Paper : Sports Medicine and Rehabilitation

Effects of Physical and Psychological Factors on Sports
Injury Occurrence in Collegiate Football Players
Naruto Yoshida*,**, Masaaki Koido***, Hideaki Waki**,Yoichi Minakawa**, Sonoko Mashimo**** and Shogo Miyazaki***Department of Sport and Wellness, Rikkyo University

1-2-26 Kitano, Niizashi, Saitama 352-8558 Japannaruto-y-ad@rikkyo.ac.jp**Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei University***Faculty of Health and Sport Sciences, University of Tsukuba****Institute for Liberal Arts and Sciences, Osaka Electro-Communication University[Received January 23, 2023; Accepted June 27, 2023]

It should be acknowledged that several factors (including physical and psychological ones) are
involved in sports injuries and conditioning. However, most reports related to the conditions of theathletes, consider their physical and psychological aspects separately. This prospective cohort study
aimed to assess whether physical and psychological factors synergistically increase the risk of injury
among Japanese footballers by examining field-based measurements and online surveys. A total of
94 footballers were followed up during the football season. Eight factors comprising four physical(current injury, pain awareness, functional movements, and ankle instability) and four psychologicalfactors (catastrophic thoughts about pain, sleepiness awareness, sleep disorder, as well as anxiety
and depression) were examined. An increased risk of injury was observed when the physical injury
was associated with emotional reactions, defined as psychological factors. This study confirms thefindings of previous reports focusing on psychological factors and shows that encouraging collegiate
athletes to seek treatment for such concerns can be extremely effective. It is, therefore, importantto adopt programs that communicate the importance of collaborative and interdisciplinary
treatment approaches to collegiate athletes, sports physicians, and administrative staff to provide
comprehensive treatment for collegiate athletes.
Keywords: mental health, prospective study, sports injury[Football Science Vol. 20, 27-37, 2023]

1. Introduction
Conditioning is the preparation for an athlete toperform well, which includes physical, environmental,
and psychological factors. Improving athletic
performance while avoiding injury is the primary
goal of training programs. Pursuing optimal training
programs for athletes has always been a concern insports science research. Even if athletes perform well,
an injury may force them to change their training
plan. Thus, preventing injury occurrence is essential
for efficient conditioning and improving athletic
performance. In addition, extracting risk factors
from injury surveys and minimizing the intrinsic
risk to athletes is a widely known approach to injury
prevention (van Mechelen et al., 1992).
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Risk factors for injury occurrence include the joint
range of motion, muscle strength, joint instability,
and sports skills among others (Bahr et al., 2003).
Delahunt and Remus (2019) reported these items
as elements of ankle instability that remain after anankle sprain, a common sports injury. Patients withankle instability often exhibit muscle weakness, joint
laxity, and altered biomechanics. These disorders
alter the load distribution in the ankle joint, leading to
the destruction of the articular cartilage (Taga et al.,1993), making ankle instability a risk factor for sports
injuries.
Basic observable patterns of behavior andmovement present from childhood are known as
fundamental movement skills, including running,
hopping, skipping (locomotor), balancing, twisting,27

Yoshida, N. et al.

