Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players

Effect of Foot Position on Ankle Muscle Activity During Wobble Board Training in Individuals With Chronic Ankle Instability

OBJECTIVE

The purpose of this study was to compare the effects of foot positioning on muscle activities of the peroneus longus (PL), medial gastrocnemius (MG), and tibialis anterior (TA)/PL ratio in individuals with chronic ankle instabilities (CAI) during wobble board training.

METHODS

Thirty individuals with CAI were included, and statistical significance of PL and MG muscle activities was determined using 1-way repeated measures analysis of variance alongside TA/PL activity ratio at the university research laboratory. The participants performed the wobble board training in 3 different foot positions: medial from the centerline of the wobble board (WBT-M), middle from the centerline of the wobble board, and lateral from the centerline of the wobble board (WBT-L). Peroneus longus, MG, and TA muscle activities were measured using surface electromyography.

RESULTS

Peroneus longus activity was significantly higher in the WBT-L position than in the other 2 positions, and it was significantly higher in the middle from the centerline of the wobble board than in the WBT-M position. Medial gastrocnemius activity was significantly greater in the WBT-L position than in the other 2 positions. Tibialis anterior/PL ratio was higher in the WBT-M position than in the other 2 positions.

CONCLUSION

The findings of this study showed that WBT-L increased PL muscle activity by >70% of the maximal voluntary isometric contraction without increasing TA/PL ratio in individuals with CAI.

Exploring Injury Prevention Strategies for Futsal Players: A Systematic Review

Futsal carries a high risk of injury for players. This systematic review aimed to assess the existing literature on injury prevention strategies for futsal players. The literature was searched using PubMed, Web of Science, and Scopus databases from inception to 20 March 2024. Relevant articles were searched using the terms "futsal" AND "injury" AND "prevention". Fourteen studies were included in the review. The review identified several injury prevention strategies with potential benefits for futsal players. Structured warm-up routines were shown to improve balance and eccentric strength and to reduce total, acute, and lower limb injuries. Proprioceptive training methods were suggested to improve joint stability and landing mechanics, which may reduce the risk of injury. Furthermore, multicomponent methods that include components such as core stability and flexibility have shown potential for reducing injury rates in futsal players. Finally, by reducing fatigue and improving movement control, strength training procedures designed to correct muscular imbalances may improve performance, which may ultimately minimize the risk of injury. This systematic review demonstrates the potential benefits of different injury prevention strategies for futsal players. The combination of several strategies, such as proprioceptive training, multicomponent programs, warm-up routines, and strength training specifically designed to address muscular imbalances, appears promising.

Proprioceptive training methods (PTM) in female soccer players - a systematic review

BACKGROUND

Although previous studies have reported that proprioceptive training methods (PTM) have positive effects, there is a relatively small number of studies regarding the impact of PTM in women's soccer. Therefore, there is a need to systematize the given results. In this regard, this systematic review aimed to investigate the effect of proprioceptive training methods in female soccer players.

METHODS

The studies' search and analysis were done according to the PRISMA guidelines. The following databases were checked (Google Scholar, PubMed Cochrane and ProQuest), with additional publication time criteria (2000-2023) using the following keywords: proprioceptive, balance, neuromuscular, training, exercise, intervention, method, activity, female football players, female soccer players, woman soccer players.

RESULTS

A total of 7 studies were included in the quantitative synthesis that meet all the criteria with the number of participants being 2.247. Based on the analysis of the previous research and detailed discussion, the main findings of the study resulted in the partial improvement of explosive strength (66%), strength (50%), muscle imbalance and flexibility (50%) and the prevention and reduction of lower extremity injuries in female soccer players (60%). Only one study reported no significant differences between groups, where rate of major injuries was higher in experimental group.

CONCLUSION

The obtained results indicate the necessity to implement proprioceptive training in female soccer training programs, in order to influence the prevention and reduction of injuries and improve balance, proprioceptive ability and body control.

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).

Electronic Method (Pro-Kin) for Improving and Speeding Up the Recovery After Ankle Sprain

BACKGROUND AND OBJECTIVE

Ankle sprains, very common injuries occurred especially during sports activities, are mainly caused by indirect trauma, which influences exaggerated stress exceeding the strength of stabilization mechanisms. Up to 85% of such injuries result from a sudden flexion and inversion of the foot. In this study, we analyzed the effectiveness of the platform Pro-kin, an innovative system that has given us the possibility to combine the functionality of the older proprioceptive boards with very accurate software in order to improve and accelerate the recovery after ankle injuries.

METHODS

30 patients with moderate ankle sprain outcomes in two groups (A and B) were included in this study. Group A was only treated with proprioceptive exercises for 3 weeks, while the group B was trained with the innovative Pro-kin. In both groups, we evaluated VAS scale, the ratio between the number of circumductions performed by the injured foot and the time spent on doing them and the percentage of load among the injured and the healthy foot in statics and dynamics with electronic baropodometry. Our data has been collected at t0 (beginning of study), t1 (one week later), t2 (two weeks later), t3 (one month later), t4 (two months later), and then analyzed by the two-way analysis of variance (2-way ANOVA) test.

RESULTS

At t0 no statistical differences of pain in the 2 groups (3.3 and 3.4); the values were similar, as well as at time t1, t2, t3 and t4. Therefore we deduce that Pro-kin treatment is not painful. The number of circumductions performed was definitely better in B group since the first week; for the A group the values considerably increased only at t3 (one month later). Comparing the load percentages on two feet detected by the electronic baropodometer in statics and in dynamics, we deduced that the patients of A group tend to lean mostly on the healthy foot than B group.

CONCLUSION

This study demonstrates that new technological resources (such as Pro-kin) may be helpful to improve and speed up the recovery of ankle sprain in athletes.

