < .001 for both), although the position players achieved significantly greater pre- to postoperative improvement (ΔVAS, -2 vs 0 points [P = .029]; ΔRowe, 45 vs 30 points [P = .046]; ΔASOSS, 45 vs 40 points [P = .028]). While all players returned to soccer, only 55% (n = 6) of goalkeepers returned to the same level versus 93% of field players (P = .003). The overall rate of recurrent instability was 8.6% but was significantly higher among goalkeepers (27.2% vs 5.7%; P = .049), and the odds of goalkeepers having a recurrence were significantly higher than field position players (odds ratio, 8.5 [95% CI, 1.2-57.2]; P = .027). Although the results of ABR were generally favorable in all soccer players, goalkeepers had significantly worse functional outcomes, a lower rate of return to the same level of sport, and a higher recurrence rate as compared with field position players.



#2 Genetic profile in genes associated with muscle injuries and injury etiology in professional soccer players

Reference: Front Genet. 2022 Nov 16;13:1035899. doi: 10.3389/fgene.2022.1035899. eCollection 2022.

Authors: Antonio Maestro, Juan Del Coso, Millán Aguilar-Navarro, Jorge Gutiérrez-Hellín, Esther Morencos, Gonzalo Revuelta, Eva Ruiz Casares, Teresa Perucho, David Varillas-Delgado

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Summary: Many causes define injuries in professional soccer players. In recent years, the study of genetics in association with injuries has been of great interest. The purpose of this study was to examine the relationship between muscle injury-related genes, injury risk and injury etiology in professional soccer players. In a cross-sectional cohort study, one hundred and twenty-two male professional football players were recruited. AMPD1 (rs17602729), ACE (rs4646994), ACTN3 (rs1815739), CKM (rs8111989) and MLCK (rs2849757 and rs2700352) polymorphisms were genotyped by using Single Nucleotide Primer Extension (SNPE). The combined influence of the six polymorphisms studied was calculated using a total genotype score (TGS). A genotype score (GS) of 2 was assigned to the "protective" genotype for injuries, a GS of 1 was assigned to the heterozygous genotype while a GS of 0 was assigned to the "worst" genotype. Injury characteristics and etiology during the 2021/2022 season were classified following a Consensus Statement for injuries recording. The distribution of allelic frequencies in the AMPD1 and MLCK c.37885C>A polymorphisms were different between non-injured and injured soccer players (p < 0.001 and p = 0.003, respectively). The mean total genotype score (TGS) in non-injured soccer players (57.18 ± 14.43 arbitrary units [a.u.]) was different from that of injured soccer players (51.71 ± 12.82 a.u., p = 0.034). There was a TGS cut-off point (45.83 a.u.) to discriminate non-injured from injured soccer players. Players with a TGS beyond this cut-off had an odds ratio of 1.91 (95%CI: 1.14-2.91; p = 0.022) to suffer an injury when compared with players with lower TGS. In conclusion, TGS analysis in muscle injury-related genes presented a relationship with professional soccer players at increased risk of injury. Future studies will help to develop this TGS as a potential tool to predict injury risk and perform prevention methodology in this cohort of football players.



#3 Exploring the true burden of a time-loss injury: full vs partial time-loss in elite academy football (soccer)

Reference: Sci Med Footb. 2022 Dec 6. doi: 10.1080/24733938.2022.2156587. Online ahead of print.

