{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:50:03Z","timestamp":1791445803644,"version":"4.3.3"},"reference-count":38,"publisher":"BMJ","issue":"23","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2025,9,28]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Youth football players are vulnerable to apophyseal injuries, which can have long-term consequences for health and performance. The objective was to assess the incidence, severity and burden of apophyseal injuries among U9\u2013U21 academy football players over two seasons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Time-loss injuries and match\/training exposure were tracked in male academy football players (U9\u2013U21) from Premier League and Category One Academies. Apophyseal injuries were identified in a cohort of 16\u2009024 player-seasons using Orchard Sports Injury Classification System (OSICS) codes, and their incidence, severity and burden were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 10\u2009589 injuries were reported, including 603 apophyseal injuries. These injuries followed a distal-to-proximal progression with age, occurring most frequently in the ankle\/foot in younger players (U9, U10 and U11), followed by the knee (U12) and hip\/groin in older players (U15, U16 and U18). Across all player phases (U9\u2013U21), injury burden (days\/1000\u2009hours) was higher in the hip\/groin (3.5) and knee (3.4), compared with the ankle\/foot (2.2) and pelvis\/sacrum (1.4), with the highest apophyseal incidence (~0.4 injuries\/1000\u2009hours) and burden (~20 days\/1000\u2009hours) observed in the U12\u2013U16 group, regardless of injury location. A significant trend of increasing injury severity (median days) was observed with age: U9\u2013U11 (20), U12\u2013U14 (29), U15\u2013U16 (38) and U18\u2013U21 (35).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Apophyseal injuries exhibit a distal-to-proximal progression with age, with the highest injury burden observed at the hip\/groin and knee regions and in the U12\u2013U16 group. These findings can help inform injury mitigation strategies adopted in youth academy football.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjsports-2024-109612","type":"journal-article","created":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T17:20:23Z","timestamp":1759684823000},"page":"1663-1669","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Distal-to-proximal progression of apophyseal injuries with age in male youth academy footballers: a two-season prospective cohort study of 16,024 player-seasons"],"prefix":"10.1136","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8805-4868","authenticated-orcid":false,"given":"Chelsea","family":"Oxendale","sequence":"first","affiliation":[{"name":"University of Bath, Bath, UK"},{"name":"Liverpool John Moores University, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Green","sequence":"additional","affiliation":[{"name":"Elite Performance Manager, Football Association Premier League, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Stokes","sequence":"additional","affiliation":[{"name":"University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Cumming","sequence":"additional","affiliation":[{"name":"University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1915-9324","authenticated-orcid":false,"given":"Gemma Nicole","family":"Parry","sequence":"additional","affiliation":[{"name":"University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1460-0085","authenticated-orcid":false,"given":"Sean","family":"Williams","sequence":"additional","affiliation":[{"name":"University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"key":"2025122907000627000_59.23.1663.1","unstructured":"Premier League . The elite player performance plan report. 2022. Available: https:\/\/www.premierleague.com\/news\/2920464"},{"key":"2025122907000627000_59.23.1663.2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.14198\/jhse.2018.132.04","article-title":"Physical demands of playing position within English Premier League academy soccer","volume":"13","author":"Abbott","year":"2018","journal-title":"J Human Sport Exerc"},{"key":"2025122907000627000_59.23.1663.3","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2019.00333","article-title":"Changes Over a Decade in Anthropometry and Fitness of Elite Austrian Youth Soccer Players","volume":"10","author":"Gonaus","year":"2019","journal-title":"Front Physiol"},{"key":"2025122907000627000_59.23.1663.4","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-019-01169-8"},{"key":"2025122907000627000_59.23.1663.5","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jshs.2021.10.002","article-title":"Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis","volume":"11","author":"Robles-Palaz\u00f3n","year":"2022","journal-title":"J Sport Health Sci"},{"key":"2025122907000627000_59.23.1663.6","article-title":"Exploring Growth, Maturity, and Age as Injury Risk Factors in High-Level Youth Football","volume":"8","author":"Wik","year":"2024","journal-title":"Sports Med Int Open"},{"key":"2025122907000627000_59.23.1663.7","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1111\/sms.13635","article-title":"Skeletal maturation and growth rates are related to bone and growth plate injuries in adolescent athletics","volume":"30","author":"Wik","year":"2020","journal-title":"Scand J Med Sci Sports"},{"key":"2025122907000627000_59.23.1663.8","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1080\/02640414.2022.2051380","article-title":"The influence of exposure, growth and maturation on injury risk in male academy football players","volume":"40","author":"Johnson","year":"2022","journal-title":"J Sports Sci"},{"key":"2025122907000627000_59.23.1663.9","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s11914-023-00796-5","article-title":"Bone Health in Young Athletes: a Narrative Review of the Recent Literature","volume":"21","author":"Armento","year":"2023","journal-title":"Curr Osteoporos Rep"},{"key":"2025122907000627000_59.23.1663.10","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00264-021-05178-z","article-title":"The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes","volume":"46","author":"Gaulrapp","year":"2022","journal-title":"Int Orthop (SICOT)"},{"key":"2025122907000627000_59.23.1663.11","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldw041"},{"key":"2025122907000627000_59.23.1663.