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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

Keller et al (1987) reviewed six major epidemiological studies in soccer. The authors again highlight the array of definitions of injury in the literature. This aside, based on the available descriptive evidence the authors concluded that, because of the increase in size and intensity of play, there were more injuries due to collision in older more elite players, but that the number of muscle injuries was less in these groups, because of better physical preparation. This hypothesis has face validity but needs to be subjected to scrutiny by further research.

So too does the theory put forward by Keller et al (1987), that muscle strain and tendonitis is significantly higher in players with reduced flexibility. This epidemiological data can provide clues leading to the formulation of an epidemiological hypothesis that is consistent with existing knowledge, but an association does not prove cause and effect. Analytical epidemiology endeavours to test a hypothesis to judge whether a particular exposure causes or prevents injury. This data is used by clinicians to allocate resources and implement injury prevention strategies. Longitudinal and experimental studies are required to test these hypotheses but, until this research is completed, clinicians must make decisions based on the available evidence and current theories which have biological grounding.

In keeping with this, it is conventional practice for clinicians to advocate a warm up and stretching program in an effort to prevent muscle and tendon injuries. More research is needed to evaluate the efficacy of these regimes. There is a lack of scientific credibility behind stretching as an injury prevention strategy, although there is biological credibility to this approach.

Hawkins and Fuller identify fatigue as a factor >