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Are Off-Field Activities an Underestimated Risk for Hamstring Injuries in Dutch Male Amateur Soccer Players? An Exploratory Analysis of a Prospective Cohort Study

Abstract

Purpose

The purpose of this study was to explore what extent male amateur soccer players participate in off-field activities and whether these off-field activities are associated with the development of hamstring injuries.

Methods

Amateur soccer players (n = 399) from first-class selection teams (n = 32) filled out a baseline screening questionnaire concerning off-field activities (i.e., work and study type and hours, traveling time, sleep, energy costs, and time spent on other activities) and their history of hamstring injury as a part of a cluster-randomized controlled trial. Throughout one competition, the players reported weekly their hamstring injuries, which were verified by medical/technical staff. Multivariable Firth corrected logistic regression models were used to explore associations between off-field activities and hamstring injuries.

Results

Sixty-five hamstring injuries were recorded. Previous injury was significantly associated with hamstring injuries (OR ranging from 1.94 [95% CI 1.45–2.61] to 2.02 [95% CI 1.49–2.73]), but off-field activities were not.

Conclusion

Although amateur soccer players spent a relatively large amount of time on off-field activities, we did not find off-field activities measured at baseline to be associated with hamstring injuries in the subsequent competitive soccer season. In contrast, previous hamstring injury was found to be strongly associated with (recurrent) hamstring injuries.

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Availability of Data, Materials and Code

The full script and the data sets used for the analysis are available upon request.

References

  1. Andersen MB, Williams JM. A model of stress and athletic injury: prediction and prevention. J Sport Exerc Psychol. 1988;10(3):294–306. https://doi.org/10.1123/jsep.10.3.294.

    Article  Google Scholar 

  2. Armitage R, Trivedi M, Hoffmann R, Rush AJ. Relationship between objective and subjective sleep measures in depressed patients and healthy controls. Depress Anxiety. 1997;5(2):97–102. https://doi.org/10.1002/(SICI)1520-6394(1997)5:2%3c97::AID-DA6%3e3.0.CO;2-2.

    CAS  Article  PubMed  Google Scholar 

  3. Árnason Á, Gudmundsson Á, Dahl HA, Jóhannsson E. Soccer injuries in Iceland. Scand J Med Sci Sports. 2007;6(1):40–5. https://doi.org/10.1111/j.1600-0838.1996.tb00069.x.

    Article  Google Scholar 

  4. Bahr R. Why screening tests to predict injury do not work-and probably never will…: a critical review. Br J Sports Med. 2016;50(13):776–80. https://doi.org/10.1136/bjsports-2016-096256.

    Article  PubMed  Google Scholar 

  5. Balogh I, Ørbæk P, Ohlsson K, Nordander C, Unge J, Winkel J, Hansson GÅ. Self-assessed and directly measured occupational physical activities—influence of musculoskeletal complaints, age and gender. Appl Ergon. 2004;35(1):49–56. https://doi.org/10.1016/J.APERGO.2003.06.001.

    CAS  Article  PubMed  Google Scholar 

  6. van Beijsterveldt AMC, van de Port IGL, Vereijken AJ, Backx FJG. Risk factors for hamstring injuries in male soccer players: a systematic review of prospective studies. Scand J Med Sci Sports. 2013;23(3):253–62. https://doi.org/10.1111/j.1600-0838.2012.01487.x.

    Article  PubMed  Google Scholar 

  7. van Beijsterveldt AMC, Steffen K, Stubbe JH, Frederiks JE, van de Port IGL, Backx FJG. Soccer injuries and recovery in Dutch male amateur soccer players. Clin J Sport Med. 2014;24(4):337–42. https://doi.org/10.1097/JSM.0000000000000028.

    Article  PubMed  Google Scholar 

  8. van Beijsterveldt AMC, Stubbe JH, Schmikli SL, van de Port IGL, Backx FJG. Differences in injury risk and characteristics between Dutch amateur and professional soccer players. J Sci Med Sport. 2015;18(2):145–9. https://doi.org/10.1016/j.jsams.2014.02.004.

