Exercise-based Injury Prevention Program Research Articles

Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and Meta-analysis.

Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations. To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success. A total of 5 databases were searched through September 26, 2022. Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used. Systematic review and meta-analysis. Level 1. Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis. A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls. The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.

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

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. We aimed to synthesise and quantify the pooled intervention effects of exercise-based injury prevention programmes delivered to adults who participate in recreation sports. Studies were eligible for inclusion if they included adult recreational athletes (aged > 16years), 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. 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). 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. The protocol for this review was prospectively registered in the PROSPERO database (CRD42021232697).

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

This systematic review and meta-analysis aimed to assess the effectiveness of exercise-based injury prevention programmes in preventing sports injuries in team handball players. Two independent researchers performed a systematic search in the electronic databases Scopus, PubMed, Web of Science (WOS), SPORTDiscus, and CINAHL from inception until Aprile 2023. Studies were included if they were randomized-controlled or prospective cohort trials, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injury, and reported injury incidence rates specific to team handball players. Two researchers independently assessed trials for inclusion criteria and methodological quality. Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by two independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: lower extremity injuries, shoulder injuries, knee injuries, ankle sprains, or ACL injuries. Extracted data were analyzed by Comprehensive Meta-Analysis software, version 3.0 (CMA.V2) using a random-effects model to compute the overall effect estimates of injury prevention programmes in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group. Meta-analyses were conducted independently for each injury classification. Results indicate that prevention programmes significantly reduced the risk of shoulder injuries (OR, 0.56; 95% CI, 0.36-0.87; P = 0.01), lower extremity (OR, 0.59; 95% CI, 0.37-0.98; P = 0.03), knee (OR, 0.53; 95% CI, 0.35-0.78; P = 0.002) and ankle sprains (OR, 0.57; 95% CI, 0.40-0.81; P = 0.002), and ACL ruptures (OR, 0.67; 95% CI, 0.45-0.97; P = 0.03) in team handball players. In team handball players, prevention programmes appear effective in reducing the risk of shoulder, lower extremity, knee, ankle, and ACL injuries.

P05-02 Implementing exercise based injury prevention programs -lessons learned

BackgroundIn youth, physical activity is for a large part accumulated through participating in sports clubs and gymnastic classes. One of the reasons youth drop-out from sports and physical education participation are the injuries they sustain while being active. And, although we know that exercise based injury prevention programs can reduce the physical activity related injury risk, it has proven to be difficult to convince coaches, trainers and physical education teachers to implement these preventive exercises in their training/teaching routines. This presentation will focus on the lessons learned regarding the experiences and views of coaches, trainers and physical education teachers that participated in our injury prevention trials.MethodsOver the past decade, we have evaluated the effectiveness of several physical activity based injury prevention programs that were used in both the sports as well as the school setting. Alongside these effectiveness trails, process evaluations have been conducted to assess if the interventions were delivered and received as intended and what their views were regarding implementation of the exercises in their daily routine.ResultsA comparison will be made between views of coaches, trainers and physical education teachers that participated in our several trials.ConclusionsCombining the views of coaches, trainers and physical education teachers regarding future implementation of injury prevention programs will help guide the implementation of the exercised based preventive routines that will be developed for the EU funded Move Healthy project.

Sports injury prevention programmes from the sports physical therapist's perspective: An international expert Delphi approach

ObjectiveTo provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports. DesignDelphi. SettingLimeSurvey platform. ParticipantsExperienced sports physical therapists from the International Federation of Sports Physical Therapy member countries. Main outcome measuresFactors related to sports IPP planning, organization and implementation. ResultsWe included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement). ConclusionStrong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.

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

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

Lower Limb Exercise-Based Injury Prevention Programs Are Effective in Improving Sprint Speed, Jumping, Agility and Balance: an Umbrella Review.

BackgroundExercise-based injury prevention programs for athletes have demonstrated consistent results in reducing the risk of lower limb injuries. Compliance is essential for program effectiveness and may be facilitated when these programs demonstrate positive effects on athletic performance.Hypothesis/PurposeTo summarize the findings of current systematic reviews on the effectiveness of lower limb injury prevention programs with multiple neuromuscular components on sports performance and quantify these effects. The authors hypothesized that injury prevention programs can improve certain sports performance criteria.Study DesignUmbrella systematic reviewMethodsSystematic reviews published in French, German, or English between January 1990 and January 2020 were identified in five databases. Only articles that investigated multicomponent lower limb injury prevention programs and their effects on the performance criteria of strength, balance, agility, jumping or speed by both amateur and professional athletes of all ages and sex were included. The methodological quality of the included systematic reviews was assessed by two reviewers independently using the Assessing the Methodological Quality of Systematic Reviews measurement tool.ResultsFive systematic reviews met the inclusion criteria. Overall, beneficial effects of multicomponent exercise-based injury prevention programs were observed for balance, agility, jumping and speed. While the effects on strength were more variable, there was a positive trend in favor of injury prevention programs.ConclusionInjury prevention programs with multiple neuromuscular exercise components demonstrate overall beneficial effects on the performance criteria of balance, agility, jumping or speed. These beneficial effects may be used to promote the implementation of such programs.Level of Evidence2a

