Epidemiology of injuries is one of the greatest contributions of science, and particularly medicine, to the sports. Their study has provided useful conclusions about their frequency, type, severity or other parameters. By analyzing thousands of data and reports, it investigates the patterns between those injuries.
The main topic of this research is to review the results of injury reports from 3 of the most popular sports worldwide. Thousands of injuries harm athletes each year with different body target zones and severity. The text aims to give an answer to questions such as which is the most common type of injury for each sport and what is the average time of absence. On the second part, a comparison between all 3 sports is made to adjudicate the similarities they bear. The aim is to illustrate the dedicated prevention or treatment each one of them may need.
Injuries have always played a key role in sports history. Unfortunate but sometimes inevitable part in an athlete’s career, quite often they have determined the winner of an event. Collisions with teammates or opponents, falls and hits by the ball or other equipment are common causes of injuries. Their study, prevention and rehabilitation have become such a major aspect of medicine and sports science, that associations spend vast amount of money in research, medical staff and facilities. However, their nature differs across sports according to the body part injured, the injury type and the absence time.
Football, basketball and volleyball are sports practiced by million of people worldwide. Apart from that, they have high injury rates in comparison with others. The researcher will audit on their epidemiology in regards with four different parameters
Data Collection and Methodology
The researcher collected and processed data concerning injuries for football, basketball and volleyball. The data concerns professional players playing in top tier leagues (European leagues for football and NBA for basketball) or international tournaments (for volleyball). Each injury is recorded according to the report that has been submitted by medical staff to the relevant association or released to the media. The period of absence is defined as the period from the day that the player suffered the injury till he returned to full practice or was cleared for game participation.
For this study’s purposes, body zones are split into 7 categories. Head & face, arm (shoulder, elbow, hand, fingers), upper trunk (neck, thorax and chest), lower trunk (including abdomen, groin, ribs and hip), back & spine, upper leg (the whole groin area) and lower leg (knee, calf, ankle, foot, toe). The various illnesses are classified as “other/unknown zone”.
The injuries will be inspected according to the zone they occur, their type, days of absence and playing position.
Football was first played in mid 19th century in England. Its fame rose quickly throughout the decades. Today more than 250 million people participate actively. 22 players split in two teams compete for 90 minutes. However it involves a lot of intense training or effort, which increases the risk of getting injured. According to a study focusing on the Dutch top football division, the overall injury rate is 6.2 injuries per 1000 player – hours, where approximately 63% of players report at least once during season (Stubbe et al., 2015).
500 injuries from football players since 2008 were recorded. The average age when they occurred is 25.8 years, with a standard deviation equal to 4.1 .
Results show that lower leg is the mostly affected zone. As a sport where the ball moves around usually by being kicked, it comes as no surprise that body parts such as ankle, toe or calf can be easily harmed. It is estimated that 80% of minor injuries happen while making/receiving tackle or kicking the ball and 100% of major while receiving a tackle, an action that most of the times aims on the opponent’s legs. Thigh related injuries dominate the relevant category (31%). It is estimated that an average professional player covers 237 (± 123) meters per game (Andrzejewski et al., 2013) and 16.5% of his playing actions consist of jumping for a header (Rahnama, Reilly and Lees, 2002). Those actions require the involvement of muscles located in thigh such as hamstring, quadriceps and adductors.
Furthermore, ankle and knee are two more parts often hit by injuries. Since use of hands or receiving a body check are quite limited, injuries in hands, shoulders, chest and other parts of upper extremity are rare. In general, ankle sprain and thigh strains (especially in hamstring) are the two most common injuries for a football player.
Amongst all four playing positions (goalkeepers, defenders, midfielders, forwards), midfielders and forwards have a higher chance of getting injured in the calf or ankle than the other two. The main reason is that they have to face more tackles or other types of physical contact of the legs, quite often against taller and heavier opponents, as usually defenders are. As they also usually need to sprint more times, they are more prone to thigh injuries.
The average time of absence is 22.8 days, with a standard deviation of 30.6 . The majority of injuries sideline the player between 3 and 14 days, making him usually miss 1 to 3 matches during season. Less than 2% are below this timeframe, since some of them are so minor that are not even reported. In addition, knee or thigh problems seem to be the most severe ones while illnesses and calf or foot injuries the least.
Probably the second most played sport worldwide, basketball is considered as the “big men” sport. Especially in professional level where players very often exceed 2m in height, even reaching 2.2m. As it might be expected though, it is not free of injuries. Hard contacts and fouls or quick and frequent change of direction while running can easily cause some of them. The injury risk in basketball is equal or even higher than in football.
Injury data for 350 incidents in NBA from 2013 onwards were processed. Regarding this statement, it should also be mentioned that injuries where the player was kept on purpose out of practice for a longer period (e.g. if his team was in “tanking mode” and therefore the coaching and medical staff did not want to rush him back into action) were not taken into consideration. The average age was 27.7 years and the standard deviation equal to 4.3 .
