A stratified ecological model of injury etiology in professional football: a context‑driven “game model” of injury risk constraints management and foresight reasoning under uncertainty
Football Sports Medicine Consultant & Associate Editor, Qatar
K Sint-Truidense VV., Belgium & Sports Science Consultant
Royal Standard Club Liège, Belgium
University of Liège, Belgium
School of Exercise and Nutrition Sciences, Queensland University of Technology, Australia
Football Science Consultant, United Kingdom
German Sport University Cologne, Germany
Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
Physical Medicine and Sport Traumatology Department, FIFA Medical Centre of Excellence, IOC Research Centre (ReFORM), FIMS Collaborative Centre of Sports Medicine, University Hospital of Liège, Liège, Belgium
Edge Hill University, United-kingdom
Sport Researcher & Consultant, United Kingdom
Naufar Centre, Doha, Qatar
Biol Sport. 2027;44:149–170
- Meeuwisse WH. Assessing causation in sport injury: A multifactorial model. Clinical journal of sport medicine. 1994; 4:166–70.
- van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med. 1992; 14(2):82–99.
- Fuller C, Drawer S. The application of risk management in sport. Sports Med. 2004; 34(6):349–56.
- Andersen MB, Williams JM. A Model of Stress and Athletic Injury: Prediction and Prevention. Journal of sport & exercise psychology. 1988; 10:294–306.
- Ekstrand J, Gillquist J, Moller M, et al. Incidence of soccer injuries and their relation to training and team success. Am J Sports Med. 1983; 11(2):63–7.
- Meeuwisse WH, Tyreman H, Hagel B, et al. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007; 17(3):215–9.
- Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med. 2005; 39(6):324–9.
- Gissane C, White J, Kerr K, et al. An operational model to investigate contact sports injuries. Med Sci Sports Exerc. 2001; 33(12):1999–2003.
- McIntosh AS. Risk compensation, motivation, injuries, and biomechanics in competitive sport. Br J Sports Med. 2005; 39(1):2–3.
- Liveris NI, Tsarbou C, Papageorgiou G, et al. Interdependent Effect of Intrinsic Risk Factors on Non-Contact Lower Limb Injuries in Male Football Players: A Structural Equation Modeling Approach. Medicina. 2026; 62(1):52:1–28.
- Bittencourt NF, Meeuwisse WH, Mendonca LD, et al. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med. 2016.
- Stern BD, Hegedus EJ, Lai YC. Injury prediction as a non-linear system. Phys Ther Sport. 2020; 41:43–8.
- Ruddy JD, Cormack SJ, Whiteley R, et al. Modeling the Risk of Team Sport Injuries: A Narrative Review of Different Statistical Approaches. Front Physiol. 2019; 10:829.
- Windt J, Gabbett TJ. How do training and competition workloads relate to injury? The workload-injury aetiology model. Br J Sports Med. 2017; 51(5):428–35.
- Fuller CW, Junge A, Dvorak J. Risk management: FIFA’s approach for protecting the health of football players. Br J Sports Med. 2012; 46(1):11–7.
- Bekker S, Clark AM. Bringing complexity to sports injury prevention research: from simplification to explanation. Br J Sports Med. 2016; 50(24):1489–90.
- Horan D, Kelly S, Hagglund M, et al. Players’, Head Coaches’, And Medical Personnels’ Knowledge, Understandings and Perceptions of Injuries and Injury Prevention in Elite-Level Women’s Football in Ireland. Sports Med Open. 2023; 9(1):64.
- Tabben M, Verhagen E, Warsen M, et al. Obstacles and opportunities for injury prevention in professional football in Qatar: exploring the implementation reality. BMJ Open Sport Exerc Med. 2023; 9(1):e001370.
- Vella S, Bolling C, Verhagen E, et al. Perceiving, reporting and managing an injury – perspectives from national team football players, coaches, and health professionals. Sci Med Footb. 2022; 6(4):421–33.
- Verhagen E, Bolling C. We dare to ask new questions. Are we also brave enough to change our approaches? Translational Sports Medicine. 2018; 1(1):54–5.
- Milner J, Houghton S. Player reflections on change: 20 years of evolving demands and support in elite football. Br J Sports Med. 2025; 59(23):1703–4.
- Ekstrand J, Hallen A, Marin V, et al. Most modifiable risk factors for hamstring muscle injury in women’s elite football are extrinsic and associated with the club, the team, and the coaching staff and not the players themselves: the UEFA Women’s Elite Club Injury Study. Knee Surg Sports Traumatol Arthrosc. 2023; 31(7):2550–5.
- Bullock GS, Mylott J, Hughes T, et al. Just How Confident Can We Be in Predicting Sports Injuries? A Systematic Review of the Methodological Conduct and Performance of Existing Musculoskeletal Injury Prediction Models in Sport. Sports Med. 2022; 52(10):2469–82.
- Bahr R. Why screening tests to predict injury do not work-and probably never will.: a critical review. Br J Sports Med. 2016; 50(13):776–80.
- Cook C. Predicting future physical injury in sports: it’s a complicated dynamic system. Br J Sports Med. 2016; 50(22):1356–7.
- Bolling C, van Mechelen W, Pasman HR, et al. Context Matters: Revisiting the First Step of the ‘Sequence of Prevention’ of Sports Injuries. Sports Med. 2018; 48(10):2227–34.
- Martins F, Przednowek K, Franca C, et al. Predictive Modeling of Injury Risk Based on Body Composition and Selected Physical Fitness Tests for Elite Football Players. J Clin Med. 2022; 11(16).
- Kalkhoven JT. Athletic Injury Research: Frameworks, Models and the Need for Causal Knowledge. Sports Med. 2024; 54(5):1121–37.
- Mattiussi AM, Shaw JW. From Evidence to Application: An Operational Extension of Existing Sports Injury Frameworks for Sports Medicine Practitioners. Sports Med. 2026.
- McLean S, Robertson S, Salmon PM. Complexity and systems thinking in sport. J Sports Sci. 2025; 43(1):1–5.
