Epidemiologic analysis of injuries occurred during the 15th Brazilian Indoor Soccer (Futsal) Sub20 Team Selection Championship

Abstracts

INTRODUÇÃO: Vários autores têm investigado a incidência de lesões no futebol. Entretanto, poucos trabalhos têm analisado as lesões no Futebol de Salão. O objetivo deste estudo foi analisar a incidência, circunstâncias e características das lesões registradas no Futebol de Salão durante o XV Campeonato Brasileiro de Futebol de Salão Sub 20. MÉTODOS: Fisioterapeutas ou médicos de todas as seleções participantes do XV Campeonato Brasileiro de Futebol de Salão Sub 20 responderam a um questionário para investigar a ocorrência de lesões durante as partidas. A taxa de resposta foi de 100%. RESULTADOS: Um total de 32 lesões foi registrado durante as 23 partidas, com incidência de 1,39 lesão por partida ou 208,6 lesões por 1.000 horas/jogo. Aproximadamente 1 a 3 lesões por partida resultaram em afastamento de jogadores em partidas ou treinamentos. As lesões de contato eram predominantes em 65,62% (21 das 32 lesões) e a maioria dessas lesões não resultou no afastamento dos jogadores. CONCLUSÕES: O presente estudo observou que a incidência das lesões durante o XV Campeonato Brasileiro de Futebol de Salão Sub 20 foi semelhante à registrada em torneios de Futebol de Salão, mas superior aos achados em torneios de futebol, caracterizando a especificidade do esporte. Entretanto, circunstâncias e características são similares entre eles devido à semelhança de demanda do esporte.

Futebol de salão; Futebol; Lesão; Taxa de incidência; Torneio

ORIGINAL ARTICLE

Epidemiologic analysis of injuries occurred during the 15^th Brazilian Indoor Soccer (Futsal) Sub20 Team Selection Championship

Análisis epidemiológico de las lesiones en el fútbol de salón durante el XV Campeonato Brasileño de Selecciones Sub 20

Rodrigo Nogueira Ribeiro^I; Leonardo Oliveira Pena Costa^II

^IMinas Gerais Federal University

^IIMinas Gerais Pontifical Catholic University

^{Correspondence to}

ABSTRACT

INTRODUCTION: Several authors have investigated the incidence of injuries occurred in the outdoor soccer game. However, there are only few works analyzing injuries occurred in the indoor soccer game (futsal). The purpose of this study was to analyze the incidence, circumstances, and characteristics of injuries recorded in the indoor soccer during the 15^th Brazilian Sub20 Futsal Championship.

METHODS: Physiotherapists and doctors of every team selection participating in the 15^th Brazilian Sub20 Futsal Championship answered a questionnaire with the purpose to investigate the occurrence of injuries during the games. The answering rate was 100%.

RESULTS: 32 total injuries were recorded along 23 games, with a 1.39 injury incidence per game, or 208.6 injuries per 1,000/game. Approximately 1 to 3 injuries per game resulted in removal of players from gaming or training. Contact injuries were predominant in 65.62% (21 out of 32 injuries), and most of these injuries did not result in removal of the players.

CONCLUSIONS: The present study observed that the injury incidence during the 15^th Brazilian Sub20 Futsal Championship was similar to the incidence during the Indoor Soccer tournaments, but higher than those found in the outdoor soccer tournaments, characterizing the specificity of the sports. Nevertheless, circumstances and characteristics are similar among them, mainly due to the similar demand of the sports.

Keywords: Indoor soccer. Futsal. Outdoor soccer. Injury. Incidence rate. Tournament.

RESUMEN

INTRODUCCIÓN: Varios autores han estado investigando la incidencia de lesiones en el fútbol. Sin embargo, pocos trabajos han estado analizando las lesiones en el fútbol de salón. El objetivo de este estudio fue el de analizar la incidencia, y las circunstancias, y características de las lesiones registradas en el fútbol de salón durante el XV Campeonato Brasileño de Fútbol de salón Sub 20.

MÉTODOS: Médicos y/o fisioterapeutas del todos los participantes del XV Campeonato Brasileño de Fútbol de salón Sub 20 contestaron una encuesta para investigar la ocurrencia de lesiones durante las salidas. La tasa de respuesta fue de 100%.

