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      Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial

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          Abstract

          Objective To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football.

          Design Cluster randomised controlled trial with clubs as the unit of randomisation.

          Setting 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months).

          Participants 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group).

          Intervention A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements.

          Main outcome measure Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).

          Results During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).

          Conclusion Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.

          Trial registration ISRCTN10306290.

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          Most cited references33

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          Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study.

          Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes. Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk. Cohort study; Level of evidence, 2. There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament. Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P<.05) at landing was 8 degrees greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P<.001) and 20% higher ground reaction force (P<.05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88. Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes. Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.
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            Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases.

            The mechanisms of anterior cruciate ligament injury in basketball are not well defined. To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations. Case series; Level of evidence, 4. Six international experts performed visual inspection analyses of 39 videos (17 male and 22 female players) of anterior cruciate ligament injury situations from high school, college, and professional basketball games. Two predefined time points were analyzed: initial ground contact and 50 milliseconds later. The analysts were asked to assess the playing situation, player behavior, and joint kinematics. There was contact at the assumed time of injury in 11 of the 39 cases (5 male and 6 female players). Four of these cases were direct blows to the knee, all in men. Eleven of the 22 female cases were collisions, or the player was pushed by an opponent before the time of injury. The estimated time of injury, based on the group median, ranged from 17 to 50 milliseconds after initial ground contact. The mean knee flexion angle was higher in female than in male players, both at initial contact (15 degrees vs 9 degrees , P = .034) and at 50 milliseconds later (27 degrees vs 19 degrees , P = .042). Valgus knee collapse occurred more frequently in female players than in male players (relative risk, 5.3; P = .002). Female players landed with significantly more knee and hip flexion and had a 5.3 times higher relative risk of sustaining a valgus collapse than did male players. Movement patterns were frequently perturbed by opponents. Preventive programs to enhance knee control should focus on avoiding valgus motion and include distractions resembling those seen in match situations.
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              Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis.

              To describe the mechanisms for anterior cruciate ligament injuries in female team handball. Descriptive video analysis. Twenty videotapes of anterior cruciate ligament injuries from Norwegian or international competition were collected from 12 seasons (1988-2000). Three medical doctors and 3 national team coaches systematically analyzed these videos to describe the injury mechanisms and playing situations. In addition, 32 anterior cruciate ligament-injured players in the 3 upper divisions in Norwegian team handball were interviewed during the 1998-1999 season to compare the injury characteristics between player recall and the video analysis. Two main injury mechanisms for anterior cruciate ligament injuries in team handball were identified. The most common (12 of 20 injuries), a plant-and-cut movement, occurred in every case with a forceful valgus and external or internal rotation with the knee close to full extension. The other main injury mechanism (4 of 20 injuries), a 1-legged jump shot landing, occurred with a forceful valgus and external rotation with the knee close to full extension. The results from the video analysis and questionnaire data were similar. The injury mechanism for anterior cruciate ligament injuries in female team handball appeared to be a forceful valgus collapse with the knee close to full extension combined with external or internal rotation of the tibia.
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                Author and article information

                Contributors
                Role: PhD student
                Role: associate professor
                Role: research fellow
                Role: professor
                Role: physical therapist
                Role: physical therapist
                Role: associate professor
                Role: professor
                Role: professor
                Role: associate professor
                Journal
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1468-5833
                2008
                2008
                09 December 2008
                : 337
                : a2469
                Affiliations
                [1 ]Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, PO Box 4014 Ullevaal Stadion, 0806 Oslo, Norway
                [2 ]Santa Monica Orthopaedic and Sports Medicine Research Foundation, 1919 Santa Monica Blvd, Suite 350, Santa Monica, CA 90404 USA
                [3 ]FIFA Medical Assessment and Research Centre, Schulthess Clinic, Lengghalde 2, CH-8008 Zurich, Switzerland
                Author notes
                Correspondence to: T Soligard torbjorn.soligard@ 123456nih.no
                Article
                solt565895
                10.1136/bmj.a2469
                2600961
                19066253
                ad4a88fd-1c23-48e4-9328-e73fa0eae49d
                © Soligard et al 2008

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 September 2008
                Categories
                Research

                Medicine
                Medicine

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