Comparison of two intervention programmes in young female players in European handball - with and without ankle disc

Is an Exercise-Based Injury-Prevention Program Effective in Team Handball Players? A Systematic Review and Meta-Analysis

OBJECTIVE

To assess the effectiveness of exercise-based injury-prevention programs in preventing sports injuries in team handball players.

DATA SOURCES

Scopus, PubMed, Web of Science, SPORTDiscus, and CINAHL from inception until April 2023.

STUDY SELECTION

Studies were included if they were randomized controlled trials or prospective cohort studies, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injuries, and reported injury incidence rates specific to team handball players. Two researchers independently evaluated studies for inclusion and assessed their methodological quality.

DATA EXTRACTION

Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by 2 independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: shoulder injuries, lower extremity injuries, knee injuries, anterior cruciate ligament injuries, and ankle injuries. Extracted data were analyzed using a random-effects model to compute the overall effect estimates of injury-prevention programs in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group.

DATA SYNTHESIS

Meta-analyses were conducted independently for each injury classification. Results indicated that prevention programs reduced the risk of shoulder injuries (OR = 0.60; 95% CI = 0.42, 0.85; P = .004), lower extremity injuries (OR = 0.59; 95% CI = 0.37, 0.95; P = .03), knee injuries (OR = 0.53; 95% CI = 0.35, 0.78; P = .002), anterior cruciate ligament injuries (OR = 0.66; 95% CI = 0.45, 0.96; P = .03), and ankle injuries (OR = 0.57; 95% CI = 0.40, 0.81; P = .002) in team handball players.

CONCLUSIONS

In team handball players, injury-prevention programs appear to effectively reduce the risk of shoulder, lower extremity, knee, ankle, and anterior cruciate ligament injuries.

The effect of 8-week combined balance and plyometric on the dynamic balance and agility of female adolescent taekwondo athletes

OBJECTIVES

To investigate the effect of combined balance and plyometric training (PT) on the agility and dynamic balance of adolescent taekwondo athletes.

METHODS

Thirty female adolescent taekwondo players volunteered to participate and were randomly assigned to the combined balance training and PT (CT; n = 15) and PT (n = 15) groups. The CT group performed balance training combined with PT 3 times a week for 6 weeks (40 minutes of plyometrics and 20 minutes of balance training) while the PT group performed only PT for the same period (3 sets × 8-12 reps for each exercise). Both groups received the same routine technical taekwondo training.

RESULTS

Post-intervention assessments revealed that both groups significantly improved their dynamic posture stability index scores (DPSI; forward jump [F-DPSI] and lateral jump [L-DPSI]). However, participants in the CT group achieved notably superior outcomes in the F-DPSI and L-DPSI scores compared with those achieved by their PT counterparts. The center of pressure metrics exhibited improvements post-intervention, with scores of specific measures in the PT group surpassing those in the CT group. Additionally, the 5-0-5 test scores exhibited improvements post-intervention, with scores of specific measures in the PT group surpassing those in the CT group, and the TAST (Taekwondo Specific Agility Test) of the CT group and the PT changed significantly after the intervention.

CONCLUSION

An 8-week regimen that integrates balance and plyometric training effectively augments knee function and proprioception in adolescent Taekwondo athletes. This study underscores the potential benefits of a combined training approach, providing coaches and athletes with valuable insights into Taekwondo training.

Effect of Coronavirus 19 on Maintaining Balance in Skilled Athletes

Preliminary studies have reported that motor control is negatively impacted following an infection of COVID-19. The purpose of this study was to evaluate the effect of COVID-19 on maintaining balance in highly skilled athletes. As part of a larger investigation that was initiated in 2019, twelve professional handball players were recruited to participate in a study that was designed to measure static balance performance. Following the initial pre-test, six participants (body height 184.8 ± 4.7 cm; body weight 85.5 ± 3.3 kg; age 21.3 ± 1.2 years) were infected with COVID-19. The remaining six participants (body height 188.7 ± 2.6 cm; body weight 92.3 ± 3.7 kg; age 26.3 ± 3.3 years) never tested positive for COVID-19 and were presumably not infected with the virus. The experimental design required all the participants to complete an initial balance assessment (pre-test) and a later balance assessment (post-test). To fully analyze our data, we conducted a 2 (condition: COVID, no-COVID) X 2 (test: pre-test, post-test) ANOVA with repeated measures on the second factor. Our analysis revealed that the skilled athletes who contracted COVID-19 had a significant decrease in balance performance from the pre-test that occurred prior to being infected with COVID-19 relative to the post-test that occurred following the COVID-19 infection. Additionally, the skilled athletes who were not infected with COVID-19 did not demonstrate the same deterioration in balance performance in the same period. This study highlights the impact COVID-19 has on static balance performance in a group of highly skilled handball players. Longitudinal studies are needed to fully understand the lasting impacts COVID-19 has on motor behavior.

Combined balance and plyometric training enhances knee function, but not proprioception of elite male badminton players: A pilot randomized controlled study

Objectives

To investigate the effect of combined balance and plyometric training on knee function and proprioception of elite badminton athletes.

Methods

Sixteen elite male badminton players (age: 20.5 ± 1.1 years, height: 177.8 ± 5.1 cm, weight: 68.1 ± 7.2 kg, and training experience: 11.4 ± 1.4 years) volunteered to participate and were randomly assigned to a combined balance and plyometric training (CT) (n = 8) and plyometric (PT) group (n = 8). The CT group performed balance combined with plyometric training three times a week over 6 weeks (40 min of plyometrics and 20 min of balance training); while the PT group undertook only plyometric training for the same period (3-4 sets × 8-12 reps for each exercise). Both groups had the same technical training of badminton.

