A School-Based Injury Prevention Program to Reduce Sport Injury Risk and Improve Healthy Outcomes in Youth: A Pilot Cluster-Randomized Controlled Trial
Richmond SA, Kang J, Doyle-Baker PK, Nettel-Aguirre A, & Emery CA. Clin J Sport Med. 2016;26:291–298. doi: 10.1097/JSM.0000000000000261
An injury prevention warm-up two to three times a week in a junior high school physical education class decreased injuries and improved overall fitness.
We have had multiple posts on Sports Med Res about the effectiveness of injury prevention programs for reducing the risk of injuries among high school and collegiate athletes. Researchers have not evaluated the effectiveness of these programs in many younger groups and have not taken into consideration aerobic intensity. The authors of this randomized trial wanted to evaluate the effectiveness of an injury prevention program in reducing injuries as well as improving body composition and fitness levels in a youth school-based population (11 to 15 year olds). Baseline measurements were taken in junior high school physical education classes and then schools were randomly assigned to either the injury prevention or standard warm-up program. The warm-up programs lasted for 12 weeks and were conducted two to three times per week in the beginning (first 15 minutes) of physical education classes. The warm-ups consisted of either standard warm-up (i.e., lower intensity aerobic with dynamic and static stretching) or injury prevention (i.e., moderate intensity aerobic with neuromuscular, strength, and balance training). The authors defined a sports injury as an injury that occurred during sport or a recreational activity that required the student to stop playing, seek medical attention, or miss at least one day from sport. Overall, the authors found that students who received the injury prevention program were ~70% less likely to have sport injury or more specifically, lower extremity injury, ankle sprain, or knee sprain. Student who performed the injury prevention program also had less time lost to injury compared with the standard warm-up group. In secondary fitness measure outcomes, the intervention group had greater time in higher exercise heart rate ranges than the standard warm-up participants. Both groups increased in waist circumference, but the intervention group had less change than the standard warm-up group.
This research study confirms findings that an injury prevention program can aid in reducing the number of injuries and amount of time lost among students in junior high schools. The interesting thing about this study is that it was conducted within the school setting. This helps to improve compliance and regular integration of the program. It would have been interesting to see how program compliance compared to programs that were typically completed with sport teams. Interestingly, the authors of this study begin to uncover that the injury prevention program may help in physical activity minutes and overall fitness within a young junior high school group. These students are susceptible to decreased activity levels and the possibility of gaining weight. It is an important time in the students’ lives to integrate a healthy lifestyle. This includes maintaining or increasing overall physical activity intensity as well as decreasing injuries. Injuries lead to decreased physical activity and potentially put these students at risk for adopting a less active lifestyle. It would be interesting to see if there are any long-term benefits to these programs if they were implemented in consecutive years in physical education curriculums. For example, would injury risk continue to decline, would fitness measures show improvements, or would students integrate these warm-ups into their recreational activities, Ultimately, we see the importance of having young physically active participants perform injury prevention warm ups. They don’t take much time, and clearly they have positive outcomes on risk of injury, fitness, and athletic performance.
Questions for Discussion
What do you think about the possibility of integrating these warm ups into physical education courses? Where do you think these warm-up programs would have the best long-term success for students to continue doing once they are no longer in school?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Richmond, S., Kang, J., Doyle-Baker, P., Nettel-Aguirre, A., & Emery, C. (2016). A School-Based Injury Prevention Program to Reduce Sport Injury Risk and Improve Healthy Outcomes in Youth Clinical Journal of Sport Medicine, 26 (4), 291-298 DOI: 10.1097/JSM.0000000000000261
Being an athletic trainer possibly interested in working in a youth sports setting, I think the results of this study could be very valuable in the future. The fact that this injury prevention program used only takes 15 minutes seems to provide a time-efficient method to decrease injuries in physically active young individuals. Before immediately suggesting these programs to coaches at secondary schools, these results may need to be verified in athletes who participate in competitive sports. It could also be beneficial if this study was recreated in an older population; using subjects currently participating in high school or collegiate sports may make the results more applicable to athletic trainers. However, if these results could be recreated in the populations stated above, I think athletic trainers would have good reason to suggest this type of injury prevention program to all coaches that they work with. With a typical team practice lasting between 2-3 hours, 15 minutes of additional warm-ups would be feasible for most coaches if they were told it could reduce lower extremity injuries by 70%.
We have several posts on the site highlighting the effectiveness of injury prevention programs in competitive athletes (from middle school to elite youth). Most of those programs take only 10-20 minutes to implement and are designed to be a warm-up routine. One of the things I loved about this study was that the program was incorporated into the phys ed class. It's a great way to get more kids participating in the injury prevention program since not everyone is playing sports for an organized team/league. It's time for every AT to be encouraging coaches, league admin, and athletic directors that injury prevention programs should be a standard part of our athletes' training routines. There will be talks on injury prevention programs at NATA and ACSM this year.