dodging (stability), throwing, catching, and kicking(object control) (Gallahue, 1989). Therefore, skills
regarded by Bahr et al. (2003) include fundamental
movement patterns. Myklebust and Bahr (2005)
reported that exercise-based injury prevention
programs could effectively prevent injury by
improving biomechanical and neuromuscularcharacteristics during functional tasks, such as
movement patterns during jumping, landing, andcutting maneuvers. Besides, movement improvement
patterns reduce the injury occurrence rates (Myklebust
et al., 2005). The Functional Movement Screen(FMS), which evaluates movement patterns (good orpoor movement pattern quality), is easy to administerin sports settings. As cut-off values have beenreported for this instrument, there have been many
investigations of its relationship to injury occurrence.
According to a systematic review by Bunn et al.
(2019), many studies have defined an FMS total scoreof ≤14 points as “high risk,” and individuals withthose scores were 51% more likely to be affected by
sports injuries than those with scores indicating low
risk (Bunn et al., 2019). Furthermore, athletes with
dysfunctional or asymmetrical movements may also
be at increased risk for sports injuries (Yeung et al.,2016).
In terms of psychological factors, the prevalenceof common mental disorders (CMD) in European
professional football players was reported for distress,
anxiety and depression, sleep disorders, and adverse
alcohol with some players having one or more ofthese conditions (Gouttebarge et al., 2017). CMD
symptoms are more likely to develop in professional
football players after sustaining a severe injury (Kilic
et al., 2018). As football players with depression are
10% more likely to be injured (Yang et al., 2014),
it is highly likely that physical and psychologicalconditions are closely related and affect performance.
It is considered necessary to evaluate psychologicalissues that may affect the occurrence of other injuries
or performance and take adequate measures toimprove them. The International Olympic Committee
established the Sports Mental Health Assessment
Tool (SMHAT) in a consensus statement and statedthe importance of psychological screening andassessment (Gouttebarge et al., 2021). Among others,
the SMHAT includes questions regarding sleep.
Sleep dysfunction has been previously reported in
24.7% of Japanese athletes (Hoshikawa et al., 2018).
Milewski et al. (2014) reported that athletes with28

sleep dysfunction were prone to injuries. Daytime
sleepiness is reportedly associated with poor academic
performance, suicidal tendencies and depression (Liuet al., 2019; Plante et al., 2017; Zhang et al., 2022).
This further demonstrates that sleep dysfunction is
also significantly associated with sports injuries andperformance deterioration in athletes. Besides, painis a common symptom recognized among athletes
and is considered significant, as evidenced by its
inclusion as a recommended investigation item by
the International Olympic Committee (Bahr, 2009).
Additionally, pain is known to be influenced byvarious factors, and one of these is catastrophic
thinking regarding pain, which has been shown to
impact athletes’ experience of pain (Sullivan et al.,2000). Catastrophic thinking leads to diminishedfunctional performance in the early postoperative
stage, as well as reduced physical responses andincreased pain intensity. Therefore, this would also be
an important indicator in assessing the condition of
athletes.
Physical and psychological conditions should beconsidered important factors affecting performanceand, therefore, should be evaluated together. In
addition, it is necessary to consider that there might
be multiple factors involved in sports injuries andconditioning (Meeuwisse, 1994; Bahr et al., 2005).
Besides, young athletes are averse to seeking mental
care support, as they perceive it as a sign of weakness.
This indicates their lack of knowledge regarding
mental health and other related factors (Gulliver et al.,2012). Therefore, it is necessary to conduct studies
targeting this younger generation as well.
Many of the aforementioned reports examined
either the physical or the psychological aspect andits impact on the risk of injury. It is possible thateven if a factor increases the risk of injury, it may
be overlooked, as no injury occurs because of theinteraction of the outcome of interest with otherfactors. Another report (Yoshida et al., 2021a) took
an integrated view of these factors to determine theextent to which these problems exist. However, theextent to which the simultaneous presence of thesefactors affects the occurrence of injury is not clear.
Therefore, this study aimed to observe the influenceof several risk factors on the occurrence of sports
injuries via a prospective investigation of Japanese
football players.

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Physical and Psychological Effects of Football Injuries

2. Methods

2.3. Measurement Items

2.1. Research Design

Baseline measurements included physicalcharacteristics (e.g., height and weight), athletic
characteristics (e.g., position and level ofcompetition), physical factors (e.g., current injury,
pain awareness, functional movement availability,
and ankle instability), and psychological factors (e.g.,catastrophic thoughts regarding pain, sleepiness,sleep disorders, anxiety and depression). Baseline
measurements were performed in February 2020,
just after the start of the football season. In addition,
sports injuries (e.g., trauma and overuse) that
occurred during the study period were investigated.

We designed a longitudinal observation study toaddress this question. This study was conducted inaccordance with the ethical standards formulated in
the Helsinki Declaration of 1964 and its revisions andwith the approval (R01-112-1) of the Teikyo Heisei
University Ethics Committee. The participants in the
study provided written informed consent.

