Injury Prevention Exercise Programme Research Articles

An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk

Knee ligament sprains are common during change-of-direction (COD) maneuvers in multidirectional team sports. This study aimed to compare the effects of an 8-week injury prevention exercise program containing COD-specific exercises and a similar program containing linear sprint exercises on injury- and performance-related variables during a 135° COD task. We hypothesized that the COD-specific training would lead to (H1) stronger reductions in biomechanical variables associated with anterior cruciate ligament (ACL) injury risk during COD, i.e. knee abduction moment and angle, hip internal rotation angle and lateral trunk lean, and (H2) more effective improvements in COD performance according to the COD completion time, executed angle, ground contact time, and approach speed. Twenty-two sports science students (40% female) completed biomechanical assessments of COD movement strategies before and after participating in two supervised 25-min training sessions per week over 8 weeks. We observed significant ‘training x group’ interaction effects in support of H1: the COD-specific training but not the linear sprint training led to reduced peak knee abduction moments (interaction, p = 0.027), initial knee abduction (interaction, p < 0.001), and initial lateral trunk lean angles (interaction, p < 0.001) compared to baseline. Although the COD-specific training resulted in sharper executed angles (interaction, p < 0.001), the sprint-specific training group showed reduced COD completion (interaction, p = 0.037) and ground contact times (interaction, p < 0.001). In conclusion, a combination of generic and COD-specific injury prevention training resulted in COD technique adaptations that can help to avoid ACL injury-prone COD movements but may negatively affect COD speed.

Developing a framework for a games-based injury prevention exercise programme for post-primary (12–18 years) physical education class: A Delphi poll study

Despite calls for injury prevention exercise programmes (IPEPs) to move to school settings for the general adolescent population, current research has had mixed outcomes regarding their efficacy in schools as many of the traditional barriers to IPEP implementation still exist, for example, lack of engagement with the programme. A games-based approach may negate some of these barriers as it has been shown to increase participation and adherence to activity. The aim of this study was to achieve consensus on the fundamental framework for the development of a games-based IPEP for physical education (PE) class. Nineteen academic and practitioner experts in the areas of PE, injury prevention and adolescent coaching took part in a four-round Delphi poll, consisting of an opening exploration round followed by three subsequent rounds of questions. Agreement of at least 67% was required for consensus to be deemed achieved on outcomes. Agreement was reached on the key components of an IPEP and potential layouts of the programme. Requirements for an activity/exercise to be deemed games-based and key outcome measures for a games-based IPEP for PE class were established. Finally, PE teacher supports and resources required for implementing a games-based IPEP in PE class were determined, including supports for PE teachers and IPEP location within the class. The recommendations of this study provide a fundamental framework for the development of future games-based IPEPs that could be applied internationally as it provides the flexibility to be adapted to suit various constraints of PE classes across the globe.

Feasibility and acceptability of a new shoulder-specific warm-up programme to prevent injuries in community youth rugby union as compared to the FIFA 11+

Injury prevention exercise programmes (IPEPs) are efficacious, though there is no IPEP specifically designed to reduce shoulder injuries in rugby. This study aimed to determine the feasibility and acceptability of the Rugby Active Shoulder Injury Prevention (RASIP) programme. Three community rugby union clubs participated in a 12-week pilot study (players, n = 51; coaches, n = 7). Two teams were randomly allocated to the RASIP programme and one to the FIFA 11+ (IPEP) intervention. Feasibility was examined by players’ adherence to the IPEP, and acceptability was described by players’ and coaches’ perceptions of the IPEP. On average, more players were exposed to 11+ training sessions (100%) than the RASIP programme (19 out of 36 players, 53%). Higher percentage of exercises was completed over the season in the 11+ (97%) than the RASIP programme (58%). Across both groups, there were different approaches followed in delivering the allocated intervention. The coach-led, prescriptively followed 11+ IPEP was better at achieving higher adherence with exercises. Coaches were concerned of not having enough time in their sessions to include the IPEP. This pilot study has shown that the intervention is feasible to deliver and is acceptable with improvements recommended by community stakeholders, coaches and players in a community youth rugby setting.