Authors: Stella Veith, Matt Whalan, Neil Gibson, John A Sampson

Summary: In football, the number of days without full participation in training/competition is often used as a surrogate measure for time-loss (TL) caused by injury. However, injury management and return-to-play processes frequently include modified participation, which to date has only been recorded through self-reports. This study aims to demonstrate the differentiation between 'full' (no participation in team football) and 'partial' (reduced/modified participation in team football) burden. Injury and exposure data were collected from 118 male elite footballers (U13-U18) over 3 consecutive seasons according to the Football Consensus Statement. TL injury burden was calculated separately as the number of total, 'full' and 'partial' days lost per 1000 hours of exposure. Injury burden (137.2 days lost/1000h, 95% CI 133.4 - 141.0) was comprised of 23% (31.9 days lost/1000h, 95% CI 30.1 - 33.8) partial TL and 77% (105.3 days lost/1000h, 95% CI 102.0 - 108.6) full TL burden. Injuries of moderate severity (8-28 days lost) showed 40% of partial TL. TL injury incidence rate (6.6 injuries/1000h, 95% CI 5.8 - 7.5), the number of severe injuries (16%) and the distribution of TL and non-TL injuries (56% and 44%) were comparable to other reports in elite youth footballers. Almost one quarter of the TL injury burden showed that injured players were still included in some team football activities, which, for injuries with TL >7 days, was likely related to the return to play process. Therefore, reporting on partial TL provides insight into the true impact of injury on participation levels.



#4 Kidney functions adaptations of professional soccer players in response to an entire game season

Reference: An Acad Bras Cienc. 2022 Dec 5;94(suppl 3):e20211536. doi: 10.1590/0001-3765202220211536. eCollection 2022.

Authors: Rodrigo A S Peres, Irnak Marcelo Barbosa, Igor R Arouca, Karen V Paiva, Tainá B Coutinho, Victor C Tadeu, Anderson P Morales, Beatriz G Ribeiro, Natália Martins Feitosa, Cintia M DE Barros, Rodrigo N DA Fonseca, Jackson DE Souza-Menezes

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Summary: This study investigated the renal function of soccer players after an entire game-season. Thirty-five athletes recruited to play for the Macae Futebol Clube were invited for this study, of which 18 athletes completed the entire game season. Blood and 24-hour urine were collected at the beginning (Pre-Season) and the end of the game season (Post-Season). Kidney functions were assessed by calculating the urinary excretion, clearance, and fractional excretion of the selected solutes. Plasma creatinine, sodium, total protein, and osmolality were lower in the Post-Season . In contrast, plasma urea was higher in the Post-Season period. Urinary excretion of urea was reduced while albumin excretion was higher in comparison to Pre-Season. The clearances of creatinine, total proteins, and albumin were higher in the Post-Season period. In accordance, the fractional excretion of albumin increased. On the other hand, the clearance and fractional excretion of urea was lower in the Post-Season period. These results show that soccer-associated exercise throughout the entire game-season induces kidney functions adaptations that may prevent dehydration in these athletes through increased urea reabsorption to conserve water. In addition, this data corroborates to increased glomerular permeability to plasma proteins, such as albumin, that soccer players may experience.



#5 Who does not respond to injury prevention warm-up programs? A secondary analysis of trial data from neuromuscular training programs in youth basketball, soccer and physical education

Reference: J Orthop Sports Phys Ther. 2022 Dec 9;1-28. doi: 10.2519/jospt.2022.11526. Online ahead of print.

Authors: Anu M Räisänen, Jean-Michel Galarneau, Carla Berg, Paul Eliason, Lauren C Benson, Oluwatoyosi B A Owoeye, Kati Pasanen, Brent Hagel, Carolyn A Emery

Summary: The aim was to identify factors associated with non-response to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of four randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education (PE). Youth who were exposed to NMT and who sustained an injury during the study were considered 'non-responders.' Odds ratios (OR) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/PE). A total of 1793 youth were included. Youth with a history of injury in the previous year had higher odds (OR=1.64 95% CI: 1.14-2.37) of injury during the study and females were more likely (OR=1.67, 95% CI: 1.21-2.31) to sustain an injury than males who were participating in NMT. Age was not associated with the odds of sustaining an injury (OR=1.10, 95% CI: 0.93-1.30). Soccer players benefited most from greater adherence, with 81% lower odds of injury (OR=0.19, 95% CI: 0.06-0.57) when completing three NMT sessions a week compared with one session per week. Factors associated with non-response to an NMT warm-up program were female sex, history of injury during the previous 12 months, and lower weekly NMT session adherence in some sports (soccer).



