PLAN FOR THE SESSION

Common injuries & mechanisms of

injury in football
UEFA Elite Club Injury Study
UEFA Elite Clubs Chief Medical Officers
report
Injury prevention
Exercise regimes
Physical preparation
Eccentric loading
Workload monitoring
Wellbeing
ZOOM HOUSEKEEPING
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QUESTION
Breakout Group Task

How are injuries managed at your

club?

 5min Discussion
 Feedback
FOOTBALL
Football is a contact sport
Physical trauma is possible
In football this can happen by contact such as kick/tackle
often unpreventable
Injury can also happen without contact (non-contact) such as muscle
tear or ligament injury
these are the injuries that we want to reduce.
All prevention strategies revolve around ‘reducing risk’
RISK
Every time a player takes part in training or a match there is a risk that
they may get injured.
Contact injury
Difficult to control actions of other players.
Often during matches
Often Severe in nature (>28 days lost to injury)
Non-contact injury
97.4% of muscle injuries are non-contact
Muscle injuries make up 33% of all injuries reported
41.5% of ligament injuries are non-contact
Ligament injuries account for 21%
Risk can be reduced by appropriate physical preparation – Multifactorial but largely
controllable!
EXPOSURE
Injury risk is often referred to as exposure and reported in literature
as incidence/1000 hours. This allows comparisons to be made
between clubs with varying schedules.
This can be understood as;
Club A has 20 players training for 1 hour. This accounts for 20 hours of
training exposure.
Club B has 20 players train for 90 minutes (1.5 hours) this accounts for 30
hours of training exposure.
UEFA Elite Club Injury Study Group
UEFA ELITE CLUB INJURY STUDY 2018/19
25 teams
180, 000 hours
150,000 hours training
30,000 hours match
OF which there was 20 Champions league teams reporting;
868 injuries
410 training (47%)
458 match (53%)
20% severe in nature (>28 days lost to injury)
50% muscular injuries
15% ligament injuries
UEFA ELITE CLUB INJURY STUDY 2018/19
Monthly average
21 Training sessions
4.9 matches
Training injuries – 1.7/ 1000 hours
18 days/ injury
36 days / 1000 hours
Match injuries – 21/1000 hours
23 days/ injury
430 days/ 1000 hours!!!
COMMON INJURIES
Most common mechanisms of an injury are;
Running/ Sprinting (22.4%)
Overuse (13.1%)
Pre-season
Christmas
European competition
Rescheduled games
 June '19 August '19

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5 (H) Vs Falkirk BETFRED CUP
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4 5 Notes

6 matches & 7 training sessions

Calendar templates by Vertex42
https://www.vertex42.com/calendars/
 November '19 January '20

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Calendar templates by Vertex42
https://www.vertex42.com/calendars/
COMMON INJURIES
Most common mechanisms of an injury are;
Running/ Sprinting (22.4%)
Overuse (13.1%)
Tackle (11.2%)
Kick (8.3%)

Lower limb injuries are most common

Thigh (34%) (Hamstring/ quads)
Knee (12%)
Hip/ Groin (11%)

Muscle (33%) and Ligament (21%) account for 54% of all injuries
throughout the season.
COMMON INJURIES
Non-contact injuries account for 32% of injuries in the study.

Most muscle injuries are non-contact (2015/16 report)

2.8/1000 hours
18 days/ injury
Most ligament injuries are non-contact (2015/16 report)
1.6/1000 hours
23 days/ injury
CONCUSSION
Definition:
“Alteration in consciousness, but not
necessarily loss of consciousness,
following head injury”

Cause:
Brain shaken inside skull, causing
bruising or bleeding of, or into, neural
tissue
QUESTION?
Does anyone know the minimum return
to play time for a 15 year old suffering
their first concussion?
Concussion - Minimum return to play protocol
UEFA ELITE CLUB CHIEF MEDICAL OFFICERS
(CMO)
CMO from 36 different elite football clubs across 5 years provided 77
post season reports.
4 main factors affecting injury burden in elite football (Ekstrand et al.,
2018).
Workload imposed
Well-being
Quality of communication
Head coach leadership style
No mention of exercise programs however likely already optimized
by clubs operating at this level.
QUESTION?
Breakout Group Task

Does anyone measure or attempt to

measure workload at their club?