    Article  PubMed  Google Scholar 

  9. Bittencourt NFN, Meeuwisse WH, Mendonça LD, Nettel-Aguirre A, Ocarino JM, Fonseca ST. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med. 2016;50(21):1309–14. https://doi.org/10.1136/bjsports-2015-095850.

    CAS  Article  PubMed  Google Scholar 

  10. Brink MS, Visscher C, Arends S, Zwerver J, Post WJ, Lemmink KA. Monitoring stress and recovery: new insights for the prevention of injuries and illnesses in elite youth soccer players. Br J Sports Med. 2010;44(11):809–15. https://doi.org/10.1136/bjsm.2009.069476.

    Article  PubMed  Google Scholar 

  11. Costill DL, Flynn MG, Kirwan JP, Houmard JA, Mitchell JB, Thomas R, Park SH. Effects of repeated days of intensified training on muscle glycogen and swimming performance. Med Sci Sport Exerc. 1988;20(3):249–54. https://doi.org/10.1249/00005768-198806000-00006.

    CAS  Article  Google Scholar 

  12. Coutinho D, Gonçalves B, Wong DP, Travassos B, Coutts AJ, Sampaio J. Exploring the effects of mental and muscular fatigue in soccer players’ performance. Hum Mov Sci. 2018;58:287–96. https://doi.org/10.1016/j.humov.2018.03.004.

    Article  PubMed  Google Scholar 

  13. Croisier J-L, Ganteaume S, Binet J, Genty M, Ferret J-M. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. 2008;36(8):1469–75. https://doi.org/10.1177/0363546508316764.

    Article  PubMed  Google Scholar 

  14. Davydov DM, Stewart R, Ritchie K, Chaudieu I. Resilience and mental health. Clin Psychol Rev. 2010;30(5):479–95. https://doi.org/10.1016/j.cpr.2010.03.003.

    Article  PubMed  Google Scholar 

  15. Devantier C. Psychological predictors of injury among professional soccer players. Sport Sci Rev. 2012;20(5–6):5–36. https://doi.org/10.2478/v10237-011-0062-3.

    Article  Google Scholar 

  16. van der Does HTD, Brink MS, Otter RTA, Visscher C, Lemmink KAPM. Injury risk is increased by changes in perceived recovery of team sport players. Clin J Sport Med. 2017;27(1):46–51. https://doi.org/10.1097/JSM.0000000000000306.

    Article  PubMed  Google Scholar 

  17. Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39(6):1226–32. https://doi.org/10.1177/0363546510395879.

    Article  PubMed  Google Scholar 

  18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7. https://doi.org/10.1016/S0140-6736(07)61602-X.

    Article  Google Scholar 

  19. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players—a prospective cohort study. Am J Sports Med. 2010;38(6):1147–53. https://doi.org/10.1177/0363546509358381.

    Article  PubMed  Google Scholar 

  20. Fishman E, Böcker L, Helbich M. Adult active transport in the Netherlands: an analysis of its contribution to physical activity requirements. PLoS One. 2015;10(4): e0121871. https://doi.org/10.1371/journal.pone.0121871.

    CAS  Article  PubMed Central  PubMed  Google Scholar 

  21. Freckleton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Br J Sports Med. 2013;47(6):351–8. https://doi.org/10.1136/bjsports-2011-090664.

    Article  PubMed  Google Scholar 

  22. Fullagar HHKK, Skorski S, Duffield R, Julian R, Bartlett J, Meyer T. Impaired sleep and recovery after night matches in elite football players. J Sports Sci. 2016;34(14):1333–9. https://doi.org/10.1080/02640414.2015.1135249.

    Article  PubMed  Google Scholar 

  23. Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med. 2006;16(2):97–106. https://doi.org/10.1097/00042752-200603000-00003.