#6 Responses of soccer players performing repeated maximal efforts in simulated conditions of the FIFA World Cup Qatar 2022: A holistic approach

Reference: PLoS One. 2022 Dec 9;17(12):e0276314. doi: 10.1371/journal.pone.0276314. eCollection 2022.

Authors: Paweł Chmura, Hongyou Liu, Marcin Andrzejewski, Antonio Tessitore, Jerzy Sadowski, Jan Chmura, Andrzej Rokita, Wojciech Tański, Leszek Cicirko, Marek Konefał

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Summary: This study aimed to assess the capacity for repeated maximal effort (RME) of soccer players in the thermo-natural conditions (NC) and in simulated conditions for the 2022 FIFA World Cup in Qatar (QSC). Twenty-four semi-professional soccer players participated in the study. The exercise test consisted of ten 6-second maximal efforts on a cycloergometer. A 90-second passive rest interval was used. The test was performed in a Weiss Technik WK-26 climate test chamber in two different conditions: 1) thermo-neutral conditions (NC-20.5°C; 58.7% humidity); and 2) simulated conditions for the 2022 World Cup in Qatar (QSC-28.5 ± 1.92°C; 58.7 ± 8.64% humidity). Power-related, physiological, psychomotor, blood, and electrolyte variables were recorded. Results showed that (1) players achieved higher peak power (max 1607,46 ± 192,70 [W] - 3rd rep), needed less time to peak power (min 0,95 ± 0,27 [s] - 3rd rep), and had a higher fatigue slope (max 218,67 ± 59,64 [W/sek] - 7th rep) in QSC than in NC (in each repetition of study protocol); (2) between the 1st repetition and subsequent repetitions a number of significants in among physiological, blood-related, and electrolyte variables were noted, but their direction was similar in both simulated conditions (e.g. V'O2/kg 37,59 ± 3,96 vs 37,95 ± 3,17 [ml/min/kg] - 3rd rep, LAC 13,16 ± 2,61 vs 14,18 ± 3,13 [mg/dl] - 10th rep or K 4,54 ± 0,29 vs 4,79 ± 0,36 [mmol/l] - 2nd rep when compare QCS and NC respectively); (3) an 8°C of temperature difference between the climatic conditions did not significantly affect the soccer players' physical and physiological responses in RME. The study results can be used in the design of training programs aimed to increase players' physiological adaptations by simulating soccer-specific conditions of play in terms of anaerobic capacity, in particular, repetitive maximal efforts. These findings will be useful during the upcoming 2022 World Cup in Qatar and in locations where high ambient temperatures are customary.



#7 Effects of match contextual factors on internal and external load in elite Brazilian professional soccer players through the season

Reference: Sci Rep. 2022 Dec 9;12(1):21287. doi: 10.1038/s41598-022-25903-x.

Authors: Rodrigo Aquino, Rodrigo Guimarães, Geraldo Oliveira Carvalho Junior, Filipe Manuel Clemente, Tomas García-Calvo, Juan José Pulido, Hadi Nobari, Gibson Moreira Praça

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Summary: This study aimed to investigate the effects of contextual match factors (quality of opposition, match outcome, change of head coach or playing style) on internal and external load in elite Brazilian professional soccer players, considering the total and effective playing time. Twenty-two professional male outfield soccer players participated in this study (age 28.4 ± 4.9 years; height 1.78 ± 0.1 cm; body mass 72.9 ± 7.1 kg). The internal (rating of perceived exertion-based load [sRPE]) and external load (distance and accelerometry-based measures) were recorded during 38 matches, over the 2021 season of the Brazilian National 1st Division League using a global position system (10 Hz) integrated with an accelerometer (200 Hz). The main results were: (i) matches played against weak opponents presented greater values of sprinting distances compared to matches against intermediate and strong opponents; (ii) players covered greater high-intensity running distances when drawing than winning the matches; (iii) matches with assistant coaches presented higher mean speed relative to effective playing time (MSEPT) compared to coach 1 and coach 2 conditions. In addition, players covered greater MSEPT and high-acceleration in matches with coach 2 vs. coach 3; (iv) finally, small positive correlations were observed between positional attack sequences and MSTPT, total distance covered, and acceleration. Coaches and practitioners should consider these results when interpreting external load variables during elite Brazilian soccer matches.