RESULTADOS: Un total de 32 lesiones fueron registradas durante los 23 partidos con una incidencia de 1.39 lesion para salida o 208.6 lesiones para 1.000 horas/juego. Aproximadamente 1 a 3 lesiones por partido provocaron la salida de jugadores en partidos o entrenamientos. Las lesiones por contacto eran predominantes en 65.62% (21 de las 32 lesiones), y la mayoría de esas lesiones no producía la salida de los jugadores.

CONCLUSIONES: El estudio presente observó que la incidencia de las lesiones durante el XV Campeonato Brasileño de Fútbol de salón Sub 20 fue similar a la incidencia observada en los torneos de Fútbol de salón pero superior a los hallazgos en los torneos del fútbol, caracterizando la especificidad del deporte. Sin embargo, las circunstancias y características son similares entre ellos debido a la similitud de demanda del deporte.

Palabras-clave: Fútbol de salón. Fútbol. Lesiones. Incidencia lesional. Torneos.

INTRODUCTION

Indoor Soccer is an ascending sport that has attracted more and more followers all over the world. In Brazil, it is one of the most spread sport, played by more than twelve million Brazilian people, according to the Futsal Brazilian Confederation (CBFS)⁽¹⁾.

Keller et al.⁽²⁾ assert that the soccer game is responsible by the highest number of sportive injuries in the world. It is estimated that these injuries are responsible by 50 to 60% of the sportive injuries in Europe, and 3.5 to 10% of the physical traumas treated in the European hospitals are caused by the soccer game^(2-4).

Several studies have analyzed the incidence and risk factors for injuries in the soccer game^(4-22), but there are few articles discussing the indoor soccer^(3,23,24), and only one study comprising the Indoor Soccer⁽¹³⁾. According to Junge et al.⁽¹³⁾ in a study performed during the International Soccer Federation (FIFA), and in the 1998 and 2001 Olympic Games, it was observed a 191 injury incidence per 1,000 gaming hours in the 2000 Guatemala World Championship of Indoor Soccer, an approximately two times higher rate found by them in the outdoor soccer tournaments (92 injuries per 1,000 game hours).

Such difference can be attributed to the nature of the game, associated to the high speed of the movement, the lower size of the court, and differences on the floor, resulting in a higher amount of collisions and sprains, respectively⁽¹³⁾. Added to the own characteristics of the sport, the Indoor Soccer is one of the most practiced sportive modalities in the world, and this fact requires systematic investigations as to the incidence of injuries.

Definition of the injury

Several epidemiologic studies define differently the term sportive injuries, thus making difficult to make a comparison between these studies^{(2,11,23,25-28)}. Some studies define injuries as those treated by the medical department and requiring hospitalization⁽⁸⁾. These sportive injuries were recorded in the insurance policy, and it was observed that the higher percentage among them was severe, and predominantly acute. Besides, low severity injuries or those caused by the overuse were not recorded, and this was called the "iceberg peak phenomenon"⁽²⁸⁾.

More recent studies have defined the injury as an event that would have as consequence the player being removed for a given period of time from the games or trainings^{(9,17,24,29,32)}. According to Junge and Dvorak⁽¹¹⁾, such definition is not completely accurate. First, its application depends on the training and gaming frequency. Second, injured athletes can have a moderate participation in the trainings through a change in their exercising program. Third, the participation in the training and games depends on other factors, such as availability of an adequate treatment and importance of the game.

The National Athletic Injuries Recording System in the United States (NAIRS) defines injury as an event that limits the athlete to participate in games or in the training for at least one day after the occurrence. This definition is more accurate, but it also does not solve all the aforementioned difficulties⁽²⁸⁾.

The definition of the European Council requires that the injury has at least one of the following consequences: 1) reduction in the amount or level of the sportive activity; 2) it requires medical assessment or treatment; 3) it has unfavorable social and economic effects. This present definition for the injury seems to be more comprising, but it has been less used^(9,20).

Besides the definition of the sportive injury, another point that deserves to be mentioned is to define the severity of the injury. The severity of the injury has been defined by the endurance of the removal from the sportive practicing, and it is classified in three categories: mild (1 to 7 days), moderate (8 to 21 days), and severe (more than 21 removal days)^(17,30-32). Van Mechelen et al.⁽²⁸⁾ recommend that the severity of the sportive injuries is described based on six criteria: nature of the injury, endurance and type of the treatment, time of the sportive removal, time of the removal from the work, permanent damage, and cost.

