BrJ Sports Med 1996;30:165-170

Risk assessment in professional football: anexamination of accidents and incidents in the1994 World Cup finals

Richard D Hawkins, ColinW Fuller

AbstractObjective-To assess the risks to foot-ballers' health and safety during com-petitive international matches, withidentification of the most common causesofinjury.Methods-Videos of 44 of the 52 matchesplayed during the 1994 World Cupfinals staged in the USA were analysed.During each match, several relevantvariables were recorded, including thenumber of fouls, injuries, treatments,times of incidents, identity of playerstreated or injured, and the injurymechanism. Additional information onplayers' injuries was obtained from theextensive media coverage ofthe event.Results-Only 29% of injuries resultedfrom foul play, whereas 71% of injuries toplayers occurred where no foul play wasadjudged by the referee to have takenplace (P < 0.01). Defenders were found tobe proportionately subjected to a greaterrisk ofinjury than other players (P < 0.05).Fifteen per cent of all injuries were judgedto be at least moderate, resulting in theplayer missing at least one match. Fre-quency of moderate injury was 1026injuries per 100 000 hours played.Conclusions-The major causes of in-juries during international football matcheswere not found to be associated with foulplay, as judged by the referees. However,in those cases where injuries occurredwithout a foul being committed, almost500/o involved player to player contact.This gives some cause for concern and isworth further investigation.(BrJSports Med 1996;30:165-170)

Key terms: professional football; injury; risk factors

Centre for Hazard andRisk Management,LoughboroughUniversity,Loughborough,Leics LEll 3TU,United KingdomR D Hawkins, researchstudentC W Fuller, lecturerCorrespondence to:Dr Colin Fuller.Accepted for publication27 November 1995

The ultimate aim of health and safetymanagement is the elimination of accidentsand ill health: in the case of professionalfootball this would be equivalent to keeping allplayers fit, at all times, thereby allowing theclub management to select from an injury-freesquad. The benefits of such a situation accrueto both individual players, by possibly en-hancing and prolonging their playing careers,and to the football clubs themselves, bymaximising the return on their investment.One step towards achieving this aim would beto undertake an assessment of the risks toplayers' health and safety.' In the United

Kingdom, such an assessment is a generalrequirement of the Health and Safety at Work(HASAW) Act 19742 and a specific require-ment of the Management of Health and Safetyat Work (MHSW) Regulations 1992.' In riskassessment the emphasis is on preventingaccidents by identifying potential hazards(cause of injury), and determining the likeli-hood (frequency of injury) and consequences(extent of injury) of accidents arising from thehazards. Inadequacies in risk management,highlighted by the assessment, then help todetermine the additional control measures thatneed to be implemented.One of the underlying principles of suc-

cessful health and safety management is losscontrol.4 The adoption of a total loss controlapproach seeks to identify and eliminate allincidents, irrespective of whether or not theyresult in injury. The severity of the outcome ofan incident often depends on chance if hazardsare not properly identified and the associatedrisks not controlled. Therefore, since theoutcome of an incident cannot be accuratelypredicted, the only reasonable way in which toreduce injuries is to control all of the under-lying causes. The use of accident triangles inloss control theory shows the relations betweenmajor injuries, minor injuries, and non-injuryincidents.5

Incidents are seldom inevitable randomevents, and even though their immediatecauses in professional football may differ, suchas an unfair tackle or a shot on goal, theunderlying cause may be similar. Injuries areusually the result of multiple causes, and it isthe intrinsic and extrinsic factors alike, whetherthey be training aspects, management tactics,or individual attributes and attitudes, that needto be identified and controlled. The causalpathways are complex and the identificationand examination of one possible risk factor canonly partly begin to address the question ofinjury prevention. Accurate information con-cerning injuries is required, together withphysical and physiological knowledge of theindividual players to enable positive steps to betaken regarding injury prevention.

In professional football, research has pre-viously identified that the majority of injuriesoccur during competitive games.6 7 Thereforeit is essential as part of the overall riskassessment process to gain a closer insight intothe types, causes, and frequencies of injuries toprofessional footballers during competitivegames.

