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      Neuromuscular Adaptations to Multimodal Injury Prevention Programs in Youth Sports: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

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          Abstract

          Objective: Neuromuscular injury prevention programs (IPP) can reduce injury rate by about 40% in youth sport. Multimodal IPP include, for instance, balance, strength, power, and agility exercises. Our systematic review and meta-analysis aimed to evaluate the effects of multimodal IPP on neuromuscular performance in youth sports.

          Methods: We conducted a systematic literature search including selected search terms related to youth sports, injury prevention, and neuromuscular performance. Inclusion criteria were: (i) the study was a (cluster-)randomized controlled trial (RCT), and (ii) investigated healthy participants, up to 20 years of age and involved in organized sport, (iii) an intervention arm performing a multimodal IPP was compared to a control arm following a common training regime, and (iv) neuromuscular performance parameters (e.g., balance, power, strength, sprint) were assessed. Furthermore, we evaluated IPP effects on sport-specific skills.

          Results: Fourteen RCTs (comprising 704 participants) were analyzed. Eight studies included only males, and five only females. Seventy-one percent of all studies investigated soccer players with basketball, field hockey, futsal, Gaelic football, and hurling being the remaining sports. The average age of the participants ranged from 10 years up to 19 years and the level of play from recreational to professional. Intervention durations ranged from 4 weeks to 4.5 months with a total of 12 to 57 training sessions. We observed a small overall effect in favor of IPP for balance/stability (Hedges' g = 0.37; 95%CI 0.17, 0.58), leg power (g = 0.22; 95%CI 0.07, 0.38), and isokinetic hamstring and quadriceps strength as well as hamstrings-to-quadriceps ratio (g = 0.38; 95%CI 0.21, 0.55). We found a large overall effect for sprint abilities (g = 0.80; 95%CI 0.50, 1.09) and sport-specific skills (g = 0.83; 95%CI 0.34, 1.32). Subgroup analyses revealed larger effects in high-level (g = 0.34–1.18) compared to low-level athletes (g = 0.22–0.75), in boys (g = 0.27–1.02) compared to girls (g = 0.09–0.38), in older (g = 0.32–1.16) compared to younger athletes (g = 0.18–0.51), and in studies with high (g = 0.35–1.16) compared to low (g = 0.12–0.38) overall number of training sessions.

          Conclusion: Multimodal IPP beneficially affect neuromuscular performance. These improvements may substantiate the preventative efficacy of IPP and may support the wide-spread implementation and dissemination of IPP. The study has been a priori registered in PROSPERO (CRD42016053407).

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          Most cited references46

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          A dynamic model of etiology in sport injury: the recursive nature of risk and causation.

          The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. If we are to truly understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology.
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            Risk factors for sports injuries -- a methodological approach

            R Bahr (2003)
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              The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis.

              In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated. HYPOTHESIS/ PURPOSE: The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations.
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                Author and article information

                Contributors
                Journal
                Front Physiol
                Front Physiol
                Front. Physiol.
                Frontiers in Physiology
                Frontiers Media S.A.
                1664-042X
                12 October 2017
                2017
                : 8
                : 791
                Affiliations
                [1] 1Department of Sport, Exercise and Health, University of Basel , Basel, Switzerland
                [2] 2Department of Public and Occupational Health & Amsterdam Movement Sciences, VU University Medical Center , Amsterdam, Netherlands
                [3] 3College of Human Medicine, Michigan State University , East Lansing, MI, United States
                [4] 4Institute of Training and Computer Science in Sport, German Sport University Cologne , Köln, Germany
                Author notes

                Edited by: Urs Granacher, University of Potsdam, Germany

                Reviewed by: Jon Oliver, Cardiff Metropolitan University, United Kingdom; Simon Steib, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany

                *Correspondence: Oliver Faude oliver.faude@ 123456unibas.ch

                This article was submitted to Exercise Physiology, a section of the journal Frontiers in Physiology

                Article
                10.3389/fphys.2017.00791
                5643472
                29075200
                ad5b1820-9d40-40ff-a84d-cf7dfd836d44
                Copyright © 2017 Faude, Rössler, Petushek, Roth, Zahner and Donath.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 July 2017
                : 26 September 2017
                Page count
                Figures: 6, Tables: 6, Equations: 0, References: 65, Pages: 15, Words: 9678
                Categories
                Physiology
                Systematic Review

                Anatomy & Physiology
                exercise training,sensorimotor,leg strength,balance,power,efficacy,risk factor,team sport
                Anatomy & Physiology
                exercise training, sensorimotor, leg strength, balance, power, efficacy, risk factor, team sport

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