Table 4 Preventive strategies continued throughout the playing season: summary of study characteristics
Author, year, study type (setting)Participants and recruitmentGroups/intervention (compliance)Outcomes (follow-up period)Comments
Emery 2005 Cluster RCT (Canada)120 subjects (aged 14–19; with no history of musculoskeletal injury or medical condition). Computer-generated random recruitment of schools and students (2 males and 2 females from PE programme roster in grades 10–12)(A) Balance training (n = 60 players): physiotherapist taught each participant a home-based, proprioceptive balance training programme; performed 20 min/day for 6/52, then weekly for remainder of 6/12 period. (B) No intervention (n = 60 players). (Self-reported compliance: daily record sheet with weekly phone call over 6/52 training period).Injury definition: any injury requiring medical attention or loss of 1 or more days of sporting activity or both. Severity classification: classified by area and type (sprain, fracture, etc) of injury. (6 months). Authors’ conclusion: positive: wobble board reduced self-reported injuryData collection methods: injury report forms; completed by subject and by any attending medical professional. The physiotherapist made biweekly phone calls to all participants to ensure all eligible injuries reported.
Wedderkopp 1999 Cluster RCT (Denmark)237 female handball players (aged 16–18; playing at elite, intermediate, recreational levels). Randomised for intervention. Controlled for age, practice time, playing level, floor composition and injury incidence in previous season (self-reported, assessed with survey).(A) Intervention protocol (11 teams; n = 111 players): various functional activities followed by use of ankle disc for 10–15 min at all practice sessions. (B) Control (11 teams; n = 126 players): subjects continued to practice as usual. (Compliance: not reported).Injury definition: any injury causing the player to miss the next game or practice, or to play with considerable discomfort. Severity classification: absence from practice/games. Minor: <1 week. Moderate: 1 week but <1 month. Major: >1 month. (August–May 1996; 10 months). Authors’ conclusion: positive: intervention group reduced injury.Data collection methods: coaches documented injury incidence and severity by questionnaire. Injury verification: club physiotherapist and doctor.
Wedderkopp 2003 Cluster RCT (Denmark)163 female European handball players (aged 14–16; playing at elite, intermediate and recreational levels). Randomised by team (8 to each group).(A) Functional training and ankle disk (n = 77 players): performed for 10–15 min at each training session plus strength activities. (B) Functional training only (n = 8 teams; 86 players) (Compliance: not reported)Injury definition: any injury causing the player to miss the next game or practice, or to play with considerable discomfort. Severity classification: absence from practice/games. Minor: 1 week. Moderate: >1 week but <1 month. Major: >1 month. (1 season). Authors’ conclusion: positive: ankle disc reduced traumatic injury when added to functional strength training.Data collection methods: investigators contacted coaches at least once a week. Injury verification: injured players contacted and interviewed by doctor. Examined if in doubt.
Olsen 2005 Cluster RCT (Norway)1837 youth handball players (aged 15–17; 1586 female, 251 male); 123 volunteer clubs. Block randomisation to intervention or control group. Clubs matched by region, playing level, sex and numbers of players.(A) Technical, balance and strengthening exercises (61 clubs; 958 players; 808 female, 150 male): structured 20 min group programme (warm-up, technical, balance and strengthening exercises). Performed before first 15 training sessions, then weekly for rest of season. (full details on each facet of warm-up described). (B) Control (59 clubs; 879 players; 778 female, 101 male): subjects advised to continue training as usual. (Compliance reported by coach of each team).Injury definition: classified as acute or overuse injury to knee or ankle. Severity classification: absence from practice/games. Slight: 0 days. Minor: 1–7 days. Moderate: 8–21 days. Major: >21 days. (1 league season 8 months). Authors’ conclusion: positive: an injury prevention protocol can prevent injuries in youth handball.Data collection methods: injury and exposure reported by physiotherapists (blinded to group allocation) each month. Injury data confirmed by coaches at end of season.
Junge, 2002 Prospective intervention study (Switzerland)Male soccer; age 14–19; 14 teams (3 high skill + 4 low skill level amateur youth teams in each group). Group allocation by geographic location (2 regions).(A) Intervention group: general education and supervision of coaches + players. (Preventative intervention included: warm-up, cool-down, taping, rehabilitation, fair play and flexibility/stability exercises). (B) Control: subjects trained and played soccer as usual. (Physiotherapists delivered the primary intervention. Amount of training and matches was recorded for each player by coaches.)Injury definition: any physical complaint caused by soccer that lasted for more than 2 weeks or resulted in absence from a subsequent match or training session. Severity classification. Mild: absence up to 1 week or complaints for >2 weeks. Moderate: absence for >1 week but <4 weeks. Severe: absence for at least 4 weeks or severe tissue damage, eg, fracture/dislocation (1 year). Incidence of injury per 1000 h. Authors’ conclusion: positive: injury prevention intervention reduced injury.Data collection methods/injury verification: doctors visited participants weekly to perform an interview and physical examination of injury. Type, severity and location of injury also documented.
Mandelbaum 2005 Prospective intervention study (USA)1041 female competitive youth soccer players (age 14–18). Non-randomised teams volunteered for inclusion.(A) Injury prevention protocol (n = 1041 (2000); n = 844 (2001); all female): warm-up, stretching and strengthening, plyometric activities, and soccer-specific agility drills. (B) Control (n = 1905 (2000); n = 1913 (2001)): continued traditional warm-up. Age and skill matched controls. (Compliance form for each team completed by coach with a spot check on last week of season).Injury definition: study focused on non-contact ACL injuries. Severity classification. (2 years 2000–2001). Authors’ conclusion: positive: a neuromuscular training programme led to a significant reduction in ACL injuries in female soccer players.Data collection methods: injuries reported by coach on a weekly injury report form to project coordinator. If knee injury occurred, player was given a “knee injury questionnaire” to complete within 10 days and return to project coordinator. Injury verification: confirmed by doctor and MRI or arthroscopy.
  • ACL, anterior cruciate ligament; RCT, randomised controlled trial.