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Foul play is associated with injury
incidence: an epidemiological study of three
FIFA World Cups (2002 −2010)
Jaakko Ryynänen, Astrid Junge, Jiri Dvorak, et al.
Br J Sports Med 2013 47: 986-991 originally published online August
28, 2013
doi: 10.1136/bjsports-2013-092676
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Original article
Foul play is associated with injury incidence: an
epidemiological study of three FIFA World Cups
(2002–2010)
Jaakko Ryynänen,1,2 Astrid Junge,3 Jiri Dvorak,3,4 Lars Peterson,2,4
Hannu Kautiainen,5,6 Jón Karlsson,2 Mats Börjesson7,8
1
Faculty of Medicine, University
of Helsinki, Helsinki, Finland
2
Department of Orthopaedics,
Sahlgrenska University
Hospital, Sahlgrenska
Academy, Gothenburg
University, Gothenburg,
Sweden
3
FIFA Medical Assessment and
Research Centre (F-MARC),
Zurich, Switzerland
4
Fédération Internationale de
Football Association (FIFA),
Zurich, Switzerland
5
Unit of Primary Health Care,
Helsinki University Central
Hospital, Helsinki, Finland
6
Department of General
Practice, University of Helsinki,
Helsinki, Finland
7
Swedish School of Sport and
Health Sciences, Stockholm,
Sweden
8
Department of Cardiology,
Karolinska University Hospital,
Stockholm, Sweden
Correspondence to
Jaakko Ryynänen,
Tarkk’ampujankatu 4 A 10,
00140 Helsinki, Finland;
jaakko.ryynanen@helsinki.fi
Accepted 1 August 2013
ABSTRACT
Background Foul play has been considered as one of
the most important known extrinsic risk factors for
injuries in football.
Aims To compare the incidence and characteristics of
foul play injuries and non-foul injuries.
Methods Team physicians’ postmatch injury reports
and official match statistics were obtained from all
matches of the 2002, 2006 and 2010 Fédération
Internationale de Football Association World Cups.
Results The number of injuries was associated with the
number of fouls in a match. The incidence of foul play
injuries (20.6/1000 match-hours, 95% CI 17.3 to 24.4)
was significantly lower than that of non-foul injuries
(42.6, 37.7 to 47.9), which also applied to all playing
positions. The causation of injury (foul/non-foul), match
period and teams’ drawing/losing/winning status were
associated with the injury incidence. The interactions
between the causation of injury (foul/non-foul) and
match time, as well as the teams’ drawing/losing/
winning status or playing position were not statistically
significant. The median (IQR) days of absence resulting
from foul play injuries were significantly shorter than that
of non-foul injuries. The lower leg and ankle were more
common locations for foul play injuries than for non-foul
injuries, whereas the opposite was observed for thigh
injuries. Contusions were a more common type of foul
play injuries than non-foul injuries, while the opposite
was found for muscle strains/ruptures/tears.
Conclusions The numbers of injuries and fouls in a
match were significantly associated. No significant
differences in the variation of foul play and non-foul
injury incidences regarding match period, teams’ current
winning/drawing/losing status and playing position were
observed, suggesting that foul play injuries and non-foul
injuries may share similar underlying risk factors.
INTRODUCTION
To cite: Ryynänen J,
Junge A, Dvorak J, et al.
Br J Sports Med
2013;47:986–991.