- Allen T, Taberner M, Zhilkin M, et al. Evolving running load demands and fixture congestion in the English Premier League: a decade of insights from 2015/2016 to 2024/2025. Br J Sports Med. 2025.
- Norton K. Update on the evolution of World Cup soccer: men and women. International Journal of Performance Analysis in Sport. 2024.
- Nassis GP, Massey A, Jacobsen P, et al. Elite football of 2030 will not be the same as that of 2020: Preparing players, coaches, and support staff for the evolution. Scand J Med Sci Sports. 2020; 30(6):962–4.
- Yang X, Feng L. Long-term physical performance trends across the five confederations: Evidence from the 19th to 22nd FIFA World Cup editions (2010–2022). PLoS One. 2026; 21(7):e0354205.
- Ekstrand J, Hagglund M, Walden M, et al. Higher level of communication between the medical staff and the performance staff is associated with a lower hamstring injury burden: a substudy on 14 teams from the UEFA Elite Club Injury Study. BMJ Open Sport Exerc Med. 2025; 11(1):e002182.
- Hulme A, Finch CF. From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury. Inj Epidemiol. 2015; 2(1):31.
- Losciale JM, Bullock GS, Collins GS, et al. Description, Prediction, and Causation in Sport and Exercise Medicine Research: Resolving the Confusion to Improve Research Quality and Patient Outcomes. J Orthop Sports Phys Ther. 2023; 53(7):381–7.
- Stovitz SD, Impellizzeri FM, Shrier I. The Risks of Misunderstanding the Term “Risk Factor”: A Primer with Suggestions to Improve Sports Medicine. Sports Med. 2025.
- Carling C, Kane K. What football performance science can learn from marketing science. Football Studies. 2026.
- Salmon P, McLean S. Complexity in the beautiful game: implications for football research and practice. Science and Medicine in Football. 2019.
- Benjaminse A, Verhagen E. Implementing ACL Injury Prevention in Daily Sports Practice-It’s Not Just the Program: Let’s Build Together, Involve the Context, and Improve the Content. Sports Med. 2021; 51(12):2461–7.
- Tee JC, McLaren SJ, Jones B. Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions. Sports Med. 2020; 50(4):689–702.
- O’Sullivan M, Vaughan J, Woods CT, et al. There is no copy and paste, but there is resonation and inhabitation: Integrating a contemporary player development framework in football from a complexity sciences perspective. J Sports Sci. 2025; 43(1):99–108.
- Sandon A, Krutsch W, Alt V, et al. Increased occurrence of ACL injuries for football players in teams changing coach and for players going to a higher division. Knee Surg Sports Traumatol Arthrosc. 2022; 30(4):1380–7.
- Chang V, Sajeev S, Ariel Xu Q, et al. Football Analytics: Assessing the Correlation between Workload, Injury and Performance of Football Players in the English Premier League. Appl Sci. 2024; 14(7217):1–32.
- Fuller CW. An assessment of the relationship between behaviour and injury in the workplace: A case study in professional football. Safety Science. 2005; 43:213–24.
- Fuller CW. Managing the risk of injury in sport. Clin J Sport Med. 2007; 17(3):182–7.
- Kalkhoven JT, Watsford ML, Impellizzeri FM. A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury. J Sci Med Sport. 2020; 23(8):726–34.
- Pol R, Hristovski R, Medina D, et al. From microscopic to macroscopic sports injuries. Applying the complex dynamic systems approach to sports medicine: a narrative review. Br J Sports Med. 2019; 53(19):1214–20.
- Newell K, M. Constraints on the development of coordination. Mot Dev Child Asp Coord Control. 1986; 34:341–60.
- Dallmeyer S, Steinfeldt H, Hubers T, et al. Monetising misfortune: the financial consequences of injuries in professional football teams. BMJ Open Sport Exerc Med. 2025; 11(2):e002437.
- Pulici L, Certa D, Zago M, et al. Injury Burden in Professional European Football (Soccer): Systematic Review, Meta-Analysis, and Economic Considerations. Clin J Sport Med. 2023; 33(4):450–7.
- Rubio-Martin G, González Sánchez F, Manuel-Garcia CM, et al. The effect of injury risk on players value: evidence from the main European Leagues. Humanit Soc Sci Commun. 2026.
- Karaman T, Devran S, Morkuzu S, et al. From injury to financial loss: Quantifying the economic and career consequences of anterior crucial ligament ruptures in European professional football. Knee Surg Sports Traumatol Arthrosc. 2026.
- Alfano H, Collins D. Good practice delivery in sport science and medicine support: Perceptions of experienced sport leaders and practitioners. . Managing Sport and Leisure. 2021; 26(3):145–60.
- Stewart P, Fletcher D, Arnold R, et al. Exploring perceptions of performance support team effectiveness in elite sport. Sport Management Review. 2024; 27:2:300–21.
- Ekstrand J, Van Zoest W, Gauffin H. Changes in head staff members in male elite-level football teams are associated with increased hamstring injury burden for that season: the UEFA Elite Club Injury Study. BMJ Open Sport Exerc Med. 2023; 9(4):e001640.
- Wiseman A. The Fallacy of the Generalist-Specialist: Does the Category Exist for Football Science Practitioners? Sport Performance & Science. 2026; 1.
- Gondwe B, Frenger M, Meyer T. The organisation of medical and performance departments in European elite football teams. Sci Med Footb. 2026:1–12.
- Pappalardo L, Rossi A, Natilli M, et al. Explaining the difference between men’s and women’s football. PLoS One. 2021; 16(8):e0255407.
- Xu W, Zhang D, Zhang X. Sex differences in association football: a scoping review. PeerJ. 2025; 13:e19976.
- Okholm Kryger K, Wang A, Mehta R, et al. Can we evidence-base injury prevention and management in women’s football? A scoping review. Res Sports Med. 2022:1–16.
