Neuromuscular Training for Sports Injury Prevention

Impact of Stabilization Exercises on Athletic Performance and Injury Risk in College Volleyball Players

PURPOSE

This study aimed to determine the effects of stabilization exercises on athletic performance and injury risk in volleyball players.

METHODS

A randomized clinical trial was conducted at university sport facilities with 23 college volleyball players age 18 to 25 years. Using a stratified randomization method, participants were randomly assigned to the control group (n = 11), which continued their routine training program, or the intervention group (n = 12), which performed additional volleyball-specific stabilization exercises twice per week for 8 weeks. The main outcomes, including injury risk, and athletic performance were assessed using functional movement screening, sit-reach flexibility test, weight-bearing lunge, medicine-ball throw, closed-kinetic-chain upper-extremity stability test, 20-m speed test, serve skill test, vertical jump test, and upper- and lower-extremity dynamic Y-balance test.

RESULTS

Both groups showed significant improvements in all parameters after the 8-week program, except for the control group's sit-reach test and asymmetry points (P < .05). When comparing the 2 groups, the intervention group showed significantly greater improvements in functional movement screening score, asymmetry points, medicine-ball throw, closed-kinetic-chain upper-extremity stability test, vertical jump, serve skill, Y-balance test scores for upper and lower extremities, lower-extremity anterior asymmetry score, and right-foot weight-bearing lunge results (P < .05).

CONCLUSIONS

Stabilization exercises effectively reduce injury risk and enhance athletic performance in volleyball players. Incorporating these exercises into training programs can be a valuable strategy for preventing injuries and improving individual and team success in volleyball.

The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial

BACKGROUND

Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI).

HYPOTHESIS

The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI.

STUDY DESIGN

A single-blind parallel-arm randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase.

RESULTS

Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73).

CONCLUSION

Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI.

CLINICAL RELEVANCE

The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.

Injury risk reduction programs including balance training reduce the incidence of anterior cruciate ligament injuries in soccer players: a systematic review and meta-analysis

BACKGROUND

Anterior cruciate ligament (ACL) injuries are exceedingly common among soccer players and severely impact their careers and health. This study evaluates the effects of injury risk reduction programs, including balance training exercises, on the incidence of ACL injuries in soccer players through a meta-analysis. The aim is to promote the health of soccer players, enhance their athletic performance, and provide valuable insights for further research in the field of sports medicine.

METHODS

This study strictly adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted through PubMed, EBSCO, and Web of Science databases, covering all entries from the inception of the databases until February 2024.

RESULTS

Eligible studies were individually assessed using the Cochrane Risk of Bias Tool version 2, and the quality of the evidence obtained was rigorously evaluated using the GRADE approach. Data analysis and processing were performed using Stata 18 software. Eight studies were ultimately selected for inclusion in the meta-analysis, encompassing 20,336 participants and 1,512,099 exposure hours, with 190 cases of ACL injuries identified among soccer players. The pooled results indicated that, compared to the control group, groups using injury risk reduction programs that included balance training had a 58% reduction in the overall rate of ACL injuries per 1,000 exposure hours (IRR 0.42, 95% CI: 0.27 to 0.66). The overall study heterogeneity was low, with an I2value of 33.3% and a P-value of 0.186. Subgroup analyses showed that in trials involving male participants, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.29 to 0.88), with an I2 value of 44.8% and P = 0.178. In trials involving female participants, ACL injuries were reduced by 61% (IRR 0.39, 95% CI: 0.24 to 0.62), with an I2 value of 42.5% and P = 0.157. In trials with participants training less than three times per week, ACL injuries were reduced by 43% per 1,000 exposure hours compared to the control group (IRR 0.57, 95% CI: 0.35 to 0.93), with an I2 value of 0.00% and P = 0.727. In trials with participants training three times or more per week, ACL injuries were reduced by 57% (IRR 0.43, 95% CI: 0.21 to 0.88), with an I2 value of 28.2% and P = 0.238. In trials with participants training for 20 min or more per week, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.26 to 0.93), with an I2 value of 1.2% and P = 0.363. In trials with participants training less than 20 min per week, ACL injuries were reduced by 46% (IRR 0.54, 95% CI: 0.33 to 0.91), with an I2 value of 0.00% and P = 0.544.

CONCLUSION

In summary, injury risk reduction programs that include balance training significantly reduce the risk of ACL injuries in soccer players. The reduction in injuries is more pronounced in female athletes, and high-frequency training along with longer-duration interventions further enhance the preventative effects.

Effectiveness of Neuromuscular Training in Preventing Lower Limb Soccer Injuries: A Systematic Review and Meta-Analysis

Background: Soccer is associated with a high risk of injuries, mainly affecting the lower limbs, leading to significant consequences for player performance and career longevity. Neuromuscular training (NMT) has been proposed as an effective preventive strategy, but its impact varies across different populations and implementation strategies. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, MEDLINE, and SPORTDiscus identified randomized controlled trials, cohort studies, and systematic reviews examining the effects of NMT on lower limb injury prevention in soccer players. Study quality was assessed using the Downs and Black tool, and injury incidence rate ratios were analyzed. Results: Eleven studies, encompassing over 10,000 soccer players, were included. NMT interventions, particularly FIFA 11+, significantly reduced injury rates compared to standard warm-ups. Higher adherence and coach education enhanced program effectiveness. Female players benefited more, particularly in ACL injury prevention. No significant differences were observed between shorter (10 min) and standard (20 min) NMT protocols. Conclusions: NMT effectively reduces lower limb injuries in soccer, with adherence and proper coaching being key determinants of success. Future research should optimize program design and long-term adherence strategies to maximize benefits across all player demographics.

Lower limb dynamic balance, strength, explosive power, agility, and injuries in volleyball players

PURPOSE

This study explores the relationship among lower limb dynamic balance, lower limb strength, explosive power, agility, and sports injuries in male volleyball players.

METHOD

The study involved thirty-one male volleyball athletes assessed for lower limb dynamic balance using the Y Balance Test Kit™. Muscle strength in the hip, knee, and ankle was measured using the Isomed 2000 isokinetic dynamometer. Power performance was evaluated through squat jump, countermovement (CMJ) jump, and drop jump tests using the Kistler force platform. Agility measurements were conducted using timing gates and a stopwatch.

RESULTS

Our findings revealed a significant correlation between interlimb asymmetry in the anterior reach of the Y balance test and non-contact injuries (r = 0.597, P < 0.01). Additionally, there were significant correlations between the Y balance test and lower limb strength (r = 0.356 to 0.715, P < 0.05), vertical jumping performance (r = 0.357 to 0.672, P < 0.05), and agility (r = -0.379 to -0.702, P < 0.05).

CONCLUSION

Based on these findings, It is recommended that interlimb asymmetry in the anterior reach direction of the Y Balance Test be considered as one of the indicators for potential non-contact lower limb injuries among elite male volleyball players. The lower limb muscle strength of the hip, knee, and ankle joints and power and agility are associated with lower limb dynamic balance capabilities. Additionally, dynamic balance may contribute to overall physical performance. Targeted strength training for unilateral muscles and incorporating various explosive exercise modes may support athletic performance and reduce the risk of sports-related injuries.

Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-analysis

PURPOSE

To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players.

METHODS

The study was preregistered on PROSPERO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Three databases were searched for Level I to IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury.

RESULTS

Nineteen articles (mean Quality Appraisal for Sports Injury Video Analysis Studies score 14.3 ± 1.9; all Level IV evidence, 1,652 videos, 17 professional males, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42%-55%]), muscle strains (hamstring: 71% [47%-87%]), and Achilles tears (80%-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament sprains (14% NC) and foot/ankle sprains (6% [4%-10%] NC). Most ACL injuries (68% [61%-75%]) occurred while defending, and quadriceps strains (81%-89%) occurred while attacking.

CONCLUSIONS

In soccer, video analysis shows that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while medial collateral ligament and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half.

LEVEL OF EVIDENCE

Level IV, systematic review and meta-analysis of Level IV studies.

Injury prevention programmes (IPPs) for preventing anterior cruciate ligament injuries

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of injury prevention programmes on anterior cruciate ligament injuries.

Effects of balance training with visual input manipulations on balance performance and sensory integration in healthy young adults: a randomized controlled trial

Although balance training can improve balance across various populations, the underlying mechanisms, such as how balance training may alter sensory integration, remain unclear. This study examined the effects of balance training with visual input manipulations provided by virtual reality versus conventional balance training on measures of postural sway and sensory integration during balance control. Twenty-two healthy young adults were randomly allocated into a balance training group (BT) or a balance training with virtual reality group (BT + VR). The BT received traditional balance training, while the BT + VR additionally received visual manipulations during the 4-week balance training to elicit sensory conflicts. Static balance was measured in the form of center of pressure (COP) sway speed in trained (eyes open) and untrained (eyes closed) balance conditions. A model-based analysis quantified the sensory integration and feedback characteristics of the balance control mechanism. Herein, the visual weight quantifies the contribution of visual orientation information to balance while the proportional and derivative feedback loop-gains correct for deviations from the desired angular position and angular velocity, respectively. Significant main time effects were observed for the visual sensory contribution to balance (p = 0.002, [Formula: see text] = 0.41) and for the derivative feedback loop-gain (p = 0.011, [Formula: see text] = 0.29). Significant group-by-time interactions were observed for COP sway speed in the untrained task (p = 0.023, [Formula: see text] = 0.23) in favor of BT + VR and in the proportional feedback loop-gain, with reductions only in the BT + VR group (p = 0.043, [Formula: see text] = 0.2). BT + VR resulted in larger performance improvements compared with traditional BT in untrained tasks, most likely due to reduced reliance on visual information. This suggests that the systematic modulation of sensory inputs leads to enhanced capacity for motor adaptation in balance training.

Body Checking Injuries in National Collegiate Athletic Association Men's Ice Hockey: Findings From the NCAA Injury Surveillance Program 2009/10 to 2019/20

OBJECTIVE

To describe the epidemiology of body checking injuries in the National Collegiate Athletic Association (NCAA) Men's Ice Hockey.

DESIGN

Secondary data analysis of historical cohort data.

SETTING

A convenience sample of injuries in NCAA Men's Ice Hockey during the 2009/10 to 2019/20 academic years.

PATIENTS OR PARTICIPANTS

NCAA student-athletes.

INDEPENDENT VARIABLES

Event type, season, time loss, body part, diagnosis, player position, and mechanism.

MAIN OUTCOME MEASURES

This study examined injuries that occurred during practice or competition, regardless of time loss, reported to the NCAA Injury Surveillance Program. Injury counts, rates, and proportions were used. The injury rate and proportion ratios with 95% confidence intervals were also constructed. Three independent logistic regression models were constructed to examine differential odds of time loss (≥1 day; TL) injury and the 2 most common injuries, between body checking injuries and all other injuries.

RESULTS

Overall, 1290 body checking injuries (rate = 1.59/1000 athlete-exposures) were reported during the study period. Most were attributed to the upper extremity (42%) or head/neck (27%). The competition injury rate generally decreased after 2012/13. After adjusting for covariates, odds of (1) a TL injury was lower and (2) an acromioclavicular sprain was higher among body checking injuries as compared with injuries attributed to all other activities. Odds of concussion was not associated with body checking injuries.

CONCLUSIONS

Body checking injuries were frequently attributed to the head/neck and upper extremities, and the rate of these injuries during competition appeared to be decreasing. Still, improvements in helmet and shoulder pad technology may further improve health and safety.

Effects of training protocols on dancers' balance: A systematic review

BACKGROUND

Balance is an essential skill for dancers, it helps reduce the risk of injury, and is related to quality of performance. This systematic review aims to investigate the effects of training protocols on the balance of dancers when compared to control groups.

METHODS

Interventional studies, published until January 2023, assessing balance in all levels of ballet, modern, and contemporary dancers were identified in the PubMed, Cochrane, Lilacs, Scielo, Embase, and SPORTDiscus databases. Publications in English, Spanish and Portuguese were considered. In two selection phases, using a standard protocol, two reviewers independently selected and extracted the data. The Downs & Black checklist was used to assess risk of bias.

RESULTS

Of the nine intervention studies included, most were classified as either "fair" or "poor" quality. Three-hundred and seventy-two dancers aged 9.6 ± 0.5 to 25.7 ± 3.7 years were analysed. The majority was female (94%), with the years of experience of ballet (35%) or ballet and modern (49%) training ranging from 4.6 ± 1.4 to 12.0 ± 7.5 years. Numerous training protocols of varying durations were found. However, neuromuscular training proved the most effective at improving balance.

CONCLUSION

Most of the studies are classified poor quality. Future studies should consider interventions lasting at least four weeks, two to three times a week, sessions between 30 and 60 min. More high-quality studies, randomized control trials using validated balance tests, as well as new validation studies for dance-specific balance tests are needed.

Age-related decline in GABAergic intracortical inhibition can be counteracted by long-term learning of balance skills

Ageing induces a decline in GABAergic intracortical inhibition, which seems to be associated not only with decremental changes in well-being, sleep quality, cognition and pain management but also with impaired motor control. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. Therefore, the present study investigated whether age-related cortical dis-inhibition could be reversed after 6 months of balance learning and whether improvements in postural control correlated with the extent of reversed dis-inhibition. The results demonstrated that intracortical inhibition can be upregulated in elderly subjects after long-term balance learning and revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition and may therefore be seminal for many pathologies in which the equilibrium between inhibitory and excitatory neurotransmitters is disturbed. KEY POINTS: Ageing induces a decline in GABAergic intracortical inhibition. So far, little is known regarding whether targeted interventions can prevent the decline of intracortical inhibition in the primary motor cortex in the elderly. After 6 months of balance learning, intracortical inhibition can be upregulated in elderly subjects. The results of this study also revealed a correlation between changes in balance performance and intracortical inhibition. This is the first study to show physical activity-related upregulation of GABAergic inhibition in a population with chronic dis-inhibition.

