Injury Prevention Practices by Amateur Football Coaches
in Gauteng South Africa
Siphesihle Mtshali
1
, Hellen Myezwa
1
, Nonceba Mbambo-Kekana
2
and Kerith Aginsky
1
1
Faculty of Health Sciences, University of the Witwatersrand, 7 York Road Parktown, Johannesburg, South Africa
2
School of Health Sciences, University of Limpopo, Polokwane, South Africa
Keywords: Observation, Injury Prevention, Coaches.
Abstract: Football coaches play a vital role in teaching safe playing skills and prevention strategies. However with
perceived incongruence between existing scientific evidence, research and implementation in practice and
delivery, there is no evidence for translation of research into practice. This study aimed to identify coaching
practices on injury prevention in amateur football players. Ten institutions and their coaches registered in
the University Sport of South Africa Gauteng Football League during the 2012 season agreed to participate
in the study. A structured observation checklist was developed from the ten point action plan of the
SportSmart injury prevention programme to observe practices of coaches. The coaches’ education was
found to be limited to an introductory level and experience. Keeping attendance registers, type of stretches
during warm up, availability of hydration and injury management during training sessions were aspects not
practised by the coaches. This paper presents aspects the coaches were focusing on, which may influence
injury prevention. Sixty percent of the items in the observation checklist were not taken into account by the
majority of coaches. Some of the omissions such as type of stretches have the potential to increase the risk
of injury among the players.
1 INTRODUCTION
For an effective injury prevention programme, it is
important to determine the pre-existing knowledge
and practice of coaches. In order to determine pre-
existing knowledge and practices most studies use
questionnaires and interviews. In social sciences
direct observation methods are used to determine
practices or behaviour of participants. There are
various observational methods which include
explorative, detailed, and inquisitive and
comparison. However in coaching, systemic
observation has been used to identify the behaviour
of coaches and teachers in sport and education
(Cushion et al., 2012a). The observation of coaches
has resulted in a wealth of information about coach
behaviour, observation instruments used in the
process and areas of improvement in coaching
(Cushion et al., 2012a). The focus of observations is
on general coach behaviour in order to implement
interventions that aim on improving interactions in
specific areas of coaching practice. Various
observation tools have been developed to capture
complex coaching behaviour and practice (Cushion
et al., 2012b, Ford et al., 2009). These tools are
specific to behaviour in terms of pre delivery
planning, safety, personal qualities and a general
coaching approach, organization of the session,
instruction, communication, observation and
feedback. Some of these observation tools also
provide self-awareness feedback to coaches in
aligning the actual and stated behaviour (Cushion et
al., 2012b, Ford et al., 2010a). Although there is a
safety component in the observation checklist, the
details do not encompass injury prevention
strategies.
Coaching observation has been used to examine
coaches’ practices and instructional (Ford et al.,
2010b) behaviour for football players using video
analysis and checklist in terms of skill acquisition,
motor learning and expert performance. The
observation method has also been used in coaches’
evaluation of practices, but not in the application of
injury prevention practices. There are few studies
that have evaluated coaches’ behavioural changes
and adherence following an intervention, that also
used the observation approach to establish the teams
adherence to the intervention (Steffen et al., 2013a).
57
Mtshali S., Myezwa H., Mbambo-Kekana N. and Aginsky K..
Injury Prevention Practices by Amateur Football Coaches in Gauteng South Africa.
DOI: 10.5220/0005160700570063
In Proceedings of the 2nd International Congress on Sports Sciences Research and Technology Support (icSPORTS-2014), pages 57-63
ISBN: 978-989-758-057-4
Copyright
c
2014 SCITEPRESS (Science and Technology Publications, Lda.)
In the above study coaches were not aware that
observation was taking place during practice and
there are no further details on the nature of the
observation. However, coaches ‘behavioural
changes and implementation of injury prevention
programmes has been mainly determined through
self-reported questionnaires with no practical
observation(Gianotti et al., 2010). As most self-
reported questionnaires rely on participants’
responses and therefore may not reflect the true
practical implementation of injury prevention
programmes.
