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A School-Based Neuromuscular Training Program and Sport-Related Injury Incidence: A Prospective Randomized Controlled
Kim D Barber Foss1,2,3, Staci Thomas1, Jane C Khoury4,5
1The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, OH.
Insights
A school-based neuromuscular training (NMT) program significantly reduced sport-related injuries in female athletes. This intervention showed particular effectiveness in preventing knee injuries across middle and high school levels.
Area of Science:
- Sports Medicine
- Injury Prevention
- Neuromuscular Training
Background:
- Millions of school-aged children participate in sports annually in the US, leading to millions of injuries and significant healthcare costs.
- Sport-related injuries in adolescents are a major public health concern, necessitating effective prevention strategies.
Purpose of the Study:
- To evaluate the impact of a school-based neuromuscular training (NMT) program on the incidence of sport-related injuries.
- To specifically assess the program's effectiveness in reducing knee and ankle injuries among middle and high school athletes in basketball, soccer, and volleyball.
Main Methods:
- A randomized controlled trial involving 474 female athletes across 5 middle schools and 4 high schools.
- Athletes were cluster-randomized into a neuromuscular training (CORE) group or a sham (SHAM) intervention group.
- The CORE intervention focused on trunk and lower extremity exercises, implemented throughout the sports season. Injury incidence was tracked weekly per athlete-exposure (AE).
Main Results:
- The CORE intervention group exhibited a significantly lower overall injury rate (5.34/1000 AEs) compared to the SHAM group (8.54/1000 AEs).
- Reduced injury incidence was observed in basketball and volleyball athletes in the CORE group versus the SHAM group.
- The NMT program demonstrated a protective effect on knee injuries, particularly at the middle school level, but did not significantly impact ankle injury rates.
Conclusions:
- Participation in a school-based neuromuscular training program effectively reduces overall sport-related injury incidence.
- The NMT intervention provides a protective benefit for athletes at both middle and high school levels.
- Targeted NMT programs can be a valuable tool for injury prevention in adolescent athletes.
Context:
An estimated 40 million school-aged children (age range = 5-18 years) participate annually in sports in the United States, generating approximately 4 million sport-related injuries and requiring 2.6 million emergency department visits at a cost of nearly $2 billion.
Objective:
To determine the effects of a school-based neuromuscular training (NMT) program on sport-related injury incidence across 3 sports at the high school and middle school levels, focusing particularly on knee and ankle injuries.
Design:
Randomized controlled clinical trial.
Setting:
A total of 5 middle schools and 4 high schools in a single-county public school district.
Patients Or Other Participants:
A total of 474 girls (222 middle school, 252 high school; age = 14.0 ± 1.7 years, height = 161.0 ± 8.1 cm, mass = 55.4 ± 12.2 kg) were cluster randomized to an NMT (CORE; n = 259 athletes) or sham (SHAM; n = 215 athletes) intervention group by team within each sport (basketball, soccer, and volleyball).
Intervention(S):
The CORE intervention consisted of exercises focused on the trunk and lower extremity, whereas the SHAM protocol consisted of resisted running using elastic bands. Each intervention was implemented at the start of the season and continued until the last competition. An athletic trainer evaluated athletes weekly for sport-related injuries. The coach recorded each athlete-exposure (AE), which was defined as 1 athlete participating in 1 coach-directed session (game or practice).
Main Outcome Measure(S):
Injury rates were calculated overall, by sport, and by competition level. We also calculated rates of specific knee and ankle injuries. A mixed-model approach was used to account for multiple injuries per athlete.
Results:
Overall, the CORE group reported 107 injuries (rate = 5.34 injuries/1000 AEs), and the SHAM group reported 134 injuries (rate = 8.54 injuries/1000 AEs; F1,578 = 18.65, P < .001). Basketball (rate = 4.99 injuries/1000 AEs) and volleyball (rate = 5.74 injuries/1000 AEs) athletes in the CORE group demonstrated lower injury incidences than basketball (rate = 7.72 injuries/1000 AEs) and volleyball (rate = 11.63 injuries/1000 AEs; F1,275 = 9.46, P = .002 and F1,149 = 11.36, P = .001, respectively) athletes in the SHAM group. The CORE intervention appeared to have a greater protective effect on knee injuries at the middle school level (knee-injury incidence rate = 4.16 injuries/1000 AEs) than the SHAM intervention (knee-injury incidence rate = 7.04 injuries/1000 AEs; F1,261 = 5.36, P = .02). We did not observe differences between groups for ankle injuries ( F1,578 = 1.02, P = .31).
Conclusions:
Participation in an NMT intervention program resulted in a reduced injury incidence relative to participation in a SHAM intervention. This protective benefit of NMT was demonstrated at both the high school and middle school levels.
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