A growing interest in football – particularly over the last decade – has made it the most popular sport in the world, with about 200 million participants of both sexes and all ages. Given that the incidence of football injuries is likely to have risen in line with this increased popularity, one would expect to find a huge body of research on injury prevention.

But, in fact, there is a serious lack of research in this area, according to Canadian researchers, who set out to review evidence on the effectiveness of current injury prevention strategies in football and determine their applicability to children and young players.

Extensive searches through the worldwide literature resulted in just four studies that met the researchers’ strict relevance criteria, as follows:

• A Swedish study assessing the effectiveness of a seven-part intervention programme in 17-36-year-old male players in a community soccer league noted 75% fewer injuries in the intervention teams than the controls. But the Canadian reviewers found problems with the quality of this study and point out that it is not possible to assess the relative contributions of the different components of the programme, which included warm-ups, cool-downs, protective equipment, ankle taping and controlled rehabilitation;
• A study of the effects of proprioceptive training on the incidence of anterior cruciate ligament (ACL) injuries in semi-professional and amateur male soccer players in Italy found a sevenfold reduction in injuries in the trained group. However, the reviewers point out that since this evidence comes from only one study, further research is needed before this kind of training can be recommended;
• A four-year US study looked at the effectiveness of strength training on the incidence of injuries in male college football players and noted a halving of the subsequent injury rate. But the researchers themselves acknowledged problems with their study design, which made it difficult to attribute the results with certainty to strength training;
• A multi-component approach to reducing heat stroke during a six-day youth football tournament involving 4,000 players led to a decrease in the rate of heat exhaustion from 21 cases per thousand players in the first two days to 13 per thousand in the last four days – numbers which were considered too small for reliable statistical analysis.

The reviewers recommend further research into all these apparently promising interventions. They also call for further research on heading, protective eyewear and mouth guards and such environmental/facilities factors as goal post padding, playing surfaces and aggressive play.

‘Effective injury prevention strategies based on sound surveillance data and high-quality research are essential for fostering safety…,’ they conclude. ‘This review set out to identify research that evaluated injury prevention interventions aimed at young soccer players and found a serious lack of research in this area (that is) surprising considering the enormous and increasing popularity of youth soccer around the world.

‘The lack also raises concerns about injury prevention strategies that are currently in use. Without adequate research we cannot know which practices are effective at reducing the risk of soccer injuries.’

Br J Sports Med 2004;38:89-94