The Influence of High Physical Demand on the Occurrence of Major Muscle and Ligament Injuries in Professional Soccer Athletes: A Systematic Review

Godoy, Matheus Martins; Gonçalves, Lucas Ferreira; Martins, Thiago da Mata; Ventura, Renato

doi:10.1055/s-0044-1786171

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Systematic Review • Rev bras ortop 59 (4) • 2024 • https://doi.org/10.1055/s-0044-1786171 copy

The Influence of High Physical Demand on the Occurrence of Major Muscle and Ligament Injuries in Professional Soccer Athletes: A Systematic Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present systematic review aimed to investigate the influence of high physical demand on the increase in muscle and ligament injuries in professional soccer athletes.

Methods

We analyzed scientific publications to determine the incidences of the main injuries, their causes and mechanisms, and their association with high physical demand. We compared amateur and professional players and assessed the effectiveness of FIFA11+ as a prevention alternative. Searches occurred on Scielo, Pubmed, and Google Scholar databases. The filters were the topic, publication date (last 5 years), and study relevance. The indexing terms were the following: Overuse, Calendar, Injuries, Muscular, Ligament, Athletes, Soccer, Football. We described the main data obtained to compare and analyze the results. This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines.

Results

The query resulted in 24 articles published from 2019 to 2023. The high physical demand increased the risk of injuries. Most injuries occurred in the lower limbs. The most common injuries were strains, sprains, contractures, and ligament ruptures. FIFA11+ presented itself as a viable prevention alternative.

Conclusion

We concluded that high physical demand increases the most frequent muscle and ligament injuries in professional soccer players, that is, strains, sprains, contractures, and ligament rupture, suggesting the FIFA11+ program as a prevention alternative.

