Background: Ankle sprain is an extremely common injury in soccer players. Despite extensive research, the intrinsic cause of this injury under noncontact conditions remains unclear. Purpose: To identify intrinsic risk factors for noncontact ankle sprains in professional soccer players. Study Design: Cohort study; Level of evidence, 2 Methods: One hundred professional soccer players were assessed in the preseason for potential risk factors of noncontact ankle sprains. The assessment included (A) ankle joint asymmetries (right-left) in isokinetic muscle strength, flexibility, proprioception, and stability; (B) somatometric asymmetries; (C) previous injuries; and (D) lateral dominance traits. Noncontact ankle sprains were prospectively recorded and diagnosed for a full competition period (10 months). Results: Seventeen of the players sustained at least 1 noncontact ankle sprain. Logistic regression revealed that players with (A) eccentric isokinetic ankle flexion strength asymmetries (odds ratio [OR] = 8.88; 95% confidence interval [CI], 1.95-40.36, P = .005), (B) increased body mass index (OR = 8.16; 95% CI, 1.42-46.63, P = .018), and (C) increased body weight (OR = 5.72; 95% CI, 1.37-23.95, P = .017 ) each had a significantly higher risk of a noncontact ankle sprain. A trend for younger players (OR = 0.28; 95% CI, 0.061-1.24, P = .092) and for players with ankle laxity asymmetries (OR = 3.38; 95% CI, 0.82-14.00, P = .093) to be at greater risk for ankle sprain was also apparent to the limit of statistical significance (.05 < P < .10). Conclusion: Functional strength asymmetries of the ankle flexors and increased body mass index and body weight raise the propensity for ankle sprains in professional soccer players. Age and asymmetries in ankle laxity are potential factors worth revisiting, as there was an indication for younger players and players with ankle instability to be at higher risk for ankle injury. Proper preseason evaluation may improve prevention strategies for this type of injury in soccer.

This study was conducted to determine if the acute: chronic workload ratio (ACWR) is related to the incidence of non-contact injuries. The purpose is to compare the external load of injured and non-injured soccer players with the same characteristics, such as position and age. The present analysis considers both the four and the two weeks preceding an injury. Physical characteristics were recorded and analyzed through global positioning systems (GPS) evaluation over one season of 24 competitive microcycles, 144 training sessions, and 32 matches in a total of 35 professional soccer players from the Greek Super League 1 and Super League 2. The loads calculated were total distance (TD), 15–20 km/h, 20–25 km/h, 25–30 km/h, accelerations (ACC) > 2.5 m/s², and decelerations (DEC) > 2.5 m/s²). Nine injured athletes exceeded the critical threshold of an ACWR > 1.3 several times compared with non-injured athletes that did not reach this level. The present study showed that ACWR is related to a subsequent occurrence of injury but that the threshold of an ACWR can vary. This seems to be mainly influenced by assessing the load of the last two weeks compared with that of the four weeks before the injury.

Aims: To investigate the effect of hamstrings’ cooling and short-duration Cryostretching on sit and reach flexibility test (SR) performance. Study Design: Crossover Randomized Clinical Trial. Place and Duration of the Study: Department of Physical Therapy, Technological Educational Institute (TEI) of Western Greece, Aigio Achaias, Greece, 3 months. Methodology: Eighteen (18) healthy male (age: 21,3±4,5 yr, weight: 79,0±12,7 Kg, body fat: 14,6±4,0%) participated in the present study. Subjects were randomly divided into 3 groups which received in a random and counterbalanced order: a) hamstrings’ cooling with cold packs for 15 minutes, b) hamstrings’ cooling and static stretching for 14 minutes and 1 minute (30’’ for each extremity), respectively and c) passive rest (control status) for 15 minutes, on three visits made. Sit and Reach (SR) test, was applied before and after each intervention to assess the hamstrings’ flexibility. Results: Baseline Sit-and Reach results (SR 1) did not differ significantly between all 3 conditions (Cooling vs Control: 13,6±5,8 cm vs 13,8±7,1 cm P = 0,817; Cryostretching vs Control: 13,4±6,3 cm vs 13,8±7,1 cm P=0,620; Cooling vs Cryostretching: 13,6±5,8 vs 13,4±6,3 cm P=0,817). A significant improvement of hamstrings’ flexibility in SR2, was observed after hamstrings’ cooling intervention compared to corresponding values of Control (14,5±6,1 cm vs 13,2±7,0 cm P=0,026) and after cryostretching intervention compared to corresponding values of Control (14,9 ± 6,6 cm vs 13,2±7,0 cm, P=0,011). Flexibility values of hamstrings’ cooling alone compared with those after hamstrings’ cooling associated with a short bout of cryostretching (in SR 2), did not differ significantly (14,5±6,1 cm vs 14,9±6,6 cm, P= 0,502). Conclusion: Hamstrings’ cooling and cryostretching can improve performance in SR test and thus can be used as alternative methods for increasing the hamstrings’ flexibility in short term.

