Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players

Coaching the coaches: exploring the effectiveness of the 'Move Well Be strong' youth injury prevention programme for grassroot coaches and PE teachers

INTRODUCTION

Coaches play a major role in developing movement in their performers, especially at grassroots levels. However, there are significant knowledge gaps amongst grassroots coaches and physical education (PE) teachers regarding movement competency and injury prevention programs. This study aimed to explore the effectiveness of knowledge gain, adoption and implementation following a youth injury prevention workshop for grassroots coaches and PE teachers.

METHODS

56 grassroots coaches and PE teachers completed a validated questionnaire exploring use, knowledge, attitude towards and confidence to deliver youth movement competency training before and after an online workshop. Bayesian Wilcoxon signed-rank tests were used to assess the knowledge, attitude, and confidence to deliver an injury prevention programme following the workshop. For all the Bayesian inference tests run, the Bayesian factor (BF10) was interpreted using the evidence categories ranging from extreme evidence (BF10 > 100) to anecdotical evidence (BF10 < 1).

RESULTS

Post-workshop there was a 34% increase in respondents indicating that they had greater knowledge of injury prevention issues (55% pre-workshop vs 89% post-workshop) with statistically positive and moderate effects (BF10 > 100 [extreme evidence]). There was also a 25% increase in respondents indicating that they had a more sympathetic attitude towards injury prevention (67% sympathetic pre-workshop vs 93% sympathetic post-workshop) with statistically moderate effects (BF10 = 87.4 [very strong evidence]). A 19% increase in attendees' confidence to deliver an injury prevention programme was observed (69% high pre-workshop vs. 89% high post-workshop) with statistically moderate effects (BF10 = 85.9 [very strong evidence]). 100% of participants indicated an intent to adopt the injury prevention programme.

CONCLUSIONS

An online workshop increased knowledge and confidence in grassroots coaches and PE teachers to deliver a youth injury prevention programme. Knowledge gained from training and upskilling created a positive attitude and confidence to deliver movement competency into coaching. Appropriate resources need to be developed and delivered in an accessible way to grassroots coaches and PE teachers via workshops and should be included in governing body coaching awards or as continuing professional development for youth coaches and PE teachers.

Comparison of two implementation strategies for anterior cruciate ligament injury prevention in amateur girls' youth soccer: a prospective cohort study

Objectives

To compare two implementation strategies, an educational handout and a knowledge-to-action (KTA) intervention, for promoting anterior cruciate ligament (ACL) injury prevention programme (ACL-IPP) implementation in amateur youth girls' soccer. The primary outcomes assessed include frequency of ACL-IPP implementation and ACL injury risk.

Methods

This was a prospective cohort study, which followed 671 amateur female soccer players (15.72±1.78 years) whose coaches received either a KTA intervention (n=400) or an educational handout (n=271) regarding implementing an ACL-IPP. Over a single season, we tracked the number of ACL injuries weekly and implementation rates at the end of the season through surveying participating coaches. A χ2 test was used to compare the ACL-IPP implementation rate between the handout and KTA intervention. Cox-hazard proportional regressions were used to examine the effect of implementation rate and educational interventions on ACL injuries.

Results

The KTA intervention yielded higher ACL-IPP implementation as compared with the educational handout (X2 (1, n=671)=25.87, p<0.001). Implementation of any ACL-IPP at least two times per week was associated with a lower risk of ACL injuries (HR=0.15, 95% CI=0.03, 0.73; p=0.019) compared with implementing once per week or fewer. The KTA intervention was not associated with a significantly lower risk of ACL injuries (HR=0.39, 95% CI=0.09, 1.61; p=0.191) compared with the educational handout.

Conclusion

Stakeholder engagement in the process of planning and execution of IPPs, such as with a KTA intervention, appears beneficial for the purposes of increasing implementation rates. Since implementation was significantly associated with lower rates of ACL injuries, this process may lead to improved results in injury prevention in amateur youth soccer.

Effect of supervision and athlete age and sex on exercise-based injury prevention programme effectiveness in sport: A meta-analysis of 44 studies

We aimed to evaluate the influence of supervision, athlete age and sex and programme duration and adherence on exercise-based injury prevention programme effectiveness in sport. Databases were searched for randomized controlled trials evaluating exercise-based injury prevention programme effectiveness compared to "train-as-normal". A random effects meta-analysis for overall effect and pooled effects by sex and supervision and meta-regression for age, intervention duration and adherence were performed. Programmes were effective overall (risk ratio (RR) 0.71) and equally beneficial for female-only (0.73) and male-only (0.65) cohorts. Supervised programmes were effective (0.67), unlike unsupervised programmes (1.04). No significant association was identified between programme effectiveness and age or intervention duration. The inverse association between injury rate and adherence was significant (β=-0.014, p = 0.004). Supervised programmes reduce injury by 33%, but there is no evidence for the effectiveness of non-supervised programmes. Females and males benefit equally, and age (to early middle age) does not affect programme effectiveness.

Practitioners' perspective of non-contact injury risk factors and injury prevention programming in professional North American male soccer

OBJECTIVE

To evaluate non-contact injury prevention strategies of professional men's soccer clubs in elite North American league soccer. To understand the application, perceived effectiveness and barriers to implementation.

DESIGN

Online cross-Sectional Study.

SETTING

North American elite soccer teams.

PARTICIPANTS

96 medical and performance support staff of elite North American teams.

MAIN OUTCOME MEASURE

The survey consisted of 20 questions and captured 1) practitioners' demographics; 2) perceptions of risk factors; 3) the use of assessment and monitoring strategies; and 4) perceptions of the implementation of injury prevention programmes'.

RESULTS

Injury prevention programmes were perceived as 'effective' (Median 4, Interquartile range 4-4) and reduced injury rates (n = 94, 98%, 95 CI% 93 to 99). A range of potential risk factors were rated as "very important" (4.58 ± 0.52 Likert scale points; mean ± standard deviation). A multi-disciplinary approach to the design, application and monitoring of programmes was generally adopted. Competing training priorities (n = 75, 78%, 95 CI% 69 to 85) and game schedules (n = 71, 74%, 95 CI% 64 to 82) were the most prevalent barriers to injury prevention implementation.

