Hägglund, Martin

Pruna Grivé, Ricard

Til Pérez, Lluís

Waldén, Markus

Revistes Catalanes amb Accés Obert

ARTICLE IN PRESSDocumento descargado de http://www.apunts.org el 24/01/2011. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.www.apunts.org
Apunts Med Esport. 2010;45(166):57–591886-6581/$ - see
doi:10.1016/j.apu
Autor para cor
E-mail addressEDITORIAL
The importance of epidemiological research in sports medicine
Importancia de la epidemiologı´a en medicina del deporteMartin Ha¨gglunda,, Markus Walde´nb, Lluis Tilc and Ricard PrunadaSports Physical Therapist, Linko¨ping University, Swedish Football Association, Linko¨ping, Sweden
bSports Physician, Linko¨ping University, Swedish Football Association, Linko¨ping, Sweden
cSports Medicine Physician, FC Barcelona, Olympic Training Center, Sant Cugat del Vall es, Barcelona, Spain
dSports Medicine Physician, FC Barcelona, Barcelona, Spain
Received 2 February 2010; accepted 8 February 2010
Available online 29 de marzo de 2010Although the positive health effects of physical activity are
well documented, sports participation is associated with a
certain injury risk. Hence, prevention of injury is of upmost
importance, and epidemiological research is the fundamen-
tal ﬁrst step in the sequence of prevention1. In some sports
the incidence, patterns and severity of injuries are well
described. For instance, the Union of European Football
Associations (UEFA) has ongoing injury surveillance in
professional and international football since 20012–4. In
other sports, however, this information is lacking and there
is an urgent need for more studies. In this editorial, we will
brieﬂy highlight some cornerstones of sports epidemiological
research.
Historically, there have been considerable methodological
variations making comparisons between studies difﬁcult. In
2006, a methodological consensus for studies of football
injury was published5 and has since then been followed by
some other team sports6 and recently also one individual
sport (tennis)7. A novel approach in the latter paper was the
recommendation to record other medical conditions than
injury, such as illnesses. This should prove an important step
to get a complete picture of the medical problems of a
speciﬁc sport, although it will put more demand on the data
suppliers.front matter & 2010 Published by Elsevier Espan˜a, S.L
nts.2010.02.006
respondencia.
: hagglund.martin@telia.com (M. Ha¨gglund).The main outcome in epidemiological sports injury
research is usually injury incidence, expressed as a ratio
between adequate numerator and denominator data.
Common numerator data are the number of injuries/
conditions or the number of injured/ill players during a
deﬁned period, and denominator data the number of
athletes at risk, the number of athlete-exposures, or the
time of sports participation. In team sports, injury incidence
is usually (and preferably) expressed as the number of
injuries per 1000 hours of participation. The injury incidence
reported in a study thus fully depends on the deﬁnitions of
injury and exposure used. In practice, injury is usually
deﬁned based on the athlete seeking medical attention, or
the athlete being absent from sports participation, i.e. time
loss5,7. In many sports, deﬁning match or competition
exposure is fairly easy and manageable to record. However,
to accurately capture training exposure can be more
difﬁcult, in particular in individual sports. In football,
training exposure is deﬁned as ‘‘team based and individual
physical activities under the control or guidance of the
team’s coaching or ﬁtness staff that are aimed at maintain-
ing or improving players’ football skills or physical condi-
tion’’5, and this should be applicable also in many other
team sports. However, to date, most studies report only
team based activities and exclude individual activities
performed by the athletes. Consequently, they will under
report the true training exposure and the most plausible
reason is that individual training is more difﬁcult to.
ARTICLE IN PRESS
Fig. 1 Martin Ha¨gglund.
Fig. 2 Markus Walde´n.
M. Ha¨gglund et al58
Documento descargado de http://www.apunts.org el 24/01/2011. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.supervise and standardise compared to training carried out
with the team. In many individual sports, e.g. alpine skiing,
track and ﬁeld, etc., recording training exposure may thus
pose a considerable challenge for the data collector.
Another key issue is to clearly deﬁne and separate between
training exposure and any alternative or partial training
