Game changer! Injury surveillance in elite-level women's football in Ireland: thinking bigger and working together

This thesis aims to provide practitioners with a clearer understanding of the current injury epidemiological profile in senior women’s (>18 years of age) amateur-club, elite-club and international football, as well as investigating the contextual factors that impact players’, head coaches and medical personnel experiences of working to prevent and manage injuries in women’s elite-club football in Ireland. In our first study, we undertook a systematic review and meta-analysis of overall, match and training IIRs in senior women’s football, stratified by injury location, type and severity. “Time-loss” training IIRs in women’s elite-club football and international football are approximately 6-7 times lower than their equivalent match IIRs. Overall “time-loss” IIRs stratified by injury type in women’s elite-club football were 2.70/1000h (95% CI = 1.12 to 6.50) for muscle and tendon, 2.62/1000h (95% CI = 1.26 to 5.46) for joint and ligaments, and 0.76/1000h (95% CI = 0.55 to 1.03) for contusions. In our second study we investigated the pattern of injuries in elite-club women’s football in Ireland, during a two-season prospective injury surveillance study in the Women’s National League (WNL). Similar to the results of our systematic review of senior women’s elite-club and international football, the IIR in matches (19.2/1000h; 95% CI = 15.9 – 22.4) was 7.5 times higher than in training (2.5/1000h; 95% CI = 1.9 – 3.1). The aim of our third study was to explore the knowledge, attitudes and behaviours of players, head coaches and medical personnel in the Irish WNL to injury prevention and injury management. Semi-structured interviews were undertaken with 17 players, 8 medical personnel and 7 head coaches in the Irish WNL. This study is located within an interpretivist, constructivist research paradigm and interviews were analysed using thematic analysis. We found that the participants had incomplete knowledge of common injuries in elite-club football, and many held beliefs about risk factors for injury, such as menstrual cycle stage, which lacked evidence to support them. Jumping and landing exercises were commonly used to reduce injury but evidence-based injury prevention exercises and programmes were rarely mentioned. Overall, there was dissatisfaction amongst players with the medical and strength and conditioning (S & C) support with resultant inadequate communication between players, head coaches and medical personnel. The aim of our fourth study was to use qualitative research methods to explore the barriers to the implementation of injury prevention and effective injury management practices in the Irish WNL using the same cohort and methodology as in study 3. We found that the participants perceived academic and work pressure, financial challenges, conflict with college football, inadequate facilities and gender inequity as being major barriers affecting the development of players and the protection of their health. Perceived gender inequity regarding access to facilities and medical and S & C support was common amongst the players.

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