Preventing musculoskeletal injury
in sports personnel is very important considering the fact that 22 million
sports injuries occur each year in UK alone. Moreover, the WHO (World Health
Organization) estimates that at least 60 percent of global population are
physically inactive adding to the economic burden of the countries because of
inactivity related disorders such as metabolic syndrome. However, increasing
physical activity will lead to increased incidence of musculoskeletal injury,
so there is a need for practical, efficient and cost effective injury
Neuromuscular training programs prevent lower limb
injuries by improving joint position sense, enhancing joint stability and
developing protective joint reflexes. Multi-intervention programs may reduce injuries
but their practicality is limited in terms of equipment purchases, additional
training sessions, and cost effectiveness for many sports clubs.
In view of this, Katie Herman and
colleagues from Centre for Sports and Exercise Medicine, William Harvey
Research Institute, Queen Mary University of London, UK, reviewed six
randomized controlled trials and three clinical trials to determine effective,
easily implemented, functional neuromuscular warm-up strategies to prevent
lower limb injuries during sports participation.
Studies included about 1,500 participants in the age group
of 13 to 26 years. Two studies investigated male and female participants, while
the other seven studies focused on women only.
Study groups were amateur football, basketball and
volleyball players, and army recruits.
The injuries evaluated were ACL (anterior cruciate
ligament, one of four major knee ligaments), anterior knee pain (AKP),
collateral ligament, meniscal and patella injuries, as well as injuries of the
foot, ankle, thigh, groin and hip.
Only those studies were included which investigated
neuromuscular warm-up strategies that could be included into regular activity
and could be performed anywhere without the use of specialist equipments.
The investigators identified four practical neuromuscular
warm-up strategies suited for prevention of lower limb injury -
* The 11+
This strategy includes slow running, active stretching, controlled contact,
exercises for strength, balance, jumping and soccer-specific agility drills and
can reduce overall and overuse lower limb and knee injuries in young amateur
female football players.
* The KIPP
Knee Injury Prevention Program combines progressive strengthening, plyometric,
balance and agility exercises, and can reduce non-contact and overuse lower
limb injuries in young amateur female football and basketball players.
* The PEP
- The Prevent injury and Enhance Performance
regimen involving vertical jump, crunches, walking lunge, hamstring lean, knee
to chest, and bridge with leg lift reduced the risk of non-contact ACL injury
in young amateur female football players.
* The AKPPTP
The Anterior Knee Pain Prevention Training Program
warm-up consists of eight exercises closed chain strengthening exercises, 10 to
14 repetitions each; and warm-down involves four stretching exercises and three
repetitions. The program reduced the risk of anterior knee pain in male and
female military recruits.
Apart from the above four, The HarmoKnee
regimen involving jogging, high-knee skipping,
lunges, squats and curls that could reduce the risk of knee injuries in teenage
female football players, could also be considered as a neuromuscular warm-up
The investigators recommended incorporating 'stretching,
strengthening and balance exercises, sports-specific agility drills and landing
techniques', for a 'duration of longer than three consecutive months at all
They suggested further research for evaluating the
effectiveness of these strategies in men and older individuals as well.
Barton C, Malliaras P, Morrissey D. The effectiveness of neuromuscular warm-up
strategies, that require no additional equipment, for preventing lower limb
injuries during sports participation: a systematic review. BMC Med. 2012 Jul