    Article  PubMed  Google Scholar 

  24. Ghomrawi HMK, Mandl LA, Rutledge J, Alexiades MM, Mazumdar M. Is there a role for expectation maximization imputation in addressing missing data in research using WOMAC questionnaire? Comparison to the standard mean approach and a tutorial. BMC Musculoskelet Disord. 2011;12:109. https://doi.org/10.1186/1471-2474-12-109.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Hägglund M, Walden M, Ekstrand J. Injury incidence and distribution in elite football-a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sport. 2005;15(1):21–8. https://doi.org/10.1111/j.1600-0838.2004.00395.x.

    Article  Google Scholar 

  26. Hagglund M, Waldén M, Ekstrand J, Hägglund M, Waldén M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40(9):767–72. https://doi.org/10.1136/bjsm.2006.026609.

    CAS  Article  PubMed Central  PubMed  Google Scholar 

  27. Hawkins RD, Fuller CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sport Med. 1999;33:196–203. https://doi.org/10.1136/bjsm.33.3.196.

    CAS  Article  Google Scholar 

  28. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sport Phys Ther. 2010;40(2):67–81. https://doi.org/10.2519/jospt.2010.3047.

    Article  Google Scholar 

  29. Heinze G, Ploner M, Dunkler D, Southworth H, Jiricka L. logistf: firth's bias-reduced logistic regression. 2020. https://CRAN.R-project.org/package=logistf.

  30. Hill Y, Den Hartigh RJR, Meijer RR, De Jonge P, Van Yperen NW. Resilience in sports from a dynamical perspective. Sport Exerc Perform Psychol. 2018;7(4):333–41. https://doi.org/10.1037/spy0000118.

    Article  Google Scholar 

  31. Hills AP, Mokhtar N, Byrne NM. Assessment of physical activity and energy expenditure: an overview of objective measures. Front Nutr. 2014;1:5. https://doi.org/10.3389/fnut.2014.00005.

    Article  PubMed Central  PubMed  Google Scholar 

  32. van de Hoef PA, Brink MS, Huisstede BMA, van Smeden M, de Vries N, Goedhart EA, Gouttebarge V, Backx FJG. Does a bounding exercise program prevent hamstring injuries in adult male soccer players? —A cluster-RCT. Scand J Med Sci Sport. 2019;29(4):515–23. https://doi.org/10.1111/sms.13353.

    Article  Google Scholar 

  33. Van de Hoef S, Huisstede BMA, Brink MS, de Vries N, Goedhart EA, Backx FJG. The preventive effect of the bounding exercise programme on hamstring injuries in amateur soccer players: the design of a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):355. https://doi.org/10.1186/s12891-017-1716-9.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Holtermann A, Hansen JV, Burr H, Søgaard K, Sjøgaard G. The health paradox of occupational and leisure-time physical activity. Br J Sports Med. 2012;46(4):291–5. https://doi.org/10.1136/bjsm.2010.079582.

    CAS  Article  PubMed  Google Scholar 

  35. van der Horst N, Backx F, Goedhart EA, Huisstede BM. Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. Br J Sport Med. 2017;51(22):1583–91. https://doi.org/10.1136/BJSPORTS-2016-097206.

    Article  Google Scholar 

  36. van der Horst N, Smits D-W, Petersen J, Goedhart EA, Backx FJG. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players. Am J Sports Med. 2015;43(6):1316–23. https://doi.org/10.1177/0363546515574057.

    Article  PubMed  Google Scholar 

  37. Ivarsson A, Johnson U. Psychological factors as predictors of injuries among senior soccer players. A prospective study. J Sports Sci Med. 2010;9(2):347–52.

    PubMed Central  PubMed  Google Scholar 

  38. Ivarsson A, Johnson U, Lindwall M, Gustafsson H, Altemyr M. Psychosocial stress as a predictor of injury in elite junior soccer: a latent growth curve analysis. J Sci Med Sport. 2014;17(4):366–70. https://doi.org/10.1016/J.JSAMS.2013.10.242.

    Article  PubMed  Google Scholar 

  39. Kenttä G, Hassmén P. Overtraining and recovery. Sport Med. 1998;26(1):1–16. https://doi.org/10.2165/00007256-199826010-00001.