Motivation and goal-pursuit for injury prevention training in amateur football coaches: a cross-sectional study using the Health Action Process Approach

BackgroundAdoption of injury prevention exercise programmes (IPEPs) in team sports is contingent on behaviour change among coaches. The aim was to study motivation and goal-pursuit in IPEP use among coaches...

Gaelic games players' awareness and use of, and attitudes towards injury prevention exercise programmes

ObjectiveThe aim was to determine the awareness of and use of injury prevention exercise programmes (IPEPs) among adult Gaelic games players and to investigate Gaelic games players' attitudes to injury prevention and barriers and facilitators to successful IPEPs use. MethodsA recruitment email was sent to all clubs and county boards throughout Ireland (whose email was available online) and the survey was advertised on social media platforms. Adult players completed an anonymous survey, including awareness, use, and attitudes towards injury prevention and injuries. Frequencies and descriptive statistics were conducted, a chi-squared test was used to assess any differences in awareness and use of IPEPs, a Mann-Whitney U test was used to examine differences between groups for attitudes to injury prevention (men vs women; elite vs non-elite). ResultsA third of players (32.4%) stated awareness of IPEPs. However, only 13.4% correctly identified one. A significantly greater number of men (35.7%) used IPEPs compared to women (26.5%) (p = 0.04). The Activate (65.5%) and GAA15 (32.5%) were most used. Players had a positive attitude towards injury prevention but agreed that injuries were an issue (68.2%) and stated that their coach didn’t have enough knowledge how to use IPEPs was a large barrier (41.6%). ConclusionDespite this positive attitude to injury prevention and believing injuries are an issue, adoption remains low. Organisations/clubs should educate players on the benefits of using IPEPs and support structures put in place to gain greater implementation, which is critical to mitigating the risk of injury.

Implementation of the injury prevention exercise programme Knee Control+: a cross-sectional study after dissemination efforts within a football district

BackgroundThe Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework can be used for evaluation of implementation initiatives in sports injury prevention. The aim was to evaluate the implementation of the...

Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study

BackgroundYouth participation in team ball sports is associated with a risk of both acute and gradual onset injuries but today there are several efficacious injury prevention exercise programmes (IPEPs). However, there is limited research about how to implement those programmes and the perceived barriers and facilitators among end-users.ObjectiveTo investigate perceptions of the IPEP Knee Control and facilitators and barriers to programme use among coaches and youth floorball players, and explore factors associated with planned maintenance of Knee Control.MethodsThis cross-sectional study is a sub-analysis of data from the intervention group of a cluster randomised controlled trial. Perceptions about Knee Control and facilitators and barriers to programme use were evaluated with surveys pre-intervention and post-season. 246 youth floorball players aged 12–17 years, and 35 coaches that reported no use of IPEPs during the preceding year were included. Descriptive statistics and univariate and multivariate ordinal logistic regression models were undertaken with the dependent variables: coaches’ planned maintenance and players’ opinions of maintenance of Knee Control. Independent variables were perceptions, facilitators and barriers regarding use of Knee Control and other potential influencing factors.Results88% of the players believed that Knee Control can reduce injury risk. Common facilitators to Knee Control use among coaches were support, education and high player motivation, and common barriers were that injury prevention training was time-consuming, lack of space to execute the exercises and lack of player motivation. Players who planned to maintain use of Knee Control had higher outcome expectancies and belief in one’s ability to use Knee Control (action self-efficacy). Coaches who planned to maintain Knee Control had higher action self-efficacy and to a lesser extent considered that Knee Control takes too much time.ConclusionsSupport, education, and high player motivation are key facilitators, while lack of time and space for injury prevention training and boring exercises are key barriers for coaches and players to use Knee Control. High action self-efficacy among coaches and players seems to be a prerequisite for maintained use of IPEPs.

Does a ten-week activate GAA warm-up intervention improve outcomes in adult male hurlers?

