Baseline characteristics
In this study, a total of 142 women players of the elite league were included, from which anthropometric assessments of the players, such as the players' age, weight, height, and BMI were 20.39 ± 3.44 years, 58, 49 ± 6.02 kg, 165.0 ± .06 cm, and 21.2 ± 1.8 kg/m2. The basic characteristics of the players were composed of 14 goalkeepers (9.9%), 54 defenders (38%), 40 midfielders (28.2%), and 34 forwards (23.9%). The dominant leg was determined in 74 participants (52.1%), the left one in 22 (11.5%) players, and both legs in 46 (32.4%) cases (Table 1).
Table 1
|
Mean
|
GK (N = 14)
|
DF (N = 54)
|
MDF (N = 40)
|
ST (N = 34)
|
Age
|
20.39 ± 3.44
|
19.93 ± 3.14
|
20.41 ± 3.51
|
21.13 ± 3.86
|
19.68 ± 2.82
|
Height
|
1.65 ± 0.6
|
1.67 ± 0.05
|
1.66 ± 0.63
|
1.64 ± 0.003
|
1.65 ± 0.071
|
Weight
|
58.49 ± 6.02
|
61.86 ± 6.10
|
58.76 ± 6.05
|
57.78 ± 5.71
|
75.53 ± 6.04
|
BMI
|
21.20 ± 1.8
|
21.97 ± 2.35
|
21.29 ± 1.67
|
21.29 ± 1.95
|
20.98 ± 1.87
|
Dominant leg
|
R
|
L
|
Bill
|
R
|
L
|
Bill
|
R
|
L
|
Bill
|
R
|
L
|
Bill
|
R
|
L
|
Bill
|
74 52.1%
|
22 15.5%
|
46 32.4%
|
7
|
1
|
6
|
28
|
11
|
15
|
18
|
6
|
16
|
21
|
4
|
9
|
BMI, body mass index; GK, goalkeeper; DF, defender; MDF, midfielder; ST, strikers; R, right; L, left; Bill, bilateral.
Incidence rate of overall injury
During the 2021–2022 season's observation period, 84 injuries were reported. The injury rate ratio (IRR) after adjusting for total exposure time was 3.21(CI: 2.56, 3.98) injuries per 1000 exposure hours. On average, each player suffered approximately 1.69 injuries during the competitive season. Injury IRRs were significantly higher (n = 84; IRR = 11.39; CI: 7.14, 17.96; p < 0.001) during competition (n = 50; IRR = 13.34; CI: 9.90, 17.59) compared to training (n = 34; IRR = 1.52, CI: 1.05, 2.12). Considering the site and extent of the damage. Out of a total of 142 women players, 84 (59.2%) injuries occurred, and no injuries were recorded in 58 (40.8%) players. While 60 (42.3%) the single body parts most frequently injured by injuries in the lower extremities were the knee, thigh, and ankle, whereas joint injuries in the upper extremities and trunk made for 24 (16.9%) of all registered injuries. In addition, the majority of injuries were categorized as mild (absence from play between 1 and 3 days, n-6; 4.2%), moderate (absence from play between 4 and 7 days, n-14; 9.9%), or severe (absence > 28 days, n-32; 22.5%). Smaller groups were categorized as minimal (absence from play between 1 and 3 days, n-6; 4.2%) and medium (absence from play between 4 and 7 days, n-14; 9.9%).
Table 2
Injuries by location and severity.