CONCLUSIONS

Injury prevention programmes were perceived as effective in reducing non-contact injuries. Managing the conflicting priorities between scheduling training, tactical and conditioning goals were considered the key barriers to desired implementation.

The 11+ injury prevention programme decreases rate of hamstring strain injuries in male collegiate soccer players

OBJECTIVES

To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk.

METHODS

This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men's soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme.

RESULTS

The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance.

CONCLUSION

The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI.

Team Approach: Neuromuscular Training for Primary and Secondary Prevention of Anterior Cruciate Ligament Injury

Neuromuscular training is a method of performance optimization-typically combining plyometrics, balancing training, agility, and dynamic stabilization-predicated on improving the efficiency of fundamental movement patterns. Neuromuscular training has consistently been shown to reduce the risk of anterior cruciate ligament injury, particularly for athletes engaged in activities associated with noncontact knee injuries (i.e., women's soccer). Successful implementation of neuromuscular training programs requires input from coaches, physical therapists, athletic trainers, and physicians to generate efficacious programs with high rates of adherence.

Financial burden of anterior cruciate ligament reconstructions in football (soccer) players: an Australian cost of injury study

OBJECTIVES

To estimate the financial burden of anterior cruciate ligament (ACL) reconstructions in amateur football (soccer) players in Australia over a single year, including both direct and indirect cost.

METHODS

Available national direct and indirect cost data were applied to the annual incidence of ACL reconstructions in Australia. Age-adjusted and sex-adjusted total and mean costs (ACL and osteoarthritis (OA)) were calculated for amateur football (soccer) players in Australia using an incidence-based approach.

RESULTS

The estimated cost of ACL reconstructions for amateur football players is $A69 623 211 with a mean total cost of $A34 079. The mean indirect costs are 19.8% higher than the mean direct costs. The mean indirect costs are lower in female (11.5%, $A28 628) and junior (15.3%, $A29 077) football players. The mean ACL costs are 3-4-fold greater than the mean OA costs ($A27 099 vs $A6450, respectively), remaining consistent when stratified by sex and age group. Our model suggests that for every 10% increase in adherence to injury prevention programmes, which equates to approximately 102 less ACL injuries per year, $A9 460 224 in ACL costs could be saved.

CONCLUSION

While the number of ACL reconstructions per year among football players in Australia is relatively small, the annual financial burden is high. Our study suggests that if injury prevention exercises programmes are prioritised by stakeholders in football, significant cost-savings are possible.

High Compliance with the 11+ Injury Prevention Program Results in Better Win-Loss Records

Background

The 11+ injury prevention program (IPP) has been shown to decrease injury rates. However, few studies have investigated compliance and its overall relationship to team performance.

Hypothesis/Purpose

To examine if level of compliance while implementing the 11+ would impact team performance outcomes (wins, losses and ties). The authors hypothesized that higher team compliance to the IPP would be consistent with improved overall team performance (more wins and fewer losses).

Study Design

Prospective, cluster randomized controlled trial.

Methods

This study was conducted in NCAA men's soccer teams for one season and examined the efficacy of the 11+ IPP. The outcome variables examined were levels of compliance and team performance record: wins, losses, and ties. Twenty-seven teams (n=675 players) served as the intervention group (IG) and used the 11+ program while 34 teams (n=850 players) served as the control group (CG). Compliance and team performance were recorded. There were three compliance categories that were defined prospectively, low (LC, < 1 dose/week), moderate (MC, >1 and <2 doses/week), and high (HC, >2 doses/week). Descriptive and inferential tests were used to compare the CG, the IG, and compliance to team performance. Three independent t-tests were used to analyze outcome to group (IG vs. CG). A one way-MANOVA test was used to analyze compliance to win/loss/tie record, followed up by one-way ANOVA tests to analyze how compliance impacted wins, losses and ties, independently. Partial η2 measures were calculated to determine the effect size of level of compliance on outcome. A Tukey post-hoc analysis was used to analyze specific differences between levels of compliance and specific outcome measures.

Results

There were significantly more wins (IG: 10.67±2.63 versus CG: 8.15±3.83, CI, 7.95 - 9.69, p = 0.005) and fewer losses (IG: 5.56±1.97 versus CG: 8.12±3.59, CI, 5.66 to 7.43, p = 0.002) recorded for the teams using the 11+ program. There was a statistically significant difference between levels of compliance (high, moderate or low) on the dependent variables (wins, losses, and ties), F(3, 22) = 3.780, p =0.004; Wilks' Λ = .435; partial η2 = .340.

Conclusion

The 11+ has the capacity to improve overall team performance in male collegiate soccer teams. The higher the compliance, the more favorable the team performance. This research may be a vital addition when attempting to persuade coaching staffs to adopt an IPP into their training regimen.

Level of Evidence

Level I.

Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data

OBJECTIVES

To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia.

DESIGN

Descriptive epidemiological study.

METHODS

Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ± standard deviation with 95 % confidence intervals.

RESULTS

Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season.

CONCLUSIONS

Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.

A systematic review of the evidence for effectiveness of interventions to address transport and other unintentional injuries among adolescents

INTRODUCTION

Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for adolescent injury prevention, evidence is needed as to effective interventions.

METHODS

A systematic review of peer-reviewed original research published between 2010-2022 was conducted. CINAHL, Cochrane Central, Embase, Medline and PsycINFO databases were searched for studies reporting the effectiveness of unintentional injury prevention interventions for adolescents (10-24 years), with assessment of study quality and equity (e.g., age, gender, ethnicity, socio-economic status).

