Incidencija, faktori rizika i protektivni faktori ozljeđivanja kod nogometnih sudaca : doktorska disertacija

Ozljeđivanje nogometnih sudaca je polje koje je slabo istraživano. Cilj ovog rada je utvrditi i obrazložiti razinu i karakterističnost ozljeda i mišično-koštanih tegoba među hrvatskim nogometnim sucima različitih nivoa natjecanja, te odrediti faktore rizika i protektivne faktore ozljeđivanja kod hrvatskih sudaca. Metode rada: Uzorak ispitanika činilo je 342 nogometna suca (svi muškarci, dob AS 32.9 ± 5.02god) od čega: glavni suci (MR; N=159; dob AS 31.4±4.9god) i pomoćni suci (AR; N=183; dob AS 34.1±5.1god) podijeljeni na: međunarodne (Union of European Football Associations-UEFA) suce (N=18; 6 MR; 12 AR); 1st (N=79; 32 MR; 47 AR), 2nd (N=90; 45 MR; 45 AR); or 3rd national level referees (N=155; 76 MR; 79 AR). Retrospektivna studija provedena je primjenom upitnika kojem je u prvoj fazi istraživanja provjerena pouzdanost, test-retest metodom. Upitnik je omogućio uvid u skup morfoloških varijabli, varijabli vezanih za suđenje i treninge, te varijabli ozljeda i koštano- mišićnih tegoba i drugih medicinskih pitanja. Rezultati: 29% MR i 30% AR zadobili su ozljedu kroz posljednjih 12 mjeseci, dok je 13% MR i 19% AR ozljedu zadobilo na sudačkim testiranjima. Učestalost ozljeda raste, kako raste rang natjecanja (suđenja), dok su UEFA suci najmanje ozljeđivani. Lokalitet ozljeda vezanje za gornji dio natkoljenice kada su sudačke norme u pitanju, a donji dio natkoljenice i gležanjsu najučestalije ozljeđivani tijekom suđenja utakmica. MR kao tegobu, učestalije su prijavljivali gležanj, dok su AR prijavljivali bol donjeg dijela natkoljenice i donjeg dijela leđa kao najučestalije tegobe. Učestalost ozljeđivanja je podjednaka za oba subuzorka, 5.29 MR i 4.58 AR po 1000 sati suđenja. Tip ozljede koju su najučestalijezadobivali tijekom utakmica su istegnuće mišića (43% od ukupnog ozljeđivanja), zatim uganuće (10%), te ruptura mišića, ozljeda ligamenta i meniska (8-9%). Tijekom sudačkih testiranja najzastupljeniji tip ozljede je istegnuće mišića/tetive (64% ukupnog ozljeđivanja tijekom normi). Ozljede koje su nastupile u posljednjem susretu su u 39% slučajeva ponovljene ozljede, dok se to kod ozljeda pretrpljenih u posljednjih 12 mjeseci događa u 33% slučajeva, a svaka četvrta ozljeda na normama je recidiv (23%). Hrvatski nogometni suci posljedice ozljede u prosjeku osjećaju od 43.07 dana do 50.81, bez treninga su prosječno od 28.75 do 38.70 dana, te u konačnici bez utakmica su u prosjeku od 43.77 do 67.72 dana.Podjednak broj sudaca konzumira (n=165) i ne konzumira (n=169) prehrambenu suplementaciju, a značajnih razlika u incidenciji ozljeđivanja nogometnih sudaca ovisno o korištenju prehrambenih suplemenata ima u varijabli ozljede i tegobe tijekom karijere gdje će korištenje prehrambenih suplemenata smanjiti incidenciju ozljeđivanja. Također, vidljiva je povezanost veće konzumacije alkohola s većim brojem ozljeda. Suđenje samih utakmica pokazalo je relativno nisku stopu ozljeđivanja, za razliku od sudačkih testiranja, koja se pokazuju kao faktor rizika ozljeđivanja hrvatskih nogometnih sudaca. Posebnu pažnju bi trebalo obratiti na ozljeđivanje donjeg dijela natkoljenice tijekom utakmica, te gornjeg dijela natkoljenice za vrijeme testiranja nogometnih sudaca. Bolja fizička pripremljenost je prepoznata kao protektivni faktor ozljeđivanja hrvatskih nogometnih sudaca. Buduće studije bi trebale istražiti specifične prediktore ozljeđivanja nogometnih sudaca.Injury among soccer referees is rarely studied, especially with regard to differences in the quality level of the refereeing. Additionally, we have found no study that has reported injury occurrence during official physical fitness testing for soccer referees. The aim of this study was to investigate the frequency, type and consequencesof match-related and fitnesstesting related injuries among soccer referees of different competitive levels. Methods. We studied 342 soccer referees (all males; mean age 32.9 ± 5.02years). The study was retrospective, and a self-administered questionnaire was used. In the first phase of the study, the questionnaire was tested for its reliability and applicability. The questionnaire included morphological/anthropometric data, refereeing variables, and musculoskeletal disorders together with the consequences. Results: The sample comprised 159 main referees (MR; mean age 31.4±4.9years) and 183 assistant referees (AR; mean age 34.1±5.1years) divided into: international level (Union of European Football Associations- UEFA) referees (N=18; 6 MRs; 12 ARs); 1st (N=78; 31 MRs; 47 ARs), 2nd (N=91; 45 MRs; 46 ARs); or 3rd national level referees (N=155; 75 MRs; 80 ARs). In total, 29% of the MRs and 30% of the ARs had experienced an injury during the previous year, while 13% of the MRs, and 19% of the ARs suffered from an injury that occurred during fitness-testing. There was an obvious increase in injury severity as the refereeing advanced at the national level, but the UEFA referees were the least injured of all referees. The results showed a relatively high prevalence of injuries to the upper leg (i.e., quadriceps and hamstrings) during physical fitness-testing for all but the UEFA referees. During game refereeing, the ankles and lower legs were the most commonly injured regions. The MRs primarily injured their ankles. The ARs experienced lower leg and lower back disorders. However, the overall injury rate was equal for both groups, with 5.29 and 4.58 injuries per 1000hours of refereeing for MRs and ARs, respectively. Most common type of injuries during match were muscle strains (43%), calf sprains (10%), muscle ruptures and meniscus lesions (8-9%), while muscle strains was most common injury type during fitness-testing (64%). Injuries which occurred during last match were previously reported (39% of injuries), while 33% previously reported injuries occurred over last 12 month. During fitness-testing almost one-quarter of injuries were previously reported (23%). Referees felt negative consequences of injuries in average 43.07- 50.81. They were out of training in average 28.75-38.7 days, and not refereeing in average 43.77-67.72 days. Conclusion: In addition to the reported risk of injury during soccer games, physical fitness testing should be classified as a risk for injury among soccer referees. Special attention should be given to (I) lower leg injuries during games and (II) upper leg injuries during physical fitness tests. A higher physical fitness level and a qualitative approach to training are recognized as protective factors against injury. Subsequent studies should investigate the specific predictors of injuries among referees