The impact of a multicomponent training program on physical fitness and joint injuries in Spanish male professional soccer players

This study aimed to assess the effects of a multicomponent training program (ProSAS) on selected measures of physical fitness and joint injuries in Spanish male professional soccer players. Twenty-six professional soccer players (age: 25.2 ± 3.1 years) were randomly assigned to either the experimental (EG; n = 16) or control group (CG; n = 10). Y-balance test (YBT), Single leg countermovement jump (SLCMJ), Single leg hop for distance test (SLH), Side-hop test (SH), Speedy jump test (SpJ), Agility T-test (TT) and Lower extremity functional test (LEFT) were performed before and after an 8-weeks training period. Additionally, any joint injury occurring during the intervention period were recorded. Significant improvements in the EG in all tests (p = 0.001 to p = 0.014), except for SLCMJ (p = 0.632) with the dominant leg were observed. CG displayed decreases in SLCMJ with the non-dominant leg (p = 0.014), SH for both legs (p = 0.001 to p = 0.050), TT (p = 0.005), and LEFT (p = 0.001). Inter-groups differences revealed better results for the EG in all variables (p = 0.001 to p = 0.008) except from SLCMJd (p = 0.555). Moreover, the EG exhibited lower joint injury incidence and burden compared to the CG (p < 0.05). These findings suggest that the ProSAS is an effective multicomponent program to improve variables related to risk of joint injuries, and consequently, to reduce the incidence and burden of these injuries in professional soccer players.

How robust are clinical trials in primary and secondary ankle sprain prevention?

OBJECTIVES

Determine the statistical stability of RCTs examining primary and secondary prevention of ankle sprains.

METHODS

Databases were searched to August 2023. We included parallel design RCTs, using conservative interventions for preventing ankle sprain, reporting dichotomous injury event outcomes. Statistical stability was quantified using Fragility Index (FI) and Fragility Quotient (FQ). Subgroup analyses were undertaken to test if FI varied based on by study objective, original approach to analysis (frequency vs time to event), follow-up duration, and pre-registration.

RESULTS

3559 studies were screened with 45 RCTs included. The median number of events required to change the statistical significance (FI) was 4 (IQR 1-6). FI was similar regardless of study objective, original analysis, follow-up duration, and pre-registration status. Median (IQR) FQ was 0.015 (0.005-0.046), therefore reversing events <2 patients/100 would alter significance. In 80% of studies the number of patients lost to follow-up was greater than the FI.

CONCLUSION

RCTs informing primary and secondary prevention of ankle sprain are fragile. Only a small percentage of outcome event reversals would reverse study significance, and this is often exceeded by the number of drop outs. Robust reporting of dichotomous outcomes requires the use P values and key metrics such as FI or FQ.

Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of preventive interventions for lateral ankle sprain in the general population.

DATA SOURCES

A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022.

REVIEW METHODS

Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies.

RESULTS

Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss.

CONCLUSION

Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.

Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

OBJECTIVES

1) determine the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients with an acute ankle sprain; 2) Determine whether prescribed exercises incorporate complex tasks associated with ankle sprain injury mechanisms?

METHODS

We searched databases CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar for RCT's including patients with acute ankle sprains, managed through exercise-based rehabilitation. Risk of bias was assessed by the Risk of Bias 2 tool. Exercises were analysed based on: the primary impairment(s) addressed; direction of movement; base of support; weightbearing status; flight phase. (PROSPERO: CRD42020210858) RESULTS: We included fourteen RCT's comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises incorporated a flight phase.

CONCLUSIONS

Rehabilitation after LAS comprises simple exercises in the sagittal plane that do not reflect mechanisms of re-injury. Future interventions should incorporate more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.

Kinesio taping for ankle sprain in youth athlete: A protocol for systematic review and meta-analysis

BACKGROUND

Ankle sprain is considered a major problem that may hinder youth athletes' athletic development because it will lead to ongoing dysfunction, reoccurrence of ankle sprain, chronic ankle instability, and posttraumatic osteoarthritis. Kinesio taping (KT) is a therapeutic taping technique that has been widely used in the treatment of various ankle issues including sprained ankles and in the prevention of ankle sprains. It can not only provide the injured ankle with support during the rehabilitation phase, but also enhance the ankle stability during activity. However, the available evidence regarding its effectiveness in the treatment and prevention of ankle sprain is inconsistent. Therefore, a systematic review will help clinicians and coaches better understand the application of KT in clinical and training practices. This study is to systematically review the literature on the use of KT to improve outcomes including ankle function, proprioception, and pain and to evaluate the effectiveness of KT in the treatment and prevention of ankle sprain injuries.

METHODS

A comprehensive electronic search of the literature will be undertaken in the following databases: PubMed, CINAHL, SPORTDiscus, Cochrane library, Web of Science and Scopus from 1979 to August 2022. The Physiotherapy Evidence Database scale will be used to assess the methodological quality of all included studies and RevMan 5.3 (Copenhagen, The Nordic Cochrane Centre) for the data analysis.

RESULTS

This study will provide a standardized evaluation and comparison for effects of KT on the treatment and prevention of ankle sprains in youth athletes.

CONCLUSION

This review will provide the evidence of the effectiveness of KT used in the treatment and prevention of ankle sprain in youth athletes. This review will also provide directions and recommendations for future research and clinical practices targeting treatment and prevention of ankle sprains in youth athletes.

Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: a systematic review

QUESTION

What is the effect of injury prevention programs that include balance training exercises on the incidence of ankle injuries among soccer players?

DESIGN

Systematic review of randomised trials with meta-analysis.

PARTICIPANTS

Soccer players of any age, sex or competition level.

INTERVENTIONS

The experimental intervention was an injury prevention program that included balance training exercises. The control intervention was the soccer team's usual warm-up program.

OUTCOME MEASURES

Exposure-based ankle injury rates.