There is a perceived incongruence or mismatch
between existing scientific evidence, research and
implementation in practice and delivery in sport
research (Ford et al., 2010a, Donaldson and Finch,
2013, Finch et al., 2013). In football there is still no
evidence as to whether coaches practically
implement the existing scientific evidence in injury
prevention. Some of the reasons for the lack of
implementation could be the lack of consensus on
injury prevention strategies and programmes by
researchers which affects the dissemination. The aim
of this study was to identify the practices of coaches
of amateur football players to assist in the
development of a coach education injury prevention
programme.
2 METHODS
Observation of injury prevention practices was used
to determine baseline information on coaches in
order to develop a coach education programme on
injury prevention in amateur football players.
Permission to conduct the study was obtained from
the University of the Witwatersrand Human
Research Ethics Committee (M110654) and
University Sport of South Africa Football. The study
was conducted in the Gauteng Province of South
Africa in university institutions that participated in
the University Sport South Africa Gauteng Football
League (UGFL) during the 2012 season. All twelve
UGFL participating institutions were invited to
participate in the study
Training days were identified with each
institution and appointments were made with the
head coaches through the team managers. A total of
two structured observations of training sessions were
done with each team. Consent for the study was
sought from the head coach. Full training sessions
were observed using the structured observation
checklist and notes were made for better
understanding where necessary. The observation of
practices was conducted over a period of six weeks
during the first half of the league season.
Clarification on specific training aspects included
the type of skills or fitness training for an example
ball handling skills, kicking skills, game set plays,
changing direction, endurance and resistance
training.
The structured observation checklist was
developed using the 10- point action plan of injury
prevention by Gianotti and Hume (2007). The 10-
point action plan includes 1) screening, 2) warm up
– cool down and stretching, 3) physical
conditioning, 4) technique, 5) fair play, 6) protective
equipment, 7) hydration and nutrition, 8) injury
reporting, 9) environment and 10) injury
management which was developed as part of the
SportSmart programme (Gianotti and Hume, 2007)
The checklist was piloted for feasibility and content
validity using teams from four provinces of South
Africa (Mpumalanga, Western Cape, Free State and
Northwest Provinces) during the University Sport of
South Africa football national championships in
2011. This was done over a five day football
tournament and adjustments were made. The injury
prevention structured observation checklist has the
following items: injury reporting, training (warm up,
cool down, stretching, skills, fitness), equipment
(use of shin guards, soccer boots), nutrition and
hydration, environmental factors (weather, playing
surfaces), injury management (availability of first
aid, availability of medical personnel, injury
protocol). A focus group of four coaches, two
players, medical doctor and a physiotherapist expert
on questionnaire development were given the list to
use during the first two days of the tournament. It
was adjusted and edited as per suggestions and
consensus was reached within the group (r = 0.98).
Fair play on the item list was removed as it required
more details and engagement with coaches and
referees to reach conclusions which were beyond the
objective of the study. Basic demographics of the
coaches were determined which included level of
coaches training. Descriptive analysis using
frequencies, percentages, means and standard
deviations were used in this study.
3 RESULTS
Ten of the twelve institutions agreed to participate in
the study and coaches were observed during their
training and match sessions. Twelve coaches
completed the demographic questionnaire. As the
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sample of the coaches was small, age ranges were
used instead of the actual age. Fifty eight percent of
the coaches were in the range of 30 – 39 age and
seventy five percent of the sample were males. In
South Africa official coaching education has four
levels: introductory level, level one, two and three.
Seventeen percent of the coaches did not have any
coaching education compared to 50% that had
introductory level. Two thirds of the sample were
head coaches and had been in the position between
two to five years. Majority (75%) gained their
football experience as players and the rest of the
coaches gained their experience as referees (17%),
managers of the teams (8%) and team trainers (8%).
