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Evaluation of team-doctor actions during football games in Japanese professional football
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Journal of Science and Medicine in Sport 12 (2009) 611–613
Original paper
Evaluation of team-doctor actions during football games in Japanese professional football Masaaki Takahashi a , Shigeo Fukuoka b , Akira Nagano a a
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Japan b Shizuoka Rheumatoid Arthritis, Orthopaedic, and Rehabilitation Hospital, Japan
Received 15 November 2007; received in revised form 21 April 2008; accepted 27 April 2008
Abstract There have been many studies on football (soccer) match injuries both in national leagues and international tournaments, including the World Cup. However, no previous study on the number and types of actions taken by a team-doctor during a football season has been investigated. The aim of this study is to investigate what actions and how much a team doctor acts during professional football matches in a typical season of the Japanese professional football league (J-League). Injuries were prospectively recorded by team doctors with a Japanese professional league club during the 2004 season. Data recorded by the attending doctor after each match included information relating to the injury, time of occurrence and actions taken by the doctor in response to the injuries. The activity of the doctor was graded into 6 categories (grade A to F). During the 42 official matches held throughout the 2004 season, a total of 67 doctor-actions were taken. The overall doctor-action frequency rate (DAFR) was 1.6 actions per match. This study demonstrated how the team doctor acts during an average football match, and provides some useful information for team-doctors who attend football matches. © 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. Keywords: Sports injury; Sports medicine; Soccer; Injury severity index
1. Introduction There have been many studies on injuries in professional football (soccer) matches in both national leagues and international tournaments including the World Cup and Olympic games.1–4 These studies investigated the epidemiology of the injuries5 and the period of absence due to the injuries.6 However, no previous study on actions taken by a team doctor during a football match in a national league or international tournament has been investigated. The Japanese Professional Football Association requires that a team doctor is necessary and should be in attendance on the bench at all official matches. The purpose of this study is to elucidate the types of interventions and how often the team-doctors of one league club E-mail address: [email protected] (M. Takahashi).
acted during matches in the 2004 season of the Japanese professional football league (J-League).
2. Methods Injuries were prospectively recorded by 9 team doctors who attended the matches of a J-League club during the 2004 season. Each doctor attended 4 or 5 matches on average during the season and recorded their actions for each game. Data recorded by the attending doctor after each match included information relating to the injury, time of occurrence and actions by the doctor in response to the injuries. The activity of the doctor was graded as follows: A, the doctor notices the injury, but just observes the player from the bench; B, the doctor goes to the sideline and observes; C, the player goes to the sideline and the doctor sees him there: D, the doctor goes on the pitch and treats the player there; E, the doctor goes
1440-2440/$ – see front matter © 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jsams.2008.04.006
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M. Takahashi et al. / Journal of Science and Medicine in Sport 12 (2009) 611–613
onto the pitch and accompanies the player off the field, with or without a stretcher; F, after action E, the doctor decides if the player must stop playing.
period of the season, then dipped in the middle of the season and was high towards the end of the season.
4. Discussion 3. Results There were 42 official matches for the team during the 2004 J-League season. In all, 67 doctor-actions were taken. The overall DAFR was 1.6 actions per match. The number of actions for each grade in all matches was: grade A = 20, grade B = 12, grade C = 7, grade D = 13, grade E = 10, grade F = 5. There were also matches where the doctor did not take action; the team-doctor took no action in 6 matches, which corresponded to 14.3% of all matches. The number of matches with only action A was 7 (16.7%). Accordingly, the percentage of matches where the doctor did not leave the bench (no action + action A) was 31%. This result indicates that the team doctor stayed on the bench throughout the match in 31% of matches. The number of matches where more than action B occurred was 29; in these, the DAFR was 1.8 actions per match. The percentages of matches between these where the doctor did not go onto the pitch (from no action to grade C) and those where the doctor went onto the pitch (from grade D to grade F) were calculated to be 50% each of all matches. Fig. 1 shows the number of the grade of the doctor actions in relation to time during the match. The number for actions taken by the doctor was relatively high in the first 30 min of the first half, and again high in the last 30 min of the second half. It is interesting to note that grade F occurred 60% in the first 15 min of a match. When assessed seasonally, the combination of the number and severity of the grade of actions was moderate in the first
Figure 1. The number of the grade of the doctor actions in relation to time during a match. Grade: A, the doctor notices the injury, but just observes the player from the bench; B, the doctor goes to the sideline and observes; C, the player goes to the sideline and the doctor sees him there: D, the doctor goes on the pitch and treats the player there; E, the doctor goes onto the pitch and accompanies the player off the field, with or without a stretcher; F, after action E, the doctor decides the player must stop playing.