RESULTS

Nine articles met the inclusion criteria. The pooled results of injury prevention programs that included balance training exercises among 4,959 soccer players showed a 36% reduction in ankle injury per 1,000 hours of exposure compared to the control group with an injury risk ratio (IRR) of 0.64 (95% CI 0.54 to 0.77). The pooled results of the Fédération Internationale de Football Association (FIFA) injury prevention programs caused a 37% reduction in ankle injury (IRR 0.63, 95% CI 0.48 to 0.84) and balance-training exercises alone cause a 42% reduction in ankle injury (IRR 0.58, 95% CI 0.41 to 0.84).

CONCLUSIONS

This meta-analysis demonstrates that balance exercises alone or as part of an injury prevention program decrease the risk of ankle injuries. PROSPERO CRD42017054450.

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.

Ankle Sprain Bracing Solutions and Future Design Consideration for Civilian and Military Use

INTRODUCTION

Ankle sprains are common injuries within the civilian and military populations, with lingering symptoms that include pain, swelling, giving-way, and a high likelihood for recurrence. Numerous bracing systems are available to stabilize the ankle joint following sprains, with new design iterations frequently entering the market. Currently available braces generally include sleeve, lace-up, and stirrup designs. Sleeves provide mild compression and warmth but limited stability for the ankle, while lace-ups and stirrups appear to be more effective at preventing and treating lateral ankle sprains.

AREAS COVERED

This review summarizes the use of various brace options in practice. Their major clinical benefits, and limitations are highlighted, followed by an overview of emerging concepts in brace design. Current advancements in biomechanical simulation, multifunctional material fabrication, and wearable, field-deployed devices for human injury surveillance are discussed, providing possibilities for conceiving new design concepts for next-generation smart ankle braces.

EXPERT OPINION

Performance of the commercially available braces are limited by their current design concepts. Suggestions on future brace design include: (1) incorporating high-performance materials suitable for extreme environments, (2) leveraging modeling and simulation techniques to predict mechanical support requirements, and (3) implementing adaptive, customizable componentry material to meet the needs of each unique patient.

Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis

Research questions

1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume?

Methods

This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed.

Results

Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up.

Conclusion

Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.

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.

Effect of the FIFA 11+ soccer specific warm up programme on the incidence of injuries: A cluster-randomised controlled trial

Background

Soccer players incur injuries that typically affect their performance. Injuries are caused by intrinsic and extrinsic factors that call for multifactorial preventive interventions. The study examines the impact of the FIFA 11+ warm up programme on the incidence and severity of injuries in second division soccer players in Rwanda.

Methods

Twelve teams (309 players) were randomised in the intervention group and 12 teams (317 players) in the control group using a cluster randomized controlled trial with teams as the unit of randomization. Intervention group teams implemented the FIFA 11+ soccer specific warm-up programme during training and matches at least three times a week over seven months of the Rwandan soccer season. Control group teams continued with usual warm up exercises. The primary outcome of this study was the overall incidence of training and match injuries. Injuries, training and match exposure as well as severity categories were recorded per the F-MARC guidelines.

Results

A lower proportion of players sustained injuries in the intervention group (52%) compared to the control group (63%) (Odd ratio: 0.7; 95%CI: 0.5–0.9). A significantly lower rate ratio was observed in the intervention group for overall (RR = 0.6; 95%CI: 0.5–0.8) and match (RR = 0.6; 95%CI: 0.5–0.8) injuries. Compliance to the injury prevention programme was 77%. In the intervention group, the incidence of injury was similar across all teams and across the medium and highly compliant teams. There was a statistically significant 55% and 71% reduction of the rate of moderate and severe injuries in the intervention group respectively.

Conclusion

The 11+ warm up injury prevention programme resulted in a significant reduction in the odds of sustaining injuries. In addition, injuries sustained were less severe. The programme should be rolled out to all teams in Rwanda and may well result in a decrease in the incidence and severity of injury in similar contexts.

Trial registration

Pan African Clinical Trial Registry (PACTR201505001045388).

Characterization of Injuries in Male and Female Ultimate Frisbee Players at the Elite Club-Level

BACKGROUND

Ultimate Frisbee is a rapidly growing sport played in all levels of competition in men's, women's, and coed divisions. Despite widespread popularity, there remains a lack of research on injury risk and prevalence during a season.

PURPOSE

To determine the prevalence of injuries among elite club-level men and women Ultimate Frisbee players and to identify elements associated with injury during a single season.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

Voluntary preseason and postseason online surveys were distributed to local elite club-level Ultimate teams in 2019. Surveys assessed players' lifetime Ultimate-associated injury history, injury status, training regimen, and other related elements.

RESULTS

Fifty-seven and 84 players were eligible to complete the preseason and postseason surveys, respectively. Prior to the 2019 season, 97% of female respondents and 100% of male respondents reported a previous Ultimate-related injury in their career, with all reporting a prior lower extremity injury. During the 2019 season, 56% of respondents reported being injured, and 12% missed one month or more of the season, with 88% of injured players reporting a lower extremity injury. Men reported more ankle and calf injuries than women, and there was a strong negative correlation between time missed due to injury during the 2018 season and the number of days per week spent weight-training and accumulated training.

CONCLUSION

There is a high prevalence of lower extremity injury among elite club-level Ultimate players during a single season and pervasive lower extremity injury history may contribute to high injury prevalence. Observed injury patterns suggest targeted interventions including Nordic Hamstring Exercises and balance and proprioceptive training may decrease injury risk. Further research into this topic is needed to help reduce injury in these athletes.

LEVELS OF EVIDENCE

Level 3.

Ankle microinstability: arthroscopic findings reveal four types of lesion to the anterior talofibular ligament's superior fascicle

PURPOSE

ATFL's superior fascicle injury has been considered to be the underlying cause in cases of ankle microinstability. As its clinical diagnosis can be difficult, arthroscopic examination may be the only objective diagnostic tool. The purpose of this study was to determine what types of injuries to the ATFL's superior fascicle are associated with ankle microinstability, and to provide the reader with an arthroscopic classification of the types of microinstability affecting the ankle.

