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Introduction
In contemporary elite football, clubs can compete in a large number of matches across the season, many of which are played within a tight time frame. Match congestion is regarded as a threat to team performance and player health. 1 Yet surprisingly, only a limited number of studies have examined the effects of match congestion on injury risk and have reported contrasting findings. In two investigations examining the impact of short congested cycles that frequently occur across the season, injury risk in match-play was comparable in consecutive matches separated by a short interval (<=3 days) versus those following a longer interval (>=4 days). 2 3 In contrast, a fivefold increase in injury incidence was observed when players participated in two successive matches played within a 4-day period compared to matches separated by 6-day intervals. 4 Regarding the risk over longer periods of match congestion, one study 5 reported a significant increase in injury incidence while another 6 did not. However, the majority of previous studies share a limitation in that data were collected and analysed at 'team' level and did not account for player rotation. Therefore, the true risk of injury in the same players when exposed to periods of match congestion in comparison to match-play outside congested periods is generally unknown.
Limited information is available on injury type and location over short match congestion cycles in elite football. One investigation in 27 elite European football teams reported similar muscle injury rates in matches (all competition formats) with <=3 days recovery versus matches with >=4 days recovery. 2 In contrast, a significant increase in sustaining a muscle injury was observed in league matches separated by a short interval (<=4 days) compared to longer intervals (>=6 days). Again, the potential effects of player rotation were unaccounted for by the authors. In addition, previous epidemiological research has shown that injury rates generally and the frequency of ankle sprains and muscle strains in particular increase during the latter stages of match-play. 7-9 However, no information exists on the potential effects of fixture congestion on the temporal distribution of injuries. Similarly, no data are available on the causes of injuries incurred over congested periods of play.
The aim of this study was to investigate injury rates and patterns...