Ladeira⁽¹⁵⁾ asserts that the epidemiologic studies are the first step to elaborate a preventive program. Physicians, therapists and physical educators must understand the incidence, risk factors and the mechanisms of the injury, in order to be able to combat its causes^(2,33). The authors of this article are not aware of epidemiologic studies on injuries occurred in Indoor Soccer in Brazil practitioners.

The purpose of this study was to make a prospective analysis on the incidence, circumstances and characteristics of the injuries occurred in the Indoor Soccer recorded during the 15^th Brazilian Sub20 Selection Championship.

METHODS

The study was performed during the 15^th Brazilian Sub20 Team Selection Championship, a tournament organized by the CBFS. It was studied one hundred and eighty 17 to 20 years old athletes representing ten State team selections.

Physicians, therapists or physical coaches of ten participating team selections answered a form (figure 1) with the purpose to investigate the occurrence of injuries occurred during the games. That form was adapted from a medical record performed by FIFA: Medical Assessment and Research Center (F-Marc)⁽¹³⁾. Whenever a player has been injured, the details of his life were recorded through an interview conducted by the main author of this research. After the end of the tournament, the author had regular telephone conversations to physiotherapists, coaches and/or athletes, in order to make a follow-up of the injuries' evolution.

In this study, an injury was defined as any commitment occurred during a game, regardless its consequences related to the subsequent removal from the games or training⁽¹³⁾. The injuries were recorded based on their circumstance (with or without contact), location, type and severity, and these data are presented on table 1. In this study, all data were descriptively presented.

This study was approved by the ethics committee of the Minas Gerais Pontifical Catholic University and the Arbitration Council of the 15^th Brazilian Sub20 Team Selection Championship, and all volunteers participating in this study gave their consent to such participation.

Calculation of the incidence

The incidence for injuries was expressed as the amount of injuries per game and the amount of injuries per 1,000 gaming hours per athlete, according to prior studies^(12,13). The amount of gaming hours per athlete was calculated according to the following equation: 10 players x 40 minutes = 6.67 hours. The extra time and the reduction in the amount of athletes playing during the games were not considered, since none of the games required an extra time, and the exclusion of athletes was a rare event that lasted a short-time.

RESULTS

A total of 32 injuries were recorded during the 15^th Brazilian Sub20 Team Selection Championship, with a 1.39 injuries/game incidence. The circumstances for the injuries were recorded by the occurrence or not of contact (direct or indirect trauma). The injuries with contact were predominant, with a 65.62% (21 out of 32 injuries) rate, and the major part of these injuries did not result in removal of athletes from the sportive activities. Complementary information on the incidence, circumstance, and characteristic of the injuries are found on table 1.

The rate of injuries resulting in the game or training removal was 0.48 injury/game, or 71.7 injuries/1,000 gaming hours. Significantly, injuries without contact (34.38%, 11 out of 32 injuries) resulted in removal of athletes from the sportive activities than contact injuries (65.62%; 21 out of 32 injuries). The severity (removal time) was higher for injuries without contact compared to injuries with contact (see details on table 2).

DISCUSSION

This study investigated the incidence and characteristics of injuries during the 15^th Brazilian Sub20 Team Selection Championship. All the ten team selections participating in the tournament cooperated in this study answering an adapted F-MARC⁽¹³⁾ questionnaire after the games, resulting in a 100% answering index. In this study, the injuries were defined as any commitment occurred during the games regardless its consequences as to the consequent removal from the games or training⁽¹³⁾.

The use of a wide definition including "every injury (overuse and trauma) caused during the soccer game, regardless its consequence" avoids any problems associated to other restricted definitions⁽¹³⁾. It allows the assessment of chronic injuries through the assessment of the impact caused by the high incidence rate of mild and moderate contusions compared to fractures, for instance.

Besides of making available additional information (such as calculation of the length of time of the removal from the activity and treatment performed by a physician or therapist), allowing to express the incidence of injuries according to different definitions, thus allowing to make a comparison of the results related to other studies.

Another important factor is that such wider definition makes possible to minimize errors occurred during the data collection that is performed by different examiners from several professions (physicians, physiotherapists, physical educators, etc.) what might be one of the limiting factor to this type of study.

Several studies have demonstrated a great difference in the incidence rates of injuries recorded in the soccer game^{(2,11,23,25-28)}. Junge and Dvorak⁽¹¹⁾ have attributed these differences to heterogeneous definitions, data collection methods, time of observation, type of the study, and characteristics of the sampling found in the works.