The Fédération Internationale de Football
Association (FIFA) has promoted Fair Play since
1988.1 Fair Play includes playing according to the
Laws of the Game and respecting the players, referees, opponents and fans.2 Fair play is also an
important aspect of injury prevention, since foul
play (defined as unfair play in a game or sport)3
has been considered as one of the most important
known extrinsic risk factors of football injuries.4
According to FIFA’s Laws of the Game, a foul in
football is an infringement of the rules leading to a
free kick or a penalty kick. This definition includes
use of excessive force and careless or reckless
offences on opponents by players or teams.5
Ryynänen J, et al. Br J Sports Med 2013;47:986–991. doi:10.1136/bjsports-2013-092676
Additionally, the following requirements for a foul
have been outlined: (1) it must be committed by a
player, (2) occur on the field of play and (3) occur
while the ball is in play.6
There is no consensus on the definition of foul
play injuries. Neither the consensus statement on
injury definitions and data collection procedures in
studies of football (soccer) injuries7 nor the Union
of European Football Associations model8 included
a definition of foul play injuries. Some authors
have based their definition of foul play injuries on
the referees’ decisions,9 10 while others have based
it on the team physician’s report.11–14 Two studies
comparing referees’ decisions in injury incidents
during the match and the interpretations by a
referee panel, performed by retrospectively viewing
the incidents on video, have shown that the panel
and the referee do not agree on all decisions,15 16
reflecting the difficulty in refereeing during match
conditions. Factors like the home/away team status,
match period and crowd size appear to influence
football referees’ decisions.17 18
Foul play is involved in 14–37% of all football
injuries,9–12 19–22 and in 35–80% of injuries resulting from contact between the players.12 13 15 23 24
The injuries caused by foul play are mostly sprains
or contusions affecting the lower extremity (mainly
the ankle, lower leg, thigh and knee).9 11 Although
foul play injuries appear to be less severe than
other injuries,20 they are responsible for 21–31%
of all severe injuries.10 21 25 The proportion of
contact injuries identified as fouls by the match
referee varies in different areas of the pitch, being
lowest in the attacking goal area.15 Junge et al26
reported that 90% of footballers were ready to
commit an intentional (‘professional’) foul if
required, depending on the score and importance
of the match. Taking this into consideration, foul
play injuries could potentially increase in certain
match conditions, for example, depending on the
teams’ drawing/losing/winning status or the match
period.
Although foul play has been regarded as one of
the causal factors for injuries in most football
injury studies, detailed comparisons between foul
play injuries and non-foul play injuries are rare.
Two studies have concentrated on rule violations
(foul play) and injuries in football,15 16 both of
which concentrated mainly on factors influencing
referees’ decisions.
The aims of the present study were to investigate
differences between foul play injuries and non-foul
injuries with regard to their characteristics and the
1 of 7
Original article
match circumstances in which they occur, as well as the
relationship between the number of fouls and the injuries per
match in three FIFA World Cups. The hypothesis was that there
is an association between the number of fouls and the number
of injuries in a match.
Number of injuries and fouls per match
The matches were categorised in four groups according to the
total number of injuries (0, 1–2, 3–4, ≥5) in order to ensure
group sizes suitable for comparison. The mean number of fouls
per match for each match category was calculated and
compared.
MATERIALS AND METHODS
The study is based on the team physicians’ reports on 441 injuries from the FIFA World Cups in 2002, 2006 and 2010,10–12
and FIFA’s official match statistics for all 192 matches in the
same tournaments.27
The match statistics included the time and number of goals,
red cards and yellow cards, as well as the total number of fouls.
The injury report forms and the data collection method have
been described in previous publications,11–14 and followed the
consensus statement for injury definitions and data collection
procedures.7 The team physicians were requested to report the
type and location of the injury, the time in the match when the
injury occurred, the circumstances (non-contact, contact, foul
play) and consequences (referees’ sanction, medical treatment)
of the injury, as well as an estimate of the absence from training
and/or playing football resulting from the injury.11–14
An injury was defined as any physical complaint incurred
during the match that received medical attention from the team
physician regardless of the consequences with respect to absence
from the match or consequent training.11–14 Injuries were
divided into foul play injuries and non-foul injuries based on
the judgement of the team physician.
Severity of injuries
The definition of injury severity was based on the duration of
absence from match play or training, as a consequence of the
injury.7 8 In the present study, the team physicians estimated the
duration of absence (in days) after the match.11–14 The injuries
were categorised as slight (0 days), minimal (1–3 days), mild
(4–7 days), moderate (8–28 days) and severe (over 28 days of
absence).7 The number of injuries in each category was counted.
Furthermore, the medians for the number of days of absence
resulting from foul play injuries and non-foul injuries were calculated and compared.
Time in the match of foul play and non-foul injuries
The match was divided into six periods of 15 min. A possible
extra time and minutes of additional time were excluded. The
injury incidences of foul play injuries and non-foul injuries for
the different match periods were calculated and compared.
Teams’ drawing/losing/winning status at time of injury
Foul play injuries and non-foul injuries were divided into three
groups according to the team’s drawing/losing/winning status at
the time of the injury: (1) drawing, (2) losing and (3) winning.28
For the time of injury, the information provided on the injury
report form was used, while the score at the time of injury was
assessed from official match statistics. The time of the different
match periods was calculated by using the times of goals from
official match statistics.27 The injury incidences for all groups
were calculated and compared.
