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What does ‘preventive training’ prevent in competitive sport?
  1. Per Bo Mahler1,2,
  2. Boris Gojanovic2,
  3. François Fourchet2,
  4. Finn Mahler2
  1. 1Service de santé de l'enfance et de la jeunesse, Swiss Olympic Partner School, Genève, Switzerland
  2. 2Hôpital de la Tour, Sports Medicine, Swiss Olympic Medical Center, Meyrin, Switzerland
  1. Correspondence to Dr Per Bo Mahler, Service de santé de l'enfance et de la jeunesse, Swiss Olympic Partner School, 11 Glacis de Rive, CH-1207 Genève (GE), Switzerland; per.mahler{at}etat.ge.ch

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We have just returned from Barcelona's ECOSEP and MuscleTech Network conference, where we had the opportunity to listen to some of the world's foremost experts on tendon and muscle injury, and to sit in the Camp Nou stadium, where some of the world's best footballers play.

It is to be expected, considering the value of the players and the budget of this club, that injury prevention is a priority and that the very best of evidence is implemented.

One of the presentations was on FC Barcelona's ‘preventive training’, where we heard an excellent talk on a series of practices encompassing strengthening, mobility drills, agility and proprioception in the hope of preventing injuries.

Does ‘preventive training’ prevent injuries?

It is intriguing that this part of the football practice is called ‘preventive training’, considering that no decrease in the number of injuries over time could be presented for FC Barcelona. This concurs with what is observed in most other elite clubs, where there continues to be a constant number of injuries over time despite the introduction of ‘preventive training’ and other preventive measures.1

Recent data on hamstring injuries in UEFA elite clubs, actually show an increase in hamstring injuries since 2001, in particular during training.2 Finally, a randomised controlled trial using the 11 programme and a systematic review, both published by Van Beijsterveldt, failed to show any effect of preventive exercises on injuries among adult amateur football players.3 ,4 Unfortunately, little information is available for professional players.

Could ‘preventive training’ contribute to performance?

This questions the targeted effect of ‘preventive training’. Considering that performance in modern football has increased considerably in recent years (∼30% increase in high intensity running distance and ∼50% increase in high intensity actions in the English premier league),5 without any concomitant increase in the number of injuries, and knowing that prevention can contribute to injury reduction and performance, one could hypothesise that ‘preventive training’ might have contributed mostly to performance enhancement rather than injury reduction.

If this is the case, the so called ‘preventive training’ can be seen as a specific, individualised, type of practice that contributes to certain abilities, which, in turn, if performance/load stays constant over time, may contribute to reducing injuries. Since performance/load does not stay constant over time (injury-free players play more, load more, push their limits) and is rarely corrected for in research, this kind of training should inherently be associated with the rest of practice for objective and compliance reasons.

Data published by Daneshioo et al6 support this hypothesis and show improvements in agility, leg power and soccer skills following the introduction of the 11+ and the HarmoKnee prevention programmes in professional players.

Considering the constantly increasing physical and psychological demands on professional players, congested seasonal calendars and little time for recuperation, one can again imagine that prevention may contribute to limiting the increase in injuries in a performance driven environment. In this context, structural approaches such as limiting playing time or the number of matches per player/per season, have their place as has been observed with Laws of the Game modifications (less elbow contact injuries with stricter refereeing), if we wish to reduce injuries.7

Can ‘non-preventive’ training and team performance contribute to injury prevention?

If one looks at the ‘non-preventive’ part of football practice, one can certainly argue that many parts of it can contribute to injury reduction. Improving agility, contact avoidance, heading technique, endurance, etc, can all be said to potentially reduce injuries.

Team performance, per se, can also be considered ‘preventive’, in that it can be observed that teams performing well frequently have less injuries or fewer long-standing injuries, than teams at the bottom of the standings. This has been reported by coaches and has been observed in some UEFA data.8

Where do we go from here?

The classical four-stage model of injury prevention therefore seems to have its limits if performance is not accounted for, even though the limits might be difficult to define.9

We strongly believe that ‘preventive training’ contributes to performance and to a lesser degree to injury prevention in a performance driven environment, thus explaining the somewhat deceiving, mid to long-term reduction in injuries found following preventive programmes.

Considering the interindividual differences in adaptation to load, travel, stress, etc, injury prevention remains an art where the coach/manager and staff have to use their knowledge and experience to best advise each player so as to get the most out of his/her potential, and limit injuries.

Due to the low compliance rates and the benefits on performance with ‘preventive training’ drills and the debatable effect on injury reduction, it might be useful to integrate these specific exercises in the usual training without giving it any preventive denomination.

References

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.