In “past, present, future”, we ask clinical or academic experts to reflect on selected Sports & Exercise Medicine topics. Today Jan Ekstrand on Football Injury Research.




Tell us more about yourself.

I am a frustrated football player who eventually became a football doctor. My speciality is Orthopaedic Surgery. My PhD in 1982 was about preventing soccer injuries, and one of the studies was the first RCT showing that it was possible to prevent sports injuries. I was team dr for the Swedish National male football team for >100 caps and have a bronze medal from the WC in USA 1994. During the years 1992 and 2015, I was a member of the Medical Committee of UEFA. I am leading the UEFA Elite Club Injury Studies since 2001. My academic affiliation is Linköping University in Sweden, where I am a professor in Sports Medicine since 2000, and I am a member of the Football Research Group (FRG).


What was hip and happening 10 years ago?

Sports injury prevention was focused on providing athletes with a training program, strengthening muscles, increasing coordination, improving core stability, etc. Several well-designed studies show that such procedures successfully reduced injuries in amateur and low professional level athletes and adolescents.


What are we doing now?

Our data from 20 years of study of male elite level football players in the UEFA  Elite Club injury study (ECIS) show that the overall injury rate has decreased in training and matches. The injury pattern has changed, though. Ligament injuries have been reduced, especially ankle sprains and medial and lateral collateral ligament injuries of the knee. The declining injury incidence could signify that injury prevention of ligament injuries has become increasingly efficient and should encourage medical staff in professional football clubs to continue implementing and monitoring preventive programmes following emerging evidence.

However, the muscle injury rate has not decreased, neither in training nor in matches. Muscle injuries, especially hamstring injuries, constitute the biggest injury problem in elite-level football teams. Despite all the promising studies on the prevention of hamstring injuries, to our surprise, the level of injury has not been affected.

To listen to the field experts, we organize an annual meeting with all the chief medical officers of the clubs participating in the ECIS for discussions on how to reduce injuries, keep the players available and increase performance

At such a meeting in Porto 2013, we asked for the chief medical officers’ views on the most important risk factors contributing to injuries. The four most common factors listed were: (1) the leadership style of the head coach, (2) the quality of internal communication, (3) the workload imposed on players, and (4) player well-being.

This suggests that preventive strategies targeting player-related risk factors may not, on their own, be sufficient to reduce injury rates at an elite level significantly. Accordingly, alternative risk factors need to be investigated to determine whether there is a correlation with injury rates and to provide guidance to the most appropriate preventive measures to be adopted. We have studied some of these and found associations between injury rates and the leadership style of the head coach, and the quality of the internal communication within a team.

We believe that injury prevention on the highest professional level is different to prevention on amateur and youth level. We must broaden our visions, reflect on new factors such as communication, leadership, load and well-being


Where do you think we will be 10 years from now?

When I did my PhD in the 80ties and discussed new preventive methods such as taping and stretching, I was surprised by the opposition and negative comments from many orthopaedic and sports medicine profiles. It took 10 years for such methods to be established, but they are today well known and accepted by athletes and laymen.

I prognosticate the same development with preventive factors like internal communication, leadership styles, load and well-being on teams and players, and well-being of the team and players. These factors are scarcely studied or implemented at present but will be well known and accepted in the coming decade


Would you like to learn more on this topic? Here is a selection of Football Injury studies published in our journal
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