Keywords
athletes; knee injuries; muscle, skeletal; soccer/injuries

#	Author and year	Article type	Title	Main findings
1	Drummond et al.,⁶6 Drummond FA, Soares DS, Silva HGR, et al. Incidência de lesões em jogadores de futebol-mappingfoot: um estudo de coorte prospectivo. Rev Bras Med Esporte 2021;27(02):189–194 2021	Prospective study	Incidence of injuries in soccer players – mapping foot: a prospective cohort study	In a soccer tournament, 86.9% of injuries in male players occurred in the lower limbs. Stretch injuries were the most common and mainly affected the semitendinosus, biceps femoris, and gastrocnemius muscles.
2	Marques,⁵5 Marques J. Lesões em atletas portuguesas de futebol feminino [dissertação]. Rio Maior, Santarém, Portugal:: Instituto Politécnico de Santarém, Escola Superior de Desporto de Rio Maior; 2021 2021	Systematic review	Injuries in Portuguese female soccer athletes	In female soccer athletes, 85.5% of injuries affected the lower limbs.
3	Lima et al.,⁸8 Lima WP, Silva PRD, Cunha Filho JAC. Lesões em atletas de futebol de campo: um estudo teórico. Vita et Sanitas 2022;16 (01):64–76 2022	Systematic review	Injuries in soccer athletes: a theoretical study	Lower limb injuries are more frequent in soccer due to the demands imposed on this anatomical region.
4	Castelo et al.,⁹9 Castelo DKF, Mendes LCS, Deus MBB, et al. Lesões no futebol profissional: uma revisão sistemática. In: Soares WD, Finelli LAC, orgs. Educacão física escolar: múltiplos olhares. Guarujá, SP: Editora Cientifica Digital; 2022:76–87 2022	Systematic review	Injuries in professional soccer: a systematic review	Stretch injuries are the most common and mainly affect the semitendinosus, biceps femoris, and gastrocnemius muscles. Muscle contracture damages the semitendinosus, semimembranosus, and biceps femoris muscles. Fatigue is the main cause of muscle contracture, which greatly affects elite soccer players.
5	Silva et al.,¹⁰10 Silva WM, Bernaldino ES, Fileni CHP, et al. Incidência de lesões musculoesqueléticas em jogadores de futebol profissional no Brasil. Rev Centro Pesq Avanç Qual Vida 2019;11(03):1–13 2019	Systematic review	Incidence of musculoskeletal injuries in professional soccer players in Brazil	Stretch injuries are the most common and affect the semitendinosus, biceps femoris, and gastrocnemius muscles. Stretching refers to an excessive fiber elongation and occurs during sudden acceleration, deceleration, or sprints.
6	Teixeira et al.,¹¹11 Teixeira LS, Araújo GSS, Sobrinho HMR. Análise epidemiológica de lesões em atletas profissionais de futebol em dois clubes de futebol de Goiânia-GO. RBFF 2021;13(52):31–38 2021	Field research	Epidemiological analysis of injuries in professional football athletes in two football clubs in Goiânia, Goiás, Brazil	Stretch injuries are the most common and affect the semitendinosus, biceps femoris, and gastrocnemius muscles.
7	Allah,¹²12 Allah OMRD. Fisioterapia nas lesões de entorse de tornozelo em jogadores de futebol: uma revisão de literatura [TCC]. Tubarão: Universidade do Sul de Santa Catarina;; 2022 2022	Systematic review	Physical therapy for ankle sprain injuries in soccer players: a literature review	A sprain is an injury to joint ligaments, and it commonly affects the ankle, with potential partial or complete rupture. It results from sudden movements, such as plantar flexion with foot inversion.
8	Ribeiro et al.,¹³13 Ribeiro LAO, Penaforte CL, Costa CRC. A abordagem fisioterapêutica na entorse lateral de tornozelo: uma revisão de literatura. Buritis: Centro Universitário de Belo Horizonte; 2022 2022	Systematic review	The physiotherapeutic approach to lateral ankle sprain: a literature review.	A sprain is an injury to joint ligaments, and it commonly affects the ankle, with potential partial or complete rupture. It results from sudden movements, such as plantar flexion with foot inversion.
9	Meneses,¹⁴14 Meneses DNFF. Lesões desportivas em atletas de futsal: uma revisão sistemática da literatura [disstertação]. Portugal: Universidade Beira Interior; 2021 2021	Systematic review	Sports injuries in futsal athletes: a systematic review of the literature	In soccer, knee sprains frequently result from a sudden directional change in the knee with the foot in a fixed position. Capsuloligamentous and meniscal injuries stand out.
10	Feitoza Neto et al.,¹⁵15 Feitoza Neto JT, Simiema GC, Souza THS, et al. Injuries to the knee structures in soccer. Res Soc Develop 2021;10(14):1–11 2021	Systematic review	Injuries to knee structures in soccer players	In soccer, knee sprains frequently result from a sudden directional change in the knee with the foot in a fixed position. Capsuloligamentous and meniscal injuries stand out.
11	Farias,¹⁶16 Farias MC. Aplicabilidade dos exercícios de força na prevenção e reabilitação das lesões musculares grau I e II em jogadores de futebol de elite [monografia]. Paripiranga: Centro Universitário AGES; 2021 2021	Systematic review	Applicability of strength exercises in the prevention and rehabilitation of grade I and II muscle injuries in elite soccer players	Contracture results from incorrect muscle contraction with no return to the regular relaxed state. The overload of anaerobic respiration leads to lactic acid accumulation, causing this phenomenon. Muscle contracture mainly damages the semitendinosus, semimembranosus, and biceps femoris muscles. Fatigue is its main cause, explaining why these injuries are common in elite soccer players.
12	Zhang and Wanh,¹⁷17 Zhang Yu, Wang Bo. Sports injuries in professional soccer players. Rev Bras Med Esporte 2023;29(01):1–4 2023	Field research	Sports injuries in professional soccer players	Muscle contracture damages the semitendinosus, semimembranosus, and biceps femoris muscles. Fatigue is its main cause, explaining why these injuries are common in elite soccer players.
13	Silva et al.,¹⁸18 Silva TSL, Silveira TS, Fortino E. Atuação do fisioterapeuta com jogadores que tiveram lesões no ligamento cruzado anterior. Rev Pesperctiva Ciênc Saúde (Porto Alegre) 2020;5(03):96–104 2020	Systematic review	Physical therapist's role with players with anterior cruciate ligament injuries	Ligament tears depend on the performed movement. Athletes frequently present anterior cruciate ligament injuries due to excessive force during knee rotation.
14	Borba,¹⁹19 Borba JCM. Critérios de retorno ao futebol após a cirurgia de reconstrução do ligamento anterior: uma revisão de literatura [monografia]. Belo Horizonte: Universidade Federal de Minas Gerais; 2021 2021	Systematic review	Criteria for return to soccer after anterior ligament reconstruction surgery: a literature review	Ligament tears depend on the performed movement. Athletes frequently present anterior cruciate ligament injuries due to excessive force during knee rotation.
