Refereeing is highly demanding, both physically and mentally, and injury prevention is as important for referees as it is for players. A referee needs to be as fit as, if not fitter than, the players, since he or she may be up to 20 years older, is rarely a full-time professional and cannot be substituted during the match. On top of the physical stress, there is also the mental strain of being in control of the match for 90 minutes under the ever watchful eye of both the bench and the public.

With this in mind, the FIFA Medical Assessment and Research Centre (F-MARC) has taken a close look at referee injuries and complaints. Its most recent study - Injuries of amateur football referees: a representative survey of Swiss referees officiating at all levels of play - focused on the extent and type of injuries sustained by referees at all national levels.

Mario Bizzini, physiotherapist at the FIFA Medical Centre of Excellence at the Schulthess Clinic, Zurich and F-MARC collaborator, is fully committed to referee care. "Over the last ten years, several studies had examined various aspects of the referees' performance and training," he says "but very little was known about injuries and musculoskeletal complaints in referees."

A previous study conducted by F-MARC concentrated on the extent and type of injuries in elite football referees in Switzerland. However, the 71 referees officiating in the top two divisions represented only a small percentage of all registered referees, making it clear that F-MARC also needed to examine the 489 active referees officiating at amateur level.

According to Bizzini, "We have to remember that the FIFA World CupTM referees represent mainly professionals and in fact correspond to only 0.02% of all registered referees in member associations worldwide. In 2006, FIFA counted more than 840,000 registered referees and assistant referees worldwide. We have to look after these many amateur referees as well. And we know from similar studies that have been conducted on players that injury frequency varies with the level of play."

The results of the study revealed that elite referees suffered almost two-thirds of their injuries during training and 39% of their injuries during matches. In contrast, amateur referees incurred 80% of their injuries during matches. Overall, nearly half (44%) of all elite referees surveyed had suffered at least one injury during their career, compared to 23% of amateur referees.

Another difference between the two groups was the frequency of musculoskeletal complaints - 86% of the elite referees reported complaints as a direct result of their refereeing, while only a quarter of the amateur referees pinpointed refereeing as a direct cause. Hamstring strains and ankle sprains were the most common injuries in male referees, both elite and amateur, while the majority of injuries differed from player injuries in that they did not involve contact.

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