Ramadan began on June 18th and will likely end on July 19 this year. For those who don’t know, Ramadan is the ninth month of the Islamic lunar calendar. Muslims believe this month to be when the first verse of the Quran was revealed to the Prophet Muhammad. As an act of devotion and self-control, Muslims intermittently fast from eating, drinking, smoking, and sexual relations between sunrise and sunset.

In 2012, the Summer Olympics in London overlapped with the month of Ramadan. Last year, the 2014 FIFA World Cup in Brazil overlapped with Ramadan for the first time 1986. This year, Ramadan overlaps with three major soccer tournaments: the 2015 FIFA Women’s World Cup in Canada, Copa America in Chile, and CONCACAF Gold Cup in North America. For many Muslim athletes, such as Mesut Ozil, Karim Benzema, and Paul Pogba, this poses a challenge for training and competition.

It is suggested that Muslim athletes may be at greater risk of physical injury while fasting during the month of Ramadan due to: hypohydration, increased perception of fatigue, glycogen depletion, altered carbohydrate intake, and sleep phase shift.

There is not much data about injury rates in Muslim athletes during the month of Ramadan. Though, a pilot study, which investigated the injury rate of a Tunisian, professional soccer team over two competitive seasons, found no significant difference between the general rate of injury between fasting and non-fasting players. However, there was a significant increase of non-contact and overuse injury rates for fasting players during Ramadan. (Injury rate was calculated as the ratio of the number of injuries per hour of exposure and expressed as the rate per 1000 hours). During these two competitive seasons, the non-contact and overuse injuries among fasting players included: muscle spasms/contractures, muscle strains, and tendinosis.

Another study, which investigated the injury risk of 527 professional soccer players in Qatar, observed no significant difference of incidence in total, match, or training injuries during Ramadan or non-Ramadan periods. However, there was an increased incidence of match injury observed in non-fasting players; this difference was maintained for 2 months following the month of Ramadan.

Despite what one might intuit, previous research indicates that elite or professional athletes are sufficiently able to maintain athletic performance and cognitive function during Ramadan – if their training schedule, nutrient intake, hydration intake, and sleep patterns are appropriately managed.

With this in mind, it is highly recommended for coaches, athletic trainers, sports dietitians, and other team managers to be involved in the management of their fasting athletes. Training schedules, cultural background, and fitness level of players should be taken into consideration when determining interventions to reduce the risk of injury related to fasting-induced fatigue, nutrition, and hydration.

P.S . — Ramadan Kareem!