Results

The knee function and proprioception were assessed at baseline and after the intervention by measuring the performance of single-legged hop tests (LSIO, LSIT, LSIC, LSIS), standing postural sway (COPAP, COPML), and LSI of dominant leg and non-dominant leg. The results showed that as compared to PT, CT induced significantly greater improvements in LSIT and LSIS (p < 0.001) and significant greater percent increase in NAP (p = 0.011). The changes in LSIO, LSIC, DAP, NAP, LSIAP, DML, NML, and LSIML induced by CT did not differ from that induced by PT (p > 0.213).

Conclusion

In elite badminton players, intervention using CT holds great promise to augment the benefits for knee function compared to the intervention using PT only, and at the same time, with at least comparable benefits for proprioception. Future studies are needed to examine and confirm the results of this study.

Effects of Mobile-Based Rehabilitation in Adolescent Football Players with Recurrent Lateral Ankle Sprains during the COVID-19 Pandemic

Football is a sport involving dynamic movements, and ankle sprains are common sports injuries experienced by football players. Ankle sprains exhibit a high recurrence rate, and rehabilitation training is effective; however, expert-supervised rehabilitation (SVR) at training centers is difficult due to the recent COVID-19 pandemic. This study investigated the effects of mobile-based rehabilitation (MBR) performed at home by high school football players. Sixty players (SVR: 30 and MBR: 30) with recurrent ankle sprains were analyzed. The rehabilitation program consisted of strength and balance training, and the training intensity was gradually increased from week 1 to week 8. The SVR group underwent training at the center with experts, and the BMR group were provided with programs and feedback using mobile devices. Ankle muscle strength was evaluated by measuring isometric eversion, inversion, plantarflexion, and dorsiflexion contraction using a hand-held dynamometer, and dynamic balance was assessed using the Y-balance test (YBT; anterior, posteromedial, and posterolateral); the Foot and Ankle Outcome Score (FAOS) was used for the subjective evaluation. Measurements were conducted at weeks 1, 4, and 8. The patients visited the clinic within 1 week after the injury, and the first test was conducted after consent to participate in the research. Patients underwent the second test at an average of 3.2 weeks after the first test, and the last test at an average of 4.4 weeks after the second test. Although only the SVR group exhibited improvement in strength (eversion and dorsiflexion), YBT and subjective satisfaction at week 4, these measurements improved in both the SVR and MBR groups at week 8. Therefore, mobile–based rehabilitation could be a suitable alternative for high school athletes with ankle sprains who cannot undergo supervised rehabilitation.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

Side differences of upper quarter Y balance test performance in sub-elite young male and female handball players with different ages

Background

Handball is characterised by repetitive passing and shooting actions mainly performed with the throwing arm. This can lead to side differences (inter-limb asymmetry) in upper quarter mobility/stability between the throwing and non-throwing arm, which could even increase with advancing age (i.e., playing experience). However, side differences in upper quarter mobility/stability is associated with an increased musculoskeletal injury risk. Therefore, we assessed side differences in upper quarter mobility/stability in young handball players at different ages using a cross-sectional study design.

Methods

Upper Quarter Y Balance test performance of the throwing and non-throwing arm was assessed in 190 sub-elite young female and male handball players (13–18 years). Per arm, relative maximal reach distances (% arm length) for all three directions (i.e., medial, inferolateral, superolateral) and the composite score (CS) were calculated and used for an age × side analysis of variance. Additionally, partial eta-squared (ηp²) was calculated as an effect size measure.

Results

Irrespective of measure, statistically significant main effects of age (except for the composite score) and side but no statistically significant age × side interaction effects were detected. Further, limb asymmetry in the inferolateral reach direction was above the injury-related cut-off value (i.e., ≥ 7.75% arm length) in 13- and 14-year-olds but not in the older players.

Conclusion

The detection of limb asymmetry above the proposed injury-related cut-off value in younger players (13- and 14-year-olds) but not in older players (15- to 18-year-olds) may be indicative for an increased injury risk for the younger age group. Thus, prevention programs should be implemented in the handball training routine, especially for the younger ones.

Effect of Functional Rehabilitation on Performance of the Star Excursion Balance Test Among Recreational Athletes With Chronic Ankle Instability: A Systematic Review

OBJECTIVE

To determine (1) the effectiveness of rehabilitation for chronic ankle instability as measured by the Star Excursion Balance Test (SEBT) and (2) the relative efficacy and the long-term effects of these rehabilitation interventions.

DATA SOURCES

Ten electronic databases were searched (2009-2019).

STUDY SELECTION

Included articles were randomized controlled trials in English investigating recreational athletes aged ≥18 years with chronic ankle instability. At least 1 functional rehabilitation intervention had to be included and the SEBT test (or the modified version) used as an outcome measure.

DATA EXTRACTION

Two researchers (L.A., O.N.) extracted data regarding participant demographics; intervention characteristics; trial size; and results at baseline, postintervention, and at follow-up, where appropriate.

DATA SYNTHESIS

A systematic review and narrative synthesis was conducted. Methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool and the van Tulder scale. The review was registered with PROSPERO (ID: 164468). Ten studies (n=368), 2 high-quality, 1 moderate-quality, and 7 low-quality, were included in the review. Interventions included balance training, strength training, vibration training, and mixed training. Results suggest that rehabilitation of chronic ankle instability that includes wobble board exercises (average percentage change: 14.3%) and hip strengthening exercises (average percentage change: 12.8%) are most effective. Few studies compared different types of rehabilitation for chronic ankle instability. However, improvements on the SEBT suggest that a rehabilitation program focusing on wobble board training and hip strengthening performed 3 times weekly for 4-6 weeks is the optimal rehabilitation program to improve dynamic postural control in recreational athletes with chronic ankle instability.

