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German Journal of Exercise and Sport Research

, Volume 48, Issue 4, pp 489–497 | Cite as

Leaving injury prevention theoretical? Ask the coach!—A survey of 1012 football coaches in Germany

  • Christian Klein
  • Thomas Henke
  • Patrick Luig
  • Petra Platen
Main Article

Abstract

High injury rates in football (soccer) suggest an urgent need for preventive approaches. Theoretical models illustrating systematic sports injury prevention procedures typically consider descriptions of injury epidemiology and etiology, but do not regard the knowledge and specific needs of important stakeholders within sport practice. This might be one reason why there is still a research-to-practice gap-reducing effectiveness of preventive approaches under real life conditions. Thus, the present study asks football coaches, as the most important decision-makers among coaching and medical staff, for their opinions about injuries and prevention. A random sample of 2000 German football coaches was drawn from the database of the German Football Federation (DFB) and invited to participate in an online survey; of these, 1012 (50.6%) were included for analysis. Participants were subdivided by age categories, coaching licenses, and performance levels of the teams they coached. Overall, lack of fitness/athletics was rated as the most important risk factor for injuries, followed by previous injuries and lack of regeneration. Coordination and core stabilization training as well as regeneration were stated as the most beneficial preventive areas. The results suggest that in general, periodization, load monitoring and reintegration of injured players must be given greater priority in future preventive approaches. Education curricula for lower-level coaching licenses should focus on basic physiology, fundamental medical and physiotherapeutic support, and on low-threshold possibilities of testing and training. To gain a more professional oriented license, coaches should qualify as decision-makers within a team of experts and be taught leadership competence and communication skills.

Keywords

Soccer Implementation Adherence Compliance Decision Maker 

Mit der Verletzungsprävention in der Theorie verharren? Besser den Trainer fragen! – Eine Befragung von 1012 Fußballtrainern in Deutschland

Zusammenfassung

Hohe Verletzungsraten im Fußball weisen auf einen dringenden Bedarf an Präventivmaßnahmen hin. Theoretische Modelle zur systematischen Sportverletzungsprävention berücksichtigen üblicherweise die Beschreibung der Epidemiologie sowie der Ätiologie von Verletzungen, betrachten jedoch nicht die Expertise und Bedürfnisse wichtiger Akteure aus der Sportpraxis. Dies könnte ein Grund sein, weshalb wissenschaftliche Erkenntnisse in der Sportpraxis häufig keine Berücksichtigung finden und die Effizienz präventiver Maßnahmen unter Realbedingungen reduziert ist. Daher wurden in der vorliegenden Studie Fußballtrainer, als wichtigste Entscheidungsträger innerhalb des Trainer- und Betreuerstabs, nach ihrer Meinung hinsichtlich Verletzungen und Prävention befragt. Eine zufällige Stichprobe von 2000 Fußballtrainern aus der Datenbank des Deutschen Fußball-Bundes (DFB) wurde eingeladen, an der Onlinebefragung teilzunehmen. Insgesamt 1012 Trainer (50,6 %) wurden in die Datenauswertung eingeschlossen. Die Teilnehmer wurden nach Altersgruppen, Trainerlizenzen und Leistungsklasse der trainierten Mannschaften unterteilt. Insgesamt wurde mangelnde Fitness/Athletik als größter Risikofaktor für Verletzungen bewertet, gefolgt von Vorverletzungen und mangelnder Erholung. Koordinations- und Rumpfstabilisationstraining sowie Regenerationsmaßnahmen wurden als wichtigste präventive Bereiche erachtet. Die Ergebnisse deuten darauf hin, dass bei zukünftigen präventiven Ansätzen insbesondere auf die Themen Periodisierung, Belastungssteuerung und Reintegration von verletzten Spielern fokussiert werden sollte. In der Ausbildung der unteren Trainerlizenzen sollten vermehrt Grundlagen der Physiologie sowie der medizinischen und physiotherapeutischen Betreuung und niedrigschwellige Möglichkeiten der Diagnostik und Intervention geschult werden. Zur Erlangung einer eher professionell ausgerichteten Trainerlizenz sollten Trainer zu Entscheidungsträgern innerhalb eines Expertenteams ausgebildet und Führungskompetenz sowie Kommunikationsfähigkeit geschult werden.

