Home > Foot/Ankle Injury, Injury Prevention, Knee Injury > Injury Prevention Training is Effective

Injury Prevention Training is Effective

Hubscher M, Zech A, Pfeifer K, Hansel F, Vogt L, Banzer W.  Neuromuscular training for sports injury prevention: a systematic review Med Sci Sports Exerc. 2010 Mar;42(3):413-21.

http://www.ncbi.nlm.nih.gov/pubmed/19952811

Rationale and Purpose: Over the past 10-15 years there have been multiple research studies published examining the effectiveness of injury prevention programs on reducing the incidence of various lower extremity injuries.  There are not consistent findings across these studies, thus calling into question the ability to prevent lower extremity injuries with an exercise based intervention.  It is difficult to synthesize the information in these different studies due to differences in type of exercises performed, duration of training program, volume of training program, type of injuries being monitored, methodologic quality, etc…  Thus, there is a need to better synthesize the current scientific literature in this area to improve our ability to prevent lower extremity injuries during sport.

The best scientific evidence to demonstrate the ability to prevent lower extremity includes use of a randomized controlled trial study design.  The second best type of evidence would be comparing a training group to a control group, but without randomization of subjects to either group.  Thus, the purpose of this article was to conduct a systematic review of the existing literature on lower extremity injury prevention and focus on the best scientific evidence (randomized controlled trials or controlled trials without randomization).

Overview of Research Methods:  A systematic literature review was conducted using a standard set of key words and databases.  Reference lists of all retrieved articles were also manually reviewed to ensure that all relevant articles were identified and included in the analysis. A total of 32 articles were originally retrieved following the literature search.  These articles were then reviewed and only articles that met the following criteria were included in the results: randomized controlled trial OR controlled trial (without randomization), athletes with and without previous injury were the subjects, only the intervention group received the exercise protocol, and the intervention group had to be compared with a control group that did not receive any other type of intervention.  All studies were required to evaluate injury incidence as the outcome.

Each of the retrieved articles were independently reviewed by two separate researchers for scientific quality.  Nine different criteria were used to evaluate the scientific quality of each study: 1) Randomization method, 2) Concealed treatment allocation (subjects blind to being in control or intervention group), 3) Intervention and control groups were similar at baseline testing, 4) blinding of assessors (researchers were blind as to who was in control or intervention group), 5) co-intervention (were other interventions being simultaneously given), 6) compliance, 7) dropout rate, 8. timing of the outcome assessment, and 9) intention to treat analysis.  A “High Quality” study was one that received a score of 5 or more on the scientific quality scale (out of 9 points possible).

A total of 7 studies were identified as “High Quality” studies and included in the final analysis.

Key Findings:  The included studies were separated into 2 groups based on the type of exercises performed: 1) Balance Training (isolated balance exercises) and 2) Multi-Intervention Training (combination of balance, strength, plyometric, and agility exercises).

  • Two studies focused on the effects of isolated Balance Training on the overall rate of sports injuries (all lower extremity injuries).  The overall rate of sports injuries was not significantly decreased with isolated Balance Training.
  • Three studies focused on the effects of isolated Balance Training on ankle sprain injuries.  There was a significant decrease in the rate of ankle sprain injuries following isolated Balance Training.
  • Two studies focused on the effects of Multi-Intervention Training on lower limb injuries.  There was a significant decrease in the rate of lower limb injuries following Multi-Intervention Training.
  • These same two studies also investigated the effects of Multi-Intervention Training on acute knee injuries and ankle sprain injuries.  There were significant decreases in both acute knee injuries and ankle sprain injuries following Multi-Intervention Training.

Clinical Implications:  Isolated balance training was effective at reducing the risk of ankle sprain injuries by 36%.  However, isolated balance training was NOT effective at reducing the risk of knee injuries.

Multi-intervention training programs were effective in reducing the risk of lower limb injuries by 39%, the risk of acute knee injuries by 54%, and the risk of ankle sprain injuries by 50%.  Thus, it appears that multi-intervention (integrated training) injury prevention programs provide the best method at preventing a variety of lower extremity injuries in young, athletic individuals.

The multi-intervention training programs involved a variety of exercises, such as: static stretching, strengthening, plyometrics, agility drills, balance training, movement technique training, and core stability.  The time needed to complete the multi-intervention training programs ranged from 10 minutes to 30 minutes.  Most of the the multi-intervention training programs were performed as part of a pre-practice warm up during the pre-season and in-season scheduleIt appears that all of the programs were performed in a team setting and programs were not individualized for the participants.  Thus, the use of a “one size fits all” type of injury prevention program incorporating multiple types of exercises is effective at reducing lower limb, knee, and ankle injuries.

There are many more questions that need to be answered to further improve the effectiveness of injury prevention programs. However, this systematic literature review provides solid evidence the injury rates can be decreased by implementing a multi-intervention injury prevention program as part of the pre-season and in-season conditioning programs.

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