Mechanism and situation of injuries in fast bowlers: A YouTube-based video analysis study

Objectives: The present study was conducted with the objective of identifying the cause of injuries in fast bowlers. Materials and Methods: The present study is a video analysis study, keywords such as “fast bowler’s injury,” “failure of bowling,” and “cricket injuries” were searched on YouTube. Bowling action was divided into four stages – Stage 1 – jump, Stage 2 – back foot contact, Stage 3 – front foot contact, and Stage 4 – follow-through. The type and timing of injury (stage) were noted after analyzing the videos. Results: Sixteen injuries were identified in five videos. It was observed that 15 athletes had acute injury to lower limb and 1 athlete had an acute injury to lower back. 13/16 injuries happened in Stage 2 and 3/16 injuries happened in Stage 4. Conclusion: Most of the injuries happened at the time of landing and follow-through. Therefore, improvement of ground conditions, especially around the bowling area, and addition of exercise-based injury prevention programs can reduce the risk of injuries. This is more important for young fast bowlers at the club levels and state levels, as proper training at an early stage, can prevent injuries in many young fast bowlers.

Modifying bowling kinematics in cricket pace bowlers with exercise-based injury prevention: A cluster-randomised controlled trial

ObjectivesUndesirable bowling kinematics can increase the risk of low back injury. This study investigated if an exercise-based injury prevention program (IPP) could modify bowling kinematics in community-level adolescent pace bowlers. DesignCluster-randomised controlled trial. MethodsPace bowlers from eight cricket organisations were cluster-randomised into an intervention or control group. At baseline and follow-up sessions biomechanical bowling data were collected. Between sessions, the intervention group completed an eight-week IPP while the control continued their normal cricket activity. Treatment effects (95% CI) were estimated with linear mixed models. ResultsThere were significant treatment effects favouring the intervention group for shoulder counter-rotation (−3.8°; −7.2° to −0.3°) and lateral trunk flexion relative to the pelvis (−2.2°; −4.0° to −0.5°). Shoulder counter-rotation also increased in the control group by 2.2° (Cohen’s d=0.22). There were no effects of the intervention on: lateral trunk flexion at front foot contact (FFC) (1.2°; −2.5° to 4.8°), lateral trunk flexion at ball release (BR) (−0.5°; −3.0° to 2.0°), pelvis rotation at FFC (0.9°; −4.0° to 2.2°), pelvis rotation at BR (−1.1°; −5.7° to 3.6°), front hip angle at FFC (1.6°; −3.6° to 6.7°), front hip angle at BR (−1.6°; −5.0° to 1.9°), front knee angle at FFC (−1.1°; −4.5° to 2.3°), front knee angle at BR (1.7°; −5.6° to 9.1°), or ball velocity (1.1kmh−1; −7.5kmh−1 to 9.7kmh−1). ConclusionsThe IPP maintained shoulder counter-rotation and lateral trunk flexion relative to the pelvis in the intervention group and this could attenuate injury risk. No treatment effects were observed for lower-limb kinematics.

Barriers and facilitators in implementing an exercise-based injury prevention program for string players.

Musicians are at risk of developing playing-related injuries/musculoskeletal problems - to the extent that several injury-prevention strategies have been employed by them. In order to ensure compliance and improve implementation strategies, this study explores the opinions of musicians and music tutors on the barriers and facilitators in implementing an injury prevention program for string players, and the perceptions of the first mentioned as to the practicality of such an exercise-based injury prevention program. This study employed a qualitative method (focus group discussion) to explore the opinions of musicians on exercise-based injury-prevention programs for string players and their implementation strategies. Content thematic analysis was used to analyze and interpret the data. Two music schools, with 11 musicians, participated in the study. The mean age and the mean years of experience of the participants were 28.2±6 years and 12.4±3.8 years respectively. The results of this study showed willingness in the musicians to adopt an exercise-based injury prevention program. However, the major challenge proved to be the time constraint of including an exercise program in the participants' normal practice and teaching routines. There is a willingness to explore possible exercise-based intervention programs to mitigate or prevent instrument-playing-related health problems. However, time constraints proved to be the major barrier to implementation. It was further concluded that consideration should be given to the duration of the intervention program and the mode to adopt in the implementation of the exercise program.