Effects of proprioceptive training on sports performance: a systematic review

BACKGROUND

Proprioception, the ability to sense the body's position and movement, is essential for athletic performance and physical well-being. The literature highlights the importance of proprioceptive training in rehabilitation, sports performance, injury prevention, and motor function enhancement. Targeted training programs can improve balance, coordination, motor learning, and overall physical performance. This systematic review aimed to examine the effects of proprioceptive training methods on sports and athletic performance.

METHODS

A comprehensive search was conducted using the Web of Science, PubMed, and Scopus databases, and a literature review was performed based on the PICO criteria outlined in the abstract and title.

RESULTS

Following the search, 178 articles were identified using relevant keywords, of which 19 directly addressed sports performance and were included in this study. The findings revealed that proprioceptive training had a positive influence on various aspects of athletic performance, including physiological capacity, balance, explosive strength, speed, agility, postural stability, knee joint position sense, muscle activation, reduction of chronic joint instability, dribbling, passing, and technical ball-control skills.

CONCLUSIONS

These results indicate that proprioceptive training can be an effective strategy for experts and coaches to enhance athletes' physical performance. Primarily, proprioceptive exercises should be used inside and outside the training sessions to enable athletes to interact more effectively with their bodies, reduce the risk of injury, and improve power transfer.

Effect of Combined Training With Balance, Strength, and Plyometrics on Physical Performance in Male Sprint Athletes With Intellectual Disabilities

Individuals with intellectual disabilities often face unique challenges in physical capabilities, making traditional training methods less effective for their specific needs. This study aimed to investigate the effect of combining balance, plyometric, and strength (CBPS) training with sprint training on physical performance in male athletes with intellectual disabilities. Twenty-seven participants were randomly assigned to either a CBPS group or a control group that only maintained their regular sprint training. Participants underwent pre- and posttraining tests, including measures of balance, jumping, agility, and sprinting ability. The results showed that the CBPS group demonstrated significant improvements (p < .05) in one-leg stance, crossover-hop jump, squat jump, countermovement jump, and 10- and 30-m sprint at posttraining compared with pretraining. CBPS training combined with sprinting significantly improves physical performance in male athletes with intellectual disabilities, suggesting implications for tailored training programs to enhance their physical fitness and overall health.

Efficacy of multicomponent interventions on injury risk among ice and snow sports participants-a systematic review and meta-analysis

BACKGROUND

Ice and snow sports, which are inherently high risk due to their physically demanding nature, pose significant challenges in terms of participant safety. These activities increase the likelihood of injuries, largely due to reduced bodily agility and responsiveness in cold, often unpredictable winter environments. The critical need for effective injury prevention in these sports is emphasized by the considerable impact injuries have on the health of participants, alongside the economic and social costs associated with medical and rehabilitative care. In the context of ice and snow sports environments, applying the E principles of injury prevention to evaluate intervention measures can guide the implementation of future sports safety and other health promotion intervention measures in this field. When well executed, this approach can substantially reduce both the frequency and severity of injuries, thereby significantly enhancing the safety and long-term viability of these challenging sports.

OBJECTIVE

The objective of this study was to rigorously assess and statistically substantiate the efficacy of diverse injury prevention strategies in ice and snow sports, aiming to bolster future safety measures with solid empirical evidence.

DESIGN

Systematic review and meta-analysis.

METHODS

The overarching aim of this research was to meticulously aggregate and scrutinize a broad spectrum of scholarly literature, focusing on the quantifiable efficacy of diverse, multicomponent intervention strategies in mitigating the incidence of injuries within the realm of ice and snow sports. This endeavour entailed an exhaustive extraction of data from esteemed academic databases, encompassing publications up to September 30, 2023. In pursuit of methodological excellence and analytical rigor, the study employed advanced bias assessment methodologies, notably the AMSTAR 2 and GRADE approaches, alongside sophisticated random-effects statistical modelling. This comprehensive approach was designed to ensure the utmost validity, reliability, and scholarly integrity of the study's findings.

RESULTS

Fifteen papers, including 9 randomized controlled trials, 3 case‒control studies, and 3 cohort studies with 26,123 participants and 4,382 injuries, were analysed. The findings showed a significant reduction in injury rates through various interventions: overall injury prevention (RR = 0.50, 95% CI 0.42-0.63), educational training (RR = 0.50, 95% CI 0.34-0.73), educational videos (RR = 0.53, 95% CI 0.34-0.81), protective equipment (RR = 0.64, 95% CI 0.46-0.87), and policy changes (RR = 0.28, 95% CI 0.16-0.49). Subgroup analysis revealed potential heterogeneity in compliance (p = 0.347). Compared to controls, multicomponent interventions effectively reduced injury rates.

CONCLUSION

This systematic review and meta-analysis demonstrated that multicomponent interventions significantly prevent injuries in ice and snow sports. By applying the E principles of injury prevention and constructing a framework for practical injury prevention research in ice and snow sports, we can gradually shift towards a systemic paradigm for a better understanding of the development and prevention of sports injuries. Moreover, sports injury prevention is a complex and dynamic process. Therefore, high-quality experiments in different scenarios are needed in future research to provide more reliable evidence, offer valuable and relevant prevention information for practitioners and participants, and help formulate more effective preventive measures in practice.

Effectiveness of exercise-based sports injury prevention programmes in reducing injury rates in adolescents and their implementation in the community: a mixed-methods systematic review

OBJECTIVE

Despite evidence supporting the efficacy of sport injury prevention programmes (SIPPs) in adolescents, implementation of SIPPs in community settings is low. This review aims to synthesise and integrate evidence on the efficacy of exercise-based SIPPs in reducing injury rates in adolescents with implementation strategies for such programmes in the community.

DESIGN

A systematic review with meta-analysis, narrative synthesis and meta-aggregation was conducted, followed by a convergent segregated approach to integrate the findings. Sensitivity and subgroup analyses were conducted. Study appraisal was performed using Joanna Briggs Institute Critical Appraisal Checklists and Mixed Methods Appraisal Tool.

DATA SOURCES

Literature search of nine databases was carried out to identify studies in English from January 2012 to December 2022.

ELIGIBILITY CRITERIA

Included were randomised controlled trials (RCTs), qualitative or mixed-methods studies. Population included adolescents (10-19 years). Interventions included SIPPs. Outcomes were injury rate and rate ratio (IRR). Phenomena of interest were facilitators and barriers to the implementation of SIPPs.

RESULTS

23 studies were included for analysis. Meta-analysis for 16 RCTs showed a protective effect of SIPP (IRR 0.63, 95% CI 0.53 to 0.74, p<0.00001) in adolescents. Meta-aggregation of seven qualitative/mixed-method studies revealed four sets of synthesised findings that impact implementation namely players' perceptions and beliefs, coaches as key facilitators, organisational support and characteristics of the SIPP.

