Ling, Daphne I; Boyle, Caroline; Schneider, Brandon; Janosky, Joseph; Childservant, James; Marx, Robert G. Clin J Sport Med. July 2022 – Part 32 – Number 4 – p. 348-354. doi: 10.1097/JSM.0000000000000936
Free article freely available
Coaches who received education about anterior cruciate ligament (ACL) injury prevention were more likely to include it in their warm-up. Personal training sessions increased the use of proper alignment cues and the incorporation of a complete prevention program.
Neuromuscular training programs can reduce an athlete’s chance of an ACL injury and can be incorporated as a simple warm-up. However, few coaches use warm-up programs for injury prevention.
Ling and colleagues completed a cluster randomized controlled trial to investigate whether live educational training for coaches with take-home documents led to better adherence to a neuromuscular training program for their teams than coaches who only received program information via email received.
The authors recruited coaches via email to athletic directors at high schools with which the authors’ institution had ties. The authors excluded schools that had previously implemented a neuromuscular training warm-up program. High schools interested in participating in the study were randomized to receive live education for coaches with reference documents or educational documents only. Coaches from schools randomized to the intervention attended a live education session and received a reference video and follow-up documents for a series of neuromuscular training warm-up routines (beginner to elite) containing 7-10 exercises. Coaches from schools in the control group only received the documents in an email. Trained data collectors observed all teams 2-3 times per week during both practices and games. They checked that the coaches performed the neuromuscular training exercises, provided instructions on the correct execution and gave the correct instructions for the technique.
The authors randomized 8 high schools, including 21 teams. Over two seasons, the data collectors observed 399 practices or games and 2,579 practices. Coaches in the intervention group used ~7 exercises per session, while coaches in the control group used only ~6 exercises. More coaches in the intervention completed a full neuromuscular training warm-up program and provided prompts to correct incorrect techniques than coaches who only received the documents.
As I suspect, the findings of this study support training coaches on proper techniques and drills in a live format. The authors used a combination of lectures and practical skills training during a 1-hour teaching session. Completing this educational session allowed coaches to ask questions, gain clarity and better understand the need to implement the program properly throughout the season. Having data collectors on site regularly throughout the seasons may have made coaches more compliant. However, coaches did not know when the data collectors would be present, making the data valid because coaches did not perform the prevention exercises in a performative manner only because they believed they were being watched. It would be interesting to see if this educational session could help coaches in more high schools and if other teachers could effectively deliver this educational session.
Clinicians should organize educational workshops for coaches to help them implement proven ACL injury prevention programs as part of their warm-up routine. These workshops can be provided by the physician, another local health care professional, or a coach with experience using these programs.
Would the implementation of exercises be higher if coaches could choose from a group of useful exercises for their team, thereby increasing “buy-in”?
Would governing bodies that approve programs and recommend training of coaches in these programs specific to their sport increase adherence and appropriate implementation or discourage participation?
Written by Shelly Fetchen DiCesaro
Reviewed by Jeffrey Driban
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