#8 Training Practices of Football Players During the Early COVID-19 Lockdown Worldwide

Reference: Int J Sports Physiol Perform. 2022 Dec 5;1-10. doi: 10.1123/ijspp.2022-0186. Online ahead of print.

Authors: Jad Adrian Washif, Iñigo Mujika, Matthew D DeLang, João Brito, Alexandre Dellal, Thomas Haugen, Bahar Hassanmirzaei, Del P Wong, Abdulaziz Farooq, Gürhan Dönmez, Kwang Joon Kim, Juan David Peña Duque, Lewis MacMillan, Ryo Matsunaga, Alireza Rabbani, Mohamed Romdhani, Montassar Tabben, Yacine Zerguini, Piotr Zmijewski, David B Pyne, Karim Chamari

Summary: The COVID-19 lockdown challenged the training options of athletes worldwide, including players from the most popular sport globally, football/soccer. The authors explored the training practices of football players worldwide during the COVID-19 lockdown. Football players (N = 2482, 30% professional, 22% semipro, and 48% amateur) completed an online survey (May-July 2020) on their training practices before versus during lockdown (March-June 2020). Questions were related to training frequency and session duration, as well as training knowledge and attitudes. Before lockdown, more professional (87%) than semipro (67%) and amateur (65%) players trained ≥5 sessions/wk, but this proportion decreased during the lockdown to 55%, 35%, and 42%, respectively. Players (80%-87%) trained ≥60 minutes before lockdown, but this proportion decreased to 45% in professionals, 43% in amateurs, and 36% in semipros during lockdown. At home, more than two-thirds of players had training space (73%) and equipment (66%) for cardiorespiratory training, while availability of equipment for technical and strength training was <50% during lockdown. Interactions between coach/trainer and player were more frequent (ie, daily) among professional (27%) than amateur (11%) and semipro (17%) players. Training load monitoring, albeit limited, was mostly performed by fitness coaches, more so with professionals (35%) than amateurs (13%) and semipros (17%). The players' training knowledge and attitudes/beliefs toward training were relatively modest (50%-59%). COVID-19 lockdown negatively affected training practices of football players worldwide, especially amateurs and semipros, for example, in training frequency, duration, intensity, technical, recovery, and other fitness training and coaching-related aspects. During lockdown-like situations, players should be monitored closely and provided appropriate support to facilitate their training.



#9 The association between statistical shape modeling-defined hip morphology and features of early hip osteoarthritis in young adult football players: Data from the femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study

Reference: Osteoarthr Cartil Open. 2022 May 20;4(3):100275. doi: 10.1016/j.ocarto.2022.100275. eCollection 2022 Sep.

Authors: M M A van Buuren, J J Heerey, A Smith, K M Crossley, J L Kemp, M J Scholes, P R Lawrenson, M G King, W P Gielis, H Weinans, C Lindner, R B Souza, J A N Verhaar, R Agricola

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Summary: The aim was to explore the relationship between radiographic hip shape and features of early hip osteoarthritis (OA) on magnetic resonance imaging (MRI) in young male and female football players without radiographic hip OA. We used baseline data from a cohort of symptomatic and asymptomatic football players aged 18-50 years. Hip shape was assessed on anteroposterior radiographs with statistical shape modeling (SSM) for men and women separately. Cartilage defects and labral tears were graded using the Scoring Hip Osteoarthritis with MRI (SHOMRI) system. We used logistic regression with generalized estimating equations to estimate associations between each hip shape variant, called shape modes, and cartilage defects or labral tears. We included 229 participants (446 hips, 77.4% male). For each sex, 15 shape modes were analyzed. In men, three shape modes were associated with cartilage defects: adjusted odds ratios (aOR) 0.75 (95%CI 0.58-0.97) per standard deviation (SD) for mode 1; 1.34 (95%CI 1.05-1.69) per SD for mode 12; and 0.61 (95%CI 0.48-0.78) per SD for mode 15; and one also with labral tears: aOR 1.30 (95%CI 1.01-1.69) per SD for mode 12. These modes generally represented variations in the femoral neck and subtypes of cam morphology, with and without pincer morphology. For women, there was no evidence for associations with the outcomes. Several hip shape variants were associated with cartilage defects on MRI in young male football players. Specifically, one subtype of cam morphology was associated with both cartilage defects and labral tears. Hip shape was not associated with early OA features in women.