BACKGROUND: Injuries are frequent in hurlers and injury prevention exercise programmes implemented during their warm-up could play a role in reducing injury risk. OBJECTIVES: To determine whether a ten-week Activate GAA warm-up intervention improves outcomes (landing mechanics, dynamic postural control, quality of movement and hamstring and adductor strength) in hurlers. METHODS: A non-randomized controlled trial was implemented in adult male non-elite hurlers (intervention n=58; control n=59) and players were eligible if they were uninjured and currently playing with a non-elite hurling team. The landing error scoring system (LESS), Y balance test, overhead squat, single leg squat, hamstring strength test and adductor break test were assessed by one Certified Athletic Therapist pre- and post-intervention. The intervention group completed the Activate GAA warm-up prior to all training and games. Two participants were unable to complete post-testing due to injury in the control group only. RESULTS: The ANCOVA analysis revealed that the intervention group’s landing mechanics (LESS total score: p&lt;0.0001, ηp2=0.34), postural control (Y balance test composite score: p&lt;0.0001, ηp2=0.23), and quality of movement (Overhead squat: p&lt;0.0001, ηp2=0.21; single leg squat dominant: p=0.04, ηp2=0.0.04; single leg squat non-dominant: p&lt;0.0001, ηp2=0.12) were significantly better than the control group. Adductor and hamstring strength were not significantly improved (p&gt;0.05). CONCLUSIONS: These findings support the use of the Activate GAA warm-up in non-elite adult male hurlers with improvements observed in landing mechanics, dynamic postural control and quality of movement. Randomised controlled trials to examine its effect on injury incidence along with consideration of long-term compliance are required.

Extended Knee Control programme lowers weekly hamstring, knee and ankle injury prevalence compared with an adductor strength programme or self-selected injury prevention exercises in adolescent and adult amateur football players: a two-armed cluster-randomised trial with an additional comparison arm

ObjectiveTo evaluate the preventive efficacy of an extended version of the Knee Control injury prevention exercise programme (IPEP) compared with an adductor strength programme and to a comparison group using...

Barriers and facilitators to implementing the Activate injury prevention exercise programme – A qualitative study of schoolboy rugby coaches

The rugby-specific Activate injury prevention exercise programme was deemed efficacious in a randomised controlled trial and subsequently disseminated nationwide by the Rugby Football Union (English rugby union governing body) in 2017. However, no assessment has been made of the factors influencing Activate implementation in an applied setting. Consequently, this study sought to assess the barriers and facilitators to coaches implementing Activate in English schoolboy rugby. This qualitative study adopted a framework approach, using four a-priori themes influencing injury prevention implementation: awareness, motivational determinants, volitional determinants and socio-environmental factors. A purposive sample of schoolboy rugby coaches were recruited from schools nationwide, participating in semi-structured, one-on-one interviews (n = 10). Transcripts were thematically coded. Participants had positive perceptions towards Activate, although only six adopted the programme. Participants reported that players were generally unaware of the programme, with some suggesting this was not an issue as coaches made the decision to adopt Activate. Participants focused heavily upon the use of resources to develop coaches’ awareness, knowledge and confidence. No participant implemented Activate as initially designed, influenced by time and engagement, instead incorporating it within training drills rather than as a block at the beginning of the session. Participants adapted the programme to make it suitable for multiple sports. Some participants reported asking players to deliver Activate, despite their lack of awareness, raising concerns around implementation. Participants heavily adapted Activate delivery to suit their contexts. How this affects the effectiveness of Activate to reduce injury risk is unknown and should be investigated. Player-specific dissemination strategies should be considered if these individuals act as delivery-agents.

ACL Research Retreat IX March 17–19, 2022 High Point, NC

ACL Research Retreat IX March 17–19, 2022 High Point, NC

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

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. 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 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). 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.

The Effect of Shoulder and Knee Exercise Programmes on the Risk of Shoulder and Knee Injuries in Adolescent Elite Handball Players: A Three-Armed Cluster Randomised Controlled Trial