METHODS

Ankle arthroscopy video records obtained during a four-year period from 232 patients with the diagnosis of ankle microinstability were reviewed. The characteristics of the ATFL's superior fascicle injury were identified, described and recorded along with any concomitant intra-articular pathology.

RESULTS

Four different injury patterns were consistently seen affecting the ATFL's superior fascicle. These ranged from ligament attenuation associated with loss of tension (type I), through to partial detachment (type II) or total detachment (type III) from the fibula. Finally, a total or partial resorption of the ATFL's superior fascicle (type IV) was also observed. There was a statistically significant association between the type of injury identified and the rate of intra-articular pathology observed arthroscopically. Equally, the higher the type in the classification, the higher the rate of loose bodies, lateral talar OCD, deltoid "open book" tears, and anterior soft-tissue formation.

CONCLUSION

Different types of ATFL's superior fascicle injury can be observed in patients with ankle microinstability, ranging from ligament attenuation associated with a loss of tension (8.2%) to different degrees of partial (69.1%) and total (16.8%) ligament detachment from the fibula, or ligament remnant resorption (5.9%). As the type of injury progresses along with the proposed classification, the rate of intra-articular injuries also increases. The clinical relevance of this study is that a morphological ATFL's superior fascicle tear is recognized in patients with the diagnosis of ankle microinstability.

LEVEL OF EVIDENCE

IV.

Change in dynamic postural control after a training program in collegiate soccer players with unilateral chronic ankle instability

BACKGROUND

Improving dynamic postural stability after lateral ankle sprain due to chronic ankle instability helps prevent recurrence, and changes in dynamic postural stability can be assessed with the Star Excursion Balance Test. To date, no studies have examined the change in Star Excursion Balance Test score after the end of a balance training program or whether chronic ankle instability affects the rate of change. To examine the effect of chronic ankle instability on changes in Star Excursion Balance Test. score over time after a balance training program.

METHODS

Fifteen collegiate soccer players with chronic ankle instability selected with the Cumberland Ankle Instability Tool and ultrasonography. Participants completed a 6-week balance training program. We assessed the Star Excursion Balance Test 5 times (before and immediately after the program and 2, 4, and 6 weeks later) and examined differences in the duration of training effects by a 2-way analysis of variance, with Bonferroni correction for post hoc comparisons to explain any significant interactions. The significance level for all analyses was set at P < .05. We performed statistical analyses with SPSS version 25.

RESULTS

Analysis of the posterolateral and posteromedial scores in Star Excursion Balance Test showed a significant effect of time. Post hoc analysis of the posterolateral score showed that for each leg, participants reached significantly farther after the program than before (P = .012). The posterolateral scores at 2, 4, and 6 weeks after the training program did not differ from before the program, but the posteromedial score was significantly improved immediately after the program (P = .008) and also 2 (P = .004) and 4 weeks later (P = .006).

CONCLUSIONS

A 6-week balance training program to improve dynamic postural control can improve posterolateral and posteromedial scores in people with chronic ankle instability, and the improvements in posteromedial are still present 4 weeks after program completion.

Football-related injuries are the major reason for the career end of professional male football players

PURPOSE

Little is known about the consequences of injuries on professional male football players' career and retirement period. The aim of this study is to investigate the impact of injuries that male professional football players endure during their career, reasons for the end of their career and the post-career phase of retirement.

METHODS

In a retrospective cross-sectional cohort study, retired male professional football players of the German Bundesliga were investigated by a standardised questionnaire to analyse the history of injuries sustained during their professional football career, the reasons for ending their career, their current health status and their suggestions for future prevention strategies.

RESULTS

Most of the 116 analysed players (n = 73 (62.9%)) stated an injury as the reason for ending their professional career. Relevant injuries were mainly located in the lower extremities (n = 587 (61.3%)) with a focus on the knee (p < 0.001) and ankle (p < 0.001). A significant majority of the participants who had retired due to injury described degenerative symptoms, such as pain or instability, and were diagnosed with osteoarthritis after retirement (p < 0.001). These players had also often been affected by symptoms of depression during their career, which had decreased significantly after retirement. Moreover, players who had not retired due to injury had significantly better overall health status and quality of life after retirement.

CONCLUSION

Football-related injuries have a significant impact on the career end of professional male football players and their health status after retirement. Future prevention strategies need to particularly address injuries to the knees and ankles and to implement measures for preventing osteoarthritis after retirement.

LEVEL OF EVIDENCE

Level III.

Does load management using the acute:chronic workload ratio prevent health problems? A cluster randomised trial of 482 elite youth footballers of both sexes

BACKGROUND

The acute:chronic workload ratio (ACWR) is commonly used to manage training load in sports, particularly to reduce injury risk. However, despite its extensive application as a prevention intervention, the effectiveness of load management using ACWR has never been evaluated in an experimental study.

AIM

To evaluate the effectiveness of a load management intervention designed to reduce the prevalence of health problems among elite youth football players of both sexes.

METHODS

We cluster-randomised 34 elite youth football teams (16 females, 18 males) to an intervention group (18 teams) and a control group (16 teams). Intervention group coaches planned all training based on published ACWR load management principles using a commercially available athlete management system for a complete 10-month season. Control group coaches continued to plan training as normal. The prevalence of health problems was measured monthly in both groups using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

RESULTS

The between-group difference in health problem prevalence (primary outcome) was 1.8%-points (-4.1 to 7.7 %-points; p=0.55) with no reduction in the likelihood of reporting a health problem in the intervention group (relative risk 1.01 (95% CI 0.91 to 1.12); p=0.84) compared with the control group.

CONCLUSIONS

We observed no between-group difference, suggesting that this specific load management intervention was not successful in preventing health problems in elite youth footballers.

TRIAL REGISTRATION NUMBER

ISRCTN18177140.

Can musculoskeletal screening test findings guide interventions for injury prevention and return from injury in field hockey?

