Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial

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.

Role of strengthening exercises in management and prevention of overuse sports injuries of lower extremity: a systematic review

INTRODUCTION

Overuse injuries are common in sports involving jumping, running, and landing, due to the repetitive nature of these activities and the strain they place on the lower extremity. The objective of the study was to determine the role of strengthening exercises in the management of overuse sports injuries of lower extremity and its effects on prevention of injury recurrence.

EVIDENCE ACQUISITION

This study employed a systematic review design. The author extracted and reviewed the papers for this study in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and then used the PEDro scale to rate the articles' quality. For the most recent and well-developed primary data, several electronic databases including Google Scholar, PubMed Central, MEDLINE, Cochrane Library, and PEDro were exhaustively searched. Inclusion criteria were based on PICO (T) model and included study population, intervention nature, outcome measures, time period, methodological quality, and linguistic extent.

EVIDENCE SYNTHESIS

The data synthesis involved analyzing randomized control/clinical trials on strengthening exercises for lower extremity overuse sports injuries in athletes, considering outcomes including muscle strength, pain scores, return to sports, and injury prevention.

CONCLUSIONS

The methodological quality of the recruited articles ranged from excellent to fair on PEDro scale. Three included studies investigated the effects of strengthening exercises on management of lower extremity injuries of athletes. Four studies evaluated its role on prevention from recurrence of injuries. This study has concluded that strength training plays a fundamental role in management and prevention of overuse injuries. It not only improves the muscle performance, fitness level, speed and agility in sports but also decreases the pain, and aids in early recovery from an injury.

Neuromuscular Training Effects on Athletes' Jumping and Lower Limb Injury: A Systematic Review

This study assessed the impact of integrated neuromuscular training (INT) on athletes' jumping performance and lower limb injury prevention. A thorough search across multiple databases, including PubMed, Web of Science, Science Direct, and the Cochrane Library, identified a sample of 19,805 athletes aged between 8.5 and 27.7 years. Results showed that INT led to a significant improvement in jumping ability (SMD = 0.45, 95% CI 0.30-0.60, P = 0.000) and a reduction in lower limb injuries (SMD = 0.68, 95% CI 0.62-0.74, P = 0.000). The most effective interventions lasted at least 25 minutes, conducted 2-5 times per week, for a minimum of 9 weeks. This approach was particularly beneficial for children and adolescents, as it enhanced their countermovement jump (CMJ) ability and helped in the prevention of injuries.

Muscle injury characteristics and incidence rates in men's amateur soccer: A one season prospective study

The objectives of the study were to examine the incident rate (IR), characteristics, and mechanisms of muscle injuries of 121 men amateur soccer players that voluntarily participated in this project. Sixty-five muscle injuries with an overall IR of 3.62/1000 h, 95% CI 2.7-4.5, were reported. The most frequently injured muscle groups were the hamstrings (IR 1.78/1000 h, 95% CI 1.1-2.3), followed by the adductors (IR 1.5/1000 h, 95% CI 0.93-2.06). Most muscle injuries were characterized as mild (IR 2.3/1000 h, 95% CI 1.53-2.92) or minimal (IR 1.28/1000 h, 95% CI 1.16-2.39. Higher incidence of injury sustained during matches (IR 14.09 injuries/1000 h, 95% CI 9.49-18.7), than in training (IR 1.88 injuries/1000 h, 95% CI 1.19-2.56). The most frequent injury mechanisms were high-speed running (84.4%) and change of direction (44.4%), for hamstring and adductors-related groin injuries, respectively. Players aged over 24 years had a 7-fold increased risk to sustain a hamstring injury but a lower risk to sustain an adductor-related groin injury. Injury prevention and rehabilitation management strategies may reduce muscle injury rates in amateur soccer.

The Effects of Exercise-Based Injury Prevention Programmes on Injury Risk in Adult Recreational Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

Injuries are common in adult recreational athletes. Exercise-based injury prevention programmes offer the potential to reduce the risk of injury and have been a popular research topic. Yet, syntheses and meta-analyses on the effects of exercise-based injury prevention programmes for adult recreational athletes are lacking.

OBJECTIVES

We aimed to synthesise and quantify the pooled intervention effects of exercise-based injury prevention programmes delivered to adults who participate in recreation sports.

METHODS

Studies were eligible for inclusion if they included adult recreational athletes (aged > 16 years), an exercise-based intervention and used a randomised controlled trial design. Exclusion criteria were studies without a control group, studies using a non-randomised design and studies including participants who were undertaking activity mandatory for their occupation. Eleven literature databases were searched from earliest record, up to 9 June, 2022. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias in all included studies. Reported risk statistics were synthesised in a random-effects meta-analysis to quantify pooled treatment effects and associated 95% confidence intervals and prediction intervals.

RESULTS

Sixteen studies met the criteria. Risk statistics were reported as risk ratios [RRs] (n = 12) or hazard ratios [HRs] (n = 4). Pooled estimates of RRs and HRs were 0.94 (95% confidence interval 0.80-1.09) and 0.65 (95% confidence interval 0.39-1.08), respectively. Prediction intervals were 0.80-1.09 and 0.16-2.70 for RR and HR, respectively. Heterogeneity was very low for RR studies, but high for HR studies (tau = 0.29, I2 = 81%). There was evidence of small study effects for RR studies, evidenced by funnel plot asymmetry and Egger's test for small study bias: - 0.99 (CI - 2.08 to 0.10, p = 0.07).

CONCLUSIONS

Pooled point estimates were suggestive of a reduced risk of injury in intervention groups. Nevertheless, these risk estimates were insufficiently precise, too heterogeneous and potentially compromised by small study effects to arrive at any robust conclusion. More large-scale studies are required to clarify whether exercise-based injury prevention programmes are effective in adult recreational athletes.

CLINICAL TRIAL REGISTRATION

The protocol for this review was prospectively registered in the PROSPERO database (CRD42021232697).

