The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains

C. Woods, R. Hawkins, M. Hulse and A. Hodson

British Journal of Sports Medicine

2003, Vol 37, pages 233-238.

Unlike their counterparts at the Norwegian Football Association, the researchers at the English Football Association didn't watch the injuries on a video tape. Instead they relied on the medical personnel within individual professional clubs to collect their data. The data was returned via a postal questionnaire method, between the 1997-98 and 1998-99 English football seasons, with return rates of 87% and 76% respectively for each season. This represents a very good response rate for this type of study. The current study is a descriptive analysis of ankle injuries.

As with previous English FA research, the method of data collection provides the major methodological flaw. Firstly, the researchers are reliant on the injury recording and interpretation of the individual medical staff at each of the ninety-one participating clubs, which affects inter-tester reliability. Each of these medical staff may have a different interpretation of an injury, based on their level of training and varying professional background. For example, while many of the medical personnel at Premiership clubs are Chartered Physiotherapistsk, with post-graduate qualifications in sports medicine, the same is often not true of those personnel working at Football League clubs, where the level of training is often limited to a four week residential course organised by the Football Association. The authors do not provide details of any reliability testing between data collectors and it appears that this problem has not been addressed.

The data presented suggests that 67% of all ankle injuries are sprains. These are then sub-divided into anatomical location. 73% of these are reported to involve the Anterior Talo Fibula Ligament and 14% are reported to involve the Medial Ligament, with the Anterior Tibio-Fibula Ligament, the Calcaneo Fibula Ligament, the Posterior Talo Fibula Ligament, the Tibio Fibula Interosseus membrane (Syndesmosis) and the Posterior Tibio Fibula Ligament accounting for just 8% of all ankle sprains when combined.

While all previous research would suggest the lateral ankle ligaments are most commonly injured in soccer (this is undisputed - although this research is now 20 years old and MRI findings were not used) the data presented appears exaggerated in this direction. Anecdotally, the incidence of injury (confirmed by MRI) to the 'lesser known' ligaments would account for more than 8% of the total and provides for some scepticism of the figures presented.

The cumulative totals of all the above mentioned ligaments (plus 1% 'Missing' and 4% 'Unspecified') add up to 100%, suggesting that each of these injuries occurred in isolation. What this suggests is that during the two seasons of English professional football that were examined, not one player suffered an ankle sprain that resulted in combined damage to two or more ankle ligaments.

Again, based on anecdotal evidence within an elite population (and supported by MRI evidence), this is somewhat hard to believe, as combined ankle ligament injuries are common. Also, during this period no player reportedly damaged either the Plantar Calcaneo Navicular Ligament, the Talo Navicular Ligament, the Cervical Ligament, or the Interosseous Talo Calcaneal Ligament.

The lack of specificity in the diagnosis is highlighted by the fact that almost 90% of reported ankle sprains had no diagnostic investigations. Only 9% had an x-ray and only 2% were followed up with an MRI scan. MRI is excellent at distinguishing anatomical location of injury and the extent of tissue disruption. Because of the low percentage of injuries which used diagnostic investigations reported in this study, the reliability of the diagnosis could be low.

As with previous injury research conducted by the English FA, the methodological flaws within this study mean that it contributes little to the knowledge base on soccer injury epidemiology. Indeed because of its lack of rigour the data presented may be perpetuating a myth that the anterior Talo Fibula Ligament is virtually the only ligament that is damaged in an ankle sprain injury. More rigorous studies utilising a correlation with MRI findings may be useful in establishing the location and extent of soft tissue damage occurring in ankle sprains within English professional football.

Go to the journal >

< top of page


SHOP
Shopping Basket

0 Items
£0.00



Pounds Euros US Dollars
Search Products
Browse Products
Supports & Braces Hot & Cold Therapy Foot Care Exercise & Rehabilitation Back & Neck Care Taping & Strapping Physio & First Aid Kits Performance & Recovery Running Accessories
Help