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MethodsThe 1994 World Cup finals, staged in theUSA, provided a four week period of intensefootball activity, which gave the opportunityof analysing injuries arising from the highestlevel of international football. During thecompetition a total of 52 matches were playedand for this study 44 televised matches wererecorded on videotape for analysis.For each match, situations in which a free

kick occurred arising from player contact andsituations in which a player received treatmentwere recorded. The following variables wereidentified where appropriate for eachincident:

(1) the playing time elapsed in minutes asshown on the video recorder;

(2) whether the treatment was a result of a foul(as indicated by the referee);

(3) whether the foul was judged (by thereferee) to be against or for the treatedplayer;

(4) whether no foul was judged (by the referee)to have occurred even though a player wasinjured.

For each treatment additional informationwas recorded:

(1) the identity of the player(s) involved;(2) his playing position;(3) the injury mechanism;(4) future involvement in the game (for

example, was he taken off immediately,taken off later, or did he complete theremainder of the game?).

Analyses of both the video recording andnewspaper reports confirmed the identity ofplayers involved in all analysed games, times ofsubstitutions, and the players cautioned or sentoff. Any additional relevant information frommatch commentaries and newspaper reportswas also recorded. The wide and extensivemedia coverage enabled complete team profilesto be constructed, and allowed reasons forgame to game team changes to be identified(for example, suspension, injury). In per-forming statistical analyses the incidents wereassumed to follow a Poisson distribution andthe x2 significance test was used; statisticalsignificance was accepted at the P < 0 05 level.

ACCIDENT/INCIDENT ASSESSMENT

Accident ratio trianglesThe ratios between accidents and incidents ofvarying levels of severity can be representedas accident triangles. For general accidentanalysis, the Health and Safety Executive(HSE)5 identified three categories and definedthem as: over-3-day injury accidents; minorinjuries (for example, first aid only); and non-injury accidents or incidents. The work ofEkstrand and Gillquist8 could be representedin this way, with four categories beingidentified: major - absence from practice formore than one month; moderate - absencefrom practice for more than one week but lessthan one month; minor - absence frompractice for less than one week; and non-injuryincidents (see below). Three levels of accident

and incident were defined and used in thisstudy.* "Moderate" injury: players received treat-ment on the field of play, or were otherwiseidentified as having been injured, and sub-sequently missed at least the followinggame.

* "Minor" injury: players received treatmenton the field of play, or were otherwiseidentified as having been injured, but wereinvolved in the following game.

* "Non-injury" incident: fouls (referee's judge-ment) not resulting in injury or treatment.

"Free-kicks": relates solely to fouls arisingfrom player contact (excludes off-side, dissentetc).The ratios between accidents of varying

levels of severity were represented as accidenttriangles.

Injuryfrequency rates (IFR)Accident frequency rates can be comparedwith accident statistics published by externalsources, such as the HSE. They are usuallycalculated per 100000 hours worked. The for-mula used for calculating accident frequencyrate (AFR) is:

Number of injuries in periodX 100000AFRT= . . x

perioTotal hours worked during period

The total hours worked during a period takesinto account the number of hours worked andthe number of people involved. In exactly thesame way IFRs in professional football can becalculated per 100 000 hours played and becompared with industrial figures.

ResultsThe 44 World Cup games analysed, four ofwhich included extra time, represented 85% ofthe total playing time during the competition.In addition, 44 matches approximates closelyto the typical number of league matches playedby each club in the English Premier League(1994/95 - 42) and First Division (1994/95 -46). Before the start of the World Cupcompetition all referees were briefed on therequired standards by FIFA: hence the level ofrefereeing over the period would be expectedto be reasonably consistent. During the 44World Cup games analysed, 1272 fouls werecommitted in the referees' judgement, re-sulting in an average of 28-9(SD 5 4) free kicksper game. There was a total of 94 treatments,made up of 33 (35%) resulting from a foulcompared to 61 (65%) where no foul had beencommitted (P < 0 0 1). Of the 33 treatmentsassociated with free kicks, 10% were given tothe culprit himself, and 90% to the victim. Inaddition to the 94 treatments described abovethere were 20 other instances, throughout theanalysed games, where players were judged tobe injured but received no treatment during thecourse of the game. These injuries could notbe associated with a foul and as the timing andmechanisms of these injuries were not knownthey could not be used in several ofthe analysescarried out.

Hawkins, Fuller

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Accidents and incidents in the World Cupfinals

Z1\<.4MajorZu u *4 Moderate

30 \ * Minor

600

0

Period of game (min)

Figure 1 Total number offree kicks in each quarter of thegame.