Football coaching experience was gained from
coaching a junior team (42%), amateur club (42%),
school level (8%) and 8% had no coaching
experience.
3.1 Training Sessions
A standard question to all the coaches at the
beginning of the training session was asked, “Are all
your players here today?” Three coaches of the 10
teams knew the number of players attending the
training sessions and explanation for the absent
players was given. Seven coaches were not sure of
the whereabouts of their players and one of them did
not even recognise some of the players during the
training session. The number of players attending
the training session was compared to the number of
official registered players per team.
3.2 Duration of Training Sessions
Although the focus of the training session varied
between fitness and skills training with each team,
all the teams included both types of training on the
days of observation. Teams were observed for the
length of training. Total duration was determined by
calculating the length of time taken for the warm up,
skills and fitness during training session. The
average duration of skills training amongst all the
teams was 38±6.12 minutes whereas time spent on
fitness training was on average 20±7.32 minutes.
The average total duration of training per session
was 75±15.58 minutes. The average duration for
warm up was 19±9.72 minutes with the least amount
of time being 10 minutes.
3.3 Considered Factors during
Training
Injury management (80%), hydration (70%) and
cool down (80%) were not highly considered factors
by the coaches during their training sessions. Even
though 60% of the coaches considered stretching as
part of the training session; 40% of the stretching
teams focused more on static stretching. There was
100% use of appropriate football shoes/boots by
players in all the teams, though not all the players in
the teams wore shin guards. Coaches did not take
any action for who did not have shin guards. At the
time of observation none of the players in the teams
were using visible taping or bracing during training.
During the training session, nine teams (60%)
completed a warm up routine. Two teams included
paced running around the field once or twice for the
cool down. Hydration in the form of water bottles or
nearby water taps was not fully available during
training but available during matches where all
teams had hydration for players on the side line.
3.4 Environment Factors
3.4.1 Playing Surface
All observed training sessions were done outdoors in
the afternoon to early evening sessions (16h00
19h00) and all participating teams played on natural
turf. The majority of the teams (80%) trained on
patchy surfaces. Patchy surfaces or fields were
defined as the surfaces where the grass was not
evenly green and did not consistently cover the
whole field.
3.4.2 Weather Conditions
The average temperature when the training sessions
occurred was 18.2 1.41 degrees Celsius for all the
teams observed. There was no time adjustment for
cool weather conditions during training sessions.
3.5 Injury Management
Only one team had an injury management protocol
which included what happens when a player gets
injured on the field, during rehabilitation and
appropriate recording or reporting of injuries.
Players in the team with injury management protocol
who were undergoing rehabilitation and were ready
to return to play participated in individualised
training sessions. Two of the teams had students
who were studying health or exercise science
degrees assisting the team with medical care that
included providing first aid care.
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4 DISCUSSION
4.1 Attendance of Training and Match
Sessions
Seventy percent of the coaches were not able to
account for non-attendance or extra players in the
team thus indicating that coaches did not maintain
an attendance register for the training sessions.
Attendance of players and keeping of registers has
been reported in studies evaluating adherence or
compliance to the intervention programme in the
injury prevention studies (Sugimoto et al., 2012).
Here players with low compliance rate were 4.9
times more at risk of ACL injury compared to those
players with high compliance to assess the effect
compliance to neuromusculoskeletal training for the
anterior cruciate ligament. Attending and completing
training sessions was used to determine the
compliance of players to the ACL intervention
programme. Players with high compliance to an
intervention programme have a lower risk of injury
(Soligard et al. (2010), Steffen et al. (2013b) and
(Steffen et al., 2008). To be able to report on
compliance to the intervention programmes in these
studies, coaches had to report on players present
during training sessions. Coaches’ compliance and
attitude toward the intervention programmes was a
predictor of injury risk (Soligard et al., 2010).