Effectiveness of a Preventative Program for Groin Pain Syndrome in Elite Youth Soccer Players: A Prospective, Randomized, Controlled, Single-Blind Study

Groin pain syndrome (GPS) is a prevalent issue in soccer. This study assessed the effectiveness of a new preventive protocol on GPS for youth soccer players. The protocol included targeted stretching and strengthening exercises for the adductor and core muscles from preseason to midseason. A questionnaire and two pain provocation tests were used for the evaluation. Mild GPS required positive results in at least two evaluations, while severe GPS was associated with pain incompatible with engagement in any activity confirmed by diagnostic ultrasound. Forty-two elite male athletes (aged 16.9 ± 0.7 years) participated in the study, with half of them assigned to the usual training (control group) and the remaining athletes undergoing the preventive protocol (treatment group) for 24 weeks. GPS rates were 14.3% (three diagnoses: two mild, one severe) in the treatment group and 28.6% (six diagnoses: three mild, three severe) in the control group. Toward the end of the season, three players, one from the treatment group and two from the control group had to stop playing due to severe GPS problems. In addition, one player in the control group stopped midseason. Even though the reduction in the risk of developing GPS was not significant (relative risk of 0.50 ([95%CI 0.14 to 1.74], p = 0.2759), the halved incidence of severe GPS and the increased muscle strength related to the treatment (p = 0.0277) are encouraging data for future studies.

Efficacy of Multi-Component Exercise-Based Injury Prevention Programs on Injury Risk Among Footballers of All Age Groups: A Systematic Review and Meta-analysis

BACKGROUND

Playing football is associated with a high risk of injury. Injury prevention is a priority as injuries not only negatively impact health but also potentially performance. Various multi-component exercise-based injury prevention programs for football players have been examined in studies.

OBJECTIVE

We aimed to investigate the efficacy of multi-component exercise-based injury prevention programs among footballers of all age groups in comparison to a control group.

METHODS

We conducted a systematic review and meta-analysis of randomized and cluster-randomized controlled trials. CINAHL, Cochrane, PubMed, Scopus, and Web of Science databases were searched from inception to June 2022. The following inclusion criteria were used for studies to determine their eligibility: they (1) include football (soccer) players; (2) investigate the preventive effect of multi-component exercise-based injury prevention programs in football; (3) contain original data from a randomized or cluster-randomized trial; and (4) investigate football injuries as the outcome. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. The outcome measures were the risk ratio (RR) between the intervention and the control group for the overall number of injuries and body region-specific, contact, and non-contact injuries sustained during the study period in training and match play.

RESULTS

Fifteen randomized and cluster-randomized controlled trials with 22,177 players, 5080 injuries, and 1,587,327 exposure hours fulfilled the inclusion criteria and reported the required outcome measures. The point estimate (RR) for the overall number of injuries was 0.71 (95% confidence interval [CI] 0.59-0.85; 95% prediction interval [PI] 0.38-1.32) with very low-quality evidence. The point estimate (RR) for lower limb injuries was 0.82 (95% CI 0.71-0.94; 95% PI 0.58-1.15) with moderate-quality evidence; for hip/groin injuries, the RR was 0.56 (95% CI 0.30-1.05; 95% PI 0.00-102.92) with low-quality evidence; for knee injuries, the RR was 0.69 (95% CI 0.52-0.90; 95% PI 0.31-1.50) with low-quality evidence; for ankle injuries, the RR was 0.73 (95% CI 0.55-0.96; 95% PI 0.36-1.46) with moderate-quality evidence; and for hamstring injuries, the RR was 0.83 (95% CI 0.50-1.37) with low-quality evidence. The point estimate (RR) for contact injuries was 0.70 (95% CI 0.56-0.88; 95% PI 0.40-1.24) with moderate-quality evidence, while for non-contact injuries, the RR was 0.78 (95% CI 0.55-1.10; 95% PI 0.25-2.47) with low-quality evidence.

CONCLUSIONS

This systematic review and meta-analysis indicated that the treatment effect associated with the use of multi-component exercise-based injury prevention programs in football is uncertain and inconclusive. In addition, the majority of the results are based on low-quality evidence. Therefore, future high-quality trials are needed to provide more reliable evidence.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42020221772.

Musculoskeletal pains among amateur and professional athletes of five disciplines in Senegal: a preliminary study

BACKGROUND

Musculoskeletal pains (MSPs) in sport are cause of poor performances and loss of competition in athletes. The present study aimed at determining the prevalence of MSPs with regard to sport disciplines and athletic status.

METHODS

A cross-sectional study was conducted among 320 Senegalese professional and amateur athletes practicing football, basketball, rugby, tennis, athletics, and wrestling. Rates of MSPs in the past year (MSPs-12) and week (MSPs-7d) were assessed using standard questionnaires.

RESULTS

Overall proportions of MSPs-12 and MSPs-7d were 70 and 74.2%, respectively. MSPs-12 were more frequently reported on shoulders (40.6%), neck (37.1%) and hips/thigh (34.4%), while MSPs-7d were predominant on hips/thigh (29.5%), shoulders (25.7%), and upper back (17.2%). Proportions of MSPs-12 and MSPs-7d varied significantly by sport disciplines, with highest values among basketball players. Again, highest MSPs-12 proportions on shoulders (29.7%, P = 0.02), wrists/hands (34.6%, P = 0.001), (40.2%, P = 0.0002), and knees (38.8%, P = 0.002) were seen among basketball players. High proportions of MSPs-7d were seen on shoulders (29.6%, P = 0.04) for tennis players, wrists/hands (29.4%, P = 0.03) for basketball and football players, and hips/thigh (38.8%, P < 0.00001) for basketball players. Football players had reduced risk of MSPs-12 by 75% on lower back (OR = 0.25; 95% CI. 0.10-0.63; P = 0.003) and by 72% on knees (OR = 0.28; 95% CI. 0.08-0. 95; P = 0.04). In contrast, tennis players were more at risk of MSPs-12 on shoulders (OR = 3.14; 95% CI. 1.14-8.68; P = 0.02), wrists/hands (OR = 5.18; 95% CI.1.40-11.13; P = 0.01), and hips/thigh (OR = 2.90; 95% CI. 1.1-8.38; P = 0.04). Professionals were protected from MSPs-12 on neck pain with a significant reduction of risk by 61% (OR = 0.39, 95% CI. 0.21-0.75, P = 0.03).

CONCLUSION

MSPs are a reality among athletes and their risk is modulated by sport disciplines, athletic status and gender.

[Groin pain in sports games: a systematic review]

BACKGROUND

In sports games, epidemiological data show that groin pain is relatively common and can lead to repeated loss of time. Consequently, it is essential to be aware of the evidence-based prevention strategies. The aim of this systematic review was to examine risk factors and prevention strategies for groin pain and to rank them based on their evidence in sports games.

METHODS

The review was conducted according to the PRISMA guidelines, using a PICO-scheme in the PubMed, Web of Science and SPOLIT databases. We included all available intervention and observational studies on the influence of risk factors and prevention strategies on groin pain in sports games. The methodological quality and level of evidence was assessed using the PEDro-Scale and OCEBM model, respectively. Finally, the quantity, quality and level of evidence was used to rank each risk factor for its grade.