FOULS AND INJURIESMatches during the competition typicallyconsisted, with injury time, of two periods of50 min play. For the purposes of analysis, thisplaying time was split into four periods ofapproximately equivalent times (that is, 0 to 25min, 25 min to half time, start of the 2nd half(45 min) to 70 min, and 70 min to full time).Figure 1 shows the number of free kicksawarded and fig 2 shows the number of playertreatments in each period. Free kicks andtreatments occurring during the extra timeperiods in the four matches were not includedin these figures. The greatest number of freekicks occurred in the first 25 minutes (30%,P < 0 0 1), although there was no statisticalsignificance in the difference between the twohalves (53% v 47%). There was, however, asignificantly greater number of treatments inthe second half (61%, P<0-05), with 36%occurring in the first 25 min after half time.Based on the typical 1:4:4:2 (goalkeeper,

defenders, midfielders, forwards) playing sys-tem used by teams in the competition, astatistically significant difference was foundbetween the incidence of injury and number ofplayers for defenders and midfielders (43% v36% and 26% v 36%, respectively, P < 0 05).However, the ratio of injuries arising from foulscompared to other causes showed no signifi-cant differences between playing positions.The kick off times for matches had no sig-

nificant influence on the incidence of injuries,the number being evenly distributed acrossmid-day, afternoon, and evening games.

4- Potential incident

Figure 3 A typicalfour category accident triangle.

ACCIDENT RATIO TRIANGLESThe approach used by Bird and Germain9 andHeinrich"0 to analyse the underlying causes ofinjuries was used. The technique involvesdetermining the ratios of major, moderate,minor, and non-injury incidents occurring inthe area of work being analysed. From thesedata it is then possible to construct accidenttriangles and compare the results with otheractivities. A typical accident ratio triangle isshown in fig 3.4

ALL "INJURIES"There was a total of 17 moderate injuries, 97minor injuries, and 1239 "no injury" (fouls)incidents recorded during the World Cupcompetition. Therefore, for every moderateinjury that prevented participation for a mini-mum of one game there were six minor injuriesand 73 incidents which could potentially haveled to an injury (fig 4).These results can be subdivided into two

categories: those injuries resulting from foulsand those where no foul was committed.

"Injuries" resultingfrom foulsFrom the 1272 fouls recorded, three incidentsresulted in moderate injuries, with a further 30classified as minor injuries. These resultsincluded one case where a player sustained afractured skull in his country's final game andas this would definitely have caused him tomiss any subsequent games the injury wascategorised as moderate. Three other playerswere treated in their countries' final games, oneof whom was substituted. It was assumed,however, in the absence of other informationthat they would have been fit if any furthergames had been played, and so these injurieswere classed as minor. This produced anaccident ratio of 1:10:413, shown in fig 5.

1 P- Moderate

/6 G s- Minor

73 \- Free kick

Figure 4 Accident ratiosfor al injuries with respect topotential incidents.

1 i\ Moderate

1\0 Minor

413 - Free kick

Figure S Accident ratios for injuries resultingfrom foulswith respect to potential incidents.

400 rC),._0)i20)

00).0Ez

300 h-

200 F-

100 H

Co

C

C

0

Ez.

Period of game (min)

Figure 2 Total number of treatments in each quarter of the game with respect torefereeing decision.

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Hawkins, Fuller

5/ \ 4 - Moderate

22 4- Minor

Figure 6 Accident ratios for injuries where nofouls werecommitted.

"Injuries" not resultingfrom foulsFourteen injuries were judged to be at leastmoderate. Seven of the 14 received treatmentduring the game, the remainder did not. Therewere a further 67 minor injuries, 54 receivingtreatment during the game. Twelve of theinjuries occurred in a country's final game,with two of the players being substituted. Inthe 13 where they did not receive treatment,seven were substituted in their team's finalgame. By normalising the results on the injuriesresulting from fouls, there was then a ratio of5:22 moderate and minor injuries (fig 6).Possible underlying causes of these injuries arediscussed later.

