By Lisa Rapaport

(Reuters Health) – Injured soccer players with few practices before they return to competition are more likely to get hurt than those who get in additional training sessions, a recent study suggests.

Professional soccer players have a high risk of injury, and matches are associated with a seven-fold greater risk than practices, researchers note in the British Journal of Sports Medicine. Previous injury and returning to play too soon afterward are both leading risk factors for re-injuries and for new injuries.

In the current study, researchers examined data on 303,637 matches among Union of European Football Associations (UEFA) Champions League teams, which include the top professional soccer teams in Europe. Data included 4,805 matches involving players returning to the field after moderate-to-severe injuries that sidelined them for at least eight days.

Injury rates were 87% higher during players’ first match after an injury than they were for typical matches during the season, the study found.

With each practice session prior to the first match after an injury, players’ risk of another injury dropped by 7%, the study also found.

“While we can’t say anything about the content of those training sessions, our data suggests that if they complete 6 training sessions after they have been cleared by the medical team to fully participate in all team activities but before they play a game, the risk of injury in that game is only marginally higher than the average risk in matches,” said Hakan Bengtsson, lead author of the study and a physiotherapist with the Football Research Group at Linkoping University in Sweden.

The biggest risk for repeat injury occurred with four practices prior to the first match, Bengtsson said, and it’s possible some athletes might not be able to wait for six training sessions due to game schedules or other factors.

But the results still underscore that rehabilitation alone may not be sufficient to prevent repeat injuries, Bengtsson said by email.

“It may be difficult to design a rehabilitation protocol that mimics what a player will be expected to do in a game,” Bengtsson added. “When the player returns to full team training it will be more similar to actual game play and thus full team training offers a better environment for the athlete to build tolerance to what he will be exposed to in matches.”

The injury rate per 1,000 hours of competition was 46.9 for injured athletes in their first match back after an absence, compared with an average of 25 per 1,000 hours across all matches.

When researchers focused just on muscle injuries, which are among the most common in soccer, the difference was starker. The average muscle injury rate across all matches was 9.5 per 1,000 hours of play, compared with 24.6 per 1,000 hours for injured athletes in their first game back.

The study wasn’t designed to prove whether or how any specific rehab or practice regimen affects the risk of repeat injuries when sidelined athletes return to competition.

Even so, “This study suggests through completing additional training sessions before returning to match play, a reduction in the risk of subsequent injury, especially muscle-related subsequent injuries, occurs,” said Liam Toohey, a physiotherapist at the Australian Institute of Sport who wasn’t involved in the research.

“This study does not provide any detail surrounding what are the most effective frequency, intensity or type of training sessions before returning to match play – the aspects of training and rehabilitation content are areas that requires further research,” Toohey said by email.

SOURCE: British Journal of Sports Medicine, online August 29, 2019.