RESULTS

Moderate evidence was found for four risk factors that significantly influence the risk of groin pain: male sex, previous groin pain, hip adductor strength and not participating in the FIFA 11+ Kids. Moreover, moderate evidence was found for the following non-significant risk factors: older age, body height and weight, higher BMI, body fat percentage, playing position, leg dominance, training exposure, reduced hip abduction, adduction, extension, flexion, and internal rotation-ROM, hip flexor strength, hip abductor, adductor, flexor and core strengthening with balance exercises, clinical hip mobility tests and physical capacities.

CONCLUSION

The identified risk factors can be considered when developing prevention strategies to reduce the risk of groin pain in sports games. Thereby, not only the significant, but also the non-significant risk factors should be considered for prioritisation.

Incidence and prevalence of hamstring injuries in field-based team sports: a systematic review and meta-analysis of 5952 injuries from over 7 million exposure hours

OBJECTIVE

This study aimed to systematically review and meta-analyse the incidence and prevalence of hamstring injuries in field-based team sports. A secondary aim was to determine the impact of other potential effect moderators (match vs training; sport; playing surface; cohort age, mass and stature; and year when data was collected) on the incidence of hamstring injury in field-based team sports.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

CINAHL, Cochrane Library, MEDLINE Complete (EBSCO), Embase, Web of Science and SPORTDiscus databases were searched from database inception to 5 August 2020.

ELIGIBILITY CRITERIA

Prospective cohort studies that assessed the incidence of hamstring injuries in field-based team sports.

METHOD

Following database search, article retrieval and title and abstract screening, articles were assessed for eligibility against predefined criteria then assessed for methodological quality using the Critical Appraisal Tool for prevalence studies. Meta-analysis was used to pool data across studies, with meta-regression used where possible.

RESULTS

Sixty-three articles were included in the meta-analysis, encompassing 5952 injuries and 7 262 168 hours of exposure across six field-based team sports (soccer, rugby union, field hockey, Gaelic football, hurling and Australian football). Hamstring injury incidence was 0.81 per 1000 hours, representing 10% of all injuries. Prevalence for a 9-month period was 13%, increasing 1.13-fold for every additional month of observation (p=0.004). Hamstring injury incidence increased 6.4% for every 1 year of increased average cohort age, was 9.4-fold higher in match compared with training scenarios (p=0.003) and was 1.5-fold higher on grass compared with artificial turf surfaces (p<0.001). Hamstring injury incidence was not significantly moderated by average cohort mass (p=0.542) or stature (p=0.593), was not significantly different between sports (p=0.150) and has not significantly changed over the last 30 years (p=0.269).

CONCLUSION

Hamstring injury represents 10% of all injuries in field-based team sports, with 13% of the athletes experiencing a hamstring injury over a 9-month period most commonly during matches. More work is needed to reduce the incidence of hamstring injury in field-based team sports.

PROSPERO REGISTRATION NUMBER

CRD42020200022.

Injury prevention programs including balance exercises with compliance and follow-up reduce the incidence of knee injuries in athletes: A systematic review and meta-analysis

BACKGROUND: The knee is one of the most common injuries in sports. However, the incidence of knee injuries can be decreased by enhancing balance and neuromuscular control. OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate how injury prevention programs (IPPs) that include balance training influence knee injury rates in athletes. METHODS: Data were obtained from different databases (1985–2021). Only randomised controlled trials that used IPPs that include balance training, were considered. Two investigators extracted data from the qualifying documents. The critical outcome data elements derived from the included studies were the number of ACL/knee injuries, ACL/knee injury rates, exposure hours, compliance rate, and follow-up duration. RESULTS: Compared to the control groups, those who participated in the IPP had a 54% lower risk of knee injuries per 1000 hours of exposure (IRR 0.457 (95% CI 0.346–0.603), P= 0.001) and a 60% lower risk of ACL injuries per 1000 hours of exposure (IRR 0.401 (95% CI 0.215–0.750), P= 0.004). CONCLUSIONS: IPPs that include balance training may reduce the risk of knee injuries.

Higher Adherence to Anterior Cruciate Ligament Injury Prevention Programs Is Associated With Lower Injury Rates: A Meta-Analysis and Meta-Regression

Background: Athletes who participate in sports that involve cutting and pivoting movements are particularly susceptible to anterior cruciate ligament (ACL) injury. Preventing this injury is the best way to combat its health consequences and costs. There may be a dose-response relationship between adherence and injury reduction. Purpose: We sought to examine whether athletes’ adherence to injury prevention programs (IPPs) is associated with reductions in ACL and lower extremity (LE) injuries. Methods: We conducted a systematic review of the PubMed, EMBASE, and Cochrane Library databases, searching for studies published between 2011 and 2021. Studies were included if they reported on the use of an ACL IPP compared with a control group and recorded the rate of injuries to calculate a rate ratio, as well as adherence to the program as a percentage of sessions performed. For the meta-analysis, the rate ratios were pooled using the DerSimonian-Laird random-effects model. Results: For the 15 studies included (11 randomized controlled trials and 4 cohort studies), the random-effects model grouped athletes’ adherence to an IPP as high (76% or more of the sessions), moderate (51%–75% of the sessions), and low (50% or fewer of the sessions). We found that athletes with the highest level of IPP adherence had a significantly lower incidence of ACL injury. The rate ratios for moderate and low adherence did not demonstrate a reduced incidence of ACL injury. Injury prevention program participation was also associated with a decrease in LE injury rates. Conclusion: This systematic review and meta-analysis found that athletes with high adherence to IPPs had reduced rates of ACL and LE injuries. Our findings suggest that educating coaches and athletes on the dose-dependent benefits of IPPs may promote the routine incorporation of these programs into warm-up sessions to decrease the risk of ACL and LE injuries.

Mechanistic evidence and exercise interventions: Causal claims, extrapolation, and implementation

RATIONALE

Exercise interventions and policies are widely prescribed in both sport and healthcare. Research investigating exercise interventions and policies is generally conducted using an Evidence-Based framework, placing an emphasis on evidence gathered from randomised controlled trials (RCTs).

AIMS AND OBJECTIVES

To explore the idea that, in addition to the assessment of evidence from RCTs when investigating exercise interventions, mechanistic studies ought to also be assessed and considered.

METHODS

This article assesses the rationale supporting the use of RCTs as evidence for exercise interventions, and the use of evidence of mechanisms in establishing efficacy, determining external validity, and tailoring interventions.