Exercise-based injury prevention for community-level adolescent cricket pace bowlers: A cluster-randomised controlled trial

ObjectivesTo investigate if an exercise-based injury prevention program (IPP) can modify risk factors for injury in community-level adolescent cricket pace bowlers. DesignCluster-randomised controlled trial. MethodsEight cricket organisations (training two times per week and no previous involvement in a structured IPP) participated in this cluster-randomised trial. Participants were aged 14–17 years, injury free, and not currently performing a rehabilitation/exercise program. Cricket organisations (clusters) were block-randomised by computerised number generation into an intervention group (performed an eight-week IPP at training) or control group (continued their usual cricket activity). Participants were not blinded to group allocation. Strength, endurance, and neuromuscular control were assessed at baseline and follow-up. Treatment effects were estimated using linear mixed models. ResultsSixty-five male adolescent pace bowlers (intervention n=32 and control n=33) were randomised. There were significant treatment effects favouring the intervention group for shoulder strength (90°/s) 0.05 (95% CI 0.02–0.09) Nm/kg, hamstring strength (60°/s) 0.32 (95% CI 0.13–0.50) Nm/kg, hip adductor strength dominant 0.40 (95% CI 0.26–0.55) Nm/kg and non-dominant 0.33 (95% CI 0.20–0.47) Nm/kg, SEBT reach distance dominant 3.80 (95% CI 1.63–6.04) percent of leg length (%LL) and non-dominant 3.60 (95% CI 1.43–5.78) %LL, and back endurance 20.4 (95% CI 4.80–36.0) seconds. No differences were observed for shoulder strength (180°/s) (p=0.09), hamstring strength (180°/s) (p=0.07), lumbopelvic stability (p=0.90), and single leg squat knee valgus angle (dominant p=0.06, non-dominant p=0.15). ConclusionsExercise-based IPPs can modify risk factors for injury in community-level adolescent pace bowlers. Future research is needed to confirm if IPPs can also reduce injury risk in this population.

The Effect of the "11+ Kids" Program on the Isokinetic Strength of Young Football Players.

The "11+ Kids" injury-prevention program has been shown to reduce injuries and related costs in youth football players less than 14 y of age. A major argument to convince coaches to use this exercise-based injury-prevention program is a potential performance enhancement of the players. Therefore, this study investigated the effects of the "11+ Kids" program on isokinetic strength. Two teams were randomly assigned to the intervention and control groups. The intervention group replaced their warm-up by the "11+ Kids" and the control group warmed up as usual. Two days before and after the 10-wk intervention, isokinetic strength of the hip adductors and abductors, knee flexors and extensors, and ankle invertors and evertors was tested. Thirty-one players (mean age 11.5 [0.8]y) completed the study. The intervention group showed large improvements in all isokinetic strength measures (P < .001 for all measures; Cohen d = 0.8-1.4), whereas the control group only showed negligible to medium positive effects (P values ranging from .006 to .718; Cohen d = -0.1 to 0.7). The intervention was beneficial compared with the control group regarding isokinetic strength of the hip adductors (P < .001), knee flexors (P = .002), and ankle evertors (P < .001) and invertors (P = .005). Given the relatively short intervention period of 10 wk, the observed improvements relate to a practically meaningful effect of the intervention. The gain in strength may improve players' performance and may contribute to a reduction of injury risk in the long-term application.

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

IntroductionAnnually, 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.MethodsPubMed 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.ResultsOf 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.ConclusionThe 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.

Injury Prevention Strategies for Adolescent Cricket Pace Bowlers

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population.

Exercise-based injury prevention in football

Injuries—a major concern in a high-intensity contact sport like football—are associated with possible short- and long-term harmful consequences for the individual, the team and club as well as for the whole society. Consequently, there is need for effective injury prevention in football at all levels of play, in all age groups and in both genders. The present review summarizes the current scientific evidence focusing on exercise-based injury prevention and presenting promising prevention strategies in different football populations and settings. There is convincing evidence that multimodal exercise-based injury prevention programs (IPP) can reduce injury incidence by more than 30% in athletes of different age groups and in both genders. Although relevant effects have already been shown for short sessions, increased frequency and regular integration into normal practice may increase efficacy up to an injury reduction of 50%. Most programs last about 15 min and can easily replace traditional warm-up programs. Furthermore, there is increasing evidence that IPP beneficially affect neuromuscular performance parameters and biomechanical movement characteristics, which are associated with injury risk. There remains, however, a major gap between research on the short-term efficacy and long-term intervention strategies. IPP should be implemented continuously and with high fidelity as training effects are transient. It is crucial that future studies report implementation components in detail in order to facilitate the replication of successful interventions.

