May 2014

Studies explore implementation options for sports injury prevention programs

5IOC-implementation-iStock16877226lrClosing the gap between lab and field

By Jordana Bieze Foster

Even if an injury prevention program is effective under controlled study conditions, that effectiveness doesn’t always translate to the real world. That’s why some researchers are now working to identify the most effective strategies for implementing prevention programs and the most common barriers to implementation.

One challenge in implementing a neuromuscular training program is finding qualified people to train the athletes. Coaches are often too busy or lack the physical fitness, and not all teams have access to professional trainers.

Researchers involved in the military-based JUMP-ACL (Joint Undertaking to Monitor and Prevent Anterior Cruciate Ligament Injury) project addressed this issue with a tiered “train the trainer” approach. Experts trained a “cadre” of 120 military upperclassmen in a neuromuscular exercise program, and those 120 were responsible for training 654 new cadets during basic training.

As part of a study presented at the IOC conference in Monaco, half of the cadre received training only during a single workshop; the other half received daily feedback from experts. Cadets trained by the cadre (two to three 10-minute sessions per week) were compared to another 659 cadets who did an active warm-up instead of the specified training.


The investigators found that the neuromuscular training was associated with significantly reduced rates of lower extremity injury compared to the active warm-up—but only when administered by the cadets who had the support of experts.

“With the proper training we can achieve injury rate reduction,” said Lindsay J. DiStefano, PhD, ATC, an assistant professor of kinesiology at the University of Connecticut in Storrs, who presented the findings in Monaco. “The problem is that this isn’t sustainable.”

Another challenge of implementation is that even coaches who do provide injury prevention training for athletes don’t always follow established evidence-based protocols, Swedish researchers have found.

Three years after completion of a very high-profile randomized controlled trial supporting neuromuscular training for reducing ACL injuries in female adolescent soccer players, researchers from Linköping University in Sweden found that 91% of current coaches in the same association knew about the training program and 74% of current coaches were using it. But only 35% of coaches said they used the training every week, and only 25% said they used the training with no modifications.

“We don’t know that the protocol is effective if it is modified,” said Hanna Lindblom, RPT, MSc, an assistant lecturer in physiotherapy at the university, who presented the findings.

Part of the problem may also be that even players and coaches who have been exposed to injury prevention training don’t necessarily believe it works, according to research from the University of Calgary in Alberta, Canada.

They found that just 14% of 29 coaches in a youth soccer league believed a warm-up could prevent muscle injuries, and none believed it could prevent knee or ankle injuries. These beliefs were not significantly changed after one season of using the FIFA 11+ warm-up program for injury prevention.

“Participation in a prevention program doesn’t necessarily change attitudes about prevention,” said Carly D. McKay, PhD, a postdoctoral fellow at the university’s Sport Injury Prevention Research Centre, who presented the findings.


Lindblom H, Walden M, Carlfjord S, Hagglund M. Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after an RCT. Br J Sports Med 2014;48(7):627.

Walden M, Atroshi I, Magnusson H, et al. Prevention of acute knee injuries in adolescent female football players: Cluster randomized controlled trial. BMJ 2012;344:e3042.

McKay CD, Steffen K, Romiti M, et al. The effect of exposure to the FIFA 11+ warm-up program on injury risk knowledge and prevention beliefs in elite female youth soccer. Br J Sports Med 2014;48(7):637.

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