RESULTS AND CONCLUSIONS

The article argues that evidence from mechanistic studies ought to be considered alongside evidence from RCTs because: as RCTs investigating exercise interventions tend to be of low quality, mechanistic studies ought to be used to reinforce the evidence base; further, evidence from mechanistic studies is highly useful for both questions of extrapolation and implementation. This article argues for this on theoretical grounds, and also draws on a number of case studies.

A Meta-Analysis of Randomized Controlled Trials on the Effectiveness of Exercise Intervention in Preventing Sports Injuries

Athletes risk injury every day during practice sessions and actual games, with the majority of the affected population being young males. The Centers for Disease Control and Prevention 2011-2014 report on sport and recreation-related injuries in the United States has consistently shown the average annual estimate of the millions of dollars spent on sport and recreation injuries. These injuries translate to a significant financial implication for the athlete, the team, the health system, and the public health.

We composed a review protocol. We enumerated our inclusion and exclusion criteria, injury definition, and search strategy. We searched PubMed and SPORTDiscus. Then we used Forrest plots for the meta-analysis of the relevant selected studies. We used various keywords in our search strategy. These included “injury,” “sports,” “exercise,” “prevention,” “techniques,” and every possible combination of them. Search results showed 2516 hits with our keywords, and we included 20 of those results.

Twenty trials, including 19712 individuals with 2855 injuries, were analyzed. Eccentric Training relative risk (RR) of 0.54 (95% CI 0.395 to 0.739 with X² of p < 0.05) showed that the risk of the injury was decreased by 54% in the intervention group compared to the control group. In the neuromuscular training group, a RR of 0.682 (95% CI 0.621 to 0.749 with X² of p < 0.001) showed that the risk of the injury was decreased by 68.2% in its intervention group subgroup compared to its control group. Also, the “11” International Federation of Association Football (FIFA) program had a RR of 0.771, indicating that there was a 77.1% decrease in injury by this set of exercises (95% CI 0.728 to 0.816 with X² of p < 0.05), and this “11” FIFA program also had the most preventative effects. Warm-up had a RR of 0.843 (95% CI 0.749 to 0.949 with X² of p < 0.05) and showed small prevention. Strength Training RR of 0.97 (95% CI 0.57 to 1.63 with X² of p > 0.05) had no preventive effect.

Our analysis showed that different exercises have preventive roles in sports injuries. The warm-up FIFA, neuromuscular training, and eccentric training reduced the risk of injury in the intervention group compared to the control group by a high percentage. At the same time, neuromuscular warm-up and FIFA 11 dynamic warm-up also decreased the relative risk of injury in the intervention group. These effects varied among exercise type, injury type, and sport.

The effectiveness of injury prevention programs that include core stability exercises in reducing the incidence of knee injury among soccer players: A systematic review and meta-analysis

BACKGROUND: The knee is one of the most common sites of injuries among soccer players. The incidence of knee injuries can be reduced by improving the neuromuscular control and core stability. OBJECTIVE: This study aimed to evaluate the effectiveness of injury prevention programs that include core stability exercises in reducing the incidence of knee injuries among soccer players. METHODS: Data were obtained from different databases (1985–2021). Only randomized controlled trials that used injury prevention programs that include core stability exercise to prevent knee injuries were included. The keywords used during the search were ‘knee injuries’, ‘core stability exercises’, ‘FIFA 11+’, ‘prevention of knee injuries’, ‘anterior cruciate ligament injury’ and variations of these search terms. RESULTS: The pooled results of 7828 soccer players and 863700 exposure h showed an overall injury reduction of 56% per 1000 h of exposure in the intervention group compared to the control group with an injury risk ratio of 0.44 (95% CI 0.321–0.619; P= 0.001). CONCLUSIONS: Injury prevention programs that include core stability exercises reduce knee injury rates among soccer players by 56% (46% in male and 65% in female soccer players).

Incidence of Injury for Professional Soccer Players in the United States: A 6-Year Prospective Study of Major League Soccer

Background:

Despite an abundance of injury research focusing on European professional soccer athletes, there are limited injury data on professional soccer players in the United States.

Purpose:

To describe the epidemiology of injury across multiple years in Major League Soccer (MLS) players.

Study Design:

Descriptive epidemiology study.

Methods:

A web-based health management platform was used to prospectively collect injury data from all MLS teams between 2014 and 2019. An injury was defined as an incident that required medical attention and was recorded into the health management platform anytime over the course of the 2014-2019 seasons. Injuries and exposure data were recorded in training and match settings to calculate injury incidence.

Results:

A total of 9713 injuries were recorded between 2014 and 2019. A mean 1.1 injuries per year per player were identified, with midfielders sustaining the largest number of injuries. The most common injuries were hamstring strains (12.3%), ankle sprains (8.5%), and adductor strains (7.6%). The mean time missed per injury was 15.8 days, with 44.2% of injuries resulting in no days missed. Overall injury incidence was 8.7 per 1000 hours of exposure, declining over the course of the investigation, with a 4.1-times greater mean incidence during matches (14.0/1000 h) than training (3.4/1000 h).

Conclusion:

Between 2014 and 2019, the most commonly reported injuries in MLS players were hamstring strains, ankle sprains, and adductor strains. Injury incidence during matches was 4.1 times greater when compared with training, while overall injury incidence was found to decline during the course of the study period.

Physical exercises for preventing injuries among adult male football players: A systematic review

BACKGROUND

Football is the most practised sport in the world and is associated with the risk of injuries in the players. Some studies have been published that identify injury prevention programs, but there is no review of the full body of evidence on injury prevention programs for use by football coaches. The aim of this article was to carry out a systematic review of published studies on injury prevention programs for adult male footballers, identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies.

METHODS

PubMed and EMBASE databases were used to identify relevant published articles using the following keywords: "soccer" AND "injury" AND "prevention".

RESULTS

A total of 2512 studies were identified initially, but only 11 studies met the inclusion criteria, and their outcomes are presented. Results revealed that injury prevention programs in football have focused on strength training, proprioceptive training, multicomponent programs (balance, core stability, and functional strength and mobility), and warm-up programs.

CONCLUSION

Based on results from the studies analyzed, football players can lower the incidence of match and training injuries by participating in dynamic warm-up programs that include preventive exercises before games or during training sessions, and by adding strength, balance, and mobility training to the training sessions.

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.

