The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review

TLDR: Effective implementation of practical neuromuscular warm-up strategies can reduce lower extremity injury incidence in young, amateur, female athletes and male and female military recruits.

Abstract: Lower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens In this review we seek to determine which easily implemented functional neuromuscular warm-up strategies are effective in preventing lower limb injuries during sports participation and in which sporting groups they are effective Seven electronic databases were searched from inception to January 2012 for studies investigating neuromuscular warm-up strategies and injury prevention The quality of each included study was evaluated using a modified version of the van Tulder scale Data were extracted from each study and used to calculate the risk of injury following application of each evaluated strategy Nine studies were identified including six randomized controlled trials (RCT) and three controlled clinical trials (CCT) Heterogeneity in study design and warm-up strategies prevented pooling of results Two studies investigated male and female participants, while the remaining seven investigated women only Risk Ratio (RR) statistics indicated 'The 11+' prevention strategy significantly reduces overall (RR 067, confidence interval (CI) 054 to 084) and overuse (RR 045, CI 028 to 071) lower limb injuries as well as knee (RR 048, CI 032 to 072) injuries among young amateur female footballers The 'Knee Injury Prevention Program' (KIPP) significantly reduced the risk of noncontact lower limb (RR 05, CI 033 to 076) and overuse (RR 044, CI 022 to 086) injuries in young amateur female football and basketball players The 'Prevent Injury and Enhance Performance' (PEP) strategy reduces the incidence of anterior cruciate ligament (ACL) injuries (RR 018, CI 008 to 042) The 'HarmoKnee' programme reduces the risk of knee injuries (RR 022, CI 006 to 076) in teenage female footballers The 'Anterior Knee Pain Prevention Training Programme' (AKP PTP) significantly reduces the incidence of anterior knee pain (RR 027, CI 014 to 054) in military recruits Effective implementation of practical neuromuscular warm-up strategies can reduce lower extremity injury incidence in young, amateur, female athletes and male and female military recruits This is typically a warm-up strategy that includes stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques applied consistently for longer than three consecutive months In order to optimize these strategies, the mechanisms for their effectiveness require further evaluation