#10 Alterations in biceps femoris long head fascicle length, Eccentric hamstring strength qualities and single-leg hop distance throughout the ninety minutes of TSAFT90 simulated football match

Reference: PLoS One. 2022 Dec 9;17(12):e0278222. doi: 10.1371/journal.pone.0278222. eCollection 2022.

Authors: Gokhan Yagiz, Vinay Kumar Dayala, Kevin Williams, Julian Andrew Owen, Hans-Peter Kubis

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Summary: Football matches show higher hamstring strain injuries (HSIs) than football training. The occurrence of HSIs increases in the last fifteen minutes of both halves of football matches and shows an incremental trend towards the end of the ninety minutes. This study aimed to examine football-specific fatigue-induced alterations in risk factors of the HSIs, including biceps femoris long head fascicle length via ultrasonography (BFlh FL), single-leg hop distance, hamstrings' maximal eccentric strength, and single-leg hamstring bridge test (SLHB) performance. During ninety minutes of the TSAFT90 football simulation, the BFlh FL and single-leg hop distance were measured three times (before, at half-time and after 90 minutes of simulated match-play), and maximal hamstrings eccentric strength and SLHB test scores were recorded twice (before and after simulated match-play) for both legs in physically active participants (n = 15). Maximal eccentric hamstrings' strength (dominant leg (D): p < 0.001, Hedges' (adjusted) g effect size = -0.969; non-dominant leg (ND): p < 0.001, g = -0.929) and the SLHB performance (D: p < 0.001, g = -1.249; ND: p < 0.001, g = -1.108) showed large decrements immediately after the TSAFT90 intervention. There were no significant alterations in the BFlh FL, and the single-leg hop distance. Maximal eccentric strength and the SLHB performance of hamstrings are reduced after 90 minutes of simulated football match-play. Practitioners may consider focusing on improving eccentric strength and the SLHB performance. Future studies should examine alterations in the BFlh fascicles' dynamic lengthening and shortening ability during a football match.



#11 Repetitive bout of controlled soccer heading does not alter heart rate variability metrics: A preliminary investigation

Reference: Front Neurol. 2022 Nov 25;13:980938. doi: 10.3389/fneur.2022.980938. eCollection 2022. 

Authors: Jonathan David Smirl, Dakota Peacock, Joel Stephen Burma, Alexander D Wright, Kevin J Bouliane, Jill Dierijck, Paul van Donkelaar

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Summary: There is elevated unease regarding how repetitive head impacts, such as those associated with soccer heading, contribute to alterations in brain function. This study examined the extent heart rate variability (HRV) and cardiac baroreceptor sensitivity (BRS) metrics are altered immediately following an acute bout of soccer heading.  Seven male elite soccer players (24.1 ± 1.5 years) completed 40 successful soccer headers in 20-min. The headers were performed under controlled circumstances using a soccer ball launcher located 25 meters away and using an initial ball velocity of 77.5 ± 3.7 km/h (heading condition). An accelerometer (xPatch) on the right mastoid process quantified linear/rotational head accelerations. Participants also completed sham (body contact) and control (non-contact) sessions. A three-lead ECG and finger photoplethysmography characterized short-term spontaneous HRV/cardiac BRS, before and after each condition. The SCAT3 indexed symptom scores pre-post exposures to all three conditions. During the heading condition, cumulative linear and rotational accelerations experienced were 1,574 ± 97.9 g and 313,761 ± 23,966 rad/s2, respectively. Heart rate trended toward an increase from pre- to post-heading (p = 0.063), however HRV metrics in the time-domain (ps > 0.260) and frequency-domain (ps > 0.327) as well as cardiac BRS (ps > 0.144) were not significantly changed following all three conditions. Following the heading condition, SCAT3 symptom severity increased (p = 0.030) with a trend for symptom score augmentation (p = 0.078) compared to control and sham. Whereas, symptoms as measured by the SCAT3 were induced following an acute bout of controlled soccer heading, these preliminary findings indicate they were not accompanied by alterations to autonomic function. Ultimately, this demonstrates further research is needed to understand the physiological underpinnings of alterations in brain function occurring immediately after a bout of soccer heading and how these may, over time, contribute to long-term neurological impairments.