Foul play injury incidence in relation to playing position
The incidences of foul play injuries and non-foul injuries were calculated and compared for all playing positions, assuming a hypothetical
1 : 4 : 4 : 2 formation (one goalkeeper, four defenders, four midfielders and two forwards).29 The playing position of each injured
player was retrieved from FIFA’s official tournament statistics.27
2 of 7
Statistical analysis
The incidence of injury per 1000 match-hours was calculated
using the formula: (number of injuries×1000 match-hours)/
((minutes of exposure/60)×N players exposed). The number of
players exposed was 22 for calculation of incidence in the different match periods and 11 for calculation of incidence for the
drawing, losing or winning teams. Minutes of additional time
were not taken into account.
The injury incidence ( per 1000 match-hours) with 95% CI
for foul play injuries and for non-foul injuries was calculated
assuming a Poisson distribution. Incidence rate ratio (IRR) and
the test for a significant trend in injury incidence across the
groups were calculated using Poisson regression models.
Frequencies, cross tabulations and χ2 test were applied for comparison of injury types and locations.
Statistical significance for the hypotheses of linearity between
the total numbers of fouls per match and numbers of injuries
per match was evaluated by using a bootstrap-type analysis of
variance. In case of violation of the assumptions (nonnormality), a bootstrap-type test was used. The normality of the
variables was tested by using the Shapiro-Wilk W test.
Mann-Whitney’s test was used for comparison of the medians
for the number of days of absence resulting from foul play injuries and non-foul play injuries.
The incidences of injury for foul play injuries and non-foul
injuries during the different match periods, according to the
team’s drawing/losing/winning status at the time of injury and
according to the player’s position were analysed with random
effect Poisson regression models for the panel. The model
included a random intercept to account for clustering within a
match, as well as fixed effects for injury type (foul vs non-foul),
as well as for match time (match period), the teams’ current
drawing/losing/winning status and playing position. The interaction term allowed assessments of differences in injury causation (foul vs non-foul) between the different match periods,
between the groups based on the teams’ drawing/losing/winning
status and between playing positions.
The level of significance was set at p values <0.05. The
STATA V.12.1, StataCorp LP (College Station, Texas, USA) statistical package was used for the analyses.
RESULTS
In the three consecutive FIFA World Cups, a total of 134 injuries
(30% of all injuries) resulted from foul play and 278 (63%)
injuries were incurred without foul play. For 29 injuries (7%),
the causation was not reported. The incidence of foul play injuries (20.6/1000 match-hours, 95% CI 17.3 to 24.4) was significantly (IRR 2.07, 95% CI 1.68 to 2.54; p<0.001) lower than
the incidence of non-foul injuries (42.6, 95% CI 37.7 to 47.9).
All foul play injuries were contact injuries, while 152 (54.7%)
of the non-foul injuries were contact injuries and 125 (45%)
were non-contact injuries. For one non-foul injury, the involvement of contact was not reported on the injury form.
Ryynänen J, et al. Br J Sports Med 2013;47:986–991. doi:10.1136/bjsports-2013-092676
Original article
Table 1 Locations of foul play injuries and non-foul injuries
Table 3
Injury severity for foul play injuries and non-foul injuries
Number of injuries (%)
Number of injuries (%)
Injured body part
Foul play
Non-foul
Severity (estimated days of absence)
Foul play
Non-foul
Lower leg
Ankle
Thigh
Head/face
Knee
Trunk
Foot/toe
Shoulder
Upper extremity
Achilles tendon
Groin
Hip
38 (28.4)
30 (22.4)
16 (11.9)
14 (10.4)
12 (9.0)
8 (6.0)
7 (5.2)
5 (3.7)
3 (2.2)
1 (0.7)
0
0
36 (12.9)
30 (10.8)
68 (24.5)
30 (10.8)
33 (11.9)
20 (7.2)
18 (6.5)
7 (2.5)
12 (4.3)
1 (0.4)
17 (6.1)
6 (2.2)
Slight (0)
Minimal (1–3)
Mild (4–7)
Moderate (8–28)
Severe (over 28)
52 (40.9)
51 (40.2)
12 (9.4)
9 (7.1)
3 (2.4)
74
102
38
31
9
The lower leg and ankle were significantly more common locations for foul play
injuries than non-foul injuries (p<0.001 and p=0.002, respectively), whereas the thigh
and groin injuries were significantly more common for non-foul injuries than foul play
injuries (p<0.01, both).