CONCLUSION

Implementation of SIPPs provides a 37% risk reduction in adolescents but requires targeting key stakeholders through a top-down multifaceted approach for its efficacy to be translated. Future research should investigate the effectiveness of SIPPs and implementation strategies in adolescents in community settings.

Impact of neuromuscular training including balance, strength and plyometric exercises on static and dynamic balance in high-level male runners with mild intellectual disability

BACKGROUND

This study aims to investigate the impact of neuromuscular training (NMT) on static and dynamic postural balance (PB) among high-level male runners with intellectual disability.

METHOD

Twenty-seven runners were randomly assigned to a NMT group and a control group who maintained their conventional training. Static and dynamic PB were assessed using the centre of pressure (CoP) excursions (in bipedal and unipedal stances under open eyes (OE) and closed eyes (CE) conditions) and the star excursion balance test (SEBT), respectively, at pre-training and post-training.

RESULTS

The NMT group showed significantly (p < 0.05) decreased CoP values and increased SEBT scores at post-training compared to pre-training. The switch from OE to CE did not affect static PB in the bipedal stance, only in the NMT group.

CONCLUSIONS

The NMT was effective in improving static and dynamic PB in runners with intellectual disability. The NMT could reduce visual dependency.

Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis

BACKGROUND

Endurance running is a popular sport and recreational activity yet is associated with a high prevalence of injury. Running related injuries (RRIs) are a leading cause of drop-out and represent a substantial financial burden to runners and healthcare services. There is clear evidence for the use of exercise-based injury prevention programs in games-based and youth sport settings, yet the research investigating the use of exercise to reduce injury risk in endurance runners has not been adequately reviewed recently.

OBJECTIVES

The aim of this review and meta-analysis was to systematically summarize the current research that has investigated the effect of exercise-based prevention programs and their state of supervision on the risk of RRIs in endurance runners.

METHODS

Three databases were searched for relevant studies. Selection and review were completed by two independent reviewers using the following inclusion criteria: (1) study population used endurance running training for health, occupational, or performance outcome(s); (2) participants performed running as their main form of exercise (> 50% of their total training time); (3) study was a randomized controlled trial; (4) a non-running-based exercise intervention was used; (5) a running-only or placebo exercise control group was included; (6) injury rate or incidence was reported; (7) injuries were recorded prospectively alongside the exercise training. Two meta-analyses were conducted using random-effects models, one based on log risk ratio and one based on log incidence rate ratio. The Cochrane Risk of Bias Assessment Tool 2 was used to evaluate the quality of studies and the Grading of Recommendations Assessment, Development and Evaluations approach was employed to grade the certainty of evidence.

RESULTS

A total of nine articles containing 1904 participants were included in analysis. Overall pooled results showed no significant differences between intervention and control groups in injury risk (z = - 1.60; p = 0.110) and injury rate (z = - 0.98; p = 0.329), while a post hoc analysis evaluating supervised interventions only showed that injury risk was significantly lower in the intervention group compared to the control group (z = - 3.75, p < 0.001). Risk of bias assessment revealed that seven studies included in the analysis were of low quality.

CONCLUSIONS

Exercise-based interventions do not appear to reduce the risk and rate of running-related injuries. Supervision may be essential for exercise-based intervention programs to reduce risk of RRIs, possibly due to increased compliance. Studies with more robust designs that include supervised exercise interventions should be prioritized in the future.

TRIAL REGISTRY

Clinical Trial Registration: PROSPERO CRD42021211274.

Attitudes Toward Injury-Prevention Program Participation Based on Race and Collegiate Division in Female Athletes

CONTEXT

Injury-prevention programs (IPPs) have been effective in reducing lower extremity injury rates, but user compliance plays a major role in their effectiveness. Race and collegiate division may affect attitudes toward participation in IPPs and compliance in female collegiate athletes.

OBJECTIVE

To compare attitudes toward IPPs based on race and collegiate division.

DESIGN

Cross-sectional study.

SETTING

Survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 118 female collegiate athletes (age = 19.71 ± 1.47 years, height = 169.46 ± 9.09 cm, mass = 69.57 ± 11.57 kg) volunteered.

MAIN OUTCOME MEASURE(S)

Participants completed the Health Belief Model Scale and the Theory of Planned Behavior Scale (TPBS) on 1 occasion. The Health Belief Model Scale contains 9 subscales (perceived susceptibility, perceived consequences, fear of injury, perceived benefits, perceived barriers, community-led self-efficacy, individual self-efficacy, general health cues, external health cues), whereas the TPBS has 5 subscales (perceived benefits, perceived barriers, perceived social norms, social influence, intention to participate). The independent variables were race (White versus Black, Indigenous, and other people of color [BIPOC]) and National Collegiate Athletic Association division (I and III). Mann-Whitney U tests were used to detect differences in attitudes toward IPP participation based on race and collegiate division.

RESULTS

White female athletes perceived fewer TPBS barriers to participation in IPPs (P = .003) and more community-led self-efficacy when compared with BIPOC female athletes (P = .009). Division I athletes perceived a greater fear of injury (P = .002) and more general health cues (P = .01) than Division III athletes.

CONCLUSIONS

For lower extremity IPPs, BIPOC and Division III female collegiate athletes may need different implementation strategies. Individuals who identify as BIPOC may benefit from interventions focusing on solutions for common barriers to participation and improving community-led self-efficacy, and Division III athletes may benefit from interventions focusing on education related to the risk of injury and general preventive health behaviors.

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.

Effect of neuromuscular injury prevention strategies on injury rates in adolescent males playing sport: a systematic review protocol

OBJECTIVE

This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports.

INTRODUCTION

Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This review will include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population.

INCLUSION CRITERIA

Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies that evaluate neuromuscular injury prevention strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and training, warm up, cool down, stretches, neuromuscular control) vs no intervention or standard training and competition exposure will be included. The outcomes of interest are injury incidence and prevalence rates.

METHODS

Databases searched will include MEDLINE (PubMed), CINAHL Complete (EBSCOhost), ClinicalKey, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCOhost), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer.

REVIEW REGISTRATION

PROSPERO CRD42022327047.

Effect of Pilates Intervention on the Physical Conditioning of a Ballet Dancer: A Single Case Study

Objective

The purpose of this case study was to report the effect of an 8-week Pilates intervention on a ballet dancer's strength, balance, and endurance.

Clinical Features

A healthy 24-year-old ballet dancer (50 kg, 1.66 meters, 12 years of practice and who had no previous experience with Pilates) presented for care. She was evaluated before and after an 8-week Pilates exercise intervention.

Intervention and Outcome

The isokinetic trunk flexion and extension, electromyographic activation of multifidus and internal oblique muscles, neuromuscular efficiency, trunk muscle endurance, and body balance were evaluated. After 8 weeks, we observed increased torque levels, neuromuscular efficiency and time spent in endurance tests and improved body balance.

Conclusion

The ballet dancer in this study demonstrated increased strength, balance, and endurance after an 8-week Pilates intervention.

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).