Schlüsselwörter

Fußball Implementation Adhärenz Akzeptanz Entscheidungsträger 

Introduction

High injury rates in professional (aus der Fünten, Faude, Lensch, & Meyer, 2014; Ekstrand, Hägglund, & Waldén, 2011; Krutsch et al., 2016), amateur (Hägglund, Waldén, & Ekstrand, 2016; Henke, Luig, & Schulz, 2014; Krutsch et al., 2016), youth (Faude, Rössler, & Junge, 2013; Krutsch et al., 2014), and veteran (Hammes et al., 2015) football (soccer) indicate the need of injury prevention approaches across all age groups and performance levels. When discussing the benefits of fewer football-related injuries, consideration must be given to the potential for positive economic aspects (Ekstrand, 2013; Ekstrand et al., 2011; Housten, Hoch, & Hoch, 2016), increased team performance (Hägglund et al., 2013), and an improved health-related quality of life (Dias, Dias, & Ramos, 2003; Milanovic et al., 2018; Oka et al., 2000) for athletes. While injury prevention is increasingly being accepted as an important topic in the football community (McCall, Dupont, & Ekstrand, 2016; McCall et al., 2015; McCall et al., 2014), high injury rates and their resulting financial and physical burden require further preventive efforts (Ekstrand et al., 2011). Initial theoretical models that illustrate systematic sports injury prevention procedures typically consider a description of injury epidemiology and etiology (Finch, 2006; van Mechelen, Hlobil, & Kemper, 1992), but do not regard the specific needs and expertise of important stakeholders within sport practice. This shortcoming could help explain the research-to-practice gap, which has historically reduced the effectiveness of preventive approaches under real life conditions (Durlak & DuPre, 2008; Green, 2001; Klesges, Estabrooks, Dzewaltowski, Bull, & Glasgow, 2005). To address this gap, more recent models such as the Five-step Knowledge Transfer Scheme (Verhagen, Voogt, Bruinsma, & Finch, 2014) and the Seven Steps for Developing and Implementing a Preventive Training Program (Padua et al., 2014) respect the target population right from the beginning of the process. In accordance with these models, our research group is pursuing the plan to complement our findings from epidemiological and etiological research (Luig, Bloch, Burkhardt, Klein, & Kühn, 2017; Luig, Bloch, Burkhardt, & Klein, 2016) with the expertise of practitioners when developing preventive approaches. Thus, the present study recognizes football coaches as the most important decision-makers within the coaching and medical staff, and as key influencers of injury rates and player availability (Ekstrand et al., 2017), and therefore solicits their personal opinions about injuries and injury prevention in football.

The aim of this survey was to gain knowledge from coaches’ feedback that will help researchers learn how to adjust future approaches, implementation strategies and education curricula to the specific needs of football practitioners. It is hoped that the findings from this study will reduce the research-to-practice gap and help to increase the effectiveness of injury prevention approaches in football.

Methods

Participants

From the database of the German Football Federation (DFB), a random sample of 2000 coaches was invited to participate in an online survey. Each participant held a current German football coaching license. The email invitations, with access to the survey, were sent to the coaches through the DFB.

Participants were divided into subgroups according to age group, coaching license, and the performance levels of the teams they coached. In Germany, there are five tiers of coaching licenses, from “Pro-level” (License I) down to “Grassroots” (License V). Team performance levels were divided into the following three categories: professional football (Pro), including coaches of national teams and club teams in the three highest divisions in German adult football; elite youth football (Pro-youth), including coaches of youth national teams as well as youth Bundesliga teams; and, amateur football (Amateur), including the coaches of senior teams below the third division, and youth teams below the youth Bundesliga. Participants who were not coaching a team at the time of the survey were excluded from the analysis of these subgroups.

Survey

The applied survey was developed on the basis of long-term experience in sports injury monitoring in Germany. Our working group established a continuous questionnaire-based injury surveillance system of club sports injuries from 1987 to 2012, which resulted in a dataset of 200,884 sports injuries (Henke et al., 2014). Oriented towards the latest version of this questionnaire, a preliminary version of the applied survey used in the present study was designed as an online survey in 2013 by the Department of Sports Science of the Ruhr-University Bochum (RUB) in collaboration with the German Football Federation (DFB) as part of a project concerning development of education modules for coaches on the subject of injury prevention in football. The final online survey that was applied in the present study is based on the results of a test survey of a smaller sample of football coaches (n = 67) with the preliminary version (Klein et al., 2013).

The online survey was generated on the website www.soscisurvey.de in both German and English. Hence, coaches were able to choose between the German or English version right at the beginning. The survey consisted of four parts. The first part comprised subjective estimations of injuries as a problem in general, the most affected body locations, and, the causes of football injuries. Part two covered evaluations of the benefits of different preventive measures. Part three focused on the impact of different professions within the coaching and medical staff, as well as on the meaning of injury prevention as a topic within various education curricula for successful injury prevention. These three parts consisted of five questions with a total of 66 items. Every item was scored using a 5-point Likert scale, in which the participants rated each item from “no problem at all/not important/marginal benefit” (1), to “very big problem/very important/great benefit” (5; Fig. 1). All items had to be rated independently. The selection of the questions and the single items was made by an expert panel of three sports scientists from the RUB and two coaching supervisors of the DFB. The item selection was meant to present all coaching levels and age categories using familiar and self-explanatory terminologies; as a result, some items may have been used synonymously or are integral components of each other (e.g., coordination training and balance training). For practical reasons, the participants were not given additional information concerning item definition.
Fig. 1

Screenshot of one item from the online survey

Finally, part four consisted of eight questions asking for participants’ personal data such as age, sex, coaching license, and performance level of the team they coached.

Statistical analysis

Raw data were exported from www.soscisurvey.de as an SPSS Statistics syntax file. Subsequent analysis was done with IBM SPSS (v. 26). Only surveys that were completed and credible were included for analysis. Results from the 5‑point Likert-scale rating were attended to as quasi-metric data because all items were normally distributed over the total sample, which was tested optically with histograms, and graphically illustrated the equal interval sizes between the five response options (Fig. 1). Thus, it was permissible to calculate arithmetic means and 95% confidence intervals (±95% CI) for these items. For comparison of different subgroups, the Kruskal–Wallis Test was conducted, followed by a Dunn–Bonferroni Test for post hoc testing (z-score). For this study, a level of 5% (p ≤ 0.05) was determined as the level of significance.

