Football and Sports Medicine: A Special Issue to Celebrate the 2014 FIFA World Cup Brazil

The importance of football, or soccer as it is called in North America, was described by the late Pope John Paul II as follows: ‘amongst all unimportant subjects, football is by far the most important’. One should only have to look at the games played during the recently concluded FIFA World Cup 2014 in Brazil to understand the influence of football on society. Every game was sold out, and many supporters flew or drove thousands of kilometers to watch the games, making the World Cup a truly universal event. Supporters were buoyed by the successes of their teams and experienced true agony with each defeat. An entire nation and many adoring international fans of Neymar Jr. anxiously awaited his diagnosis when he injured his back during a game. They were extremely relieved when they were told that his injury would not affect his life or his career.

The game of football has changed over the last quarter century. Elite players cover more distance during games and sprint and jump more than years ago (Di Salvo, Pigozzi, González–Haro, Laughlin, & De Witt, 2013). A significant focus is placed on the nutrition of footballers, training techniques, and monitoring of the training load of players (Reilly, 2008). Players are also placed on injury prevention programs in an attempt to prevent acute and overuse injuries (Mayo, Seijas, & Alvarez, 2014). When players do become injured, returning to play within the shortest possible time is required by all professional clubs. The pressure on injured players to play even if not yet fully fit has caused injured players to use and abuse large amounts of analgesics in an attempt to participate in the games (Tscholl & Dvorak, 2012). The knowledge and skill of the team physician regarding football should be diverse enough for him or her to be able to handle situations that could arise among players and staff (Babwah & Rogers, 2008).

In 2007, FIFA estimated that 265 million male and female players and five million referees and officials were actively involved in football worldwide; at that time, this number was equal to 4% of the world’s population (FIFA, 2007). Football does not only include elite, professional players who represent their clubs or countries. Most footballers are amateur players or those who participate in games solely for recreation. A growing number of females, youths, and children also participate in football internationally.

With this background, any comprehensive scientific publication on football medicine and science must include professional, amateur, male, female, and young footballers from the perspective of both developed and developing countries. Referees are also integral to football games, and health issues that affect them should be addressed. This special edition of Research in Sports Medicine, which examines football and health, truly represents the international football community. In this spirit, nine studies are presented covering such topics as the epidemiology of injuries, pain, and pain-related behaviors, issues that involve maturing players, monitoring of the training load of footballers, training various fitness components for footballers, dynamic balance and fatigue, and factors that affect postural sway.

The first article, ‘The incidence of injury in a Caribbean amateur women’s football league’ by Babwah, presents a study on injuries among amateur female players who play on artificial turf and grass surfaces. The study shows that at this level, no differences exist in the incidence of injury between games played on the two surfaces. Preliminary reports suggest that amateur female players who train/play predominantly on artificial turf could sustain more reported injuries when playing on grass than when playing on artificial turf, but larger studies are necessary to verify this finding.

In the second article, ‘Pain, injury and related behaviors among footballers partaking in tournaments,’ the same author found that footballers who represent their national teams have a high frequency of injuries and pain. This pain burden was previously unexplored in footballers. The high occurrence of pain and/or injury among male and female adult and young players who represent their national teams led many players to use painkillers before playing games. Being injured also resulted in a sense of desperation among some players. Thus, they were tempted to use banned substances to prepare themselves to play in important games. Doping control could be extended to players who have injuries and who have been out for long periods.

Morton, Morgans, Orme, Anderson, and Drust, in their article, ‘An intensive winter fixture schedule induces a transient fall in salivary IgA in English Premier League soccer players,’ reported that among professional footballers, serum IgA exhibited transient declines when players were subjected to physiological and physical stress during a congested winter calendar of games. This non-invasive method of detecting short-term physical and psychological stress could become more widely used to monitor football players who may require a rest period during a busy season.

The fourth article, ‘Characterization of static balance abilities in elite football (soccer) players by playing position and age,’ by Pau, Ibba, and Scorcu, shows that single-leg balancing ability among elite adult and young footballers, as evaluated by their postural sway, seemed to vary with age and player position. This factor appears to be important in planning the training and rehabilitation of players. This measure may also contribute to the talent identification of footballers.

The fifth article, ‘Soccer-specific fatigue decreases reactive postural control with implications for ankle sprain injury,’ by Greig and McNaughton, reports that dynamic balance performance decreased but reaction time increased as players became more fatigued during a simulated football game. This result could be a contributory factor to the finding that ankle injuries commonly occurred during the ends of both halves of football games. These findings could be used to implement an injury prevention program.

In the sixth article, ‘Acute effects of the number of players and scoring method on physiological, physical, and technical performance in small-sided soccer games,’ Clemente, Wong, Martins, and Mendes found that coaches of male amateur players could use different small-sided games that consist of differing player compositions, such as 2 vs. 2 or 4 vs. 4. Such games could be used to train players in terms of technical awareness and various components of fitness, including distance covered, speed, and aerobic components. This approach could maximize the time spent in training while ensuring player satisfaction.

The seventh article, ‘The biological age of 14-year-old boys and success in adult soccer: do early maturers predominate in the top-level game?’ contributed by Ostojic, Castagna, Calleja–Gonzalez, Jukic, Idrizovic, and Stojanovic, reports that early maturity among adolescent footballers appears to be beneficial for age-related competitions. However, the results of a longitudinal study conducted among adolescent footballers over eight years show that late maturing adolescents were more likely to achieve elite status than early maturing adolescents.

In the eighth article, ‘Physical growth and changes in intermittent endurance run performance in young male Basque soccer players,’ Carvalho, Bidaurrazaga–Letona, Lekue, Amado, Figueiredo, and Gil report that the performance of players in an intermittent endurance run increased from the ages 10 to 15 among male footballers. This result was positively influenced by football training during the year.

Finally, Taylor, Watkins, Castle, Mauger, Sculthorpe, Fitch, Aldous, Brewer, and Midgley in the article, ‘The effect of different environmental conditions on the decision-making performance of soccer goal line officials,’ report that match line officials from Europe assist referees in making important and timely decisions during games. The finding that cold temperatures negatively influence decision making among these officials could significantly influence the clothing worn by these officials or, even more importantly, show that the goal line technology that was successfully used in the recent World Cup should be more widely implemented.

The contents of this special edition would definitely be of great interest to people who are interested in football medicine and science.