Failure to attend training sessions and poor record
keeping could increase the risk of injury among
these amateur players as they are missing football
skills development and conditioning.
4.2 Warm up
Except for one team, teams performed an active
warm up routine during training sessions and pre
match warm up routine. Warm up before training or
performance in physical activity is physiologically
and psychologically important to prepare players for
improved performance, reduce risk of injuries
(Bishop, 2003). With increased core body
temperature there is reduced viscosity to muscles
and joints and increased oxygen release and
delivery. Warm up increases blood circulation to the
working muscles and thus increases temperature.
Baseline oxygen consumption (VO
2
) is elevated
decreasing the initial oxygen deficit which preserves
more anaerobic capacity for the task (Bishop, 2003,
Towlson et al., 2013). The inclusion of warm up by
the majority of the teams is a positive finding from
this study. However, the actual impact of the warm
up programmes on injury prevention needs further
investigating. The appropriate duration for warm
also need further investigation as there is no
consensus from football research. There are mixed
findings on the effect of a longer duration of warm
up, particularly for pre matches, on performance
and risk of being injured (Zois et al., 2011, Towlson
et al., 2013).
The average pre-match warm up duration in this
study was 28±5.72 minutes which is about ten
minutes longer than the recommended minutes
(Soligard et al., 2008). Warm up of more than 25
minutes has been found to have a negative influence
on performance as it may induce fatigue (Zois et al.,
2011) and deplete energy stores (Gregson et al.,
2005). However their finding and the finding in this
study is in contradiction to Zois et al. (2011) who
found that longer duration of pre match warm up had
no influence on performance. About 90% of the
teams went through a warm up routine during
training sessions which lasted for an average of
19±9.72 minutes. The pre-training warm up routine
for this study is within the ranges of the FIFA 11+
comprehensive warm up programme which is 15 –
20 minutes. Though the teams engaged in pre-
training warm up, four of the nine teams did not
have a structured warm up that covers the basic
components required for football training. The basic
components of pre-training warm up include but not
limited to ball handling, kicking skills, sprinting,
football drills and endurance training (Lees and
Nolan, 1998). This is despite evidence that
structured warm up routines reduce the risk of injury
(Soligard et al., 2010, Steffen et al., 2013a).
4.3 Stretches (Pre Participation)
Sixty percent of the teams included stretching during
the warm up routine and 40% did pre-participation
static stretching. Pre participation regular stretching
reduces the risk of muscle tendinous injuries and
improves performance when combined with
dynamic drills (McHugh and Cosgrave, 2010,
Shrier, 2004). However, static stretching has been
found to reduce acute muscle performance up to an
hour following the stretch and is therefore not
recommended pre-participation. It is recommended
that players engage in dynamic stretching pre-
participation (Fattahi-Bafghi and Amiri-Khorasani
(2013). The stretching regiment being done in this
cohort was found to be inappropriate as static
stretching was done prior to exercise and after warm
up which has been found to reduce performance and
strength (Fowles et al., 2000). Static stretching
routine combined with dynamic activities (Fattahi-
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Bafghi and Amiri-Khorasani, 2013) prior to training
session should be advocated to reduce the risk of
muscle injuries (Jamtvedt et al., 2010).
4.4 Cool down and Post Participation
Static stretching together with cold water immersion,
compression garments, rehydration and energy
refuelling are considered as the standard basic
activities to facilitate recovery post exercise
(Montgomery et al., 2008). In this study, only two
teams performed static stretching post training.
Although outcomes on post activity stretching are
inconclusive (Jamtvedt et al., 2010, Herbert and
Gabriel, 2002), there is conflicting evidence that it
may reduce muscle soreness and assist in recovery
of muscles (Ne´de´lec et al., 2013).
4.5 Equipment
During matches all the teams used appropriate gear
for football including boots, shin guards and
goalkeeper kit. However, during the training
sessions 40% of the teams were not using shin
guards. Mtshali et al. (2009) found that wearing of
shin guards had a 65% likelihood of reducing leg
injuries. The use of shin guards during training
seems to be problematic in other countries as well.