- Hassan A, Dufour S, Brockwell E, et al. Pregnant Pitches: Navigating Football Before and During Pregnancy. Sports Med. 2026; 56(Suppl 1):91–107.
- Crossley KM, Whittaker JL, Patterson B, et al. Female, woman and/or girl Athlete Injury pRevention (FAIR) practical recommendations: International Olympic Committee (IOC) consensus meeting held in Lausanne, Switzerland, 2025. Br J Sports Med. 2025; 59(22):1546–59.
- Jones G, Kubayi A, Stone JA, et al. Game models in football coaching: an ecological dynamics perspective. International Journal of Performance Analysis in Sport. 2026.
- Halle Petiot G, Coutinho D, Farrokh D, et al. The fundamentals of the design of organized practice in team sports. Team Sports Studies. 2026; 2.
- Kwon JW. The analytics-practice gap: why sports data fails to translate into coaching decisions. Front Sports Act Living. 2026; 8:1866960.
- Bradley PS. Contextualised Training Load in Elite Football: Adding a Narrative to the Numbers. Football and Medicine performnabce association. 2022:30–4.
- Buchheit M, Settembre M, Tarascon A, et al. Know-your-own-league context: insights for player preparation and recruitment – Part 1: Team formations. Sports performance and science reports. 2023.
- Simonelli C, Formenti D, Trecroci A, et al. Translating physical training theoretical framework to soccer practice: a narrative review. Sport Sciences for Health. 2026; 22:68:7–10.
- Petrov D, Parpa K, Michaelides M. The Impact of Managerial Changes on Physical Performance in Elite Soccer Players. Sports (Basel). 2025; 13(7).
- Field AE, Tepolt FA, Yang DS, et al. Injury Risk Associated With Sports Specialization and Activity Volume in Youth. Orthop J Sports Med. 2019; 7(9):2325967119870124.
- Li X, Feng R, Luo S, et al. The associations of early specialization, sports volume, and maturity status with musculoskeletal injury in elite youth football players. Front Physiol. 2023; 14:1183204.
- Fransen J, Pion J, Vandendriessche J, et al. Differences in physical fitness and gross motor coordination in boys aged 6–12 years specializing in one versus sampling more than one sport. J Sports Sci. 2012; 30(4):379–86.
- Hagglund M, Walden M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006; 40(9):767–72.
- Drezner JA, O’Connor FG, Harmon KG, et al. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med. 2017; 51(3):153–67.
- Dunn A. The pre-signing medical examination: The radiologists’ role. Eur J Radiol. 2019; 118:239–44.
- Bezuglov E, Khaitin V, Lazarev A, et al. Asymptomatic Foot and Ankle Abnormalities in Elite Professional Soccer Players. Orthop J Sports Med. 2021; 9(1):2325967120979994.
- Hohne E, Mahmoudi S, Vogl T, et al. Common MRI findings in pre-signing medical assessments of professional soccer players. BMJ Open Sport Exerc Med. 2026; 12(2):e003233.
- Sato VN, Moriwaki TL, do Amaral ECA, et al. Pubic apophyseal MRI findings in asymptomatic elite youth soccer players: a cross-sectional comparison with non-athletes. Skeletal Radiol. 2026.
- Gouttebarge V, Burgess D. FIFPRO. Medical Position Statement on Minimum Player Workload Safeguards in Men’s Professional Football. FIFPRO. 2025.
- Ekstrand J, Spreco A, Windt J, et al. Are Elite Soccer Teams’ Preseason Training Sessions Associated With Fewer In-Season Injuries? A 15-Year Analysis From the Union of European Football Associations (UEFA) Elite Club Injury Study. Am J Sports Med. 2020; 48(3):723–9.
- Page RM, Field A, Langley B, et al. The Effects of Fixture Congestion on Injury in Professional Male Soccer: A Systematic Review. Sports Med. 2023; 53(3):667–85.
- Grammenou M, Nulty C. Managing Fatigue in Team Sports: A Brief Review of Concurrent Training Effects Within the Microcycle. Strength and Conditioning Journal. 2025; 47(5):589–600.
- Gonzalez-Fernandez FT, Martinez-Aranda LM, Sanz-Matesanz M, et al. Impact of Four-Match Congestion on the Well-Being of Under-16 Male Soccer Players. Sports (Basel). 2025; 13(7).
- Brink M, Frencken W, de Bloom J. Give Me a Break: Insights From Vacation Research for Football Recovery. Int J Sports Physiol Perform. 2026:1–5.
- Ekstrand J, Spreco A, Davison M. Elite football teams that do not have a winter break lose on average 303 player-days more per season to injuries than those teams that do: a comparison among 35 professional European teams. Br J Sports Med. 2019; 53(19):1231–5.
- Bengtsson H, Hagglund M, Ekstrand J, et al. No major changes in injury incidence in European club football during the 2022/23 FIFA World Cup season: a subanalysis of the UEFA Elite Club Injury Study. BMJ Open Sport Exerc Med. 2025; 11(3):e002772.
- Hydes S, Strafford BW, Stone JA, et al. Mono-, multi-, inter-, and transdisciplinarity in sport performance support teams: definitions and objectives. Sports Coaching Review. 2026.
- Jimenez C, Verhagen E. Reimagining athlete monitoring for true indicative injury prevention. BMJ Open Sport Exerc Med. 2025; 11(2):e002479.
- Montull L, Slapsinskaite-Dackeviciene A, Kiely J, et al. Integrative Proposals of Sports Monitoring: Subjective Outperforms Objective Monitoring. Sports Med Open. 2022; 8(1):41.
- Drayton AM, Hamad MJ, Spyrou K. The Time Course of Postmatch Physical Impairments in Professional Soccer: A Systematic Review. J Strength Cond Res. 2025; 39(11):e1345–e55.
- Hader K, Rumpf M, Hertzog M, et al. Monitoring the Athlete Match Response: Can External Load Variables Predict Postmatch Acute and Residual Fatigue in Soccer? A Systematic Review with Metaanalysis. Sports Medicine – Open. 2019; 5:48.