Results

Of the 2000 invited coaches, 1188 (59.4%) participated in the survey. Out of these, 176 (14.8%) were excluded because of incomplete (e.g., missing personal data) or incredible (e.g., all items rated “1”) response. In total, 1012 (50.6%) coaches answered the survey properly and were included in the analysis, leading to a total drop-out rate of 49.4%. In all, 95.6% of the included coaches were male; all the participants chose the German version of the survey (Table 1).
Table 1

Total sample characteristics and distribution of subgroups

 

Total sample

Age categories

Distribution

Coaching license

Distribution

Performance level

Distribution

n

%

n

%

n

%

Mean age (SD)

43.7 (±10.8)

<31

126

12.5

I

12

1.2

Pro

27

2.7

Sex

4.4% female 95.6% male

31–40

280

27.5

II

426

42.1

Youth-Pro

58

5.7

41–50

333

32.9

III

452

44.7

Amateur

751

74.2

Language of survey

100.0% German

51–60

202

20.0

IV

95

9.4

No team at present

176

17.4

>60

71

7.0

V

27

2.7

Total (n)

1012

Total

1012

100.0

Total

1012

100.0

Total

1012

100.0

SD standard deviation

Injuries and injury causes

The mean rating for injuries as a problem in general was 3.82 (3.77–3.87). Younger coaches (<31) estimated injuries as a bigger problem than did 41- to 50-year-old (z = 3.207, p = 0.013) and >60-year-old coaches (z = 3.234, p = 0.012). Concerning injured body locations, injuries to lower extremities were rated as the most serious problem, particularly knee injuries (4.58; 4.54–4.62), followed by ankles (4.26; 4.21–4.31), feet (3.95; 3.90–4.01), thighs (3.70; 3.63–3.76), and the hip/groin area (3.50; 3.44–3.56). The last was deemed a more serious problem by coaches younger than 40 years compared with their older colleagues (≤30 vs. >60: z = 3.273, p = 0.011; 31–40 vs. >60: z = 3.067, p = 0.022; ≤30 vs. 41–50: z = 3.074, p = 0.021; 31–40 vs. 41–50: z = 2.999, p = 0.027).

Concerning injury causes, participants ranked lack of fitness/athletics as most important (3.95; 3.89–4.01) followed by previous injuries (3.66; 3.60–3.71), lack of regeneration (3.64; 3.58–3.71), false or poor training (3.59; 3.53–3.65), and foul play/unfairness (3.59; 3.53–3.65; Fig. 2). The following injury causes were ranked as more considerable by younger versus older coaches: poor playing technique (31–40 vs. 51–60: z = 3.213, p = 0.013; 41–50 vs. 51–60: z = 3.129, p = 0.018), poor nutrition (≤30 vs. 41–50: z = 3.127, p = 0.018; ≤30 vs. >60: z = 3.205, p = 0.013), and previous injuries (≤30 vs. 41–50: z = 4.883, p = 0.000; ≤30 vs. 51–60: z = 4.777, p = 0.000; ≤30 vs. >60: z = 3.451, p = 0.006; 31–40 vs. 41–50: z = 3.199, p = 0.014; 31–40 vs. 51–60: z = 3.151, p = 0.016).
Fig. 2

Coaches’ mean ratings of the relative importance of injury causes in football (±95% confidence interval)

Prevention

The participants ranked the area of training approaches as most promising for injury prevention, particularly coordination (4.21; 4.16–4.26) and core stabilization training (4.20; 4.15–4.25). From a coach’s perspective, regeneration (4.16; 4.10–4.21), warm-ups (4.04; 3.98–4.10), and physiotherapy (3.99; 3.93–4.05) are also beneficial preventive areas. Less relevant are pitch conditions, changes of the match rules, and the area of (protective) equipment (Fig. 3).
Fig. 3

Coaches’ mean ratings of the benefits of preventive approaches in football (±95% confidence interval)

However, holders of higher coaching licenses and coaches in higher performance levels ranked performance diagnostics (I vs. III: z = 2.856, p = 0.043; I vs. IIII: z = 3.101, p = 0.019; Pro-youth vs. Amateur: z = 3.656, p = 0.002) and medical health check-ups (Pro-youth vs. Amateur: z = 3.078; p = 0.012) higher than others did. Older coaches regarded fair play (≤30 vs. >60: z = −3.711, p = 0.002; 31–40 vs. 41–50: z = −3.959, p = 0.001; 31–40 vs. 51–60: z = −5.700, p = 0.000; 31–40 vs. >60: z = −5.956, p = 0.000; 41–50 vs. >60: z = −3.599, p = 0.003) and changes to the match rules (≤30 vs. 51–60: z = −3.437, p = 0.006; ≤30 vs. >60: z = −2.847, p = 0.041; 31–40 < 51–60: z = −3.184, p = 0.015) as more beneficial than younger coaches did.

