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Injuries and Musculoskeletal Complaints in Referees-A Complete Survey in the Top Divisions of the Swiss Football League

Bizzini, Mario MSc*†; Junge, Astrid PhD*†; Bahr, Roald MD, PhD; Dvorak, Jiri MD, PhD*†§

Clinical Journal of Sport Medicine: March 2009 - Volume 19 - Issue 2 - p 95-100
doi: 10.1097/JSM.0b013e3181948ad4
Original Research

Objective: To analyze the extent and characteristics of injuries and musculoskeletal complaints in elite football referees and to analyze differences between match and assistant referees.

Design: Retrospective cohort study.

Setting: Training camp organized by the Swiss Referees Association.

Participants: All 71 referees of the 2 top divisions of the Swiss Football League (2005-2006 season).

Interventions: The referees (66 males and 5 females) completed a questionnaire on their personal characteristics, referee qualifications, time spent in training and matches, career history of injuries, and musculoskeletal complaints caused by training or refereeing and were subsequently interviewed about the location, type, circumstances, and consequences of reported injuries.

Main Outcome Measures: Incidence of injuries, frequency of musculoskeletal complaints, type of injuries, and complaints.

Results: A total of 41 injuries during the career were reported by 31 of 71 referees (44%). Injuries were incurred more frequently in training than during matches, and all injuries reported resulted in at least 2 weeks of absence from sport. About a quarter of the referees reported an injury, and almost 90% of the referees reported musculoskeletal complaints caused by refereeing during the preceding 12 months. In male referees, hamstring strains and ankle sprains were the most common injuries, and the hamstrings, knee, Achilles tendon, and calf were the most prevalent locations of musculoskeletal complaints. No significant difference in the incidence of injury or in the frequency of complaints was observed between match and assistant referees.

Conclusions: Future studies should be designed prospectively and should include a larger group of female referees. Regarding the incidence of injuries and frequency of musculoskeletal complaints related to refereeing, prevention programs for football referees should be developed, evaluated, and implemented.

From the *Schulthess Clinic, Zurich, Switzerland; †FIFA-Medical Assessment and Research Centre, Zurich, Switzerland; ‡Oslo Sports Trauma Research Centre, Oslo, Norway; and §Fédération Internationale de Football Association, Zurich, Switzerland.

Submitted for publication April 1, 2008; accepted November 10, 2008.

The authors state that they have no financial interest in the products mentioned within this article.

Reprints: Mario Bizzini, MSc, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.