This is the first study investigating the activity (actions) of team doctors in professional football matches. Although there have been studies on the incidence of injuries in the National professional football leagues or International tournaments,1–4 little attention has been given to how a team doctor acts during a match. Of course, a team doctor’s actions are primarily injury-driven; that is, as player injuries occur more frequently, so too will the actions of the team doctor also increase. Another unique feature of the present study is the development of a table to grade the actions of team doctors. This study documents that team doctors stayed on the bench (no action and grade A) throughout the game in 13 (31%) of the 42 matches. This rate will of course differ in different sports; one can speculate that the frequency and amount of team doctor actions per match in a collision sport, such as rugby football, would be greater than those in the present study.7,8 The overall doctor-action frequency rate (DAFR) was 1.6 actions per match, whereas in the two thirds of matches where the doctor left the bench, DAFR was 1.8 actions per match. Among the grades of actions, action A was the most frequent and predictably decreased to grade F. It should be noted that action C was an exception because it does not seem to occur as frequently; players more often go down on the pitch (grades D and E) than go to the sideline for treatment by the doctor (grade C). In relation to match time-periods, the number of actions taken by the doctor was relatively high in the first 30 min of the first half, and also high in the last 30 min of the second half. Although there is no other study of team doctor actions during match play, a study of the injuries sustained in matches during the 2002 World Cup9 found that fewer injuries occurred in the first 15 min of each half, and an increasing number occurred toward the end of each half, with injuries most frequently in the 31–45 min period followed by the 16–30 min period. In the present study, the numbers of doctor actions were not less frequent and grade F occurred 60% in the first 15 min of the first half; thus, a discrepancy exists between these two studies. Although a precise reason for this discrepancy in timing cannot be pinpointed, differences in the level of play by top players in an international tournament and that of regular professional play in the J-League should be considered as well as psychologically factors driving players in the first 15 min of match play. The combination of the number and the severity of the grade of the actions taken by team doctors were moderate in the first third of the season, then remained low during the middle of the season, and was high in the last third of
M. Takahashi et al. / Journal of Science and Medicine in Sport 12 (2009) 611–613
the season. Again, because the amount of doctor activity depends on the frequency and type of player injury, these time-related or seasonal changes in the activity of a teamdoctor reflects the changes in injuries that could be critical to professional football players’ future careers and the fortunes of their teams. A limitation of the current study is that there may be significant variability in data recorded by the multiple doctors who attended the team matches during the 2004 season. Some team doctors are more likely to go to the sidelines to observe or go on the field with a trainer even for a minor injury. Another limitation is the difficulty in collecting data that is scientifically indicative of the team doctor’s active role. Especially in football, whether a physician decides to get up from the bench or move to the sideline is a matter of style and preference in some ways, and might not be indicative of injury type, severity or risk. Also in football, physicians go onto the field with the trainer when called on by the referee; indeed, the number of times a doctor goes onto the field is primarily determined by the referee’s judgment. In addition, some of the field visits by trainers and doctors may not be for any real injuries, but where the player apparently goes down to try to draw a foul card against their opponent, or to waste time, or to take a breather. Thus, doctor actions as defined in the present study are not only directly relevant to injury, but are also a reflection of doctor-style, team-style and the referee. However, the present study does provide an examination of what a team doctor actually does at professional football games and provides a basis for future studies of teamdoctor actions and injury frequency in professional football games.
