Neuromuscular training for preventing ankle joint injuries in athletes: a systematic review and meta-analysis

Ankle joint injuries are among the most common sports-related injuries. However, determining the most effective training method to prevent these injuries remains a challenge. Neuromuscular training (NMT) is a preventive strategy aimed at reducing muscle and ligament injuries, yet its effectiveness in preventing ankle joint injuries is not fully understood, and robust clinical evidence is lacking. This systematic review and meta-analysis aim to summarize the preventive effects of NMT on ankle joint injuries and provide an overview of effective exercise components. To investigate the impact of neuromuscular training on the incidence of ankle joint injuries, dynamic neuromuscular control, foot and ankle functionality, and postural stability in athletes. A comprehensive search was conducted in Web of Science, PubMed, Cochrane Library, Google Scholar, and Embase databases for randomized controlled trials (RCTs) related to the use of neuromuscular training for the prevention of primary and secondary ankle joint injuries in athletes. The search was limited to studies published up until July 31, 2024. Relevant references from the included studies were also reviewed to identify additional literature. Two independent reviewers performed the search, selection, and data extraction. The risk of bias was assessed independently using the Cochrane Handbook. Meta-analyses were performed using Review Manager5.3. The quality of evidence was evaluated using the GRADE methodology. A total of 13 randomized controlled trials, involving 1, 476 participants, were included in the final analysis. Compared to no training or conventional training, neuromuscular training was associated with a 55% reduction in the incidence of ankle joint injuries (RR: 0.45, 95%CI: 0. 25-0. 81, I²: 62%, P: 0.007). In terms of dynamic neuromuscular control, NMT significantly increased reach distances in the Star Excursion Balance Test, specifically in the posteromedial direction (MD: 5.02 cm, 95%CI: 2.22-7. 81, I²: 1%, P: 0.0004), posterolateral direction (MD: 3.05 cm, 95%CI: 0.74-5.35, I²: 0%, P: 0.01), and anterior direction (MD: 2.23 cm, 95%CI: 0.05-4.40, I²: 0%, P: 0.05). Additionally, NMT improved foot and ankle function in the sports domain, as evidenced by an increased score in the Foot and Ankle Ability Measure (FAAM-Sports) (MD: 8.66, 95%CI: 5.10-12.21, I²: 0%, P: <0.00001). Descriptive analysis also suggested improvements in postural stability and ankle instability. However, there was no significant improvement in the foot and ankle function in the daily living domain (FAAM-ADL) (MD: 2.86, 95%CI: -2.20-7.92, I²: 80%, P: 0.27). This meta-analysis demonstrates that neuromuscular training significantly reduces the incidence of ankle joint injuries, enhances dynamic neuromuscular control, improves foot and ankle function in sports, and appears to positively influence postural stability and ankle instability. However, further high-quality, large-scale RCTs are needed to confirm the preventive effects of neuromuscular training on ankle joint injuries. No external funding was received for this study, and the authors declare no conflicts of interest.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024572932, identifier CRD42024572932.