Owoeye et al. (2013) found that only 40% of players
in Nigeria wore shin guards during training. It is
clear in this study that use of the shin guards during
training is poor and demonstrates a lack of
understanding of appropriate use of equipment in
soccer to prevent injuries. The danger of sustaining
injuries is just as real during training as it is during
matches.
4.6 Hydration
The aim of rehydrating before, during and after
exercise is to maintain fluid balance and avert
compromised performance from fluid loss (Shirreffs
et al., 2006). Hydration enhances performance
before and after exercise especially when combined
with electrolytes and carbohydrates (Shirreffs et al.,
2006, Sawka et al., 2007). Fluid intake in warm
temperatures increases body water reserves and
improves temperature regulation and does not
decrease performance (Rico-Sanz et al., 1996). This
study was done during the cool season (July to
August) where temperatures were below 20°C.
There was minimal fluid intake by the teams (30%)
during training. Less fluid intake during cool
weather conditions observed in this study is similar
to what was established by Maughan et al. (2005a).
They established that sweat loss when training in
cool conditions in a 90 minute training session was
similar to that experienced when exercising in warm
conditions. With sweat loss similar in warm and cool
conditions, conclusions can be drawn that fluid
intake when exercising in cool temperature is just as
important as exercising in warm temperatures to
prevent heat related injuries (Maughan et al.,
2005b).
4.7 Injury Management
There was 20% presence of medical care during
training sessions in this study and there was only one
team coach who had an injury management protocol.
Health and safety protocols for players state that
there should be basic medical care coverage during
sporting events for players as well as spectators
regardless of the level of competition (Murphy and
Waddington, 2007, Almquist et al., 2008). The role
of medical care coverage in teams is to provide
injury prevention and rehabilitation once the injury
has occurred (McLean, 1990). The lack of initial
injury management may in the long run influence
the team’s performance due to injury, player
absenteeism and poor return to play
protocols(Matheson et al., 2011). It may also have
cost implications where lack of proper acute
management of sport injuries results in progression
to chronic conditions like osteoarthritis later in life
which has an impact on the health system and
concerned individuals (Drawer and Fuller, 2001,
Dvorak, 2011).
5 CONCLUSION
This study provides information on coach practices
and oversight regarding injury prevention during
training sessions. Sixty percent of the items in the
observation list were not taken into consideration by
most of the coaches during training. Items such as
warm up, stretches and appropriate use of equipment
were considered by most of the teams. The
observations of coaches practices may assist in the
development, adherence and implementation of
injury prevention programmes specific to the needs
identified.
5.1 Implications for Prevention
(Practical Implications)
Observation method can be used to evaluate
InjuryPreventionPracticesbyAmateurFootballCoachesinGautengSouthAfrica
61
coaches’ implementation of injury prevention
programmes.
5.2 What This Study Adds
Observation method in determining the pre-
existing practices of football coaches.
Experience as a player is the main source of
knowledge for amateur coaches
Insight on the existing gap on implementation
and adherence to injury prevention evidence
into practice.
ACKNOWLEDGEMENTS
This research was funded by the Carnegie Research
Grant and supported by the Consortium for
Advanced Research Training in Africa (CARTA).
CARTA is jointly led by the African Population and
Health Research Center and the University of the
Witwatersrand and funded by the Wellcome Trust
(UK) (Grant No: 087547/Z/08/Z), the Department
for International Development (DfID) under the
Development Partnerships in Higher Education
(DelPHE), the Carnegie Corporation of New York
(Grant No: B 8606), the Ford Foundation (Grant No:
1100-0399), Google.Org (Grant No: 191994), Sida
(Grant No: 54100029) and MacArthur Foundation
Grant No: 10-95915-000-INP”
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InjuryPreventionPracticesbyAmateurFootballCoachesinGautengSouthAfrica
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