Education and staff

The mean rating in importance of the topic of injury prevention in general was 4.20 (4.16–4.25). For the topic of prevention as part of the education curricula of specific professions, participants rated the education of physiotherapists and club physicians as most important (4.64; 4.60–4.68), followed by youth players (4.25; 4.19–4.30), coaches (4.22; 4.17–4.27), players in general (4.08; 4.04–4.13), and referees (3.03; 2.95–3.10).

In response to the question of which stakeholders are most important to reach with new preventive approaches and programs, physiotherapists were ranked highest (4.67; 4.63–4.71), followed by coaches (4.57; 4.53–4.61), athletic coaches (4.51; 4.47–4.55), club physicians (4.51; 4.47–4.56), players (4.47; 4.42–4.51), nutritionists (3.46; 3.40–3.53), sport psychologists (3.25; 3.18–3.32), and club managers (2.72; 2.65–2.79; Fig. 4).
Fig. 4

Coaches’ mean ratings of importance of professions within football training and medical staff for successful injury prevention (±95% confidence interval)

Compared with younger coaches, older coaches ranked coaches themselves as more important stakeholders (31–40 vs. 51–60: z = −3.450, p = 0.006). However, younger coaches assessed athletic coaches (≤30 vs >60: z = 3.048, p = 0.023; 51–60 vs. >60: z = 2.817, p = 0.048) and sport psychologists (31–40 < 51–60: z = −3.642, p = 0.003; 41–50 vs. 51–60: z = −3.044, p = 0.023) as more important stakeholders to target with preventive contents.

Discussion

The most important findings of the present survey are that coaches rate injury prevention as a topic of high relevance, and that approaches in the areas of training and regeneration are of key importance for reducing the number and severity of injuries in football. In accordance with the findings of McCall et al. (2016), coaches view a lack of fitness, a lack of regeneration, and previous injuries as the most important risk factors for injuries. Previous studies have found all three to be risk factors for injuries in football (Dvorak et al., 2000; Fulton et al., 2014; Hägglund, Waldén, & Ekstrand, 2006).

Benefits for injury prevention

While our results demonstrate that coaches consider the topic of injury prevention highly relevant, and despite the large body of evidence showing the efficacy of preventive approaches under a wide variety of circumstances, settings, and populations (Faude, Rommers, & Rössler, 2018), it is clear that comprehensive, continuous and sustainable implementation of preventive approaches is lacking (Ekstrand, Waldén, & Hägglund, 2016; Faude et al., 2018). There are two main rationales that should be noted in this context: First, there is a high probability that the real awareness of all football coaches in Germany concerning injuries and their prevention is lower than stated in this study. Although our participation rate is within the range of normal standards for online surveys (Manfreda, Berzelak, Vehovar, Bosnjak, & Haas, 2008), we acknowledge that a drop-out rate of 49.4% may have biased the representativeness of the sample. The academic literature strongly suggest that non-response is not random and that differences between respondents and non-respondents can bias results (Groves et al. 2006; Heerwegh, Abts, & Loosveldt, 2007). We assume that coaches who were not willing to participate in the survey are less interested in the given topic and thus pay less attention to it within their daily coaching work. Consequently, the overall estimation of football coaches in Germany concerning the relevance of injuries and their prevention might be lower than the results suggested by our sample. Second, it should be noted that rating injury prevention as highly relevant does not necessarily mean that preventive measures are being sustainably implemented. There are still time-, personnel-, environment-, and organization-related barriers that can deter coaches from implementing preventive measures (Padua et al., 2014). As a result, systematic implementation strategies are needed that (1) raise coaches’ (and other stakeholders’) awareness and (2) help them overcome predominant barriers. Several recently published papers describe research frameworks that lead to successful implementation (Verhagen et al., 2014), such as the Five-step Knowledge Transfer Scheme (KTS; Verhagen et al., 2014) and the Seven Steps for Developing and Implementing a Preventive Training Program (Padua et al., 2014). Both models focus on bridging the knowledge-to-practice gap to increase effectiveness under real life conditions. To reach this goal, these more recent models differ to the extent from the first models by van Mechelen et al. (1992) and Finch (2006), that consideration of important stakeholders from sports practice is a key component. The present study should be seen as a part of this “key component” for implementing preventive measures in German football practice. Regarding the model by Padua et al. (2014), the performed survey addresses Step 1 (Establish Administrative Support) and Step 2 (Develop an Interdisciplinary Implementation Team). Asking coaches as key decision-makers within the coaching staff for their personal assessments and about demands they face, and thus involving them in the development process, can help ensure that coaches are committed to implementing new interventions (Step 1). Involving coaching supervisors of the DFB as key decision-makers in coaching education curricula can ensure the integration of the research findings, and the resulting preventive approaches into coaching education (Step 2; Padua et al., 2014).

