This study reviewed the health profile of soccer players in Northern Ireland (NI) as described through the UEFA pre-participation medical screening procedure. The club at which the medicals were performed is one of the most successful currently in NI, winning four top flight trophies over the period of time for which the medicals were conducted and having three full NI internationals amongst their players.
Pre-participation medical screening of athletes is a controversial topic
[17, 18]. It does not fulfill the requirements for an appropriate screening test
, to detect the known causes of sudden cardiac death in athletes
. However, the medical allows a time to review the athlete, identify potential injury risk factors
, help prevent injuries and provide health education, e.g. anti-doping guidelines
, and maximise recovery strategies for the athlete
. There is also a need to optimise treatment of current medical conditions such as asthma
One of the biggest risk factors for injury in elite footballers is a previous history of injury
[25, 26] and an important part of the pre-participation medical screening is therefore to be aware of all players’ injury history and to instigate preventative work as required. For example the player with pes planus was referred for custom-made insoles, the player with iliotibial band syndrome was started on an appropriate stretching programme and the player with osteitis pubis was advised to report any hip or groin symptoms early to allow appropriate modification of his training load.
It is vital for the team physician to know what medical conditions exist in the team, to determine medications that need to be carried. This study’s findings highlight how medications may be needed to deal with emergencies related to diabetes, asthma or epilepsy and how appropriate therapeutic use exemptions (TUEs) may be requested.
The study data reflect use of sport supplementation, which is becoming more common amongst footballers
. Sport physicians need to provide appropriate education to players regarding supplement use and the issue of contamination
. One area which the club could improve upon is the provision of a nutritionist to provide dietary advice.
Testing for urinary glucose is a poor screening test for diabetes
. Dipstick urinalysis for proteinuria has been reported to be a poor screening test for renal damage, particularly within pre-participation medical screening examinations
. Physiological reasons for proteinuria amongst athletes include exercise, particularly of an intense nature
, and prolonged standing. The club now reinforces with players the need for relative rest 48 hours prior to a medical and advises adequate hydration to avoid false positives for proteinuria.
Previous authors have commented that tinea pedis is common amongst athletes
. The low prevalence of this fungal infection in our cohort may be explained by the emphasis which the club places on foot hygiene, for example wearing flip-flops in the showering area.
The players with evidence of knee crepitus and reduced internal rotation at the hip may be developing early signs of osteoarthritis of these joints and sporting participation, with or without joint injury, appears to be a risk factor for early development of osteoarthritis
. Athletes therefore need to be counseled appropriately regarding future elite sporting participation and may need to consider early retirement from professional sport.
All the players in our cohort were found to be normotensive. One previous study reviewing BP in Norwegian footballers using ambulatory BP monitors, found that 32% of their cohort had masked hypertension
. The use of ambulatory BP monitoring instead of office BP recordings may be of interest although the cost may be prohibitive.
Poor ankle stability as measured by the SOLEC test is reported to increase the risk of injury
, particularly of the ankle and knee regions
, with proprioception training in footballers with previous ankle inversion injuries reducing further ankle sprains
. The players averaged approximately 30 seconds on each leg. Previous authors have advised that if players are unable to undertake the SOLEC test for at least 60 seconds on each leg, then balance training using a balance board should be instigated, with positive results following 3 months of training
. As a result proprioception work has now been integrated routinely into the club’s training sessions.
The height, weight and body mass index (BMI) of the semi-professionals in our cohort were consistent with a previous study looking at professional footballers in the top four European leagues
. Although despite being of a similar average height, our players were nearly 8 kg heavier than a cohort of footballers from the Czech Republic which included amateur and professional players
. A measurement which may be of more relevance is percentage body fat
Typical findings reported by previous authors reviewing athletic ECGs have included sinus bradycardia and first-degree AV block with a PR interval of greater than 200 ms
. The average ventricular rate of our cohort was 61 bpm with a PR interval of 159.3 ms. Athletic changes to the heart may occur after a minimum of four hours activity per week
: our semi-professional cohort might only train for approximately three hours a week. Any abnormal ECG findings would require further investigation with an echocardiogram, as suggested by previous authors
There is some evidence to suggest that as age increases, the risk of hamstring strains increases
[40, 41] and indeed the rate of all muscular injuries. A common injury within football/soccer is groin injuries
[42–44]. Dallinga et al.
 report in a systematic review that hip adduction-to-abduction strength ratio was a significant predictor of a future adductor strain (RR-17, based on a hip adduction of <80% of abduction strength), which is supported by previous authors
[43, 45]. Heavier and shorter players are also reported to be at increased risk of quadriceps strains
[46, 47]. During the pre-participation medical screening players need to be educated about these facts with attempts made to modify the other intrinsic risk factors, e.g. flexibility and strength deficits
, to allow them to reduce their risk from this injury.
Full blood count parameters in elite German footballers have been reported
 but this is the first time that such parameters have been documented in NI footballers. As would be expected in an athletic cohort, the mean values for haematocrit and haemoglobulin are at the high end of the normal range for the general population.
This study is only of one team, reporting on a relatively small cohort and over the course of four seasons. One un-blinded doctor conducted the medicals, therefore ensuring a consistent approach. However, possible bias in observations may exist. Whilst the study reviews medicals performed before the start of the season, further relevant detail may be elicited if middle and end of the season medicals were conducted. The preseason medical largely relies on player recall of data, e.g. previous injuries, which may underestimate the prevalence of certain conditions. Further details of ECG changes (ST and T wave changes, etc) may have been identified if the ECGs were read by independent, blinded cardiologists.