CONCLUSIONS

Few studies directly compared different rehabilitation interventions, and there was limited long-term follow-up; therefore, the relative efficacy of different rehabilitation programs remains unclear. However, it seems that rehabilitation of chronic ankle instability should include proprioceptive and strengthening exercises of relatively short duration.

Epidemiology of injuries in female and male senior Slovenian handball leagues

BACKGROUND

Handball is associated with a high frequency of injuries due to unexpected situations, external disturbances of movement and extreme positions of body segments. The purpose of this study was to identify and analyze injuries among female and male players from all five senior Slovenian handball leagues in the season 2010/2011.

METHODS

We conducted a retrospective epidemiological study using a questionnaire. Data were collected between February and May 2012. Descriptive analysis is provided.

RESULTS

Forty-five percent of all the players were injured, reporting 92 injuries. 0.58 injuries/player occurred, 57 (62%) in females and 35 (38%) in males. Injury incidence in females (27.7 injuries/1000 hours match, 0.97 injuries/1000 hours training) was higher than in men (10.6 injuries/1000 hours match, 0.5 injuries/1000 hours training), respectively. The left- and right-back players were injured most often (41%). Sprain was the most common injury type (55%). Most injuries were severe (29%). The lower limb was injured most frequently (62%). Ankle was injured the most commonly (35%), but ankle injuries were in most cases moderate (38%). More than 70% of knee injuries and 50% of shoulder injuries were severe. In 33%, cause of injury was contact with an opponent/teammate. Thirty-six percent of players reported shoulder and 36% ankle overuse syndromes.

CONCLUSIONS

Present findings showed a higher incidence of injuries in female than in male senior Slovenian handball players in the 2010/2011 season. Preventive programs should focus not only on the acute ankle and knee injuries, but also on overuse syndromes of the shoulder and ankle.

[Epidemiology and injury prevention in handball]

Handball is characterised by a high rate of injuries. Recent epidemiologic studies, which take the characteristics of handball into account, demonstrate a clear picture of injury patterns and injury risks for handball athletes. While more than half of all athletes can continue playing handball after medical treatment, the other half of injuries is accompanied by loss of training and match time. Although the sustained injuries are associated with a contact mechanism, they are not related to a high rate of foul play in the league setting. This shows that there is a high potential for prevention. Handball medicine strongly aims to primarily reduce and thus prevent injuries in this sport. The existing evidence for the potential of prevention of severe knee injuries must now be implemented into daily training. Due to the high prevalence of overuse injuries to the throwing shoulder, here, too, the first insights have been implemented in a prevention programme. This is described in detail in this article.

Incidence of injury in young handball players during national competition: A 6-year survey

BACKGROUND

An updated injury surveillance of young handball players is needed because of the increased risk of injury in recent handball games with increased intensity. This study examined acute injuries in young handball players during games.

METHODS

We retrospectively assessed the injuries occurring during 6 national competitions, including 550 games from 2013 to 2018, held in March of each year. All players were 13 or 14 years old.

RESULTS

In total, 169 injuries were reported. The number of match injuries per 1000 player hours was 26.5. The injury incidence in boys was higher than that in girls (p = 0.001). No significant differences were found in injury incidence according to the position and date during the tournament (p = 0.108 and 0.483, respectively). Of all injuries, 43.2% were in the lower extremities and 20.7% affected the upper extremities. Most injuries occurred in the head/face (n = 53, 31.4%), followed by the ankle/foot (n = 41, 24.3%), knee (n = 23, 13.6%), and wrist/hand (n = 22, 13%). The most common injury type was sprain (n = 64, 37.9%), followed by contusion (n = 50, 30.0%) and wound (n = 35, 20.7%). In field players, ankle sprain was the most frequent diagnosis, followed by head/face wound and contusion. In contrast, contusion was the main cause of injury in goalkeepers, followed by wound on the head/face.

CONCLUSIONS

Preventive measures focussing on sprains in the lower extremity and improved skill in ball-handling technique should be considered to prevent head/face and wrist/hand injuries, especially in boys.

STUDY DESIGN

Retrospective cohort study.

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

Injury incidence and injury patterns by category, player position, and maturation in elite male handball elite players

The aim of this cohort study is to estimate the influence of position, category, and maturity status on the incidence and pattern of injury in handball players, across two seasons. Injury registration from 164 players-season (12-27 years) was conducted, and players were categorized into youth (133) and adults (31), and per position: 27 goalkeepers, 67 backs, 70 wings and pivots. Maturity status in youth players was also measured by testicular volume on clinical examination (32 immature, 101 mature). 190 injuries occurred during 34 221 hours of exposure. Injury incidence in youth was 6.0 per 1000 total hours [CI 95%, 4.8-7.2] (14.9 match [9.7-20.1] and 3.7 training hours [2.7-4.6]; n= 142 injuries), and in adults 6.5 per 1000 total hours [4.4-8.6] (22.2 match [8.8-35.6] and 3.0 training hours [1.3-4.6]; n=48 injuries). There were significant differences in knee (P=0.01) and cartilage injury (P=0.05) according to playing position. There were significant differences according to age category in ankle (P=0.03), head (P=0.01), thigh (P=0.05) and muscular injury (P= 0.02), and apophysitis (P=0.04) for biological maturity state. Adult handball players had more ankle and muscle injuries than youths. Pivot and wings (2^nd line) had more knee and cartilage problems. A higher incidence of apophysitis was found in immature youth players.

