The effectiveness of neuromuscular training in preventing sports injuries of different genders, body parts, and types in adolescents: a systematic review of meta-analysis
DOI:
https://doi.org/10.12775/QS.2024.34.56154Keywords
Neuromuscular training, injury care, sports rehabilitation, meta-analysisAbstract
Objective: Neuromuscular training is a relatively new comprehensive rehabilitation treatment method in recent years. Although its preventive effect on adolescent sports injuries is indisputable, its specific effects on gender, injury site, and type are still poorly understood. This study evaluated the clinical efficacy of neuromuscular training on adolescents of different genders, injury sites, and types through systematic meta-analysis.
Method: A comprehensive search was conducted on clinical randomized controlled trials related to the prevention of adolescent sports injuries through neuromuscular training in databases such as PubMed, Web of Science, EBSCO, and Scopus. The databases were established until May 2024. The neuromuscular training group (experimental group) used neuromuscular training or neuromuscular training as the main intervention method; The control group is either a blank group or a routine exercise group, without paying special attention to neuromuscular control. Outcome measures include any form of muscle, ligament, or bone injury, including acute or chronic injury data. The quality of the included literature was determined using the Cochrane bias risk assessment tool and the physical therapy evidence database scale, and statistical analysis was conducted using RevMan 5.4 and Stata 16.0 software.This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), INPLASY2024110054.
Result: A total of 32 clinical randomized controlled trials were included, with a sample size of 34581 cases. The meta-analysis results showed that: 1. The overall effect of neuromuscular training: the experimental group was better than the control group, with a combined IRR of 0.67 (95% CI2 0.57-0.79); Z = 4.78;P < 0.00001). The male group had a higher risk of loss compared to females in the experiment; 2. Upper limb motor injury: combined IRR of 0.73 (95% CI2 0.59-0.9); Z = 3.12;P =0.002). The male group had a lower risk of injury compared to females in the experiment. 3. Lower limb motor injury: combined IRR of 0.66 (95% CI2 0.56-0.77); Z = 5.12;P< 0.00001). The male group had a higher risk of loss compared to the female group in the experiment. 4. Knee movement injury: combined IRR of 0.73 (95% CI2 0.63-0.84); Z = 4.44;P< 0.00001). The female group had a higher risk of loss compared to the male group in the experiment. 5. Ankle sports injury: combined IRR of 0.54 (95% CI2 0.40-0.74); Z = 3.90;P< 0.00001). The male group had a higher risk of loss compared to females in the experiment. 6. Acute sports injury: The combined IRR is 0.60 (95% CI2 0.49-0.74); Z = 4.84;P< 0.00001), The male group had a similar reduced risk of loss compared to females in the experiment. 7. Chronic sports injury: The combined IRR was 0.72 (95% CI2 0.52-0.98; Z=2.07; P=0.04), and the female group had a higher risk of loss compared to males in the trial.
Conclusion: Neuromuscular training has significant effects in preventing upper and lower limbs, knees, ankles, and acute and chronic sports injuries of different genders. Research has shown that neuromuscular training has similar effects on different genders, effectively reducing the burden of public health and promoting participation in sports activities. However, more high-quality randomized controlled trials are still needed to further validate these findings.
References
. Soomro, et al., The Efficacy of Injury Prevention Programs in Adolescent Team Sports: A Meta-analysis. American Journal of Sports Medicine, 2016.
. R Ssler, R., et al., Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis. Sports Medicine, 2014. 44(12): p. 1733-48.
. Hägglund, M., et al., Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT. British journal of sports medicine, 2013. 47(15): p. 974-979.
. Soligard, T., et al., Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med, 2010. 44(11): p. 787-793.
. Emery, C.A. and H. Tyreman, Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools. Paediatrics & Child Health, 2009(7): p. 439-44.
. Emery, C.A., W.H. Meeuwisse and J.R. Mcallister, Survey of sport participation and sport injury in Calgary and area high schools. Clinical Journal of Sport Medicine Official Journal of the Canadian Academy of Sport Medicine, 2006. 16(1): p. 20.
. Richmond, S.A., et al., Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 2013. 43(8): p. 515-524.
. Blair, S.N., et al., Changes in Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy and Unhealthy Men. Annals of medicine, 1991. 23(3): p. 307-12.
. Schiff, M.A., D.J. Caine and R. O'Halloran, Injury Prevention in Sports. American Journal of Lifestyle Medicine, 2010. 4(1): p. 42-64.
