Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The “Italian Injury Study” during the Serie a Championship

Alessandro Corsini (), Andrea Bisciotti, Raffaele Canonico, Andrea Causarano, Riccardo Del Vescovo, Pierluigi Gatto, Paolo Gola, Massimo Iera, Stefano Mazzoni, Paolo Minafra, Gianni Nanni, Giulio Pasta, Ivo Pulcini, Stefano Salvatori, Marco Scorcu, Luca Stefanini, Fabio Tenore, Stefano Palermi, Maurizio Casasco and Stefano Calza
Additional contact information
Alessandro Corsini: Italian Sport Medicine Federation (FMSI), 7000196 Rome, Italy
Andrea Bisciotti: Kinemove Rehabilitation Center, 54027 Pontremoli, Italy
Raffaele Canonico: Società Sportiva Calcistica Napoli, 81030 Napoli, Italy
Andrea Causarano: Associazione Sportiva Roma, 00182 Rome, Italy
Riccardo Del Vescovo: Hellas Verona Football Club, 37126 Verona, Italy
Pierluigi Gatto: Genoa Cricket and Football Club, 16155 Genoa, Italy
Paolo Gola: Spezia Calcio, 19136 La Spezia, Italy
Massimo Iera: Football Club Crotone, 88900 Crotone, Italy
Stefano Mazzoni: Sport Medicine Department—Milan Lab, Associazione Calcistica Milan, 20149 Milano, Italy
Paolo Minafra: Torino Football Club, 10121 Torino, Italy
Gianni Nanni: Bologna Football Club 1909, 40132 Bologna, Italy
Giulio Pasta: Parma Calcio, 43123 Parma, Italy
Ivo Pulcini: SS Lazio, 00060 Rome, Italy
Stefano Salvatori: Benevento Calcio, 82100 Benevento, Italy
Marco Scorcu: Cagliari Calcio, 09124 Cagliari, Italy
Luca Stefanini: Juventus Football Club, 10151 Torino, Italy
Fabio Tenore: Udinese Calcio, 33100 Udine, Italy
Stefano Palermi: Public Health Department, University of Naples Federico II, 80131 Naples, Italy
Maurizio Casasco: Italian Sport Medicine Federation (FMSI), 7000196 Rome, Italy
Stefano Calza: Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy

IJERPH, 2023, vol. 20, issue 6, 1-13

Abstract: Introduction: Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury. Methods: A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020–2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database. Results: Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI 95% 1.05; 1.77, p -value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI 95% 1.21; 2.86, p -value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI 95% 0.54; 1.58, p -value = 0.77). A significantly higher proportion of muscle–tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI 95% 0.002%; 26.9%, p -value = 0.047) was found when comparing level II/III versus Non-COVID-19. Conclusions: This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.

Keywords: COVID-19; football; muscle injury; risk factor; epidemiology (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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