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Article
Journal Club
November 2011

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools: Cluster Randomized Controlled Trial

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Author Affiliations

Author Affiliations: Departments of Pediatrics (Drs LaBella and Kaufer Christoffel) and Preventive Medicine (Dr Kim), Feinberg School of Medicine, and Biostatistics Collaboration Center (Dr Kim and Ms Peng), Northwestern University, Chicago, Illinois; and Institute for Sports Medicine (Dr LaBella and Messrs Huxford and Grissom), Division of Rehabilitative Services (Mr Huxford), and Mary Ann and J. Milburn Smith Child Health Research Program (Dr Kaufer Christoffel), Children's Memorial Hospital, Chicago.

Arch Pediatr Adolesc Med. 2011;165(11):1033-1040. doi:10.1001/archpediatrics.2011.168
Abstract

Objective  To determine the effectiveness of coach-led neuromuscular warm-up on reducing lower extremity (LE) injuries in female athletes in a mixed-ethnicity, predominantly low-income, urban population.

Design  Cluster randomized controlled trial.

Setting  Chicago public high schools.

Participants  Of 258 coaches invited to participate, 95 (36.8%) enrolled (1558 athletes). Ninety coaches and 1492 athletes completed the study.

Interventions  We randomized schools to intervention and control groups. We trained intervention coaches to implement a 20-minute neuromuscular warm-up. Control coaches used their usual warm-up.

Main Outcome Measures  Coach compliance was tracked by self-report and direct observation. Coaches reported weekly athlete exposures (AEs) and LE injuries causing a missed practice or game. Research assistants interviewed injured athletes. Injury rates were compared between the control and intervention groups using χ2 and Fisher exact tests. Significance was set at P < .05. Poisson regression analysis adjusted for clustering and covariates in an athlete subset reporting personal information (n = 855; 57.3%).

Results  There were 28 023 intervention AEs and 22 925 control AEs. Intervention coaches used prescribed warm-up in 1425 of 1773 practices (80.4%). Intervention athletes had lower rates per 1000 AEs of gradual-onset LE injuries (0.43 vs 1.22, P < .01), acute-onset noncontact LE injuries (0.71 vs 1.61, P < .01), noncontact ankle sprains (0.25 vs 0.74, P = .01), and LE injuries treated surgically (0 vs 0.17, P = .04). Regression analysis showed significant incidence rate ratios for acute-onset noncontact LE injuries (0.33; 95% CI, 0.17-0.61), noncontact ankle sprains (0.38; 95% CI, 0.15-0.98), noncontact knee sprains (0.30; 95% CI, 0.10-0.86), and noncontact anterior cruciate ligament injuries (0.20; 95% CI, 0.04-0.95).

Conclusion  Coach-led neuromuscular warm-up reduces noncontact LE injuries in female high school soccer and basketball athletes from a mixed-ethnicity, predominantly low-income, urban population.

Trial Registration  clinicaltrials.org Identifier: NCT01092286

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