RESULTS

Sixty-two studies were included; 59 (95.2%) from high-income countries (HIC). Thirty-eight studies (61.3%) reported no aspect of equity. Thirty-six studies (58.1%) reported prevention of sports injuries (commonly neuromuscular training often focused on soccer-related injuries, rule changes and protective equipment). Twenty-one studies (33.9%) reported prevention of road traffic injury, with legislative approaches, commonly graduated driver licensing schemes, found to be effective in reducing fatal and nonfatal road traffic injury. Seven studies reported interventions for other unintentional injuries (e.g., falls).

DISCUSSION

Interventions were strongly biased towards HIC, which does not reflect the global distribution of adolescent injury burden. Low consideration of equity in included studies indicates current evidence largely excludes adolescent populations at increased risk of injury. A large proportion of studies evaluated interventions to prevent sports injury, a prevalent yet low severity injury mechanism. Findings highlight the importance of education and enforcement alongside legislative approaches for preventing adolescent transport injuries. Despite drowning being a leading cause of injury-related harm among adolescents, no interventions were identified.

CONCLUSION

This review provides evidence to support investment in effective adolescent injury prevention interventions. Further evidence of effectiveness is needed, especially for low- and middle-income countries, populations at increased risk of injury who would benefit from greater consideration of equity and for high lethality injury mechanisms like drowning.

Risk factors associated with football injury among male players from a specific academy in Ghana: a pilot study

There seems to be no information on the incidence of injury and associated risk factors for academy football players in Ghana. We determine the risk factors associated with match and training injuries among male football players at an academy in Ghana. Preseason measurements of players' height, weight, and ankle dorsiflexion (DF) range of motion (ROM) were measured with a stadiometer (Seca 213), a digital weighing scale (Omron HN-289), and tape measure, respectively. The functional ankle instability (FAI) of players was measured using the Cumberland Ankle Instability Tool (CAIT), and dynamic postural control was measured with the Star Excursion Balance Test. Injury surveillance data for all injuries were collected by resident physiotherapists throughout one season. Selected factors associated with injury incidence were tested using Spearman's rank correlation at a 5% significance level. Age was negatively associated with overall injury incidence (r = - 0.589, p = 0.000), match (r = - 0.294, p = 0.008), and training incidence (r = - 0.314, p = 0.005). Previous injury of U18s was associated with training injuries (r = 0.436, p = 0.023). Body mass index (BMI) was negatively associated with overall injury incidence (r = - 0.513, p = 0.000), and training incidence (r = - 0.395, p = 0.000). CAIT scores were associated with overall injury incidence (n = 0.263, p = 0.019) and match incidence (r = 0.263, p = 0.029). The goalkeeper position was associated with match incidence (r = 0.241, p = 0.031) while the U16 attacker position was associated with training incidence. Exposure hours was negatively associated with overall injury incidence (r = - 0.599, p = 0.000). Age, BMI, previous injury, goalkeeper and attacker positions, ankle DF ROM, and self-reported FAI were associated with injury incidence among academy football players in Ghana.

Epidemiology of Injuries in Amateur Male Soccer Players: A Prospective One-Year Study

The purpose of this study was to prospectively monitor and analyze injuries in Greek amateur male soccer players over one competitive season. One hundred and thirty male soccer players in a regional amateur league participated in this study. Injury data and exposure were collected from six teams during training and competition match over one season (2018/19). Injuries were collected weekly and were classified by setting, mechanism, severity, type, calendar distribution, period of injury occurrence, and anatomical location. A total of 103 injuries were recorded during the season, with an incident rate (IR) of 5.5 injuries/1000 h with 95% confidence intervals (CI) values of 4.45 (lower limit) and 6.09 (upper limit). Furthermore, IR was greater for the posterior thigh (IR 1.83/1000 h, 95% CI 1.21-2.44) and hip/groin complex (IR 1.45/1000 h, 95% CI 0.90-1.99) compared to other anatomical locations. Similarly, muscle injuries had greater IR (IR 3.61/1000 h, 95% CI 2.74-4.47) than other tissues. Amateur soccer players had a seven-fold greater chance of getting injured during games (IR 20.76/1000 h, 95% CI 15.28-26.24) rather than during training (IR 3.077/1000 h, 95% CI 2.16-3.80), while injury rates were higher towards the end of a session and peaked in October and February of the season. Based on these results, amateur soccer may benefit from injury prevention strategies incorporated into their regular training practice and focus on muscle injuries, especially in the posterior thigh and the hip/groin complex.

Aerodynamic Analysis and Training Research of an S-Shaped Arc Ball Based on Hydrodynamics

The aerodynamic characteristics of S-shaped arc ball, such as poor combat performance and low intelligence, are studied and analyzed. In this paper, the aerodynamic analysis model of S-shaped arc soccer intelligent algorithm is established, and the dynamic tracking model of Soccer Tactics Based on fluid dynamics search algorithm is designed. The data information is collected from many aspects, such as the position of the players, the change of the arc ball movement, the trajectory of the football movement, and tactical flexibility. The results show that Benn's algorithm can start the layout mechanism effectively. It has high feasibility and accurate algorithm accuracy and can effectively improve the aerodynamic layout performance of the system. The aerodynamic analysis and training optimization method of the S-shaped arc ball based on ant colony optimization has sped up the intelligent training system of Chinese football tactics.

Adherence to an injury prevention program in male amateur football players is affected by players’ age, experience and perceptions

Objectives

Adherence to injury prevention programmes in football remains low, which is thought to drastically reduce the effects of injury prevention programmes. Reasons why (medical) staff and players implement injury prevention programmes, have been investigated, but player’s characteristics and perceptions about these programmes might influence their adherence. Therefore, this study investigated the relationships between player’s characteristics and adherence and between player’s perceptions and adherence following an implemented injury prevention programme.

Methods

Data from 98 of 221 football players from the intervention group of a cluster randomised controlled trial concerning hamstring injury prevention were analysed.

Results

Adherence was better among older and more experienced football players, and players considered the programme more useful, less intense, more functional and less time-consuming. Previous hamstring injuries, educational level, the programme’s difficulty and intention to continue the exercises were not significantly associated with adherence.