2.2. Participants
The participants were recruited among 131
university football players belonging to a single teamin the Kanto University Football League in February
2020. Those whose responses could not be measured
at baseline and those who stopped participating inpractices and games during the study period (37weeks from March 30, 2020, to December 13, 2020)
were excluded owing to the possibility of injury orillness from sports activities that were not accountedfor.
We identified 94 eligible participants from the
131 recruited football players (Figure 1). Further
descriptive data are presented in Table 1. In addition,
the distribution frequencies of each participant’s
physical and psychological problems are presented
in Table 2. None of the participants experienced
concussions during the study period.
Invited to participate(131 players)
Declined to participate(29 players)
Agreed to participate(102 players)
Excluded(1 player with no baseline data)
Dropout (7 players)
withdrawn, n=1
retired from football, n=6
Analysed(94 players)

Figure 1 Study flowchart of participants
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2.4. Methods of Measurement
Physical and athletic characteristics, as well
as physical and psychological factors other thanfunctional movement ability at baseline, wereassessed with the Japanese versions of appropriatequestionnaires. For “current injury” at baseline,“injury” was defined as the inability or time lost fromparticipating in practice or games resulting from theinjury (Fuller et al., 2006). An injury was deemedas one “problem” for any participant. Regarding“pain awareness,” pain was defined as an unpleasantsensory and emotional experience associated with orresembling actual or potential tissue damage (Raja etal., 2020); pain awareness was also considered one“problem.” In this study, injury and pain were treatedas two different entities and included separately in thesurvey to make this distinction. Body parts with pain
and the degree of this pain (at an 11-point numericalrating scale rated from 0 - “no pain” to 10 - “worst
imaginable pain”) were investigated. The Cumberland
Ankle Instability Tool (CAIT) was used to assessankle instability, with the cut-off score defined as≥25 points based on the results of a previous study(Tanen et al., 2014; Kunugi et al., 2017). Functional
movement was assessed using the FMS by a Level
1-certified person with a cut-off score of <14 points
based on a previous study (Kiesel et al., 2011). The
criteria for judging psychological factors as “negative”
were as follows: Pain Catastrophizing Scale score>30 points for catastrophic thoughts concerning pain
(Sullivan et al., 1995; Matsuoka and Sakano, 2007),the Epworth Sleepiness Scale score of ≥11 points
for sleepiness (Carter et al., 2020; Takegami et al.,2009), and the Pittsburgh Sleep Quality Index (PSQI)
29

Yoshida, N. et al.

Table 1 Descriptive statistics of the cohort

Characteristic
General information
Male sex, no. (%)
Age, years
Height, cm
Weight, kg
Football experience, months
Player position, no. (%)
FW
MF
DF
GK

30

Descriptive dataa
94 (100)
20 (19-21)
174.3±5.5
68.8±5.7
168.0 (150.5-187.0)
14 (14.9)42 (44.7)
29 (30.9)9 (9.6)

Physical factors
1. Presence of sports injury
Traumatic injury, no. (%)
Contact
Non-contact
Overuse injury, no. (%)

21 (22.3)
14 (14.9)9 (9.6)5 (5.3)7 (7.4)

2. Presence of pain, no. (%)
Pain in only one body part, no. (%)
Head/face
Neck/cervical spine
Sternum/ribs/upper backLower back/pelvis/sacrum
Shoulder/clavicula
Upper arm
Elbow
Forearm
Wrist
Hand/finger/thumb
Hip/groin
Thigh
Knee
Lower leg/Achilles tendon
Ankle
Foot/toe44 (46.8)
27 (28.7)
0 (0.0)0 (0.0)0 (0.0)4 (4.3)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)3 (3.2)
1 (1.1)3 (3.2)0 (0.0)14 (14.9)
2 (2.1)Pain in two body parts, no. (%)
Sternum/ribs/upper back and thighLower back/pelvis/sacrum and hand/finger/thumb
Lower back/pelvis/sacrum and knee
Shoulder/clavicula and ankle
Hand/finger/thumb and knee
Hip/groin and knee
Hip/groin and Lower leg/Achilles tendon
Hip/groin and Ankle

17 (18.1)
1 (1.1)1 (1.1)1 (1.1)1 (1.1)1 (1.1)1 (1.1)1 (1.1)2 (2.1)

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Physical and Psychological Effects of Football Injuries