 5min Discussion
 Feedback
WORKLOAD
Can be calculated by many different methods:
GPS
Distance covered
High speed running
Accelerations & Decelerations
Heart rate
Resting
Recovery
Variability
TRaining IMPluse (TRIMP)
Duration of training X sessional RPE (s-RPE)
WORKLOAD
However measuring workload often requires
specialised staff to interpret the results.

Considerations when measuring workload:

Same workload expected all year round?
Workload of individual Vs workload of squad?
Return to play post injury
Management of this important
PRE-SEASON
High Risk period for load management
Level of fitness when all players return
Non-contact most common reason for injury during pre-season
most common mechanism during running/ shooting drills.
Muscle strains most common injury (37%) during pre-season
Rec Fem x2 during pre-season rather than in season (p<0.001)
Ligament strains next most common (19%) during pre-season
PRE-SEASON
‘A perfect storm’ for Achilles issues

33% of all Achilles related injuries occur in pre-season

Hard ground (Summer time – 70% dry surfaces)
Resumption after a break (First period of training after a break)
Poor footwear (New ‘pretty’ boots/ Poor support/ Little or no heel lift/ Rigid
sole)
Increased intensity (More running/ opportunity to create physiological
overload).
Top division ~ Double of training hours Pre (18.5) Vs In season training (9.6).
Endless running = Reducing glycogen content of gastroc - ? Placing undue stress on
Achilles tendon.
PRE-SEASON
Maintenance of fitness lowers the risk of injury during pre-season

Risk management is important

Off season programme
Workload during initial phase of pre-season
QUESTION?
Breakout Group Task

Can you think of 3 questions that you

would want to ask your players?
How often would you want to ask
them?

 10min Discussion
 Feedback
Total Score <14 or a ‘1’ recorded at any component is considered ‘high risk’
Total Score 14-17 or a ‘2’ recorded at any component is considered ‘above normal risk’

Total Score >17 is considered ‘normal state’

WELLBEING
Drew & Finch (2016) have shown a link between training load and
injury.
Wellbeing questionnaires offer a subjective measurement to aim to
quantify ‘readiness’.
Which is more sensitive to daily training load fluctuation (Thorpe et al., 2016)
Perceived fatigue (Questionnaire) is relative to total high intensity distance
(GPS) (Thorpe et al., 2015 & 2017).
WELLBEING
Simple and effective too to offer useful information about
your players.
Easy scoring system to interpret.
Caution advised when used in isolation.

Benefits
Provides a good representation of player readiness
Gives an understanding on readiness
Best used in conjunction with other measures ie. RPE
WELLBEING
Considerations
Does player also know how scoring works
Is it easy for them to ‘fix’ results
How much do they want to train/ play
How serious do they perceive results are taken
How are the results given ? Laptop/ Phone/ Verbal
COMMUNICATION
Low quality communication between medical and technical staff
Decreased training attendance of players (76.2% Vs 83.4%)
Increased injury burden (183.6 Vs 105 days)
Increase incidence of severe injury (1.7 Vs 0.9/ 1000 hours)
Decreased match availability (81.7% Vs 87.5%)

As a coach consider the implications of having a good line of

communication with your medical team
INJURY PREVENTION
Physical preparation
Warm up
Session Specific
Matchday
Eccentric loading programmes
Flexibility
Workload
Acute:chronic ratio
Wellbeing
FIFA 11+
FIFA 11+ is an example of a multifactorial warm up;
Running (straight lines)
Strength/ Plyometrics/ Balance
Running (High speed & Change of direction)
Reduced injury rate by 46.1%
665 injuries in the control group
285 injuries in the intervention group (FIFA 11+)
Reduced time lost to injury by 26.6%
FIFA 11+
QUESTION?
Breakout Group Task

Does the plan for the session change

the way you prepare the players?

