Neuromuscular warm-up strategies can reduce lower extremity injury incidence


Today’s blog continues our London 2012 Olympic theme and some of the comments in response to our blog on running related musculoskeletal injuries on 1st August. The old adage that ‘prevention is better than cure’ appears to be true according to the results of a systematic review, published in BMC Medicine. The review evaluated the effect of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation.

Here’s what they did

The authors, from London, searched 7 databases up to January 2012. All 9 studies they included (6 Randomised Controlled Trials and 3 controlled clinical trials) were of moderate quality (assessed with a modified version of the van Tulder scale). Studies included an average of 1,500 participants (range 1,020 to 2,020).

Here’s what they found

  • The ’11+ prevention strategy’ significantly reduces overall (RR 0.67, CI 0.54 to 0.84) and overuse (RR 0.45, CI 0.28 to 0.71) lower limb injuries as well as knee (RR 0.48, CI 0.32 to 0.72) injuries among young amateur female footballers.
  • The ‘Knee Injury Prevention Program’ (KIPP) significantly reduced the risk of noncontact lower limb (RR 0.5, CI 0.33 to 0.76) and overuse (RR 0.44, CI 0.22 to 0.86) injuries in young amateur female football and basketball players.
  • The ‘Prevent Injury and Enhance Performance’ (PEP) strategy reduces the incidence of anterior cruciate ligament (ACL) injuries (RR 0.18, CI 0.08 to 0.42).
  • The ‘HarmoKnee’ programme reduces the risk of knee injuries (RR 0.22, CI 0.06 to 0.76) in teenage female footballers.
  • The ‘Anterior Knee Pain Prevention Training Programme’ (AKP PTP) significantly reduces the incidence of anterior knee pain (RR 0.27, CI 0.14 to 0.54) in military recruits.
  • None of the strategies evaluated were able to produce significant reductions in hip or thigh injuries, or lower leg or ankle injuries.

The Musculoskeletal Elf’s thoughts

The Msk ElfThe authors also concluded that the common components of effective neuromuscular warm-up strategies include; stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques applied consistently for longer than three consecutive months. It appears that practical neuromuscular warm-up strategies can reduce lower extremity injury incidence, especially of the knee, in young, amateur, female athletes and male and female military recruits.

However our old friend heterogeneity (variability) in study design and warm-up strategies prevented pooling of results. Only two studies investigated male and female participants, while the remaining seven investigated women only. The duration of the prevention strategies ranged from 12 weeks to two years. Furthermore sample sizes were often too small to evaluate specific injury types and methods of recording injury incidence were inconsistent. This makes generalisability of the results difficult. Further studies should also focus on men, other age groups, and other sports. Attention should be given to reporting of adverse effects of, and compliance with, the warm-up strategies.

people stretching

Common components of effective neuromuscular warm-up strategies include; stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques

In the meantime the Chartered Society of Physiotherapy produce a document on sports specific warm up advice. Alternatively you can see the Scottish tennis player Andy Murray performing a rather unconventional warm up strategy for the Australian Open in 2008 displaying football skills with a tennis ball!

Do you recommend warm-up strategies for sports participation? What is your view on this review, will it change your clinical practice? Send us your views on this blog and become part of the Musculoskeletal Elf community.


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