OBJECTIVES

The aim of this study is to identify if intrinsic factors tested in the preseason screening (PSS) can identify an elevated risk of injury. This aim has two aspects; to assess whether previous injury is associated with ongoing deficits in performance, and to assess if the PSS can identify differences in intrinsic factors that profile risk of future injury.

DESIGN

A cohort of state level field hockey players were tested on a screening test battery including proprioception, postural stability, muscular strength and range of motion, to establish if these intrinsic factors were useful in identifying elevated risk of injury. Retrospective injury data was collated to determine association with previous injury and prospective injury data was collated to determine association with future injury.

PARTICIPANTS

A total of 130 field hockey players were included in this study, from state level squads (age ± SD = 20.96 (3.75); height = 176.09 cm). Groups for prescreening and post screening injury status (injured/not injured) were established for comparison to screening test results.

RESULTS

Right Active Movement Extent Discrimination Assessment (AMEDA), left AMEDA and right Y-balance test (YBT) anterior direction (Ant) were significantly associated (p < 0.05) with injury prior to screening. Right YBTAnt and right and left hip internal rotation (IR) were significantly associated (p < 0.05) with injury post screening. The YBTAnt and YBT posteromedial (PMed) reach directions and Hip IR are associated with previous hamstring injury and show a difference between post screening injured and non-injured groups.

CONCLUSIONS

AMEDA, R YBTAnt, Hip IR tests should be a focus for recovery after previous injury and during season preparation. Full recovery may improve readiness to return to play and reduce risk of primary injury or re-injury. YBTAnt and YBTPmed and Hip IR show a performance deficit link between previous injury and subsequent re-injury of hamstrings. Since these are the most common re-injury types in this cohort, these tests are clinically useful in informing return to play decisions for hockey players.

Proprioceptive Training on Dynamic Neuromuscular Control in Fencers: A Clinical Trial

CONTEXT

Fencing is a sport of agility, with a higher incidence of lower-limb injuries, of which the ankle sprain is the most prevalent. Injury prevention is very important to improve performance and decrease the withdrawal time of athletes. Proprioceptive training programs can be added to the training of athletes, since, in addition to easy application and low cost, proprioception has the function of stabilizing the ankle joint to prevent injuries.

OBJECTIVE

To verify the influence of a 12-week proprioceptive training program on dynamic neuromuscular control in fencing athletes.

DESIGN

The study was a clinical trial, and the athletes were allocated, for convenience, in the intervention group or in the control group.

SETTING

The study was developed in 4 stages (preintervention, intervention, postintervention, and follow-up of 3). The neuromuscular control during the star excursion balance test was evaluated.

PARTICIPANTS

The participants were 19 fencing athletes (intervention group: 10, and control group: 9), aged 14-35 years, from a multisport club.

INTERVENTIONS

The athletes performed the proprioceptive training during 12 weeks, 3 times a week, with a duration of 30 minutes.

MAIN OUTCOME MEASURES

Dynamic neuromuscular control.

RESULTS

The data and SE were considered for statistical analysis, submitted to the generalized estimates equations test with Bonferroni post hoc. The level of significance was .05. The distance reached in the star excursion balance test increased significantly in all 8 directions evaluated in the 2 legs of the intervention group.

CONCLUSIONS

The proprioceptive training program was able to improve dynamic neuromuscular control in fencing athletes.

Epidemiology of Foot Injuries Using National Collegiate Athletic Association Data From the 2009-2010 Through 2014-2015 Seasons

CONTEXT

Researchers analyzing data from the National Collegiate Athletic Association Injury Surveillance Program have not considered the differences in foot injuries across specific sports and between males and females.

OBJECTIVE

To describe the epidemiologic differences in rates of overall foot injuries and common injuries among sports and between sexes.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury-surveillance data from 15 unique sports involving males and females that demonstrated 1967 injuries over 4 821 985 athlete-exposures.

PATIENTS OR OTHER PARTICIPANTS

Male and female athletes competing in National Collegiate Athletic Association sports from the 2009-2010 through 2014-2015 seasons.

MAIN OUTCOME MEASURE(S)

Foot injury rates (per 10 000 athlete-exposures) and the proportion of foot injuries were calculated for each sport. The effect of sex was calculated using Poisson-derived confidence intervals for 8 paired sports. A risk analysis was performed using a 3 × 3 quantitative injury risk-assessment matrix based on both injury rate and mean days of time loss.

RESULTS

Foot injury rates differed between sports, with the highest rates in female gymnastics, male and female cross-country, and male and female soccer athletes. Cross-country and track and field had the highest proportions of foot injuries for both female and male sports. The 5 most common injuries were foot/toe contusions, midfoot injuries, plantar fascia injuries, turf toe, and metatarsal fractures. Only track and field athletes demonstrated a significant sex difference in injury rates, with female athletes having the higher rate. The quantitative injury risk-assessment matrix identified the 4 highest-risk injuries, considering both rate and severity, as metatarsal fractures, plantar fascia and midfoot injuries, and foot/toe contusions.

CONCLUSIONS

Important differences were present among sports in terms of injury rates, the most common foot injuries, and the risk (combination of frequency and severity) of injury. These differences warrant further study to determine the mechanisms of injury and target intervention efforts.

Effects of Textured Balance Board Training in Adolescent Ballet Dancers With Ankle Pathology

CONTEXT

Ankle sprains are common among adolescent ballet dancers and may be attributed to inadequate ankle proprioception. Thus, a short period of training utilizing proprioceptive activities requires evaluation.

OBJECTIVE

To assess training conducted for 3 or 6 weeks on a textured-surface balance board using ankle proprioception scores for ballet dancers with and without chronic ankle instability, and with and without previous ankle sprain (PAS).

DESIGN

Intervention study.

SETTING

The Australian Ballet School.

PARTICIPANTS

Forty-two ballet dancers, aged 14-18 years.