Conclusion

These player’s characteristics and perceptions should be considered when implementing injury prevention programmes.

Prehabilitation for Recreational Runners: Motivators, Influencers, and Barriers to Injury Prevention Strategies for Running-Related Injury

CONTEXT

Injury prevention programs are effective when implemented in team sports, but many recreational runners have less access to such focused interventions or peer support and often seek other sources to learn about injury reduction strategies.

OBJECTIVE

This study aimed to explore runners' motivations in attending a prehabilitation (prehab) for runners workshop, establish their comprehension of prehab, and identify barriers to ongoing engagement with injury prevention.

DESIGN

Qualitative study using focus groups.

PARTICIPANTS AND SETTING

Twenty-two runners participating in prehab for runners workshops took part in one of 4 focus groups, each recorded, transcribed, and analyzed using Grounded Theory to create codes, subthemes, and themes.

RESULTS

Four themes emerged: (1) Participation was influenced by experience of previous injury and worry of cessation of running. As the workshop ran weekly for 4 weeks, opportunity to see someone more than once who was also a physiotherapist influenced participation. (2) Runners welcomed clarification for online exercises and advice suggested for runners. They were surprised by the difficulty of single-leg neuromuscular facilitation exercises and reported benefit from most or all information especially non-exercise-based approaches such as load management, pain monitoring, and running cues. (3) Participants were empowered by a structured, holistic, and evidence-based approach that embraced autonomy for exercise self-selection and progression. Confidence to engage in open discussion was due to small group size. (4) Barriers to prehab were personal responsibility, equipment, time, lack of supervision, and peer influence.

CONCLUSION

A composite approach to strategies for injury risk reduction during prehab, combining progressive exercises with educational resources, can address runners' individual needs. Early discussion of motivational tools on commencement of prehab with guidance from runners on how to incorporate prehab independently into running training is recommended. Providing these tools allows runners to self-identify the approach best suited to their personal running profile at that given time.

Lower Extremity Injury After Return to Sports From Concussion: A Systematic Review

Background:

Recent studies have suggested increased rates of lower extremity (LE) musculoskeletal injury after a diagnosed concussion, although significant heterogeneity exists.

Purpose:

To examine the current body of research and determine whether there is an increased risk for LE musculoskeletal injury after a concussion and to identify populations at an increased risk.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

A systematic review of current literature using MEDLINE and PubMed databases was performed. Keywords included concussion, athlete, lower extremity injury, and return to sport. Inclusion criteria required original research articles written in the English language examining the rate of LE injuries after a diagnosed concussion.

Results:

A total of 13 studies involving 4349 athletes (88.1% male and 11.9% female; mean age, 19.8 years) met inclusion criteria. Athletes were classified as high school (46.1%), collegiate (17.0%), or professional (36.9%). Of the 13 studies, 4 demonstrated an increased risk of LE injury within 90 days of a diagnosed concussion (odds ratio [OR], 3.44; 95% CI, 2.99-4.42), and 6 revealed an elevated risk of injury within 1 year of concussion (OR, 1.85; 95% CI, 1.73-2.84). Increased risk was seen in professional (OR, 2.49; 95% CI, 2.40-2.72) and collegiate (OR, 2.00; 95% CI, 1.96-2.16) athletes compared with high school athletes (OR, 0.97; 95% CI, 0.89-1.05). A stepwise increase in risk of sustaining an LE injury was observed with multiple concussions, with increasing risk observed from ≥2 (OR, 2.29; 95% CI, 1.85-2.83) to ≥3 (OR, 2.86; 95% CI, 2.36-3.48) career concussions.

Conclusion:

An increased incidence of LE injuries was observed at 90 days and 1 year after the diagnosis of a concussion. Higher levels of competition, such as at the collegiate and professional levels, resulted in an increased risk of sustaining a subsequent LE injury after a diagnosed concussion. These results suggest an at-risk population who may benefit from injury prevention methods after a concussion. Future studies should focus on identifying which injuries are most common, during what time period athletes are most vulnerable, and methods to prevent injury after return to sports.

Part 2 of the 11+ as an effective home-based exercise programme in elite academy football (soccer) players: a one-club matched-paired randomised controlled trial

Background:Although the 11+ is known to reduce injuries and improve performance in adolescent footballers, its duration presents a notable barrier to implementation. Hence, this study investigated injury and performance outcomes when 65 elite male academy footballers either performed Part 2 3x/week at training (TG) or at home (HG).Methods:Time to stabilisation (TTS), eccentric hamstring strength (EH-S) and countermovement jump height (CMJ-H) were collected 4 times during the 2019 football season. Linear mixed models were used to evaluate main and interaction effects of group and time. Bonferroni post-hoc tests were used to account for multiple comparisons. Differences in time loss and medical attention injuries were determined using a two-tailed Z test for a comparison of rates.Results:Relative to baseline, EH-S (HG 4.3 kg, 95% CI 3 to 5.7, p < 0.001; TG 5.5 kg, 95% CI 4.3 to 6.6, p < 0.001) and CMJ-H (HG 3.5 cm, 95% CI 2.2 to 4.7, p < 0.001; TG 3.2 cm, 95% CI 2.2 to 4.3, p < 0.001) increased, with no difference between groups observed at the end of the season. All injury outcomes were similar.Conclusion: Rescheduling Part 2 did not affect performance or increased injury risks in academy footballers.

Most amateur football teams do not implement essential components of neuromuscular training to prevent anterior cruciate ligament injuries and lateral ankle sprains

PURPOSE

Neuromuscular training (NMT) is effective at reducing football injuries. The purpose of this study was to document the use of NMT to prevent anterior cruciate ligament injuries and lateral ankle sprains in adult amateur football and to identify barriers for using NMT.

METHODS

A preseason and in-season online survey was completed by players and coaches of 164 football teams. The survey contained questions concerning injury history, type and frequency of NMT, and barriers when NMT was not used.

