The impact of playing in matches whilst injured on injury surveillance findings in professional football

This study aimed to analyze the frequency, nature, and consequences of footballers playing matches while injured, and to examine the impact on injury surveillance findings. High levels of inter‐rater reliability and content validity were established for a tool designed to document players who were already injured at the start of a match. The tool was implemented in three English football teams (a Championship, League 1, and League 2 team) for one season, using a “time loss” definition of injury. One hundred forty‐three matches were surveyed, revealing 102 match appearances by players who were already injured. Almost half of all games featured at least one injured player, with episodes of playing with injury occurring more frequently and lasting longer in League 2 players compared with higher level players. No association was observed between the number of injured players starting matches and match outcome [χ2(4, N = 143) = 3.27, P = 0.514]. Fifteen percent of all injury episodes captured were only through prospective documentation of playing while injured. The findings show that both traumatic and overuse injuries are managed by footballers through competitive matches, and have important implications for aiding understanding of the epidemiology of injury in professional football.

The published consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries (Fuller et al., 2006) has been widely cited, guiding researchers to internationally accepted methods for collecting, analyzing, and interpreting football injury surveillance data. Through the adoption of mixed definitions (any physical complaint, medical presentation, and time loss definitions concurrently), this framework appears to circumvent criticisms levied at many injury surveillance studies concerning a poor representation of continuing to play when injured with overuse syndromes. Nevertheless, recent evaluation of the prevalence and severity of overuse injury through new registration methods suggests that overuse injuries are still dramatically underreported in most papers and are not captured effectively through traditional surveillance approaches, contributed to by researchers continuing to adopt time loss definitions (Bahr, 2009; Clarsen et al., 2013).

Separately, there is evidence from the social sciences that in professional football, fear of losing one's place in the team, avoiding loss of contract bonuses, and wanting to play because of the significance of forthcoming games are common incentives to continue to play when injured (Roderick, 2006; Hammond et al., 2013). “Playing” is suggested to have central importance to footballers, who have strongly masculine self‐images and demonstrate a strong sense of professional pride (Roderick et al., 2000; Roderick, 2006). Issues and behavioral practices such as delaying surgery to the off‐season and playing when injured in high‐importance games are purported to impact on injury surveillance findings (Hammond et al., 2009, 2011). However, to the best of our knowledge, prospective documentation of playing in matches while injured or in pain has not been conducted in professional football to date, and there has been no evaluation of whether acute injuries are “managed” through matches in a similar way to overuse injuries.

Therefore, the aims of this study were (a) to validate purpose‐designed methods to prospectively record instances of participation in professional football matches while injured; (b) to analyze the frequency, nature, and consequences of professional football players in the English football league playing while injured; and (c) to examine the extent to which these practices impact upon injury surveillance findings.