When looking at the KTS model (Verhagen et al., 2014), it becomes obvious that there is a combination of a “top-down” and a “bottom-up” approach within Step 1. The “top-down” approach, as in previous models, essentially represents the evidence-based description of the problem in terms of injury epidemiology and etiology. In addition, however, the problem is described “bottom-up” by sports practice, after which, in Step 2, evidence is sought to potentially solve the posed problem. For the purpose of the present study, this means that the results of the survey would never be intended as evidence-based results, but would rather complement them and help us understand the character of the community, its members, its strengths, weaknesses, and challenges. In case that coaches’ estimation is in accordance with evidence-based knowledge, such as the identified main risk factors for injuries (i.e., lack of fitness/athletics, previous injuries, and lack of regeneration), they can be affirmed and supported in solving the identified problem. If coaches’ assessments differ from scientific findings, as with the relatively low-rated relevance of thigh injuries (cf. Ekstrand et al., 2016; Ueblacker, Müller-Wohlfahrt, & Ekstrand, 2015) or the comparably highly rated benefit of stretching for injury prevention (cf. Faude et al., 2018) and cool-down (cf. van Hooren & Peake, 2018), closer consideration is needed. It is necessary to question what the coaches’ reasons for these assessments are and if there are possible circumstances that may legitimate deviations from scientific findings. These points must be discussed and scientific findings must be promoted within coaching education. However, in our opinion, forcing all coaches to fully adopt research results is not expedient. Coaches must continue making their own decisions, but these decisions should be anchored in a more in-depth substantive dialogue about the respective issue. In addition, regarding the bottom-up approach, future research should consider whether divergent findings should be reviewed in the context of the particular circumstances.

Altogether, the benefits of the present study are: (1) an illustration of the current opinions of football coaches, which will help to develop new preventive measures or to adjust existing programs, and identify alignment with as well as deviations from the scientific literature; (2) a demonstration of how to begin bridging the knowledge-practice gap by involving key decision-makers from sports practice and thus help ensure that coaches are committed to implementing new interventions, and (3) a means of ensuring the integration of injury prevention as a subject into coaching education by involving coaching supervisors of the DFB as key-decision makers in coaching education curricula.

Substantive findings and differences between subgroups

Given that a coaches’ leadership style directly affects injury rates and player availability (Ekstrand et al., 2017), it is important to highlight that coaches represent the biggest preventive potential within their own range of influence. Approaches dealing with equipment, facilities, refereeing, and changes or interpretations of rulebooks should be a lower priority.

Concerning the disruptive potential of injured body locations, injuries to the lower extremities are perceived as the biggest problem, which aligns with current epidemiological data for all performance levels and age groups (Faude et al., 2013; Hägglund, et al., 2016; Hammes et al., 2015; Krutsch et al., 2016). However, a closer look at coaches’ ranking of injured body locations in the present study suggests that thigh injuries are deemed less relevant than the current epidemiological data might predict (Hägglund et al., 2016; Ueblacker et al., 2015). Younger coaches view injuries as a greater problem in general than do older coaches; the same age-based contrast is apparent for increasing and currently often discussed injury types such as thigh and hip/groin injuries (Ekstrand et al., 2016; Mosler et al., 2017). Furthermore, younger coaches pay more attention than older coaches due to the risk inherent in previous injuries and poor nutrition. While younger coaches rate themselves as less important stakeholders in the execution of injury prevention methods, they consider athletic coaches and sport psychologists as significantly relevant for successful injury prevention. These findings suggest that younger coaches are more receptive to current topics within injury prevention research and are open to making decisions in collaboration with other experts and professions.

Holders of higher coaching licenses regard performance diagnostics and medical health check-ups as most important, compared with those holding lower licenses. Similarly, coaches of elite-youth football teams versus amateur coaches rate these two factors higher in terms of importance for injury prevention. As discussed elsewhere (Hägglund et al., 2016; Krutsch et al., 2014; van Beijsterveldt, Stubbe, Schmikli, van de Port, & Backx, 2015), this difference may be explained by the presence of better human, infrastructural, and monetary resources within more professional teams, which offer greater opportunities for elite coaches to execute performance diagnostics and health check-ups for their athletes.

Lessons learned

Existing training programs such as FIFA 11+, which include core stabilization and coordination exercises, are already compatible with the estimation of football coaches concerning beneficial preventive measures (Bizzini & Dvorák, 2015; Barengo et al., 2014). However, to achieve comprehensive and sustainable implementation of such programs, their practicability and promotion strategies of these programs need to be revised (Ekstrand et al., 2016; Faude et al., 2018). From a practical point of view, future preventive approaches should focus on the development of tools that can help coaches detect an individual’s lack of fitness and regeneration such as low-threshold load- and well-being-monitoring tools (Bourdon et al., 2017; Saw, Kellmann, Main, & Gastin, 2017). Furthermore, clear return-to-play guidelines for common injury types should be developed and promoted to coaches and medical staff to reduce subsequent and recurrent injuries (Ardern, Bizzini, & Bahr, 2016). Based on the present results, periodization, load monitoring, and reintegration of injured players must be given greater priority within education curricula across all license levels. Holders of higher football coaching licenses are often accustomed to heading a coaching team that includes other professions such as assistant coaches, athletic coaches, physiotherapists and physicians. Thus, education content can be more football-specific and tactical. Additionally, however, it seems to be important to teach leadership competence, along with communication skills and a clear schedule of responsibilities, to make the best use of the existing expertise (Ekstrand et al., 2017). By contrast, amateur-football coaches are typically more limited because of greater monetary restrictions and less support from other professions (Krutsch et al., 2014). Thus, these coaches must be more generalists with basic knowledge of many different topics. Consequently, rather than focusing on advanced football-specific tactics within the time available, the given education modules for lower coaching levels should primarily focus on general physiology, basic exercise science, medical and physiotherapeutic support, as well as on low-threshold possibilities of testing and training.

