Prevention
of acute knee injuries in adolescent female football players: cluster
randomized controlled trial.
of acute knee injuries in adolescent female football players: cluster
randomized controlled trial.
Waldén
M, Atroshi I, Magnusson H, Wagner P, Hägglund M. BMJ. 2012
May 3;344:e3042. doi: 10.1136/bmj.e3042.
M, Atroshi I, Magnusson H, Wagner P, Hägglund M. BMJ. 2012
May 3;344:e3042. doi: 10.1136/bmj.e3042.
https://www.ncbi.nlm.nih.gov/pubmed/22556050
(full text available for free)
(full text available for free)
Soccer
is a popular sport throughout the world; however, female soccer athletes are
much more prone to anterior cruciate ligament (ACL) injury than their male
counterparts. One theory why female
athletes are more prone to ACL injuries involves the different firing patterns
of the muscles in the lower extremity in women compared to men, which leads to
increased valgus load at the knee in females. Considering this hypothesis, is there a short,
effective, and applicable intervention that could be implemented on a large
scale to help prevent ACL injuries? The
aim of this randomized clinical trial was to evaluate the effectiveness of a
neuromuscular warm-up program to reduce acute knee injuries, and more
specifically ACL injuries, among adolescent female soccer players. In this study, 4564 female soccer players
between the ages of 12 and 17 years (in 309 soccer clubs) were randomly divided
based on their teams into two parallel study groups: control group (2085
athletes in 155 clubs) and intervention (2479 athletes in 154 clubs). A neuromuscular
warm-up program was designed focusing on knee control and core stability
and was comprised of 6 exercises, further subdivided into four steps with
progressive difficulty. The program took
about 15 minutes to complete and was implemented in the intervention group and
maintained through the entire duration of the soccer season. The study staff taught the program to the
coach and one player on each team. Compliance
was monitored by coaches during each training session in addition to random
spot checks by physiotherapists throughout the study duration. Coaches also notified the physiotherapists of
any knee injuries and the clinician then conducted an evaluation. Severe knee injuries were defined as an absence
from play for more than four weeks. The
authors noted that the intervention group had less ACL injuries (7 injuries,
0.28%) than the control group (14 injuries, 0.67%); a 64% reduction. However, there were no differences between
the groups in regards to the additional end points of severe knee injuries or
any acute knee injury. The authors
provided some evidence that severe knee injuries or any acute knee injuries may
have been lower among those considered compliant with the intervention program
compared to the control group.
is a popular sport throughout the world; however, female soccer athletes are
much more prone to anterior cruciate ligament (ACL) injury than their male
counterparts. One theory why female
athletes are more prone to ACL injuries involves the different firing patterns
of the muscles in the lower extremity in women compared to men, which leads to
increased valgus load at the knee in females. Considering this hypothesis, is there a short,
effective, and applicable intervention that could be implemented on a large
scale to help prevent ACL injuries? The
aim of this randomized clinical trial was to evaluate the effectiveness of a
neuromuscular warm-up program to reduce acute knee injuries, and more
specifically ACL injuries, among adolescent female soccer players. In this study, 4564 female soccer players
between the ages of 12 and 17 years (in 309 soccer clubs) were randomly divided
based on their teams into two parallel study groups: control group (2085
athletes in 155 clubs) and intervention (2479 athletes in 154 clubs). A neuromuscular
warm-up program was designed focusing on knee control and core stability
and was comprised of 6 exercises, further subdivided into four steps with
progressive difficulty. The program took
about 15 minutes to complete and was implemented in the intervention group and
maintained through the entire duration of the soccer season. The study staff taught the program to the
coach and one player on each team. Compliance
was monitored by coaches during each training session in addition to random
spot checks by physiotherapists throughout the study duration. Coaches also notified the physiotherapists of
any knee injuries and the clinician then conducted an evaluation. Severe knee injuries were defined as an absence
from play for more than four weeks. The
authors noted that the intervention group had less ACL injuries (7 injuries,
0.28%) than the control group (14 injuries, 0.67%); a 64% reduction. However, there were no differences between
the groups in regards to the additional end points of severe knee injuries or
any acute knee injury. The authors
provided some evidence that severe knee injuries or any acute knee injuries may
have been lower among those considered compliant with the intervention program
compared to the control group.
The
findings of the study suggest that a structured 15-minute neuromuscular warm-up
program can help reduce the number of ACL injuries in adolescent female soccer
players. One advantage of such warm-up
program is that it is monitored and implemented by the coaching staff and only
requires minimal outside intervention.
