Injury prevention warm-up programs, one size fits some?

Who doesn’t respond to warm-up programs for injury prevention? A secondary analysis of pilot data from neuromuscular training programs in youth basketball, football, and physical education.

Anu M. Raisänen, Jean-Michel Galarneau, Carla Van Den Berg, Paul Eliason, Lauren C. Benson, Oluwatoyosi BA Owoeye, Kati Pasanen, Brent Hagel and Carolyn A. Emery. Journal of orthopedic and sports physiotherapy 0 0:0, 1-28

Full article available for free

Take home message

Although neuromuscular training warm-up programs for injury prevention are effective in reducing one’s risk of injury, not everyone reaps the same benefits. Women and youth with a history of injury in the previous year are more likely to not respond to these programs.

Background

Preventive neuromuscular training programs can effectively reduce an active person’s risk of injury. However, these programs can be more effective if they are tailored to a person’s physical capabilities and characteristics.

Study aim

Räisänen and colleagues conducted a secondary analysis of data from young active individuals (11–18 years old) who performed a neuromuscular training warm-up program during one of four previous clinical trials. They examined whether differences in adherence were associated with non-response to the program (injury) and which factors were associated with non-response.

Methods

The authors used data collected across four studies (1793 participants), including high school basketball (18-week intervention), community football (20 weeks), and two separate high school physical education studies (12-14 weeks). The authors examined age, gender, body mass index (BMI), height, weight, lower limb dominance and balance. They also monitored participants throughout the season for injuries, number of warm-up sessions completed, number of weeks of warm-up completed, and sports participation or exposure. The warm-up programs all lasted 15 minutes and were tailored to the sport or class. All warm-ups include an aerobic and balance component. However, basketball included static and dynamic stretches, while the other two used only dynamic stretches. In addition, the soccer and gym classes included various strengthening exercises, and soccer was the only warm-up that included agility.

Results

The authors found that women and participants with a history of injury in the previous 12 months were more likely to fail to respond to a neuromuscular training warm-up. Furthermore, greater weekly compliance with warm-up reduced the risk of injury, only in football.

Viewpoints

Fifteen-minute neuromuscular training warm-up programs reduce the risk of injury in organized sports activities and general physical education courses. Consistent with existing literature, the authors demonstrated the importance of adherence (performing the program more times per week) in reducing the risk of injury in football players. However, adherence may be less relevant in high school physical education and basketball classes. The authors also found that women and people with a previous injury were more likely to be non-responders than men and people without a previous injury, respectively. We should avoid suggesting that women or people with a history of injury won’t benefit from these programs, because they could – just less so than their peers. Instead, we must find ways to optimize these programs for these populations. We should also note that the authors examined all injuries, not just lower extremity injuries, as these programs are typically designed. So it is possible that a ‘non-responder’ in the study was a ‘lower extremity responder’ if he or she had suffered an upper extremity or other injury.

Clinical implications

Clinicians should encourage the use of neuromuscular training programs and consider how these can be better tailored to women or those with a history of injury.

Questions for discussion

Would an ‘a la carte’ approach work for those identified as high risk? This means that a general warm-up can be created with a few additional movements added specifically to the participants and considered high risk?

Written by Shelly Fetchen DiCesaro
Reviewed by Jeffrey Driban

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