613
Acknowledgements We would like to thank the following team-doctors for access to their records: Dr. Koukai Kin, Dr. Tsuyoshi Ohishi, Dr. Satoru Sakata, Dr. Shun Doi, Dr. Kenichi Naito, Dr. Kouzou Hasegawa, Dr. Masashi Abe, Dr. Mitsuhito Doi, and Dr. Daisuke Suzuki. We wish to thank Gregory O’Dówd for his assistance in proofreading this paper.
References 1. Nielsen AB, Yde J. Epidemiology and traumatology of injuries in soccer. Am J Sports Med 1989;17:803–7. 2. Arnason A, Gudmundsson A, Dahl HA, Jóhannsson E. Soccer injuries in Iceland. Scand J Med Sci Sports 1996;6:40–5. 3. Luthje P, Nurmi I, Kataja M, Belt E, Helenius P, Kaukonen JP, et al. Epidemiology and traumatology of injuries in elite soccer: a prospective study in Finland. Scand J Med Sci Sports 1996;6:180–5. 4. Junge A, Dvorak J, Graf-Baumann T, Peterson L. Football injuries during FIFA tournaments and the Olympic Games, 1998–2001: development and implementation of an injury-reporting system. Am J Sports Med 2004;32(Suppl. 1):80S–9S. 5. Hawkins RD, Fuller CW. An examination of the frequency and severity of injuries and incidents at three levels of professional football. Br J Sports Med 1998;32:326–32. 6. Hagglund M, Walden M, Ekstrand J. Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001. Scand J Med Sci Sports 2003;13:364–70. 7. Bathgate A, Best JP, Craig G, Jamieson M. A prospective study of injuries to elite Australian rugby union players. Br J Sports Med 2002;36:265–9. 8. Hoskins W, Pollard H, Hough K, Tully C. Injury in rugby league. J Sci Med Sport 2006;9:46–56. 9. Junge A, Dvorak J, Graf-Baumann T. Football injuries during the World Cup 2002. Am J Sports Med 2004;32(Suppl. 1):23S–7S.
Journal of Science and Medicine in Sport 12 (2009) 611–613
Original paper
Evaluation of team-doctor actions during football games in Japanese professional football Masaaki Takahashi a , Shigeo Fukuoka b , Akira Nagano a a
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Japan b Shizuoka Rheumatoid Arthritis, Orthopaedic, and Rehabilitation Hospital, Japan
Received 15 November 2007; received in revised form 21 April 2008; accepted 27 April 2008
Abstract There have been many studies on football (soccer) match injuries both in national leagues and international tournaments, including the World Cup. However, no previous study on the number and types of actions taken by a team-doctor during a football season has been investigated. The aim of this study is to investigate what actions and how much a team doctor acts during professional football matches in a typical season of the Japanese professional football league (J-League). Injuries were prospectively recorded by team doctors with a Japanese professional league club during the 2004 season. Data recorded by the attending doctor after each match included information relating to the injury, time of occurrence and actions taken by the doctor in response to the injuries. The activity of the doctor was graded into 6 categories (grade A to F). During the 42 official matches held throughout the 2004 season, a total of 67 doctor-actions were taken. The overall doctor-action frequency rate (DAFR) was 1.6 actions per match. This study demonstrated how the team doctor acts during an average football match, and provides some useful information for team-doctors who attend football matches. © 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. Keywords: Sports injury; Sports medicine; Soccer; Injury severity index
1. Introduction There have been many studies on injuries in professional football (soccer) matches in both national leagues and international tournaments including the World Cup and Olympic games.1–4 These studies investigated the epidemiology of the injuries5 and the period of absence due to the injuries.6 However, no previous study on actions taken by a team doctor during a football match in a national league or international tournament has been investigated. The Japanese Professional Football Association requires that a team doctor is necessary and should be in attendance on the bench at all official matches. The purpose of this study is to elucidate the types of interventions and how often the team-doctors of one league club E-mail address: [email protected] (M. Takahashi).
acted during matches in the 2004 season of the Japanese professional football league (J-League).
