Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players

Holly J Silvers-Granelli; Mario Bizzini; Amelia Arundale; Bert R Mandelbaum; Lynn Snyder-Mackler

doi:10.1007/s00167-018-4895-5

Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players

Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):1975-1983. doi: 10.1007/s00167-018-4895-5. Epub 2018 Mar 19.

Authors

Holly J Silvers-Granelli^{1

2}, Mario Bizzini³, Amelia Arundale⁴, Bert R Mandelbaum⁵, Lynn Snyder-Mackler^{6

7}

Affiliations

¹ Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA. hollysilverspt@gmail.com.
² Velocity Physical Therapy, 11611 San Vicente Boulevard, GF-1, Los Angeles, CA, 90049, USA. hollysilverspt@gmail.com.
³ Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
⁴ Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
⁵ Santa Monica Orthopaedic Group, 1919 Santa Monica Boulevard, 4th Floor, Santa Monica, CA, 90404, USA.
⁶ Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
⁷ Department of Biomechanical and Movement Sciences, University of Delaware, Newark, DE, USA.

Abstract

Purpose: The 11+ injury prevention program has been shown to decrease injury rate. However, few studies have investigated compliance and if it is correlated to time loss. The purpose of this study was to (1) analyze how differences in compliance may impact injury rate and (2) if compliance may impact time loss due to injury.

Methods: This study was a Level 1 prospective cluster randomized controlled trial conducted in NCAA men's football (soccer) teams that examined the efficacy of the 11+ injury prevention program. The two outcome variables examined were number of injuries and number of days missed from competition. Twenty-seven teams (n = 675 players) used the 11+ program. Compliance, injuries and time loss were recorded. There were three compliance categories, low (LC, 1-19 doses/season), moderate (MC, 20-39 doses/season), and high (HC, > 40 doses/season).

Results: There was a significant difference among the groups for injuries, p = 0.04, _pη² = 0.23. The LC group [mean (M) = 13.25, 95% confidence interval (CI) 9.82-16.68, injury rate (IR) = 10.35 ± 2.21] had a significantly higher injury rate than the HC group (M = 8.33, 95%CI 6.05-10.62, IR = 10.35 ± 2.21), p = 0.02. The MC group (M = 11.21, 95%CI 9.38-13.05, IR = 8.55 ± 2.46) was not significantly different than the LC group, p = 0.29, but was significantly greater than the HC group, p = 0.05. When examined as a continuous variable, compliance was significantly negatively related to injury rate (p = 0.004). It was also significantly negatively related to number of days missed (p = 0.012).

Conclusions: When compliance was high, there was a significant reduction in injury and time loss. This evidence reinforces the importance of consistent injury prevention program utilization. Clinically, these findings have important implications when discussing the importance of consistent utilization of an injury prevention protocol in sport.

Level of evidence: Level 1-Randomized controlled trial (RCT).

Keywords: 11+; Compliance; Football (soccer); Injury prevention; Program fidelity.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Athletic Injuries / prevention & control*
Humans
Incidence
Lower Extremity / injuries*
Male
Patient Compliance*
Prospective Studies
Soccer / injuries*
Warm-Up Exercise*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding