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Concept: Football


In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.

Concepts: Alzheimer's disease, Pathology, Parkinson's disease, Dementia, Lewy body, Autopsy, Cerebral amyloid angiopathy, Football


There is growing concern around the effects of concussion and sub-concussive impacts in sport. Routine game-play in soccer involves intentional and repeated head impacts through ball heading. Although heading is frequently cited as a risk to brain health, little data exist regarding the consequences of this activity. This study aims to assess the immediate outcomes of routine football heading using direct and sensitive measures of brain function.

Concepts: Thought, Association football, Football, Head


Do coaches' leadership styles affect injury rates and the availability of players in professional football? Certain types of leadership behaviour may cause stress and have a negative impact on players' health and well-being.

Concepts: Sociology, Management, Injuries, Injury, Leadership, Coaching, Football, Professional sports


Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme-biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence.

Concepts: Time, Game theory, Association football, American football, Chess, Football, Professional sports, Columbus, Ohio


To investigate incidence of concussion, clinical outcomes and subsequent injury risk following concussion.

Concepts: Football, Rugby union in Australia


The acknowledgement of risks for traumatic brain injury in American football players has prompted studies for sideline concussion diagnosis and testing for neurological deficits. While concussions are recognized etiological factors for a spectrum of neurological sequelae, the consequences of sub-concussive events are unclear. We tested the hypothesis that blood-brain barrier disruption (BBBD) and the accompanying surge of the astrocytic protein S100B in blood may cause an immune response associated with production of auto-antibodies. We also wished to determine whether these events result in disrupted white matter on diffusion tensor imaging (DT) scans. Players from three college football teams were enrolled (total of 67 volunteers). None of the players experienced a concussion. Blood samples were collected before and after games (n = 57); the number of head hits in all players was monitored by movie review and post-game interviews. S100B serum levels and auto-antibodies against S100B were measured and correlated by direct and reverse immunoassays (n = 15 players; 5 games). A subset of players underwent DTI scans pre- and post-season and after a 6-month interval (n = 10). Cognitive and functional assessments were also performed. After a game, transient BBB damage measured by serum S100B was detected only in players experiencing the greatest number of sub-concussive head hits. Elevated levels of auto-antibodies against S100B were elevated only after repeated sub-concussive events characterized by BBBD. Serum levels of S100B auto-antibodies also predicted persistence of MRI-DTI abnormalities which in turn correlated with cognitive changes. Even in the absence of concussion, football players may experience repeated BBBD and serum surges of the potential auto-antigen S100B. The correlation of serum S100B, auto-antibodies and DTI changes support a link between repeated BBBD and future risk for cognitive changes.

Concepts: Immune system, Brain, Traumatic brain injury, College football, Blood-brain barrier, American football, Concussion, Football


The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement’s themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.

Concepts: United States, American football, Rugby union, Football, Rugby league, Team sports, Rugby football, Tag Rugby


Although the incidence of football injuries should relate to team success there is little empirical evidence.

Concepts: Injury, Empirical, Empirical research, Football, Professional sports


Does adding a post-training Fédération Internationale de Football Association (FIFA) 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduce injury rates among male amateur soccer players?

Concepts: Association football, Football, The Football Association, FIFA World Cup, FIFA


BACKGROUND AND AIM: Strength and power are crucial components to excelling in all contact sports; and understanding how a player’s strength and power levels fluctuate in response to various resistance training loads is of great interest, as it will inevitably dictate the loading parameters throughout a competitive season. This is a systematic review of training, maintenance and detraining studies, focusing on the development, retention and decay rates of strength and power measures in elite rugby union, rugby league and American football players. SEARCH STRATEGIES: A literature search using MEDLINE, EBSCO Host, Google Scholar, IngentaConnect, Ovid LWW, ProQuest Central, ScienceDirect Journals, SPORTDiscus™ and Wiley InterScience was conducted. References were also identified from other review articles and relevant textbooks. From 300 articles, 27 met the inclusion criteria and were retained for further analysis. STUDY QUALITY: Study quality was assessed via a modified 20-point scale created to evaluate research conducted in athletic-based training environments. The mean ± standard deviation (SD) quality rating of the included studies was 16.2 ± 1.9; the rating system revealed that the quality of future studies can be improved by randomly allocating subjects to training groups, providing greater description and detail of the interventions, and including control groups where possible. DATA ANALYSIS: Percent change, effect size (ES = [Post-Xmean - Pre-Xmean)/Pre-SD) calculations and SDs were used to assess the magnitude and spread of strength and power changes in the included studies. The studies were grouped according to (1) mean intensity relative volume (IRV = sets × repetitions × intensity; (2) weekly training frequency per muscle group; and (3) detraining duration. IRV is the product of the number of sets, repetitions and intensity performed during a training set and session. The effects of weekly training frequencies were assessed by normalizing the percent change values to represent the weekly changes in strength and power. During the IRV analysis, the percent change values were normalized to represent the percent change per training session. The long-term periodized training effects (12, 24 and 48 months) on strength and power were also investigated. RESULTS: Across the 27 studies (n = 1,015), 234 percent change and 230 ES calculations were performed. IRVs of 11-30 (i.e. 3-6 sets of 4-10 repetitions at 74-88 % one-repetition maximum [1RM]) elicited strength and power increases of 0.42 % and 0.07 % per training session, respectively. The following weekly strength changes were observed for two, three and four training sessions per muscle region/week: 0.9 %, 1.8 % and 1.3 %, respectively. Similarly, the weekly power changes for two, three and four training sessions per muscle group/week were 0.1 %, 0.3 % and 0.7 %, respectively. Mean decreases of 14.5 % (ES = -0.64) and 0.4 (ES = -0.10) were observed in strength and power across mean detraining periods of 7.2 ± 5.8 and 7.6 ± 5.1 weeks, respectively. The long-term training studies found strength increases of 7.1 ± 1.0 % (ES = 0.55), 8.5 ± 3.3 % (ES = 0.81) and 12.5 ± 6.8 % (ES = 1.39) over 12, 24 and 48 months, respectively; they also found power increases of 14.6 % (ES = 1.30) and 12.2 % (ES = 1.06) at 24 and 48 months. CONCLUSION: Based on current findings, training frequencies of two to four resistance training sessions per muscle group/week can be prescribed to develop upper and lower body strength and power. IRVs ranging from 11 to 30 (i.e. 3-6 sets of 4-10 repetitions of 70-88 % 1RM) can be prescribed in a periodized manner to retain power and develop strength in the upper and lower body. Strength levels can be maintained for up to 3 weeks of detraining, but decay rates will increase thereafter (i.e. 5-16 weeks). The effect of explosive-ballistic training and detraining on pure power development and decay in elite rugby and American football players remain inconclusive. The long-term effects of periodized resistance training programmes on strength and power seem to follow the law of diminishing returns, as training exposure increases beyond 12-24 months, adaptation rates are reduced.

Concepts: Effect size, Meta-analysis, American football, Rugby union, Football, Rugby league, Rugby football, Tag Rugby