- Fenni Y, Ikiouane M, Kettab K, et al. Post-match changes in biomarkers and fatigue-related physical performance parameters in adult amateur soccer players: the effects of fasting. BMC Sports Sci Med Rehabil. 2026; 18(1).
- Materne O, Bennett F, Sweeney A, et al. Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies. Res Sports Med. 2025; 33(1):10–28.
- Abbott W, Rowland SN, McKnight CE, et al. The Effects of Match-Play on Markers of Recovery in Professional Female and Male Soccer Players. J Strength Cond Res. 2026.
- Cosio PL, Pinal-Fernandez I, Moreno-Simonet L, et al. Transcriptomic Profiling of the Biceps Femoris Long Head 72 h Following a Football Match and Associations With Recovery Biomarkers. Scand J Med Sci Sports. 2026; 36(7):e70339.
- Van Hooren B. Rethinking Acute Sports Injuries: Evidence for an Overuse Mechanism in Hamstring and ACL Injuries. Scand J Med Sci Sports. 2025; 35(10):e70146.
- Materne O, Chamari K, Farooq A, et al. Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years. Br J Sports Med. 2020.
- Iatropoulos S, Edouard P. The ‘vicious circle’ of sports injuries: an analysis of 165 athletics (track and field) athletes over a 39-week follow-up using Markov chains. BMJ Open Sport Exerc Med. 2025; 11(2):e002420.
- Holm-Jensen A, Vlachos E, Storm LK, et al. The Consistency of Primary, Secondary and Tertiary Prevention Definitions in the Context of Musculoskeletal Sports Injuries: A Rapid Review and Critical Exploration of Common Terms of Usage. Sports Med Open. 2025; 11(1):28.
- Pate JW. Pain Gets Misunderstood: New Lenses for Seeing Pain More Clearly. J Orthop Sports Phys Ther. 2025; 55(8):1–4.
- Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med. 2009; 43(13):966–72.
- Whalan M, Lovell R, Sampson J. Do Niggles Matter? – Increased injury risk following physical complaints in football (soccer). Science and Medicine in Football. 2019; 4:3:216–24.
- Bahr R, Clarsen B, Derman W, et al. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med. 2020.
- Wik EH, Materne O, Chamari K, et al. Involving research-invested clinicians in data collection affects injury incidence in youth football. Scand J Med Sci Sports. 2019; 29(7):1031–9.
- Chen JH, Alagappan M, Goldstein MK, et al. Decaying relevance of clinical data towards future decisions in data-driven inpatient clinical order sets. Int J Med Inform. 2017; 102:71–9.
- Fonseca ST, Souza TR, Verhagen E, et al. Sports Injury Forecasting and Complexity: A Synergetic Approach. Sports Med. 2020; 50(10):1757–70.
- Toohey LA, Drew MK, Cook JL, et al. Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis. Br J Sports Med. 2017; 51(23):1670–8.
- Zhang G, Brink MS, Szymski D, et al. Subsequent Injury Risk After Return-to-Play From Lower-Extremity Muscle Injuries in Professional Male Football (Soccer). Orthop J Sports Med. 2026; 14(7):23259671261449235.
- Tabben M, Chamari K, Alkhelaifi K, et al. Longitudinal cohort study on subsequent injury risk in professional football players in the Qatar Stars League: a probabilistic approach using basic learning. Biol Sport. 2026; 43:489–98.
- Gabbett TJ, Nielsen RO, Bertelsen ML, et al. In pursuit of the ‘Unbreakable’ Athlete: what is the role of moderating factors and circular causation? Br J Sports Med. 2019; 53(7):394–5.
- Verhagen E, McGinley P, McKay CD. Beyond tame solutions: a new paradigm for injury prevention in sports. BMJ Open Sport Exerc Med. 2025; 11(2):e002478.
- Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ. 2001; 323(7313):625–8.
- Mujika I, Halson S, Burke LM, et al. An Integrated, Multifactorial Approach to Periodization for Optimal Performance in Individual and Team Sports. Int J Sports Physiol Perform. 2018; 13(5):538–61.
- Impellizzeri FM, Shrier I, McLaren SJ, et al. Understanding Training Load as Exposure and Dose. Sports Med. 2023; 53(9):1667–79.
- Coban U, Uca M, Atalan E, et al. Training Load-Recovery Mismatch and Injury Occurrence in Competitive Athletes: Insights From Longitudinal Monitoring. Sports Health. 2026:19417381261473754.
- Dixon B, Alexander J, Harper D. ‘Match load’ construct in professional football: complexities and considerations. BMJ Open Sport Exerc Med. 2026; 12(1):e002894.
- Pillitteri G, Clemen FM, Sarmento H, et al. Translating player monitoring into training prescriptions: Real world soccer scenario and practical proposals. International Journal of Sports Science & Coaching. 2024:1–19.
- Nilsson T, Fransson D, Borjesson M, et al. Hamstring injury risk in male professional football: do external training loads play a role? BMJ Open Sport Exerc Med. 2025; 11(3):e002649.
- Gabbett TJ, Oetter E. From Tissue to System: What Constitutes an Appropriate Response to Loading? Sports Med. 2025; 55(1):17–35.
- Hostrup M, Bangsbo J. Performance Adaptations to Intensified Training in Top-Level Football. Sports Med. 2023; 53(3):577–94.
- Rampinini E, Impellizzeri FM, Castagna C, et al. Factors influencing physiological responses to small-sided soccer games. J Sports Sci. 2007; 25(6):659–66.
- Diez A, Bataller-Cervero AV, Mainer-Pardos E, et al. Comparison of the worst-case scenarios between training and competition weeks for each playing position in an elite football season. Biol Sport. 2025; 42(4):135–44.
- Díez A, Lozano D, Arjol-Serrano JL, et al. Training Tasks vs. Match Demands: Do Football Drills Replicate Worst-Case Scenarios? Appl Sci. 2025; 15 8172.