 5min Discussion
 Feedback
EUROPEAN MODEL EXAMPLE ACTIVITIES
Day Intensity Themes Example Activity Area
MD Highest Intensity Provides
comparison points
for training plan
MD+1/ Low Intensity Recovery Passing Small
MD+2 8v2 Torro Box
Head Tennis
MD-4 Moderate Intensity Technical 3v3 Possession with Wall players Small
4v4/5v5 SSG
MD-3 High Intensity Conditioning 8v8 End Zone Game Large
9v9 LSG
MD-2 Moderate Intensity Tactical/Speed 4v2 Overloads Large
Crossing & Finish
MD-1 Low Intensity Reaction Match Prep (Low Reps)
BRITISH MODEL EXAMPLE ACTIVITIES
Day Intensity Themes Example Activity Area
MD Highest Intensity Provides
comparison points
for training plan
MD+2 Low Intensity Recovery Passing Small
8v2 Torro Box
Head Tennis
MD-4 High Intensity Conditioning/ 3v3 Possession with Wall players Small
Technical 4v4/5v5 SSG
MD-2 Moderate Intensity Tactical/Speed 8v8 3 Zone Game Large
8v6 Overloads
9v9 LSG (Reduced Time)
MD-1 Low Intensity Reaction Match Prep (Low Reps) Large
MD+1 RECOVERY
Set Up
20 x 20 area, with half the players
working.

Instructions
Players are advised on how to return
feed. Orange players are fed ball from
Yellow. They then move through centre
towards another yellow.

Coaching Points
Encourage controlled actions, changes
of direction and mobility whilst working.
MD+2 FOOTBALL SPECIFIC MOVEMENTS
Set Up
4 cones and 1 ball per 3m x 3m stations.
Approx 4/5 players per station. A marker at
5m and 10m.

Instructions
Players are fed the ball in the square.
Players then react to coaches command.
Straight line sprint to 5m or 10m.

Coaching Points
Encourage a variety of feeds.
Controlled reaction and straight line run to
distance marker.
MD-4/-3 CONDITIONING
Set Up
Box to Box. 1 ball. Players working in
groups of 4.

Instructions
Players complete passing as show in
the group before finishing at opposite
side of pitch. Next group then perform
same rotation.

Coaching Points
Weight of pass.
Communication.
MD-4/-3 CONDITIONING
Set Up
Box to Box. 1 ball. Players working in
groups of 4.

Instructions
Players complete passing as show in
the group before finishing at opposite
side of pitch. Next group then perform
same rotation.

Coaching Points
Weight of pass.
Communication.
MD-4/-3 CONDITIONING – SPEED EXPOSURE
Set Up
18 yard box – half way line (Up to 40m). 2
markers placed parallel at 10m, 20m and 1
placed at 30-40m. Players working
individually.
Instructions
Players sprint to cone as instructed.
Jog back to start.
Coaching Points
Aiming to hit top speeds for distances.
Movement quality important.
Run through marker – no sharp
braking.
MD-4/-3 CONDITIONING – SPEED EXPOSURE
Set Up
18 yard box – half way line (Up to 40m). 2
markers placed parallel at 10m, 20m and 1
placed at 30-40m. Players working
individually.
Instructions
Players sprint to cone as instructed.
Jog back to start.
Coaching Points
Aiming to hit top speeds for distances.
Movement quality important.
Run through marker – no sharp
braking.
MD-4/-3 CONDITIONING – SPEED EXPOSURE
Set Up
18 yard box – half way line (Up to 40m). 2
markers placed parallel at 10m, 20m and 1
placed at 30-40m. Players working with
feed.
Instructions
Players are fed ball until instruction from
coach. Then sprint to cone as instructed.
Jog back to start.

Coaching Points
Take care of feed with controlled returns.
Aiming to hit top speeds for distances.
Encourage variety of feeds/ run shapes.
Run through marker – no sharp braking.
MD-2 GAME RELATED SPEED
Set Up
20 x 30 area, 1/3 of the players on the
outside with a ball. Players inside area
working in pairs.

Instructions
Player A receives ball from ‘C’ and complete
passing as shown in pairs before moving to
another ‘C’. Yellow players do not rotate and
remain in position.

Coaching Points
Timing of run
Weight of pass
Spatial awareness of partner
MD-2 GAME RELATED SPEED
Set Up
20 x 30 area, 1/3 of the players on the
outside with a ball. Players inside area
working in pairs.

Instructions
Player A receives ball from ‘C’ and complete
passing as shown in pairs before moving to
another ‘C’. Yellow players do not rotate and
remain in position.

Coaching Points
Timing of run
Weight of pass
Spatial awareness of partner
MD-2 GAME RELATED SPEED
Set Up
20 x 30 area, 1/3 of the players on the
outside with a ball. Players inside area
working in pairs.

Instructions
Player A receives ball from ‘C’ and complete
passing as shown in pairs before moving to
another ‘C’. Yellow players do not rotate and
remain in position.