2. Methods Injuries were prospectively recorded by 9 team doctors who attended the matches of a J-League club during the 2004 season. Each doctor attended 4 or 5 matches on average during the season and recorded their actions for each game. Data recorded by the attending doctor after each match included information relating to the injury, time of occurrence and actions by the doctor in response to the injuries. The activity of the doctor was graded as follows: A, the doctor notices the injury, but just observes the player from the bench; B, the doctor goes to the sideline and observes; C, the player goes to the sideline and the doctor sees him there: D, the doctor goes on the pitch and treats the player there; E, the doctor goes
1440-2440/$ – see front matter © 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jsams.2008.04.006
612
M. Takahashi et al. / Journal of Science and Medicine in Sport 12 (2009) 611–613
onto the pitch and accompanies the player off the field, with or without a stretcher; F, after action E, the doctor decides if the player must stop playing.
period of the season, then dipped in the middle of the season and was high towards the end of the season.
4. Discussion 3. Results There were 42 official matches for the team during the 2004 J-League season. In all, 67 doctor-actions were taken. The overall DAFR was 1.6 actions per match. The number of actions for each grade in all matches was: grade A = 20, grade B = 12, grade C = 7, grade D = 13, grade E = 10, grade F = 5. There were also matches where the doctor did not take action; the team-doctor took no action in 6 matches, which corresponded to 14.3% of all matches. The number of matches with only action A was 7 (16.7%). Accordingly, the percentage of matches where the doctor did not leave the bench (no action + action A) was 31%. This result indicates that the team doctor stayed on the bench throughout the match in 31% of matches. The number of matches where more than action B occurred was 29; in these, the DAFR was 1.8 actions per match. The percentages of matches between these where the doctor did not go onto the pitch (from no action to grade C) and those where the doctor went onto the pitch (from grade D to grade F) were calculated to be 50% each of all matches. Fig. 1 shows the number of the grade of the doctor actions in relation to time during the match. The number for actions taken by the doctor was relatively high in the first 30 min of the first half, and again high in the last 30 min of the second half. It is interesting to note that grade F occurred 60% in the first 15 min of a match. When assessed seasonally, the combination of the number and severity of the grade of actions was moderate in the first
Figure 1. The number of the grade of the doctor actions in relation to time during a match. Grade: A, the doctor notices the injury, but just observes the player from the bench; B, the doctor goes to the sideline and observes; C, the player goes to the sideline and the doctor sees him there: D, the doctor goes on the pitch and treats the player there; E, the doctor goes onto the pitch and accompanies the player off the field, with or without a stretcher; F, after action E, the doctor decides the player must stop playing.
This is the first study investigating the activity (actions) of team doctors in professional football matches. Although there have been studies on the incidence of injuries in the National professional football leagues or International tournaments,1–4 little attention has been given to how a team doctor acts during a match. Of course, a team doctor’s actions are primarily injury-driven; that is, as player injuries occur more frequently, so too will the actions of the team doctor also increase. Another unique feature of the present study is the development of a table to grade the actions of team doctors. This study documents that team doctors stayed on the bench (no action and grade A) throughout the game in 13 (31%) of the 42 matches. This rate will of course differ in different sports; one can speculate that the frequency and amount of team doctor actions per match in a collision sport, such as rugby football, would be greater than those in the present study.7,8 The overall doctor-action frequency rate (DAFR) was 1.6 actions per match, whereas in the two thirds of matches where the doctor left the bench, DAFR was 1.8 actions per match. Among the grades of actions, action A was the most frequent and predictably decreased to grade F. It should be noted that action C was an exception because it does not seem to occur as frequently; players more often go down on the pitch (grades D and E) than go to the sideline for treatment by the doctor (grade C). In relation to match time-periods, the number of actions taken