The Effect of Exercise Compliance on Risk Reduction for Hamstring Strain Injury: A Systematic Review and Meta-Analyses

Eccentric strength training can reduce the risk of hamstring strain injury (HSI) occurrence; however, its implementation can be impacted by athlete compliance and prescription. The aim of this review was to investigate the effects of intervention compliance, consistency and modality, on the prevention of HSIs among athletes. A literature search was conducted. 868 studies were identified prior to the application of the exclusion criteria which resulted in 13 studies identified. Random effects models were used to produce log odds ratios and 95% confidence intervals. Very high (>75.1%), moderate-high (50.1-75%), low-moderate (25.1-50%) and very low (<25%) and <1-, 1.01-3.00-, >3.01-weeks/session were used as thresholds of compliance and consistency, respectively. Modality was also observed. A positive effect on HSI incidence -0.61 (-1.05 to -0.17), favoring the intervention treatments (Z = -2.70, p = 0.007). There were non-significant, large differences between compliance (p = 0.203, Z = -1.272) and consistency (p = 0.137, Z = -1.488), with increased compliance and consistency showing greater effectiveness. A significant difference between intervention modalities was observed (p < 0.001, Z = -4.136), with eccentric interventions being superiorly effective. Compliance of >50.1% and consistent application with <3 weeks/session having positive effects on HSI incidence. Training interventions that can achieve high levels of compliance, and can be consistently performed, should be the objective of future practice.

Injury prevention knowledge, beliefs, and practices among women's football teams in South Africa

Background

Numerous factors account for injury prevention or lack thereof in any team setting. With the increasing burden of injuries in women's football, and limited human resources accessible in sub-Saharan Africa, it is important to investigate the ways in which standardised injury prevention practices can be achieved.

Objectives

The study aimed to evaluate injury prevention knowledge, beliefs, and practices in women's football teams in the University Sport South Africa (USSA) Football League in Gauteng Province, South Africa.

Methods

A cross-sectional self-administered survey was conducted among women's football teams registered to participate in the USSA Football League in South Africa's Gauteng Province.

Results

A total of 107 respondents participated in the study, which included both players (n=98; 92%) and their support staff (n=9; 9%). The median (interquartile range) age of the participants was 22 (20-25) years. In the population sampled, 36% of the participants perceived that they had adequate knowledge of injury prevention practices in football, while others felt they had limited knowledge of the basic injury prevention programmes (IPPs). The results also indicated that the injury prevention practices of coaches (93%) and their beliefs in this regard (70%) are sufficient for achieving the basic injury prevention goals. Most of the respondents (89%) indicated that a medical support system is important in attaining the goals of injury prevention.

Conclusion

Members of women's teams in the USSA Football League have recognised limited knowledge about the basic IPPs, while they do employ some of the basic injury prevention practices in football. These practices could be influenced by the beliefs of the coaches and the players, and most of them believe that IPPs are important. It is essential as key stakeholders that coaches' and players' education and knowledge of injury prevention strategies should be considered as an integral part of the process to succeed. It should be strongly highlighted and implemented, thus augmenting the credibility, trust and compliance for IPPs in the sport.

Return to Play After a Hamstring Strain Injury: It is Time to Consider Natural Healing

Return to play (RTP) criteria after hamstring strain injuries (HSIs) help clinicians in deciding whether an athlete is ready to safely resume previous sport activities. Today, functional and sport-specific training tests are the gold standard in the decision-making process. These criteria lead to an average RTP time between 11 and 25 days after a grade 1 or 2 HSI. However, the high re-injury rates indicate a possible inadequacy of the current RTP criteria. A possible explanation for this could be the neglect of biological healing time. The present review shows that studies indicating time as a possible factor within the RTP-decision are very scarce. However, studies on biological muscle healing showed immature scar tissue and incomplete muscle healing at the average moment of RTP. Twenty-five percent of the re-injuries occur in the first week after RTP and at the exact same location as the index injury. This review supports the statement that functional recovery precedes the biological healing of the muscle. Based on basic science studies on biological muscle healing, we recommend a minimum period of 4 weeks before RTP after a grade 1 or 2 HSI. In conclusion, we advise a comprehensive RTP functional test battery with respect for the natural healing process. Before deciding RTP readiness, clinicians should reflect whether or not it is biologically possible for the injured tissue to have regained enough strength to withstand the sport-specific forces. In an attempt to reduce the detrimental injury-reinjury cycle, it is time to start considering (biological healing) time.

Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions

In recent years, an understanding has developed that sports injuries are the emergent outcomes of complex, dynamic systems. Thus, the influence of local contextual factors on injury outcomes is increasingly being acknowledged. These realisations place injury prevention research at a crossroads. Currently, injury prevention researchers develop universally applicable injury prevention solutions, but the adoption of these solutions in practice is low. This occurs because implementation contexts are both unique and dynamic in nature, and as a result singular, static solutions are often incompatible. In contrast, practitioners address injury prevention through iterative cycles of trial and error, aiming to optimise the injury prevention process within their own unique contexts. The purpose of this critical review is to draw attention to the misalignment between research and practice-based approaches to injury prevention. In light of this, we propose alternative research approaches that acknowledge the process-driven nature of injury prevention in practice. We propose that a core focus of sport injury prevention research should be to provide practitioners with useful and relevant information to support their decision making around their localised injury prevention practice. Through this approach, injury prevention research ceases to be about what works, and begins to engage with understanding what works in what contexts and why?

Injuries in functional fitness: an updated systematic review

INTRODUCTION

This study aimed to analyze injuries of functional fitness participants through a systematic review.

EVIDENCE ACQUISITION

A systematic search of the literature was conducted in CINAHL, EMBASE, PEDro, PubMed, SCOPUS, SPORTDiscus, and Web of Science, supplemented by searching in the grey literature, from 2017 to November 2020. This systematic review followed the PRISMA guidelines and was documented in the PROSPERO registry (CRD42020201259). Two reviewers independently extracted data including methodological (age, sex, time of practice, location, period, time frame, and completion rate) and injury (definition, diagnosis, prevalence, incidence, severity, mechanism, type, location, risk factors, and treatment) variables, as well as assessing study quality and risk of bias.

EVIDENCE SYNTHESIS

Twenty-six studies were included (10967, range 6-3049, participants). Injury was defined fairly differently across studies. The majority of studies used a retrospective study design and the main variables reported were prevalence, body location, and associated factors of injuries. The mean prevalence of musculoskeletal injuries was 32.8%, ranging from 2.4 to 60.6%, and the injury incidence per 1000 hours ranged from 0.21 to 67 36. The most affected body location in the studies was the shoulder, followed by lumbar spine, and knee. Muscle, joint, and ligament/tendon injuries were the most frequently reported. The majority of studies were of moderate methodological quality. All studies were considered as high risk of bias.