#12 Perspectives on Postmatch Fatigue From 300 Elite European Soccer Players

Reference: Int J Sports Physiol Perform. 2022 Dec 15;1-6. doi: 10.1123/ijspp.2022-0200. Online ahead of print.

Authors: Valter Di Salvo, Daniele Bonanno, Mattia Modonutti, Andrea Scanavino, Claudio Donatelli, Fabio Pigozzi, Lorenzo Lolli

Summary: The purpose was to examine the general perspectives of elite soccer players on the time course of perceived postmatch fatigue and the influence of away matches on subjective perceptions. Adopting a cross-sectional study design, we invited 371 subjects from 14 top-division European clubs competing in the Belgian First Division A, English Premier League, French Ligue 1, Italian Serie A, Portuguese Primeira Liga, Russian Premier League, and Swiss Premier League to take part in a short survey on general issues relating to postmatch fatigue measurement and tracking in professional soccer. Three hundred male professional soccer players completed the short questionnaire. For perceptions relevant to the time course of postmatch fatigue, two-thirds of respondents (67%) indicated higher postmatch fatigue perceived 2 days (48 h) after an official competition. Among these respondents, a higher proportion of answers was observed in wide midfielders (74%), attackers (74%), and central midfielders (68%). Approximately two-thirds of respondents (63%) indicated more than usual and much more than usual perceived postmatch fatigue following away matches. For the first time, our investigation addressed practical aspects that remained unexplored and fundamental to the definition of an optimal player management process following a competition. From a practical standpoint, perspectives of individual elite soccer players substantiated the notion of implementing processes with dedicated recovery protocols within 48 hours postmatch and highlighted the need for differential strategies addressing the additional burden of away matches and travel.



#13 The effect of exercise-induced fatigue and heat exposure on soccer-specific decision-making during high-intensity intermittent exercise

Reference: PLoS One. 2022 Dec 15;17(12):e0279109. doi: 10.1371/journal.pone.0279109. eCollection 2022.

Authors: Kate J Donnan, Emily L Williams, Nicholas Stanger

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Summary: Global warming and the globalisation of sport has increased the prevalence of sports competitions being held in hot environments. However, there is currently limited research investigating the impact of the heat on soccer-specific decision-making skills during exercise reflective of the physical demands of match-play. Therefore, the effects of heat exposure on physical and soccer-specific decision-making performance, biological markers (i.e., metanephrines), appraisal (i.e., challenge vs. threat) and affective states, during prolonged high-intensity intermittent exercise were investigated. Nine well-trained male soccer players completed a 92-min cycling intermittent sprint protocol (CISP), whilst simultaneously responding to a series of soccer-specific decision-making trials at various time points, in two temperature conditions: hot (32°C, 50%rh) and temperate (18°C, 50%rh). Results showed that decision-making score (p = .030) was impaired in the hot compared to the temperate condition. There was a reduced workload in the second half during the hot condition (p = .016), which coincided with a heightened threat state (p = .007) and more unpleasant feelings (p = .008) experienced in the hot, compared to temperate, condition. Furthermore, plasma normetanephrine (NMET) was higher at half-time (p = .012) and post-CISP (p ≤ .001). Also, plasma metanephrine (MET) was higher post-CISP (p = .009) in the hot compared to temperate condition, reflecting a heightened stress response. Our findings highlight the need for practitioners to consider the detrimental effects heat exposure can have on both physical and decision-making performance when looking to facilitate performance in hot conditions.