Thigh and Knee
Thigh and Lower leg/Achilles tendon
Thigh and Ankle
Knee and Ankle
Lower leg/Achilles tendon and Ankle
Lower leg/Achilles tendon and Foot/toe
Ankle and Ankle
Degree of pain during exercise (11-point Numerical
Rating Scale: NRS) (27+17×2 = total 61 parts)

1 (1.1)1 (1.1)1 (1.1)1 (1.1)1 (1.1)1 (1.1)2 (2.1)4.0 (3.0-5.0)

3. Fundamental pattern of movement: FMS
FMS risk (score<14), no. (%)

15.0 (14.0-16.0)
20 (21.3)

4. Ankle instability: CAIT
CAIT risk (score≤25), no. (%)

25.0 (22.0-27.0)
51 (54.3)

Psychological factors
1. Catastrophic thoughts of pain: PCS
PCS risk (score>30), no. (%)
2. Daytime sleepiness: ESS
ESS risk (score≥11), no. (%)
3. Sleep disorder: PSQIPSQI risk (score≥6), no. (%)
4. Symptoms of anxiety and depression: HADSHADS risk (score≥15)23.5±8.0
17 (18.1)
10.3±3.7
46 (48.9)
3.0 (2.0-4.0)
15 (16.0)
9.0 (6.8-12.3)
12 (12.8)a

The Shapiro–Wilk test denotes that the variables do not follow a normal distribution when p < 0.05, and the
median (25th percentile–75th percentile) is used in such cases. When p ≥ 0.05 in the Shapiro–Wilk test, thevariables follow a normal distribution, and the means ± standard deviations are used in such cases.

Table 2 Distribution of physical and psychological conditions

The number of physical problems
0

1

2

3

0

8 (8.5)8 (8.5)8 (8.5)8 (8.5)1

12 (12.8)8 (8.5)12 (12.8)

13 (13.8)

22 (2.1)4 (4.3)2 (2.1)0 (0.0)33 (3.2)

1 (1.1)3 (3.2)0 (0.0)4

0 (0.0)2 (2.1)0 (0.0)0 (0.0)Psychologicalproblems

no. (%), Percentages may not total 100 because of rounding.
The number of physical problems + psychological problems ≤ 2 (n=46)
The number of physical problems + psychological problems ≥ 3 (n=48)
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31

Yoshida, N. et al.

of ≥6 points for sleep disorders (adapted from Carter
et al., 2020). Sleep dysfunction was assessed using
the Pittsburgh Sleep Quality Index (Doi et al., 1998;
Doi et al., 2000). Furthermore, a Hospital Anxiety
and Depression Scale score of ≥15 points for anxiety
and depression (Fischerauer et al., 2018; Kugaya
et al., 1998) was used to establish whether eitherof these criteria had any impact. The occurrenceof sports injuries (e.g., trauma and overuse) was
measured every week during the study period (i.e.,
37 weeks from March 30, 2020, to December 13,2020) with the Oslo Sports Trauma Research Centerquestionnaire (Clarsen et al., 2014; Mashimo et al.,2020). For participants with an injury at the start ofthe study, new sports injuries were defined as thoseoccurring after recovery from the current injury.
No cases were observed where a current injury wasworsened by further injury. The definition of an injury
was, therefore, considered the most significant factor
affecting the survey results (Bahr, 2009). Based onrecent research, this prospective study defined sports
injury as all physical complaints of a player that
resulted from a football match or training, irrespectiveof the need for medical attention or time lost fromfootball activities (Fuller et al., 2006).

2.5. Statistical analyses
The following analysis flow was conducted to
examine physical and psychological problems as risks
for sports injuries. The data were assessed with Cox
proportional hazards analysis for comparing a small
number (one or less) and a large number (more thantwo) of factors. The group with one or less physicalrisk and the other with two or more physical risks
at the beginning of follow-up were compared first.
Then, the number of mental risks at the beginningof the follow-up was compared between the groups
with less than one and two or more risks. In addition,
to assess the combined effects of physical andpsychological problems, the total number of physicaland psychological risks at the start of follow-up was
assigned to groups with two or fewer risks and groups
with three or more risks. Furthermore, Kaplan–
Meier analysis and the log-rank test were conducted
to assess the risk factors for the occurrence of sports
injury with the Cox proportional hazards analysis.
IBM SPSS Statistics 19 (IBM Corp., Armonk, NY,
USA) was used for all statistical analyses.

