A retrospective survey on injuries in Croatian football/soccer referees

BACKGROUND Injury among soccer referees is rarely studied, especially with regard to differences in the quality level of the refereeing. Additionally, we have found no study that has reported injury occurrence during official physical fitness testing for soccer referees. The aim of this study was to investigate the frequency, type and consequences of match-related and fitness-testing related injuries among soccer referees of different competitive levels. METHODS We studied 342 soccer referees (all males; mean age 32.9 ± 5.02 years). The study was retrospective, and a self-administered questionnaire was used. In the first phase of the study, the questionnaire was tested for its reliability and applicability. The questionnaire included morphological/anthropometric data, refereeing variables, and musculoskeletal disorders together with the consequences. RESULTS The sample comprised 157 main referees (MR; mean age 31.4 ± 4.9 years) and 185 assistant referees (AR; mean age 34.1 ± 5.1 years) divided into: international level (Union of European Football Associations-UEFA) referees (N = 18; 6 MRs; 12 ARs) ; 1st (N = 78; 31 MRs; 47 ARs), 2nd (N = 91; 45 MRs; 46 ARs); or 3rd national level referees (N = 155; 75 MRs; 80 ARs). In total, 29% (95%CI: 0.23-0.37) of the MRs and 30% (95%CI: 0.22-0.36) of the ARs had experienced an injury during the previous year, while 13% (95%CI: 0.05-0.14) of the MRs, and 19% (95%CI: 0.14-0.25) of the ARs suffered from an injury that occurred during fitness testing. There was an obvious increase in injury severity as the refereeing advanced at the national level, but the UEFA referees were the least injured of all referees. The results showed a relatively high prevalence of injuries to the upper leg (i.e., quadriceps and hamstrings) during physical fitness testing for all but the UEFA referees. During game refereeing, the ankles and lower legs were the most commonly injured regions. The MRs primarily injured their ankles. The ARs experienced lower leg and lower back disorders. However, the overall injury rate was equal for both groups, with 5.29 (95%CI: 2.23-8.30) and 4.58 (95%CI: 2.63-6.54) injuries per 1000 hours of refereeing for MRs and ARs, respectively. CONCLUSION In addition to the reported risk of injury during soccer games, physical fitness testing should be classified as a risk for injury among soccer referees. Special attention should be given to (I) lower leg injuries during games and (II) upper leg injuries during physical fitness tests. A higher physical fitness level and a qualitative approach to training are recognized as protective factors against injury. Subsequent studies should investigate the specific predictors of injuries among referees.