#14 The Happiness for Italy's Victory at the European Soccer Championships Costs a "Happy Heart Syndrome"

Reference: Eur J Case Rep Intern Med. 2022 Nov 8;9(11):003572. doi: 10.12890/2022_003572. eCollection 2022.

Authors: Luca Fazzini, Maria Francesca Marchetti, Mattia Biddau, Francesca Aste, Silvia Maiani, Roberta Montisci

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Summary: Takotsubo syndrome (TTS) is usually caused by physical or emotional negative stressors. Sometimes positive emotions trigger a rare form of Takotsubo syndrome, called the "happy heart" syndrome. We discuss the management of a 52-year-old female with happy heart syndrome, the differences between these stress cardiomyopathies and the relationship with hyperthyroidism. The happy heart syndrome is less common than other stress cardiomyopathies but emergency doctors, cardiologists and all specialists in internal medicine should take into account this cardiomyopathy, which occurs in patients with previous positive emotions. It is triggered by opposite stressors to Takotsubo syndrome and sometimes it may be misdiagnosed. Beyond triggers it has some different clinical features, and the management is similar. It is a rare disease, and is therefore underdiagnosed.Everybody experiences positive emotions in life but only a small percentage develop stress cardiomyopathy. A susceptibility is needed to trigger these cardiomyopathies such as hyperthyroidism, which has to be promptly treated with an endocrinologist's help.In clinical practice it is common to diagnose stress cardiomyopathies without following up the patients. We need to follow up these patients especially looking for concomitant conditions such as hyperthyroidism or hypersympathetic activity, which could present during follow-up.



#15 Soccer player with painful toe

Reference: J Fam Pract. 2022 Oct;71(8):367-369. doi: 10.12788/jfp.0491.

Authors: Stephanie Price, Shayna Rivard

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Summary: An x-ray revealed the source of the toe nodule and the nail dystrophy.



#16 A Thirteen-Year Analysis of Facial Fractures Among Professional Soccer Players

Reference: Facial Plast Surg. 2022 Dec 12. doi: 10.1055/a-1996-7595. Online ahead of print.

Authors: Konrad M Kozlowksi, Peter A Rosston, Asher C Park, Amir A Hakimi, Leandro Socolovsky, Brian Wong

Summary: This study aims to identify the epidemiology and effects of facial fractures on return to play (RTP) in Major League Soccer (MLS) and the English Premier League (EPL). A total of 39 MLS players and 40 EPL players who sustained facial fractures from 2007-2019 were identified. Data on player demographics, the injury, and the impact of their injury on RTP were collected. Elbow-to-head was the most common mechanism of injury (20.3%). The most common fracture involved the nasal bone (48.3%). Most players (90%) RTP the same season. Players who sustained nasal fractures missed significantly fewer games (p<0.001) than those who suffered other craniofacial fractures. Players treated surgically missed significantly more games (3.21 v 0.71, p=0.006) and days (30.1 v 8.70, p=0.002) than those managed non-operatively. Significantly more EPL players who sustained facial fractures wore headgear upon RTP compared to MLS players (82% vs 56%, p<0.01). Most professional soccer players who sustain a facial fracture RTP the same season, but their recovery time can vary depending on the type of fracture, injury management, or injury severity. Our findings can help inform future craniofacial injury management as well as guidelines on player safety and fracture prevention.



#17 Epidemiology of Upper Limb Injuries in two major Brazilian Soccer Championships from 2016 to 2019

Reference: J Exp Orthop. 2022 Dec 14;9(1):120. doi: 10.1186/s40634-022-00560-1.