BackgroundThe risk of injury in adolescent handball is high, and shoulder and knee injuries are among the most frequent and burdensome. The Swedish Knee Control programme reduced the risk of anterior cruciate ligament injuries in female youth football players and traumatic knee injuries in male and female youth floorball players. However, to date, Knee Control has not been evaluated in an elite youth sport setting. The literature on the prevention of shoulder injuries in sport is scarce, and there are to our knowledge no previous studies evaluating the preventative efficacy of injury prevention exercise programmes (IPEPs) on shoulder injuries in adolescent handball players.ObjectivesTo study the preventive efficacy of IPEPs on shoulder and knee injuries in adolescent elite handball players.MethodsEighteen Swedish handball-profiled secondary schools (clusters) with players aged 15–19 years, 54% males were randomised into either the Shoulder Group or Knee Group (interventions) or a Control Group. Players in the Shoulder Group were instructed to perform the Shoulder Control programme, and players in the Knee Group to perform the Knee Control programme, three times per week during May 2018 to May 2019. Control Group players continued their usual training. Outcomes were shoulder and knee injuries defined by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Intention-to-treat analyses were performed using Cox regression models with hazard rate ratios (HRRs) with corresponding 95% confidence intervals (CI).ResultsSix clusters (199 players) in the Shoulder Group, six clusters (216 players) in the Knee Group and six clusters (212 players) in the Control Group were included. There were 100 shoulder injuries and 156 knee injuries. The Shoulder Group had a 56% lower shoulder injury rate, HRR 0.44 (95% CI 0.29 to 0.68), and the Knee Group had a 31% lower knee injury rate, HRR 0.69 (95% CI 0.49 to 0.97) than the Control Group. The absolute risk reduction was 11% and 8%, and the number needed to treat was 9 and 13, respectively.ConclusionsAdolescent elite handball players who performed the Shoulder Control and the Knee Control programmes had a lower risk of shoulder and knee injuries, respectively, than players who continued their usual training. Further research on how these two programmes can be combined to reduce knee and shoulder injuries in a time effective way is warranted.Trial registration ISRCTN15946352.Key pointsThe burden of knee and shoulder injuries in handball is high.The Shoulder Control programme reduces the risk and overall burden of shoulder injuries in adolescent elite handball players.The Knee Control programme reduces the risk and overall burden of knee injuries in adolescent elite handball players.

Effects of prevention programmes on injury risk in military personnel: a systematic review with meta-analysis

IntroductionExercise programmes have been used to prevent injuries in military personnel, as they can reduce modifiable risk factors for injuries. Our aim was to review the literature to evaluate the...

Players’, parents’ and staffs’ perceptions of injury prevention exercise programmes in youth rugby union

Background and aimDespite evidence of their efficacy, there is no widespread adoption of injury prevention exercise programmes (IPEPs) among young players and coaches in community rugby union. The purpose of...

Effectiveness of the Activate injury prevention exercise programme to prevent injury in schoolboy rugby union

ObjectiveThe efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of...

Knowledge, attitude, and practice of injury prevention exercise programmes and the FIFA 11+ among Malaysian elite soccer league coaches

Background: A number of injury prevention programmes have been introduced in soccer. However, the familiarity and utility of these programmes by coaches in Malaysia is yet to be determined. Aim and Objectives: This study aimed to record the knowledge, attitude and practice of injury prevention exercise programmes (IPEPs), specifically the FIFA 11+, amongst coaches of elite league teams in Malaysia.Materials and Methods: Active coaches from four elite soccer leagues (Super League, Premier League, President's Cup and Youth Cup) in Malaysia were invited to participate. Thirty-three (n = 33) responses were returned.Results: Most respondents (87.9%) agree that soccer players are at high risk of lower-limb injury, and that it could have adverse effects on teams' and players' performances, careers and quality of life. More than two-thirds (71.9%) of respondents were optimistic about lower-limb soccer injury prophylaxis, however, familiarity toward the FIFA 11+ was considerably low, thus its practice is relatively low. Most respondents familiar to the programme believe that improvements could be introduced to suit their teams better or develop an own version of the FIFA 11+ specifically tailored for their teams. Having the need for equipment and lack of supervision may hinder IPEP maintenance in a team.Conclusion: Injury prevention programmes need early implementation and progressive variation for ongoing practice. Clearly, no IPEP may serve as the perfect 'one-programme-fits-all' injury prevention measure. This study may provide some insight for practitioners and soccer club organizers to develop future IPEPs and exercise better programme delivery amongst professional soccer teams.

11+ Dance: A Neuromuscular Injury Prevention Exercise Program for Dancers

ABSTRACT Epidemiological studies over the past decade indicate high injury prevalence in preprofessional ballet (76%) and professional contemporary and ballet dancers (60–69%). Injuries can have detrimental effects both for the dancers and the dance company. Most injuries are in the lower limb and reported as the gradual onset of overuse. Professional dance companies have reduced injury incidence and severity through the implementation of comprehensive injury audit programs and proactive exercise prescription. Injury prevention research in dance is scarce, and there has been no intervention targeting dance injuries. This article describes the development of 11+ Dance, an injury prevention training program designed for dancers, based on current evidence and best practice on injury prevention in sports. It is a 25–30-minute neuromuscular-based training program focused on strength, balance, and jumping/landing technique, with special attention to ankle, knee, and hip alignment. The high prevalence of injuries reported in the different styles of dance suggests that implementation of an injury prevention program is both the plausible and ethical action to take for all levels of performance.

