Injury-Free Children and Adolescents: Towards Best Practice in Swedish Football (FIT project)

Injury pattern research demonstrates that injuries are a significant problem in (Swedish) youth sport and athletes have been found to leave (overuse) injuries unreported. Current knowledge, however, has not been able to reduce the current injury rate. A reason for this deficit is that the current discipline-specific knowledge misses integration. No research has to date produced evidence-informed inter-disciplinary prevention guidelines. This deficit is particularly acute in youth football.

Available knowledge shows the following about injuries and injury development:

Biomechanical/clinical knowledge

In terms of biomechanical, clinical and training parameters, several authors have pointed to the multidimensional nature of (overuse) injury onset (Bergeron et al., 2015; Grau et al., 2011; Wiese-Bjornstal, 2010; von Rosen et al., 2017). Typical such variables that contribute to the development of overuse injuries are axial alignment insufficiencies (e.g. foot, leg axis), and strength deficits and dysbalances (mainly lower extremity). Insufficient range of motion of major joints and shortened muscles, as well as the amount, type and intensity of training, are also risk factors (Brenner, 2007).

Sporting contexts

Sporting contexts in youth sport have also been examined, although with less direct focus on injury risk factors and prevention. Nevertheless, psychological research demonstrates that a positive motivational climate is important for continued athlete participation and social development (Fraser-Thomas, Côté, & Deakin, 2008). Such a climate requires positive coach-athlete (Lafrenière et.al. 2008) and peer-relationships (Côté, Strachan, & Fraser-Thomas, 2008), which have also been found to prevent injuries (Hedstrom & Gould, 2004). Sociological research has problematized sporting contexts in relation to hyper-competitiveness and coach-athlete relationships (Barker-Ruchti, 2011).

In terms of athletic ideals, research shows that norms are specific to the settings they exist in. Competitive and performance-oriented contexts are likely to involve values relating to continuous progressive performance enhancement and winning (Barker, Barker-Ruchti, Wals, & Tinning, 2014). This may lead to a climate in which risk-taking to reach success is normalized (and even enforced). Athletes may thus accept and conceal pain and injuries (Carless & Douglas, 2012; Schubring & Thiel, 2014), which in turn have been found to cause (long-term) ill-health (McMahon & Penney, 2012).

Local practices

Coaching practices within such contexts have been found to relate to over-training, poor communication between coaches and athletes (Kerr & Stirling, 2012), ill-health, injuries and drop-out (Schubring & Thiel, 2014). In a similar way, the pedagogical perspective has pointed to how performance-oriented training contexts can be stressful and detriment athlete health and development (Barker et.al. 2012).

Research procedure

In order to provide evidence-informed prevention strategies, injury development will be researched in a sample of youth athletes from Swedish football. The following sub-studies will be conducted.

Questionnaire

Sub-Study 1 aims to investigate the occurrence of injuries in youth football players. To collect data, an age-appropriate web-based version of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H) will be employed. Football players aged 10-19 will complete the survey from January to June 2018 on a weekly basis. The players that indicate health problems will be transferred to medical staff for diagnosis. In addition to the weekly survey, players standing height (cm), sitting height (cm) and weight (kg) will be taken. These measurements allow the calculation of the maturity onset in the participating players (Peak Height Velocity).

Measurement of biomechanical, clinical and training-specific factors

Sub-Study 2 aims to investigate biomechanical, clinical and training-specific factors that may lead to the onset of injuries in youth football players. The testing will involve 3D-Kinematics of running and landing, isometric strength, knee stability, range of motion of major joints and flexibility of relevant muscles.

Further, the players’ coaches will from January – June 2018 document each training using the training data program S2S - Secrets to Sports, (www.s2s.net). In S2S the coaches record the participating players’ types of training sessions (slow, medium, fast or competition), training exercises, playing field/turf (sand, grass), and intensity.

Observation of training sessions

Sub-Study 3 aims to investigate the role of sporting contexts in injury development from September till December 2018. For a period of one month, two training sessions per week will be observed. An established observation schedule (Barker-Ruchti, Barker, & Annerstedt, 2014) will focus the observations on training atmosphere and load, communication, coach-athlete relationship, training ethic, and injury prevention/management. If possible, informal talks with coaches and players will be held.

Interviews with players and coaches

Sub-Study 4 aims to investigate athletes’ and coaches’ injury understanding between September and December 2018. For data collection, semi-structured interviews will be conducted with the observed athletes and their coach(es) from sub-study 3. An established interview schedule (Barker-Ruchti et al., 2014; Barker-Ruchti et.al., 2015; Lindgren & Barker-Ruchti, 2017) will be adopted to prepare questions relating to coaching/training philosophy, ideals in relation to sport, performance, training, body, age, and injuries.

Findings

• Hausken, S., Barker-Ruchti, N., Schubring, A., & Grau, S. (2018). Injury-free children and adolescents: Towards better practice in Swedish football (FIT project). Research Ideas and Outcomes, 4(e30729), 16 pages. doi: 10.3897/rio.4.e30729.
  Publication: Injury-Free Children and Adolescents: Towards Better Practice in Swedish Football (FIT project)
• Boije af Gennäs, K., Hausken, S., Schubring, A., Grau, S., & Barker-Ruchti, N. Researching overuse injuries among adolescent soccer players using an interdisciplinary approach. Svensk Beteendevetenskaplig Idrottsforsknings konferens (SVEBI), 21-22 November 2018, University of Dalarna, Sweden.
  Poster SVEBI 2018 
• Hausken, S., Schubring, A., Grau, S., & Barker-Ruchti, N. Understanding and researching youth football injuries with an interdisciplinary approach: Current literature and project experiences. World Congress of Sociology of Sport, 5-8 June 2018, University of Lausanne, Switzerland.
  ISSA 2018 presentation Hausken, S.