Implementing neuromuscular warm-up training in an effective manner can
reduce the chances of lower limb injuries in young female athletes and military
recruits, according to a BMC review study.
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 prevention strategies.
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 strategy.
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 training sessions'.
They suggested further research for evaluating the effectiveness of these strategies in men and older individuals as well.
Source: Herman K, 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 19;10(1):75.
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