Sports Medicine Research: In the Lab & In the Field: Nationwide Injury Prevention is On Our Side (Sports Med Res)

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Wednesday, February 6, 2019

Nationwide Injury Prevention is On Our Side

A Nationwide Follow-Up Survey on the Effectiveness of an Implemented Neuromuscular Training Program to Reduce Acute Knee Injuries in Soccer Players

Aman M, Larsen K, Forssblad M, Nasmark A,Walden M, & Hagglund M.  Orthop J Sports Med. Published online December 2018; DOI: 10.1177/2325967118813841

Take Home Message: The implementation of an injury prevention program nationwide was related to a reduction in knee injuries among soccer players, especially females.

Knee injuries are relatively common in soccer players and can result in considerable time loss. There are many neuromuscular training injury prevention programs, including the Knee Control Program, which reduces the number of ACL injuries among female adolescent soccer players.  Sweden implemented the Knee Control Program nationwide in 2010, which created a great opportunity to study its effectiveness at a national level. Hence, the authors evaluated the effectiveness of this program to reduce acute knee injuries among soccer players at a national level. The authors also assessed the dissemination and implementation of this program.  In Sweden, all soccer players over 15 years of age are registered and use the same insurance company. The authors retrospectively found over 17,500 players with a knee injury, including 9,318 soccer players with an acute cruciate ligament injury between 2006 to 2015.  After implementation of the Knee Control Program there was a decrease in “cruciate ligament” injuries by 6 to 13% and overall knee injuries by 8 to 21% compared to the years prior to implementation.  There were no decreases in major knee injuries among athletes between the ages of 15 to 17 years.  About 90% of the 24 districts held at least one educational workshop over a 5-year period, and it was heavily aimed at female soccer teams.

Knee injuries were reduced among national soccer players, especially females, after implementation of the Knee Control Program.  The authors noted that the program had very early positive effects on female soccer players, which led to more education and positive attention within this population.  The authors were concerned about the lack of efficacy among adolescents 15 to 17 years of age given their high risk for a knee injury.  The authors suggested that this age group may be more aware of knee injuries, which lead to an increase in diagnoses.  However, I wonder if this group is limited by poor motivation or neuromuscular pattern development.  I also wonder if they might have benefited more if these programs were implemented at an earlier age when these types of programs may be most effective.  This study is paramount in looking at such a large time period within a national cohort of soccer players that included adolescent, amateur, and professional players.  The program was associated with almost 100 fewer knee injuries per year, which seems impactful, especially since the authors concluded that the program has only been partially implemented nationwide.  It also remains unknown how well teams complied/adhered to the program, which is important since compliance is related to the efficacy of these programs. Despite, potential issues with compliance/adherence and implementation, this program effectively reduced knee injuries in soccer nationwide. Clinicians need to encourage coaches, parents, players, and other stakeholders to adopt evidence-based neuromuscular training injury prevention programs.

Questions for Discussion:  Are there any strategies that have worked for you in creating team buy into an injury prevention program? What do you think we need to do as a profession to improve the implementation and adherence to injury prevention programs overall?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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