by the doctor was relatively high in the first 30 min of the first half, and also high in the last 30 min of the second half. Although there is no other study of team doctor actions during match play, a study of the injuries sustained in matches during the 2002 World Cup9 found that fewer injuries occurred in the first 15 min of each half, and an increasing number occurred toward the end of each half, with injuries most frequently in the 31–45 min period followed by the 16–30 min period. In the present study, the numbers of doctor actions were not less frequent and grade F occurred 60% in the first 15 min of the first half; thus, a discrepancy exists between these two studies. Although a precise reason for this discrepancy in timing cannot be pinpointed, differences in the level of play by top players in an international tournament and that of regular professional play in the J-League should be considered as well as psychologically factors driving players in the first 15 min of match play. The combination of the number and the severity of the grade of the actions taken by team doctors were moderate in the first third of the season, then remained low during the middle of the season, and was high in the last third of
M. Takahashi et al. / Journal of Science and Medicine in Sport 12 (2009) 611–613
the season. Again, because the amount of doctor activity depends on the frequency and type of player injury, these time-related or seasonal changes in the activity of a teamdoctor reflects the changes in injuries that could be critical to professional football players’ future careers and the fortunes of their teams. A limitation of the current study is that there may be significant variability in data recorded by the multiple doctors who attended the team matches during the 2004 season. Some team doctors are more likely to go to the sidelines to observe or go on the field with a trainer even for a minor injury. Another limitation is the difficulty in collecting data that is scientifically indicative of the team doctor’s active role. Especially in football, whether a physician decides to get up from the bench or move to the sideline is a matter of style and preference in some ways, and might not be indicative of injury type, severity or risk. Also in football, physicians go onto the field with the trainer when called on by the referee; indeed, the number of times a doctor goes onto the field is primarily determined by the referee’s judgment. In addition, some of the field visits by trainers and doctors may not be for any real injuries, but where the player apparently goes down to try to draw a foul card against their opponent, or to waste time, or to take a breather. Thus, doctor actions as defined in the present study are not only directly relevant to injury, but are also a reflection of doctor-style, team-style and the referee. However, the present study does provide an examination of what a team doctor actually does at professional football games and provides a basis for future studies of teamdoctor actions and injury frequency in professional football games.
613
Acknowledgements We would like to thank the following team-doctors for access to their records: Dr. Koukai Kin, Dr. Tsuyoshi Ohishi, Dr. Satoru Sakata, Dr. Shun Doi, Dr. Kenichi Naito, Dr. Kouzou Hasegawa, Dr. Masashi Abe, Dr. Mitsuhito Doi, and Dr. Daisuke Suzuki. We wish to thank Gregory O’Dówd for his assistance in proofreading this paper.
References 1. Nielsen AB, Yde J. Epidemiology and traumatology of injuries in soccer. Am J Sports Med 1989;17:803–7. 2. Arnason A, Gudmundsson A, Dahl HA, Jóhannsson E. Soccer injuries in Iceland. Scand J Med Sci Sports 1996;6:40–5. 3. Luthje P, Nurmi I, Kataja M, Belt E, Helenius P, Kaukonen JP, et al. Epidemiology and traumatology of injuries in elite soccer: a prospective study in Finland. Scand J Med Sci Sports 1996;6:180–5. 4. Junge A, Dvorak J, Graf-Baumann T, Peterson L. Football injuries during FIFA tournaments and the Olympic Games, 1998–2001: development and implementation of an injury-reporting system. Am J Sports Med 2004;32(Suppl. 1):80S–9S. 5. Hawkins RD, Fuller CW. An examination of the frequency and severity of injuries and incidents at three levels of professional football. Br J Sports Med 1998;32:326–32. 6. Hagglund M, Walden M, Ekstrand J. Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001. Scand J Med Sci Sports 2003;13:364–70. 7. Bathgate A, Best JP, Craig G, Jamieson M. A prospective study of injuries to elite Australian rugby union players. Br J Sports Med 2002;36:265–9. 8. Hoskins W, Pollard H, Hough K, Tully C. Injury in rugby league. J Sci Med Sport 2006;9:46–56. 9. Junge A, Dvorak J, Graf-Baumann T. Football injuries during the World Cup 2002. Am J Sports Med 2004;32(Suppl. 1):23S–7S.