Influence of warm-up duration on physical performance and psychological perceptions in handball players

The purpose of the study was to analyse the effect of two warm-up protocols of different duration on physical performance, perceived load and perception of being ready for a match in handball players. Eighteen handball players were randomly divided into two groups (Wup_34min, warm-up protocol of 34 min, Wup_17min, warm-up protocol of 17 min). Before and after the warm-up protocols, they performed a battery of physical tests and recorded their perception of feeling ready for a match. At the end of the warm-up protocols, all the players evaluated their differentiated perceived effort (dRPE). The results showed that neither of the protocols significantly modified (p > 0.05) the players' physical performance. However, the Wup_34min group showed higher values in the differentiated warm-up perceived load (dRPE-WL) (p < 0.01, TE = 0.97-1.27, high) than the Wup_17min group. The players with a greater perceived muscular load (RPE_MUSC) experienced a greater decrease in their acceleration capacity (r = 0.48-0.49, p < 0.05). In spite of the fact that neither of the warm-up protocols significantly modified the players' physical performance, a greater perceived muscular load may cause a greater decrease in acceleration capacity.

National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury

OBJECTIVE

  To provide certified athletic trainers, physicians, and other health care and fitness professionals with recommendations based on current evidence regarding the prevention of noncontact and indirect-contact anterior cruciate ligament (ACL) injuries in athletes and physically active individuals.

BACKGROUND

  Preventing ACL injuries during sport and physical activity may dramatically decrease medical costs and long-term disability. Implementing ACL injury-prevention training programs may improve an individual's neuromuscular control and lower extremity biomechanics and thereby reduce the risk of injury. Recent evidence indicates that ACL injuries may be prevented through the use of multicomponent neuromuscular-training programs.

RECOMMENDATIONS

  Multicomponent injury-prevention training programs are recommended for reducing noncontact and indirect-contact ACL injuries and strongly recommended for reducing noncontact and indirect-contact knee injuries during physical activity. These programs are advocated for improving balance, lower extremity biomechanics, muscle activation, functional performance, strength, and power, as well as decreasing landing impact forces. A multicomponent injury-prevention training program should, at minimum, provide feedback on movement technique in at least 3 of the following exercise categories: strength, plyometrics, agility, balance, and flexibility. Further guidance on training dosage, intensity, and implementation recommendations is offered in this statement.

Evidence-based concepts for prevention of knee and ACL injuries. 2017 guidelines of the ligament committee of the German Knee Society (DKG)

INTRODUCTION

Knee injuries and especially anterior cruciate ligament (ACL) tears are frequent in athletes. Therefore, primary and secondary prevention of sports-related lower limb injuries is an ongoing topic of interest. The aim of present study was to establish guidelines for the prevention of knee and ACL injuries on the basis of evidence-based concepts represented in current literature.

METHODS

A comprehensive literature review regarding prevention programs for knee and ACL injuries was conducted.

RESULTS

Several modifiable and non-modifiable risk factors for knee injuries in athletes have been reported in literature. Referring to the ACL, specific injury mechanisms have been identified and are well understood. In particular, it has been demonstrated that dynamic valgus is one of the most important modifiable risk factors. Simple tests like the drop jump test have shown their efficacy in screening and detecting athletes at risk. There is only few evidence for the preventive effect on knee and ACL injuries by single exercises. However, in order to prevent or correct endangering movement patterns including dynamic valgus, several complex prevention programs have been developed in the past. These prevention programs are included in standard warm-up exercises and are focusing on muscle strength, balance, and proprioception, as well as running and flexibility. It is reported that these training programs can reduce the incidence of knee injuries by up to 27% and ACL injuries by up to 51%.

CONCLUSIONS

Screening, identification, and correction of endangering movement patterns like the dynamic valgus are the first crucial steps in order to prevent knee and ACL injuries in athletes. Furthermore, jumping, running and flexibility exercises as well as balance and strength training are proven to reduce the incidence of these injuries and should, therefore, be integrated into the regular warm up program. Appropriate complete prevention programs are freely accessible via the Internet and should be adapted to the specific sport disciplines.

Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review

INTRODUCTION

Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for.

OBJECTIVE

The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention.

METHODS

An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included.

RESULTS

Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented.

CONCLUSIONS

Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.

Preventive Neuromuscular Training for Young Female Athletes: Comparison of Coach and Athlete Compliance Rates

CONTEXT

 Fewer athletic injuries and lower anterior cruciate ligament injury incidence rates were noted in studies of neuromuscular-training (NMT) interventions that had high compliance rates. However, several groups have demonstrated that preventive NMT interventions were limited by low compliance rates.

OBJECTIVE

 To descriptively analyze coach and athlete compliance with preventive NMT and compare the compliance between study arms as well as among school levels and sports.

DESIGN

 Randomized, controlled clinical trial.

SETTING

 Middle and high school athletic programs. Participants or Other Participants: A total of 52 teams, comprising 547 female athletes, were randomly assigned to the experimental or control group and followed for 1 athletic season.

INTERVENTION(S)

 The experimental group (n = 30 teams [301 athletes]: 12 basketball teams [125 athletes], 6 soccer teams [74 athletes], and 12 volleyball teams [102 athletes]) participated in an NMT program aimed at reducing traumatic knee injuries through a trunk-stabilization and hip-strengthening program. The control group (n = 22 teams [246 athletes]: 11 basketball teams [116 athletes], 5 soccer teams [68 athletes], and 6 volleyball teams [62 athletes]) performed a resistive rubber-band running program.

MAIN OUTCOME MEASURE(S)

 Compliance with the assigned intervention protocols (3 times per week during the preseason [mean = 3.4 weeks] and 2 times per week in-season [mean = 11.9 weeks] of coaches [coach compliance] and athletes [athlete compliance]) was measured descriptively. Using an independent t test, we compared coach and athlete compliance between the study arms. A 2-way analysis of variance was calculated to compare differences between coach and athlete compliance by school level (middle and high schools) and sport (basketball, soccer, and volleyball).