32

3. Results
No significant effects were observed on the numberof risks or trauma injuries in any of the groups. In
contrast, overuse injuries occurred in the group with
≤ 1 physical risks (10.4%) and the group with ≥ 2risks (34.8%) (Table 3). A significant effect was notedwith a hazard ratio (HR) of 4.40 (95% confidence
interval, CI: 1.60–12.07; Table 3). Although nosignificant effect was found for mental risk alone,
overuse injuries occurred in the group with a sumof the number of physical and mental risks of ≤ 2(8.7%) and the group with a sum of the number ofphysical and mental risks of ≥ 3 (35.4%), with asignificant HR of 4.75 (95% CI: 1.59–14.15; Table3). In addition, the Kaplan–Meier survival curves forthe “occurrence of overuse injury and physical risk”
and the “occurrence of overuse injury and the total
number of physical and mental risks,” which showedsignificant effects, are illustrated, and log-rank tests
were performed (Figure 2a, 2b). The results showedthat the relationship between the number of physicalrisks (≤ 1, ≥ 2) and the time (weeks) of overuseinjury (P = 0.002) and that between the total numberof physical and mental risks (≤ 2, ≥ 3) and the time
(weeks) of overuse injury (P = 0.002) were bothsignificant.

4. Discussion
4.1. Key Results
Similar to conditioning, many factors are likely
involved in the occurrence of sports injuries. This
study aimed to determine whether eight examinedfactors in two categories would arise, either
individually or in combination, as risk factors ofsports injury occurrence.
Hoegh et al. (2021) reported that pain without
an identifiable pathology is common in athletes;
therefore, sports injuries and pain should beconsidered with a clear distinction. Considering all
pain as a direct sign of tissue damage may result in
low priority being given to psychological and social
aspects of a return to sports. In addition, inherently
unnecessary assessments and interventions may be
performed when an athlete has an injury (Nickel etal., 2017). Fear and anxiety concerning pain may
be increased when pain is linked to an unconfirmed
injury, such as when a clear clinical diagnosis isFootball Science Vol. 20, 27-37, 2023
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Physical and Psychological Effects of Football Injuries

Table 3 Association of incidence of sports injury with the low/high-risk groups

No. of players (%) Relative risk
(95%CI)

Survival time Hazard ratio(95%CI)a(95%CI)

Physical<2 (n=48)

26 (54.2)

27.8(24.9-30.7)

Physical≥2 (n=46)

22 (47.8)

Psychological<2 (n=77)

40 (51.9)

p-value

Incidence of traumatic injury

0.88(0.59-1.32)

24.3(20.7-27.8)

1.41(0.80-2.49)

0.241

0.72
(0.33-1.53)

0.387

1.05
(0.59-1.86)

0.871

4.40
(1.60-12.07)

0.004

1.22
(0.44-3.33)

0.703

4.75
(1.59-14.15)

0.005

25.4
(22.8-28.0)

Psychological≥2 (n=17)

8 (47.1)

0.97(0.80-1.17)

Physical+Psychological<3 27 (58.7)(n=46)
Physical+Psychological≥3 21 (43.8)(n=48)

30.1(25.8-34.3)
26.7(23.7-29.7)

0.73(0.48-1.12)

25.8(22.3-29.3)

Incidence of overuse injury
Physical<2 (n=48)

5 (10.4)

Physical≥2 (n=46)

16 (34.8)

Psychological<2 (n=77)

16 (20.8)

34.1(31.7-36.5)
2.47(1.12-5.44)

26.6(22.4-30.7)
30.7(27.9-33.4)

Psychological≥2 (n=17)

5 (29.4)

Physical+Psychological<3(n=46)

4 (8.7)

Physical+Psychological≥3(n=48)

17 (35.4)

1.10(0.85-1.42)

30.7(25.6-35.9)
34.1(31.4-36.9)

3.02(1.22-7.46)

27.2(23.3-31.0)a

For athletes who had a sports injury at the start of follow up, follow up was started after they recovered and were able
to participate in practice.

lacking (Ardern et al., 2013). A disagreement wasnoted regarding whether ankle instability alone(Attenborough et al., 2014) or FMS scores alone(Moran et al., 2017) would influence the occurrenceof other injuries. However, in this study, ankle
instability and functional movement ability based
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on the FMS score were both included as physicalfactors that may influence sports injuries. The results
suggested that ankle instability and functional
movement ability can be included in the physicalfactors as indicators for calculating the risk of overuseinjuries. Ankle instability or impairment of physical
33

1.00

1.00

0.75

0.75
cumulative risk

cumulative risk

Yoshida, N. et al.