Balance Training Under Fatigue: A Randomized Controlled Trial on the Effect of Fatigue on Adaptations to Balance Training

ABSTRACT

Keller, M, Lichtenstein, E, Roth, R, and Faude, O. Balance training under fatigue: a randomized controlled trial on the effect of fatigue on adaptations to balance training. J Strength Cond Res 38(2): 297-305, 2024-Balance training is an effective means for injury prevention in sports. However, one can question the existing practice of putting the balance programs at the start of a training session (i.e., train in an unfatigued state) because the occurrence of injuries has been associated with fatigue. Therefore, the aim of this study was to assess the influence of balance training in a fatigued or an unfatigued state on motor performance tested in fatigued and unfatigued conditions. Fifty-two, healthy, active volunteers (28.0 years; 19 women) were randomly allocated to 1 of 3 different training groups. The BALANCE group completed 6 weeks of balance training. The other 2 groups completed the identical balance tasks either before (BALANCE-high-intensity interval training [HIIT]) or after (HIIT-BALANCE) a HIIT session. Thus, these groups trained the balance tasks either in a fatigued or in an unfatigued state. In PRE and POST tests, balance (solid ground, soft mat, wobble board) and jump performance was obtained in fatigued and unfatigued states. Balance training resulted in reduced sway paths in all groups. However, the linear models revealed larger adaptations in BALANCE-HIIT and BALANCE when compared with HIIT-BALANCE ( d = 0.22-0.71). These small to moderate effects were-despite some uncertainties-consistent for the "unfatigued" and "fatigued" test conditions. The results of this study revealed for the first time that balance training under fatigue results in diminished adaptations, even when tested in a fatigued state. Therefore, the data indicate that balance training should be implemented at the start of a training session or in an unfatigued state.

Clinical Determinants of Knee Joint Loads While Sidestepping: An Exploratory Study With Male Rugby Union Athletes

Background

While several clinical factors have independently been linked to anterior cruciate ligament (ACL) injury risk factors, their collective impact on knee loading during the sidestep maneuver is unknown. To better understand these factors, we assessed the relationship between strength, balance, and sprint kinetics and external knee abduction moments during sidestepping on each leg.

Methods

Sixteen male academy-level rugby union athletes (age, 20 ± 3 years; body-height, 186 ± 9 cm; body-mass, 99 ± 14 kg) were bilaterally assessed in single-leg: isokinetic concentric and eccentric knee and concentric hip strength, balance at 2 difficulty levels, vertical and horizontal force production during maximal sprinting, and 3-dimensional motion capture while sidestepping on the preferred and non-preferred leg. A hierarchical multiple regression analysis based on this theoretical approach of the mechanics of ACL injury risk was performed.

Results

When sidestepping on the preferred leg, larger abduction moments were explained by less concentric hip extension strength and vertical force production during maximal sprinting (R 2 = 41%; ES = 0.64); when sidestepping on the non-preferred leg, larger abduction moments were explained by more concentric hip flexion strength (R 2 = 8%; ES = 0.29). Larger symmetry scores between the legs (representing greater abduction moments) were explained by more horizontal force production during maximal sprinting and less eccentric knee flexion strength (R 2 = 32%; ES = 0.56).

Conclusions

Independently, the preferred and non-preferred legs contribute to increased knee abduction moments via unique distributions of strength and/or sprint kinetics. The allocations of strength and sprint kinetics appear interrelated through weaker posterior muscular strength and may be modifiable through a targeted strength training approach.

Informing wobble-board training and assessment through an investigation of the effect of biological-sex, anthropometrics, footwear and dual-tasking in young adults

BACKGROUND

Despite wobble board use being common in physiotherapy the effect of certain factors, essential to clinical reasoning, have not been investigated.

OBJECTIVE

To determine the effect of biological sex, anthropometrics, footwear and dual tasking (DT) on wobble board balance performance.

METHODS

Eighty-six healthy participants (44 females) had their wobble board performance measured during double-leg-stance (DLS) with eyes open (DLSEO), closed (DLSEC) and single-leg-stance (SLS) tasks, with and without footwear and a DT added. Anthropometrics were also measured.

RESULTS

Females outperformed males during most tasks, with some large effect sizes (ES). Performance was moderately related to weight and shoulder, waist and hip circumference. Overall, there were no differences between footwear and no footwear, except for males during SLS. DT made little difference, except during DLSEO and SLS, where single task was better than DT, though only females had a large ES.

CONCLUSION

During wobble board tasks, biological sex differences were observed and a modest correlation between anthropometrics and performance noted. DT and footwear had minimal effect.

A 10-week FIFA 11+ program improves the short-sprint and modified agility T-test performance in elite seven-a-side soccer players

Objective: The primary objective of this study was to assess the effects of 10 weeks of FIFA 11+ training on the physical performance of elite seven-a-side soccer players. Methods: Twenty-five seven-a-side soccer players were recruited from two senior national teams. The players completed the following protocols during 10 weeks of training: a) FIFA 11+: The FIFA group (n = 13) underwent the FIFA 11+ program combined with regular soccer training; b) Dynamic conventional warm-up: The control group (n = 12) underwent regular soccer training. Their ability was validated using a pre-test followed by a post-test to measure the sprint performance (5-, 10-, and 20-m sprints), a modified agility T-test (MAT), and a five-jump test (FJT). Results: A comparison of pre- and post-tests for physical performance in each group demonstrated that the FIFA 11+ warm-up significantly improved the 10-m sprinting performance (p = 0.034; F = 5.04; ηp 2 = 0.17) and reduced the time spent to perform the MAT (p = 0.000; F = 23.16; ηp 2 = 0.52) in the FIFA group compared with the control group; however, no significant changes were observed in the 5- and 20-m sprints and FJT. Conclusion: The main findings of this research showed that the 10-week FIFA 11+ program led to significant improvements in the 10-m sprint and MAT compared to regular training among elite seven-a-side soccer players. Given these positive outcomes, further studies on the practical implementation and optimization of the FIFA 11+ program are warranted to provide valuable guidance for coaches and athletes, seeking to maximize its benefits in real-world settings.