CONCLUSIONS

This review broadened the scope of 75 previous reviews on injuries in functional fitness. There have been few investigations regarding severity, mechanism, and treatment of injuries, so further research is warranted.

Incidence of Acute Hamstring Injuries in Soccer: A Systematic Review of 13 Studies Involving More Than 3800 Athletes With 2 Million Sport Exposure Hours

OBJECTIVE

To estimate the incidence and recurrence rates of acute hamstring injuries in all levels of soccer.

DESIGN

Epidemiology systematic review.

LITERATURE SEARCH

We searched the PubMed (including MEDLINE), CINAHL, SPORTDiscus, Embase, and Cochrane Central Register of Controlled Trials electronic databases.

STUDY SELECTION CRITERIA

We included prospective studies of all levels of adult soccer players that registered acute hamstring injuries and provided a description of incidence of acute hamstring injuries per 1000 playing hours (or available data to calculate this).

DATA SYNTHESIS

Due to heterogeneity, we synthesized the data descriptively.

RESULTS

Thirteen studies including 3868 players met the inclusion criteria. Two of 13 included studies reported on hamstring injuries in women, and all reported the same in men. The incidence of acute hamstring injury ranged from 0.3 to 0.5 per 1000 exposure hours in women and 0.3 to 1.9 per 1000 exposure hours in men. Hamstring injuries accounted for 5% to 15% of all soccer-related injuries. Hamstring injury recurrence rates ranged from 4% to 68%, depending on the injury definition. Certainty of evidence ranged from moderate to very low.

CONCLUSION

The incidence of acute hamstring injury in soccer was 0.3 to 1.9 per 1000 exposure hours. The recurrence rate was 4% to 68%. The strength of the evidence was limited by a lack of methodological rigor, the use of varying definitions for acute hamstring injury, and heterogeneous methods of reporting on acute hamstring injuries. J Orthop Sports Phys Ther 2021;51(1):27-36. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9305.

Value of isokinetic strength testing for hamstring injury risk assessment: Should the 'strongest' mates stay ashore?

Although isokinetic strength testing is commonly used in hamstring strain injury (HSI) rehabilitation and prevention, research findings concerning its predictive value remain inconclusive. Existing research focuses on peak torque (PT) and angle of PT, not analysing the torque behaviour throughout the testing range of motion (ROM). This study intended to assess the value of isokinetic curve evaluation in association with HSI. A sample of 116 male football players with and without a recent HSI history was submitted to bilateral isokinetic assessment of the knee and hip muscles. Raw isokinetic data were filtered and normalized prior to curve analysis submission in MATLAB. Torque development of each muscle group throughout the entire testing ROM was assessed using HSI history as an independent variable. Curve analysis revealed significant differences in torque behaviour in function of injury history. Players with an HSI history demonstrated significantly stronger concentric knee flexion and extension, eccentric knee extension and concentric hip extension patterns compared to the controls and their uninjured limb. HSI history was also associated with lower concentric hip flexion torques and lower mixed H:Q ratios compared to the control group and their contralateral limb. HSI history was associated with altered knee and hip muscle strength profiles, potentially due to isolated focus on local strength training in rehabilitation or mechanisms of neuromuscular inhibition. Because the differences in torque amplitude were range-dependent and did not systematically concur with the point of PT achievement, isokinetic strength evaluation should most probably be conducted using curve analysis.

Effects of pelvic and core strength training on biomechanical risk factors for anterior cruciate ligament injuries

BACKGROUND

Little is known about the changes in biomechanical risk factors for an anterior cruciate ligament (ACL) injury after participation in a pelvic and core strength training (PCST) program in female team players.

METHODS

This is a randomized controlled trial for which a total of 29 female soccer players were recruited from a soccer club and split into two groups, namely, experimental group (EG, N.=18; mean [SD] age, 17.8 [2.0 years], weight 64.0 [6.6] kg and height 1.7 [0.0] m) and control group (control, N.=11; mean [SD] age, 16.2 [1.2] years, weight 61.6 [7.3] kg and height 1.7 [0.0] m). The EG participated in an in-season 8-week PCST program (twice/week). Participants in the CG performed their normal training without additional pelvic and core strengthening. Pre- and postintervention knee frontal plane projection angle (FPPA), hip, knee and ankle peak flexion angles and jump height were collected during bilateral and unilateral drop jumps.

RESULTS

PCST significantly reduced FPPA at dynamic landing, in both dominant (-7.1º) and non-dominant lower extremities (-8º). Further, this training significantly increased the peak hip (24.4º) and knee flexion angles (14.94º), but not the peak ankle dorsiflexion angle (P>0.05) which, significantly decreased in the CG (-3.5º). Following the intervention, EG significantly increased measures obtained for both bilateral (2.84 cm) and unilateral jumps (1.33 cm for the dominant leg and 1.22 cm for the non-dominant leg) (P<0.05), not so for CG (P<0.05).

CONCLUSIONS

PCST resulted in improvements on ACL injury risk factors and vertical drop jump performance, suggesting that strengthening this body part warrants not only injury prevention, but increases jumping performance.

Pronounced Heterotopic Ossifications after Traumatic Hamstring Rupture: Is an Ossification Prophylaxis Useful?

Hamstring injuries include a wide range of injuries and affect mainly athletes with high eccentric loads (football, athletics, rugby, climbing). According to the latest literature, unrecognized traumatic ruptures can cause permanent discomfort and may be associated with a poorer postoperative outcome when delayed surgical therapy is performed. Heterotopic ossifications (HO) after hamstring rupture have been described in individual case reports and smaller studies so far. Heterotopic ossifications are mainly known in hip surgery and elbow fractures. In this case report, a 48-year-old patient presented with an increasing swelling with hardening in the area of the right ischial tuberosity. One year before, an impact trauma was the reason for a traumatic hamstring rupture which was diagnosed with a delay. The HO was excised and the tendon refixed with two suture anchors. By limiting the range of motion with a hip-knee orthosis for 9 weeks, a regular postoperative healing process was observed. Heterotopic ossifications after hamstring ruptures have been reported repeatedly but have not been evaluated in any major study so far. It should therefore be considered whether prophylaxis with NSAIDs should be used for conservatively and surgically treated hamstring ruptures, analogous to the ossification prophylaxis for hip endoprostheses or fractures in the elbow region.

