Lower injury rates for newcomers to professional soccer: a prospective cohort study over 9 consecutive seasons

Am J Sports Med. 2013 Jun;41(6):1419-25. doi: 10.1177/0363546513485358. Epub 2013 Apr 23.


Background: No study has investigated whether newcomers to professional soccer have a different injury rate than established players.

Purpose: The primary objective was to investigate whether being a newcomer to professional soccer influences injury rates. The secondary objective was to evaluate whether playing position and player age influence injury rates.

Study design: Cohort study; Level of evidence, 2.

Methods: Twenty-six soccer clubs, with 1401 players, were followed prospectively over 9 consecutive seasons between 2001 and 2010. Club medical staff recorded time-loss injuries and soccer exposure on an individual level. Cox regression analyses were used to evaluate associations between time-loss injuries and time in professional soccer, playing position, and age.

Results: In total, 6140 injuries and 797,389 hours of exposure were registered. A decreased general injury rate was observed for newcomers (n = 116) compared with established players (n = 3091) (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.99). In contrast, newcomers had a higher rate of fractures (rate ratio [RR], 1.77; 95% CI, 1.05-2.97), especially stress-related bone injuries (RR, 2.68; 95% CI, 1.08-6.69). Using goalkeepers as a reference, all outfield playing positions had significantly higher adjusted injury rates: defenders with an HR of 1.91 (95% CI, 1.64-2.24), midfielders with an HR of 1.78 (95% CI, 1.53-2.07), and forwards with an HR of 1.82 (95% CI, 1.55-2.14). Using players aged ≤21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68).

Conclusion: Newcomers to professional soccer had a lower general injury rate than established players but a higher rate of stress-related bone injuries. Being a goalkeeper was associated with lower injury rates than all outfield playing positions. Injury rates increased with age, a pattern that persisted after adjusting for playing position and match exposure.

Keywords: age; playing position; risk factor; soccer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Athletic Injuries / epidemiology*
  • Confidence Intervals
  • Europe / epidemiology
  • Fractures, Stress / epidemiology
  • Humans
  • Incidence
  • Male
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Soccer / injuries*
  • Time Factors
  • Young Adult