title: The effect of hypermobility on the incidence of injury in professional football: A multi-site cohort study.
abstract: BACKGROUND
  A recent study demonstrated joint hypermobility increased the incidence of injury in an elite football team utilising a univariate statistical model.
  
  
  OBJECTIVE
  To compare injury incidence between hypermobile and non-hypermobile elite football players incorporating a multi-site design and multivariate inferential statistics.
  
  
  METHODS
  80 players comprising 3 English Championship football teams were followed prospectively during the 2012-2013 season. Joint hypermobility was assessed according to the 9-point Beighton Criteria at the start of the study period. A cut-off score of ≥4 categorised a participant as hypermobile. Player exposure and time-loss injuries were recorded throughout.
  
  
  RESULTS
  Mean ± standard deviation incidence of injuries was 9.2 ± 10.8 injuries/1000 h. The prevalence of hypermobility was 8.8%. Hypermobiles had a tendency for higher injury incidence (mean [95% confidence interval] difference, 5.2 [0.9-2.7] injuries/1000 h; p = 0.06). Cox regression analyses found training exposure to be highly significant in terms of injury risk (p < 0.001) for all participants. Non-hypermobiles had a lower injury risk (p = 0.11), according to the Cox model, which is suggestive but not conclusive that hypermobility predisposes injury risk.
  
  
  CONCLUSIONS
  Hypermobility showed a trend towards increased risk of injury. Training exposure is a significant injury risk factor in elite football.
authors.affiliation: Liverpool Football Club, Liverpool, UK; Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK. Electronic address: matt.konopinski@liverpoolfc.com.
authors.forename: Matt
authors.initials: M
authors.lastname: Konopinski
authors.affiliation: Liverpool Football Club, Liverpool, UK. Electronic address: ian.graham@liverpoolfc.com.
authors.forename: Ian
authors.initials: I
authors.lastname: Graham
authors.affiliation: Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK; Leeds Pallium Research Group, Leeds, UK. Electronic address: m.johnson@leedsbeckett.ac.uk.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Johnson
authors.affiliation: Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK; Leeds Pallium Research Group, Leeds, UK. Electronic address: g.j.Jones@leedsbeckett.ac.uk.
authors.forename: Gareth
authors.initials: G
authors.lastname: Jones
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000150:complications*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012916:Soccer / Q000293:injuries*
keywords: Exposure; Football; Hypermobility; Injury