RESULTS

 The protocols were completed at a mean rate of 1.3 ± 1.1 times per week during the preseason and 1.2 ± 0.5 times per week in-season. A total of 88.4% of athletes completed 2/3 of the intervention sessions. Coach compliance was greater in the experimental group than in the control group (P = .014). Coach compliance did not differ by sport but was greater at the high school than the middle school (P = .001) level. Athlete compliance did not differ by study arm, sport, or school level.

CONCLUSIONS

 Athletes received instruction in about 50% of each protocol. Nearly 90% of athletes performed more than 2/3 of the assigned NMT interventions. The assigned intervention was performed more often in the experimental arm compared with the control arm. Coaches at the high school level complied with the given protocol more than middle school coaches did. Athletes complied well with the protocol, but coaches did not, especially at the middle school level.

The Efficacy of Injury Prevention Programs in Adolescent Team Sports: A Meta-analysis

BACKGROUND

Intensive sport participation in childhood and adolescence is an established cause of acute and overuse injury. Interventions and programs designed to prevent such injuries are important in reducing individual and societal costs associated with treatment and recovery. Likewise, they help to maintain the accrual of positive outcomes from participation, such as cardiovascular health and skill development. To date, several studies have individually tested the effectiveness of injury prevention programs (IPPs).

PURPOSE

To determine the overall efficacy of structured multifaceted IPPs containing a combination of warm-up, neuromuscular strength, or proprioception training, targeting injury reduction rates according to risk exposure time in adolescent team sport contexts.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

With established inclusion criteria, studies were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, SPORTDiscus, Web of Science, EMBASE, CINAHL, and AusSportMed. The keyword search terms (including derivations) included the following: adolescents, sports, athletic injuries, prevention/warm-up programs. Eligible studies were then pooled for meta-analysis with an invariance random-effects model, with injury rate ratio (IRR) as the primary outcome. Heterogeneity among studies and publication bias were tested, and subgroup analysis examined heterogeneity sources.

RESULTS

Across 10 studies, including 9 randomized controlled trials, a pooled overall point estimate yielded an IRR of 0.60 (95% CI = 0.48-0.75; a 40% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested an 8% reduction in the estimate (IRR = 0.68, 95% CI = 0.54-0.84), and the prediction interval intimated that any study estimate could still fall between 0.33 and 1.48. Subgroup analyses identified no significant moderators, although possible influences may have been masked because of data constraints.

CONCLUSION

Compared with normative practices or control, IPPs significantly reduced IRRs in adolescent team sport contexts. The underlying explanations for IPP efficacy remain to be accurately identified, although they potentially relate to IPP content and improvements in muscular strength, proprioceptive balance, and flexibility.

CLINICAL RELEVANCE

Clinical practitioners (eg, orthopaedics, physical therapists) and sports practitioners (eg, strength and conditioners, coaches) can respectively recommend and implement IPPs similar to those examined to help reduce injury rates in adolescent team sports contexts.

Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

The effects of methods to prevent injuries have been studied in several systematic reviews. However, no meta-analysis taking into account all randomised controlled intervention trials aiming at the prevention of sports injuries has been published.

OBJECTIVE

To summarise the effects of sports injury prevention interventions.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

PubMed, MEDLINE, SPORTDiscus, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and Web of Science, searched in September 2013. The reference lists of retrieved articles and reviews were hand searched.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

To be selected articles had to examine the effects of any preventive intervention on sports injuries, be randomised/quasi-randomised and controlled trials, published in a peer-reviewed journal. The outcome of the trial had to be injury rate or the number of injured individuals.

RESULTS

Of the 5580 articles retrieved after a search of databases and the relevant bibliography, 68 randomised controlled trials were included in the systematic review and 60 trials were included in the meta-analysis. Insoles (OR 0.51, 95% CI 0.32-0.81), external joint supports (OR 0.40, 95% CI 0.30-0.53), and specific training programmes (OR 0.55, 95% CI 0.46-0.66) appeared to be effective in reducing the risk of sports injuries. Stretching (OR 0.92, 95% CI 0.80-1.06), modified shoes (OR 1.23, 95% CI 0.81-1.87), and preventive videos (OR 0.86, 95% CI 0.44-1.68) seemed not to be effective.

CONCLUSIONS

This meta-analysis showed that certain interventions can reduce the risk of sports injuries. There were limitations regarding the quality of the trials, generalisability of the results, and heterogeneity of the study designs. In future, the mechanisms behind effective methods and the most beneficial elements of preventive training programmes need to be clarified.

The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist.

OBJECTIVE

Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity.

METHODS

We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields.

RESULTS

One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain.

CONCLUSIONS

Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

Injury incidence in a sports school during a 3-year follow-up

PURPOSE

This study prospectively analysed sports injury incidence over 3 seasons in a regional sports school within an injury surveillance project, involving 372 athletes (12-19 years) from 16 different disciplines.

METHODS

A personal sports diary was used to record all sporting activities daily for every athlete. Injuries (time-loss definition) were registered via a standardized questionnaire.

RESULTS

Sports injury incidence (injuries/1,000 h) evolved from 3.9 in the first year to 4.8 in the second (p < 0.01) and down to 2.8 in the third (p < 0.001, compared to the preceding periods). Significant decreases of injury incidence in the third year were also observed when classifying injuries as traumatic or overuse, and as new or recurrent. The proportion of recurrent injuries was lower in the third period (11 %) when compared to the first (19.5 %, p < 0.05) and the second one (26.3 %, p < 0.05). Injury incidence was lowest during the third period for all severity categories. The same was found when considering injuries within racket, team and individual sports.