The aim of this study was to record and interpret external load parameters in professional soccer players in competitive microcycles with one or two matches per week, while investigating the interaction between training load and non-contact musculoskeletal injuries during training and matches. Musculoskeletal injuries in athletes are closely associated with workload fluctuations, particularly the acute:chronic workload ratio (ACWR) over preceding weeks. This study analyzed the physical workload of 40 high-level soccer players competing in the Greek championship across two seasons, encompassing 50 competitive microcycles, 60 official matches, and 300 training sessions. GPS-based assessments recorded total distance (TD), running speeds (15–20 km/h, 20–25 km/h, 25–30 km/h), accelerations (>2.5 m/s²), and decelerations (>2.5 m/s²). An independent sample t-test was conducted to compare injured and uninjured athletes, with statistical significance set at p < 0.05. Results showed that 20 injured athletes frequently exceeded the ACWR threshold (>1.3) compared to uninjured players. Analysis of the four weeks preceding the injury revealed that increased workload in high-intensity categories significantly contributed to non-contact injuries. Specifically, high running speeds of 15–20 km/h (p = 0.015), 20–25 km/h (p = 0.045) and >25 km/h (p = 0.008), as well as accelerations (p = 0.010), were linked to a higher risk of injury. The three-week ACWR model indicated statistically significant differences in the ACWR index for total distance (p = 0.033), runs at 15–20 km/h (p = 0.007), >25 km/h (p = 0.004), accelerations (p = 0.009), and decelerations (p = 0.013). In the two-week model, significant differences were found in runs at 15–20 km/h (p = 0.008) and >25 km/h (p = 0.012). In the final week, significant differences were observed in runs at 15–20 km/h (p = 0.015), >25 km/h (p = 0.016), and accelerations (p = 0.049). Additionally, running speeds of 25–30 km/h (p values between 0.004 and 0.016) played a key role in injury risk when limits were exceeded across all weekly blocks. These findings highlight the importance of monitoring ACWR to prevent injuries, particularly by managing high-intensity workload fluctuations in elite athletes.

Background and Objectives: This study aimed to assess the week-by-week predictive value of Acute:Chronic Workload Ratios (ACWRs) for non-contact injury risk in professional soccer players. Materials and Methods: A cohort of 40 elite players was monitored using GPS over two competitive seasons. Binomial logistic regression and ROC curve analyses were performed on ACWR metrics—including total distance, moderate-to high-speed running, sprinting, acceleration, and deceleration—during the four weeks prior to injury (W4 to W1). p-values were further adjusted for multiple comparisons using the false discovery rate (FDR) correction (q < 0.05). Results: Significant predictive models emerged mainly for ACWR metrics related to moderate-speed running (15–20 km/h), sprinting (>25 km/h), and acceleration/deceleration. The ACWR for 15–20 km/h (DSR15–20) demonstrated the highest predictive accuracy, particularly in Week 3 (AUC = 0.811, p = 0.004). Sprinting (DSR>25) was also significantly associated with injury occurrence across Weeks 1–4 (AUC = 0.709–0.755, p = 0.011–0.024). Acceleration (ACC) and deceleration (DEC) metrics showed significant associations prior to correction—ACC in Weeks 3–4 (AUC = 0.737–0.755, p = 0.020–0.026) and DEC in Weeks 3–4 (AUC = 0.720–0.741, p = 0.029–0.043)—but these associations did not retain significance following FDR adjustment (q = 0.052–0.086). In contrast, total distance (ACWR TD) and high-speed running (20–25 km/h) were weaker predictors, reaching only marginal or nonsignificant levels (e.g., Week 3, AUC = 0.675, p = 0.054). After FDR correction, only DSR15–20 and DSR>25 remained statistically significant (q < 0.05), confirming them as robust predictors of non-contact injury risk. Multivariable models adjusted for age and playing position confirmed these findings, with DSR15–20 and DSR>25 retaining their predictive value independent of confounding factors. Injury risk thresholds were established through Estimated Marginal Means (EMMs), defining the “Sweet Spot” and “Danger Zone” for each metric, whereas the “Low Load” zone was treated as exploratory. Conclusions: This weekly ACWR monitoring approach enables practical injury risk profiling, helping training staff optimize load management and minimize non-contact injury risk in elite soccer.