Risk Factors in Elite, Adolescent Male Soccer Players: Prospective Study

Purpose. To find risk factors for soccer-related musculoskeletal injuries among elite, adolescent male soccer players. Methods. Prior to the season, various physical, clinical, and functional measurements were taken. One season was used as an injury surveillance period. Then, after the season, measures of potential risk factors were compared between (1) those players who sustained musculoskeletal injuries and (2) those who remained injury free. Results. Among 61 players, 37.7% (23/61) sustained soccer-related musculoskeletal injuries. After adjusting for covariates in a logistic regression model, presence of previous hip and low back injury (adjusted odds ratio [aOR] = 8.93, P = .046) and Functional Movement Screen (FMS) scores (aOR = 1.92, P = .022) were independently associated with musculoskeletal injures. Conclusion. Elite, adolescent male soccer players with a history of hip and back injury are at greater risk of sustaining a soccer-related musculoskeletal injury. In addition, our study indicated greater risk of sustaining a future soccer-related injury as FMS scores increase.

Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport - grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

Functional assessment of women practising combat sports and team sports using the Functional Movement Screen

Study aim: The objective of the study was to reveal the functional limits of the motor system in women practising combat sports and team sports.

Material and methods: 102 women (mean age 25.2 years, body mass 62.2 kg, body height 168.3 cm) practising competitive ITF (International Taekwon-Do Federation) taekwon-do (n = 22), Brazilian jiu-jitsu (BJJ) (n = 15), football (n = 35) and basketball (n = 30) participated in the study. The assessment tool was the FMS test, comprising 7 movement patterns scored on a scale of 0–3.

Results: The studied female athletes earned medium scores. Women practising combat sports scored generally higher in the FMS test, although the difference was not significant (combat sports – mean value 15.57 ± 2.39, team sports – mean value 14.72 ± 1.93, difference – p = 0.07). Statistically significant differences (p < 0.05) were observed in the second (hurdle step) and the fifth pattern (active straight leg raise – ASLR). The aggregated FMS results of female taekwon-do (15.77) and BJJ athletes (15.22) were similar. Significant differences (p < 0.05) were observed in one pattern (ASLR). Women practising football (14.77) and basketball (14.67) attained a similar level of results in the test. Statistically significant differences were noted in two trials: footballers scored higher in the ASLR task (p < 0.05), and basketball players scored higher in rotary stability (p < 0.01).

Conclusion: A statistically significant result in the FMS test was obtained by martial arts athletes, which may point to a higher level of functional movement, which may be a result of more universal training.

Injury Prevention in Amateur Soccer: A Nation-Wide Study on Implementation and Associations with Injury Incidence

Prevention programmes can reduce injury risk in amateur soccer. Hence, we examined the implementation of injury prevention in the real-world context of Swiss amateur soccer. In 2004 (n = 1029), 2008 (n = 705) and 2015 (n = 1008), a representative sample of Swiss amateur soccer coaches was interviewed by telephone about the frequency of injuries in their teams, the implementation of preventive measures and the use of injury prevention programmes. In the 2015 survey, 86.1% of amateur coaches stated that injury prevention is important and 85.3% of amateur coaches reported that they would implement some kind of preventive measures. The proportion of teams which performed a prevention programme according to minimal standards remained unchanged between 2008 (21.7%) and 2015 (21.9%), although a second prevention programme was made available in 2011. Only 8.6% of the 30+/40+ league teams, which are composed as a function of age, implemented a programme. Overall, the level of implementation of prevention programmes in this real-world context is still unsatisfactory. Offering an additional programme did not lead to a higher willingness to implement such programmes among the coaches. Concerted efforts are needed to remove barriers that hinder the use of such programmes, particularly among coaches of 30+/40+ league teams.

Does a bounding exercise program prevent hamstring injuries in adult male soccer players? - A cluster-RCT

Background

Although the Nordic Hamstring Exercise (NHE) prevents hamstring injury in soccer players effectively, the annual incidence of these injuries still increases. This may be because of poor long‐term compliance with the program. Furthermore, the timing and amplitude of gluteal and core muscle activation seem to play an important role in hamstring injury prevention, the NHE program was not designed to improve activation of these muscles. Therefore, we propose plyometric training as an alternative to reduce hamstring injuries in soccer players.

Purpose

To determine the preventive effect of the Bounding Exercise Program (BEP) on hamstring injury incidence and severity in adult male amateur soccer players.

Study design

A cluster‐Randomized Controlled Trial.

Methods

Thirty‐two soccer teams competing in the first‐class amateur league were cluster‐randomized into the intervention or control group. Both groups were instructed to perform their regular training program, and the intervention group additionally performed BEP. Information about player characteristics was gathered at baseline and exposure, hamstring injuries and BEP compliance were weekly registered during one season (2016‐2017).

Results

The data of 400 players were analyzed. In total, 57 players sustained 65 hamstring injuries. The injury incidence was 1.12/1000 hours in the intervention group and 1.39/1000 hours in the control group. There were no statistically significant differences in hamstring injury incidence (OR = 0.89, 95% CI 0.46‐1.75) or severity between the groups (P > 0.48).

Conclusion

In this large cluster‐randomized controlled trial, no evidence was found for plyometric training in its current form to reduce hamstring injuries in amateur soccer players.

Specific interventions for prevention of muscle injury in lower limbs: systematic review and meta-analysis

Abstract Introduction: Muscle injuries show an incidence associated with extreme stretching, or even a high-intensity eccentric contraction. Such injuries cause severe damage to athletes, including lower performance, withdrawal, and psychological distress. In this scenario, the study of effective preventive methods is an indispensable factor in the routine of professional athletes, to reduce the incidence of injuries. Objective: To verify the effectiveness of three different interventions (warm-up, neuromuscular training, and eccentric exercise) to prevent muscle injuries in the lower limbs. Method: We searched the Cochrane Library, EMBASE, SPORTDiscus, PEDro, and PubMed databases from the earliest records until January 20, 2018. The search was performed from word combinations such as clinical trial, muscle strain, injury prevention. The data related to the outcome of prevention were grouped in meta-analysis and described in Risk Ratio (RR) with 95% confidence interval. Results: Sixteen studies were included: five assessed eccentric exercise, three investigated neuromuscular training, and eight observed warm-up. The eccentric exercise (RR = 3.49, 95% CI 2.36, 5.16, p < 0.00001) and the neuromuscular training (RR = 2.73, 95% CI 2.03, 2.68, p < 0.00001) showed significant effects on the prevention of muscle injuries in lower limbs. On the other hand, warm-up (RR = 1.57, 95% CI 0.92, 2.7, p = 0.10) was irrelevant in reducing the incidence of injuries in the body segment investigated. Conclusion: The outcomes presented provide clinical relevance inherent in the field practices, with intrinsic potential for practical application in the management of specific preventive techniques.