Implementation of an evidence-based injury prevention program in professional and semi-professional soccer

The ideal implementation of soccer injury prevention programs is essential knowledge for soccer coaches. The objective of this study was to investigate and compare the implementation of injury prevention programs, specially the FIFA 11+ program, among Australian and Saudi Arabian soccer coaches. A Web-based survey was used to obtain information regarding the coaches’ implementation of injury prevention programs, the FIFA 11+ program, the Nordic hamstring exercise, pre- and post-training exercises. Sixty coaches—30 from both selected countries—responded to the survey (response rate = 75%). In Australia, 93% of the coaches implemented an injury prevention program; while 73% implemented the FIFA 11+ program, only 51% implemented all the FIFA 11+ exercise components as recommended. In Saudi Arabia, 70% of the coaches stated that they followed an injury prevention program, but only 40% followed the FIFA 11+ program. However, 70% reported using all the FIFA 11+ exercise components in their current practices, which they may have adapted from different exercise-based injury prevention programs. The Australian coaches were significantly more likely to implement injury prevention programs ( p = 0.020) and the FIFA 11+ program ( p = 0.009). Nonetheless, no significant difference in the full implementation of the FIFA 11+ exercises components was found ( p = 0.114). The Australian coaches had greater awareness of injury prevention programs and more familiarity with the FIFA 11+ program than the Saudi Arabian coaches. Nevertheless, there was a gap between the coaches’ knowledge and their actual practice.

Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes

ObjectiveTo investigate the effect of FIFA injury prevention programmes in football (FIFA 11 and FIFA 11+).DesignSystematic review and meta-analysis.Eligibility criteria for selecting studiesRandomised controlled trials comparing the FIFA injury prevention...

Evaluation of the Effectiveness and Implementation of the BokSmart Safe Six Injury Prevention Programme: a study protocol

BackgroundThe injury burden in rugby union (‘rugby’) is high. While exercise-based injury prevention programmes have successfully reduced injuries in other sports such as football, there is minimal research on this...

Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis.

The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth. The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables. An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth). Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age. Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model. Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7-17.8]), were included. The overall RR was 0.54 (95% CI 0.45-0.67) [p < 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95% CI 0.37-0.63]) and those aiming at all injuries (RR 0.62 [95% CI 0.48-0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95% CI 0.35-0.57], Z = 6.35, p < 0.001) than studies without such exercises (RR 0.74 [95% CI 0.61-0.90], Z = 3.03, p = 0.002). The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.

How Effective are Exercise-Based Injury Prevention Programmes for Soccer Players?

The incidence of soccer (football) injuries is among the highest in sports. Despite this high rate, insufficient evidence is available on the efficacy of preventive training programmes on injury incidence. To systematically study the evidence on preventive exercise-based training programmes to reduce the incidence of injuries in soccer. The databases EMBASE/MEDLINE, PubMed, CINAHL, Cochrane Central Register of controlled trials, PEDro and SPORTDiscus™ were searched for relevant articles, from inception until 20 December 2011. The methodological quality of the included studies was assessed using the PEDro scale. The inclusion criteria for this review were (1) randomized controlled trials or controlled clinical trials; (2) primary outcome of the study is the number of soccer injuries and/or injury incidence; (3) intervention focusing on a preventive training programme, including a set of exercises aimed at improving strength, coordination, flexibility or agility; and (4) study sample of soccer players (no restrictions as to level of play, age or sex). The exclusion criteria were: (1) the article was not available as full text; (2) the article was not published in English, German or Dutch; and (3) the trial and/or training programme relates only to specific injuries and/or specific joints. To compare the effects of the different interventions, we calculated the incidence risk ratio (IRR) for each study. Six studies involving a total of 6,099 participants met the inclusion criteria. The results of the included studies were contradictory. Two of the six studies (one of high and one of moderate quality) reported a statistical significant reduction in terms of their primary outcome, i.e. injuries overall. Four of the six studies described an overall preventive effect (IRR<1), although the effect of one study was not statistically significant. The three studies that described a significant preventive effect were of high, moderate and low quality. Conflicting evidence has been found for the effectiveness of exercise-based programmes to prevent soccer injuries. Some reasons for the contradictory findings could be different study samples (in terms of sex and soccer type) in the included studies, differences between the intervention programmes implemented (in terms of content, training frequency and duration) and compliance with the programme. High-quality studies investigating the best type and intensity of exercises in a generic training programme are needed to reduce the incidence of injuries in soccer effectively.