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1. Introduction to epidemiology
2. Soccer injury epidemiology
3. Reliability of soccer injury epidemiology studies
4. Ekstrand and Gillquist propose stretching and strengthening
5. Keller et al advocate warm up and stretching
6. Hawkins and Fuller identify fatigue as a factor
7. Conclusion
8. References

Ekstrand and Gillquist (1983) undertook a prospective study of 180 amateur football players to elucidate the incidence of injury during the year. The authors found that 88% of injuries involved the lower extremity and that strains accounted for 48% of all injuries. This lead the authors to advocate a lower limb stretching and strengthening regime as a strategy to reduce the incidence of these injuries - these suggestions being based in convention rather than being backed by strong scientific evidence. Ekstrand and Gillquist (1983) also found that 69% of knee injuries were caused by trauma and that 61% of these were caused by a collision. On face value this may be useful data for the clinician to consider and the strategies advocated by the authors may conceivably be beneficial. However, there is a sense that the data does not inform the clinician more than they subjectively know from experience. This together with methodological issues, reduce the clinical worth of the study and make it of limited use in the clinical reasoning process.

Ekstrand and Gillquist (1983) provide a confusing definition of injury, where return to practice is the main criteria, but this may be related to other factors such as the player, for some personal reason, not wanting to return to practice, rather than the severity of the injury. The study only incorporated about ten teams in total and each team coach selected 15 players to take part. The authors do not state the selection criteria used by the coaches and this may affect the outcome. Although all of the injuries were examined by the same orthopaedic consultant the data was recorded retrospectively and therefore not all the information may be recalled. In research terms, this can be classified as systematic error. This level of reliability may be no better than the sports clinicians subjective recall, and for this reason it is likely the personal experience of the clinician will have a greater bearing on the clinical reasoning process than research of this standard.

Keller et al advocate warm up and stretching >