CONCLUSIONS

Implementing an injury surveillance system in this setting was associated with a lower injury incidence in the third observation period. This project may have influenced stakeholders' awareness and attitude towards the sports injury problematic.

Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis

CONTEXT

No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury.

OBJECTIVE

To systematically review and synthesize the published literature to determine if compliance with neuromuscular training is associated with reduced incidence of ACL injury in young female athletes.

DATA SOURCES

We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective knee prevention, neuromuscular training, and neuromuscular intervention.

STUDY SELECTION

Criteria for inclusion required that (1) the number of ACL injuries was reported, (2) a neuromuscular training program was used, (3) females were included as participants, (4) the study design was prospective and controlled, and (5) compliance data for the neuromuscular training program were provided.

DATA EXTRACTION

Extracted data included the number of ACL injuries, total number of participants per group, observation time period, number of participants who completed each session, number of sessions completed by an entire team, and number of total sessions. Attendance was calculated as the number of participants who completed each session converted into a percentage of the total number of participants. Intervention completion was calculated as the number of sessions completed by an entire team converted into a percentage of the total number of training sessions. These data were used to calculate an overall rate of compliance.

DATA SYNTHESIS

Six of 205 identified studies were included. Incidence rates of ACL injury were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance rates (incidence rate ratio = 0.27 [95% confidence interval = 0.07, 0.80]). Tertile analysis indicated rates of ACL injury incidence were lower in studies with high compliance rates than in studies with moderate and low compliance rates (incidence rate ratio = 0.18 [95% confidence interval = 0.02, 0.77]).

CONCLUSIONS

A potential inverse dose-response relationship exists between compliance with neuromuscular training and incidence of ACL injury. Attending and completing recommended neuromuscular sessions appears to be an important factor for preventing ACL injuries.

Preventive exercise in sports

Sports injuries are common and can result in significant problems, such as pain, social isolation, depression, disability (temporary or permanent), loss of income, or loss of scholarship. Further, sports injuries can predispose the athlete to future injury or degenerative disorders, for example, osteoarthritis. Therefore, a preventive approach is paramount, and exercise can be used as an effective tool to prevent sports-related injuries. This article describes the process by which successful injury prevention programs can be developed and implemented by using noncontact anterior cruciate ligament injury programs as an example. The knowledge gained from this information can be used in the future to assist in the creation of new injury prevention programs for other common sports injuries.

Alterations of Muscular Strength and Left and Right Limb Balance in Weightlifters after an 8-week Balance Training Program

[Purpose] Balance is generally defined as the ability to maintain the body's center of gravity within its base of support and may be categorized by either static or dynamic balance. The purpose of the present study was to evaluate the effect of 8 weeks of balance training on strength, and the functional balance ability of elite weightlifters. [Subjects] Thirty-two elite weightlifters were recruited for the present study. They were divided into exercise groups (8 high school students, 8 middle school students) and control groups (8 high school students, 8 middle school students). [Methods] Body compositions were measured by the electrical impedance method, and a Helmas system was used to measure basic physical capacities. The muscular function test was conducted using a Cybex 770. [Results] There were no significant changes in body composition after the training. In contrast, significant changes were found in the number of push-ups, one-leg standing time with eyes closed, and upper body back extension. Interestingly, only the left arm external rotation value after the exercise training program showed a statistically significant difference from the baseline value. [Conclusion] The peak torque values of shoulder internal rotation and knee extension were significantly changed compared to the baseline values, which mean subjects showed balance of their muscular power. Therefore, the results of the present study suggest that an 8-week balance-training program would positively affect elite weightlifters' balance ability and flexibility. We think that well-balanced muscular functionality may enhance athletes' sport performance.

Efficacy and degree of bias in knee injury prevention studies: a systematic review of RCTs

BACKGROUND

Knee injury prevention programs have been developed to address the epidemic of knee injuries in young athletes. These programs include exercises that focus on balance, proprioception, and neuromuscular control. Some studies have suggested such specialized exercise programs may reduce the risk of knee injury.

QUESTIONS/PURPOSES

We conducted a systematic review of randomized controlled trials (RCTs) of knee injury prevention programs and evaluated the risks of bias in these studies.

METHODS

We performed a systematic search using MEDLINE (from 1966), CINAHL (from 1982), Cochrane (CENTRAL), and EMBASE (from 1974) in April 2011. The searches were limited to RCTs. Two reviewers independently assessed the internal validity of the included studies using the van Tulder critical appraisal tool for RCTs. Authors were contacted when internal validity was unclear in the methodology. Ten Level I studies (RCTs) met the inclusion criteria. The average risk of bias score for these studies was 7 of 11 (range, 5-10).

RESULTS

Two of the 10 studies reported a reduction in knee injuries. Of the three studies that provided ACL injuries as an outcome measure, none showed a reduction in overall ACL injury.

CONCLUSIONS

Current evidence suggests most (eight of 10) well-designed RCTs show no difference of treatment benefit. Perhaps refinements of interventions may lead to a reduction in knee and ACL injuries in future trials. Limitations in the number and heterogeneity of currently published RCTs of injury prevention programs place restraints on quantifying intervention efficacy with a meta-analytic approach. Future research articles should more clearly describe the different elements of their methodology, consistent with the standards set forth by the CONSORT statement.

