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
Take-Home Message
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
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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