LARS PETERSON is Professor of Othopaedics at the Universtity of Gothenburg (Sweden) and a member of the Sports Medical Committee of FIFA.
PER RENSTRÖM is Professor of Sports Medicine at the Karolinska Institute in Stockholm (Sweden).

The goalkeeper frequently becomes tangled in tricky situations during play, often involving physical contact with opponents, goalposts and the ground. The risk of injury is therefore never very far away for the man in the number 1 shirt.

Goalkeepers risk life and limb in attempting to prevent goals.
Photos: Bongarts (2), Allsport (1)
The goalkeeper not only needs to be in good shape but he must also be able to react like lightning. He needs to be agile and to move quickly in all directions. He is obliged to leap into the air at corner kicks and jostle for the ball, positioning himself accurately so as to catch or parry the ball. His sense of timing must therefore be very precise. The goalkeeper must, in other words, be an all-round athlete with an instinctive flair for the game of football.

From the psychological point of view, being the goalkeeper is especially demanding, as it requires the ability to concentrate continuously on the play. A goalkeeper can be uninvolved in playing situations for ten minutes, and then suddenly be thrust into the centre of the action. One single error can result in a goal and give rise to major criticism even if he has made 15 outstanding saves prior to the one visible mistake. In the next match he plays, the goalkeeper is the the main focus of attention. He must therefore be able to withstand criticism from the other players, coaches, spectators and the press.

In a nutshell, one can say that being a goalkeeper is a major challenge requiring special talent combined with extraordinary athletic ability and an unruffled psyche.

Injury aetiology
Football is becoming increasingly intense, resulting in much more body contact and tougher tackles. The playing season is long with varying weather, which affects the different turfs and, in turn, may account for an increased incidence in injury. The goalkeeper is often involved in dangerous situations entailing injury and therefore has a specific injury pattern somewhat different from the other players in the team.

As already mentioned, the goalkeeper needs special qualifications and talent to be a good goalkeeper. His pattern of reaction must be well developed so that he can react quickly and appropriately when the ball is shot at him. There is intense body contact with other players on the ground, when they collide in the air, when he runs for the ball against the opponents and so on. In crowded situations such as corners, the goalkeeper has to react in the air, which is packed with players fighting for the ball.

Injuries
Injury Frequency
Field PositionRenstrom et al.
(1977)
Hunt & Fulford
(1990)
Goalkeeper17(8,2)*28(14)
Defender87(41,8)45(22,5)
Midfielder54(26)120(60)
Forward50(24)6(3)
Referee0(0)1(0,5)
Total208(100)200(100)
 
Type of injury in goalkeepers
Type of injuryRenstrom et al.
(1977)
Hunt & Fulford
(1990)
Sprain (ankle)48
Fracture49
Bruise36
Laceration21
Dislocation-2
Head injury2-
Other22
Total17/20828/200
 (8,2%)(14%)

He often has to catch the ball in the air and then land on the ground without the protection of his hands and arms. The result is that the goalkeeper is often subjected to direct trauma against the body, which increases the risk for contusions, abrasions, and other injuries produced by direct trauma. The goalkeeper can also land on another player's feet and so twist an ankle or a knee joint. Ankle and knee injuries are common in goalkeepers. They may also be injured by ground contact, which frequently occurs when saving goals and colliding with goalposts. Goalkeepers must sometimes throw themselves in front of the players that are attacking. The player can then kick the goalkeeper, and contusion injuries, such as muscle haematomas, can be the result. Occasionally, the goalkeeper can also hit his head and other parts of the body against the goalposts and thus sustain contusion of the head and so on.

The goalkeeper must often turn quickly and twist his body in another direction. As football boots have studs, they often stick to the ground, and a rotation trauma may occur with ligament and joint injuries in the knee and ankle as a result.

When the ball is kicked directly at the goalkeeper, the ball can knock his fingers and hands. Sprains, dislocations and fractures of the fingers and the hands are not uncommon in goalkeepers. The ball and the opponents' fingers, hands and elbows can also hit the goalkeeper's face and cause eye injuries.

Research has revealed that the danger of injury is greater in top divisions because play is much more intense and players are more inclined to take risks to score goals. On the other hand, those playing in lower divisions and for recreation are not as experienced and can constitute a risk to the goalkeepers simply because of their carelessness and lack of skill. There are, however, no statistics available on the implications of this for goalkeepers.

Research has shown that 73% of football injuries occur during matches. The players train on average 2.5 times as much as they play actual games. The risk of injury is much higher during matches because goalkeepers are usually not tackled or severely challenged during practice sessions.

Most injuries occur in the beginning of the first half and towards the end of the second half. They occur in the beginning because of insufficient warming up and the initial intensity at the start of a match. Towards the end of a game, muscle fatigue results in decreased coordination and judgment and increased risk-taking.

Prevention of injury
Goalkeepers should be urged to protect those parts of the body that are prone to injury. Goalkeepers are liable to be injured on unprotected elbows and patellae. They should therefore wear pads over the elbow to protect the olecranon, and over the kneecaps to protect them from direct trauma otherwise haemorrhagic bursitis could be the result. These protective pads should be mandatory for goalkeepers.

Goalkeepers should also wear pants that are well padded on the sides to prevent hip pointers and trochanteric bursitis. Genital protectors should be worn.

It is mandatory for goalkeepers to wear shinguards just like field players. The goalkeeper can easily be kicked on the shin, which is very sensitive to pain and susceptible to injury. Shinguards can, to a certain extent, protect against fractures. The goalkeeper should regularly practise special exercises in agility as a general means of preventing injury. Because his situation is different, he should train individually as well as with the team, concentrating on stretching exercises, specific movements and quick reactions. He should also be made to train his capacity for concentration.

Finally, the extraordinary demands made on the goalkeeper should be recognised by his coach and team-mates.