My colleagues and I have a new paper out in the International Journal of Sports Physical Therapy (IJSPT). Shout out to Courtney Fernandes, MS, ATC for her work on this project as part of her Masters’ Thesis! We believe it offers proof-of-concept for going beyond biomechanics when investigating why injuries occur in sport.

The Role of Interpersonal Dynamics in Soccer Injuries

Soccer, the world's most popular sport, carries a high risk of injury due to its intense physical demands and fast-paced nature. While traditional injury prevention and rehabilitation focus on physical recovery, recent studies suggest that understanding how players interact on the field—known as interpersonal dynamics—could play a critical role in both preventing injuries and enhancing recovery processes.

Study Design: Examining Interpersonal Coordination After Injury

A novel study explored how female soccer players with and without prior injuries coordinate movements during a collision-avoidance task. This experiment aimed to offer insights into whether disrupted coordination could be a factor in injury risks, providing a new angle on traditional rehabilitation approaches.

Methods: Analyzing Movement Synchronization in Soccer Players

Researchers gathered eighteen female soccer players divided into pairs or dyads. Each pair consisted of one player with a history of lower extremity injuries and one without. These dyads underwent a series of tasks designed to simulate game conditions, where coordination to avoid collisions was crucial. The study employed motion capture technology and non-linear methods to analyze how well the players synchronized their movements, particularly in relation to an unexpected perturbation. The agility task set-up and perturbation were specifically designed to mimic on-field, game-like scenarios.

Two of our researchers running an pilot session of the collision-avoidance task. Participants were paced by a metronome and we recorded their locations with motion capture.

Scientific Figure showing analysis process for this collision-avoidance experiment — **Figure 1.**

A. Schematic of collision-avoidance task. Upon oddball tone (whistle) within the audio, participants would make a 90 degree turn at the center and continue the task (e.g., red would follow gold path and vice versa). B. Raw Cartesian position of the dyad movement. C. Euclidean displacement of participant position. D. The time series subjected to CRQA analysis, producing the cross-recurrence plot.

Results: Participants with history of injury had worse coordination and fell into follower roles

**Experiment 1:** The results indicated that all participants, regardless of injury history, found it challenging to maintain coordination during sudden perturbations in the task. Notably, those with a history of injuries showed a marked difficulty in regaining coordination after disruptions. This finding suggests a potential lingering effect of injuries on a player's ability to dynamically interact with teammates or opponents.

**Figure 2**

Windowed analysis by leader-follower status through each stage of the collision-avoidance task for outcomes of determinism and laminarity from CRQA. These results demonstrate that those with history of injury had weaker coupling to the non-injured leader after perturbation, and that this weaker coordination was less stable.

**Experiment 2:** Further findings revealed that injured players were more likely to assume follower roles in the dyads. This tendency could reflect a residual caution or decreased confidence stemming from their injury experiences. These role dynamics were consistent across different stages of the task, highlighting the psychological and behavioral impacts of past injuries during high-pressure situations.

**Figure 3**

Although underpowered to find an effect, we were curious to see whether fear/confidence of the players influences who because the *de facto* leader in each dyad. These data are preliminary and suggest that ACL-RSI may indicate how likely a player is to “take control” in a task that required coordinated motion.

Discussion: Rethinking Injury Prevention and Rehabilitation in Soccer

To be clear, this is a very preliminary analysis without connection to performance detriment or increase injury risk among the participants. However, we believe these results serve as a proof-of-concept that interpersonal dynamics may significantly influence the risk of injury or re-injury in soccer. They emphasize the need for rehabilitation programs to go beyond physical recovery and consider the athlete's ability to adapt to the interactive and unpredictable nature of sports. Integrating assessments of interpersonal coordination into rehabilitation protocols could better prepare athletes for the demands of actual gameplay, potentially reducing the risk of future injuries.

Conclusion: Integrating Interpersonal Dynamics into Soccer Rehabilitation

This study highlights the importance of considering interpersonal dynamics in injury prevention and rehabilitation strategies. By understanding how athletes interact during play, particularly those recovering from injuries, we can develop more comprehensive rehabilitation programs that address both physical and interactive readiness. This approach not only aids in physical recovery but also bolsters confidence and decision-making on the field, paving the way for safer and more effective returns to sport.

This research, while limited in scope, underscores the potential benefits of incorporating interpersonal coordination assessments into routine rehabilitation practices, offering a broader perspective on how we understand and prevent soccer-related injuries.

How Interpersonal Dynamics Influence Soccer Injury Prevention and Rehabilitation