    Article  Google Scholar 

  40. Knufinke M, Nieuwenhuys A, Geurts SAEE, Coenen AMLL, Kompier MAJJ. Self-reported sleep quantity, quality and sleep hygiene in elite athletes. J Sleep Res. 2018;27(1):78–85. https://doi.org/10.1111/jsr.12509.

    Article  PubMed  Google Scholar 

  41. Kosmidis I. brglm: bias reduction in binary-response generalized linear models. 2021. https://CRAN.R-project.org/package=brglm.

  42. Luke A, Lazaro RM, Bergeron MF, Keyser L, Benjamin H, Brenner J, d'Hemecourt P, Grady M, Philpott J, Smith A. Sports-related injuries in youth athletes: Is overscheduling a risk factor? Clin J Sport Med. 2011;21(4):307–14. https://doi.org/10.1097/JSM.0b013e3182218f71.

    Article  PubMed  Google Scholar 

  43. Matthews KA, Patel SR, Pantesco EJ, Buysse DJ, Kamarck TW, Lee L, Hall MH. Similarities and differences in estimates of sleep duration by polysomnography, actigraphy, diary, and self-reported habitual sleep in a community sample. Sleep Heal. 2018;4(1):96–103. https://doi.org/10.1016/J.SLEH.2017.10.011.

    Article  Google Scholar 

  44. McIntosh AS. Risk compensation, motivation, injuries, and biomechanics in competitive sport. Br J Sports Med. 2005;39(1):2–3. https://doi.org/10.1136/bjsm.2004.016188.

    CAS  Article  PubMed Central  PubMed  Google Scholar 

  45. van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sport Med. 1992;14(2):82–99. https://doi.org/10.2165/00007256-199214020-00002.

    Article  Google Scholar 

  46. Meeusen R, Duclos M, Foster C, Fry A, Gleeson M, Nieman D, Raglin J, Rietjens G, Steinacker J, Urhausen A, European College of Sport Science, American College of Sports Medicine. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the european college of sport science and the American College of Sports Medicine. Med Sci Sports Exerc. 2013;45(1):186–205. https://doi.org/10.1249/MSS.0b013e318279a10a.

    Article  PubMed  Google Scholar 

  47. Meeuwisse WH, Tyreman H, Hagel B, Emery C. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007;17(3):215–9. https://doi.org/10.1097/JSM.0b013e3180592a48.

    Article  PubMed  Google Scholar 

  48. Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TAL, Barzdukas A. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129–33. https://doi.org/10.1097/BPO.0000000000000151.

    Article  PubMed  Google Scholar 

  49. Pol R, Hristovski R, Medina D, Balague N. From microscopic to macroscopic sports injuries. Applying the complex dynamic systems approach to sports medicine: a narrative review. Br J Sports Med. 2019;53(19):1214–20. https://doi.org/10.1136/bjsports-2016-097395.

    Article  PubMed  Google Scholar 

  50. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R foundation for statistical computing; 2020. http://www.R-project.org/.

    Google Scholar 

  51. Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA. Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review: J Orthop Sport Phys Ther. 2013;43(8):515-B19. https://doi.org/10.2519/jospt.2013.4796.

    Book  Google Scholar 

  52. Roeters A. Time use the Netherlands. 1st ed. The Hague: The Netherlands Institute for Social Research (SCP); 2018.

    Google Scholar 

  53. Rubin DB. Inference and missing data. Biometrika. 1976;63(3):581. https://doi.org/10.2307/2335739.

    Article  Google Scholar 

  54. Ruzic L, Heimer S, Misigoj-Durakovic M, Matkovic BR. Increased occupational physical activity does not improve physical fitness. Occup Environ Med. 2003;60(12):983–5. https://doi.org/10.1136/OEM.60.12.983.

    CAS  Article  PubMed Central  PubMed  Google Scholar 

  55. Rytter S, Jensen LK, Bonde JP, Jurik AG, Egund N. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers. J Rheumatol. 2009;36(7):1512–9. https://doi.org/10.3899/jrheum.081150.