0.50

0.50

0.25

0.25

0.00

0.00
0

10

20
30
1 season (37 weeks)

0

40

10

20
30
1 season (37 weeks)

40

No. at Risk (Overuse injury)

No. at Risk (Incidence of overuse injury)
Physical≥2

0/46

12/46

13/46

14/46 16/46

Physical≤1

0/48

2/48

5/48

5/48

5/48

Physical+
0/48
Psychological ≥ 3

7/48

12/48

15/48 17/48

Physical+
Psychological ≤ 2

3/46

4/46

4/46

0/46

4/46

Figure 2 K aplan–Meier survival curves for the occurrence of overuse injury and physical risk and occurrence of overuse injury
and the total number of physical and mental risks.
(a) Time to the first adjudicated sports injury (n=94) in terms of the relationship between the number of physical risks (≤ 1, ≥ 2) and thetime (weeks) of overuse injury(b) Time to the first adjudicated sports injury (n=94) in terms of the relationship between the total number of physical and mental risks (≤ 2,≥ 3) and the time (weeks) of overuse injury

function may lead to poor dynamic alignment andcompensatory movements (Chang et al., 2019; Kim etal., 2019), which could contribute to the developmentof overuse injuries. It has been reported that balance
training can improve neuromuscular control,
proprioception, strength, and postural control of ankle
stability (Anguish et al., 2018), and implementationof corrective exercises targeting the FMS can improve
FMS scores (Yoshida et al., 2021b). Applying theseapproaches could be useful in reducing the risk ofoveruse injuries.
Although a previous report denied the association
between sleep deprivation and injury occurrence(Burke et al., 2020), another study (Von Rosen et al.,2017) presented a positive association. In addition,it has been recommended to include catastrophic
thoughts concerning pain as an item in a medical
check before sports participation (Sciascia et al.,2020). Injury risk was also higher in athletes whoreported anxiety or depression (Li et al., 2017).
Therefore, this study included catastrophic thoughts
concerning pain, sleepiness, sleep disorder, anxiety
and depression as psychological factors. Our results
34

showed that psychological factors alone were notdirectly related to sports injuries. However, even if
the number of physical risks was less than two, thesum of the number of physical and psychologicalrisks was a risk factor for the occurrence of new
sports injuries during a season if the total numberof physical and psychological risks together was
three or more. In a previous study (Vetter et al.,2010), a statistically significant difference wasfound between mental fatigue and the occurrenceof injury during competitive (in-season) and noncompetitive (off-season) activities; our study results
support this finding. A low literacy level has beenfound to contribute to sleep and mental health issues
among young athletes (Gulliver et al., 2012), and
it is possible that addressing these issues throughawareness improvement approaches could help
to alleviate them (Castaldelli-Maia et al., 2019).
While more severe cases may require specializedinterventions, for young college-going athletes suchas those in this study, introducing approaches toimprove awareness is the recommended first step.
Many reports have examined the relationshipFootball Science Vol. 20, 27-37, 2023
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Physical and Psychological Effects of Football Injuries

between injury occurrence based on a single
indicator, and the existence of an association has
been controversial. Conversely, the results of thisstudy suggest that, by investigating several indices,it may be possible to extract factors associated withthe occurrence of overuse injuries. However, thefactors analyzed in this study had no significant effecton trauma injuries. In either case, this work suggeststhat it may be difficult to use the items adopted in thisstudy to predict the risk of trauma injuries based on
the presence or absence of physical and psychologicalproblems.
Concussion has also been cited as an injury
that affects psychological issues and may follow a
different return-to-play protocol in anterior cruciate
ligament (ACL) injuries and sprains. These injuries
can be very challenging for collegiate athletes tohandle emotionally, and the timeline for recovery
and return to play is unknown. This is very different
from an ACL injury that has a somewhat predictable
timeline for rehabilitation and recovery (Weberet al., 2018). Moreover, the athlete appears to befunctioning normally, which makes the requirement tostay away from training more challenging. However,concussions did not occur in any of the participants inthis study.