For clinical relevance in daily football routines, the assessments and needs of other stakeholders within the coaching and medical staff should also be sought. With this additional data, a fact sheet can be created to synthesize and present the convergent and divergent views of all the stakeholders; making this content publicly available will, ideally, influence the education process of the different subgroups and professions involved in football. This type of information may also help to increase mutual understanding amongst an entire staff and, finally, lead to improved communication within the team behind the team, which is of great importance for injury prevention (Ekstrand et al., 2018).

Methodical considerations

There are some limitations with the current study we like to disclose. (1) It should be noted, that in spite of the randomized selection process, and the large number of invited football coaches from the DFB database, the respondents are not necessarily representative of all German football coaches in terms of the distribution of age, sex, coaching licenses, and performance levels coached. As already mentioned, we stated an additional risk of bias within the given results owing to a drop-out rate of 49.4%. (2) The still large size of the total survey sample enhanced the generalizability of the overall findings; however, the size of several subgroups differed considerably, as shown in Table 1. Thus, comparisons between different subgroups warrants a cautious interpretation of the findings. (3) The basis of the survey design was long-term experiences and expert knowledge from sports injury researchers and representatives of the sport practice; however, the single items were not a priori evaluated.

Nevertheless, to the best of our knowledge, no other study to date has interviewed a larger sample of football coaches about injuries and their prevention and included multiple coaching licenses and performance levels.

Conclusion

This study presents practical relevant information about coaches’ assessment of injuries and injury prevention in football. The results indicate that load- and well-being-monitoring tools that can help coaches detect lack of fitness and regeneration are needed, as are return-to-play guidelines for common injury types. Concerning coaches’ education curricula in general, periodization, load monitoring, and reintegration of injured players must be given greater priority. Education of coaches with lower coaching licenses should focus on basic physiology, fundamental medical, and physiotherapeutic support, as well as on the low-threshold possibilities of testing and training. More professional-oriented licensees should be taught leadership competence and communication skills to help qualify them as decision-makers within a team of experts.

Future preventive initiatives must occur in closer collaboration with research groups and practitioners to increase the adherence of these approaches.

Notes

Acknowledgements

The authors thank the 1012 coaches for participating in this survey and thereby supporting scientific work. We also thank the DFB for disseminating the survey within the target group.