Prevention of ACL injury, part II: effects of ACL injury prevention programs on neuromuscular risk factors and injury rate

Prevention strategies have been developed based on existing knowledge in an attempt to alter neuromuscular control and lower extremity biomechanics in order to reduce anterior cruciate ligament (ACL) injury rates. These strategies have included different training programs ranging from injury education to multicomponent training. Many training programs have been demonstrated as resulting in altered lower extremity movement patterns. The effects of current training programs on ACL injury rate, however, are inconsistent. This review was focused on the effects of current ACL injury training programs on neuromuscular risk factors and ACL injury rate. Recommendations were made based on the available evidence for clinicians and coaches to implement ACL injury prevention programs.

Exercise program for prevention of groin pain in football players: a cluster-randomized trial

Groin injuries cause major problems in sports and particularly in football. Exercise is effective in treating adductor-related groin pain, but no trials have been published regarding the specific prevention of groin pain or prevention specifically targeting overuse injuries in sport using exercise programs. We performed a cluster-randomized trial including 55 football clubs representing 1211 players. The clubs were randomized to an exercise program aimed at preventing groin injuries (n=27) or to a control group training as usual (n=28). The intervention program consisted of six exercises including strengthening (concentric and eccentric), coordination, and core stability exercises for the muscles related to the pelvis. Physiotherapists assigned to each club registered all groin injuries. Twenty-two clubs in each group completed the study, represented by 977 players. There was no significant effect of the intervention (HR=0.69, 95% CI 0.40-1.19). The risk of a groin injury was reduced by 31%, but this reduction was not significant. A univariate analysis showed that having had a previous groin injury almost doubles the risk of developing a new groin injury and playing at a higher level almost triples the risk of developing a groin injury.

Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study

BACKGROUND

The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service.

METHODS

The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs.

RESULTS

In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04).

CONCLUSIONS

A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts. A similar programme could be useful for all young individuals by initiating a regular exercise routine.

TRIAL REGISTRATION

ClinicalTrials.gov identifier number NCT00595816.

Training affects knee kinematics and kinetics in cutting maneuvers in sport

PURPOSE

The current study examined how different training affects the kinematics and applied moments at the knee during sporting maneuvers and the potential to reduce loading of the anterior cruciate ligament (ACL). The training programs were 1) machine weights, 2) free weights, 3) balance training, and 4) machine weights + balance training.

METHODS

Fifty healthy male subjects were allocated either to a control group or to one of four 12-wk training programs. Subjects were tested before and after training, performing running and cutting maneuvers from which knee angle and applied knee moments were assessed. Data analyzed were peak applied flexion/extension, varus/valgus, and internal/external rotation moments, as well as knee flexion angles during specific phases of stance during the maneuvers.

RESULTS

The balance training group decreased their peak valgus and peak internal rotation moments during weight acceptance in all maneuvers. This group also lowered their flexion moments during the sidestep to 60 degrees . Free weights training induced increases in the internal rotation moment and decreases in knee flexion angle in the peak push-off phase of stance. Machine weights training elicited increases in the flexion moment and reduced peak valgus moments in weight acceptance. Machine weights + balance training resulted in no changes to the variables assessed.

CONCLUSIONS

Balance training produced reductions in peak valgus and internal rotation moments, which could lower ACL injury risk during sporting maneuvers. Strength training tended to increase the applied knee loading known to place strain on the ACL, with the free weights group also decreasing the amount of knee flexion. It is recommended that balance training be implemented because it may reduce the risk of ACL injury.

Integrated injury prevention program improves balance and vertical jump height in children

Implementing an injury prevention program to athletes under age 12 years may reduce injury rates. There is limited knowledge regarding whether these young athletes will be able to modify balance and performance measures after completing a traditional program that has been effective with older athletes or whether they require a specialized program for their age. The purpose of this study was to compare the effects of a pediatric program, which was designed specifically for young athletes, and a traditional program with no program in the ability to change balance and performance measures in youth athletes. We used a cluster-randomized controlled trial to evaluate the effects of the programs before and after a 9-week intervention period. Sixty-five youth soccer athletes (males: n = 37 mass = 34.16 +/- 5.36 kg, height = 143.07 +/- 6.27 cm, age = 10 +/- 1 yr; females: n = 28 mass = 33.82 +/- 5.37 kg, height = 141.02 +/- 6.59 cm) volunteered to participate and attended 2 testing sessions in a research laboratory. Teams were cluster-randomized to either a pediatric or traditional injury prevention program or a control group. Change scores for anterior-posterior and medial-lateral time-to-stabilization measures and maximum vertical jump height and power were calculated from pretest and post-test sessions. Contrary with our original hypotheses, the traditional program resulted in positive changes, whereas the pediatric program did not result in any improvements. Anterior-posterior time-to-stabilization decreased after the traditional program (mean change +/- SD = -0.92 +/- 0.49 s) compared with the control group (-0.49 +/- 0.59 s) (p = 0.003). The traditional program also increased vertical jump height (1.70 +/- 2.80 cm) compared with the control group (0.20 +/- 0.20 cm) (p = 0.04). There were no significant differences between control and pediatric programs. Youth athletes can improve balance ability and vertical jump height after completing an injury prevention program. Training specificity appears to affect improvements and should be considered with future program design.

Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews

BACKGROUND

The Military Training Task Force of the Defense Safety Oversight Council chartered a Joint Services Physical Training Injury Prevention Working Group to: (1) establish the evidence base for making recommendations to prevent injuries; (2) prioritize the recommendations for prevention programs and policies; and (3) substantiate the need for further research and evaluation on interventions and programs likely to reduce physical training-related injuries.

