The World Cup in Qatar 2022: challenge for injuries during the tournament

The Qatar 2022 World Cup represents a revolution in many areas, from the perspective of performance due to the weather to the epidemiology of injuries due to its relationship with the moment of the season. Just like COVID-19 was at the time, the World Cup can be an object of study because it is a new paradigm for European league competitions.

There are numerous studies that analyze the type of injury and the characteristics during an international tournament. Authors such as Ekstrand et al. (2016) have investigated the evolution of injuries in tournaments such as UEFA Euro from 2004 to 2016. Their main conclusions point to a reduction in the number of total injuries in recent years with a significant change in the paradigm of the mechanism of injury. While in 2004, 59% of injuries were caused by contact, in 2016 the majority of injuries, 64%, were caused by a non-contact mechanism.

The authors point out that in 2016, 55% of the injuries were of a muscular nature, while in the 2004 competition, only 23% had that nature. This may be due to the change in regulations that protect the player from contact, together with the increase in competitive demand that increases the risk of muscle injury (Ekstrand et al. 2016).

In addition, the authors point out that there is a significant difference between the injuries that occur in the preparatory phase with respect to the final phases (from the round of 16 to the final), with these last phases where the most injuries occur. This could be explained by the accumulation of fatigue and the congested schedule of the last phases of the tournament, the latter being one of the risk factors for muscle injury, especially in the hamstrings and quadriceps (Julian et al. 2021).

The behavior in the FIFA World Cup world tournaments is very similar to the previous one, with the difference that contact injuries are relatively higher than in the UEFA Euro. In a longitudinal study by Junge et al. (2015) it has been seen how injuries per match have decreased from 2.4 to 1.7 in the 2014 FIFA World Cup in Brazil, where most did not exceed 7 days of absence. Muscle injury and bruises continued to be the protagonists. These injuries are the ones that worry the professional services of the national teams the most (Junge et al. 2015).

On the other hand, in a study by Noya et al. (2014) carried out in a regular championship, in this case in LaLiga, it was observed that, unlike in international competition, most injuries occurred without contact, and that the injury muscle continued to be the protagonist with the highest number of incidents.

How the calendar can affect the injuries.

Unlike previous world tournaments, the FIFA World Cup Qatar 2022 will take place at a time of the season that is highly sensitive. In previous tournaments the players were in a summer period and had more time to prepare.

However, the Qatar 2022 World Cup will take place in the middle of the season of the European domestic tournaments. This is decisive because although it is true that other tournaments such as the Mexican League, the Brasileirão or the eastern leagues are on holiday break, most of the players who play in the World Cup, 44%, have a European origin (Tuo et al. 2019).

At this point in the season, players have already accumulated considerable fatigue from the number of games played (Heisterberg et al. 2013). In addition, this period of the season is where most injuries occur, 46% of a muscular nature involving the adductor, quadriceps and hamstring muscles (Noya et al. 2014).

In addition, as we have seen, the congestion of matches does not help to improve the prognosis of muscle injury (Julian et al. 2021).

How it can affect acclimatization.

On the other hand, the acclimatization time to the competition and the environment is also a focus of concern for the team staff. With less time than in previous events, some teams will only have 10 days to meet with their players and prepare for the competition. This is the case of the Ecuadorian National Team, which will have little acclimatization time and will also play the opening match.

Other teams will only have 6 days of training in Qatar before their first match. This is far from previous editions, where, for example, the Australian team had 4 weeks of “training camp” before the first game: 2 weeks in Sydney and 2 weeks in Vitória (Brazil). Researchers have seen that the load of 4 weeks before the training camp is decisive for the injuries that occur during it. In this sense, a change of 1.7 in the ratio of the load measured with the sRPE (the perceived effort of the session), is associated with the players who are injured (n=7), compared to the ratio of 1.3 of those who do not (n=10) (McCall et al. 2018). This differs a lot from what the selections are going to find and that supposes an uncertain panorama.