    Article  PubMed  Google Scholar 

  56. da Silva JCL, Tarassova O, Ekblom MM, Andersson E, Rönquist G, Arndt A. Quadriceps and hamstring muscle activity during cycling as measured with intramuscular electromyography. Eur J Appl Physiol. 2016;116(9):1807–17. https://doi.org/10.1007/s00421-016-3428-5.

    Article  PubMed Central  PubMed  Google Scholar 

  57. van Smeden M, de Groot JAH, Moons KGM, Collins GS, Altman DG, Eijkemans MJC, Reitsma JB. No rationale for 1 variable per 10 events criterion for binary logistic regression analysis. BMC Med Res Methodol. 2016;16(1):163. https://doi.org/10.1186/s12874-016-0267-3.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Snoeker BAM, Bakker EWP, Kegel CAT, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sport Phys Ther. 2013;43(6):352–67. https://doi.org/10.2519/jospt.2013.4295.

    Article  Google Scholar 

  59. Steeves JA, Tudor-Locke C, Murphy RA, King GA, Fitzhugh EC, Harris TB. Classification of occupational activity categories using accelerometry: NHANES 2003–2004. Int J Behav Nutr Phys Act. 2015;12:89. https://doi.org/10.1186/s12966-015-0235-z.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Taylor NAS, Dodd MJ, Taylor EA, Donohoe AM. A retrospective evaluation of injuries to Australian urban firefighters (2003 to 2012): injury types, locations, and causal mechanisms. J Occup Environ Med. 2015;57(7):757–64. https://doi.org/10.1097/JOM.0000000000000438.

    Article  PubMed  Google Scholar 

  61. Verbeek J, Mischke C, Robinson R, Ijaz S, Kuijer P, Kievit A, Ojajärvi A, Neuvonen K. Occupational exposure to knee loading and the risk of osteoarthritis of the knee: a systematic review and a dose-response meta-analysis. Saf Health Work. 2017;8(2):130–42. https://doi.org/10.1016/j.shaw.2017.02.001.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Verde T, Thomas S, Shephard RJ. Potential markers of heavy training in highly trained distance runners. Br J Sp Med. 1992;26(3):167–75. https://doi.org/10.1136/bjsm.26.3.167.

    Article  Google Scholar 

  63. de Visser H, Reijman M, Heijboer M, Bos P. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46(2):124–30. https://doi.org/10.1136/bjsports-2011-090317.

    Article  PubMed  Google Scholar 

  64. Walch OJ, Cochran A, Forger DB. A global quantification of “normal” sleep schedules using smartphone data. Sci Adv. 2016;2(5):1–7. https://doi.org/10.1126/sciadv.1501705.

    Article  Google Scholar 

  65. Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A, Football Association Medical Research Programme. The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med. 2004;38(1):36–41. https://doi.org/10.1136/BJSM.2002.002352.

    CAS  Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgements

The authors thank the players, coaches, and medical staff members of the participating teams for their contribution in this study. We would also like to thank Jane Sykes for language corrections.

Funding

This work was supported by the Netherlands Organization for Health Research and Development (ZonMw) under Grant [536001002]. J.J. Brauers received partial financial support from the Netherlands Organization for Health Research and Development (ZonMw) under Grant [546003004].

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Correspondence to Jur J. Brauers.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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The trial was approved by the Medical Ethics committee of University Medical Centre of Utrecht (16–332\C) and is registered in the Dutch trial register (http://www.trialregister.nl/trialreg/index.asp) (NTR6129).

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Informed consent was obtained from all individual participants included in the study.

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Brauers, J.J., van de Hoef, P.A., van Smeden, M. et al. Are Off-Field Activities an Underestimated Risk for Hamstring Injuries in Dutch Male Amateur Soccer Players? An Exploratory Analysis of a Prospective Cohort Study. J. of SCI. IN SPORT AND EXERCISE 4, 28–36 (2022). https://doi.org/10.1007/s42978-021-00160-y

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Keywords

  • Risk factors
  • Activities of daily living
  • Psychosocial factors
  • Football
  • Athletic injuries