It’s that time of year again where the managers at the top premier league clubs resent the hectic fixture list that’s thrown at them. Less time to prepare and to recover and as a result, a risk of a reduction in the quality of performance. However, is there also an added risk to the player’s well being? With a forced significant change in their pre and post match routines, are they at higher risk of injury?

If we take a look at one of those clubs affected in this manner, West Ham (European Champions and Premier League heavyweights), their fixture list over the next month consists of 10 games. A mix of league, Carabao cup, FA Cup and Europa League games make for an incredibly intense festive period. As a club that doesn’t have the same luxury, as say Man City, when it comes to squad size, and therefore the ability to rotate playing staff, there is a good chance you will see a very similar starting 11 in most of these games. The intensity of each of these games, the colder weather, the travel up and down the country and into Europe are all factors that can impact how a player feels and therefore performs on the pitch.

Julian, Page and Harper, 1, (2020) conducted a systematic review on the effects of fixture congestion on performance during male professional football matches and found that performance variables such as low and moderate intensity distances covered during the 90 mins reduces. They also suggest a possible reduction in tactical performance, with decreased synchronisation between the players.

Page et. al, 2, (2022) have then gone on to take a look at a direct correlation between fixture congestion and injury in professional male soccer. They state that overall injury risk is increased during matches completed within fixture-congested periods. This is further supported by findings from a substantial European competition review which shows an increase in hamstring and quadricep muscular injuries during periods of fixture congestion. 3. (Bengtsson et. al 2014)

This leads to a very valid point of discussion, that these findings could help provide a source of scientific evidence for governing bodies to elicit change  to support player welfare and develop a more sustainable match calendar that promotes a player’s career longevity.

In the meantime however, it will continue to be a period of time where coaching and medical staff will have to regularly review and adapt their training, pre and post match plans in order to keep injury risk at a minimum and performance levels as high as possible. Players may be required to take on a role of being more active in their own recovery away from the training ground. Nutrition plans being altered to suit the increased regularity of match days. The use of alternative therapies such as heat, ice and compression when at home and ensuring plenty of sleep and rest when the opportunity arises.

Reference List

• Julian, R., Page, R.M. and Harper, L.D. (2020). The Effect of Fixture Congestion on Performance During Professional Male Soccer Match-Play: A Systematic Critical Review with Meta-Analysis. Sports Medicine, 51. doi:https://doi.org/10.1007/s40279-020-01359-9.

• Page, R.M., Field, A., Langley, B., Harper, L.D. and Julian, R. (2022). The Effects of Fixture Congestion on Injury in Professional Male Soccer: A Systematic Review. Sports Medicine. doi:https://doi.org/10.1007/s40279-022-01799-5.

• Bengtsson, H., Ekstrand, J., Waldén, M. and Hägglund, M. (2014). MUSCLE INJURY RATES IN PROFESSIONAL FOOTBALL INCREASE WITH FIXTURE CONGESTION: AN 11-YEAR FOLLOW-UP OF THE UEFA CHAMPIONS LEAGUE INJURY STUDY. British Journal of Sports Medicine, 48(7), pp.566.2-567. doi:https://doi.org/10.1136/bjsports-2014-093494.19.

What a game. What a Rugby World cup. What a final performance from both the Springboks and Kiwis. But, as always when there is any form of controversy in a big match, we will ask the question. If New Zealand captain Sam Cane didn’t have his yellow card upgraded to a red card so early on in the contest would it have been the same outcome? The rugby fan in me would love to have seen 15 vs 15 for a full 80 mins of course. However, to witness the sense taken by the officials in making an example of what is a direct shoulder to head shot, on the biggest stage there is, was a great decision. We need to protect contact sport athletes around head and spinal injuries and I personally hope this particular event will help to amplify this.

Some fantastic research was done into the frequency and type of head injuries experienced at the 2019 rugby world cup. Across 45 matches, 68 head injuries occurred with just over half of these players being removed from the field of play (Cooke et al 2023). 1. It’s going to be fascinating to see if with the recent changes in approach to the treatment and discipline of head injury related incidents in this year’s tournament correlates to a significant statistical shift compared to 2019.

Thankfully there has been much change In recent years in both the medical management of head injuries in rugby union and also the disciplinary approach to offending players.

A huge contributing factor to the progression of management and increase in discipline towards head injuries has been driven by the recent cases of ex players receiving a diagnosis of dementia with probable chronic traumatic encephalopathy. A recent paper on ‘Football’s Influence on Lifelong health and Dementia risk (FIELD)’ found that ex-professional international rugby players had twice the risk of developing dementia in later life than compared to the general population (Russell et. al 2019)2.

From the medical side, there’s been much clearer guidelines set out on the in play decision making on concussion and also on the return to play protocol. The emphasis on both the ‘recognise and remove’ principle and ‘Graduated return to Activity and Sport (GRAS) programme’ are highlighted in the HEADCASE extended guidelines posted by the RFU. 3.

Hopefully, the sensible refereeing decision made in last weekend’s final will have had a suitable impact on all those involved in the coaching and playing of rugby union. Understanding the importance of trying to abide by the safe tackling laws of the game, should correlate to us seeing less cases of longer term head injury consequences in competitors of the sport.

• Cooke, R., Strang, M., Lowe, R. and Jain, N. (2022). The epidemiology of head injuries at the 2019 Rugby Union World Cup. The Physician and Sportsmedicine, pp.1–7. doi:https://doi.org/10.1080/00913847.2022.2083458.
• Russell, E.R., Stewart, K., Mackay, D.F., MacLean, J., Pell, J.P. and Stewart, W. (2019). Football’s InfluencE on Lifelong Health and Dementia Risk (FIELD): protocol for a retrospective cohort study of former professional footballers. BMJ Open, 9(5), p.e028654. doi:https://doi.org/10.1136/bmjopen-2018-028654.
• September 2023 Headcase EXTENDED Guidelines. (n.d.). Available at: https://keepyourbootson.co.uk/wp-content/uploads/2023/09/HEADCASE_Extended-Guidelines_Aug_2023.pdf [Accessed 1 Nov. 2023].