Compliance with ethical guidelines

Conflict of interest

C. Klein, T. Henke, P. Luig and P. Platen declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. Ardern, C. L., Bizzini, M., & Bahr, R. (2016). It is time for consensus on return to play after injury: five key questions. British Journal of Sports Medicine, 50(9), 506–508.CrossRefGoogle Scholar
  2. Barengo, N. C., Meneses-Echavez, J. F., Ramirez-Velez, R., Cohen, D. D., Tovar, G., & Bautista, J. E. C. (2014). The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. International Journal of Environmental Research and Public Health, 11(11), 11986–12000.CrossRefGoogle Scholar
  3. van Beijsterveldt, A. M. C. A.-M., Stubbe, J. H., Schmikli, S. L., van de Port, I. G. L., & Backx, F. J. G. (2015). Differences in injury risk and characteristics between Dutch amateur and professional soccer players. Journal of Science and Medicine in Sport, 18(2), 145–149.CrossRefGoogle Scholar
  4. Bizzini, M., & Dvorák, J. (2015). FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review. British Journal of Sports Medicine, 49(9), 577–579.CrossRefGoogle Scholar
  5. Bourdon, P. C., Cardinale, M., Murray, A., Gastin, P., Kellmann, M., Varley, M. C., & Cable, N. T. (2017). Monitoring athlete training loads: consensus statement. International Journal of Sports Physiology and Performance, 12(2 Suppl), S2161–S2170.CrossRefGoogle Scholar
  6. Dias, R. C., Dias, J. M. D., & Ramos, L. R. (2003). Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee. Physiotherapy Research International, 8(3), 121–130.CrossRefGoogle Scholar
  7. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3–4), 327–350.CrossRefGoogle Scholar
  8. Dvorak, J., Junge, A., Chomiak, J., Graf-Baumann, T., Peterson, L., Rosch, D., & Hodgson, R. (2000). Risk factor analysis for injuries in football players. Possibilities for a prevention program. The American Journal of Sports Medicine, 28(5 Suppl), 69–74.Google Scholar
  9. Ekstrand, J. (2013). Keeping your top players on the pitch: the key to football medicine at a professional level. British Journal of Sports Medicine, 47(12), 723.CrossRefGoogle Scholar
  10. Ekstrand, J., Hägglund, M., & Waldén, M. (2011). Injury incidence and injury patterns in professional football: the UEFA injury study. British Journal of Sports Medicine, 45(7), 553–558.CrossRefGoogle Scholar
  11. Ekstrand, J., Waldén, M., & Hägglund, M. (2016). Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. British Journal of Sports Medicine, 50(12), 731–737.CrossRefGoogle Scholar
  12. Ekstrand, J., Lundqvist, D., Lagerbäck, L., Vouillamoz, M., Papadimitiou, N., & Karlsson, J. (2017). Is there a correlation between coaches’ leadership styles and injuries in elite football teams? A study of 36 elite teams in 17 countries. British Journal of Sports Medicine.  https://doi.org/10.1136/bjsports-2017-098001.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Ekstrand, J., Lundqvist, D., Davison, M., D’Hooghe, M., & Pensgaard, A. M. (2018). Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. British Journal of Sports Medicine. Advance online publication.  https://doi.org/10.1136/bjsports-2018-099411.CrossRefGoogle Scholar
  14. Faude, O., Rössler, R., & Junge, A. (2013). Football injuries in children and adolescent players: Are there clues for prevention? Sports Medicine (Auckland, N.Z.), 43(9), 819–837.CrossRefGoogle Scholar
  15. Faude, O., Rommers, N., & Rössler, R. (2018). Exercise-based injury prevention in football. German Journal of Exercise and Sport Research, 48(2), 157–168.CrossRefGoogle Scholar
  16. Finch, C. (2006). A new framework for research leading to sports injury prevention. Journal of Science and Medicine in Sport, 9(1–2), 3–9.CrossRefGoogle Scholar
  17. Fulton, J., Wright, K., Kelly, M., Zebrosky, B., Zanis, M., Drvol, C., & Butler, R. (2014). Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. International Journal of Sports Physical Therapy, 9(5), 583–595.PubMedPubMedCentralGoogle Scholar
  18. aus der Fünten, K., Faude, O., Lensch, J., & Meyer, T. (2014). Injury characteristics in the German professional male soccer leagues after a shortened winter break. Journal of Athletic Training, 49(6), 786–793.CrossRefGoogle Scholar
  19. Green, L. W. (2001). From research to ”best practices“ in other settings and populations. American Journal of Health Behavior, 25(3), 165–178.CrossRefGoogle Scholar
  20. Groves, R. M., Couper, M. P., Presser, S., Singer, E., Tourangeau, R., Acosta, G. P., & Nelson, L. (2006). Experiments in producing nonresponse bias. The Public Opinion Quarterly, 70(5), 720–736.CrossRefGoogle Scholar
  21. Hägglund, M., Waldén, M., & Ekstrand, J. (2006). Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. British Journal of Sports Medicine, 40(9), 767–772.CrossRefGoogle Scholar
  22. Hägglund, M., Waldén, M., Magnusson, H., Kristenson, K., Bengtsson, H., & Ekstrand, J. (2013). Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA champions league injury study. British Journal of Sports Medicine.  https://doi.org/10.1136/bjsports-2013-092215.CrossRefPubMedGoogle Scholar
  23. Hägglund, M., Waldén, M., & Ekstrand, J. (2016). Injury recurrence is lower at the highest professional football level than at national and amateur levels: Does sports medicine and sports physiotherapy deliver? British Journal of Sports Medicine, 50(12), 751–758.CrossRefGoogle Scholar
  24. Hammes, D., aus der Fünten, K., Kaiser, S., Frisen, E., Dvorak, J., & Meyer, T. (2015). Injuries of veteran football (soccer) players in Germany. Research in Sports Medicine, 23(2), 215–226.CrossRefGoogle Scholar
  25. Heerwegh, D., Abts, K., & Loosveldt, G. (2007). Minimizing survey refusal and noncontact rates: Do our efforts pay off? Survey Research Methods.  https://doi.org/10.18148/srm/2007.v1i1.46.CrossRefGoogle Scholar