- Castellano J, Errekagorri I, Echeazarra I, et al. Tell me your position and the possession style of your team, and I will tell you your running demands. International journal of performance analysis in sport. 2026.
- Beneitez-Andres E, Sanchez-Sanchez J, Rodriguez-Fernandez A, et al. The influence of contextual factors on the physical demands of soccer match-play. Biol Sport. 2026; 43:729–41.
- Freitas I, Gouveia ÉR, Saldanha C, et al. Load distribution and positional demands in female soccer: An analysis of training and match play. International Journal of Sports Science & Coaching. 2026; 0(0):1–9.
- Springham M, Singh N, Stafford L, et al. A contextual comparison of UEFA Youth League and English Premier League academy match running demands across the professional development phase. International Journal of Sports Science & Coaching. 2026:1–10.
- Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016; 50(5):273–80.
- Aiello F, Impellizzeri FM, Brown SJ, et al. Injury-Inciting Activities in Male and Female Football Players: A Systematic Review. Sports Med. 2023; 53(1):151–76.
- Aiello F, Avery L, Gardner T, et al. Broadening our understanding of injury mechanisms to include at-risk situations: an overview of potential injuries at the FIFA men’s World Cup Qatar 2022(TM). Sci Med Footb. 2025; 9(3):283–92.
- Bahdura K, Prunab R, Erasmusc H, et al. Does cognition play a role in injury prevention and return to play in the elite football player? A perspective from the field. Apunts Med Esport. 2018.
- Giesche F, Peskar M, Slosar L, et al. Influence of selected cognitive performances on musculoskeletal injury occurrence in adult male professional Slovenian PrvaLiga football players in a prospective cohort study. Sci Rep. 2025; 15(1):30828.
- Gehring D, Ebner C, Di Paolo S, et al. Anterior cruciate ligament rupture during a cognitively demanding change-of-direction task in football: biomechanical insights from a laboratory injury. BMC Musculoskelet Disord. 2026; 27(1).
- Mineta S, Koyama T, Yamaguchi S, et al. Epidemiology of lateral ankle sprain focusing on indirect contact mechanism in male and female soccer players: An 18.5-month cohort study. Injury. 2024; 55(8):111699.
- Carli ADE, Koverech G, Gaj E, et al. Anterior cruciate ligament injury in elite football players: video analysis of 128 cases. J Sports Med Phys Fitness. 2022;62(2):222-8
- Rekik RN, Bahr R, Cruz F, et al. Mechanisms of ACL injuries in men’s football: A systematic video analysis over six seasons in the Qatari professional league. Biol Sport. 2023; 40(2):575–86.
- Lucarno S, Zago M, Buckthorpe M, et al. Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Female Soccer Players. Am J Sports Med. 2021; 49(7):1794–802.
- Achenbach L, Bloch H, Klein C, et al. Four distinct patterns of anterior cruciate ligament injury in women’s professional football (soccer): a systematic video analysis of 37 match injuries. Br J Sports Med. 2024.
- Hampstead W, Lovell R, Whalan M, et al. Mechanisms and situational patterns of anterior cruciate ligament injuries in professional women’s football (soccer): A systematic video analysis across 25 leagues (2022–2024). Knee Surg Sports Traumatol Arthrosc. 2026.
- Hoenig T, Gronwald T, Hollander K, et al. Video analysis of Achilles tendon ruptures in professional male football (soccer) reveals underlying injury patterns and provides strategies for injury prevention. Knee Surg Sports Traumatol Arthrosc. 2023; 31(6):2236–45.
- Cassoudesalle H, Laborde B, Orhant E, et al. Video analysis of concussion mechanisms and immediate management in French men’s professional football (soccer) from 2015 to 2019. Scand J Med Sci Sports. 2021; 31(2):465–72.
- Della Villa F, Massa B, Bortolami A, et al. Injury mechanisms and situational patterns of severe lower limb muscle injuries in male professional football (soccer) players: a systematic video analysis study on 103 cases. Br J Sports Med. 2023; 57(24):1550–8.
- Jokela A, Mecho S, Pasta G, et al. Indirect Rectus Femoris Injury Mechanisms in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings. Clin J Sport Med. 2023; 33(5):475–82.
- Gronwald T, Klein C, Hoenig T, et al. Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cases. Br J Sports Med. 2022; 56(3):165–71.
- Palermi S, Vittadini F, Pedret C, et al. From the Field to the Screen: A Scoping Review of Video Analysis as a Tool for Understanding Thigh Muscle-Tendon Injuries in Football. Clin J Sport Med. 2025; 35(6):675–86.
- Klein C, Luig P, Henke T, et al. Nine typical injury patterns in German professional male football (soccer): a systematic visual video analysis of 345 match injuries. Br J Sports Med. 2020.
- Putukian M, Bilgoe SC, McDuff D, et al. Bidirectional association between injuries and mental health symptoms among elite athletes: a systematic review. Br J Sports Med. 2026.
- Ashdown B, Mulvenna C, Nicholls S, et al. The evolving role of performance analysis in football: Integrating the observation of psychological behaviours. International Journal of Sports Science & Coaching. 2026; 21(3):1739–50.
- Verhagen E, Ferrer E, Antero JDS, et al. UEFA consensus statement on menstrual cycle tracking in women’s football. BMJ Open Sport Exerc Med. 2025; 11(3):e002769.
- Fuller CW, Smith GL, Junge A, et al. An assessment of player error as an injury causation factor in international football. Am J Sports Med. 2004; 32(1 Suppl):28S-35S.
- Gu J, Li Y, Wang Y, et al. Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis. Ann Med. 2026; 58(1):2652116.
- Brown JC, Gardner-Lubbe S, Lambert MI, et al. Coach-directed education is associated with injury-prevention behaviour in players: an ecological cross-sectional study. Br J Sports Med. 2018; 52(15):989–93.