EVIDENCE ACQUISITION

A work group was formed to identify, evaluate, and assess the level of scientific evidence for various physical training-related injury prevention strategies through an expedited systematic review process. Of 40 physical training-related injury prevention strategies identified, education, leader support, and surveillance were determined to be essential elements of a successful injury prevention program and not independent interventions. As a result of the expedited systematic reviews, one more essential element (research) was added for a total of four. Six strategies were not reviewed. The remaining 31 interventions were categorized into three levels representing the strength of recommendation: (1) recommended; (2) not recommended; and (3) insufficient evidence to recommend or not recommend.

EVIDENCE SYNTHESIS

Education, leadership support, injury surveillance, and research were determined to be critical components of any successful injury prevention program. Six interventions (i.e., prevent overtraining, agility-like training, mouthguards, semirigid ankle braces, nutrient replacement, and synthetic socks) had strong enough evidence to become working group recommendations for implementation in the military services. Two interventions (i.e., back braces and pre-exercise administration of anti-inflammatory medication) were not recommended due to evidence of ineffectiveness or harm, 23 lacked sufficient scientific evidence to support recommendations for all military services at this time, and six were not evaluated.

CONCLUSIONS

Six interventions should be implemented in all four military services immediately to reduce physical training-related injuries. Two strategies should be discouraged by all leaders at all levels. Of particular note, 23 popular physical training-related injury prevention strategies need further scientific investigation, review, and group consensus before they can be recommended to the military services or similar civilian populations. The expedited systematic process of evaluating interventions enabled the working group to build consensus around those injury prevention strategies that had enough scientific evidence to support a recommendation.

Resistance training among young athletes: safety, efficacy and injury prevention effects

A literature review was employed to evaluate the current epidemiology of injury related to the safety and efficacy of youth resistance training. Several case study reports and retrospective questionnaires regarding resistance exercise and the competitive sports of weightlifting and powerlifting reveal that injuries have occurred in young lifters, although a majority can be classified as accidental. Lack of qualified instruction that underlies poor exercise technique and inappropriate training loads could explain, at least partly, some of the reported injuries. Current research indicates that resistance training can be a safe, effective and worthwhile activity for children and adolescents provided that qualified professionals supervise all training sessions and provide age-appropriate instruction on proper lifting procedures and safe training guidelines. Regular participation in a multifaceted resistance training programme that begins during the preseason and includes instruction on movement biomechanics may reduce the risk of sports-related injuries in young athletes. Strategies for enhancing the safety of youth resistance training are discussed.

Youth resistance training: updated position statement paper from the national strength and conditioning association

Faigenbaum, AD, Kraemer, WJ, Blimkie, CJR, Jeffreys, I, Micheli, LJ, Nitka, M, and Rowland, TW. Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. J Strength Cond Res 23(5): S60-S79, 2009-Current recommendations suggest that school-aged youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate and enjoyable and involves a variety of activities (). Not only is regular physical activity essential for normal growth and development, but also a physically active lifestyle during the pediatric years may help to reduce the risk of developing some chronic diseases later in life (). In addition to aerobic activities such as swimming and bicycling, research increasingly indicates that resistance training can offer unique benefits for children and adolescents when appropriately prescribed and supervised (). The qualified acceptance of youth resistance training by medical, fitness, and sport organizations is becoming universal ().Nowadays, comprehensive school-based programs are specifically designed to enhance health-related components of physical fitness, which include muscular strength (). In addition, the health club and sport conditioning industry is getting more involved in the youth fitness market. In the U.S.A., the number of health club members between the ages of 6 and 17 years continues to increase () and a growing number of private sport conditioning centers now cater to young athletes. Thus, as more children and adolescents resistance train in schools, health clubs, and sport training centers, it is imperative to determine safe, effective, and enjoyable practices by which resistance training can improve the health, fitness, and sports performance of younger populations.The National Strength and Conditioning Association (NSCA) recognizes and supports the premise that many of the benefits associated with adult resistance training programs are attainable by children and adolescents who follow age-specific resistance training guidelines. The NSCA published the first position statement paper on youth resistance training in 1985 () and revised this statement in 1996 (). The purpose of the present report is to update and clarify the 1996 recommendations on 4 major areas of importance. These topics include (a) the potential risks and concerns associated with youth resistance training, (b) the potential health and fitness benefits of youth resistance training, (c) the types and amount of resistance training needed by healthy children and adolescents, and (d) program design considerations for optimizing long-term training adaptations. The NSCA based this position statement paper on a comprehensive analysis of the pertinent scientific evidence regarding the anatomical, physiological, and psychosocial effects of youth resistance training. An expert panel of exercise scientists, physicians, and health/physical education teachers with clinical, practical, and research expertise regarding issues related to pediatric exercise science, sports medicine, and resistance training contributed to this statement. The NSCA Research Committee reviewed this report before the formal endorsement by the NSCA.For the purpose of this article, the term children refers to boys and girls who have not yet developed secondary sex characteristics (approximately up to the age of 11 years in girls and 13 years in boys; Tanner stages 1 and 2 of sexual maturation). This period of development is referred to as preadolescence. The term adolescence refers to a period between childhood and adulthood and includes girls aged 12-18 years and boys aged 14-18 years (Tanner stages 3 and 4 of sexual maturation). The terms youth and young athletes are broadly defined in this report to include both children and adolescents.By definition, the term resistance training refers to a specialized method of conditioning, which involves the progressive use of a wide range of resistive loads and a variety of training modalities designed to enhance health, fitness, and sports performance. Although the term resistance training, strength training, and weight training are sometimes used synonymously, the term resistance training encompasses a broader range of training modalities and a wider variety of training goals. The term weightlifting refers to a competitive sport that involves the performance of the snatch and clean and jerk lifts.This article builds on previous recommendations from the NSCA and should serve as the prevailing statement regarding youth resistance training. It is the current position of the NSCA that: