Two studies retrieved by this present review included monitoring of the recovery status of their

respective cohorts. Brink et al. (2010) utilized the Dutch Version of the RESTQ-Sport to assess
the psychosocial stress and recovery state of the soccer players and found “no clear” relationship
between components of stress and recovery and the occurrence of injuries. Further, when
compared to healthy players, subscale Fitness/Injury was considerably greater for players with a
traumatic injury as well as players with an overuse injury. In contrast, Laux et al. (2015)
discovered a strong relationship between the general stress scale Fatigue, the sport-specific stress
scales Disturbed Breaks and Injury, and the general recovery scale Sleep Quality and the
increased risk of injury in their study. For both studies, traumatic injuries were greater than
overuse injuries.
 In a generalised linear model, the stress-related scales Fatigue (OR 1.70, P = 0.007),
Disturbed Breaks (OR 1.84, P = 0.047) and Injury (OR 1.77, P < 0.001) and the recovery-
related scale Sleep Quality (OR 0.53, P = 0.010)
o Laux, P., Krumm, B., Diers, M., & Flor, H. (2015). Recovery-stress balance and
injury risk in professional football players: a prospective study. Journal of sports
sciences, 33(20), 2140–2148. https://doi.org/10.1080/02640414.2015.1064538
 Brink et al. (2010): FOR TRAUMATIC INJURIES - Fatigue (OR 0.93, CI (95%) = 0.72,
1.20), Disturbed Breaks (OR 0.94, CI (95%) = 0.72, 1.22) and Fitness/Injury (OR 1.29,
CI (95%) = 1.01, 1.66) and the recovery-related scale Sleep Quality (OR 0.99, CI (95%)
= 0.77, 1.27); FOR OVERUSE INJURIES - Fatigue (OR 0.96, CI (95%) = 0.70, 1.33),
Disturbed Breaks (OR 1.00, CI (95%) = 0.73, 1.37) and Fitness/Injury (OR 1.46, CI
(95%) = 1.09, 1.96) and the recovery-related scale Sleep Quality (OR 0.86, CI (95%) =
0.64, 1.16)
 SIMILARITY: 2 SEASONS, greater TRAUMATIC THAN OVERUSE INJURIES
 DIFFERENCE: Laux et al. (2015) 25.8 ± 5 years, all were male; Brink et al. (2010) 16.5
± 1.2/1.1

In instance, older groups reported a higher number of injured players and a higher incidence than
younger groups, particularly with regard to traumatic injuries. This could be attributed to an
increase in TL in older groups, as documented in Vanderlei et al. (2014)'s study, which found
that injured youth players trained for more weekly hours. Although there is no agreement in the
literature on the association between athlete age and injury risk, smaller and lighter soccer
players are thought to be more resistant to injury (Rommers et al., 2020). Furthermore, it has
been established that the risk of injury in children and adolescents increases with age as the
degree of competitiveness and contact in sport grows (Emery, 2003). Football, like other sports,
has a constant peak in injuries among older teenagers (Emery, 2003; Yde & Nielsen, 1990).
However, rather than chronological age, maturity state may play a significant effect.

REVISE STARTING WITH MO: In this study by Mandorino et al. (2022), TQR was found to
be significantly lower in the Post-PHV stage compared to the other stages (pre-PHV and circa-
PHV), and TQR was significantly correlated with non-contact injuries. The authors used a
maturity offsets (MO) algorithm to classify participants as Pre-PHV with MO -0.3 years, Circa-
PHV with MO between -0.3 and +0.3 years, and Post-PHV with MO +0.3 years (Pre-PHV refers
to the athlete's most accelerated period of growth that is yet to occur; Circa-PHV refers to the
athlete's current growth spurt; and Post-PHV refers to the athlete's post-accelerated growth
spurt). According to the study, a sudden rise in TL paired with a fall in TQR indicated an
increased risk of injury, with more mature athletes displaying a higher perception of effort and a
lesser ability to recover. This could explain why Circa- and Post-PHV athletes had a higher
injury rate and injury load than Pre-PHV players.
Periods around PHV have been linked to an elevated risk of injury (van der Sluis et al., 2015).
The higher injury load post-PHV may be attributable to the higher incidence and burden of
muscular injuries in older age groups (Wik et al., 2021), which may be ascribed to increasing
physical demands at these ages (Goto et al., 2015). According to Towlson et al. (2021), players
sustain more injuries during PHV, and these injuries are more serious. A reduction in flexibility
and bone density during the growth spurt may increase the skeletal system's vulnerability (Swain
et al., 2018). Physical impairments and lower performance during this period may occur from
adolescent frailty caused by the rapid increase in the length of arms and legs relative to the trunk
(Davies & Rose, 2000). Furthermore, increasing TLs and match congestion in young soccer
academies are linked to a higher injury rate in this group of athletes (Hawkins & Metheny,
2001). In contrast to the findings of this review, Towlson et al. (2021) indicated that Post-PHV
injuries are less traumatic and severe, and are more typically overuse injuries. In Dutch academy
soccer players, the period from 6 months before PHV to 6 months after PHV had a higher Injury
Incidence Density of acute injuries when compared to the previous year (van der Sluis et al.,
2015). Another study discovered greater overuse injuries from 1 year before PHV to 1 year after
PHV, as well as more time lost due to acute injuries from 1 year after PHV (van der Sluis et al.,
2014).

On the basis of fatigue perception as it relates to the occurrence of injuries, it was found that
male soccer players aged 14.5 ± 0.2 years have an increased risk of lower limb injuries, which
has been attributed to fatigue due to altered neuromuscular control of the ankle, compared with
older ones (Pau et al., 2014). This describes that younger athletes may perceived fatigue easily
than older athletes because of lesser exposure to training.

Pau, M., Ibba, G., & Attene, G. (2014). Fatigue-induced balance impairment in young soccer
players. Journal of athletic training, 49(4), 454–461. https://doi.org/10.4085/1062-6050-
49.2.12
van der Sluis, A., Elferink-Gemser, M. T., Coelho-e-Silva, M. J., Nijboer, J. A., Brink, M. S., &
Visscher, C. (2014). Sport injuries aligned to peak height velocity in talented pubertal
soccer players. International journal of sports medicine, 35(4), 351–355.
https://doi.org/10.1055/s-0033-1349874
Davies, P. L., & Rose, J. D. (2000). Motor skills of typically developing adolescents:
awkwardness or improvement?. Physical & occupational therapy in pediatrics, 20(1),
19–42.
Emery C. A. (2003). Risk factors for injury in child and adolescent sport: a systematic review of
the literature. Clinical journal of sport medicine : official journal of the Canadian
Academy of Sport Medicine, 13(4), 256–268. https://doi.org/10.1097/00042752-
200307000-00011
Goto, H., Morris, J. G., & Nevill, M. E. (2015). Match analysis of U9 and U10 english premier
league academy soccer players using a global positioning system: relevance for talent
identification and development. Journal of strength and conditioning research, 29(4),
954–963. https://doi.org/10.1519/JSC.0b013e3182a0d751
Hawkins, D., & Metheny, J. (2001). Overuse injuries in youth sports: biomechanical
considerations. Medicine and science in sports and exercise, 33(10), 1701–1707.
https://doi.org/10.1097/00005768-200110000-00014
Rommers, N., Rössler, R., Goossens, L., Vaeyens, R., Lenoir, M., Witvrouw, E., & D'Hondt, E.
(2020). Risk of acute and overuse injuries in youth elite soccer players: Body size and
growth matter. Journal of science and medicine in sport, 23(3), 246–251.
https://doi.org/10.1016/j.jsams.2019.10.001
Swain, M., Kamper, S. J., Maher, C. G., Broderick, C., McKay, D., & Henschke, N. (2018).
Relationship between growth, maturation and musculoskeletal conditions in adolescents:
a systematic review. British journal of sports medicine, 52(19), 1246–1252.
https://doi.org/10.1136/bjsports-2017-098418

Towlson, C., Salter, J., Ade, J. D., Enright, K., Harper, L. D., Page, R. M., & Malone, J. J.
(2021). Maturity-associated considerations for training load, injury risk, and physical
performance in youth soccer: One size does not fit all. Journal of Sport and Health
Science, 10(4), 403–412. https://doi.org/10.1016/j.jshs.2020.09.003

van der Sluis, A., Elferink-Gemser, M. T., Brink, M. S., & Visscher, C. (2015). Importance of
peak height velocity timing in terms of injuries in talented soccer players. International
journal of sports medicine, 36(4), 327–332. https://doi.org/10.1055/s-0034-1385879
Vanderlei, F. M., Vanderlei, L. C., Bastos, F. N., Netto Júnior, J., & Pastre, C. M. (2014).
Characteristics and associated factors with sports injuries among children and
adolescents. Brazilian journal of physical therapy, 18(6), 530–537.
https://doi.org/10.1590/bjpt-rbf.2014.0059
Wik, E. H., Lolli, L., Chamari, K., Materne, O., Di Salvo, V., Gregson, W., & Bahr, R. (2021).
Injury patterns differ with age in male youth football: a four-season prospective study of
1111 time-loss injuries in an elite national academy. British journal of sports medicine,
55(14), 794–800. https://doi.org/10.1136/bjsports-2020-103430
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basketball. British journal of sports medicine, 24(1), 51–54.
https://doi.org/10.1136/bjsm.24.1.51