A number of psychological and sociocultural factors have been suggested to influence athletes' willingness to play despite being injured. Investigation of this phenomenon is undertaken optimally at the time when athletes are injured; however, many studies have relied upon retrospective recall of feelings in individuals following recovery. This study aimed, through semi-structured existential-phenomenological interviews, to explore decision-making and attitudes surrounding playing with injury in professional footballers that were currently injured but continuing to play in matches in the English football leagues. Using deductive qualitative content analysis, cultural, situational and personal moderators that have been theorised to influence playing with injury in professional football were tested. The sample comprised nine professional footballers from three different playing leagues that were identified as playing whilst injured by team physiotherapists. There was a high level of agreement in the findings of this study with previous research. Personal and cultural moderators were stable across participants, and included conforming to the athlete role and operating in a culture where pain has been normalised. Situational factors, however, were unstable and were influenced by playing league, with constraints in squad size being an important influence for lower league players. These professional footballers sought windows of opportunity for treatment and recovery both within the season and at the end of the season. It appeared that a decline in performance, rather than the presence of pain, is used as a critical marker for injury. More research is needed to explore differences in presenteeism practices at different playing levels using larger number of participants.
This study aimed to analyze the frequency, nature, and consequences of footballers playing matches while injured, and to examine the impact on injury surveillance findings. High levels of inter-rater reliability and content validity were established for a tool designed to document players who were already injured at the start of a match. The tool was implemented in three English football teams (a Championship, League 1, and League 2 team) for one season, using a "time loss" definition of injury. One hundred forty-three matches were surveyed, revealing 102 match appearances by players who were already injured. Almost half of all games featured at least one injured player, with episodes of playing with injury occurring more frequently and lasting longer in League 2 players compared with higher level players. No association was observed between the number of injured players starting matches and match outcome [χ(2) (4, N = 143) = 3.27, P = 0.514]. Fifteen percent of all injury episodes captured were only through prospective documentation of playing while injured. The findings show that both traumatic and overuse injuries are managed by footballers through competitive matches, and have important implications for aiding understanding of the epidemiology of injury in professional football.
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