RESULTS

A total of 2013 players (40% female) and 180 coaches (10% female) completed the preseason survey, whereas 1253 players and 140 coaches completed the in-season survey. Thirty-four percent (preseason) to 21% (in-season) of players used NMT, but only 8% (preseason) to 5% (in-season) performed adequate NMT (i.e. both balance and plyometric exercises, at least twice per week). In the subpopulation of players with an injury history, 12% (preseason) and 7% (in-season) performed adequate NMT. With respect to the coaches, only 5% (preseason) and 2% (in-season) implemented adequate NMT. Most important barriers for using NMT for both players and coaches were a lack of belief in its effectiveness, a lack of knowledge, the belief that stretching is sufficient, and not feeling the need for it.

CONCLUSION

Most amateur football teams do not implement essential components of NMT. The results highlight the urgent need for developing strategies to enhance the adequate use of NMT in amateur football.

LEVEL OF EVIDENCE

II.

High compliance with the injury prevention exercise programme Knee Control is associated with a greater injury preventive effect in male, but not in female, youth floorball players

PURPOSE

Evaluate team and player compliance with the Knee Control injury prevention exercise programme, study the association between player compliance and injury rates, and compare coach demographics, baseline prevention expectancies, and programme utilisation between teams with high and low compliance.

METHODS

Prospective one-season cohort study based on a cluster randomised controlled trial on 301 (107 female) floorball players aged 12-17 years. Floorball exposure and injuries were self-reported weekly by players using the Oslo Sports Trauma Research Center questionnaire. Team and player compliance to Knee Control was reported monthly by coaches. Additionally, coaches answered pre- and post-season surveys. Teams were divided into a high (≥ 80%) or low (< 80%) compliance group based on their use of Knee Control during the season. Players were divided into three compliance groups based on their average weekly number of Knee Control sessions; high (≥ 2 sessions), intermediate (≥ 1 to < 2 sessions), and low dose (< 1 session).

RESULTS

Mean team compliance for the high and low compliance groups were 95% (range 82-100) and 50% (range 13-66), respectively. Mean ± SD weekly Knee Control dose in the three player compliance groups were 2.4 ± 0.3, 1.4 ± 0.3, and 0.7 ± 0.3 sessions, respectively. There were no differences in total injury incidence between the player compliance groups, but players in the high-dose group had a 35% lower prevalence of injuries overall [adjusted prevalence rate ratio (PRR) 0.65, 95% CI 0.48-0.89] and 60% lower prevalence of substantial injuries (adjusted PRR 0.40, 95% CI 0.26-0.61) compared with the low-dose group. Male players in the high-dose group had consistently lower injury incidence and prevalence, while no between compliance group differences were seen in female players. There were no differences in sex, years of coaching experience, or baseline prevention expectancies in general between coaches for teams in the high vs. low compliance groups, but teams in the high compliance group had a better utilisation fidelity.

CONCLUSION

There was a clear dose-response relationship between more frequent Knee Control use and lower injury rates in male floorball players, but not in female players. Teams with higher compliance also showed a better utilisation fidelity with the programme.

LEVEL OF EVIDENCE

Level II.

ACL injury prevention: Where have we come from and where are we going?

Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.

Exercise-Based Injury Prevention in High-Level and Professional Athletes: Narrative Review and Proposed Standard Operating Procedure for Future Lockdown-Like Contexts After COVID-19

In regular times, implementing exercise-based injury prevention programs into the training routine of high-level and professional athletes represents a key and challenging aspect to decrease injury risk. Barriers to implementing such prevention programs have previously been identified such as lack of resources, logistic issues or motivation. The COVID-19 pandemic associated with restrictions on daily life dramatically impacted sports participation from training to competition. It is therefore reasonable to assume that such lockdown-like context has exacerbated the challenge to implement exercise-based injury prevention programs, potentially leading to a greater musculoskeletal injury risk. In this narrative review, recommendations are proposed for building an expertise- and evidence-based Standard Operating Procedure for injury prevention in lockdown-like contexts for high-level and professional athletes. The following recommendations can be provided: (1) assess the global and sport-specific risks in the light of the ongoing cause of isolation; (2) adapt remote training materials and programs; (3) ensure regular quality communication within the staff, between athletes and the staff as well as between athletes; (4) follow the athlete's mental well-being; and (5) plan for a safe return-to-sports as well as for an ongoing monitoring of the load-recovery balance. These key domains should further be addressed to comply with local policies, which are subject to change over time in each individual country. The use of these recommendations may improve the readiness of athletes, coaches, physicians and all sports stakeholders for future lockdown-like contexts.

Hand and wrist injuries among collegiate athletes vary with athlete division

BACKGROUND

The rates, severity and consequences of hand and wrist injuries sustained by National Collegiate Athletic Association athletes are not well characterized. This study describes the epidemiology of hand and wrist injuries among collegiate athletes competing in different divisions.

METHODS

The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) was accessed from 2004 to 2015 for the following sports: baseball, basketball, football, ice hockey, lacrosse, soccer, wrestling, field hockey, gymnastics, softball and volleyball. The data were used to identify all hand and wrist injuries, the specific injury diagnosis, mean time loss of activity following injury, and need for surgery following injury. These were then stratified by gender. Descriptive statistics were performed to examine the association between sports, event type and division. Student's t test was used to calculate p-values for independent variables. Chi-Square test was used to calculate odds ratio. P < 0.05 was considered significant.

RESULTS

103,098 hand and wrist injuries were reported in in the studied NCAA sports from 2004 to 2015. Male athletes sustained 72,423 injuries (6.01/10,000 athlete exposure) and female athletes sustained 30,675 injuries (4.13/10,000 athlete exposure). Division I athletes sustained significantly more injuries compared to divisions II and III. Overall, 3.78% of hand and wrist injuries required surgical intervention. A significantly higher percentage of division I athletes (both male and female) underwent surgical intervention compared to divisions II and III. The mean time lost due to hand and wrist injury was 7.14 days for all athletes. Division I athletes missed the fewest days due to injury at 6.29 days though this was not significant.