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.

General versus sports-specific injury prevention programs in athletes: A systematic review on the effect on injury rates

Introduction

Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes.

Methods

PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools.

Results

Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed.

Conclusion

The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.

Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention

The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on the exercise-based prevention of knee injuries. J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303.

Prevalence of musculoskeletal injuries and a proposal for neuromuscular training to prevent lower limb injuries in Brazilian Army soldiers: an observational study

BACKGROUND

The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.

METHODS

This observational (cross-sectional) study recruited a sample of 103 soldiers who required medical attention, from a total 202 new battalion soldiers. The medical records (paper and online) had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury, and recurring injury.

RESULTS

A total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for 1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.

CONCLUSION

This study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.

Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis

BACKGROUND

Hamstring injuries are among the most common non-contact injuries in sports. The Nordic hamstring (NH) exercise has been shown to decrease risk by increasing eccentric hamstring strength.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the injury prevention programs that included the NH exercise on reducing hamstring injury rates while factoring in athlete workload.

METHODS

Two researchers independently searched for eligible studies using the following databases: the Cochrane Central Register of Controlled Trials via OvidSP, AMED (Allied and Complementary Medicine) via OvidSP, EMBASE, PubMed, MEDLINE, SPORTDiscus, Web of Science, CINAHL and AusSportMed, from inception to December 2015. The keyword domains used during the search were Nordic, hamstring, injury prevention programs, sports and variations of these keywords. The initial search resulted in 3242 articles which were filtered to five articles that met the inclusion criteria. The main inclusion criteria were randomized controlled trials or interventional studies on use of an injury prevention program that included the NH exercise while the primary outcome was hamstring injury rate. Extracted data were subjected to meta-analysis using a random effects model.

RESULTS

The pooled results based on total injuries per 1000 h of exposure showed that programs that included the NH exercise had a statistically significant reduction in hamstring injury risk ratio [IRR] of 0.490 (95 % confidence interval [CI] 0.291-0.827, p = 0.008). Teams using injury prevention programs that included the NH exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures.

CONCLUSIONS

This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42015019912).

The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial

Background

Groin injuries represent a considerable problem in male football. Previous groin-specific prevention programmes have not shown a significant reduction in groin injury rates. An exercise programme using the Copenhagen Adduction exercise increases hip adduction strength, a key risk factor for groin injuries. However, its preventive effect is yet to be tested.

Aim

To evaluate the effect of a single-exercise approach, based on the Copenhagen Adduction exercise, on the prevalence of groin problems in male football players.

Methods

35 semiprofessional Norwegian football teams were cluster-randomised into an intervention group (18 teams, 339 players) and a control group (17 teams, 313 players). The intervention group performed an Adductor Strengthening Programme using one exercise, with three progression levels, three times per week during the preseason (6–8 weeks), and once per week during the competitive season (28 weeks). The control group were instructed to train as normal. The prevalence of groin problems was measured weekly in both groups during the competitive season using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire.

Results

The average prevalence of groin problems during the season was 13.5% (95% CI 12.3% to 14.7%) in the intervention group and 21.3% (95% CI 20.0% to 22.6%) in the control group. The risk of reporting groin problems was 41% lower in the intervention group (OR 0.59, 95% CI 0.40 to 0.86, p=0.008).

Conclusion

The simple Adductor Strengthening Programme substantially reduced the self-reported prevalence and risk of groin problems in male football players.

Trial registration number

ISRCTN98514933.

Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel

OBJECTIVES

To update the current injury prevention strategy evidence base for making recommendations to prevent physical training-related musculoskeletal injury.

DESIGN

We conducted a systematic review to update the evidence base on injury prevention strategies for military personnel.

METHODS

Literature was systematically searched and extracted from five databases, and reported according to PRISMA guidelines. Sixty one articles meeting the inclusion criteria and published during the period 2008-2015 were selected for systematic review.

RESULTS

The retrieved articles were broadly categorised into six injury prevention strategies; (1) conditioning, (2) footwear modifications, (3) bracing, (4) physical activity volume, (5) physical fitness, and (6) leadership/supervision/awareness. The majority of retrieved articles (n=37 (of 61) evaluated or systematically reviewed a conditioning intervention of some nature. However, the most well-supported strategies were related to reducing physical activity volume and improving leadership/supervision/awareness of injuries and injury prevention efforts.

CONCLUSIONS

Several injury prevention strategies effectively reduce musculoskeletal injury rates in both sexes, and many show promise for utility with military personnel. However, further evaluation, ideally with prospective randomised trials, is required to establish the most effective injury prevention strategies, and to understand any sex-specific differences in the response to these strategies.

Osteoarthritis action alliance consensus opinion - best practice features of anterior cruciate ligament and lower limb injury prevention programs

AIM

To identify best practice features of an anterior cruciate ligament (ACL) and lower limb injury prevention programs (IPPs) to reduce osteoarthritis (OA).

METHODS

This consensus statement started with us performing a systematic literature search for all relevant articles from 1960 through January 2017 in PubMed, Web of Science and CINAHL. The search strategy combined the Medical Subject Heading (MeSH) and keywords for terms: (1) ACL OR “knee injury” OR “anterior cruciate ligament”; (2) “prevention and control” OR “risk reduction” OR “injury prevention” OR “neuromuscular training”; and (3) meta-analysis OR “systematic review” OR “cohort study” OR randomized. We found 166 different titles. The abstracts were reviewed for pertinent papers. The papers were reviewed by at least two authors and consensus of best practice for IPP to prevent OA was obtained by conference calls and e-mail discussions. All authors participated in the discussion.

RESULTS

The best practice features of an IPP have the following six components: (1) lower extremity and core strengthening; (2) plyometrics; (3) continual feedback to athletes regarding proper technique; (4) sufficient dosage; (5) minimal-to-no additional equipment; and (6) balance training to help prevent injuries. Exercises focused on preventing ankle sprains, hamstring injuries and lateral trunk movements are important. Plyometric exercises should focus on correcting knee valgus movement. Exercises should focus on optimizing the hamstring to quadriceps strength ratio. In order for IPP to be successful, there should be increased education and verbal feedback along with increased athletic compliance. Additional equipment is not necessary. Balance training alone does not significantly reduce injuries, but is beneficial with other exercises. Not enough evidence to recommend stretching and agility exercises, with no ill effects identified. Therefore, we suggest making these optional features.

CONCLUSION

Best practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.

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.