Coaching Points
Timing of run
Weight of pass
Spatial awareness of partner
MD-2 GAME RELATED SPEED
Set Up
20 x 30 area, 1/3 of the players on the
outside with a ball. Players inside area
working in pairs.

Instructions
Player A receives ball from ‘C’ and complete
passing and dribble as shown in pairs
before moving to another ‘C’. Yellow players
do not rotate and remain in position.

Coaching Points
Timing of run
Weight of pass
Spatial awareness of partner
MD-1 REACTIONS
Set Up
14 x 30 area, with 4 markers.

Instructions
Players line up along centre. On
coaches command players move left or
right as quick as they can to the line
between the markers.

Coaching Points
Want player to react as quick as
possible.
Try not to be predictable.
MD-1 REACTIONS
Set Up
Four different coloured cones per 3m x 3m
area. If same colour cones used advise
players that the cones are numbered.

Instructions
Players can work in the square doing
games specific movements. Players
then react to coaches command
(colour/ number). Then leave square.

Coaching Points
Encourage variety with a quick
reaction.
MD-1 REACTIONS – WITH BALL
Set Up
Four different coloured cones and 1 ball per
3m x 3m area. If same colour cones used
advise players that the cones are
numbered.
Instructions
Players are fed the ball in the square.
Players then react to coaches command
(colour/ number). Then leave square.

Coaching Points
Encourage variety of the feed with a
quick reaction.
MATCHDAY WARM UP
Set Up
20 x 30 area. 18 Cones. Players
working in two groups.

Instructions
Work through parts A, B, and C. Allow
short 1minute breaks between sections
for self directed preparation. 12
minutes total.

Coaching Points
Quality of movements
Build up intensity gradually.
Active but not continuous.
MATCHDAY WARM UP – PART A
Set Up
20 x 30 area. 18 Cones. Players
working in two groups.

Instructions
Players complete a lateral change of
direction before a variation of running
exercises. Utilising as many game
specific movements as possible.

Coaching Points
Encourage control of movements and
changes of direction.
Quality of movements important.
MATCHDAY WARM UP – PART B
Set Up
20 x 30 area. 18 Cones. Players
working in two groups.

Instructions
Players complete a variation of
plyometric type exercises. Hopping,
jumping bounding on the way out.
Jogging and ‘fast feet’ on return.

Coaching Points
Encourage control and quality of
movements and changes of direction.
Increasing intensity from part A.
MATCHDAY WARM UP – PART C
Set Up
20 x 30 area. 18 Cones. Players
working in two groups.

Instructions
Players complete a lateral change of
direction before an explosive
movement to Yellow. Jog back to start.
Repeat for Blue and Orange cones.

Coaching Points
Encourage control and quality of
sprints.
TASK
FIFA 11+ is just an example of a group of drills that prepare the player
for a football match. You should consider the aim for every session
you deliver.
Ask yourself, do the drills at the start of my session prepare the players for
what I am going to ask them to do?
BREAKOUT GROUP TASK
Think of the theme for your session.
Counter attack session
Building from the back
Choice of your own

What does your session involve and what do

you need to prepare your players for?

 5min Discussion
 Feedback
SESSION SPECIFIC PREPARATION
Counter attack session
Physiological aspects
Reactions
Change of direction
Change of speed
Opportunity to hit top speeds
Ball manipulation
Close control
 dribbling
Maximum force
 Crossing
 Shooting
SESSION SPECIFIC PREPARATION
Counter attack session
Session to include
Reactions – Speed & Agility drills + Command
Change of direction
Change of speed
Opportunity to hit top speeds – Speed control (Speed up/ slow down)
Ball manipulation – Variety of ball manipulation & Range of passing
Close control
 dribbling
Maximum force
 Crossing
 Shooting
SESSION SPECIFIC PREPARATION – COUNTER ATTACK
Set Up
20 x 30 area, cones set up as
instructed. 1 ball per station. Players
working in groups of 4/5.

Instructions
Players complete passing as show in pairs
before reacting and completing at pace the
movement required for the station. Feeds to
player working at coaches discretion.

Coaching Points
Take care of the ball.
Once instructed movements should be
controlled but at speed.
SESSION SPECIFIC PREPARATION – COUNTER ATTACK
Set Up
20 x 30 area, cones set up as
instructed. 1 ball per station. Players
working in groups of 4/5.