Epidemiology of Injuries in Professional and Amateur Football Men (Part II)

Background (1): Men's football is a physically demanding contact sport that involves intermittent bouts of sprinting, jogging, walking, jumping and changes of direction. The physical demands of the game vary by level of play (amateur club, sub-elite and open club or international), but injury rates at all levels of the men's football game remain the highest of all sports. Objective: The aim of this study is to conduct a systematic review of data from the epidemiological literature regarding the profile, severity and mechanisms of injuries and the frequency of recurrent injuries in professional and amateur football players. Methods (2): A systematic review, according to PRISMA guidelines, was performed up to June 2023 in the databases of PubMed, Web of Science, Google academic, Google scholar and the Diva portal. Twenty-seven studies that reported data on the type, severity, recurrence and mechanisms of injury in professional and amateur men's football were selected and analyzed. Two reviewers independently audited data and assessed the study quality using the additional and adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): In professional male football players, the mean prevalence of muscle/tendon injuries was 39.78%, followed by joint and ligament injuries-21.13%, contusions-17.86%, and fractures-3.27%, and for amateur football players, the prevalence's were 44.56% (muscle/tendon injuries), 27.62% (joint and ligament injuries), 15.0% (contusions) and 3.05% (fracture), respectively. The frequency of traumatic injuries was higher in amateur football players (76.88%) compared to professional football players (64.16%), the situation being reversed in the case of overuse injuries: 27.62% in professional football players and 21.13% in amateur football players. Most contact injuries were found in professional footballers (50.70%), with non-contact injuries predominating in amateur footballers (54.04%). The analysis of the severity of injuries showed that moderate injuries dominated in the two categories of footballers; the severe injuries in amateur footballers exceeded the severe injuries recorded in professional footballers by 9.60%. Recurrence proportions showed an inverse relationship with the level of play, being higher in amateur footballers (16.66%) compared to professional footballers (15.25%). Conclusions (4): Football-related injuries have a significant impact on professional and amateur football players and their short- and long-term health status. Knowing the frequency of severe diagnoses, such as strains, tears and cramps of the thigh muscles, ankle ligament sprains and hip/groin muscle strain requires the establishment of adequate programs to prevent them, especially in amateur football players, who are more prone to serious injuries.

Hip Abductor and External Rotator Strengths Correlate With Hop Symmetry in Men Athletes 2 Years After Anterior Cruciate Ligament Reconstruction

CONTEXT

Hip muscle strength and hop performance limb symmetries after anterior cruciate ligament reconstruction (ACLR) are not well studied. This study aimed to determine the differences in hip abductors' (ABD) and external rotators' (ER) muscle strength measures between limbs, and the relationship between hip ABD and ER muscle strengths and hop performance limb symmetry indices (LSIs) 2 years after ACLR.

DESIGN

Cross-sectional study.

METHODS

Forty (level I/II) men athletes 2 years after unilateral ACLR completed 4 single-legged hop tests and involved hip ABD and ER strength testing (maximum voluntary isometric contraction [MVIC]; isokinetic peak torque [PKTQ] at 60°, 180°, and 300°/s; and isotonic peak velocity at 75% of their MVICs). Muscle strength measures were normalized to body mass, and hop performances were reported as LSIs. Paired t test was used to determine strength differences between limbs, and the Pearson correlation coefficient was used to assess the relationship between involved hip muscle strength measures and hop performance LSIs.

RESULTS

Hip ER-MVIC (involved: 60.26 [12.01], uninvolved: 63.68 [13.17] N·m/kg) and ER eccentric PKTQ at 60°/s (involved: 32.59 [9.28]; uninvolved: 35.73 [10.50] N·m/kg) were significantly different between limbs (P ≤ .018). Single-hop LSI correlated with hip ER-PKTQ at 180°/s (r = .354) and 300°/s (r = .324, P ≤ .041), while triple-hop LSI correlated with hip ER-MVIC (r = .320), concentric ER-PKTQ at 180°/s (r = .355), eccentric ER-PKTQ at 60°/s (r = .314), and hip ABD-PKTQ at 60°/s (r = .364) and 300°/s (r = .336, P ≤ .049).

CONCLUSIONS

Men athletes demonstrated symmetrical hop performance and hip muscle strengths, except for ER hip's MVIC and isokinetic eccentric peak torque at 60°/s 2 years after ACLR. Hop performance LSIs had a few, yet positive moderate relationships with involved hip ABDs and ER strength measures. This may indicate that hip ABD and ER muscle strength measures contribute to athletes' hop performances 2 years after ACLR. Post-ACLR rehabilitation programs might incorporate hip muscle strengthening training to improve athletes' functional performances.

Effects of the FIFA 11+ program on performance, biomechanical measures, and physiological responses: A systematic review

BACKGROUND

The side effects of the FIFA 11+ program on performance have not been generally reviewed. The objective of this study was to synthesize the literature on the effects of the 11+ on players' performance.

METHODS

Five online databases (PubMed, Scopus, ScienceDirect, Springer, and Google Scholar) were searched (from April 2006 to March 2022) using predefined keywords and sub-keywords. The potential references were primarily recorded through Endnote and imported to Covidence. Out of the 123 references screened by 2 blinded researchers through the software, 59 full texts were assessed for eligibility, 33 of which were ultimately included. The quality of the studies and the risk of bias were then assessed. Study ID, title, place, aim, design, start/end dates, population description, study criteria, statistical analysis, and outcomes were extracted.

RESULTS

Studies were conducted on male and female players aged 10-32 years old. The quality of the studies was moderate to high, and except for unclear bias for blinding outcome assessment, the risk of bias for all domains was low. Long-term application of the 11+ improved most biomechanical measures and physiological responses except for lower extremity stability, ankle evertors time latency, ankle dorsiflexion, and proprioception. Conversely, the 11+ showed acute negative effects on physical performance compared to dynamic warm-ups and non-significant effects on technical abilities.

CONCLUSION

Mid-to-long-term implementation of the 11+ improved the majority of biomechanical and a couple of physical measures but showed no effects on technical skills. Precaution must be observed for using the 11+ before competitions, as it could acutely decrease physical/technical performance. Given the contradictory nature of the literature, further studies should evaluate the short-to-mid-term effects of the 11+. Further studies are required to address ankle responses to the 11+ intervention.

Strength and Conditioning Practices of Brazilian Olympic Sprint and Jump Coaches

Olympic coaches are likely to have adequate knowledge and implement effective training programs. This study aimed to describe and critically examine the strength and conditioning practices adopted by Brazilian Olympic sprint and jump coaches. Nineteen Olympic coaches (age: 50.2 ± 10.8 years; professional experience: 25.9 ± 13.1 years) completed a survey consisting of eight sections: 1) background information; 2) strength-power development; 3) speed training; 4) plyometrics; 5) flexibility training; 6) physical testing; 7) technology use; and 8) programming. It was noticed that coaches prioritized the development of explosiveness, power, and sprinting speed in their training programs, given the specific requirements of sprint and jump events. Nevertheless, unexpectedly, we observed: (1) large variations in the number of repetitions performed per set during resistance training in the off-season period, (2) a higher volume of resistance training prescribed during the competitive period (compared to other sports), and (3) infrequent use of traditional periodization models. These findings are probably related to the complex characteristics of modern competitive sports (e.g., congested competitive schedule) and the individual needs of sprinters and jumpers. Identification of training practices commonly used by leading track and field coaches may help practitioners and sport scientists create more effective research projects and training programs.

Current Practices, Willingness and Perceived Ability to Implement an Injury Prevention Exercise Program Among Post-Primary Physical Education Teachers

BACKGROUND

Musculoskeletal injuries are common in adolescents, and recently schools have been suggested as an opportune location for injury prevention strategies. This study aimed to identify the current practices and perceptions of post-primary PE teachers in Ireland on injury prevention exercise programs (IPEP), which are key to informing potential implementation strategies.