The definition of the injury as well as its severity are important aspects when recording sportive injuries, and they have been discussed by several authors^{(2,11,23,27,28)}. Junge and Dvorak⁽¹¹⁾ assert that the definition of the injury must be based on the prevalence of the appropriate complaint to the soccer game, and the severity is not determined only by the endurance of the symptoms, but also by the damaged tissue, since small injuries and those "healed" using analgesia or medication are neglected, and the incidence rate of injuries may be underestimated.

The data collection system has also been aim for several discussions. Liendefeld et al.⁽³⁾ assert that the adequate recording system must include components such as location, type and circumstance of the injury.

Junge and Dvorak⁽¹¹⁾ recommend that the exact calculation of the incidence of the injuries, as well as the amount of the game and training must be individually documented for each athlete. Besides, they assert that record of the sportive injury must be performed prospectively, since retrospective data have a limited value, and the prospective studies besides of assessing the incidence of injuries, can also identify the groups and risk factors.

In the present study, the incidence of injuries (208.6 injuries/1,000 game hours) was slightly higher than the incidence recorded by Junge et al.⁽¹³⁾ during the 2000 Guatemala World of Indoor Soccer Championship (191 injuries/1,000 game hours). Such higher incidence may be explained by a technical and tactic fragility, as well as a lower muscular strength, resistance, coordination and skill found in young athletes. Modifications in the training system for young athletes, aiming the technique, ability, as well as the physical conditioning can minimize the incidence of sportive injuries⁽¹⁹⁾.

It was not possible to assess injuries during the training, since in short tournaments like that, teams play daily games, and in the majority of cases, this makes unviable to train between competitions, and thus, our work was limited to assess only the incidence of injuries/gaming hours.

The incidence rate of injuries without contact was higher than the rates found in other tournaments⁽¹³⁾, and 45% of these injuries resulted in removal from the games or training. Such high incidence rate of injuries without contact may be an indicator that athletes had not time enough to prepare themselves to all the tournament's demand, and/or there was no available recovering time from injuries along the competition.

The major part of the injuries (65.62%) was caused by direct contact, and the contusions and sprains were the most common type of injury along the tournament, and this result was similar to other studies^(3,12,23,24). We found a slightly higher sprain rate than those recorded by Junge et al.^(12,13) in the 1998 and 2002 FIFA's soccer tournaments, as well as in the 2000 Olympic Games. This difference may be attributed to the rubber and more adherent floor of the Indoor Soccer's court, compared to the outdoor soccer's grass that predisposes athletes to a higher amount of sprains.

The location of the recorded injuries was similar to the ones found in other studies^{(3,4,10,12,13,15-17,19,21-23)}, predominantly affecting the ankle and knee's joints, and the thigh and leg's muscles. The disproportion between body's parts may be attributed to the higher demand imposed to the lower end in that sport⁽¹⁹⁾.

CONCLUSION

The present study observed that the incidence, circumstance, and characteristics of the injuries occurred during the 15^th Brazilian Sub20 Team Selections Championship are similar to those verified both in Indoor and outdoor soccer tournaments, characterizing the specificity of the sport. The analysis on the incidence and risk factors related to sportive injuries, as well as preventive program development are extremely important aiming to reduce injuries while practicing the sport.

THANKFULNESS

The authors wish to thank the cooperation of every physiotherapist and physical coaches of the delegations (Espírito Santo, Maranhão, Mato Grosso do Sul, Minas Gerais, Paraná, Pernambuco, Rio de Janeiro, Santa Catarina, São Paulo, Tocantins) that voluntarily disposed their time to the data collection for the accomplishment of this work. We would like to express our gratitude to every athlete who participated in this study.

All the authors declared there is not any potential conflict of interests regarding this article.

REFERENCES

Received in 25/1/05.

Final version received in 16/8/05.

Approved in 5/9/05.

• ¹
  Confederação Brasileira de Futebol de Salão. Texto disponível na internet. [Acessado em 1º de dezembro de 2004]; formato URL: http://www.cbfs.com.br
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Publication Dates

• Publication in this collection
  02 May 2007
• Date of issue
  Feb 2006

History

• Accepted
  05 Sept 2005
• Received
  25 Jan 2005
• Reviewed
  16 Aug 2005