INTERVENTIONS

Dancers randomized into 2 groups: group 1 undertook 1 minute of balance board training daily for 3 weeks; group 2 undertook the same training for 6 weeks.

MAIN OUTCOME MEASURES

Preintervention, Cumberland Ankle Instability Tool questionnaire data were collected, and PAS during the last 2 years was reported. Active ankle inversion movement discrimination ability was tested immediately pre and post intervention and at 3 and 4 weeks.

RESULTS

Ankle discrimination acuity scores improved over time for both groups, with a performance decline associated with the early cessation of training for group 1 (P = .04). While dancers with PAS had significantly worse scores at the first test, before balance board training began (P < .01), no significant differences in scores at any test occasion were found between dancers with and without chronic ankle instability. A significantly faster rate of improvement in ankle discrimination ability score over the 4 test occasions was found for dancers with PAS (P = .002).

CONCLUSIONS

Three weeks of textured balance board training improved the ankle discrimination ability of ballet dancers regardless of their reported level of chronic ankle instability and at a faster rate for dancers with PAS. Previous ankle sprain was associated with a lower level of ankle discrimination ability; however, following 3 weeks of balance board training, previously injured dancers had significantly improved their ankle discrimination acuity scores.

Ankle Bracing is Effective for Primary and Secondary Prevention of Acute Ankle Injuries in Athletes: A Systematic Review and Meta-Analyses

BACKGROUND

Ankle bracing has been verified as being effective for secondary prevention of ankle injuries. However, new studies have recently been published that are not included in previous meta-analyses. Furthermore, the effects of bracing for primary prevention of ankle injuries are still unclear.

OBJECTIVE

The objective of this article was to systematically review the literature about the effectiveness of ankle bracing on primary and secondary prevention of acute ankle injuries in athletes.

METHODS

We searched PubMed, EMBASE, SPORTDiscus, CINAHL, and PEDro databases for eligible articles until July 2018. Randomized controlled trials that studied ankle bracing vs. no intervention for athletes were included. Risk of bias was assessed with the Cochrane Risk of Bias tool. Meta-analyses were conducted to study the effect of ankle bracing for primary and secondary prevention of ankle injuries. The Grading of Recommendation Assessment, Development, and Evaluation method was used to determine the quality of evidence.

RESULTS

We included six randomized controlled trials. Significant risk ratios of 0.53 (95% confidence interval 0.32-0.88) and 0.37 (95% confidence interval 0.24-0.58) were found in favor of ankle bracing vs. no ankle bracing for primary (low quality of evidence, I² = 77%) and secondary prevention (moderate quality of evidence, I² = 0%) of acute ankle injuries. Numbers needed to treat were 26 and 12 for the primary and secondary prevention of acute ankle injuries.

CONCLUSIONS

Ankle bracing is effective for primary and secondary prevention of acute ankle injuries among athletes. However, conclusions in regard to primary prevention should be drawn cautiously because of the low quality of evidence and significant heterogeneity.

Ten-Year Epidemiology of Ankle Injuries in Men's and Women's Collegiate Soccer Players

CONTEXT

Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players.

OBJECTIVE

To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance.

MAIN OUTCOME MEASURE(S)

The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics.

RESULTS

When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98).

CONCLUSIONS

Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

Balance and proprioception responses to FIFA 11+ in amateur futsal players: Short and long-term effects

Background: The FIFA 11+ has shown positive effects on balance and proprioception parameters in football players. As there have been very few research studies involving futsal, we examined the short and long term effects of the FIFA 11+ on static and dynamic balance, as well as proprioception in male amateur futsal players. Methods: Seventy-one male futsal players were randomized to two groups (FIFA 11+: n = 37, age: 27.33 ± 4.33 years; Control: n = 34, age: 25.55 ± 4.65 years). Intervention lasted 10 weeks, 2 sessions per week, succeeded by a 10-week follow-up period. For balance testing, we assessed the single-legged postural sway with a force platform (static balance) and the Y balance test (dynamic balance). Proprioception was assessed with active joint position sense testing. Results: Complete pre-post intervention and follow-up tests were available for 61 players. The FIFA 11+ group showed higher training exposure and lower body mass index and body weight. After adjustment for baseline differences, no significant differences between groups were observed in the pre-post changes for centre of pressure measures, Y-balance and proprioception parameters both at short and long-term. Conclusions: Performing FIFA 11+ for 10 weeks did not improve static and dynamic balance as well as proprioception in amateur futsal players.

Prevention of Lateral Ankle Sprains

CONTEXT

Given the frequency of ankle sprains, especially in the athletic population, prevention is a primary task of athletic trainers and other sports health care professionals.

OBJECTIVE

To discuss the current evidence as it relates to prophylactic programs for the prevention of ankle sprains and to provide critical interpretation of the evidence supporting and refuting the implementation of preventive programs.

CONCLUSIONS

External prophylactic supports and preventive exercise programs are effective for reducing the risk of ankle sprains in both uninjured and previously injured populations. Ankle bracing appears to offer the best outcomes in terms of cost and risk reduction. However, there remains a paucity of well-designed, prospective randomized controlled trials relevant to the primary prevention of lateral ankle sprains, especially across a range of sport settings.

Performance on a Single-Legged Drop-Jump Landing Test Is Related to Increased Risk of Lateral Ankle Sprains Among Male Elite Soccer Players: A 3-Year Prospective Cohort Study

BACKGROUND

Soccer has a high injury rate, with lateral ankle sprains being a common injury. Therefore, an approach to prevent or at least reduce the occurrence is warranted. Injury prevention can be improved by identifying specific risk factors and individuals at risk.

PURPOSE

To assess drop-jump landing performance as a potential predictor of lateral ankle sprain within 3-year follow-up.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Single-legged drop-jump landing tests were performed by 190 elite soccer players. Based on ground-reaction forces, 6 outcome measures were calculated that aim to reflect the impact and stabilization phase. Lateral ankle sprains were registered during up to 3 years of follow-up. Following a z score correction for age, a multivariate regression analysis was performed.