METHODS

Post-primary PE teachers (n = 287) completed an online anonymous survey. Outcome measures included current IPEP practices in PE class, teachers' attitudes toward IPEPs, willingness to implement, and perceived ability to implement an IPEP in PE class. Descriptive statistics were calculated, and Mann-Whitney U tests were used to compare differences between groups.

RESULTS

Results indicated that only 1 in 5 PE teachers currently used an IPEP in class. Of these, no teacher used an existing IPEP exactly as intended, while most teachers were willing to implement an IPEP (80.5%). Those who previously received formal IPEP education or were aware of an existing IPEP had significantly higher perceived ability to implement an IPEP in class (p < .001).

CONCLUSIONS

This study demonstrates that despite a willingness among PE teachers to implement IPEPs in class, few currently do. Thus, post-primary PE class may be an under-utilized setting for adolescent injury prevention and warrants further investigation.

KNEE JOINT REHABILITATION IN BADMINTON ATHLETES

ABSTRACT Introduction: Athletic injuries are common in badminton, and the knee joint is the most affected. This type of injury can reduce the athlete's career, and poor treatment can cause secondary injuries during the rehabilitation period, requiring a thorough study of the causes and treatment methods. Objective: Study the causes and rehabilitation methods of knee joint injuries in badminton players. Methods: Junior badminton students and professional players from a university volunteered for a study on the causes of their knee joint injuries and the various types of rehabilitation training they were allocated to. The control group was treated with traditional physical therapy, and the experimental group was treated with slow recovery training under the guidance of doctors and teachers. The experiment lasted 6 weeks, and pain recovery and joint stability index were the main indicators. Results: Knee joint injuries in athletes often occur when performing intense or unfamiliar movements. The scores of the experimental group evolved rapidly during the 6 weeks of rehabilitation. The total stability index before training was 6.3432 ± 0.4647 versus 5.7190 ± 0.3747 after the experiment. Conclusion: Training in the physical rehabilitation of knee joint injuries in athletes has a good effect on pain relief and gain in joint stability, proving to be superior to acupuncture and traditional physiotherapy. Therefore, adding this restorative training protocol to knee joint rehabilitation in athletes is recommended. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

JOINT INJURIES IN MARTIAL ARTS AND THEIR PREVENTIVE MEASURES

ABSTRACT Introduction: Martial arts athletes are highly prone to joint injuries during training or sports events. These injuries can affect professional performance and cause deleterious psychological damage to athletes. Objective: Explore the current status of joint injuries in martial arts and propose effective preventive measures. Methods: Martial arts athletes were selected to evaluate the types of joint injuries and the method of training in rehabilitating these injuries (n=32). They were randomly divided into an experimental group and a control group. The experimental group received a specific functional preventive training protocol based on updated scientific findings, while the control group received traditional physical training. Range of motion and functional FMS tests were performed before and after the interventions. The results were compared statistically. Results: The most common type of injury for athletes in martial arts is joint injury, followed by ligament and synovial inflammation. The probability of a joint injury rises when athletes are in continuous action training; the FMS test results of the athletes in the experimental group were significantly improved, with a very significant effect. Conclusion: The preventive functional training proposed in this paper can improve athletes’ fitness, improve coordination and joint stability, and prevent sports injuries. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

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.

Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis

Background

Ankle sprains remain prevalent across most team sports. However, despite divergent ankle sprain injury rates in male and female athletes, little is known about potential sex-specific risk factors for ankle sprain.

Objective

To systematically investigate the sex-specific risk factors for ankle sprain.

Methods

Combinations of the key terms were entered into PubMed, Web of Science, Embase and Cochrane Library databases, and prospective studies reporting ankle sprain risk factors in males or females were included for meta-analysis.

Results

Sixteen studies were eligible for inclusion, for a total of 3636 athletes (735 female) and 576 ankle sprains (117 female). Out of 21 prognostic factors, previous ankle sprain injury (odds ratio = 2.74, P < .001), higher body mass index (SMD = 0.50, P < 0.001), higher weight (SMD = 0.24, P = 0.02), lower isometric hip abduction strength (SMD = − 0.52, P < 0.0001) and lower dynamic balance performance (SMD = − 0.48 to − 0.22, P < 0.001–0.04) were identified as risk factors in male athletes. In female athletes, out of 18 factors eligible for meta-analysis, only lower concentric dorsiflexion strength was identified as a risk factor (SMD = − 0.48, P = 0.005).

Conclusion

This meta-analysis provides novel evidence for different risk factor profiles for ankle sprain injuries between female and male athletes. Further studies, particularly in female athletes, are needed to strengthen the evidence.

Effects of the FIFA 11+ and a modified warm-up programme on injury prevention and performance improvement among youth male football players

Introduction

The effects of the FIFA11+ programme (the 11+) on ankle and groin injuries and performance have remained questionable. The latter, particularly, has potentially reduced the implementation rate and applicability of the programme. This study aimed to evaluate the mid-to-long-term effects of the 11+ and a modified programme including football-specific exercises on injury prevention and performance improvement.

Materials and methods

Three teams of the Iranian Youth League (division two) volunteered to participate in this study and were randomly assigned to two intervention groups (F11+; n = 29, M11+; n = 31) and a control group (n = 30). The F11+ followed the FIFA 11+ programme, whereas the M11+ performed modified exercises three times weekly as a warm-up protocol before training and competition through a football season. The control group carried out its routine warm-ups, including joggings, basic football drills, and static stretches, while having no injury prevention approaches. Lower extremity injuries, as well as exposure time for each player, were recorded. The football-specific performance was assessed using the Illinois Agility and Slalom Dribbling tests. ANOVA, Fisher Freeman Halton, and chi-square tests were used to analyze the data.

Results

Injury incidences differed significantly between groups (p = 0.02, C = 0.40), with M11+ reporting the lowest incidence. Significant differences between the pre- and posttest as well as differences between the groups for development over time were revealed for the Illinois agility and dribbling speed (p≤0.01). Both performance tests demonstrated a large time effect, as the effect sizes for time in agility and dribbling speed were 0.74 (CI = [0.66; 0.79]) and 0.86 (CI = [0.79; 0.87]), respectively. The effect size for the interaction can be categorized as medium, with 0.38 (CI = [0.25; 0.49]) for agility and 0.52 (CI = [0.40; 0.61]) for dribbling speed. M11+ showed the largest improvement in both.

Discussion

Mid-to-long-term application of a structured dynamic warm-up that integrates injury prevention and performance approaches may lower injury incidences and improve youth subelite players’ performance. Although additional studies with larger samples are needed to prove the results of the current study, the amateur clubs/teams could integrate such twofold dynamic warm up into their routine training plan and benefit its advantages on injury prevention and performance improvement.