Therefore, it can serve as a preventive tool for ACL injuries in female
adolescent players. The impact on ACL
injury prevention by a neuromuscular warm-up program was also echoed in a previous
study by Mandelbaum et al. It demonstrated that a neuromuscular and
proprioception training program may help reduce the occurrence of ACL injuries
over the long-term. In summary, more research
is needed to establish the validity and clinical benefit of neuromuscular
warm-up programs to prevent ACL injuries specifically and all knee injuries in
general. The biggest limitation of this
study is that it was neither designed nor powered to look at the rate of injury
reduction during contact vs. non-contact ACL injuries with and without a
neuromuscular warm up. Do you
incorporate a neuromuscular training program with your adolescent females? Do you think these findings may be applied to
other female sports as well as male sports?
findings of the study suggest that a structured 15-minute neuromuscular warm-up
program can help reduce the number of ACL injuries in adolescent female soccer
players. One advantage of such warm-up
program is that it is monitored and implemented by the coaching staff and only
requires minimal outside intervention.
Therefore, it can serve as a preventive tool for ACL injuries in female
adolescent players. The impact on ACL
injury prevention by a neuromuscular warm-up program was also echoed in a previous
study by Mandelbaum et al. It demonstrated that a neuromuscular and
proprioception training program may help reduce the occurrence of ACL injuries
over the long-term. In summary, more research
is needed to establish the validity and clinical benefit of neuromuscular
warm-up programs to prevent ACL injuries specifically and all knee injuries in
general. The biggest limitation of this
study is that it was neither designed nor powered to look at the rate of injury
reduction during contact vs. non-contact ACL injuries with and without a
neuromuscular warm up. Do you
incorporate a neuromuscular training program with your adolescent females? Do you think these findings may be applied to
other female sports as well as male sports?
Written
by: Christian Glaser, DO and Marc I. Harwood, MD reviewed
by: Christian Glaser, DO and Marc I. Harwood, MD reviewed
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Related
Posts:
Posts:
Waldén M, Atroshi I, Magnusson H, Wagner P, & Hägglund M (2012). Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ (Clinical research ed.), 344 PMID: 22556050
I have worked with both high school and division 1 female soccer teams in the last two years and only had 1 ACL injury. Although I am just starting out in my career, I have been doing a lot of reading about ACL injury prevention programs. Neither school I worked at had any kind of program for the athletes, but that is something that I would like to definitely try to include if I am working with a women's soccer team or other high-risk sport (like women's gymnastics or w. basketball). Many of the prevention programs out there incorporate multiple different types of training (balance, plyometric, landing, etc) and have varying lengths (anywhere from 15 to 90 minutes). I think that this study is good, but that it would be helpful to know which types of training are most effective and how much time should be devoted to the training. Also, some other types of training preograms warrant consideration. Dance training, for instance, would probably have good results as a prevention program.
Thank you for your comment. You raise an important point about ALC injuries, the choice and duration of prevention program. Currently Tim Hewitt and Mandelbaum are focusing parts of their research on that topic and both agree on the benefit of a warm up program. As you pointed out, there are many different programs available but a couple of important factors need to be considered when choosing a warm up program: length and complexity. Most of the programs are implemented and supervised by the coaching staff, which potentially could serve as the limiting factor in their use.
There is most certainly the need for more research in this field to address the above asked questions but also to evaluate the long term benefit of warm up programs in ACL injury prevention.
I think that adding in a neuromuscular training program can be very beneficial. So many adolescent females are getting knee injuries and ACL injuries. Adding in a program, which can help limit the number of ACL injuries, will be a good thing and could also help further down the road when these athletes continue on to college. I think that these findings could be added in with basketball players. I say this because I have also seen female basketball players sustain ACL injuries just as much as soccer players. For males sports I think it could not hurt added them into their daily warm-up routine.
Kaitlyn
Thank you very much for your comment. You are absolutely right, that a NMT warm up program will help female athletes as they progress through different levels of competition. Educating female athletes at an early age hopefully helps to incorporate the NMT programs into their daily warm up routine. Despite most studies for NMT warm up programs involve female soccer players, the results could be extrapolated to other sports as well in particular ones that involve sudden pivoting and jumping.
I agree with Kaitlyn! I think that incorporating a NMT program for female athletes is a great idea because of their disadvantage in valgus stress to the knee. I also think that performing the program with males isn't a bad idea either considering ACL tears can happen in any athlete and since reducing the risk of injury is as simple as a different warm-up technique, why not?
I agree with Kaitlyn! I think that incorporating a NMT program for female athletes is a great idea because of their disadvantage in valgus stress to the knee. I also think that performing the program with males isn't a bad idea either considering ACL tears can happen in any athlete and since reducing the risk of injury is as simple as a different warm-up technique, why not?