Prevalence, seasonal variation and nature of illness in youth floorball players: a prospective cohort study

Introduction: Acute illness presents a significant health burden to athletes, including training interference, impaired performance, time-loss from competition and increased subsequent injury risk. Although most youth participate in sport at recreational level, illness epidemiology in this population during a season or competition has not been well studied to direct prevention initiatives. We aim to provide a first detail profile of illness and illness symptoms by sex in Swedish youth floorball players during one season. Methods: This prospective cohort study was part of a Sport Without Injury ProgrammE cluster randomised controlled trial in floorball evaluating the efficacy of the Knee Control injury prevention exercise programme. Weekly illness data were collected from youth players during the 2017-2018 season (26 weeks) using the Oslo Sports Trauma Research Center questionnaire on health problems. Illness symptoms were grouped into clusters according to the 2020 International Olympic Committee consensus recommendations. Sex differences in average weekly illness prevalence was compared with a prevalence rate ratio and corresponding 95% CI, and proportion of reported illness symptoms with the chi-square test. Results: The mean age for 329 male and 142 female players was 13.3(SD 1.0) and 13.7(SD 1.5) years, respectively. The mean number of weekly reports per player was 14.4(SD 7.8) (13.5(SD 8.1) males vs 16.3(SD 6.8) females). 61% of players (60% males vs 64% females) reported at least one illness week during the season. The average weekly illness prevalence was 12%(95% CI 10.8-12.3%) for all players, and slightly higher in females (13%, 95% CI 11.6-14.3%) than males (11%, 95% CI 9.9-11.7%), prevalence rate ratio 1.20(95% CI 1.05-1.37, p=0.009). 49%(53% males, 43% females) of illness reports indicated time-loss from sport. Illness prevalence was highest in calendar weeks 4-7 (peak winter weeks) and ranged from 15%-18%(20%-23% females vs 12%-17% males) during this period. Upper/lower respiratory symptoms (fever (30%), sore throat (16%) and cough (14%) were common). More females (16% vs 3% males, p<0.001) reported difficulty of breathing/tight airways. 7% females and no males reported fainting. Discussion: Two third of players reported at least one illness. Flu-like symptoms dominated the season. Athletes, coaches, parents and support personnel need to be aware of risk of infections and educated about risk mitigation of viral infections. Improved awareness of self-monitoring of respiratory symptoms could help reduce the risk of spreading the infection to team members. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Compliance and Fidelity With an Injury Prevention Exercise Program in High School Athletics.

Use of injury prevention programs (IPPs) by high school athletes has increased but their success in reducing injury depends on program compliance and fidelity of exercise performance. Compliance with the 11+ IPP and exercise performance fidelity by high school athletic teams depend on sex, sport, and level of play. Secondary analyses of data from a randomized controlled trial (RCT). Level 2. The 11+ IPP was implemented by 100 male and female high school athletic teams (American football, soccer, basketball, and lacrosse). Team compliance and fidelity with the program were evaluated by direct observation of warm-up routines and a weekly online survey completed by coaches. Differences in compliance and fidelity due to sport, sex, and level of play were assessed by analysis of variance. Coaches reported that their teams performed the full IPP an average of 1.45 times per week, and 28% of observed warm-ups included all exercises in the IPP. Compliance differed by sport but not by level of play or the athletes' sex. At the end of the season, cueing was observed 19% of the time and differed by sport. Good technique was observed 66% of the time and varied by level of play. Team compliance with the IPP varied by sport and was below the recommended number of sessions per week needed to reduce injury. Removal of implementation barriers and improved support from coaches are needed at all levels of play for IPPs to be effective. Clinical and sports practitioners intending to implement an IPP at the high school level should anticipate and address barriers that affect program compliance and fidelity of exercise performance. Frequent follow-up and instruction may be necessary for successful adoption of the IPP.