# Injuries and Pain Associated with Goalkeeping in Football--Review of the Literature
## 4 Discussion  
### Outfield Players' Injuries vs. Goalkeepers' Injuries  
On average, an elite football player suffers from 1.5 to 7.6 injuries per 1000 training hours and 12 to 35 injuries per 1000 h of a match [23]. [PERSON] and [PERSON] reported that the most common injury location in all positions was the lower limb (67.7%), followed by the upper limb (13.4%) [42]. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Study** & **Match/Training** & **Main Findings** \\ \hline [PERSON] et al. (2003) [43] & Match & Less injuries in GK \\ \hline [PERSON] et al. (2012) [44] & Match & Less injuries in GK \\ \hline [PERSON] et al. (2011) [45] & Match & Less injuries in GK \\ \hline [PERSON] et al. (2013) [46] & Match and training & Less injuries in GK \\ \hline [PERSON] et al. (2007) [47] & Match and training & Less injuries in GK \\ \hline [PERSON] et al. (2009) [48] & Match & Less injuries in GK \\ \hline [PERSON] et al. (2021) [49] & Match and training & Less injuries comparing to FW \\  & Female football & and MDF, more injuries \\  & & comparing to DF \\ \hline [PERSON]\&[PERSON] (2011) [50] & Match and training & No differecne according to player position \\ \hline [PERSON] and [PERSON] (2001) [51] & Match and training & No differecne according to player position \\ \hline [PERSON] et al. (2008) [52] & Match & No differecne according to player position \\ \hline \hline \end{tabular} GK—goalkeepers, FW—forwards, MDF—midfielders, DF—defenders.  
\end{table} 
Table 1: Injuries in GKs and field players. Many studies show that GKs suffer fewer injuries than field players. There are also studies indicating that GKs do not differ in injury incidence from field players (Table 1). GKs suffer more injuries during training than matches due to much more explosive actions and goalkeeper-to-player interactions comparing to matches [9; 12; 25]. This stands in contrast to field players who suffer more injuries during matches than training [2; 46] and is typical for many other sports [2]. However, different studies present contrasting results, i.e., in the study of [PERSON], GKs' injury incidence was higher in competition than in training (12.1 vs. 3.5, respectively) [46], which is proven also in female football GKs by the study of [PERSON] et al. with the results of IR 14.04 in matches vs. 2.57 in training [49]. [PERSON] et al. published a study of Norwegian elite GKs showing that GK injury incidence was 27.9 per 1000 playing hours of matches, 23.6 for specific GK training and 9.1 for other types of exercise [35]. GKs cover shorter distance during play and training [7; 9] and use the upper limbs more frequently to execute defenisve and offensive actions comparing to field players. When it comes to the distribution of injuries location, there are controversies in the literature. Some authors claim that GKs have higher upper limbs than lower limbs injuries incidence [23; 46; 53], especialy of fingers, hands and wrists [53] but results of other studies do not agree with this statement. (Table 2). In the study of [PERSON] et al. injuries of the upper limbs represented 36% of all injuries in GKs [35]. [PERSON] et al. and [PERSON] et al. reported a greater risk of shoulder injuries in GKs than in outfield players [54; 55]. The most injured area of the shoulder is the rotator cuff, causing partial or total tear. A report by [PERSON] et al. about injuries in all football players positions with an emphasis on newcomers to professional football showed higher injury hazard rates (HR) for field players (defenders = 1.91, midfielders = 1.78, forwards = 1.82) compared to GKs (HR = 1.0) as defined by time-loss injuries. Most injuries occurred with no contact (HR = 3.2) compared to those resulting from contact (HR = 0.9) with another player or with an object (HR = 0.3). Most GK injuries concerned muscle and tendon (injury incidence--II = 1.8) followed by joint/ligament (II = 1.2). The most common locations were the lower limbs (II = 2.7) compared to the upper limbs, trunk and head/neck (1.0; 0.7; 0.2 respectively).