Authors: Ewerton Borges de Souza Lima, Gabriel Paris de Godoy, Guilherme Ladeira Osés, Paulo Henrique Schmidt Lara, Leandro Masini Ribeiro, Carlos Vicente Andreoli, Alberto de Castro Pochini, Paulo Santoro Belangero, Gustavo Gonçalves Arliani, Benno Ejnisman, Moisés Cohen

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Summary: The aim was to evaluate epidemiological data of upper limb injuries in professional athletes who participated in two major Brazilian soccer championships between 2016 and 2019. A prospective cohort study was conducted to evaluate the teams of two divisions over four seasons within the Brazilian Soccer Championship and the Paulista Soccer Championship. Clubs and their doctors were contacted to participate in the study and guided on the correct way to enter data via online platforms: Transfermarkt (Transfermarkt GmbH & Co. KG) and Survey Monkey (Momentive.AI). Demographic data, injury characteristics, and FIFA Incidence Formula were analyzed. Overall, the study analyzed 3,828 matches and 126,357 hours of play. Upper limb injuries were registered 169 times, representing 6.8% of total injuries, with a FIFA incidence of 1.34. Most lesions occurred in forward players (21.3%), the shoulder exhibited the highest number of injuries (63.3%). The player's position was related to the location on the field where the injury occurred (p < 0.001); however, there was no relationship between the type of injury and the location on the body (p > 0.001). The average time to return to play was 19.1 days (range 0-200 days) and it was longer for goalkeepers. The necessity of surgical treatment was statistically associated with additional time to return to play (p < 0.001). Shoulder injuries were the most frequent upper limb injury sustained during the two major Brazilian soccer championships. Forward players suffered the most upper limb injuries and goalkeepers experienced the longest time to return to play.



#18 Postcolonial control of Fiji soccer and the return of subjugated knowledges: From the 1970s to the 2010s

Reference: Front Sports Act Living. 2022 Nov 28;4:1005733. doi: 10.3389/fspor.2022.1005733. eCollection 2022.

Authors: Kieran E James, Henry D Tuidraki, Sheikh Ali Tanzil

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Summary: The primary aim of this article is to use Foucault's idea of subjugated knowledges to search out areas and viewpoints within Fiji soccer which are suppressed by the governing authorities. To fulfill this aim, we explore and assess, via ethnographic research, the racial and ethnic aspects of Fiji soccer, from the 1970s to the 2010s, and how cultural hegemony facilitates continued Fiji Indian control and dominance within the sport. Next, and although we note the positive dimension of Fiji Football Association's 2014 Veterans' Dinner, we suggest that some ex-Ba players were apparently discriminated against by, puzzlingly, not being invited. The regulator was also unaware of, or insensitive to, ex-players' transportation needs as some were poor or invalid. We then look at the cases of Sweats Soccer Club (SSC) and Nadi Legends Football Club (NLFC) to show how, in the face of the regulator's indifference to the financial plight of an Indigenous village club (SSC), the ex-Nadi players set up instead a self-help organization (NLFC) to assist and encourage ex-players going through hard times. The latter was a cross-ethnic group/cross-class collaboration between ex-officials and ex-players and was largely outside the regulator's sphere of interest or intent.



#19 The Moderating Role of Sociability and Social Connection for the Relationship between Soccer Participation and Teamwork Ability among Chinese College Students

Reference: Int J Environ Res Public Health. 2022 Nov 22;19(23):15441. doi: 10.3390/ijerph192315441.

Authors: Yuetao Liu, Songhui You, Zhiyuan Wang

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Summary: In order to provide empirical evidence for soccer's promotion of teamwork ability and to examine whether sociability and social connection have an effect on this promotion, we explored the relationship between soccer participation (volume, duration), teamwork ability and sociability and social connection (SSC). Using the method of stratified sampling, a questionnaire survey was carried out in four universities in Shanghai. All the respondents are undergraduate students, which include the specially recruited soccer athletes and the soccer participants from ordinary college students. The findings from this study indicate that participating in soccer can positively predict the teamwork ability of college students, and SSC can negatively moderate the effect of soccer participation on teamwork ability. The effect of soccer participation on teamwork ability was different in the collegiate soccer athletes and collegiate soccer participants groups. An important value of soccer, which is often overlooked, is the help it provides college students, who have insufficient sociability and social connections, in better integrating into the team and in improving their teamwork ability. We highly recommend that college students participate in soccer to improve their teamwork skills in study and work and to better prepare for their careers.


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