1. Musculoskeletal pain in Hyundai A- League and Westfield W-League match officials An observational study Corey L 1, Hirschhorn AD 2,3, Mungovan SF 1,2,3, Breckenridge J 1,2,3 1 Central West Orthopaedic and Sports Physiotherapy, Sydney 2 The Clinical Research Institute, Sydney 3 Westmead Private Physiotherapy Services, Sydney

2. Introduction Musculoskeletal pain and injury patterns among elite football (soccer) players have been extensively researched There are limited data on musculoskeletal pain and injury patterns among elite football match officials The physical demands of match officiating at the elite level are comparable to those of playing. 1 Study questions: 1.How prevalent is musculoskeletal pain among elite (Hyundai A-League, Westfield W-League) football match officials? 2.Does pain prevalence change over the course of the season? 3.Are there differences between referees and assistant referees (linesmen)?

3. Subjects Football Federation of Australia (FFA) contracted match officials (n=45) 2012/13 Hyundai A-League and Westfield W-League M:F = 28:17 Age: 28 ± 4 years (range: 19 to 41 years) Referees (n=26) Assistant referees (n=19) All match officials undertook a mandated fitness program both before and during the football season

4. Methods Match officials completed self-report pain surveys on three occasions: 1.Pre-season 2.Mid-season 3.End-season Presence/severity of musculoskeletal pain across 11 anatomical sites in four body regions (spinal, hip, knee, foot/ankle) were assessed using 0 to 10 Likert scales Scores 4/10 were considered positive for (moderate or greater) pain

5. Results: Prevalence of musculoskeletal pain Pre-season, 40/45 referees (89%) reported pain at one site. End-season, 32/45 (71%) reported pain at one site (p = 0.063 vs pre-season). There was a significant reduction in the reported number of painful sites across the football season (pre- season: 3.6 ± 2.8 sites vs end-season: 2.1 ± 2.1 sites, p = 0.004) – see Figure 1

6. Results: Change in pain prevalence over season There was a significant reduction in the prevalence of hip (p=0.017), knee (p=0.010) and ankle (p=0.017) pain from pre-season to end-season – see Figure 2

7. Results: Differences between referees and assistant referees A significantly higher proportion of assistant referees than referees reported end- season knee pain (p = 0.008) – see Figure 3

8. Conclusions and implications Musculoskeletal pain is common in elite football match officials Pain prevalence decreases across the course of the football season Knee pain is more prevalent in assistant referees than referees As with players, match officials may benefit from formalised training and injury prevention programs

9. Directions for future research What are the causative mechanisms of pain for assistant referees vs referees? What are the optimal training and injury prevention programs for elite football match officials?

10. Injury-time reading 1. Drayton, J, REVEALED: Refs run more than the Premier League stars (yes, really!) and get 99% of offside calls correct, media release, 13th August, Associated Newspapers Ltd, viewed 22nd August 2013,.http://www.dailymail.co.uk/sport/football/article-2391215/Referees-run- players-99-cent-offsides-correct-claims-report.html#ixzz2cehv76be