RESULTS

During follow-up, 45 players (23.7%) suffered a primary lateral ankle sprain. Of those, 34 were regarded as severe (absence >7 days). Performance was related to increased risk of ankle sprain ( P = .005 for all sprains and P = .001 for severe sprains). Low mediolateral stability for the first 0.4 seconds after landing (a larger value indicates more force exerted in the mediolateral direction, resulting in rapid lateral stabilization) and high horizontal ground-reaction force between 3.0 and 5.0 seconds (a smaller value indicates less sway in the stabilization phase) were identified as risk factors. A player that scored 2 SD below average for both risk factors had a 4.4-times-higher chance of sustaining an ankle sprain than a player who scored average.

CONCLUSION

The current study showed that following a single-legged drop-jump landing, mediolateral force over 0 to 0.4 seconds and/or mean resultant horizontal ground-reaction force over 3 to 5 seconds has predictive value with regard to the occurrence of an ankle sprain among male elite soccer players within 3 years.

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.

The effectiveness of proprioceptive and neuromuscular training compared to bracing in reducing the recurrence rate of ankle sprains in athletes: A systematic review and meta-analysis

BACKGROUND

Ankle sprains are common musculoskeletal injuries in which the ligaments of the ankle partially or completely tear due to sudden stretching.

OBJECTIVES

To critically appraise, evaluate and establish the best available evidence to determine the effectiveness of proprioceptive and neuromuscular training (PNT) compared to bracing in reducing the recurrence rate of ankle sprains in athletes.

METHODOLOGY

The following seven databases were searched in June 2017: PubMed, Cochrane Library, PEDro, ScienceDirect, Scopus, SPORTDiscus, EBSCO Host: CINAHL. The main search terms used were "ankle sprains", "proprioceptive training", "neuromuscular training" and "bracing". The quality of the trials were critically appraised according to the PEDro scale. The RevMan 5© software was used to pool results.

RESULTS

Three studies met the inclusion criteria and the quality according to the PEDro scale ranged from 4/10-7/10. The pooled data showed no difference between PNT and bracing in reducing the recurrence rate of ankle sprains in athletes at 12 months after initiation of the study.

CONCLUSION

This systematic review of the overall effect suggested that current evidence (Level II) does not favour the use of PNT over bracing in reducing the recurrence rate of ankle sprains. Physiotherapists are advised to use either PNT or bracing according to the patients preference and their own expertise.

Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis

OBJECTIVE:

To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials.

DATA SOURCES:

The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018.

METHODS:

RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations.

RESULTS:

Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense.

CONCLUSION:

Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.

Prevention of Ankle Sprain Injuries in Youth Soccer and Basketball: Effectiveness of a Neuromuscular Training Program and Examining Risk Factors

OBJECTIVES

The primary objective of this study was to examine the effectiveness of a neuromuscular training (NMT) warm-up program in reducing the risk of ankle sprain injury (ASI) in youth soccer and basketball. The secondary objective included the evaluation of risk factors for ASI.

STUDY DESIGN

Secondary analysis of pooled data from 5 studies.

PARTICIPANTS

Male and female youth (11-18 years) soccer and basketball players (n = 2265) in Alberta, Canada.

OUTCOME MEASURES

Ankle sprain injury was the primary outcome and was recorded using a validated prospective injury surveillance system consistent in all studies. The primary exposure of interest was NMT warm-up, which included aerobic, strength, agility, and balance components. Multivariable Poisson regression, controlling for clustering by team and offset for exposure hours, was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs), with considerations for confounding and effect modification and evaluating all covariates as potential risk factors.

RESULTS

A total of 188 ASIs were reported in 171 players. Neuromuscular training significantly reduced the risk of ASI [IRR = 0.68 (95% CI; 0.46-0.99)]. Independent risk factors for ASI included previous ASI [IRR = 1.98 (95% CI; 1.38-2.81)] and participation in basketball versus soccer [IRR = 1.83 (95% CI; 1.18-2.85)]. Sex, age, body mass index, and previous lower extremity injury (without previous ASI) did not predict ASI (P > 0.05).

CONCLUSIONS

Exposure to an NMT program is significantly protective for ASI in youth soccer and basketball. Risk of ASI in youth basketball is greater than soccer, and players with a history of ASI are at greater risk.

THE EFFECT OF BRACING AND BALANCE TRAINING ON ANKLE SPRAIN INCIDENCE AMONG ATHLETES: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Background

Ankle sprains are common musculoskeletal injuries in the athletic population that have been addressed with prevention strategies that include bracing and balance training. Many authors have examined ankle sprain incidence after bracing or balance training in athletes at different levels of competition and in various sports. No systematic review has analyzed the results of both interventions.

Purpose

The purpose of this review was to compare the effect of balance training and bracing in reducing the incidence and relative risk of ankle sprains in competitive athletes, with or without prior injury, across different sports.

Design

Systematic review, with meta-analysis.

Methods

A literature search of four databases was conducted for randomized control trials that reported ankle sprain incidence published from 2005 through 2016. Included articles studied high school, college, or professional level athletes with or without a history of a prior sprain, who received bracing or balance training as an intervention compared to a non-intervention control group. Methodological study quality was assessed by two reviewers using the PEDro scale, with scores ≥5 considered moderate quality. Group incidence and relative risk were determined to assess the preventative effect of bracing or balance training compared to control.

Results

From 1832 total citations, 71 full-text articles were reviewed, and eight articles were included in the study. Methodological quality of the available evidence contained in the systematic review was moderate. Five studied the effect of balance training, two studied the effect of bracing, and one studied the effect of bracing and balance training compared to the control condition. In all eight studies, athletes in the control condition did not receive any intervention. Athletes who wore braces had fewer ankle sprains (p=0.0037) and reduced their risk of sprains by 64% (RR=0.36) compared to controls, based on analysis of 3,581 subjects. Athletes performing balance training had fewer ankle sprains (p=0.0057) and reduced their risk by 46% (RR=0.54) compared to controls, based on analysis of 3,577 subjects.

