Sports Medicine Research: In the Lab & In the Field: Neuromuscular Warm-up Reduces Risk for Knee Sprains in Elite Female Basketball Players (Sports Med Res)


Monday, February 12, 2018

Neuromuscular Warm-up Reduces Risk for Knee Sprains in Elite Female Basketball Players

Neuromuscular training reduces lower limb injuries in elite female basketball players. A cluster randomized controlled trial

Bonato M, Benis R, La Torre A. Scandinavian Journal of Medicine and Science in Sports. 2017;00:1–10. doi: 10.1111/sms.13034.

Take Home Message: Elite female basketball players who participated in neuromuscular training as part of a warm-up had reduced rates of injuries, especially knee sprains, than those who participated in a warm-up without neuromuscular training.
Lower extremity injuries comprised ~62% of orthopedic injuries in the National Basketball Association. Professional female basketball players sustain 60% more knee and ankle injuries than professional male basketball players. Interventions focused on neuromuscular control improve lower extremity alignment, muscle recruiting, shock attenuation, balance, and posture, which may reduce the risk of injury. The authors conducted a clinical trial to investigate if a new neuromuscular training program designed for basketball would decrease the number of lower limb injuries among elite women basketball teams. The investigators conducted a two-armed parallel group cluster randomized controlled trial with 15 of the 17 teams from the premier Italian national league (160 athletes). The authors randomized the teams into the control (74 athletes) and neuromuscular training (86 athletes) groups and blinded both groups to the purpose of the study. The neuromuscular training intervention was a structured 30-minute warmup with five stages: low-speed running, active stretching, general strength, plyometrics, and agility exercises with the ball. The control group did light aerobic exercises, basketball and team drills, and major muscle group dynamic stretches. Both did their respective warmups 4 times a week before a regular practice session. The medical doctors for each team reported injuries that occurred during games or training and prevented a player from participating in the next session. The authors reported 32 injuries for the neuromuscular training group and 79 for the control group. This translates to the neuromuscular training group having 1.7 injuries per 1000 athletic exposures and the control group having 4.7 injuries per 1000 athletic exposures. The neuromuscular training group consistently had fewer injuries at the knee and ankle as well as during practice and games.

This study is important because it highlights that an elite female basketball player who warms up with a neuromuscular training intervention will have a decreased risk of injury, especially knee sprains, as compared to those in the control group. The teams had great compliance (78%), which likely contributed to the successful decrease in injury rate with the intervention. This is particularly relevant because this neuromuscular training program is longer (30 minutes) than some other programs that are < 20 minutes. It would be interesting to see how this rate of compliance was achieved so clinicians could use those strategies in their athletic settting. It will be interesting to see if these programs work for college, high school, or younger female basketball players. This study adds further evidence that neuromuscular training may help prevent injuries and should be encouraged by athletic trainers, physicians, parents, and coaches.

Questions for Discussion:   Do you implement neuromuscular training into your warmups/rehabilitation? If not, are you considering using it after reading this article? Even though this study was only done on professional female basketball players, do you see it potentially benefitting other levels of athlete/other sports? Do you see any possible complications if less experienced players were to use this technique?

Written by: Amy Virostek
Reviewed by: Jeffrey Driban

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Dan Rosenblum said...


There is a decent amount of research out there right now that examines the effects that neuromuscular training programs have on injury prevention. Most of it shows relatively positive effects of these programs successfully reducing injury rates.

I think that it's really important to incorporate a program like this into the warm-ups of the athletes that we work with. The obvious problems with doing so is that these programs can take a decent amount of time (like this one) and ultimately take up practice-time. This can pose a problem at the high school level where practices are generally fairly short meaning that cutting out 30 minutes to do a warm up may not be favorable by the coach.

Another issue I see with implementing one of these programs in younger athletes is that some of them are simply not strong enough to even complete a warm-up like this with the correct technique. I know that seems ridiculous, but some of these younger athletes can't hold a plank for longer than 20 seconds.

If we can implement programs like this in younger athletes before high-school, it can help make them stronger earlier and improve their motor control before it's too late. I hope that a program can be designed for kids that 1. doesn't take too long and 2. is easy enough for them to complete, yet beneficial for making strength and NMC gains.

Overall, I am for these programs and I think it is really important to at least try to introduce our athletes to them, especially at an early age.

Jeffrey Driban said...

Hi Dan:
Great points! Many of the programs that have been studied tend to be shorter than this one (often 10-20 minutes). The OA Action Alliance provided a best practice features document that highlights the key elements of efficacious preventive training programs. This provides a nice template for how we can work with coaches to modify their existing warm-ups rather than replace them. If you think about it many coaches are probably already implementing some key exercises into their warm-ups. We just need to help them identify what's missing (and in some cases what might not be needed). This might be an easy way to get coaches to adopt these programs.

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