CONCLUSIONS

Hand and wrist injuries are common among collegiate athletes. Division I athletes sustain higher rates of injuries and higher surgical intervention rates, while tending to miss fewer days due to injury. Improved characterization of divisional differences in hand and wrist injuries can assist injury management and prevention.

Compliance and Fidelity With an Injury Prevention Exercise Program in High School Athletics

BACKGROUND

Use of injury prevention programs (IPPs) by high school athletes has increased but their success in reducing injury depends on program compliance and fidelity of exercise performance.

HYPOTHESIS

Compliance with the 11+ IPP and exercise performance fidelity by high school athletic teams depend on sex, sport, and level of play.

STUDY DESIGN

Secondary analyses of data from a randomized controlled trial (RCT).

LEVEL OF EVIDENCE

Level 2.

METHODS

The 11+ IPP was implemented by 100 male and female high school athletic teams (American football, soccer, basketball, and lacrosse). Team compliance and fidelity with the program were evaluated by direct observation of warm-up routines and a weekly online survey completed by coaches. Differences in compliance and fidelity due to sport, sex, and level of play were assessed by analysis of variance.

RESULTS

Coaches reported that their teams performed the full IPP an average of 1.45 times per week, and 28% of observed warm-ups included all exercises in the IPP. Compliance differed by sport but not by level of play or the athletes' sex. At the end of the season, cueing was observed 19% of the time and differed by sport. Good technique was observed 66% of the time and varied by level of play.

CONCLUSION

Team compliance with the IPP varied by sport and was below the recommended number of sessions per week needed to reduce injury. Removal of implementation barriers and improved support from coaches are needed at all levels of play for IPPs to be effective.

CLINICAL RELEVANCE

Clinical and sports practitioners intending to implement an IPP at the high school level should anticipate and address barriers that affect program compliance and fidelity of exercise performance. Frequent follow-up and instruction may be necessary for successful adoption of the IPP.

Facilitators and barriers for implementation of a load management intervention in football

BACKGROUND

In a recent randomised controlled trial, we found that a commonly used training load management approach was not effective in preventing injuries and illnesses in Norwegian elite youth footballers.

AIM

To investigate players' and coaches' barriers and facilitators to a load management approach to prevent injuries and illnesses and their attitudes and beliefs of load management and injuries and illnesses in general.

METHODS

We asked players and coaches about their views on injury risk in football, the benefits and limitations of load management in general and implementation of load management in football. The questionnaires used were based on similar studies using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.

RESULTS

We recorded answers from 250 players and 17 coaches. Most players (88%) reported that scientific evidence showing improved performance from the intervention measures is a key facilitator to completing the intervention. Similarly, coaches reported that the most important facilitator was scientific evidence that the preventive measures were effective (100%). Players reported that the coach's attitude to preventive measures was important (86%), and similarly, 88% of coaches reported that the player's attitude was important.

CONCLUSIONS

By having a mutual positive attitude towards the intervention, players and coaches can positively contribute to each other's motivation and compliance. Both players and coaches reported scientific evidence for load management having injury-preventive and performance-enhancing effect and being time efficient as important facilitators.

TRIAL REGISTRATION NUMBER

Trial registration number.

Can we explain running-related injury preventive behavior? A path analysis

BACKGROUND

Behavioral and social science theories/models have been gaining attention in sports injury prevention.

OBJECTIVE

To investigate the potential of the Theory of Planned Behavior in explaining running-related injury preventive behavior.

METHODS

Six-month prospective cohort study based on data gathered from a randomized controlled trial. From a total of 1512 invited trail runners, 232 were included in this study. Preventive behaviors and their determinants were assessed at baseline and two and six months after baseline. Five-point Likert scales were used to assess the determinants of preventive behavior. A Bayesian path analysis was conducted applying mixed models and mediation analysis.

RESULTS

A 1-point increase in intention, attitude, subjective norm, and perceived behavioral control predicted an increase of 54% (95% Bayesian credible interval [BCI]: 38, 71) in the rate of performing running-related injury preventive behavior, explaining 49% (R² 0.49; 95% BCI: 0.41, 0.56) of the variance around preventive behavior. Intention and perceived behavioral control predicted running-related injury preventive behavior directly, while 40% (95% BCI: 21, 61) and 44% (95% BCI: 20, 69) of the total effect of attitude was mediated by intention and perceived behavioral control, respectively. Attitude, subjective norm, and perceived behavioral control predicted intention.

CONCLUSIONS

The Theory of Planned Behavior may have the potential to explain half of the variance around running-related injury preventive behavior and intention. Therefore, such theory may be considered a relevant and useful tool in developing, investigating, and/or implementing programs aimed at preventing running-related injuries.

The prognostic value of the hamstring outcome score to predict the risk of hamstring injuries

OBJECTIVES

Hamstring injuries are common among soccer players. The hamstring outcome score (HaOS) might be useful to identify amateur players at risk of hamstring injury. Therefore the aims of this study were: To determine the association between the HaOS and prior and new hamstring injuries in amateur soccer players, and to determine the prognostic value of the HaOS for identifying players with or without previous hamstring injuries at risk of future injury.

DESIGN

Cohort study.

METHODS

HaOS scores and information about previous injuries were collected at baseline and new injuries were prospectively registered during a cluster-randomized controlled trial involving 400 amateur soccer players. Analysis of variance and t-tests were used to determine the association between the HaOS and previous and new hamstring injury, respectively. Logistic regression analysis indicated the prognostic value of the HaOS for predicting new hamstring injuries.

RESULTS

Analysis of data of 356 players indicated that lower HaOS scores were associated with more previous hamstring injuries (F=17.4; p=0.000) and that players with lower HaOS scores sustained more new hamstring injuries (T=3.59, df=67.23, p=0.001). With a conventional HaOS score cut-off of 80%, logistic regression models yielded a probability of hamstring injuries of 11%, 18%, and 28% for players with 0,1, or 2 hamstring injuries in the previous season, respectively.