Location and type of injuries
The injury locations of foul play injuries and non-foul injuries
are presented in tables 1 and 2.
Severity of injuries
For 127 (94.8% of all) foul play injuries and 254 (91.4%)
non-foul injuries, an assessment of injury severity was reported
on the injury form. The numbers of injuries in the different
severity categories are presented in table 3. The median (IQR)
days of absence resulting from foul play injuries were significantly shorter than for non-foul injuries (1 (0, 3) and 2 (0, 5),
respectively; p<0.01).
Timing of foul play injuries and non-foul injuries
within the match
Figure 1 shows the incidences of foul play injuries and non-foul
injuries during six 15 min periods of the match. The causation
(29.1)
(40.2)
(15.0)
(12.2)
(3.5)
(foul vs non-foul) of injury and match time had a significant
main effect on the injury incidence ( p<0.001, both). No interaction between causation of injury (foul/non-foul) and match
time was observed ( p=0.99).
Foul play injuries and non-foul injuries and teams’
drawing/losing/winning status
The incidences of foul play and non-foul injuries for the
drawing, losing and winning teams are presented in figure 2.
The causation of injury (foul vs non-foul) and the teams’
current drawing/losing/winning status had a significant main
effect on the injury incidence ( p<0.001 and p=0.01, respectively). The interaction between causation of injury (foul/
non-foul) and the teams’ drawing/losing/winning status was not
statistically significant ( p=0.34).
Incidences of foul play and non-foul play injuries for
different playing positions
The incidences of non-foul play injuries were significantly
higher than those of foul play injuries for all playing positions
(forwards: 53.2 (95% CI 41 to 68.2) vs 26.2 (95% CI 17.8 to
37.2) ( p<0.01), midfielders: 34.3 (95% CI 27.2 to 43.6) vs
21.6 (95% CI 16.1 to 28.4) ( p<0.05), defenders: 46.1 (95% CI
37.9 to 55.6) vs 17.3, (95% CI 12.5 to 23.5) ( p<0.001), goalkeepers: 28.8, (95% CI 16.8 to 46.1) vs 5.1 (95% CI 1.1 to
14.8) ( p<0.01); figure 3). The interaction between the
Table 2 Types of foul play injuries and non-foul injuries
Number of injuries (%)
Type of injury
Foul
Non-foul
Contusion
Ligament sprain
Laceration/abrasion/skin lesion
Muscle strain/rupture/tear
Concussion
Fracture
Ligamentous rupture
Other bone injuries
Other
Muscle cramps
Tendinosis/tendinopathy
Lesion of the meniscus
Arthritis/synovitis/bursitis
Fasciitis/aponeurosis injury
91 (67.9)
21 (15.7)
7 (5.2)
5 (3.7)
3 (2.2)
3 (2.2)
1 (0.7)
1 (0.7)
1 (0.7)
0
0
0
0
0
105
33
18
69
3
5
6
0
19
10
3
3
2
1
(37.8)
(11.9)
(6.5)
(24.8)
(1.1)
(1.8)
(2.2)
(6.8)
(3.6)
(1.1)
(1.1)
(0.7)
(0.4)
Contusions were a significantly (p<0.001) more common type of foul play injuries
than non-foul injuries, while muscle strains/ruptures/tears were a significantly
(p<0.001) more common type of non-foul injuries than foul play injuries. For one foul
play injury and one non-foul injury, the type was not reported on the injury form.
Ryynänen J, et al. Br J Sports Med 2013;47:986–991. doi:10.1136/bjsports-2013-092676
Figure 1 Injury incidence (with 95% CIs) in different match periods
for foul play injuries and non-foul injuries.
3 of 7
Original article
Figure 2 Incidence of foul play injuries (with 95% CIs) and non-foul
injuries according to teams’ current drawing/losing/winning status.
causation of injury (foul/non-foul) and playing position was not
statistically significant ( p=0.085).
Figure 4 Average number of fouls (with 95% CIs) in matches with
different number of injuries.
Injury frequency per match in relation to number of fouls
A total of 6678 fouls were registered in the three FIFA World Cups
(2002: 2300, 2006: 2367 and 2010: 2011). The number of fouls
per match varied between 13 and 62, with a mean of 35 fouls per
match (SD 1.7). From 22 matches, no injuries were reported, from
101 matches 1–2 injuries, from 46 matches 3–4 injuries and from
23 matches five or more injuries. There was a statistically
Figure 3 Incidence of foul play injuries (with 95% CIs) and non-foul
injuries according to playing position.
