A systematic review and network meta-analysis on the effectiveness of exercise-based interventions for reducing the injury incidence in youth team-sport players. Part 2: an analysis by movement patterns

Figures & data

Figure 1. PRISMA flow diagram of the selection of studies for this systematic review and network meta-analysis.

Table 1. Component breakdown of injury prevention programs according to specific movement patterns.

Reference	Upper body pushing and pulling	Lower body concentric and eccentric	Core (anti-rotation and core bracing)	Mechanics (COD, jumping and landing, and rebounding)	Acceleration (incl. deceleration, and re-acceleration)	Lower body stability
Sport, sex, age
Achenbach et al. [39] Handball, mix, age IG: 14.9 (0.9); age CG: 15.1 (1)	No	Yes Nordic hamstring	Yes Plank, side plank	Yes Multidirectional single-leg jumps, ice-skater jump, jump run	No	Yes SL stabilization
Åkerlund et al. [40] Floorball, mix, age IG: 13.6 (1.1); age CG: 13.2 (1.3)	No	Yes SL/DL squat, pelvic lift, forward lunge	Yes Prone/side plank	Yes SL hop forward/backward, side-to-side hop (SL landing), DL jump with ball header	No	No
Al Attar et al. [37] Soccer, male, age IG: 7–13 (range); age CG: 7–13 (range)	Yes Press-ups, spiderman	Yes Spiderman	Yes Press-ups, spiderman	Yes Skating jumps, SL jumps	No	Yes “Alertness” running game, SL stance
Barboza et al. [41]^a Field hockey, mix, age IG: 11.5 (1.5); age CG: 12.9 (1.9)	No	Yes SL/DL squats, walking lunges, etc.	Yes Plank, skater figure, etc.	Yes SL/DL forward, vertical, and lateral jumps, skating jumps, etc.	Yes Dribbling, sprint, etc.	Yes Skater figure, cross-country skiing
Emery and Meeuwisse [42] Indoor soccer, mix, age IG: 13–18 (range); age CG: 13–18 (range)	No	Yes Nordic hamstring, walking lunges, calf raises	Yes Abdominal strength exercise	Yes SL jumps	No	Yes SL balance, balance exercises using wobble boards
Emery et al. [43] Basketball, mix, age IG: 13–18 (range); age CG: 12–18 (range)	No	No	Yes Isometric contraction of abdominal and gluteal muscles	No	No	Yes Balance exercises using wobble boards
Hislop et al. [44]^a Rugby, male, age IG: 16 (1.2); age CG: 15.9 (1.1)	No	Yes Lunges, Nordic hamstring, etc.	Yes Side bridge, static side press up with perturbation, etc.	Yes SL/DL jumps, planned plant and cut, etc.	Yes Side shuffle, diagonal side shuffle, etc.	Yes SL balance
Imai et al. [45] Soccer, male, age IG: 12–14 (range); age CG: 12–14 (range)	No	No	Yes Bird dog (hand-knee), elbow-toe with raised arm and leg, and back bridge with one leg raised	No	No	No
Longo et al. [46] Basketball, male, age IG: 13.5 (2.3); age CG: 15.2 (4.6)	No	Yes Nordic hamstring, squats	Yes Plank, side plank	Yes Vertical, lateral and box jumps, running and cutting	Yes Quick run, running over pitch, bounding run	Yes SL balance
Olsen et al. [30] Handball, mix, age IG: 16.3 (0.6); age CG: 16.2 (0.6)	No	Yes Nordic hamstring, DL squat, SL/DL squat on unstable surface	No	Yes Jump shot landing, bounding, forward jumps, planting and cutting	Yes Speed runs, forward running with intermittent stops	Yes DL ball pass unstable surface, SL squat unstable surface, DL squat unstable surface, ball bounce with eyes closed unstable surface, perturbations on unstable surface
Owoeye et al. [31] Soccer, male, age IG: 17.8 (0.9); age CG: 17.5 (1.1)	No	Yes Nordic hamstring, squats	Yes Plank, side plank	Yes Vertical, lateral and box jumps, running and cutting	Yes Quick run, running over pitch, bounding run	Yes SL balance
Rössler et al. [3] Soccer, mix, age IG: 10.8 (1.4); age CG: 10.7 (1.4)	Yes Press-ups, spiderman	Yes Spiderman	Yes Press-ups, spiderman	Yes Skating jumps, SL jumps	No	Yes “Alertness” running game, SL stance
Soligard et al. [2] Soccer, female, age IG: 15.4 (0.7); age CG: 15.4 (0.7)	No	Yes Nordic hamstring, squats	Yes Plank, side plank	Yes Vertical, lateral and box jumps, running and cutting	Yes Quick run, running over pitch, bounding run	Yes SL balance
Steffen et al. [32] Soccer, female, age IG: 15.4 (0.8); age CG: 15.4 (0.8)	No	Yes Nordic hamstring	Yes Prone/side plank	Yes SL hop forward/backward, side-to-side hop, bounding	Yes Zigzag shuffle	Yes Cross-country skiing, SL stance chest pass, SL stance forward bend, SL stance figure-of-8
Verhagen et al. [38]^a Volleyball, mix, age IG: 12.9 (1.6); age CG: 12.6 (1.7)	Yes Shoulder muscle training exercises with elastic bands, etc.	Yes Squats, walking lunges, etc.	Yes Prone/side plank, superman, etc.	Yes Squat jumps back/forward/sideways, drop jumps, etc.	Yes Relay race, acceleration/deceleration, etc.	Yes SL balance, SL balance with ball pass, etc.
Wedderkopp et al. [33] Handball, female, age IG: 16–18 (range); age CG: 16–18 (range)	Yes Functional strength training for all major muscle groups	Yes Functional strength training for all major muscle groups	No	No	No	Yes Exercises using ankle discs
Zarei et al. [34] Soccer, male, age IG: 15.3 (0.6); age CG: 15.5 (0.7)	No	Yes Nordic hamstring, squats	Yes Plank, side plank	Yes Vertical, lateral and box jumps, running and cutting	Yes Quick run, running over pitch, bounding run	Yes SL balance
Zarei et al. [35] Soccer, male, age IG: 12.1 (1.8); age CG: 12.2 (1.7)	Yes Press-ups, spiderman	Yes Spiderman	Yes Press-ups, spiderman	Yes Skating jumps, SL jumps	No	Yes “Alertness” running game, SL stance
Zouita et al. [36] Soccer, male, age IG: 13–14 (range); age CG: 13–14 (range)	Yes Multiple-joint strength exercises, such as the bench press	Yes Multiple-joint strength exercises, such as the squat	Yes Sit-ups	No	No	No