INJURY INCIDENCE RATESIf the 24 teams represented in the World Cupused all 22 players in their squads then 528players would have been involved in the 52games. However, only two countries used alltheir players and in total 427 players wereinvolved. In the 44 games covered in thisanalysis a total of 412 players was involved.Therefore, the injury incidence in this study,per player for all injuries, was 27-7% (8-0%and 19-7% as a result of a foul and no foul,respectively), with moderate injuries rep-resenting 4-1% (0 7% and 3-4% as a result ofa foul and no foul, respectively) of the total.

INJURY FREQUENCY RATESFrom the number of moderate and minorinjuries recorded during the 44 games, theaverage frequency of injuries with respect to anindividual team and an individual player can becalculated (table 1).For the determination of injury frequency

rate (IFR), it was assumed that there were 100minutes in each standard game, 130 minutesin games where extra time was played, and that22 players were involved at all times. This givesthe total equivalent playing hours as 1657hours.From equation 1 the IFRs per 100 000 playinghours were calculated for both minor andmoderate injuries where fouls and no foulswere indicated (table 2).

Table 1 Average injuryfrequency rates for each team and individualplayersFouls No fouls

Minor Moderate Minor Moderate

TeamNumber of injuries/team-game 0 34 0 03 0-76 0-16Number of games for one team player to 2-9 29-3 1-3 6-3be injuredPlayerNumber of injuries/player-game 0-031 0-003 0-069 0-014Number of games for an individual player 32-3 322-7 14-4 69-1to be injured

Table 2 Injuryfrequency rates per 100 000 playing hours

Injuries/i 00 000 hours

Minor Moderate

Resulting from fouls 1811 181Not resulting from fouls 4043 845Total 5854 1026

The overall injury frequency rate was 6880injuries per 100 000 hours played.

DiscussionPrevious research on soccer injuries has inmost cases been based on youth" -'4 or semi-professional football.8 15 16 Other informationhas been obtained from hospital medicalrecords6 17 and insurance claims.7 In the casesof hospital records and insurance claims,detailed information concerning minor injuriesis unavailable and with information from thelower levels of soccer, the exercise intensity isless, with a smaller number ofphysical contactsthan with higher levels of competition'8;consequently the risk of injury may be lower.The main objective of this study was to addressthe issues of injury frequency and causation atthe international level. In this respect, the 1994World Cup finals provided an ideal oppor-tunity to observe and record a large number ofcompetitive games involving the best 24national teams in the world at the time. Withthe comprehensive media coverage, muchinformation was obtained which otherwisewould only be available from working directlywith the teams.

INJURY CAUSATIONAll injuries and treatments were divided intothose that resulted from a foul and those thatdid not. However, one problem was that thecause of some reported injuries could not beidentified; some players possibly received aninjury without receiving treatment and playedon. Twenty players were identified as havingsustained an injury during a game withoutreceiving treatment during the game; none ofthese injuries was the result of a foul. However,there were a further 34 instances throughoutthe whole tournament where players may havereceived minor or moderate injuries, duringtraining or games, resulting in their missinggames due to their injuries. The fact that thesewere not included in the analyses - togetherwith other training and playing injuries notreported - suggests that there may be anunderestimation of the level of injury. Thishypothesis is supported in a study byJorgenson,"9 where 47% of reported injuriesdid not receive medical attention but werestill defined as a handicap or preventingparticipation altogether.

In the present study 28-9% of all treatmentsreceived on the pitch were found to be theresult of a foul. This is a slightly higher levelthan that obtained by other investigators,6 19-21who have reported that fouls were responsiblefor 19-28% of game injuries. No correlationwas found, however, between free kicks andinjuries, and on the basis of the accident ratios,

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0

U)

.0

E

z)To

z

20 r

io V-

oTackled Collision Heading Tackling Foul

play

Injury mechanismFigure 7 Mechanisms of the player to player contactinjuries where no fouls were committed.

