Eduard Bezuglov, Oleg Talibov, Mikhail Butovskiy, Anastasiya Lyubushkina, Vladimir Khaitin, Artemii Lazarev, Evgeny Achkasov, Zbigniew Waśkiewicz, Thomas Rosemann, Pantelis T. Nikolaidis, Beat Knechtle and Nicola Maffulli

Thirty-one to 41 % of all injuries in soccer involve the muscles, with most occurring in the thigh. The hamstring muscles account for up to 37 % of all muscle injuries in soccer players, a number on the increase. The second and third most prevalent injuries are the injuries of the adductor muscles of the hip and the quadriceps femoris muscle (23 % and 19 %, respectively). Muscle injuries in elite male football constitute to about a third of total time loss. Hamstring injuries are on the rise and now account for nearly one in every four injuries.

Age, previous history of injuries, imbalance between strength and flexibility, and decrease in both eccentric power and mobility all play an important role in non-contact muscle injury. Eccentric exercises aimed at hamstrings are currently considered the best method to prevent their injury. Most often, muscle injuries occur during eccentric contraction, and eccentric exercises should be included in training programs to prevent muscle injury. Some studies high­lighted the association between lumbar and pelvic mobility and the frequency of hamstring injury.  

Prayer (also called Salat and Namaz) is a traditional Muslim prayer. In traditional Islam, Salah is performed five times a day. Each Salah consists of a set of repeated movements called Rakats. Up to 48 Rakats may be performed daily, and at least 17 of them are mandatory. Rakat consists of a specific sequence of 7 to 9 postures. Therefore, the overall number of postures taken when performing Salah cannot be less than 119 per day. Each of the nine postures has a specific duration, which varies from 3 – 4 to 40 – 60 s. 

The regular practice of Salah may positively impact an individual’s health, including the health of the musculoskeletal, cardiovascular, and nervous systems. 

Sitting (Jalsa), Bowing (Ruku), and prostration (Sajdah) postures involve all the muscles of the lower limb and the lumbosacral spine, as well as all the large joints. Most of the movements in these postures involve eccentric loading of certain muscles of the lower limbs. The total time spent in these postures during the day is at least about 20 min.

Bowing posture strengthens the back and increases hip mobility and the mobility of the popliteus tendon. It reduces spinal, back, and neck stiffness and helps to improve body posture, balance, and coordination. Performing movements similar to Bowing positively affects the lower spine and body stability.

Sitting posture leads to the extension of the muscles of the shins and buttocks and to the maximum flexion of the knee joint. This and similar postures reinforce the core and mus­cles and the mus­cles of the lower back, an important factor in preventing the development of pain in this region. The regular performance of Salah by soccer players may affect their rate of muscle injuries.

The prevalence of non-contact muscle injuries, including hamstring injuries, were lower in soccer players who regularly perform prayer (Salah). Although the reasons for such finding is likely to be multifactorial, this could be attributed to eccentric lengthening of the muscles of the lower limbs during certain movements undertaken several times per day during prayers plays a major role. 

Literatur

1. Eduard Bezuglov, Oleg Talibov, et al. The prevalence of non contact muscle injuries of the lower limb in professional soccer players who perform Salah regularly: a retrospective cohort study. J Orthop Surg Res. 2020; 15: 440.
2. López-Valenciano A, Ruiz-Pérez I, Garcia-Gómez A, Vera-Garcia FJ, De Ste Croix M, Myer GD, Ayala F. Epidemiology of injuries in professional football: a systematic review and meta-analysis. Br J Sports Med. 2019. 10.1136/bjsports-2018-099577.
3. Hägglund M, Waldén M, Magnusson H, et al. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA champions League injury study. Br J Sports Med 2013;47:738–42.
4. Hickey J, Shield AJ, Williams MD, et al. The financial cost of hamstring strain injuries in the Australian football League. Br J Sports Med 2014;48:729–30.

Insufficient preparation and recovery time for players

The 2022 world cup was the first edition of the tournament held during the winter. Most players arrived only few days before the tournament, expected to perform at their highest level after a demanding period of club matches in their domestic leagues and continental competitions. 

• Less than 50 % of players believed they had sufficient time to prepare for the 2022 FIFA World Cup, espe­-
  cially those whose teams progressed to at least the quarter-finals.
• 75 % of surveyed players from these teams reported inadequate time to prepare for the tournament. 
• Around 68 % of the players stated that optimal preparation time should be between 14 – 21 days (Fig. 1& 2). 

Condensed match schedule result in an intense workload on the players

Due to the winter timing, the World Cup had a compressed schedule with 64 matches played in just 29 days. This put intense physical demands on players. Even with 32 participating nations, the tournament became the shortest one since the 1978 tournament which featured only 16 teams. Players at the top of the game were pushed to their limits as many of them experienced an alarming increase in their already heavy workload without having sufficient time to recover between the games (Fig. 3). 