  26. Henke, T., Luig, P., & Schulz, D. (2014). Sports injuries in German club sports, aspects of epidemiology and prevention [Sportunfälle im Vereinssport in Deutschland. Aspekte der Epidemiologie und Prävention. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 57(6), 628–637.CrossRefGoogle Scholar
  27. van Hooren, B., & Peake, J. M. (2018). Do we need a cool-down after exercise? A narrative review of the psychophysiological effects and the effects on performance, injuries and the long-term adaptive response. Sports Medicine (Auckland, N.Z.).  https://doi.org/10.1007/s40279-018-0916-2.CrossRefGoogle Scholar
  28. Houston, M. N., Hoch, M. C., & Hoch, J. M. (2016). Health-related quality of life in athletes: a systematic review with meta-analysis. Journal of Athletic Training, 51(6), 442–453.CrossRefGoogle Scholar
  29. Klein, C., Luig, P. & Henke, T. (2013). Entwicklung und Evaluierung von Ausbildungsmodulen „Verletzungsprävention“ für die Trainerausbildung in den Profiteamsportarten Fußball, Handball und Eishockey. Projektabschlussbericht, Ruhr-Universität Bochum.Google Scholar
  30. Klesges, L. M., Estabrooks, P. A., Dzewaltowski, D. A., Bull, S. S., & Glasgow, R. E. (2005). Beginning with the application in mind: designing and planning health behavior change interventions to enhance dissemination. Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine, 29(Suppl), 66–75.CrossRefGoogle Scholar
  31. Krutsch, W., Voss, A., Gerling, S., Grechenig, S., Nerlich, M., & Angele, P. (2014). First aid on field management in youth football. Archives of Orthopaedic and Trauma Surgery, 134(9), 1301–1309.CrossRefGoogle Scholar
  32. Krutsch, W., Zeman, F., Zellner, J., Pfeifer, C., Nerlich, M., & Angele, P. (2016). Increase in ACL and PCL injuries after implementation of a new professional football league. Knee Surgery, Sports Traumatology, Arthroscopy, 24, 2271–2279.CrossRefGoogle Scholar
  33. Luig, P., Bloch, H., Burkhardt, K., & Klein, C. (2016). VBG-Sportreport 2016 – Analyse des Unfallgeschehens in den zwei höchsten Ligen der Männer: Basketball, Eishockey, Fußball und Handball. Hamburg: VBG.Google Scholar
  34. Luig, P., Bloch, H., Burkhardt, K., Klein, C., & Kühn, N. (2017). VBG-Sportreport 2017 – Analyse des Unfallgeschehens in den zwei höchsten Ligen der Männer: Basketball, Eishockey, Fußball und Handball. Hamburg: VBG.Google Scholar
  35. Manfreda, K. L., Berzelak, J., Vehovar, V., Bosnjak, M., & Haas, I. (2008). Web surveys versus other survey modes: a meta-analysis comparing response rates. International Journal of Market Research, 50(1), 79–104.CrossRefGoogle Scholar
  36. McCall, A., Carling, C., Nedelec, M., Davison, M., Le Gall, F., Berthoin, S., & Dupont, G. (2014). Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues. British Journal of Sports Medicine, 48(18), 1352–1357.CrossRefGoogle Scholar
  37. McCall, A., Davison, M., Andersen, T. E., Beasley, I., Bizzini, M., Dupont, G., & Dvorak, J. (2015). Injury prevention strategies at the FIFA 2014 World Cup: perceptions and practices of the physicians from the 32 participating national teams. British Journal of Sports Medicine, 49(9), 603–608.CrossRefGoogle Scholar
  38. McCall, A., Dupont, G., & Ekstrand, J. (2016). Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. British Journal of Sports Medicine, 50(12), 725–730.CrossRefGoogle Scholar
  39. van Mechelen, W., Hlobil, H., & Kemper, H. C. (1992). Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Medicine (Auckland, N.Z.), 14(2), 82–99.CrossRefGoogle Scholar
  40. Milanović, Z., Pantelić, S., Čović, N., Sporiš, G., Mohr, M., & Krustrup, P. (2018). Broad-spectrum physical fitness benefits of recreational football: a systematic review and meta-analysis. British Journal of Sports Medicine.  https://doi.org/10.1136/bjsports-2017-097885.CrossRefPubMedGoogle Scholar
  41. Mosler, A. B., Weir, A., Eirale, C., Abdulaziz, F., Thorborg, K., Whiteley, R., Hölmich, P., & Crossley, K. M. (2017). Epidemiology of time loss groin injuries in a men’s professional football league: a 2-year prospective study of 17 clubs and 606 players. British Journal of Sports Medicine.  https://doi.org/10.1136/bjsports-2016-097277.CrossRefPubMedGoogle Scholar
  42. Oka, R. K., de Marco, T., Haskell, W. L., Botvinick, E., Dae, M. W., Bolen, K., & Chatterjee, K. (2000). Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. American Journal of Cardiology, 85(3), 365–369.CrossRefGoogle Scholar
  43. Padua, D. A., Frank, B., Donaldson, A., de la Motte, S., Cameron, K. L., Beutler, A. I., Marshall, S. W., et al. (2014). Seven steps for developing and implementing a preventive training program: lessons learned from JUMP-ACL and beyond. Clinics in Sports Medicine, 33(4), 615–632.CrossRefGoogle Scholar
  44. Saw, A. E., Kellmann, M., Main, L. C., & Gastin, P. B. (2017). Athlete self-report measures in research and practice: considerations for the discerning reader and fastidious practitioner. International Journal of Sports Physiology and Performance, 12(Suppl 2), 2127–2135.CrossRefGoogle Scholar
  45. Ueblacker, P., Müller-Wohlfahrt, H.-W., & Ekstrand, J. (2015). Epidemiological and clinical outcome comparison of indirect (‘strain’) versus direct (‘contusion’) anterior and posterior thigh muscle injuries in male elite football players: UEFA Elite League study of 2287 thigh injuries (2001–2013). British Journal of Sports Medicine, 49(22), 1461–1465.CrossRefGoogle Scholar
  46. Verhagen, E., Voogt, N., Bruinsma, A., & Finch, C. F. (2014). A knowledge transfer scheme to bridge the gap between science and practice: an integration of existing research frameworks into a tool for practice. British Journal of Sports Medicine, 48(8), 698–701.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Fakultät für Sportwissenschaft, Lehr- und Forschungsbereich Sportmedizin und SporternährungRuhr-Universität BochumBochumGermany
  2. 2.Bezirksverwaltung Bergisch GladbachVerwaltungs-Berufsgenossenschaft (VBG)Bergisch GladbachGermany
  3. 3.Bezirksverwaltung DuisburgVerwaltungs-Berufsgenossenschaft (VBG)DuisburgGermany

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