Injury Prevention for the Lower Limb
Participation in sports is great for a person’s health and well being. This does however increase the risk of injury for all participants, from the elite to the recreational athlete3. Sport is the leading cause of injury in young and adolescences4. the problem with this is that injury has the potential to reduce future participation in physical activity which adversely affects future health4. Lower limb injuries are extremely common when participating in team sports. Serious knee injuries, i.e. the anterior cruciate ligament (ACL), and lower limb injuries in general, are a growing cause of concern in sport3. Regarding ACL injuries, the highest occurance is seen in adolescents who participate in sports involving pivoting, such as football, basketball, and team handball3. When comparing women and men in the same sports, women are 3-5 times more likely than men to have a serious knee injury3. This is why injury prevention plays a very important roll in when participating in team sports.
Although surgeries and rehabilitation processes are improving all the time, prevention is always better. Interventions to reduce injury risk have become a focal point for researchers and clinicians1. There are two categories for risk factors, extrinsic (those outside of the body) and intrinsic (those from within the body)1. Extrinsic risk factors can include level of competition, skill level, shoe type1. Intrinsic risk factors are, but not limited to; age, sex, previous injury and inadequate rehabilitation, muscle strength, imbalance and reaction time1. It is generally agreed that higher injury rates occur in competition than training sessions1.
There is mounting evidence suggesting, prevention of lower limb injuries is possibly through targeted training protocols5. These interventions or protocols should ideally be split into two main components, neuromuscular training and sports specific conditioning, including technique correction2, 3. Neuromuscular training contains stretching, strengthening, balance exercises, while sports-specific encompasses agility drills (cutting, changing direction) and landing techniques2, 3. This should be applied for a period longer than three months2. Most interventions are incorporated into the warm up of team sports2. In one study the rate of injuries in adolescent athletes reduced by 50% for knee and ankle injuries, after using a structured warm-up programme as a part of their training3.
One such program that has a growing pool of evidence is the FIFA 11+: training program for injury prevention. Current evidence shows that the FIFA 11+ displays considerable reductions in the number of injured players, ranging between 30% and 70%6. Compliance is the key6. This is supported as players with high compliance rates had an estimated risk reduction of all injuries by 35%6. These players also showed significant improvements in components of neuromuscular and motor performance when participating in the program at least 1.5 times/week6. In female players, aged 13–18, were the program performed at least twice a week, FIFA 11+ showed a significant reduction (up to 50%) of injuries7.
It is still preferred when implementing injury prevention program, they are specifically structured for the individual/ team focused to their chosen sport. Therefore, it is important to make sure the correct health professionals are used when structuring and adjusting the program accordingly.
Here at START training our exercise physiologists are experienced with writing and implementing injury prevention programs. If you would like more information, are looking at returning to sport or even wanting to decrease your chances of injury please contact us on ph: 3356 9119.
D. F., Connolly. D. A. J., Beynnon. B. D.: Risk factors for lower extremity injury: a review of the literature: Br J Sports Med 2003; 37:13–29
K., Barton. C., Malliaras. P., Morrissey. D.: The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review; BMC Medicine 2012, 10: 75
O., Myklebust. G., Engebretsen. L., Holme. I., Bahr. R.; Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial: BMJ, Feb 2005
C. A., Roy. T., Whittaker. J. L., Nettel-Aguirre. A., van Mechelen., W.: Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis: British Journal of Sports Medicine; Volume 49, Issue 13
D., Finch. C., Roediger. E., Lloyd. D. G.; Preventing lower limb injuries: Is the latest evidence being translated into the football field?: Journal of Science and Medicine in Sport Volume 12, Issue 4, July 2009, Pages 452-456
N. C., Meneses-Echávez. J. F., Ramírez-Vélez. R., Cohen. D. D., Tovar. G., Bautista. J. E. C.; The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players A Systematic Review; International Journal of Environmental Research and Public Health; Nov 2014, 11, 11986-12000
M., Dvorak. J.; FIFA 11+ an effective programme to prevent football injuries in various player groups worldwide—a narrative review; Br J Sports Med 2015; 49: 577–579