3 out of 5 injuries occur to the lower or upper leg zone. Those are both overuse (e.g. tendinopathy) and traumatic (like ligamentous sprains) injuries (Taylor et al., 2015). Basketball is a sport that requires 35 to 46 vertical jumping activities per game, that increase the chance of harming muscles located in ankle, knee, hip or even shoulders. Therefore, it is interesting to also point out that arm injuries are also ordinary.
Unlike football, ankle related injuries such as sprains or soreness are the most common. Knee injuries (e.g. sprains, soreness, contusion) follow on the second place, while hamstring or calf sprains can be found quite lower on the relevant list.
One intriguing conclusion though is that ankle injuries occur more often in guard players and knee injuries in forward or center players than vice versa. Studies reveal that shooting guards have the greatest frequency of drawing fouls (Vanderlei et al., 2013). Strictly speaking, guards have to move around the court or attack the basket more often than forwards or centers and therefore more footwork is usually required.
Average absence time is equal to 18.4 days. Most of the injuries could be characterized as mild or moderate nonetheless, since only in 53 out of 350 cases the player was held out of training or games for more than 4 weeks.
It is a general belief that volleyball is one of the safest team sports. The main reason is that contact with opponents or teammates is practically limited, thus minimizing the risk of relevant injuries. However, the players are still prone to injuries due to activities such as jumping to spike or block the ball and digging. Bulgarian Matey Kaziyski achieved a spike speed of 132km/h in 2013 (Fivb.org, 2012), which can apply great force to the hands (or other body part) of the opponent that this attack hits. A study focusing on NCAA (National Collegiate Athletic Association) revealed that game injury rate in volleyball is approximately 4.5 injuries/1000 playing hours.
FIVB (The International Volleyball Federation) has developed the so called Injury Surveillance Program to register injuries during its major tournaments. Data obtained from the ISP from September 2010 to November 2014 during 32 FIVB tournaments were used to shed light on the nature of 440 injuries, through an article that was published online in British Journal of Sports Medicine in 2015 (Bere et al., 2015).
As demonstrated by this graph, more than half of injuries occur to the lower leg zone. As actions like running, stretching and tackling are finite, upper leg or lower trunk injuries happen with less frequency. Yet, arm injuries make approximately 21% of total number, with the majority of them occur either in shoulder of fingers. This easily leads to the conclusion that upper and lower limbs are the two zones that are the most exposed to injuries.
Earlier it was mentioned that volleyball involves a lot of vertical jumping (like basketball). Players such as outside hitters and the middle blocker can jump even up to 200 times during a 5 – set game. The risk of landing improperly or applying a massive amount of force increases. Those facts can explain why knee and ankle are the two most common injury locations for sprains, strains or contusion. Moreover, frequent touches with the ball while attacking or defending result in a variety of injuries such as sprain or dislocation of fingers. Results show that ankle sprains in liberos are less than other positions, while outside hitters suffer more from shoulder injuries. In general, the risk injury for centers is higher than any other position.
The majority of injuries could be characterized as mild, since in 285 occasions the player did not miss more than 2 days of full participation in training or matches. Severe injuries were quite rare, as underlined by the fact that less than 3% of them caused an absence longer than 4 weeks. Volleyball is a sport with lower injury risk than others : only 32.5% of total number of injuries were reported to cause notable time – loss.
Results and discussion
The comparison of results across the 3 sports inspected in this research, leads to interesting conclusions. It was proven that lower extremity is the most commonly injured body zone amongst football, basketball and volleyball. Ankle sprain is the type of injury that occurs with the greatest frequency, especially in the two latest sports where vertical jumping is required in many phases of the game.
However, the rest of top injury target zones or types differ from sport to sport. Injuries in the upper leg zone, hitting the thigh, are more common in football. Volleyball has the highest percentage of injuries in arms. In addition, the back/spine injury risk in basketball and volleyball is higher than football.
A significant difference was also found regarding the days missed. Football injuries were more severe than basketball and volleyball, where results show that is considered to be the safest sport amongst them. For football players, the time of absence was greater than 4 weeks in 25% of occasions, while this number for basketball and volleyball is equal to 21% and 2.3% (even with the missing information, the increase will not be great probably) respectively.
As it was also evident, the distribution of injuries across the playing positions was different for all 3 sports. There were not any injuries that were reported only for specific playing positions (e.g. defenders in football, centers in basketball or liberos in volleyball), however their frequency may differ according to this criterion.
The current research showed that epidemiology of injuries in those 3 sports leads to various similarities and differences among them. Lower and upper leg zone is the most common area for injuries for all three of them. Ankle sprain, thigh strain and knee soreness are three popular types of injury. Nevertheless, their severity is not the same with volleyball usually being the safest sport. Preventive measures should take into consideration results and conclusions like those demonstrated earlier in order to limit the risk of injuries to specific areas.
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