Effectiveness of injury prevention programs with core muscle strengthening exercises to reduce the incidence of hamstring injury among soccer players: a systematic review and meta-analysis.
Al Attar WSA, and Husain MA. Sports Health. 2023 [Epub Ahead of Print].
Take-Home Message
Injury prevention programs that include core muscle strengthening exercises reduce the risk of hamstring injuries in soccer players.
Background
Soccer players are at risk for many lower extremity injuries, especially hamstring injuries. Many investigators have demonstrated that injury prevention programs, which often include core muscle strengthening exercises, can reduce the risk of lower extremity injuries. However, it remains unclear if injury prevention programs with core muscle strengthening exercises effectively reduce the risk of hamstring injuries.
Study Goal
The researchers completed a systematic review and meta-analysis to investigate if an injury prevention program, including core muscle strengthening exercises, reduces the rates of hamstring injuries.
Methods
Researchers performed a comprehensive literature search for randomized clinical trials with (1) injury prevention training programs with core muscle strengthening exercises, (2) an outcome measure of hamstring injury rate, (3) a control comparison, and (4) soccer players at any level. Two researchers evaluated the risk of bias among the included studies.
Results
The authors analyzed five studies. One study was a randomized controlled trial, while the others were cluster randomized controlled trials. Each trial included 209 to 1892 participants, totaling 4,485 participants across all studies. Participants completed the injury prevention programs for 10 weeks to 8 months and had compliance rates ranging from 21% to 91%. Three of the 5 studies were considered to have a low risk of bias. Across all studies, 171 hamstring injuries were recorded over 379,102 exposures. Overall, completing an injury prevention training program with core muscle strengthening exercises (e.g., FIFA 11+) offered a 47% reduction in hamstring injuries compared to the control group (typically a standard warm-up program).
Viewpoints
Overall, this study supports implementing an injury prevention program with core muscle strengthening exercises to reduce the risk of hamstring injuries among soccer players. While this finding is helpful to many clinicians, gaps remain. For example, the low number of studies that met the inclusion criteria limits our confidence in the results. For example, while we estimate that these prevention programs offer a 47% reduction in hamstring injury risk, we can only be confident that the real risk reduction likely ranges from 2% to 72%. More studies and a larger sample size would help us better understand precisely how effective these programs are at reducing the risk of hamstring injuries. The studies also did not use identical interventions. While this may frustrate some people that we can’t say do this specific program, it also can reassure us that we may have some flexibility to adapt programs for each team and still experience benefits. Ultimately, injury prevention programs with core muscle strengthening exercises are low risk and cost and could help reduce the risk of injury, especially hamstring injuries.
Clinical Implications
Clinicians should encourage soccer teams to use injury prevention training programs with core muscle strengthening exercises. These programs are often low-risk, low-cost, and completed in less than 15 minutes.
Questions for Discussion
What do you look for when evaluating injury prevention programs for implementation? Have you specifically looked for core strengthening in the past? Why or why not?
Written by Kyle Harris
Reviewed by Jeffrey Driban
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