Weekly soccer warm-ups significantly reduced ACL injuries in girls

A neuromuscular warm-up program consisting of knee control and core stability exercises reduced ACL injury rates in female soccer players by up to 83%.

  •             Orthopaedics Today Europe, Issue 2

SAN FRANCISCO — Completing a 15-minute neuromuscular warm-up program twice a week during the competitive season led to significant reductions in ACL injuries in female soccer players aged 12 years to 17 years compared to a control group who completed their usual warm-up exercises during the same period, according to Swedish investigators.

After allowing for in season drop-outs, of the 309 soccer clubs in the two-armed parallel randomized study, final results were available for 121 clubs (2,479 players) in the interventional arm and 109 clubs (2,085 players) in the control arm.

“This makes our study the largest sports injury prevention trial in the world to date,” Markus Waldén, MD, PhD, of the Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, said.

Waldén, a co-lead investigator with Martin Hägglund, PT, PhD, presented results at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting here.

During the 2009 competitive season, the interventional group completed a 15-minute neuromuscular warm-up program that was intended to replace the teams’ normal conventional warm-up exercises. It consisted of six knee control and core stability exercises — one-legged and two-legged knee squats, pelvic lifts, the bench, lunges and jump/landings — each with increased difficulty and involving paired exercises, according to Waldén.

“Nothing but the ball is needed, and the coaches were instructed to carry out the program twice weekly,” he said.

For the 96 acute knee injuries Waldén and colleagues recorded among participants, there were 21 ACL injuries. One-third of them occurred in the intervention group vs. two-thirds in the control group.

“A 15-minute neuromuscular warm-up program reduced the ACL injury rate by nearly two-thirds in adolescent female soccer [players]. Compliant players carrying out the program at least once per week had an even greater effect of the program,” Waldén said. “Our recommendation is neuromuscular training should be a part of the warm-up in female youth soccer.”

Investigators saw an 83% reduction in ACL injuries in compliant players when they accounted for age, menstrual history, match frequency and match play.

“As poor compliance might be a key factor in previous studies showing no effect, we tried to control this factor carefully by letting the coaches report the execution of the program in the attendance form and also by unannounced visits to the clubs,” Waldén said.

He told Orthopaedics Today Europe, “However, we did not specifically record whether the clubs carried out any other exercises as well and, in clubs having more than two weekly sessions, it is thus possible they carried out other exercises during these days that might enhance the effects of the program or counteract it, and this is a limitation of our study.” – by Susan M. Rapp

Reference:

  • Waldén M, Atroshi I, Magnusson H, Wagner P, Hägglund M. A randomized trial of anterior cruciate ligament injury prevention in adolescent female soccer. Paper #95. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.

For more information:

  • Markus Waldén, MD, PhD, can be reached at email: markus.walden@telia.com.
  • Disclosure: Waldén has no relevant financial disclosures.
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