4 of 7
significant relationship between the number of fouls per match
and the number of injuries (figure 4; p for linearity <0.001).
DISCUSSION
The main finding of the present study was that the number of
fouls and the number of injuries in a match during FIFA World
Cups were associated ( p<0.001). To our knowledge, this association has not been reported previously. Hawkins and Fuller30
did not find a correlation between free kicks and injuries in the
1994 FIFA World Cup, using video analysis and media coverage
as injury data, making direct comparisons difficult. A tendency
of high foul frequency in the beginning of a match resulting in
high total foul rates in a match has been shown, in the Turkish
Football Super League.31 Whether or not the association
between the number of injuries and fouls is caused by an
increasing number of foul play injuries could not be assessed.
However, the results suggest that a high foul frequency is also
associated with a high non-foul injury incidence. The general
injury incidence has previously been shown to be higher after
yellow or red cards, injuries and goals.32 Previous research also
suggests that an athlete’s concentration is negatively affected by
aroused, angry behaviour and by a social environmental setting
of considerable complexity and stress.33 Psychological stressors
and situation-dependent emotional states also seem to have an
effect on athletes’ risk of injury.34 These previous findings
provide some possible underlying factors for the association
between the frequencies of fouls and injuries.
In the present study, most foul play injuries did not result in
any absence from playing football, and were less severe than
Ryynänen J, et al. Br J Sports Med 2013;47:986–991. doi:10.1136/bjsports-2013-092676
Original article
non-foul injuries. They accounted for one-fourth of all the severe
injuries (3/12) and a fifth of all the moderate injuries (9/40),
which is in accord with previous studies.10 21 25 The clinical relevance of this finding remains unclear, due to the low total
numbers of severe injuries. A small proportion of severe injuries
is a common finding in studies relying on postmatch medical
reports.11–14 35 Future studies should assess, for example, by use
of follow-up questionnaires, whether underestimation of injury
severity occurs in postmatch conditions.
The findings that contusions (mainly of the lower leg and
ankle) constituted a larger proportion of foul play injuries compared with non-foul injuries and that the opposite was found
for muscle strains/ruptures/tears (mainly of the thigh), support
the results of previous studies,9 11 and appear to be logical, as
all foul play injuries were contact injuries, while almost half of
the non-foul injuries did not result from contact between
players.
Waldén et al20 found no differences in the frequency of foul
play injuries between six 15 min periods of a match in the
European Championships. However, their data included only
17 foul play injuries. Junge et al11 reported that the number of
foul play injuries increased from the first to the second 15 min
period of a match and thereafter remained stable in the 2002
FIFA World Cup. Ekstrand et al9 found no differences in frequency of foul play injuries between the two halves of a match
in European professional men’s club football. In the present
study, the variation in foul play injury incidence within the different time periods of a match was similar to that of non-foul
injuries, and their interaction was not statistically significant,
showing that foul play injuries and non-foul injuries peaked
during the same match periods (figure 1). The interaction
between foul play injuries and non-foul injuries was not significant according to the teams’ current drawing/losing/winning
status either. Ryynänen et al28 reported previously that teams
currently leading the game in FIFA World Cups had the highest
injury incidence.
The incidence of injury has previously been shown to vary
significantly between different playing positions in FIFA World
Cups.28 In the present study, all playing positions were found to
have a higher incidence of non-foul injuries than of foul play
injuries. No interaction was found between foul play injuries
and non-foul injuries according to playing positions. These
observations suggest that none of the positions run a substantially higher relative risk of suffering an injury caused by foul
play compared with the other positions. However, while the
incidence of foul play injury was similar for all playing positions, forwards and defenders had a substantially higher
non-foul injury incidence than midfielders and goalkeepers
(figure 3), as shown previously for all injuries.28
Implications for football authorities and teams’
management
Recognising match conditions and/or player groups with an
increased risk of foul play injuries may be of use for the
football governing bodies in order to adjust the rules of football for maximising the protection of players. It may also
guide the referees to emphasise their injury protective role,
that is, by severely sanctioning fouls during these match conditions. Team management and medical staff may also benefit
from the knowledge, as it may enable them to take precautions, such as substitutions of players already under increased
risk of suffering an injury, due to a recent previous injury, for
example.