performed due to an existing injury/medical condition.
The current recommendations for conducting high quality
epidemiological sports injury research put great demands on
medical practitioners and other data recorders on the ﬁeld.
To be successful in such research it is therefore important to
establish a win-win situation between researchers and data
providers in order to increase compliance and accuracy of
data collection. A prerequisite is that the research questions
are up-to-date and relevant for the medical personnel
attending to the athletes and that they are given useful
feedback to be able to work proactively to prevent injuries.
For example, clubs can be provided with team speciﬁc injury
statistics in relation to average values of the total sample. A
key issue for the UEFA research group has therefore been to
establish a close collaboration with the medical teams of the
participating top clubs, including FC Barcelona and Real
Madrid CF, during the course of the study. We believe that
this working model has developed the study further and also
ensured a dual exchange of knowledge about injury
prevention.
Performing a well-conducted prevention study is even
more difﬁcult, and many of the existing studies have been
under powered or have signiﬁcant methodological limita-
tions. To make proceedings transparent and to subject
methodology to external review it is recommended that the
design and planned outcomes are published a priori8.Fig. 3 Lluı´s Til.
Conclusions and future recommendations Solid epidemiological research is currently lacking in
several sports. Therefore, more studies are urgently
needed to establish the extent of the injury problem as
well as the underlying risk factors and mechanisms of
injury. We recommend that the consensus proposal for football
injury can be used in future studies of other team sports,
such as team handball and basketball.
Fig. 4 Ricard Pruna.In accordance with the recent consensus statement for
tennis, we suggest that other medical conditions than
injury are also included in sports epidemiological studies
in order to get a complete overview of the health hazards
for the athletes. In addition to collecting team based training exposure,
researchers should strive to collect additional individual
training exposure also in team sports, but to report this
separately to facilitate comparison with previous studies. Finally, the ultimate goal of all sports injury research is
injury prevention. Much of the prevention research
published so far has been under powered and associated
with other more or less severe limitations. It is therefore
an obvious strength of a study if the protocol, sample size
calculation and planned statistical analyses according to
the main outcome are subjected to external review and
published before data collection starts.(Figs. 1–4)References1. Van Mechelen W, Hlobil H, Kemper HC. Incidence, severity,
aetiology and prevention of sports injuries: a review of concepts.
Sports Med. 1992;14:82–99.
2. Ha¨gglund M, Walde´n M, Bahr R, Ekstrand J. Methods for
epidemiological study of injuries to professional football players:
developing the UEFA model. Br J Sports Med. 2005;39:340–6.
3. Ha¨gglund M, Walde´n M, Ekstrand J. UEFA injury study—an injury
audit of European Championships 2006 to 2008. Br J Sports Med.
2009;43:483–9.
4. Walde´n M, Ha¨gglund M, Ekstrand J. UEFA Champions League
study: a prospective study of injuries in professional football
during the 2001–2002 season. Br J Sports Med. 2005;39:542–6.
ARTICLE IN PRESS
The importance of epidemiological research in sports medicine 59
Documento descargado de http://www.apunts.org el 24/01/2011. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.5. Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, et
al. Consensus statement on injury deﬁnitions and data collection
procedures in studies of football (soccer) injuries. Br J Sports
Med. 2006;40:193–201.
6. Rodas Font G, Medina Leal D, Moize´ Arcone L, Yanguas Leyes J,
Bros Mene´ndez A, Simo´n Lobera B. Epidemiologia lesional en un
club d’hoquei sobre herba. Apunts Med Esport. 2006;41:60–5.7. Pluim BM, Fuller CW, Batt ME, Chase L, Hainline B, Miller S, et al.
Consensus statement on epidemiological studies of medical
conditions in tennis. Br J Sports Med. 2009;43:893–7.
8. Ha¨gglund M, Walde´n M, Atroshi I. Preventing knee injuries in
adolescent female football players—design of a cluster rando-
mized controlled trial [NCT00894595]. BMC Musculoskelet Dis-
ord. 2009;23;10:75.


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