Characteristics of the referees
70 referees participated in the study – their characteristics are summarized in Table 2.
Table 2
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|
Referees (n = 70)
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Demographics
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Age [years]
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31.8 ± 7.2
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|
Female gender [n]
|
7
|
|
BMI [kg/m2]
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24.8 ± 2.1
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Training habits
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Duration per training unit [h]
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1.2 ± 0.8
|
|
Endurance training [%]
|
64.7 ± 24.4
|
|
Strength training [%]
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26.3 ± 21.6
|
|
Circuit training [%]
|
5.9 ± 10.9
|
Referees' characteristics
|
Experience [years]
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14.9 ± 6.4
|
|
Commitment international [%]
|
12.9
|
|
Commitment 1. league [%]
|
35.7
|
|
Commitment 2. league [%]
|
62.9
|
|
Commitment 3. league [%]
|
52.9
|
|
Commitment in 1. league women [%]
|
51.4
|
|
Match load [hours/week]
|
1.0 ± 0.4
|
|
Training load [hours/week]1
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3.6 ± 2.5
|
1based on three days of training / week
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Retrospectively reported injuries
Twenty-two (31.4%) referees had suffered a sports-related injury within the last year. Most of the injuries occurred during training. In total, 28 injuries were reported, with foot (53.6%) and knee (32.1%) injuries being most common (Table 3). Injury mechanism included turns and changes of direction (29.7%), as well as sprints (21.6%) and physical contact with players or ball (21.6%). Physical overload was reported by none of the referees. Due to their injury, daily living activities were affected: refereeing (72.0%), walking (60.0%), stair climbing (44.0%), occupation (24.0%), car driving (20.0%), and sleeping (16.0%). Therapy included physiotherapy (64.0%), analgesics (44.0%), taping (40.0%), massage (24.0%), trans-dermal electro stimulation (12.0%), and surgery (12.0%).
Table 3
Injuries reported by referees during the last year
|
Match
|
Training
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Both
|
Total
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Foot
|
1
|
12
|
2
|
15
|
Knee
|
1
|
6
|
2
|
9
|
Pelvis
|
|
1
|
1
|
2
|
Chest
|
|
1
|
|
1
|
Hand
|
|
1
|
|
1
|
Total
|
2
|
21
|
5
|
28
|
Retrospectively reported pain
Sports-related pain was reported by 24 (34.3%) referees during the last year; the pain occurred, immediately after the match in 37.5% of the (9/24 referees), on the day after the match (9/24; 37.5%), up to 4 days (3/24; 12.5%), up to one week (1/24; 3.1%), or continuously (3/24; 12.5%). The mean pain intensity perceived among referees was 3.0 ± 1.8 Numeric Rating Scale (NRS) with a maximum perceived pain of 5.3 ± 2.2 NRS and a minimum pain of 0.9 ± 1.1 NRS. The point-prevalence of pain intensity at the time of the survey was 1.6 ± 1.8 NRS. Fifteen (21.4%) referees reported using analgesics with different frequency.
Twenty-six (37.1%) referees reported that they officiated at matches despite suffering from pain, and 8 (11.4%) referees reporting doing so regularly.
Other retrospective information
To gain a better understanding of causes for injuries, we divided the referees into two groups. Group 1 included all referees who suffered an injury within the last year, the second group (group 2) of referees did not have an injury during the last year. We found an association with training load and injury during the last year (trainings load in group 1: 1.5 ± 0.9 h vs. trainings load in group 2: 1.1 ± 0.7 h; p = 0.04). Significant more referees who experienced an injury during the last year officiated a handball match despite of pain (p < 0.02).
Referees suffering from sports-related pain mediated an increased mean pain intensity (NRS: 3.4 ± 1.6 vs. 1.4 ± 1.3; p < 0.02). Furthermore, we found some moderate correlations: age (r = 0.493; p < 0.02) and experience (r = 0.499; p < 0.02) were associated with a higher intake of analgesics. A higher BMI moderately correlated with increased analgesic intake (r = 0.441; p = 0.04), and mean pain intensity (r = 0.420; p < 0.04).
Prospectively reported injuries and pain
Fifty-two of the 70 referees (74.3%) responded in the prospective part of the survey. Seventeen (32.7%) referees suffered a sports-related injury during the observational period, with injuries occurring more often during training than during a match. In total, 27 injuries were reported, with foot (51.9%) and knee (25.9%) injuries being most common (Table 4). Injury mechanism included turns and changes of direction, as well as sprints (both 27.6%). Physical overload was reported by four of the referees. Due to their injury, daily living activities were affected: refereeing (82.4%), walking (82.4%), stair climbing (58.9%), car driving (35.3%), occupation (29.4%), and sleeping (11.8%). Therapy included physiotherapy (82.4%), analgesics (64.7%), taping (64.7%), and massage (35.3%). A physician attended 41.2% of the injured referees.
Table 4
Injuries reported by referees during the season
|
Match
|
Training
|
Both
|
Total
|
Foot
|
5
|
8
|
1
|
14
|
Knee
|
3
|
1
|
3
|
7
|
Pelvis
|
|
1
|
1
|
2
|
Trunk
|
|
1
|
|
1
|
Arm
|
|
1
|
|
1
|
Shoulder
|
|
1
|
|
1
|
Head
|
|
1
|
|
1
|
Total
|
8
|
14
|
5
|
27
|
The cumulative training load of 205 hours per week, resulted in 2.6 injuries per 1000 training hours (95% CI: 2.09 to 3.31). Taken cumulatively, 56 officiated matches per week resulted in 11.6 injuries per 1000 match hours (95% CI: 10.3 to 13.0).
Most referees reported officiating despite having pain (n = 43). 18 referees reported sports-related pain during the season. Their mean pain intensity during the season was 2.3 ± 1.4 (maximum pain 4.8 ± 2.7; minimum pain 1.0 ± 1.4). The point-prevalence of pain intensity at the time of the survey was 1.5 ± 1.8, and pain intensity immediately after their last officiated match was reported to be 3.1 ± 2.2. 20 (46.5%) of these pain-affected referees reported the use of analgesics. Furthermore, 67.4% of these referees also agreed to the sentence that a referee need to be ready to tolerate pain due to sporting reasons. The accordance with this statement was significantly higher in referees suffering from pain than in those without pain (p < 0.04). The incidence of sports-related pain was 19.0 (95%-CI 16.8 to 21.3) per 1000 match hours.
Gender differences
Aside anthropometric data (height, weight, BMI), we could not detect gender differences.