Impactful extended stoppage time 

During the World Cup, players experienced extended stoppage times as referees were instructed to follow a new interpretation. During this immensely congested schedule, this change led to several matches that were unusually long, often exceeding 100 minutes in length. 

This increase in playing time may seem small, but it could have a significant impact on the players’ workload, rest and recovery and conditioning. By requiring players to spend more time on the field, it could put ­additional strain on their bodies and potentially increase the risk of injury. If this new interpretation was adopted more widely across all compe­titions, players would be forced to cope with longer effective playing times amid their already overloaded match calendars. The average stoppage time was around 11.6 minutes at the 2022 tournament (excluding matches that went into extra time). This is a significant, almost 60 % increase compared to the World Cup in Russia four years prior. 53 % of surveyed players liked the new interpretation of stoppage time rules at the FIFA WORLD CUP™ but stressed that widespread adoption could be only supported if the extended playing time impact was accounted for in fixture planning.

Inadequate recovery and  its impact on player’s physical and mental health

One of the main challenges for players after the conclusion of the 2022 FIFA World Cup™ was the short turnaround between the end of the tournament and the resumption of club football. The majority of the players surveyed (61 %) indicated that they would like to have had 14 – 21 days for recovery before returning to play with their clubs. 67 % of Germany-­based players felt positive about the time for recovery, as the Bundesliga resumed only in mid-­January. Only 38 % of England-based players felt that they had enough time for reco­very. The consistent imbalance between workload and recovery is likely to lead to increase risk of injuries, both phy­sical and mental, to players. Mental fatigue, 20 % of players reported experiencing extremely high levels of mental or emotional fatigue at this time of the season (January) compared to usual at this point in a regular season with a further 23 % feeling more mental fatigue than usual (Fig. 4). 

Physical fatigue, 44 % of players experienced extreme or increased levels of fatigue compared to how they usually feel at this time of the season (January). Unfortunately, as we have seen in the post-tournament period, this accumulated fatigue has likely contributed to a number of leading players suffe­ring soft-tissue injuries as extreme fixture congestion continues (Fig. 5). Injury risk, accor­ding to the FIFPRO survey, 52 % of players reported suffe­ring an injury or feeling more susceptible to injury due to the congested schedule. Interestingly, this trend was more prominent among non-first time World Cup players, who tend to be older, more experienced, and have a better understanding of their bodies, with 75 % of them reporting such injuries or susceptibility.

Since the start of the World Cup, there have been 66 players who suffered an injury, according to media reports. This equates to approximately 8 % of all players who participated at the tournament in Qatar. These players had 76 injuries in total as some recorded more than one. It is also strongly assumed that minor injuries often go unreported, hence the actual number could even be higher. 

58 % of reported injuries occurred du­ring the World Cup, while 42 % happened after the conclusion of the tournament. Key players for both club and country such as Virgil van Dijk (Liverpool FC), Aurelien Tchouameni (Real Madrid CF), Marcelo Brozovic (FC Internazionale Milano), Angel Di María (Juventus FC) all picked up an injury very soon upon returning to their clubs (Fig. 6).

Burden of player participation on leagues and clubs

For the 2022 World Cup, 55 different leagues had at least one player at the tournament. The Premier League is the standout in this ranking: 13 players from the English top division accumulated    more than 33,000 minutes during the tournament. This is almost equal to the combined record of the second and third ranked leagues (Spanish La Liga and Italian Serie A). Subsequently, this places a significant workload on players during the season. On top of to their regular workload, they were now subjected to a mid-season interruption and additional matches at the World Cup.

Clube  most affected by World cup participation are Manchester city who had 16 players reached close to 5,200 combined World Cup minutes; they are followed by FC Barcelona with 4,741 minutes (17 players) and Manchester United FC with 4,364 minutes (14 players).

Conclusions of the FIFPRO Player Workload Monitoring (PWM) Report

• The unprecedented winter schedule of the 2022 FIFA World Cup™ posed many challenges for players, especially concerning the short turnaround between the end of the tournament and the resumption of club football. Several players were subject to extremely limited rest and recovery times, increasing the risk of injury and hinder performance optimisation.
• 86 % of participating players want a preparation period of at least 4 days going into the World Cup, with the vast majority seeking 14 – 21.
• 52 % of players reported an injury or were concerned about the likelihood of getting injured due
  to the congested calendar.
• Only 11 % of players favour the November / December timing of the World Cup. 
• Those Findings should be consi­dered by the FIFA and tournament organizers in future tournaments and to be aware not only of timing and length of the tournament but also to listen to the player’s voice.