{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T09:23:55Z","timestamp":1771493035269,"version":"3.50.1"},"reference-count":68,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury. Methods: A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020\u20132021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database. Results: Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II\/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle\u2013tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II\/III versus Non-COVID-19. Conclusions: This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.<\/jats:p>","DOI":"10.3390\/ijerph20065182","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T03:14:35Z","timestamp":1678936475000},"page":"5182","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The \u201cItalian Injury Study\u201d during the Serie a Championship"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5793-3221","authenticated-orcid":false,"given":"Alessandro","family":"Corsini","sequence":"first","affiliation":[{"name":"Italian Sport Medicine Federation (FMSI), 7000196 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Bisciotti","sequence":"additional","affiliation":[{"name":"Kinemove Rehabilitation Center, 54027 Pontremoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaele","family":"Canonico","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Sportiva Calcistica Napoli, 81030 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Causarano","sequence":"additional","affiliation":[{"name":"Associazione Sportiva Roma, 00182 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Del Vescovo","sequence":"additional","affiliation":[{"name":"Hellas Verona Football Club, 37126 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierluigi","family":"Gatto","sequence":"additional","affiliation":[{"name":"Genoa Cricket and Football Club, 16155 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Gola","sequence":"additional","affiliation":[{"name":"Spezia Calcio, 19136 La Spezia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Iera","sequence":"additional","affiliation":[{"name":"Football Club Crotone, 88900 Crotone, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-2634","authenticated-orcid":false,"given":"Stefano","family":"Mazzoni","sequence":"additional","affiliation":[{"name":"Sport Medicine Department\u2014Milan Lab, Associazione Calcistica Milan, 20149 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1932-5003","authenticated-orcid":false,"given":"Paolo","family":"Minafra","sequence":"additional","affiliation":[{"name":"Torino Football Club, 10121 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianni","family":"Nanni","sequence":"additional","affiliation":[{"name":"Bologna Football Club 1909, 40132 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio","family":"Pasta","sequence":"additional","affiliation":[{"name":"Parma Calcio, 43123 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivo","family":"Pulcini","sequence":"additional","affiliation":[{"name":"SS Lazio, 00060 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Salvatori","sequence":"additional","affiliation":[{"name":"Benevento Calcio, 82100 Benevento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Scorcu","sequence":"additional","affiliation":[{"name":"Cagliari Calcio, 09124 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2258-3788","authenticated-orcid":false,"given":"Luca","family":"Stefanini","sequence":"additional","affiliation":[{"name":"Juventus Football Club, 10151 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Tenore","sequence":"additional","affiliation":[{"name":"Udinese Calcio, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Palermi","sequence":"additional","affiliation":[{"name":"Public Health Department, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Casasco","sequence":"additional","affiliation":[{"name":"Italian Sport Medicine Federation (FMSI), 7000196 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4996-7995","authenticated-orcid":false,"given":"Stefano","family":"Calza","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/10408363.2020.1783198","article-title":"The COVID-19 Pandemic","volume":"57","author":"Ciotti","year":"2020","journal-title":"Crit. 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