only 2/6% of fouls committed actually led toa player requiring treatment. Moderate injurieswere found to occur five times more frequentlywithout a foul being involved than to be theresult of a foul.Where an injury results from a foul, then the

cause of the injury can easily be identified.Sixty six per cent of these recorded treatmentswere due to players sustaining an injury whenbeing tackled, the free kick being awarded infavour of the injured player in 95% of thosecases. The laws of the game are written toprotect players from such incidents, and thefew injuries sustained from foul play comparedto other causes seem to suggest that the lawsact as a deterrent and are being properlyenforced. There are occasions, though, whereno fouls have been deemed by the referee tohave been committed but injuries still arise.The immediate causes of these are not alwaysidentifiable; however, of the 81 injuriesanalysed in this category (minor and mod-erate), 49% were associated with contact withanother player, 20% did not involve anotherplayer, and in 31% an immediate cause couldnot be established from the informationavailable. An analysis of the events leading tothe player to player contact injuries is shownin fig 7. The high number of injuries arisingfrom player to player contacts, which were notdeemed to be fouls, gives some cause forconcern and is worth further investigation todetermine whether minor changes to the lawsof the game could reduce this figure. Overall,64% of the observed injuries involved player toplayer contact, which is in accordance withresults reported by other researchers: Hoff andMartin14 reported 66% and Sandelin et a1752%.The results showed that 43% of injuries were

sustained by defenders, indicating that they aresubjected to a greater risk of injury than otherplayers, a finding similar to that of Huntand Fulford,'5 who reported that defenders

Table 3 Industrial accidents andfootball injuries per 100 000 working andplaying hoursrespectively

Accidents/Incidents per 100 000 working/playing hours

Employment category "Over-3-day injuries" Missing at least one game

Open cast coal workings 1-8Construction 0-6Banking and finance 0-04Professional football - 1026

sustained 55% of 200 injuries researched.Ekstrand and Gillquist,5 however, did not findany difference in the incidence of injurybetween playing positions. Comparisons ofdifferent investigations are difficult owing tothe different designs and populations understudy, but the high injury incidence amongdefenders in the World Cup could well beattributed to the attacking football that wasencouraged through recent FIFA directives,and the need for defenders to take greater risksand be more reactive to prevent attackingsituations developing and goals being scored.

Injuries were more common in the secondhalf of matches (P < 0 05), and although thetime of day of the games had no effect on thenumber of injuries, heat stress could well havebeen a contributory fatiguing factor, as severalgames were played in excess of 1 000F. In anumber ofgames, the incidence ofnon-contactinjuries was particularly high in the first fiveminutes of the second half. This may reflect ageneral failure to maintain muscle flexibilityduring the extended mid-game breaks whichwere common during the competition. Detailson the mechanism and aetiology of injurieswere not available, though, to make informedjudgements on this.

INJURY FREQUENCY RATESFor each team the average injury incidence formoderate injuries was 113/1000 game hours;this is lower than the 300/1000 game hoursreported by Ekstrand and his colleagues.16However, as discussed above, the figuresreported in this study are considered to beconservative as there may be injuries whichhave not been identified. The total injuryincidence was 27-7% per player, which issimilar to the figures reported by Jorgenson'9and Hoy et al,6 of 36% and 18% respectively.For "moderate" injuries alone the incidencewas 4-1%, which can be compared to "over-3-day injuries". The highest incidence of thesereportable (over-3-day) injuries in industry isfor open cast coal workings, where there is anincidence rate of 4 4% per employee per year,while the average rate for all industries is 0 7%per employee per year.22

Industrial accident frequency rates in theUK are normally reported as accidents per100 000 working hours. The industrial cat-egory of accidents resulting in more than threedays' absence from work can be consideredequivalent to the "moderate" category used inthis study of football injuries, and examples ofthese are compared in table 3.Compared to the accident statistics issued by

the Health and Safety Commission, the injuryfrequency rates in football are three orders ofmagnitude higher than in many industries. Putin another context, based on the frequency offootball injuries, the average person who worksa 40 hour week in industry would expect toobtain a moderate injury and be absent fromwork for at least three days every third week.

INJURY COSTSThe financial loss to professional football clubsdue to injuries is not known. There have been

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170 Hawkins, Fuller

reports of insurance companies paying outlarge sums ofmoney,'7 but these most probablydo not compensate for the direct costs (forexample, medical treatment, player's wageswhile unable to play) and indirect costs (forexample, loss of matches, buying a replace-ment player) incurred by clubs. In a SwedishDivision IV team (semiprofessional) Ekstrand23reported a loss of $US 420 000 due to medicalcare costs and sick leave over one season.