Ryynänen J, et al. Br J Sports Med 2013;47:986–991. doi:10.1136/bjsports-2013-092676
Developing means for efficient intervention at the beginning
of the match may be important. A possible way to reduce injuries could be the referees’ early interventions in matches that
start with high foul frequencies, for example, by severely sanctioning foul play or by communication with the team captains
and/or management, in order to caution the teams or resolutely
instruct them to play fair.
Definition of foul play injuries
The optimal method for defining foul play injuries may not
have been the team physicians’ estimations, as the rules of
football may not be their area of expertise. Therefore, some
misinterpretations regarding the causation of injury (foul/
non-foul) may have occurred. However, considering the
factors affecting the match referees’ decisions during match
circumstances, as discussed in the introduction, the referees’
decisions may also be biased, and therefore not optimal. While
the match referee often has to make a decision within a fraction of a second, the team physician can base the postmatch
evaluation on several factors: detailed incident description by
the injured player, clinical examination of the injured player,
discussion with other team staff, referees’ decision, his/her
own vision of the incident and, in some cases, postmatch
video recordings. Therefore, the evaluation may be easier for
the team physician in postmatch conditions than for the match
referee under match conditions.
Study limitations
Limitations of the present study are that all injury information
were based on the team physicians’ reports after the matches,
the exclusion of minutes of additional time and the assumption that all teams played in the 1 : 4 : 4 : 2 formation (one
goalkeeper, four defenders, four midfielders and two
forwards).
A possible source of bias may have been the inclusion of noncontact injuries in the analysis. As all non-contact injuries were
non-foul by causation, they could have distinguished non-foul
injuries from foul play injuries due to some different underlying
risk factors for contact and non-contact injuries. All injuries
were included in the analysis, because we wanted to investigate
whether foul play injuries show some characteristics that distinguish them from all other injuries. The finding that, despite the
potential bias, no significant differences in match conditions
between foul play injuries and non-foul injuries were observed
may suggest that non-contact and contact injuries share similar
underlying, and partly unknown, risk factors.
The accuracy of postmatch diagnoses and of the estimation of
injury severity was not assessed. As many players return to their
clubs after international tournaments, the follow-up and treatment of injuries is often taken care of by the clubs’ medical
staff.
CONCLUSIONS
In summary, the present study showed an association between
the number of fouls and the number of injuries in a match. No
significant differences in the variation of foul play and non-foul
injury incidences regarding match period, teams’ current
winning/drawing/losing status and playing position were
observed, suggesting that foul play injuries and non-foul injuries
may share similar underlying risk factors. Studies using alternative approaches (eg, video analysis) are needed for identifying
factors underlying foul play in greater detail.
5 of 7
Original article
8
What are the new findings?
9
▸ The average numbers of fouls and injuries in a match were
associated.
▸ The distribution of foul play injuries and non-foul injuries
was similar with regard to time in the match, teams’ current
drawing/losing/winning status and playing position.
▸ The incidence of non-foul injuries was higher than that of
foul play injuries for all playing positions.
10
11
12
13
14
How might it impact on clinical practice in the near
future?
▸ The teams may be able to reduce the risk of injuries through
interaction between players, team medical personnel and
team management.
▸ The findings may be of use for referees in order to prevent
more fouls and associated injuries during matches with high
initial foul frequencies.
15
16
17
18
19
20
Acknowledgements The authors gratefully acknowledge FIFA (Fédération
Internationale de Football Association) for the funding of this study. We also greatly
appreciate the co-operation of all team physicians who provided the injury data.
Contributors JR coordinated the study, collected part of the data, conducted the
statistical analysis together with HK, and drafted the manuscript. All authors participated
in the study design, through revision and by partly writing the research plan, as well as
approving the final manuscript. JD and LP played a key role in the collection of injury
data. AJ prepared the anonymous injury data files. JK, AJ and MB participated in the
revision and writing of the research plan, the first draft, and the final manuscript.
21
22
23
Funding Fédération Internationale de Football Association (FIFA).
24
Competing interests None.
25
Ethics approval The ethics approval for injury surveillance was obtained previously
by F-MARC. This approval covers the data of the present study and articles based on
these data have been published previously.13
26
Provenance and peer review Not commissioned; externally peer reviewed.
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