- van de Hoef PA, Brink MS, Brauers JJ, et al. Adherence to an injury prevention program in male amateur football players is affected by players’ age, experience and perceptions. BMJ Open Sport Exerc Med. 2022; 8(3):e001328.
- Chamari K, Haddad M, Wong del P, et al. Injury rates in professional soccer players during Ramadan. J Sports Sci. 2012; 30 Suppl 1:S93–102.
- Clements E, Ehrmann F, Clark A, et al. Flight Path and Scheduling Effects on Perceived Jet Lag, Fatigue, and Sleep in Footballers Traveling to and From National Teams. Int J Sports Physiol Perform. 2023; 18(10):1132–40.
- Canton E, Raga J, Peris-Delcampo D. Sleep, Stress, and Recovery as Predictors of Injury Risk in Soccer Players: A Systematic Review. Healthcare (Basel). 2026; 14(2).
- Clements E, Ehrmann F, Clark A, et al. Effects of Prematch Travel and Training on Physical and Technical Performance in International Football Matches. Int J Sports Physiol Perform. 2025; 20(1):73–9.
- Clements E, Ehrmann F, Clark A, et al. Influence of Travel Demands and Match Load on Recovery Following Postmatch Travel in National-Team Footballers. Int J Sports Physiol Perform. 2025; 20(5):629–37.
- Silva JR, Buchheit M, Hader K, et al. Building Bridges Instead of Putting Up Walls: Connecting the “Teams” to Improve Soccer Players’ Support. Sports Med. 2023; 53(12):2309–20.
- Genovesi F, Tabone M, Nuara S, et al. Injury risk profile for soccer players: identification of the risk factors for soccer-related injuries – an umbrella review. Res Sports Med. 2025; 33(4):385–411.
- Perez RF, Lecumberri-Arteta J, Kulis M, et al. Epigenetic signatures, age acceleration, and injury risk in elite female and male soccer players. Sci Rep. 2025; 15(1):41826.
- Pescatore SM, DeShazo SJ, Weiss WM. Effects of Soccer Cleat Stud Patterns Worn Versus Lower Extremity Injuries in the English Premier League. Orthop J Sports Med. 2025; 13(7):23259671251353762.
- Vecchiato M, Russo L, Livio A, et al. Protective Equipment in Football: A Review of History, Evolution, Materials, and Contemporary Use. Sports (Basel). 2025; 13(11).
- DeLang MD, Salamh PA, Farooq A, et al. The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis. Biol Sport. 2021; 38(3):397–435.
- Mandorino M, Figueiredo AJ, Gjaka M, et al. Injury incidence and risk factors in youth soccer players: a systematic literature review. Part II: Intrinsic and extrinsic risk factors. Biol Sport. 2023; 40(1):27–49.
- Sanchez-Sanchez J, Raya-González J, Martín V, et al. Understanding Injuries in Young Female Soccer Players: A Narrative Review on Incidence, Mechanism, Location Risk Factors, and Preventive Strategies. Appl Sci. 2025; 15(1612).
- John G, AlNadwi A, Georges Abi Antoun T, et al. Injury Prevention Strategies in Female Football Players: Addressing Sex-Specific Risks. Sports (Basel). 2025; 13(2).
- Parry GN, Williams S, McKay CD, et al. Associations between growth, maturation and injury in youth athletes engaged in elite pathways: a scoping review. Br J Sports Med. 2024; 58(17):1001–10.
- Materne O, Chamari K, Farooq A, et al. Association of Skeletal Maturity and Injury Risk in Elite Youth Soccer Players: A 4-Season Prospective Study With Survival Analysis. Orthop J Sports Med. 2021; 9(3):2325967121999113.
- Hall ECR, Erskine RM. The Association of Growth and Maturation with Injury in Academy Soccer Players: A Narrative Review. Sports Med. 2025.
- Materne O, Chamari K, Farooq A, et al. Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study. Scand J Med Sci Sports. 2021.
- Caine D, Meyers R, Nguyen J, et al. Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports Med. 2022; 52(4):741–72.
- Hughes T, Riley R, Callaghan MJ, et al. Can prognostic factors for indirect muscle injuries in elite football (soccer) players be identified using data from preseason screening? An exploratory analysis using routinely collected periodic health examination records. BMJ Open. 2023; 13(1):e052772.
- Leppanen M, Jarske H, Krosshaug T, et al. No Association Between Anatomic Factors and Non-Contact ACL Injury Risk in 217 Female Team Sport Players: A Prospective 4.5-Year Study. Scand J Med Sci Sports. 2026; 36(5):e70290.
- Vigneswaran A, Serner A, Farooq A, et al. Is limb asymmetry an intrinsic risk factor for time-loss groin injury in professional male soccer players? Phys Ther Sport. 2025; 71:53–60.
- Bianco A, Spedicato M, Petrucci M, et al. A Prospective Analysis of the Injury Incidence of Young Male Professional Football Players on Artificial Turf. Asian J Sports Med. 2016; 7(1):e28425.
- Mears AC, Osei-Owusu P, Harland AR, et al. Perceived Links Between Playing Surfaces and Injury: a Worldwide Study of Elite Association Football Players. Sports Med Open. 2018; 4(1):40.
- Yang F, Huang J, Wei Q, et al. The Impact of Football Boot Design on Lower Limb Injury Risk: A Systematic Review. Sports Med Open. 2026; 12(1).
- Andersen TE, Engebretsen L, Bahr R. Rule violations as a cause of injuries in male norwegian professional football: are the referees doing their job? Am J Sports Med. 2004; 32(1 Suppl):62S-8S.
- Kobal R, Aquino R, Carvalho L, et al. Does the Number of Substitutions Used during the Matches Affect the Recovery Status and the Physical and Technical Performance of Elite Women’s Soccer? Int J Environ Res Public Health. 2022; 19(18).
- Alexandru BI, Remus DF. The impact of increasing substitutions from 3 to 5 on football team performance. Journal of Physical Education and Sport. 2026; 26(6):1060 – 7.