Injuries by location and severity
|
Severity category
|
Injured body part
|
Minimal (1 to 3 days)
|
Mild (4 to 7 days)
|
Moderate (8 to 28 days)
|
Severe
(> 28 days)
|
Total
|
Head/Face
|
-
|
1–7.1%
|
1–3.13%
|
-
|
2–2.4%
|
Neck / Cervical Spine
|
-
|
1–7.1%
|
-
|
-
|
1–1.2%
|
Lumbar Spine
|
-
|
1–7.1%
|
-
|
1–3.1%
|
2–2.4%
|
Pelvis / Sacrum
|
1–16.7%
|
-
|
1–3.13%
|
-
|
2–2.4%
|
Shoulder
|
-
|
1–7.1%
|
2–6.25%
|
3–9.4%
|
6–7.1%
|
Elbow
|
-
|
-
|
-
|
1–3.1%
|
1–1.2%
|
Lower Arm
|
-
|
-
|
1–3.13%
|
-
|
1–1.2%
|
Wrist
|
-
|
1–7.1%
|
1–3.13%
|
3–9.4%
|
5–6.0%
|
Hand
|
-
|
-
|
1–3.13%
|
-
|
1–1.2%
|
Finger / Thumb
|
-
|
1–7.1%
|
1–3.13%
|
1–3.1%
|
3–3.6%
|
Hip
|
-
|
1–7.1%
|
-
|
-
|
1–1.2%
|
Groin
|
-
|
-
|
1–3.13%
|
-
|
1–1.2%
|
Musculus adductor
|
-
|
-
|
2–6.25%
|
1–3.1%
|
3–3.6%
|
Hamstring
|
-
|
1–7.1%
|
3–9.38%
|
1- 3.1%
|
5–6.0%
|
Quadriceps
|
-
|
-
|
1–3.13%
|
-
|
1–1.2%
|
Thigh
|
-
|
-
|
1–3.13%
|
-
|
1–1.2%
|
Knee
|
1–16.7%
|
1–7.1%
|
5–15.63%
|
14–43.8%
|
21–25.0%
|
Lower Leg
|
1–16.7%
|
-
|
1–3.13%
|
1–3.1%
|
3–3.6%
|
Achilles Tendon
|
-
|
2–14.3%
|
2–6.25%
|
1–3.1%
|
5–6.0%
|
Ankle
|
1–16.7%
|
-
|
5–15.63%
|
4–12.5%
|
10–11.9%
|
Foot
|
2–33.3%
|
2–14.3%
|
2–6.25%
|
1–3.1%
|
7–8.3%
|
Toe
|
-
|
1–7.1%
|
1–3.13%
|
-
|
2–2.4%
|
Total
|
6–7.1%
|
14–16.7%
|
32–38.1%
|
32–38.1%
|
84–100%
|
When analysing the injury occurrence based on the body region (Table 2), it can be observed that the majority of injuries are with in the lower extremities (n = 58, 69.2%), including knee (n = 21, 25.0%), ankle (n = 10, 11.9%) and foot (n = 7, 8.3%) as the three most common sites. Lower extremities were followed by upper extremities (n = 17, 20.3%), trunk (n = 5, 8.4%), head and face (n = 2, 3.9%), and concluding with the lest injured region hip and groin (n = 2, 2.4%). It should be highlighted that shoulder injuries were the most common type of injury to the upper extremities (7.1%), whereas the dispersion of injuries within the trunk was rather equal in between lumbar (n = 2, 2.4%), pelvis/sacrum (n = 2, 2.4%) and cervical spine (n = 1, 1.2%).
Another interesting finding that was observed in Table 2 was the fact that moderate and severe injuries made up the bulk of the total number of injuries (n = 64, 76.2%), with an equal dispersion in between these two groups (n = 32, 38.1% each).
Table 3 highlights the distribution of injuries by type and severity. Contusions (n = 15, 17.9%), sprains (n = 12, 14.3%), fractures (n = 8, 9.5%) and dislocations (n = 8, 9.5%) injuries that occurred most frequently, representing more than half of all injuries combined (n = 43, 51.2%). The most frequent injuries requiring minimal recovery time were contusions (n = 4, 66.7%), followed by lacerations / abrasions (n = 1, 16%) and dislocations (n = 1, 16.7%), whereas for a mild period of time (4–7 days) the most frequent ones were lacerations / abrasions (n = 3, 21.4%) and tendonitis (n = 3, 21.4%). The most prominent injuries requiring moderate (8 to 28 days) and severe (> 28 days) recovery time were sprains (n = 7, 21.9%), strains (n = 6, 18.8%) and lacerations (n = 4, 12.5%), as well as fractures, dislocations and ligamentous ruptures with or without instability (n = 5, 15.6% in all cases).