Instructions
Players complete passing as show in pairs
before reacting and completing at pace the
movement required for the station. Feeds to
player working at coaches discretion.

Coaching Points
Take care of the ball.
Once instructed movements should be
controlled but at speed.
SESSION SPECIFIC PREPARATION
Training should be an integrated process

The idea of the ‘sport scientist’ taking non-ball related activities and
the coach introducing the ball must be left in the past

All aspects of training should include technical, tactical, physical and

psychological demands
ECCENTRIC LOADING & FLEXIBILITY
Physical preparation and injury prevention in elite football is
not reserved to what a player does on the pitch.
Eccentric loading programs (muscle develops tension on the
lengthening phase of a movement) have varied results. Here
is a couple of positive findings.
3 x 12/10/8 Nordic Hamstring exercises = Reduced injury rate (Arnason, 2008)
Nordic Hamstrings pre & post training = reduced injury rate Vs pre training
only (Elerian, 2019)
 Flexibility & Stretching

ECCENTRIC EXERCISE– NORDIC HAMSTRING CURL

FLEXIBILITY & STABILITY
Flexibility & balance work again have varied results in the research when
used in isolation.

Stability however is an important concept of pre-habilitation early in a

warm up to engage the muscles that offer control of a joint. Or during
rehabilitation from an injury to improve control of movements that leave a
player at risk of re-injury.
Knee ligaments
Ankle ligaments

Therefore drills incorporating stability and control can be useful in injury

prevention.
STABILITY EXERCISE – ANKLE
EXERCISE REGIMES
It is unlikely that one component alone is able to provide
significant reduction in injury risk for a squad as a whole.

A multifactorial approach to prevention provides the most

robust results to reduce injury risk (Melegati, 2013, and
Owen 2013);
Eccentric loading
Flexibility
Balance/ Proprioception
Dynamic plyometrics (Izzo, 2019).
WORKLOAD
Understanding the acute:chorinc workload ratio you are placing your
players under is important.

High (>1.3) and low (<0.8) workloads increase incidence of injury

(Gabbett et al., 2016).
WORKLOAD
WORKLOAD
Variety of ways to measure workload are available;
GPS
HR
Sessional RPE (TRIMP)
The cheapest way to understand workload can be just as effective as
the more expensive methods depending on who is interpreting the
data.
TRIMP
Cheap and reliable.
Requirements
Borg Scale (session RPE)
Stopwatch (duration)
Pen & Paper
Reported as AU (Augmented Units). It
is simply:
 sessional RPE x duration (mins).
BORG
RATING OF PERCEIVED EXERTION
Therefore a rating of 4 (somewhat hard) on Borg scale and a training
session that lasts 90 minutes;
AU = 4 x 90 = 360.
Application of TRIMP to reduce injury risk;
Sum of week <1500 AU
Week to week variation <200
When using AU to work out acute:chronic ratio;
Overall a 1-1.25 = a reduction in injury risk
1:4 week
>1.38 = Very likely to cause injury
1:3 week
>1.4 = Very likely to cause injury with almost double injury risk
TRIMP
As with fitness, one session does not automatically mean all players
will respond in the same way.
Player A rating of session as 3 using Borg
Player B only 2 weeks after returning to training rating session as 5 using Borg
For a 90 minute session that = 270AU Vs 450 AU.
Be aware of the needs of the individual player also.
WELLBEING (RECAP)
Easy scoring system to interpret.
Caution advised when used in isolation.
Benefits
On the whole gives a good representation of player readiness
Gives an understanding on readiness
Best used in conjunction with other measures ie. RPE

Considerations
Does player also know how scoring works
Is it easy for them to ‘fix’ results
How much do they want to train/ play
How serious do they perceive results are taken
How are the results given ? Laptop/ Phone/ Verbal
Total Score <14 or a ‘1’ recorded at any component is considered ‘high risk’
Total Score 14-17 or a ‘2’ recorded at any component is considered ‘above normal risk’

Total Score >17 is considered ‘normal state’

RECAP
Common injuries & mechanisms of injury in football
UEFA Elite Club Injury Study
UEFA Elite Clubs Chief Medical Officers report
Injury prevention
Exercise regimes
Physical preparation
Eccentric loading
Workload monitoring
Wellbeing
QUESTIONS?
ASSIGNMENT
Please complete the multiple choice questions linked to this task.