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0190503","article-title":"Risk assessment of the onset of Osgood-Schlatter disease using kinetic analysis of various motions in sports","volume":"13","author":"Itoh","year":"2018","journal-title":"PLoS ONE"},{"key":"2025122907000627000_59.23.1663.13","doi-asserted-by":"crossref","DOI":"10.1177\/23259671211065063","article-title":"Apophysitis Among Male Youth Soccer Players at an Elite Soccer Academy Over 7 Seasons","volume":"10","author":"Gudelis","year":"2022","journal-title":"Orthop J Sports Med"},{"key":"2025122907000627000_59.23.1663.14","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/sms.14059","article-title":"Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study","volume":"32","author":"Materne","year":"2022","journal-title":"Scand J Med Sci Sports"},{"key":"2025122907000627000_59.23.1663.15","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2003.005165"},{"key":"2025122907000627000_59.23.1663.16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s13018-022-02979-9","article-title":"Incidence of calcaneal apophysitis (Sever\u2019s disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years","volume":"17","author":"Belikan","year":"2022","journal-title":"J Orthop Surg Res"},{"key":"2025122907000627000_59.23.1663.17","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/24733938.2023.2261399","article-title":"Growth-related sports injuries among young male professional football players in the Netherlands: a prospective cohort study concerning injury incidence, severity and burden","volume":"9","author":"Juch","year":"2025","journal-title":"Sci Med Footb"},{"key":"2025122907000627000_59.23.1663.18","doi-asserted-by":"crossref","first-page":"6138","DOI":"10.3390\/jcm12196138","article-title":"Injury Patterns and Incidence in an Elite Youth Football Academy\u2014A Prospective Cohort Study of 138 Male Athletes","volume":"12","author":"Weishorn","year":"2023","journal-title":"JCM"},{"key":"2025122907000627000_59.23.1663.19","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/17461391.2021.2006316","article-title":"The burden of injuries according to maturity status and timing: A two\u2010decade study with 110 growth curves in an elite football academy","volume":"23","author":"Monasterio","year":"2023","journal-title":"Eur J Sport Sci"},{"key":"2025122907000627000_59.23.1663.20","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1080\/24733938.2021.1943756","article-title":"Injuries are negatively associated with player progression in an elite football academy","volume":"6","author":"Larruskain","year":"2022","journal-title":"Sci Med Footb"},{"key":"2025122907000627000_59.23.1663.21","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098160"},{"key":"2025122907000627000_59.23.1663.22","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-018-0953-x"},{"key":"2025122907000627000_59.23.1663.23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2006.00528.x"},{"key":"2025122907000627000_59.23.1663.24","doi-asserted-by":"crossref","first-page":"207","DOI":"10.2147\/OAJSM.S7715","article-title":"Revision, uptake and coding issues related to the open access Orchard Sports Injury Classification System (OSICS) versions 8, 9 and 10.1","volume":"1","author":"Orchard","year":"2010","journal-title":"OAJSM"},{"key":"2025122907000627000_59.23.1663.25","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106405"},{"key":"2025122907000627000_59.23.1663.26","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1055\/a-2292-5263","article-title":"Why Median Severity and Ordinal Scale Severity Values should not be used for Injury Burden Results: A Critical Review","volume":"38","author":"Fuller","year":"2024","journal-title":"Sportverletz Sportschaden"},{"key":"2025122907000627000_59.23.1663.27","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101969"},{"key":"2025122907000627000_59.23.1663.28","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1405"},{"key":"2025122907000627000_59.23.1663.29","first-page":"1009","article-title":"A CHecklist for statistical Assessment of Medical Papers (the CHAMP statement): explanation and elaboration","volume":"55","author":"Mansournia","year":"2021","journal-title":"Br J Sports Med"},{"key":"2025122907000627000_59.23.1663.30","doi-asserted-by":"crossref","first-page":"235","DOI":"10.5114\/biolsport.2024.129472","article-title":"The combined effects of growth and maturity status on injury risk in an elite football academy","volume":"41","author":"Monasterio","year":"2024","journal-title":"Biol Sport"},{"key":"2025122907000627000_59.23.1663.31","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1002\/tsm2.252","article-title":"Long\u2010term outcome of conservatively treated lower limb apophyseal injuries in children and adolescents: A systematic review","volume":"4","author":"Apers","year":"2021","journal-title":"Transl Sports Med"},{"key":"2025122907000627000_59.23.1663.32","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13071915","article-title":"The Impact of Injury on Career Progression in Elite Youth Football-Findings at 10 Years","volume":"13","author":"Bangert","year":"2024","journal-title":"J Clin Med"},{"key":"2025122907000627000_59.23.1663.33","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2024-108215"},{"key":"2025122907000627000_59.23.1663.34","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.4103\/2230-8210.145075","article-title":"Advances in pubertal growth and factors influencing it: Can we increase pubertal growth?","volume":"18","author":"Soliman","year":"2014","journal-title":"Indian J Endocrinol Metab"},{"key":"2025122907000627000_59.23.1663.35","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1080\/03014460.2023.2261854","article-title":"Can we reduce injury risk during the adolescent growth spurt? An iterative sequence of prevention in male academy footballers","volume":"50","author":"Johnson","year":"2023","journal-title":"Ann Hum Biol"},{"key":"2025122907000627000_59.23.1663.36","doi-asserted-by":"crossref","unstructured":"Malina RM , Bouchard C , Bar-Or O , et al . Growth, maturation, and physical activity. 2nd edn. Champaign, Ill;Leeds: Human Kinetics, 2004.","DOI":"10.5040\/9781492596837"},{"key":"2025122907000627000_59.23.1663.37","doi-asserted-by":"publisher","DOI":"10.1177\/1941738109334214"},{"key":"2025122907000627000_59.23.1663.38","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1080\/24733938.2024.2316093","article-title":"What contextual factors influence pain management decision making concerning player availability in professional men\u2019s football? A qualitative analysis of practitioner perceptions","volume":"9","author":"Read","year":"2025","journal-title":"Sci Med Footb"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2024-109612","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T15:00:21Z","timestamp":1767020421000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2024-109612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,5]]},"references-count":38,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12,29]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bjsports-2024-109612"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2024-109612","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,5]]}}}