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Prognostic factors for specific lower extremity and spinal musculoskeletal injuries identified through medical screening and training load monitoring in professional football (soccer): a systematic review
  1. Tom Hughes1,2,
  2. Jamie C Sergeant2,3,
  3. Matthew J Parkes2,
  4. Michael J Callaghan1,2,4
  1. 1Manchester United Football Club, Manchester, UK
  2. 2Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  3. 3NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  4. 4Department of Health Professions, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Tom Hughes, Manchester United Football Club, Manchester, M16 0RA, UK;{at}


Background Medical screening and load monitoring procedures are commonly used in professional football to assess factors perceived to be associated with injury.

Objectives To identify prognostic factors (PFs) and models for lower extremity and spinal musculoskeletal injuries in professional/elite football players from medical screening and training load monitoring processes.

Methods The MEDLINE, AMED, EMBASE, CINAHL Plus, SPORTDiscus and PubMed electronic bibliographic databases were searched (from inception to January 2017). Prospective and retrospective cohort studies of lower extremity and spinal musculoskeletal injury incidence in professional/elite football players aged between 16 and 40 years were included. The Quality in Prognostic Studies appraisal tool and the modified Grading of Recommendations Assessment, Development and Evaluation synthesis approach was used to assess the quality of the evidence.

Results Fourteen studies were included. 16 specific lower extremity injury outcomes were identified. No spinal injury outcomes were identified. Meta-analysis was not possible due to heterogeneity and study quality. All evidence related to PFs and specific lower extremity injury outcomes was of very low to low quality. On the few occasions where multiple studies could be used to compare PFs and outcomes, only two factors demonstrated consensus. A history of previous hamstring injuries (HSI) and increasing age may be prognostic for future HSI in male players.

Conclusions The assumed ability of medical screening tests to predict specific musculoskeletal injuries is not supported by the current evidence. Screening procedures should currently be considered as benchmarks of function or performance only. The prognostic value of load monitoring modalities is unknown.

  • prediction
  • lower extremity injuries
  • injury profiling
  • risk factors
  • prediction models

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors Literature searching (TH, MP), data extraction (TH, MJC), data appraisal (TH, JCS, MJC), data synthesis (TH), data interpretation (TH, JCS, MJC) manuscript writing (TH, JCS, MJC), manuscript review (TH, JCS, MP, MJC).

  • Funding The lead reviewer (TH) is currently receiving sponsorship by Manchester United Football Club Limited to complete a PhD study programme.

  • Competing interests None declared.

  • Patient consent None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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