- Meyer J, Klatt S. Additional substitutions in elite European football. International Journal of Sports Science & Coaching. 2023:1–10.
- Wei X, Shu Y, Liu J, et al. Analysing substitutions in recent World Cups and European Championships in male and female elite football – influence of new substitution rules. Biol Sport. 2024; 41((3)):267–74.
- Bradley PS. ‘Setting the Benchmark’ Part 3: Contextualising the Match Demands of Specialised Positions at the FIFA Women’s World Cup Australia and New Zealand 2023. Biol Sport. 2025; 42(1):99–111.
- Bradley PS. ‘Setting the Benchmark’ Part 2: Contextualising the Physical Demands of Teams in the FIFA World Cup Qatar 2022. Biol Sport. 2024; 41(1):271–8.
- Bradley PS. ‘Setting the Benchmark’ Part 1: The Contextualised Physical Demands of Positional Roles in the FIFA World Cup Qatar 2022. Biol Sport. 2024; 41(1):261–70.
- Tscholl P, O’Riordan D, Fuller CW, et al. Tackle mechanisms and match characteristics in women’s elite football tournaments. Br J Sports Med. 2007; 41 Suppl 1(Suppl 1):i15–9.
- Bartsch P, Saltin B, Dvorak J, et al. Consensus statement on playing football at different altitude. Scand J Med Sci Sports. 2008; 18 Suppl 1:96–9.
- Esh CJ, Carter S, Bougault V, et al. The 2026 Men’s FIFA Football World Cup: Evidence-Based Guidelines to Protect Player Health and Performance from Environmental Challenges. Sports Med. 2026.
- Uludağ V, Tekin RT, Selki K, et al. Impact of ambient air pollution on match outcomes and injury patterns in professional football: a four‑year retrospective study. Sport Sciences for Health. 2026; 22(3).
- Draper G, Wright MD, Ishida A, et al. Do environmental temperatures and altitudes affect physical outputs of elite football athletes in match conditions? A systematic review of the ‘real world’ studies. Sci Med Footb. 2023; 7(1):81–92.
- Illmer S, Daumann D. The effects of weather factors and altitude on physical and technical performance in professional soccer: A systematic review. Journal of Science and Medicine in Sport. 2022.
- Racinais S, Hosokawa Y, Akama T, et al. IOC consensus statement on recommendations and regulations for sport events in the heat. Br J Sports Med. 2023; 57(1):8–25.
- Schwarz E, Oliveira CB, Duarte Munoz M, et al. Core temperature responses of male football players during matches in the heat – Associations with physiological and running demands. J Sci Med Sport. 2025.
- Bolling C, Ekstrand J, Walden M, et al. ‘Good communication and good team building, it’s half of the work in managing a player’: how team doctors perceive communication in the European professional men’s football context. BMJ Open Sport Exerc Med. 2025; 11(1):e002392.
- Dijkstra HP, Pollock N, Chakraverty R, et al. Managing the health of the elite athlete: a new integrated performance health management and coaching model. Br J Sports Med. 2014; 48(7):523–31.
- Ekstrand J, Lundqvist D, Davison M, et al. Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. Br J Sports Med. 2019; 53(5):304–8.
- Marques J, Chamari K. Performance Management in Elite Football: A Teamwork Modeling Approach. Int J Sports Physiol Perform. 2023; 18(12):1371–3.
- Afonso P, Forte P, Branquinho L, et al. Shaping Training Load, Technical-Tactical Behaviour, and Well-Being in Football: A Systematic Review. Sports (Basel). 2025; 13(8).
- Glasgow P, Bleakley CM, Phillips N. Being able to adapt to variable stimuli: the key driver in injury and illness prevention? Br J Sports Med. 2013; 47(2):64–5.
- Stewart P, Fletchera D, Arnoldb R, et al. Performance support team effectiveness in elite sport: a narrative review. International Review of Sport and Exercise Psychology. 2024.
- Dello Iacono A, Datson N, Clubb J, et al. Data analytics practices and reporting strategies in senior football: insights into athlete health and performance from over 200 practitioners worldwide. Sci Med Footb. 2026; 10(1):80–95.
- King R, Yiannaki C, Rhodes D, et al. From chaos to clarity: how leaders leverage the value and impact ofthe multidisciplinary team in elite sport. Manag Sport Leis. 2026
- Rebelo A, Bishop C, Thorpe RT, et al. Monitoring Training Effects in Athletes: A Multidimensional Framework for Decision-Making. Sports Med. 2026; 56(7):1603–24.
- Moshman D, Geil M. Collaborative Reasoning: Evidence for Collective Rationality. Thinking & Reasoning. 1998; 4(3):231–48.
- Steinmann A, Jaitner D, Koerner S. Together, alongside or against each other? A qualitative content analysis on the intersystem sensitivity of coaches and physiotherapists in German elite sport support teams. Front Sociol. 2026; 11(18).
- Tenan MS, Alejo B. Athlete Health and Human Performance Will Not Improve Without Transdisciplinary Collaboration and Data Sharing in Elite Sport. J Athl Train. 2024; 59(10):979–83.
- Hassanmirzaei B, Tabben M, Schumacher YO, et al. Applying the principles of risk management in male professional football: a feasibility study, introducing the Aspetar sports injury and illness risk management tool. Br J Sports Med. 2025.
- Walden M, Mountjoy M, McCall A, et al. Football-specific extension of the IOC consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020. Br J Sports Med. 2023; 57(21):1341–50.
- Little T, Buchheit M. Slaves to (GPS) norms. Science Performance and Science Reports. 2025; 274.
- Buchheit M, Lopez Sagarra A, Boskovic A, et al. GPS 3.0: from distance into zones toward better proxies of internal neuromuscular load in elite football. Sport Performance & Science. 2026; 1.
- Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. Br J Sports Med. 2016; 50(5):281–91.
- Dos Santos SN, Ananias GEO, da Rocha ER, Jr., et al. NMR-Based Metabolomics Reveals Position-Specific Signatures Associated with Physical Demands in Professional Soccer Players. Biomedicines. 2025; 13(11).