In industry the subject of the costs ofaccidents is more clearly understood andappreciated. Compensation received by peopleinjured at work often involves large sums ofmoney; however, the extent of the losses fromless serious injuries is not so well known. TheHSE's Accident Prevention Advisory Unit5conducted a series of case studies, the aimbeing to accurately identify the full cost ofaccidents. In football, equivalent costs mayinvolve medical fees, increased insurancepremiums, and reduced income from lowermatch attendances. Few clubs, if any, havethe mechanism or resources to identify thelosses separately, and probably none actuallyidentify and examine them systematically. Theaccident ratios reported by the HSE can beconveniently compared with those repres-enting all the injuries reported in the presentstudy, giving some indication of the possibleextent of the preventable financial losses thatclubs sustain. Four studies produced anaverage accident ratio of over-3-day injuryaccidents: first aid only: non-injury accidentsof 1:7:189 which is comparable to the figuresin the present study of 1:6:73. The averageannualised reported loss for each company wasover £1.2 million.

In professional football, especially at thehighest level, the financial consequences ofinjuries to clubs is expected to be proportion-ately more than in industry, as the relativenumber of injuries in football greatly over-

shadows industrial figures. To accuratelyidentify the full cost of injuries to a professionalfootball club requires an in depth investigationand our current research is addressing thisissue.

1 Fuller CW. Implications of health and safety legislation forthe professional sportsperson. Br J Sports Med 1995;29:5-9.

2 Health and Safety at Work etc. Act 1974. London: HMSO,1974.

3 Management of Health and Safety at Work Regulations 1992(SI 1992 No 2051). London: HMSO, 1992.

4 Health and Safety Executive. Successful health and safetymanagement. HS(G)65, 1993.

5 Health and Safety Executive. The costs of accidents at work.HS(G)96, 1993.

6 Hoy K, Lindblad BE, Terkelsen CJ, Helleland HE.European soccer injuries: a prospective epidemiologic andsocioeconomic study. Am J Sports Med 1992;20:318-22.

7 Sandelin J, Santavirta S, Kiviluoto 0. Acute soccer injuriesin Finland in 1980. BrJ Sports Med 1985;19:30-3.

8 Ekstrand J and Gillquist J. Soccer injuries and theirmechanisms: a prospective study. Med Sci Sports Exerc1983;15:267-70.

9 Bird FE, Germain GL. Damage control. New York:American Management Association Inc, 1966.

10 Heinrich HW. Industrial accident prevention: a safetymanagement approach. New York: McGraw Hill, 1959.

11 Yde J, Nielsen AB. Sports injuries in adolescents' ballgames: soccer, handball and basketball. Br J Sports Med1990;24:51-4.

12 Schmidt-Olsen S, Bunemann KH, Lade V, Brassoe JOK.Soccer injuries ofyouth. BrJ Sports Med 1985;19:161-4.

13 McCarroll JR, Meaney C, Sieber JM. Profile ofyouth soccerinjuries. Phys Sportsmed 1984;12:113-7.

14 Hoff GL, Martin TA. Outdoor and indoor soccer: injuriesamong youth soccer. Am J Sports Med 1986;14:231-3.

15 Hunt M, Fulford S. Amateur soccer: injuries in relation tofield position. BrJ' Sports Med 1990;24:265.

16 Ekstrand J, Gillquist J, Mueller M, Oberg B, Liljedahl SO.Incidence of soccer injuries and their relation to trainingand team success. Am J Sports Med 1983;11:63-7.

17 Roass A, Nilsson S. Major injuries in Norwegian football.BrJ Sports Med 1979;13:3-5.

18 Ekblom B. Applied physiology of soccer. Sports Med1986;3:50-60.

19 Jorgensen U. Epidemiology of injuries in typical Scan-dinavian team sports. BrJ' Sports Med 1984;18:59-63.

20 Engstrom B, Forssblad M, Johansson C, Tornkvist H. Doesa major knee injury definitely sideline an elite soccerplayer? Am J Sports Med 1990;18: 101-5.

21 Nielson AB, Yde, J. Epidemiology and traumatology ofinjuries in soccer. AmJISports Med 1989;17:803-7.

22 Health and Safety Commission. Health and safety statistics:statistical supplement to the 1993/94 annual report. London:HMSO, 1994.

23 Ekstrand J. Soccer injuries and their prevention. Linkoping,Sweden: Linkoping University, 1982. [Medical disser-tationNo 130.]

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 R D Hawkins and C W Fuller the 1994 World Cup finals.examination of accidents and incidents in Risk assessment in professional football: an

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