Effects of neuromuscular training on athletes physical fitness in sports: A systematic review

Objective: This review study aimed to assess the impact of neuromuscular training (NT) on athletes' physical fitness in sports. Methods: Three independent reviewers conducted a literature search in various databases: EBSCOHOST, PubMed, WOS, Mendeley, Scopus, ProQuest, Science Direct, additional references, and Google Scholar. The methodological quality was examined using Lubans' predetermined methods, and data that included trials were excluded. Results: This review included 18 well-conducted systematic studies from 144 relevant publications. These studies were reviewed and have been given a score of 6. Medium-risk studies were scored 3 or 4, while low-risk studies were scored 5 or 6. None of the studies had a high-risk bias. The NT intervention revealed that balance (n = 10) was the main characteristic of physical fitness that was evaluated, followed by agility (n = 6), muscular strength (n = 4), speed (n = 5), endurance and muscular power (n = 2). Subsequently, most studies used an intervention such as plyometric and strength training exercises to improve agility, balance, and muscular strength among athletes. Conclusion: This review implicated that (NT) focuses on exercises that enhance motor skills which aid athletes in moving their bodies according to their situational needs. The athletes' slower and faster directions influence their agility, muscular strength, and balance, essential for player performance. It is recommended for future research to investigate the effects of neuromuscular training (length of 12-weeks, frequency of 3 days per week and 90-min duration) on physical fitness components (coordination, reaction-time, flexibility, cardiovascular fitness, cardiorespiratory fitness and body composition) that are essential for all ages of male and female athletes in all sports.

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.

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).

Effectiveness of Warm-Up Intervention Programs to Prevent Sports Injuries among Children and Adolescents: A Systematic Review and Meta-Analysis

Sports participation by children and adolescents often results in injuries. Therefore, injury prevention warm-up programs are imperative for youth sports safety. The purpose of this paper was to assess the effectiveness of Warm-up Intervention Programs (WIP) on upper and lower limb sports injuries through a systematic review and meta-analysis. Searches for relevant studies were performed on PubMed, EMBASE, Web of Science, SPORTDiscus, and Cochrane databases. Studies selected met the following criteria: original data; analytic prospective design; investigated a WIP and included outcomes for injury sustained during sports participation. Two authors assessed the quality of evidence using Furlan’s criteria. Comprehensive Meta-Analysis 3.3 software was used to process and analyze the outcome indicators of the literature. Across fifteen studies, the pooled point estimated injury rate ratio (IRR) was 0.64 (95% CI = 0.54−0.75; 36% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested a 6% reduction in the estimate (IRR = 0.70, 95% CI = 0.60−0.82), and the prediction interval intimated that any study estimate could still fall between 0.34 and 1.19. Subgroup analyses identified one significant moderator that existed in the subgroup of compliance (p < 0.01) and might be the source of heterogeneity. Compared with the control group, WIPs significantly reduced the injury rate ratio of upper and lower limb sports injuries in children and adolescents.

Combined Plyometric and Short Sprint Training in U-15 Male Soccer Players: Effects on Measures of Jump, Speed, Change of Direction, Repeated Sprint, and Balance

This study examined the effect of 8 weeks of biweekly combined plyometric and short sprint training into the typical within-season training schedule of youth male soccer players. Participants were allocated at random to an experimental group (EG; n = 17, age: 14.6 ± 0.5 years, body mass: 60.5 ± 7.1 kg, height: 1.64 ± 0.08 m, body fat: 11.3 ± 1.4%) and a control group (CG; n = 17, age: 14.6 ± 0.4 years, body mass: 61.0 ± 3.9 kg, height: 1.67 ± 0.05 m, body fat: 11.8 ± 1.4%). Measures obtained pre- and post-intervention included vertical and horizontal jump performances (i.e., squat jump (SJ), countermovement jump with aimed arms (CMJA), and five-jump test (FJT)) and sprint performances (i.e., 10 and 30 m sprint). In addition, change-of-direction ability (sprint with 90° Turns (S90°) and sprint 9–3–6–3–9 m with backward and forward running (SBF)), repeated shuttle sprint ability (RSSA), and dynamic balance performance (Y balance test) were measured pre- and post-intervention. The EG experienced higher jump (all p < 0.05; d ≥ 0.71), sprint (all p < 0.05; d ≥ 0.64), change-of-direction ability (all p < 0.05; d ≥ 0.66), RSSA (all parameters except the fatigue index p < 0.01; d ≥ 0.71), and dynamic balance (all p ≤ 0.05; d ≥ 0.50) improvement compared to the CG. Adding biweekly combined plyometric and short sprint training to standard training improves the athletic performance of youth male soccer players (under 15 (U15)).

Balance on different unstable supports: a complementary approach based on linear and non-linear analyses

Maintenance of postural control is a complex task that requires the integration of different sensory-motor processes. To improve postural control, balance training is often implemented using unstable surfaces. Little is known, however, about how different surfaces compare in terms of postural control strategy. Non-linear dynamical system analysis, like recurrent quantification analysis (RQA) applied to the center of pressure (CoP) trajectory, represents a useful tool in this respect. The aim of this study is to investigate the effects of different unstable supports on the CoP trajectory through a complementary approach based on linear and non-linear analyses. Seventeen healthy adults performed barefoot single-leg balance trials on a force plate and on three different balance training devices (soft disc, foam pad, and pillow). Sets of parameters were extracted from the CoP trajectories using classical stabilometric analysis (sway path, mean velocity, root mean square) and RQA (percent recurrence and determinism, maximum line length, entropy). Both classical and RQA analyses highlighted significant differences between stable (force plate) and unstable conditions (p < 0.001). Conversely, only classical stabilometric parameters showed significant differences among the considered balance training devices, indicating that the different characteristics of the devices do not influence the dynamic/temporal structure of the CoP trajectory. Analysis of the center of pressure trajectory during single-leg standing on three different balance training devices and on a rigid surface using both linear and non-linear techniques.

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

CONTEXT

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

OBJECTIVE

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

DESIGN

Qualitative study using focus groups.

PARTICIPANTS AND SETTING

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

RESULTS

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

CONCLUSION

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

Single Leg Balance Training: A Systematic Review

Single leg balance training promotes significant increments in balance control, but previous reviews on balance control have not analyzed this form of balance training. Accordingly, we aimed to review the single leg balance training literature to better understand the effects of applying this training to healthy individuals. We searched five databases-PubMed, EMBASE, Scopus, Lilacs, and Scielo-with the following inclusion criteria: (a) peer-reviewed articles published in English; (b) analysis of adult participants who had no musculoskeletal injuries or diseases that might impair balance control; and (c) use of methods containing at least a pre-test, exclusive single leg balance training, and a post-test assessment. We included 13 articles meeting these criteria and found that single leg balance training protocols were effective in inducing balance control gains in either single- or multiple-session training and with or without progression of difficulty. Balance control gains were achieved with different amounts of training, ranging from a single short session of 10 minutes to multiple sessions totaling as much as 390 min of unipedal balance time. Generalization of balance gains to untrained tasks and cross-education between legs from single leg balance training were consistent across studies. We concluded that single leg balance training can be used in various contexts to improve balance performance in healthy individuals. These results extend knowledge of expected outcomes from this form of training and aid single leg balance exercise prescription regarding volume, frequency, and potential progressions.