- Thema MT, Jacobs S, van den Berg L, et al. The role of playing position in soccer injury characteristics: evidence from sub-elite athletes. Front Sports Act Living. 2025; 7:1542300.
- Della Villa F, Mandelbaum BR, Lemak LJ. The Effect of Playing Position on Injury Risk in Male Soccer Players: Systematic Review of the Literature and Risk Considerations for Each Playing Position. Am J Orthop (Belle Mead NJ). 2018; 47(10).
- Schuth G, Carr G, Barnes C, et al. Positional interchanges influence the physical and technical match performance variables of elite soccer players. J Sports Sci. 2016; 34(6):501–8.
- Yang X, Zhou C, Xu Z, et al. The negative impact of squad rotation on football match outcomes: Mediating roles of passing and shooting performance. J Sports Sci. 2025; 43(22):2820–9.
- Moreno-Perez V, Carles Bove B, Courel-Ibanez J, et al. Non-contact injury incidence in professional women’s football depends on the starting status of the player. Biol Sport. 2025; 42(3):99–107.
- Morgans R, Oliveira R, Mandorino M, et al. The loading impact of training and match-play on non-contact muscle injuries in elite male soccer players. A seasonal analysis. Biol Sport. 2026; 43:107–14.
- Tedeschi R, Giorgi F, Donati D. Sprint Training for Hamstring Injury Prevention: A Scoping Review. Appl Sci. 2025;15, 9003:1-16.
- Pillitteri G, Clemente FM, Petrucci M, et al. A new conceptual framework for managing hamstring injury risk in soccer – implementing a data-informed approach: a narrative review. Biol Sport. 2026; 43:329–53.
- Kalkhoven JT, Watsford ML, Coutts AJ, et al. Training Load and Injury: Causal Pathways and Future Directions. Sports Med. 2021; 51(6):1137–50.
- Bowen L, Gross AS, Gimpel M, et al. Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players. Br J Sports Med. 2017; 51(5):452–9.
- Moreno-Perez V, Paredes V, Pastor D, et al. Under-exposure to official matches is associated with muscle injury incidence in professional footballers. Biol Sport. 2021; 38(4):563–71.
- Mueller MJ, Maluf KS. Tissue adaptation to physical stress: a proposed “Physical Stress Theory” to guide physical therapist practice, education, and research. Phys Ther. 2002; 82(4):383–403.
- Staniucha KO, Birse MS, Ferris ED, et al. Understanding Anterior Cruciate Ligament Adaptation: Structural, Mechanical, and Healing Considerations. Sports Medicine. 2026.
- Moreno-Perez V, Del Coso J, Lopez-Del Campo R, et al. Reduced Match Exposure in the Previous 2 Matches Accounts for Hamstring Muscle Injury Incidence in Professional Football Players. Sports Health. 2024; 16(1):109–14.
- Manuel Clemente F, Pillitteri G, Palucci Vieira LH, et al. Balancing the load: A narrative review with methodological implications of compensatory training strategies for non-starting soccer players. Biol Sport. 2024; 41(4):173–85.
- Milheiro A, Baptista I, Nakamura FY, et al. The Influence of Competition Time on Soccer Players’ Performance Factors: A Scoping Review with Evidence Gap Map. Sports Med. 2026; 56(1):169–99.
- Raya-Gonzalez J, Pulido JJ, Beato M, et al. Analysis of the Effect of Injuries on Match Performance Variables in Professional Soccer Players: A Retrospective, Experimental Longitudinal Design. Sports Med Open. 2022; 8(1):31.
- Pecci J, Sanchez-Trigo H, Mancha-Triguero D, et al. Return to performance: machine learning insights into how absence time following muscle injuries affects match running performance in LaLiga soccer players. Biol Sport. 2025; 42(4):275–86.
- Schwiete C, Roth C, Mester J, et al. Overlaps of Skeletal Muscle Fatigue and Skeletal Muscle Damage: The Muscle Injury Continuum. Sports Med Open. 2025; 11(1):73.
- Logerstedt DS, Ebert JR, MacLeod TD, et al. Effects of and Response to Mechanical Loading on the Knee. Sports Med. 2022; 52(2):201–35.
- Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med. 2009; 43(4):247–52.
- Warden SJ, Thompson WR. Become one with the force: optimising mechanotherapy through an understanding of mechanobiology. Br J Sports Med. 2017; 51(13):989–90.
- Sullivan A, Vanrenterghem J, Robinson MA, et al. Mapping adaptive processes in football: A scoping review of research approaches. Football Studies. 2026; 1:1–11.
- Hammond LE, Lilley JM, Pope GD, et al. The impact of playing in matches while injured on injury surveillance findings in professional football. Scand J Med Sci Sports. 2014; 24(3):e195–200.
- Leppanen M, Pasanen K, Clarsen B, et al. Overuse injuries are prevalent in children’s competitive football: a prospective study using the OSTRC Overuse Injury Questionnaire. Br J Sports Med. 2019; 53(3):165–71.
- O’Brien J, Finch CF, Pruna R, et al. A new model for injury prevention in team sports: the Team-sport Injury Prevention (TIP) cycle. Science and Medicine in Football. 2018.
- Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport. 2006; 9(1–2):3–9; discussion 10.
- Yuan J, Zeng Q, Wang A, et al. Machine Learning Applications in Non-Contact Lower Limb Sports Injury Prediction: A Systematic Review. J Sports Sci Med. 2026; 25(1):172–94.
- Dhahbi W, Jebabli N, Souaifi M, et al. Application of Artificial Intelligence for Predicting Sports Injuries and Customizing Personalized Prevention Strategies: A Scoping Review. Bioengineering (Basel). 2026; 13(6).
- Dergaa I, Barbaria S, Dhahbi W, et al. Toward autonomous artificial intelligence agents in sports science: a modular framework for development, validation, and implementation. Biol Sport. 2026;43:1353-426.