Table 3
Injuries by type and severity
Type of injury * Severity category Crosstabulation
|
Severity category
|
Type of injury
|
Minimal (1-3days)
|
Mild
(4–7 days)
|
Moderate
(8 to 28 days)
|
Severe (> 28 days)
|
Total
|
Fracture
|
-
|
1–7.1%
|
2–6.3%
|
5–15.6%
|
8–9.5%
|
Dislocation
|
1 -16.7%
|
-
|
2–6.3%
|
5–15.6%
|
8–9.5%
|
Rupture of muscle
|
-
|
-
|
-
|
1–3.1%
|
1–1.2%
|
Ligamentous rupture with instability
|
-
|
-
|
-
|
5–15.6%
|
5–6.0%
|
Ligamentous rupture without instability
|
-
|
-
|
1–3.1%
|
5–15.6%
|
6–7.1%
|
Lesion of meniscus
|
-
|
-
|
-
|
1–3.1%
|
1–1.2%
|
Sprain
|
-
|
2–14.3%
|
7–21.9%
|
3–9.4%
|
12–14.3%
|
Strain
|
-
|
2–14.3%
|
3–9.4%
|
2–6.3%
|
7–8.3%
|
Contusion
|
4–66.7%
|
1–7.1%
|
6–18.8%
|
4–12.5%
|
15–17.9%
|
Tendonitis / Bursitis
|
-
|
3–21.4%
|
3–9.4%
|
-
|
6–7.1%
|
Dental Injury
|
-
|
1–7.1%
|
-
|
-
|
1–1.2%
|
Deep wound
|
-
|
1–7.1%
|
1–3.1%
|
-
|
2–2.4%
|
Laceration / Abrasion
|
1–16.7%
|
3–21.4%
|
4–12.5%
|
-
|
8–9.5%
|
Others Diagnosis
|
-
|
-
|
3–9.4%
|
1–3.1%
|
4–4.8%
|
Total
|
6–7.1%
|
14–16.7%
|
32–38.1%
|
32–38.1%
|
84–100%
|
Traumatic vs. overuse injuries
Dividing the total injuries (n = 84; IR = 2.00; CI: 1.24, 3.27) into traumatic and overuse ones (Fig. 1), it became clear that the traumatic ones made up the majority of 66.7% (n = 56; IR = 2.14; CI: 1.61, 2.78) while being significantly higher (p < 0.05) than the overuse injuries (33.3%; n = 28; IRR = 1.07; CI: 0.71, 1.54).
Overall number of injuries differed between those occurring in training and those in match (34 versus 50). Interestingly, this number declined with age from 36.90% and 48.81% (31 and 41 participants respectively) amongst participants aged 24-year-old and younger, 3.57% and 9.52% (3 and 8, respectively) in those aged between 25 and 29, and 0% and 1.19% (0 and 1, respectively) in athletes aged 30 years and older (Fig. 2).
Additionally, the number of injuries (both from overuse and traumatic origins) decline with age amongst the participants, from 29.76% and 55.95% (25 overuse and 47 traumatic injuries, respectively) in the age group of 24 years old and below, to 3.57% and 9.52% (3 and 8, respectively) in the 25–29-year-old group, and no injuries and 1.19% (0 and 1, respectively) in the above age group of 30 years and above (Fig. 2).
Injuries depending on the position playing
A total of 84 injuries were recorded. In absolute terms, goalkeepers (n = 9, 10.7%, IR = 1.07; CI = 0.49, 2.03), strikers (n = 17, 20.2%; IR = 2.02; CI = 1.18, 3.24), midfielders (n = 23, 27.4%; IR = 2.74; CI = 1.74, 4.11), and represented the most frequently affected groups, followed by defenders (n = 35, 4.17%; IR = 2.47; CI = 1.72, 3.43 of all injuries). Defenders, on average, were the group's youngest members (20.4 ± 3.52 years), while midfielders were the oldest (20.9 ± 3.56 years). Forwards (20.24 ± 2.70 years old), goalkeepers (20 ± 3.16 years old).
Injury IRRs were significantly higher (IRR = 25.71, CI = 10.87, 54.57, p < 0.001) in goalkeepers (n = 9, 10%.7) comparing to defenders (n = 35, 41.7%). Yet this was not the case in between strikers (n = 17, 20.2%) and midfielders (n = 23, 27.4%), where no observable differences were significant (IRR = 1.35, CI = 0.69, 2.69 (p = 0.349).
Injuries depending on age
Players were divided into groups according to their ages: young (< 24 years n = 72, 85.7% IR = 8,57; CI = 6,70, 10.79), middle (24–29 years; n = 11, 13.1% IR = 1,31; CI = 0,65, 2.34) or old (> 29 years older; n = 1, 1.2%). The major findings observed in this context were the significantly higher number of injuries occurring amongst younger women soccer players (IRR = 6.54, CI = 3.43, 13.69 (p < 0.001) in comparison to the “middle” age group (Table 4).
Table 4
Injuries depending on age.
Age & Injuries
|
|
Total Injuries (n %)
|
Total
|
Age
|
< 24
|
72
|
85.70%
|
72
|
24–29
|
11
|
13.10%
|
11
|
≥ 30
|
1
|
1.20%
|
1
|
Total
|
84
|
100%
|
84
|