4.2. Limitation
In this study, we set four physical problems as
evaluation items because of their potential to impact
the whole body and cause injury. Various factors
may contribute to injury occurrence beyond the
problems we examined in this study. Besides, several
studies have shown no relationship between ankle
instability and other injuries in the body. The mostsignificant limitation of this study was that it did notinvestigate the relationship of injury occurrence withother factors, including knee-, hip-, and trunk-related
issues. Future research should consider these otherfactors. This study only included male collegiate
football players. It is necessary to expand the scopeof the research to include female football players
and players of other sports, as well as individuals
belonging to a wider age range and at varying
levels of competition. Additionally, this study did
not investigate methods for improving the factors
under consideration, thereby failing to indicate an
appropriate approach for resolution of the issues.
Future studies should aim to devise methods toFootball Science Vol. 20, 27-37, 2023
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improve these issues.

4.3. Generalizability
Our results may be applicable to a wider
population, including players of other sports thatprimarily involve the lower limbs or to athletes insimilar age groups. To affirm this, it is necessary
to conduct research involving a broader and varied
sample including female players.

5. Conclusion
This study investigated the influence of physicaland psychological factors on the occurrence of sports
injuries in Japanese football players. It is possible
to screen players at high risk of overuse injury bymonitoring their physical and mental conditions.
However, it is difficult to screen the players’ wholebody for high trauma injury risk. In addition, highrisk players should improve their physical andpsychological well-being to prevent such injuries in
the future.
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1120-1126.
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Football Science Vol. 20, 27-37, 2023
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Name:
Naruto Yoshida
Affiliation:
Department of Sport and Wellness, Rikkyo
University

Address:
1-2-26 Kitano, Niizashi, Saitama 352-8558 Japan
Brief Biography:
2023- Specially Appointed Assistant professor, R ik k yo
University
2017-2022 Associate Professor, Teikyo Heisei University
2013-2017 Lecturer, Teikyo Heisei University
2009-2013 Assistant professor, Teikyo Heisei University
Main Publications:•Yoshida, N., Ojio, Y., Waki, H., Minakawa, Y., Koido, M., andMiyazaki, S. (2023) A survey of sleep status of Japanese malecollege soccer players with the Japanese version of the Athlete
Sleep Screening Questionnaire (ASSQ-J). J. Athl. Train., 8(2):191-203.
•Yoshida, N., Kunugi, S., Konno, T., Masunari, A., Nishida,S.,
Koumura, T., Kobayashi, N., and Miyakawa, S. (2021).
Differences in muscle activities and kinematics between forefootstrike and rearfoot strike in the lower limb during 180° turns.
International Journal of Sports Physical Therapy, 16(3):715-723.
• Yoshida, N., Takashima, N., Miyakawa, Y., Waki, H.,
Yamamoto, J., and Kobayashi, N. (2019). Effect of change inheight and stability of feet on muscle activity during side bridge.
J. Athl. Train., 4(2): 147-153.
•Yoshida, N., Okuma, Y., and Miyazaki, S. (2016). Effect ofacupuncture stimulation on muscle fatigue during the M-test
and Functional Movement Screen. Japanese Acupuncture andMoxibustion, 12(1): 24-31.
•Yoshida, N., Kunugi, S., Mashimo, S., Okuma, Y., Masunari, A.,
Miyazaki, S., Hisajima, T., and Miyakawa, S. (2016). Effect offorefoot strike on lower extremity muscle activity and knee joint
angle during cutting in female team handball players. Sports
Medicine Open, 2(32).
Membership in Learned Societies:• Japanese Society of Science and Football• Japan Association of Handball Research• Japan Society of Acupuncture and Moxibustion• Japan Society of clinical sports medicine• Japanese Society of Physical Fitness and Sports Medicine• Japanese Society for Athletic Training37