. Caine, D., N. Maffulli and C. Caine, Epidemiology of Injury in Child and Adolescent Sports: Injury Rates, Risk Factors, and Prevention. Clin Sports Med, 2008. 27(1): p. 19-50.
. Attar, W.S.A.A., et al., How effective are F-MARC injury prevention programs for soccer players? A systematic review and meta-analysis. Sports Medicine, 2016. 46(2).
. Schiftan, G.S., L.A. Ross and A.J. Hahne, The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. Journal of Science & Medicine in Sport, 2015. 18(3): p. 238-244.
. Lauersen, J.B., D.M. Bertelsen and L.B. Andersen, The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 2014. 48(11): p. 871-7.
. Hübscher, M., et al., Neuromuscular training for sports injury prevention: a systematic review. Medicine & Science in Sports & Exercise, 2010. 42(3): p. 413.
. Simon, S., et al., Dose-Response Relationship of Neuromuscular Training for Injury Prevention in Youth Athletes: A Meta-Analysis. Frontiers in Physiology, 2017. 8: p. 920.
. Soomro, et al., The Efficacy of Injury Prevention Programs in Adolescent Team Sports: A Meta-analysis. American Journal of Sports Medicine, 2016.
. Emery, C.A., et al., Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. British Journal of Sports Medicine, 2015. 49(13): p. 865.
. Labella, C.R., et al., Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 2011. 165(11): p. 1033.
. Emery, C.A., et al., A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial. Clinical Journal of Sport Medicine, 2007. 17(1): p. 17-24.
. Mcguine, T.A. and J.S. Keene, The Effect of a Balance Training Program on the Risk of Ankle Sprains in High School Athletes. The American Journal of Sports Medicine, 2006. 34(7): p. 1103-1111.
. Hewett, et al., The Effect of Neuromuscular Training on the Incidence of Knee Injury in Female Athletes. American Journal of Sports Medicine, 1999.
. Steffen, K., et al., Preventing injuries in female youth football – a cluster-randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 2008. 18(5): p. 605-614.
. Soligard, T., et al., Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj, 2008. 337(dec09 2): p. a2469.
. Mandelbaum and R. B., Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes 2-Year Follow-up. Am J Sports Med, 2005. 33(7): p. 1003-1010.
. Malliou, P., et al., Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. Journal of Back & Musculoskeletal Rehabilitation, 2004. 17(3-4): p. 101-104.
. Heidt, R.S., et al., Avoidance of Soccer Injuries with Preseason Conditioning. American Journal of Sports Medicine, 2000. 28(5): p. 659.
. Hewett, et al., The Effect of Neuromuscular Training on the Incidence of Knee Injury in Female Athletes. American Journal of Sports Medicine, 1999.
. Zech, A., et al., Balance Training for Neuromuscular Control and Performance Enhancement: A Systematic Review. J Athl Train, 2010. 45(4): p. 392-403.
. Hübscher, M., et al., Neuromuscular training for sports injury prevention: a systematic review. Medicine & Science in Sports & Exercise, 2010. 42(3): p. 413.
. Astrid, Z., W. Kai and D.C. Fernando, Perceptions of football players regarding injury risk factors and prevention strategies. Plos One, 2017. 12(5): p. e0176829.
. Van Tiggelen, D., et al., Effective prevention of sports injuries: a model integrating efficacy, efficiency, compliance and risk-taking behaviour. British journal of sports medicine, 2008. 42(8): p. 648-652.
. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. PLoS Med 2009;6:e1000097.
. Higgins, J.P., et al., Measuring inconsistency in meta-analyses. BMJ, 2003. 327(7414): p. 557-60.
. Sakata, J.E.T.M., Throwing Injuries in Youth Baseball Players: Can a Prevention Program Help? A Randomized Controlled Trial. American Journal of Sports Medicine, 2019. 47(11).
. Mendez-Rebolledo, G., et al., The Protective Effect of Neuromuscular Training on the Medial Tibial Stress Syndrome in Youth Female Track-and-Field Athletes: A Clinical Trial and Cohort Study. Journal of Sport Rehabilitation, 2021(7).
. Longo, U.G., et al., The FIFA 11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players: A Cluster Randomized Controlled Trial. American Journal of Sports Medicine, 2012. 40(5): p. 996-1005.
. Sommerfield, L.M., et al., The Effects of a School-Based Injury Prevention Program on Injury Incidence in Young Females. Journal of Science in Sport and Exercise, 2021. 3(1): p. 47-55.