CONCLUSIONS

The HaOS is associated with previous and future hamstring injury and might be a useful tool to provide players with insight into their risk of sustaining a new hamstring injury risk when used in combination with previous injuries.

Hamstring muscle injury in the athlete: state of the art

Hamstring injuries (HSI) are the source of significant impairment and disability for both professional and recreational athletes. The incidence and prevalence of HSIs has been well documented in the literature, as they are among the most common soft tissue injuries reported. The significant time loss due to injury and the inherent risk of reinjury pose a significant issue to the athlete, their career longevity and the success of their respective team. This review will deal predominantly with describing the prevalence and incidence of HSI in athletes, discuss risk factors and the mechanisms of injury for HSI, how to properly diagnose, image and prognosticate appropriate return to sport (RTS) for individuals who have sustained an HSI, prescribe treatment and prevention strategies and to discuss relevant options to decrease overall risk of primary and secondary recurrence of HSI.Current treatments of acute HSI necessitate a thorough understanding of the mechanism of injury, identifying muscle imbalances and/or weakness, inclusion of eccentric and concentric hamstring (HS) and hip extension (HE) exercises, evaluation of pathokinematic movement patterns and use non-surgical methods to promote healing and RTS. This methodology can be used prospectively to mitigate the overall risk of HSI. Injection therapies for HSI, including ultrasound-guided platelet-rich plasma and corticosteroids, may impart some short-term benefit, but the existing literature is largely inconclusive with respect to long-term functional outcomes. Future directions should prioritise injury prevention, early diagnosis and targeted interventions that combine both non-surgical and minimally invasive orthobiological approaches and identifying biomechanical risk factors prospectively to mitigate risk.

The Impact of the FIFA 11+ Program on the Injury in Soccer Players: A Systematic Review

OBJECTIVES The purpose of this study was to integrate information about the effects of FIFA 11+ injury prevention program in soccer.DESIGN AND METHODS Systematic review. We used PubMed, Medline, PMC, and Web of Science to search randomized controlled trials comparing FIFA 11+ injury prevention program with control groups among soccer players.RESULTS Total of 13 studies was selected through eligibility criteria. 7 studies included overall, ankle, knee, and hamstring injury rate between FIFA 11+ versus control groups, while the other 6 studies included improvement of physical performance, such as vertical jump, 20m sprint, agility, hip adduction strength, and FMS total score between FIFA 11+ versus control groups. There was a lower rate of injury in the intervention group from all 7 studies. Couple of studies had different criteria to compare with other studies. Most values of physical performance were also significantly improved from all 6 studies except for the values of agility time.CONCLUSIONS Multiple studies have proven injury rate reduction and physical performance improvement of FIFA 11+ program between intervention and control groups. We also found that it at least required a few weeks of intervention time to be effective. Therefore, coaches and players might need to consider including FIFA 11+ program as a warm-up period to prepare the regular season.

How much, how often, how well? Adherence to a neuromuscular training warm-up injury prevention program in youth basketball

Adherence is a key implementation outcome that determines the effectiveness of an intervention. This study, an observational design involving coaches and players from 33 high school basketball teams, evaluated the dimensions of adherence to a basketball-specific neuromuscular training (NMT) warm-up program in youth basketball. Coach adherence (daily report of team adherence) was collected prospectively. Adherence measures: cumulative utilization (proportion of total sessions possible), utilization fidelity (average # of exercises completed per NMT session), utilization frequency (average # of NMT sessions completed per week) were calculated and further evaluated for optimal adherence (≥80%, ≥10.4 exercises/session and ≥2 sessions/week, respectively) per coach. Additionally, exercise fidelity (proportion of players performing individual exercises correctly) was assessed. Coach (n = 31; 27-59 years) median cumulative utilization was 80%, utilization fidelity was 12 (of a possible 13 exercises per session) and utilization frequency was 2.3 sessions per week. Optimal adherence ranged from 52% to 71% across measures of adherence. Player exercise fidelity was 48%. Time constraint (47%) was the most frequently reported adherence barrier. While coach adherence to the NMT warm-up program was reasonably high across measures of adherence, a considerable proportion of coaches did not attain optimal adherence levels and player exercise fidelity was low.

Prevention of severe knee injuries in men's elite football by implementing specific training modules

PURPOSE

Injury prevention of knee injuries by means of training and warm-up exercises has been investigated in several studies in amateur football. However, the number of investigations in elite football is limited despite the currently higher injury incidence of severe knee injuries. Therefore, the purpose of this study was to investigate whether specifically adapted preventive training modules may reduce severe knee injuries in elite football.

METHODS

In a prospective controlled cohort study of elite football players in Germany, an injury prevention programme with 5 modules was implemented in the season of 2015-2016. The training modules were specifically adapted to this skill level and based on scientific evidence, team coach preferences, and the specific environment of this playing level. Of the 62 teams taking part in this study, 26 used the new trainings modules and 36 continued their standard programme as a control group. Success of the programme was documented by means of an injury report over one season. The primary outcome was reduction in severe knee injuries.

RESULTS

A pre-seasonal investigation had identified five modules to be implemented in the training routine. Postural stability, mobilisation of lower extremity joints, leg and trunk stabilisation, jumping, and landing exercises as well as agility movements were incorporated into the programme to prevent severe knee injuries in elite football. Over the season, the study group (529 players) with the adapted training modules had sustained 52 severe knee injuries (incidence: 0.38 per 1000 h football exposure; prevalence: 9.8%) compared to 108 severe knee injuries in the control group (601 players) using the standard programme (incidence: 0.68 per 1000 h football exposure; prevalence: 18.0%; p < 0.05). The overall injury incidence for any other type of injury was comparable between the two groups (3.3 vs. 3.4 in h 1000 football, n.s.).

