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ObjectivesTo evaluate the restart of the German Bundesliga (football (soccer)) during the COVID-19 pandemic from a medical perspective.MethodsParticipants were male professional football players from the two highest German leagues and the officials working closely with them. Our report covers nine match days spread over 9 weeks (May to July 2020). Daily symptom monitoring, PCR testing for SARS-CoV-2 RNA twice weekly, and antibody tests (on two occasions—early during the phase in May 2020 and in the week of the last match) were conducted. Target variables were: (1) onset of typical COVID-19 symptoms, (2) positive PCR results, and (3) IgG seroconversion against SARS-CoV-2. All detected seroconversions were controlled by neutralisation tests.FindingsSuspicious symptoms were reported for one player; an immediate additional PCR test as well as all subsequent diagnostic and antibody tests proved negative for coronavirus. Of 1702 regularly tested individuals (1079 players, 623 officials members), 8 players and 4 officials tested positive during one of the first rounds of PCR testing prior to the onset of team training, 2 players during the third round. No further positive results occurred during the remainder of the season. 694 players and 291 officials provided two serum samples for antibody testing. Nine players converted from negative/borderline to positive (without symptoms); two players who initially tested positive tested negative at the end of the season. 22 players remained seropositive throughout the season. None of the seroconversions was confirmed in the neutralisation test.ConclusionProfessional football training and matches can be carried out safely during the COVID-19 pandemic. This requires strict hygiene measures including regular PCR testing.

AimWe aimed to identify patterns and mechanisms of injury situations in men’s professional handball by means of video match analysis.MethodsModerate and severe injuries (absence of >7 days) sustained in competition in one of six seasons (2010 to 2013 and 2014 to 2017) in men’s professional handball were prospectively analysed with a newly developed standardised observation form. Season 2013 to 2014 was excluded because of missing video material.Results580 injuries were identified: 298 (51.4%) contact injuries, 151 (26.0%) indirect contact injuries and 131 (22.6%) non-contact injuries. Head (87.5%), hand (83.8%), shoulder (70.2%) and ankle (62.9%) injuries were mainly sustained during direct contact. Typical contact injuries included collision with an opponent’s upper extremity or torso, and ankle injuries mainly consisted of foot-to-foot collisions. A large proportion (41.7%) of knee injuries were caused by indirect contact, whereas thigh injuries mainly occurred (56.4%) through non-contact mechanism. Wing (56.9%) and pivot (58.4%) players had the highest proportion of contact injuries, whereas backcourt players had a high proportion of indirect contact injuries (31.5%) and goalkeepers of non-contact injuries (48.9%). The injury proportion of foul play was 28.4%. Most injuries occurred in the central zone between the 6-metre and 9-metre lines (26.1%) and during the last 10 min of each match half (OR 1.71, p=0.016).ConclusionsIn men’s professional handball in a league setting, contact — but not foul play — was the most common mechanism associated with moderate and severe injuries. Head, hand, shoulder and ankle injury were mainly sustained during direct contact.

Objective Reaction testing is an integral part of sideline testing in sport-related concussion. Present established tools include time-demanding computer-based tools and analysis of the clinical reaction time with a special apparatus. The present tool is a mobile phone program using a simple reaction time equivalent. Design Case control study. Setting Professional German Hockey League Players and regional youth players. Participants 20 professional ice-hockey players. Interventions (or Assessment of risk factors) Analysis of a simple dual task reaction time (sRT; one of two symbols) and a complex one of four symbol reaction time (cRT). Outcome measures Analysis of average baseline times, fastest and slowest 10% values, overall application time and comparison to 4 players sustaining concussions. Main results Mean sRT was 0,354s (95% confidence intervals (0,330;0,377) with fastest 10% 0,294s and slowest time 0,539s. The overall procedure needed 65,4s. Mean cRT was 0,43s (95% confidence intervals (0,423;0,437) with fastest 10% 0,34s and slowest time 0,592s. The overall procedure needed 117,364. The 4 patients with sustained concussion had immediately a sRT and a cRT of 0,518s and 0,677s, respectively. A value of 0,5s is probably an expected cut-off. Conclusions This simple web- and mobile-phone-based program allows safe analysis of prolonged reaction times in concussed athletes. Competing interests None.

Background Football injuries are a common problem for players, coaches and clubs. To improve prevention strategies, the player and coach view needs to be known. Objective The aim of the study was to reveal current views about injuries prevention strategies in football. Design Retrospective cohort study in elite football level. Setting The elite football level of salaried football players (n=486) and team coaches (n=88) were investigated. Participants Team coaches (c) and male football players (p) of all age levels of the 4th until 6th division in German football were included. Interventions One questionnaire at the beginning of a football season was completed in the context of an intervention study regarding injury prevention in elite football. Main Outcome Measurements Investigated topics were points view about influencing factors on injuries, screening tests, injury profile and return to play decision-making. Results Physiotherapy (p:77.8%; c:75.9%) and screening examinations (p: 56.3%; c: 62.1%) were highest ranked as prevention strategy in football. The most important preventive training topics were warm up exercises (p: 76.1%; c: 74.7%), regeneration (p: 54.1%; c: 56.3%) and core stability (p: 53.8; c: 70.1%), while practical transfer to the field was low for core stability (p: 27.5%; c: 32.1%) and balancing exercises (p: 22.0; c: 19.8%). Knee injuries (p: 90.7%; c: 93.1%) were reported as the most common problem in football. Decision-making for return to play after injuries presented players with own will for a decision-making (81.4%) and the team coaches with the opinion that doctors are main decision maker (83.5%). Thus, decisions against doctors9 recommendation in the past were frequently made among participants (p: 64.4%; c: 87.1%). Conclusions The basic knowledge about prevention of injuries in elite football is sufficient, while practical implementation is insufficient.

Background Prevention strategies for ACL injuries in Olympic sports are mandatory and the collection of data about risk factors and injury characteristics have highest priority. Objective What are the main risk and influencing factors on ACL injuries and safe return to play in different sports, beginning with worl9s number one sport football? Design A prospective analysis of ACL injuries in German amateur and professional football. Setting ACL injury registration over two football seasons and investigation of ACL injured player by 2 questionnaire after injury and after one year. Patients Players of German football divisions were investigated, including all divisions, both gender and all age levels. Interventions Beside typical influencing and risk factors for ACL injuries, circumstances for a return to play decision were investigated. Main Outcome Measurements Investigated variables are anthropometric data, football exposure data, training and warm up data, regeneration data and return to play decision-making. Results 512 ACL injuries in football were registered in the first season with 71.1% non-contact injuries, 85.5% match injuries, younger female players and 93.5% surgical treatment rate. 68% of ACL injuries occurred in the preseason period, 60% of 1st division players were internationals and the first professional division revealed a higher ACL rate than the 2nd and 3rd division. Balancing exercises ( Conclusions To improve injury prevention strategies for ACL injuries, a detailed knowledge about injury characteristics is necessary in all sports.