. Emery, C.A. and W.H. Meeuwisse, The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. British Journal of Sports Medicine, 2012. 44(8): p. 555.
. Mchugh, M.P., et al., The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. American Journal of Sports Medicine, 2007. 35(8): p. 1289.
. Mcguine, T.A. and J.S. Keene, The Effect of a Balance Training Program on the Risk of Ankle Sprains in High School Athletes. The American Journal of Sports Medicine, 2006. 34(7): p. 1103-1111.
. Emery, C.A., et al., The "SHRed Injuries Basketball" Neuromuscular Training Warm-up Program Reduces Ankle and Knee Injury Rates by 36% in Youth Basketball. The Journal of orthopaedic and sports physical therapy, 2022. 52(1): p. 40-48.
. Hislop, M.D., et al., Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. British journal of sports medicine, 2017. 51(15): p. 1140-1146.
. Kiani and Ashkan, Prevention of soccer-related knee injuries in teenaged girls. Archives of Internal Medicine, 2010. 170(1): p. 43.
. Junge, A., et al., Prevention of soccer injuries: a prospective intervention study in youth amateur players. American Journal of Sports Medicine, 2002. 30(5): p. 652-659.
. Wedderkopp, N., et al., Prevention of injuries in young female players in European team handball. A prospective intervention study. Scandinavian Journal of Medicine & Science in Sports, 2010. 7(6): p. 342-347.
. Owoeye, O.B.A., L.M. Palacios-Derflingher and C.A. Emery, Prevention of Ankle Sprain Injuries in Youth Soccer and Basketball: Effectiveness of a Neuromuscular Training Program and Examining Risk Factors. Clin J Sport Med, 2017(4).
. Steffen, K., et al., Preventing injuries in female youth football – a cluster-randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 2008. 18(5): p. 605-614.
. Hilska, M., et al., Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children's Soccer: A Cluster Randomized Controlled Trial. Orthop J Sports Med, 2021. 9(4): p. 23259671211005769.
. Pfeiffer, R.P., et al., Lack of Effect of a Knee Ligament Injury Prevention Program on the Incidence of Noncontact Anterior Cruciate Ligament Injury. Journal of Bone & Joint Surgery American Volume, 2006. 88(8): p. 1769-74.
. Emery, C.A., et al., Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT). British Journal of Sports Medicine, 2019. 54(15): p. bjsports-2019-101117.
. Olsen and O. E., Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. Bmj, 2005. 330(7489): p. 449-452.
. Steffen, K., et al., Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomised trial. British Journal of Sports Medicine, 2015. 47(8): p. 480-.
. Owoeye, O.B.A., et al., Efficacy of the FIFA 11+ Warm-Up Programme in Male Youth Football: A Cluster Randomised Controlled Trial. J Sports Sci Med, 2014. 13(2): p. 321-328.
. Cumps, E., E. Verhagen and R. Meeusen, Efficacy of a sports specific balance training programme on the incidence of ankle sprains in basketball. Journal of Sports Science & Medicine, 2007. 6(2): p. 212-9.
. Collard, D.C.M., et al., Effectiveness of a school-based physical activity injury prevention program: A cluster randomized controlled trial Collard D.C.M. Archives of Pediatrics & Adolescent Medicine, 2010. 164(2): p. 145---150.
. Mandelbaum and R. B., Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes 2-Year Follow-up. Am J Sports Med, 2005. 33(7): p. 1003-1010.
. Labella, C.R., et al., Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 2011. 165(11): p. 1033.
. Soligard, T., et al., Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj, 2008. 337(dec09 2): p. a2469.
. Wedderkopp, N., et al., Comparison of two intervention programmes in young female players in European handball--with and without ankle disc. Scand J Med Sci Sports, 2003. 13(6): p. 371-5.
. Delfino, S., et al., A Warm-Up Program to Reduce Injuries in Youth Field Hockey Players: A Quasi-Experiment. Journal of athletic training, 2019.
. Foss, K.D.B., et al., A School-Based Neuromuscular Training Program and Sport-Related Injury Incidence: A Prospective Randomized Controlled Clinical Trial. J Athl Train, 2018. 53(1): p. 20-28.
. Richmond, S.A., et al., A School-Based Injury Prevention Program to Reduce Sport Injury Risk and Improve Healthy Outcomes in Youth: A Pilot Cluster-Randomized Controlled Trial. Clinical Journal of Sport Medicine Official Journal of the Canadian Academy of Sport Medicine, 2015. 26(4): p. 291.