Finally, temperature and humidity can be determining factors to take into account in acclimatization to the environment. As we have seen, the selections will have very little time and what the scientific literature shows us is that between 12 and 14 days are needed to acclimatize to the heat and not suffer a loss of yield (Périard et al. 2021). Therefore, it is yet another sign that there may be a competitive advantage for those teams more accustomed to the climate, and that this may be a risk factor for injury due to a greater physiological load and greater fluid loss, which leads to dehydration (Périard et al. 2021).

How can thermography help to reduce injuries?

Thermography, through the ThermoHuman software, is a tool that allows to quickly establish a segmentation of body regions. This segmentation has the objective of measuring the thermal asymmetries of soccer players. This asymmetries metric has been used for its relationship with the reduction of muscle injuries in several scientific articles, proving its usefulness in reducing muscle injuries (Cortê et al. 2019, Gómez-Carmona et al. 2020).

In addition, in a recent investigation by Gregson et al. (2022) they have seen the interest of controlling through various tools, such as thermography, the type of fatigue that is generated after the competition. In addition, it is a matter of special relevance when the matches take place in a congested calendar.

What the preliminary results show is that, depending on the type of fatigue, the signaling in skin temperature will be different. On the one hand, if there is high muscle damage, there will be an increase in body temperature. On the other hand, if there is increased metabolic fatigue, the response will be hypothermic. You can see an in-depth analysis with real clinical cases in this post.

Conclusion

During the tournament and, above all, in the final phases, muscle injuries are the protagonists of the epidemiology of the tournament, from what we can see from previous tournaments and from the type of calendar. Controlling the external and internal load can be of great help in managing the risk of injury.

Thermography is postulated as an auxiliary tool for the control of internal load and recovery processes thanks to the possibility of individualizing recovery strategies in soccer players. In addition, the control of body regions through the asymmetries methodology allows a significant reduction of muscle injuries.

References

Côrte, A. C., Pedrinelli, A., Marttos, A., Souza, I. F. G., Grava, J., & José Hernandez, A. (2019). Infrared thermography study as a complementary method of screening and prevention of muscle injuries: pilot study. BMJ Open Sport & Exercise Medicine, 5(1), e000431.

Ekstrand, J. (2016). UEFA EURO 2016 Injury Study Report – [Archivo PDF] UEFA.com

Gómez-Carmona, P. M., Fernández-Cuevas, I., Sillero-Quintana, M., Arnáiz-Lastras, J., & Navandar, A. (2020). Infrared Thermography Protocol on Reducing the Incidence of Soccer Injuries. Journal of Sport Rehabilitation. 

Gregson, W. Howatson, G. & Thorpe R. A periodised recovery strategy framework for the elite football player. Aspetar Magazine 2022

Heisterberg MF, Fahrenkrug J, Andersen JL. Multiple blood samples in elite soccer players. Is it worthwhile? J Sports Sci. 2014;32(13):1324-7.

Julian, R., Page, R. M., & Harper, L. D. (2021). The effect of fixture congestion on performance during professional male soccer match-play: a systematic critical review with meta-analysis. Sports Medicine, 51(2), 255-273.

Junge A, Dvořák J. Football injuries during the 2014 FIFA World Cup. Br J Sports Med. 2015 May;49(9):599-602.

McCall, A., Jones, M., Gelis, L., Duncan, C., Ehrmann, F., Dupont, G., & Duffield, R. (2018). Monitoring loads and non-contact injury during the transition from club to National team prior to an international football tournament: A case study of the 2014 FIFA World Cup and 2015 Asia Cup. Journal of science and medicine in sport, 21(8), 800-804.

Noya Salces, J., Gómez-Carmona, P. M., Gracia-Marco, L., Moliner-Urdiales, D., & Sillero-Quintana, M. (2014). Epidemiology of injuries in First Division Spanish football. Journal of sports sciences, 32(13), 1263-1270.

Périard JD, Eijsvogels TMH, Daanen HAM. Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies. Physiol Rev. 2021 Oct 1;101(4):1873-1979.

Tuo, Q., Wang, L., Huang, G., Zhang, H., & Liu, H. (2019). Running performance of soccer players during matches in the 2018 FIFA World Cup: Differences among confederations. Frontiers in psychology, 10, 1044.