Conclusion

The findings of the current systematic review and meta-analysis support the use of bracing and balance training to reduce the incidence and relative risk of ankle sprains in athletic populations. Clinicians can utilize this information to educate their patients on wearing a brace or performing balance training exercises to decrease the risk of an ankle sprain.

Level of evidence

Level 1a.

Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review

Reference:  Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244.

CLINICAL QUESTION

  Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population?

DATA SOURCES

  The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof.

STUDY SELECTION

  Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates.

DATA EXTRACTION

  Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate.

MAIN RESULTS

  Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000).

CONCLUSIONS

  Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.

The influence of foot position on lower leg muscle activity during a heel raise exercise measured with fine-wire and surface EMG

OBJECTIVE

Exercises for lower leg muscles are important to improve function. To examine the influence of foot position on lower leg muscle activity during heel raises.

DESIGN

Cross-sectional laboratory study.

SETTING

Laboratory.

PARTICIPANTS

Fourteen healthy men participated in this study.

MAIN OUTCOME MEASURES

The muscle activity levels of the tibialis posterior (TP), peroneus longus (PL), flexor digitorum longus (FDL) and medial gastrocnemius (MG) were measured. The heel raises consisted of three foot positions: 1) neutral, 2) 30° abduction, and 3) 30° adduction. The EMG data for five repetitions of each foot position were normalized to maximum voluntary contraction. One-way repeated measure ANOVA was employed for statistical analysis.

RESULTS

The muscle activity level of TP, PL and FDL was significantly different between the three foot positions during the heel raises. TP and FDL showed the highest activity level in 30° foot adduction while PL demonstrated the highest activity level in 30° foot abduction.

CONCLUSIONS

Heel raises with 30° foot adduction and abduction positions can change lower leg muscle activity; These findings suggest that altering foot posture during the heel raise exercise may benefit patients with impaired TP, PL or FDL function.

Strategies for injury prevention in Brazilian football: Perceptions of physiotherapists and practices of premier league teams

OBJECTIVES

To describe the physiotherapists perceptions and the current practices for injury prevention in elite football (soccer) clubs in Brazil.

DESIGN

Cross-sectional study.

SETTING

Group of Science in Sports & Exercise, Federal University of Healthy Sciences of Porto Alegre (Brazil).

PARTICIPANTS

16 of the 20 football clubs involved in the Brazilian premier league 2015.

MAIN OUTCOME MEASURES

Physiotherapists answered a structured questionnaire.

RESULTS

Most physiotherapists (∼88%) were active in design, testing and application of prevention programs. Previous injury, muscle imbalance, fatigue, hydration, fitness, diet, sleep/rest and age were considered "very important" or "important" injury risk factors by all respondents. The methods most commonly used to detect athletes' injury risk were: monitoring of biochemical markers (100% of teams), isokinetic dynamometry (81%), questionnaires (75%), functional movement screen (56%), fleximetry (56%) and horizontal jump tests (50%). All clubs used strength training, functional training, core exercises and balance/proprioception exercises in their injury prevention program; and Nordic hamstring exercise and other eccentric exercises were used by 94% of clubs. "FIFA 11+" prevention program was adapted by 88% of clubs.

CONCLUSION

Physiotherapists perceptions and current practices of injury prevention within Brazilian elite football clubs were similar to those employed in developed countries. There remains a gap between clinical practice and scientific evidence in high performance football.

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.

The effect of combined mechanism ankle support on postural control of patients with chronic ankle instability

BACKGROUND

Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients.

OBJECTIVES

The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients.

STUDY DESIGN

Cross-sectional study.

METHODS

An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform.

RESULTS

The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support.

CONCLUSION

The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals. Clinical relevance Application of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

BACKGROUND

Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports.

OBJECTIVE

To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI.

DESIGN

Overview of intervention systematic reviews.

PARTICIPANTS

Individuals with acute ankle sprain/CAI.

MAIN OUTCOME MEASUREMENTS

The primary outcomes were injury/reinjury incidence and function.

RESULTS

46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains.

CONCLUSIONS

For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.

Ankle Injury Prevention Programs for Soccer Athletes Are Protective: A Level-I Meta-Analysis

BACKGROUND

Soccer has one of the highest rates of ankle injury in sports for both males and females. Several injury prevention programs have been developed to address this concern. The purposes of this study were to conduct a meta-analysis of ankle injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs.

METHODS

A systematic search of the literature was conducted in PubMed (MEDLINE), Embase, CINAHL (Cumulative Index to Nursing and Allied Health), and the Cochrane Central Register of Controlled Trials (CENTRAL) database. Studies were limited to clinical investigations of injury prevention programs specific to the ankle in soccer players. Title, abstract, and full-text review were utilized to identify articles that met the inclusion criteria. The Cochrane Q test and I(2) index were independently used to assess heterogeneity among the studies. Sensitivity analyses were performed to assess heterogeneity. The pooled risk difference was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique.

RESULTS

Ten studies met the inclusion criteria as randomized controlled trials. A total of 4,121 female and male soccer athletes were analyzed for ankle injuries. Significant heterogeneity was found among studies of ankle injury prevention (p = 0.002), with an I(2) index of 65.2%. For studies of ankle injury prevention programs, the risk ratio was 0.60 (95% confidence interval, 0.40 to 0.92) and a significant reduction in the risk of ankle injury was found in the prevention group (p = 0.002). No evidence of publication bias was found among the included studies.

CONCLUSIONS

This meta-analysis of studies regarding ankle injury prevention programs identified a significant reduction in the risk of ankle injury. Future high-quality research designs with a low risk of bias are necessary to further evaluate the effectiveness of specific exercises and the optimal timing and age at intervention for the prevention of ankle injuries in the athletic soccer player.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.