IG: intervention group; CG: control group; COD: change of direction; SL: single leg; DL: double leg.

^a These programs include different exercises for each age group or individual. For a matter of space, only the most relevant exercises are mentioned in each component.

Figure 2. Network graphs for the direct evidence comparing programs for overall, lower extremity, thigh, knee, and ankle injuries. UB: upper body pushing and pulling; LB: lower body concentric and eccentric; CORE: core (anti-rotation and core bracing); MEC: mechanics (change of direction (COD), jumping and landing, and rebounding); ACC: acceleration (including deceleration, and re-acceleration); LBSta: lower body stability.

Figure 3. Forest plots for the random-effects network meta-analyses conducted for overall, lower extremity, thigh, knee, and ankle injuries. UB: upper body pushing and pulling; LB: lower body concentric and eccentric; CORE: core (anti-rotation and core bracing); MEC: mechanics (change of direction (COD), jumping and landing, and rebounding); ACC: acceleration (including deceleration, and re-acceleration); LBSta: lower body stability. Values below 1 favor the intervention over the control (treatment 1).

Table 2. Results of the network meta-analysis for overall injuries: estimates and 95% confidence intervals for comparisons between each pair of injury prevention programs (programs in rows vs. programs in columns).

Program
1	1
2	0.821	2
	[0.746, 0.903]
3	0.566	0.69	3
	[0.479, 0.67]	[0.568, 0.837]
4	0.302	0.368	0.533	4
	[0.098, 0.925]	[0.119, 1.132]	[0.172, 1.655]
5	0.766	0.934	1.354	2.54	5
	[0.581, 1.011]	[0.697, 1.252]	[0.979, 1.871]	[0.801, 8.055]
6	0.647	0.788	1.143	2.144	0.844	6
	[0.524, 0.8]	[0.625, 0.995]	[0.872, 1.498]	[0.685, 6.708]	[0.596, 1.196]
7	0.819	0.997	1.446	2.713	1.068	1.265	7
	[0.645, 1.039]	[0.771, 1.29]	[1.08, 1.936]	[0.863, 8.531]	[0.741, 1.539]	[0.92, 1.74]
8	0.493	0.6	0.87	1.632	0.643	0.761	0.602	8
	[0.388, 0.625]	[0.464, 0.776]	[0.65, 1.165]	[0.519, 5.134]	[0.446, 0.926]	[0.553, 1.047]	[0.429, 0.843]
9	0.261	0.318	0.461	0.865	0.341	0.404	0.319	0.53	9
	[0.147, 0.465]	[0.177, 0.571]	[0.253, 0.841]	[0.245, 3.052]	[0.18, 0.646]	[0.218, 0.746]	[0.171, 0.595]	[0.284, 0.99]
10	0.536	0.654	0.948	1.778	0.7	0.829	0.655	1.089	2.055	10
	[0.325, 0.886]	[0.392, 1.09]	[0.558, 1.609]	[0.521, 6.071]	[0.395, 1.242]	[0.481, 1.43]	[0.376, 1.143]	[0.625, 1.899]	[0.956, 4.414]
11	0.61	0.743	1.077	2.02	0.796	0.942	0.745	1.238	2.335	1.136	11
	[0.387, 0.96]	[0.467, 1.181]	[0.664, 1.747]	[0.603, 6.768]	[0.468, 1.353]	[0.571, 1.554]	[0.446, 1.243]	[0.741, 2.066]	[1.121, 4.863]	[0.578, 2.236]

