Medical conditions and illness in elite football players during international competition
Background: Previous clinical research of football players participating in international tournaments has mainly focussed on documentation of injuries and risk factors for injury. However, despite anecdotal evidence that medical symptomatology, illness and medical complaints are common during travel to international competitions, the epidemiology of medical conditions before, during or after elite level football tournaments, has not been well documented. Objective: The aims of the research presented in this dissertation were: 1) to determine the prevalence of medical conditions in elite football players 2) to determine the incidence and nature of medical conditions and illness in the elite football players participating in an international tournament (2009 FIFA Confederations Cup tournament) and 3) to provide data for the medical planning and management of elite football players during future events. Methods: The first component of this dissertation consisted of a comprehensive review of the current literature describing the prevalence and incidence of medical conditions and illness in athletes. The original research component of this dissertation consisted of two parts, and both studies were conducted during the FIFA Confederations Cup tournament, which was held in South Africa in June 2009. All the players in the 8 participating teams (23 players per team – a total of 184 players) were approached by the FIFA Medical Assessment and Research Centre (F-MARC) through their team physicians and invited to participate as research subjects in the studies. Part 1 (descriptive cross-sectional study): Prior to the tournament, all the players completed a previously validated medical history and illness questionnaire. Furthermore, the questionnaire contained sections on player demographics, training history, medication and supplement use, life-style history, family history of atopy, current and past history of medical conditions and detailed sections pertaining to upper respiratory tract infections (URTI), allergies, asthma, exercise associated muscle cramping (EAMC) and history of previous surgery. Part 2 (prospective cohort study): During the 15 days of the tournament each team physician was requested to complete a daily injury, medical illness and treatment log for each player. Finally, data on the environmental conditions at each venue were collected, as recorded by the South African Weather Service. Results: The main findings in part 1 of this study were: 1) exercise associated muscle cramping (EAMC) was the most prevalent medical condition reported, with 64 (46%) of the players reporting a history of EAMC, 2) the prevalence of allergy was 27 (20%) and asthma 6 (4%), 3) the prevalence of dermatological conditions was 16 (12%), 4) the prevalence of gastro-intestinal conditions was 10 (7%) and central nervous system conditions was 6 (4%), 5) URTI one week before the tournament was reported by 7 (5%) of the players, 6) 68 (49%) of the players reported a history of previous surgery and 7) 72 (52%) of the players reported the use of supplements or vitamins and 11 (8%) the use of medication. Knee surgery was the most common anatomical area operated with 33 (24%) of the players reporting previous knee surgery. This was followed by a much lower prevalence of ankle surgery, 8 (6%). In part 2 of the study, a total of 56 injuries and 35 illnesses were recorded during the tournament. The main findings in this study were: 1) an overall injury rate of 64.4 injuries per 1000 match hours or 2.1 injuries per match, 2) an overall rate of 2.7 injuries and 1.7 illnesses per 100 player days, 3) that 0.88 days were lost per injury and 0.46 days were lost per illness, 4) the lower limb was the most commonly injured body part, 5) 11 (20%) of the injuries reported were to the thigh, 6) 15 (44%) of the injuries reported were due to a contusion, 6) 13 (37%) of the illnesses reported were due to ENT conditions, and 7) 7 (20%) were due to respiratory tract symptoms. Summary and conclusion: Illness and injury are common during an international football tournament. The pattern of injury was similar to that previously reported. However, the novel finding of this dissertation was that illness is a significant component to the medical care to a travelling team and needs to be considered by team physicians managing the medical needs of elite football teams.
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