CONCLUSION

Appropriate preventive training modules reduce severe knee injuries in elite football significantly. The key for the sustainability of preventive training measures are programmes specifically adapted to the demands of the playing level and to the preferences of the coaches LEVEL OF EVIDENCE: II.

Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12-17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial

Objective

To study whether an injury prevention exercise programme would reduce the number of injuries in youth floorball players.

Methods 

81 youth community level floorball teams (48 clusters=clubs) with female and male players (12–17 years) were cluster-randomised into an intervention or control group. Intervention group coaches were instructed to use the Swedish Knee Control programme and a standard running warm-up before every training session, and the running warm-up before every match, during the season. Control teams continued usual training. Teams were followed during the 2017/2018 competitive season (26 weeks). Player exposure to floorball and occurrence of acute and overuse injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre Questionnaire.

Results 

17 clusters (301 players) in the intervention group and 12 clusters (170 players) in the control group were included for analyses. There were 349 unique injuries in 222 players. The intervention group had a 35% lower incidence of injuries overall than the control group (adjusted incidence rate ratio (IRR) 0.65, 95% CI 0.52 to 0.81). The absolute risk reduction was 6.6% (95% CI 3.2 to 10.0), and the number needed to treat was 152 hours of floorball exposure (95% CI 100 to 316). Intervention group teams had a 45% lower incidence of acute injuries (adjusted IRR 0.55, 95% CI 0.37 to 0.83). There was no difference in the prevalence of overuse injuries (adjusted prevalence rate ratio 0.96, 95% CI 0.73 to 1.26).

Conclusion 

The Knee Control injury prevention programme reduced acute injuries in youth floorball players; there was no effect on overuse injuries.

Trial registration number

Clinical Trials NCT03309904.

Could a specific exercise programme prevent injury in elite orienteerers? A randomised controlled trial

OBJECTIVES

To determine the effect of a specific exercise programme on preventing lower extremity injury in adult elite orienteerers.

DESIGN

Randomised controlled trial.

SETTING

Elite orienteering.

PARTICIPANTS

Sixty-two orienteerers (n = 32/30, male/female) were randomized and followed over 14 weeks. The intervention group completed an exercise programme 4 times per week.

MAIN OUTCOME MEASURES

Number of substantial injuries, average substantial injury prevalence and incidence of ankle sprains over the competitive season. In per-protocol analyses, compliance rate to exercise programme was considered.

RESULTS

No significant differences between control and intervention group were found for substantial injured orienteerers (OR 0.50, 95% CI 0.19-1.34), number of substantial injuries (OR 0.46, 95% CI 0.18-1.13) and incidence of ankle sprains (p = 0.775). In per-protocol analyses, significant differences in substantial injured orienteerers (difference -7.9%, OR 0.25, 95% CI 0.06-0.97) and number of substantial injuries (difference -8.5%, OR 0.26, 95% CI 0.07-0.92) in favour for the orienteers completing the exercises at least twice a week, compared to the control group, were found.

CONCLUSIONS

An exercise programme, consisting of balance and jump exercises, is suggested to be performed at least twice per week in order to reduce the risk of lower extremity injury in elite orienteerers.

Inter-rater Reliability in Assessing Exercise Fidelity for the Injury Prevention Exercise Programme Knee Control in Youth Football Players

BACKGROUND

To receive maximum benefits from injury prevention exercise programmes (IPEP) such as Knee Control, players need to perform the exercises as prescribed. But, exercise fidelity in IPEPs is seldom evaluated. We developed a checklist to assess exercise fidelity in the Knee Control IPEP, and the primary aim was to evaluate its inter-rater reliability. The secondary aim was to study Knee Control exercise fidelity in youth football players and compare sex differences.

METHODS

This observational study included 11 teams with male and female youth players (11-18 years). On average, the players trained with the Knee Control IPEP for 7 weeks (SD 1.4, range 6-10 weeks). After the training period, two physiotherapists attended a team training session to observe players executing exercises and individually assessed their performance of these exercises as correct or incorrect based on standardised criteria set in the fidelity checklist. Agreement between observers was assessed using Cohen's kappa coefficient.

RESULTS

The observers agreed on 144 out of 160 (90%) observations (Kappa = 0.80, substantial agreement). Both observers agreed on correct exercise performance for 69 out of 144 observations (exercise fidelity 48%). Exercise fidelity was higher in females (56%) than males (40%), but the difference was not statistically significant (p = 0.18).

CONCLUSION

The Knee Control exercise fidelity checklist had high inter-rater reliability with substantial agreement. The exercise fidelity was low, which could hamper the preventive effects of an IPEP. Understanding the reasons for low exercise fidelity is important and more effort should focus on increasing exercise fidelity alongside the implementation of IPEPs.

Implementation of the Adductor Strengthening Programme: Players primed for adoption but reluctant to maintain - A cross-sectional study

Groin injuries represent a considerable problem in male football, accounting for 4%‐19% of all time‐loss injuries. The Adductor Strengthening Programme is the first groin‐specific prevention program shown to reduce the risk of groin problems. We aimed to use the RE‐AIM framework to examine the players’ experiences with the implementation of the program and player attitude toward groin injury prevention in football. Of the 632 players involved in the trial examining the effect of the Adductor Strengthening Programme, 501 agreed to participate in a survey at the end of the season. Most players thought that footballers are at moderate to high risk for groin injuries (87%) and that there is a need for preventive measures (96%). They also believed that a preventive program with strengthening exercises would reduce the risk of groin injuries (91%). Majority of the players reported using <5 minutes to complete the program (73%), and only 11% wanted additional exercises. However, only 46% reported to have performed the program as recommended, and an even smaller proportion (31%) planned to continue using it as recommended the next season. Our results suggest that footballers believe that prevention of groin injuries is needed. Attitude toward implementation of the Adductor Strengthening Programme was positive, and the single‐exercise approach was considered an important facilitator. However, in future dissemination of the program, the players’ reluctance to maintain the exercise protocol may be a potential barrier to implementation that should be addressed.