15	Sousa,²⁰20 Sousa JVP. Pliometria na prevenção de lesão de ligamento cruzado anterior em atletas de futebol: uma revisão integrativa de literatura {TCC]. João Pessoa: Centro Universitário de João Pessoa;; 2021 2021	Systematic review	Plyometrics in the prevention of anterior cruciate ligament injuries in soccer athletes: an integrative literature review	Knee ligament injuries can cause loss of integrity and functionality in the short and long term and be irreversible, resulting in the retirement of soccer players.
16	Choriyev,²¹21 Choriyev DI. Planning And Organizing Training of Football Players. Am J Soc Sci Educ Innovat 2021;3(07):9–14 2021	Field research	Planning and organizing training of football players	We must consider the relatively low functional capacity of children aged 8 to 11. These children required training in age-specific ball techniques and game tactics. For teenagers aged 12 to 17, the focus changes to individual preparation, with more elaborate exercises emphasizing movement speed, resistance, agility, and flexibility in different age groups. Therefore, we must select proper exercises based on the match, their influence on the body's functions, and their duration and intensity.
17	Jones et al.,²²22 Jones S, Almousa S, Gibb A, et al. Injury incidence, prevalence and severity in high-level male youth football: a systematic review. Sports Med 2019;49(12):1879–1899 2019	Systematic review	Injury incidence, prevalence, and severity in high-level male youth football: a systematic review	Age influences the total incidence of injuries in athletes. Older players have higher injury incidence rates. One-fifth of injuries are severe and can cause the athlete to stop playing for at least 28 days, which harms the subject and the team, as both lose out in seasonal development.
18	Pfirrmann et al.,²³23 Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train 2016;51(05): 410–424 2016	Systematic review	Analysis of injury incidences in male professional adult and elite youth soccer players: a systematic review	Injury rates were higher in matches than in training both for young and adult players. Youth athletes had a higher incidence of training injuries than professional players.
19	Cezarino et al.,²⁴24 Cezarino LG, Grüninger BLDS, Scattone Silva R. Injury Profile in a Brazilian First-Division Youth Soccer Team: A Prospective Study. J Athl Train 2020;55(03):295–302 2020	Prospective study	Injury profile in a Brazilian first-division youth soccer team: a prospective study	The injury incidence was higher in matches than in training, and the oldest age group (sub-20) had the highest injury incidence rate in games, while the sub-17 group had the highest injury incidence rate in matches. Injury incidence rates for players under 20 years old are close to professional players.
20	Yang et al.,²⁵25 Yang J, Wang Y, Chen J, et al. Effects of the "FIFA11 + Kids" Program on Injury Prevention in Children: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022;19(19): 12044 2022	Systematic review and meta-analysis	Effects of the "FIFA11+ Kids" program on injury prevention in children: a systematic review and meta-analysis	FIFA11+ significantly decreased the risk of overall injuries compared to regular warm-up training. Soccer players aged under 15 are at the highest risk of injuries among all age groups analyzed as they have a lower level of physical development. FIFA11+ Kids is effective in preventing soccer-related injuries in young players. The program can significantly reduce the risk of ankle, knee, and lower limb injuries.
21	Al Attar et al.,²⁶26 Al Attar WSA, Bizzini M, Alzahrani H, et al. The FIFA 11 + Kids Injury Prevention Program Reduces Injury Rates Among Male Children Soccer Players: A Clustered Randomized Controlled Trial. Sports Health 2023;15(03):397–409 2022	Clinical trial	The FIFA 11+ kids injury prevention program reduces injury rates among male children soccer players: a clustered randomized controlled trial	FIFA11+ significantly reduced knee, leg, and ankle injuries, the likelihood of a player becoming injured, and the rates of contact, non-contact, and overuse injuries. Therefore, this study confirms the critical role of implementing the program in younger players to prevent injuries.
22	Pinto et al.,²⁷27 Pinto J, Direito-Santos B, Lobo R, Gustavo D, Carvalho P. FIFA 11 + para a Prevenção de Lesões em Jogadores de Futebol: Revisão sistemática. Rev Med Desp Informa 2021;12(02):22–25. Disponível em: https://doi.org/10.23911/FIFA11plus_2021_mar https://doi.org/10.23911/FIFA11plus_2021... 2021	Systematic review	FIFA 11+ for injury prevention in soccer players: a systematic review	In addition to all the indications from Al Attar's study, the prevention effect is higher when all team players adhere to the program. When targeted at high-competition athletes, outcomes are less significant due to periodization and competition calendar. Furthermore, the arrival of players from other clubs in midseason reduces the program's effectiveness, as do players who fail to complete the protocols due to injury or illness. The program also improves performance variables, causing significant improvements in dynamic postural control.
23	Materne et al.,²⁸28 Materne O, Chamari K, Farooq A, et al. Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years. Br J Sports Med 2021;55(09):493–500 2020	Prospective study	Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years	Compared to other age groups, sub-16 and sub-18 players had higher incidence rates of overuse injuries. In the remaining players, bruises, sprains, and growth-related injuries were the most common. Meniscus/cartilage injuries were the most severe lesions.
24	Aiello et al.,²⁹29 Aiello F, Impellizzeri FM, Brown SJ, Serner A, McCall A. Injury-Inciting Activities in Male and Female Football Players: A Systematic Review. Sports Med 2023;53(01):151–176 2022	Systematic review	Injury-inciting activities in male and female football players: a systematic review	High-intensity running and kicking activities may be the main triggers for thigh and groin injuries, while contacts may be the most common triggers for ankle injuries. Contact and pressure may be the most common inciting activities leading to anterior cruciate ligament injuries, but there is no consensus in the literature.

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[1] Address for correspondence
Matheus Martins Godoy, Rua Sete, 201, Bloco 6, apt 201 (Residencial Belém), Santa Maria, Contagem, Minas Gerais, Brasil (e-mail: matheusgodoy@unipam.edu.br).