. Emery, C.A., et al., A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial. Clinical Journal of Sport Medicine, 2007. 17(1): p. 17-24.
. Scase, E., et al., Teaching landing skills in elite junior Australian football: evaluation of an injury prevention strategy. Br J Sports Med, 2006. 40(10): p. 834-8; discussion 838.
. Bergeron, M.F., et al., International Olympic Committee consensus statement on youth athletic development. British Journal of Sports Medicine, 2015. 49(13): p. 843-851.
. Hulteen, R.M., et al., Development of Foundational Movement Skills: A Conceptual Model for Physical Activity Across the Lifespan. Sports Medicine, 2018. 48(7): p. 1533-1540.
. Myer, G.D., et al., When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth? Current Sports Medicine Reports, 2011. 10(3): p. 155-166.
. Moeskops, S., et al., Individual Responses to an 8-Week Neuromuscular Training Intervention in Trained Pre-Pubescent Female Artistic Gymnasts. Sports, 2018. 6(4).
. Fort-Vanmeerhaeghe, A., et al., Integrative Neuromuscular Training in Youth Athletes. Part II: Strategies to Prevent Injuries and Improve Performance. Strength and conditioning journal, 2016. 38(4): p. 9-27.
. Noguera, C.P., et al., Training Effects of the FIFA 11+ Kids on Physical Performance in Youth Football Players: A Randomized Control Trial. Frontiers in Pediatrics, 2018. 6: p. 40.
. Achenbach, L., et al., Neuromuscular exercises prevent severe knee injury in adolescent team handball players. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. 26(7): p. 1901-1908.
. Emery, C.A., et al., Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med, 2015. 49(13): p. 865-70.
. Steib, S., et al., Dose-Response Relationship of Neuromuscular Training for Injury Prevention in Youth Athletes: A Meta-Analysis. Front Physiol, 2017. 8: p. 920.
. Finch, C.F., et al., Implementing an exercise-training programme to prevent lower-limb injuries: considerations for the development of a randomised controlled trial intervention delivery plan. British journal of sports medicine, 2011. 45(10): p. 791-796.
. Emery, C.A. and W.H. Meeuwisse, The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. Br J Sports Med, 2010. 44(8): p. 555-62.
. Soligard, T., et al., Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med, 2010. 44(11): p. 787-93.
. Twomey, D., et al., Preventing lower limb injuries: is the latest evidence being translated into the football field? J Sci Med Sport, 2009. 12(4): p. 452-6.
. Steffen, K., et al., Preventing injuries in female youth football--a cluster-randomized controlled trial. Scand J Med Sci Sports, 2008. 18(5): p. 605-14.
. Richardson, A., et al., High prevalence of self-reported injuries and illnesses in talented female athletes. BMJ Open Sport & Exercise Medicine, 2017. 3(1): p. e000199-e000199.
. Caine, D., C. Caine and N. Maffulli, Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med, 2006. 16(6): p. 500-13.
. Myklebust, et al., ACL injury incidence in female handball 10 years after the Norwegian ACL prevention study: important lessons learned. British Journal of Sports Medicine, 2013.
. Verhagen, E., et al., A knowledge transfer scheme to bridge the gap between science and practice: an integration of existing research frameworks into a tool for practice. Br J Sports Med, 2014. 48(8).
. Finch, C.F. and A. Donaldson, A sports setting matrix for understanding the implementation context for community sport. British Journal of Sports Medicine, 2010. 44(13): p. 973-978.
. Emery, C., Research designs for evaluation studies. 2010: Research designs for evaluation studies.
. Emery, C.A., B. Hagel and B.A. Morrongiello, Injury Prevention in Child and Adolescent Sport: Whose Responsibility Is It? Clinical Journal of Sport Medicine, 2006. 16.
. Keats, M.R., C.A. Emery and C.F. Finch, Are we having fun yet? Fostering adherence to injury preventive exercise recommendations in young athletes. Sports Medicine, 2012. 42(3): p. 175-184.
. Soomro, et al., The Efficacy of Injury Prevention Programs in Adolescent Team Sports: A Meta-analysis. American Journal of Sports Medicine, 2016.
. R Ssler, R., et al., Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis. Sports Medicine, 2014. 44(12): p. 1733-48.
. Hägglund, M., et al., Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT. British journal of sports medicine, 2013. 47(15): p. 974-979.
. Soligard, T., et al., Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med, 2010. 44(11): p. 787-793.
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