Program 1 = control; program 2 = lower body concentric and eccentric + core + mechanics + acceleration + lower body stability; program 3 = upper body pushing and pulling + lower body concentric and eccentric + core + mechanics + lower body stability; program 4 = upper body pushing and pulling + lower body concentric and eccentric + core; program 5 = lower body concentric and eccentric + core + mechanics + lower body stability; program 6 = lower body concentric and eccentric + core + mechanics; program 7 = core + lower body stability; program 8 = lower body concentric and eccentric + mechanics + acceleration + lower body stability; program 9 = upper body pushing and pulling + lower body concentric and eccentric + lower body stability; program 10 = core; program 11 = upper body pushing and pulling + lower body concentric and eccentric + core + mechanics + acceleration + lower body stability.

Values below 1 favor the row intervention.

Figure 4. Forest plots for the random-effects network meta-analyses at component level conducted for overall injuries. con/ecc: concentric and eccentric; push/pull: pushing and pulling. Values below 1 favor the training component over the control.

Achenbach L, Krutsch V, Weber J, et al. Neuromuscular exercises prevent severe knee injury in adolescent team handball players. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):1901–1908. doi: 10.1007/s00167-017-4758-5.

 PubMed Web of Science ®Google Scholar

Åkerlund I, Waldén M, Sonesson S, et al. Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12–17 years) who used an injury prevention exercise programme: two- armed parallel-group cluster randomised controlled trial. Br J Sports Med. 2020;54(17):1028–1035. doi: 10.1136/bjsports-2019-101295.

 PubMed Web of Science ®Google Scholar

Al Attar WSA, Bizzini M, Alzahrani H, et al. The FIFA 11+ kids injury prevention program reduces injury rates among male children soccer players: a clustered randomized controlled trial. Sports Health. 2023;15(3):397–409. doi: 10.1177/19417381221109224.

 PubMedGoogle Scholar

Barboza SD, Nauta J, Emery C, et al. A warm-up program to reduce injuries in youth field hockey players: a quasi-experiment. J Athl Train. 2019;54(4):374–383. doi: 10.4085/1062-6050-79-18.

 PubMed Web of Science ®Google Scholar

Emery CA, Meeuwisse WH. The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. Br J Sports Med. 2010;44(8):555–562. doi: 10.1136/bjsm.2010.074377.

 PubMed Web of Science ®Google Scholar

Emery CA, Rose MS, McAllister JR, et al. A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial. Clin J Sport Med. 2007;17(1):17–24. doi: 10.1097/JSM.0b013e31802e9c05.

 PubMed Web of Science ®Google Scholar

Hislop MD, Stokes KA, Williams S, et al. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Br J Sports Med. 2017;51(15):1140–1146. doi: 10.1136/bjsports-2016-097434.

 PubMed Web of Science ®Google Scholar

Imai A, Imai T, Iizuka S, et al. A trunk stabilization exercise warm-up may reduce ankle injuries in junior soccer players. Int J Sports Med. 2018;39(4):270–274. doi: 10.1055/s-0044-100923.

 PubMed Web of Science ®Google Scholar

Longo UG, Loppini M, Berton A, et al. The FIFA 11+ program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. Am J Sports Med. 2012;40(5):996–1005. doi: 10.1177/0363546512438761.

 PubMed Web of Science ®Google Scholar

Olsen O-E, Myklebust G, Engebretsen L, et al. Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ. 2005;330(7489):449. doi: 10.1136/bmj.38330.632801.8F.

 PubMed Web of Science ®Google Scholar

Owoeye OBA, Akinbo SRA, Tella BA, et al. Efficacy of the FIFA 11+ warm-up programme in male youth football: a cluster randomised controlled trial. J Sport Sci Med. 2014;13(2):321–328.

 PubMed Web of Science ®Google Scholar

Rössler R, Junge A, Bizzini M, et al. A multinational cluster randomised controlled trial to assess the efficacy of “11 + kids”: a warm-up programme to prevent injuries in children’s football. Sports Med. 2018;48(6):1493–18. doi: 10.1007/s40279-017-0834-8.

 PubMed Web of Science ®Google Scholar

Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008;337(2):1. doi: 10.1136/bmj.a2469.

 Google Scholar

Steffen K, Myklebust G, Olsen OE, et al. Preventing injuries in female youth football – a cluster-randomized controlled trial. Scand J Med Sci Sports. 2008;18(5):605–614. doi: 10.1111/j.1600-0838.2007.00703.x.

 PubMed Web of Science ®Google Scholar

Verhagen E, Vriend I, Gouttebarge V, et al. Effectiveness of a warm-up programme to reduce injuries in youth volleyball players: a quasi-experiment. Br J Sports Med. 2023;57(8):464–470. doi: 10.1136/bjsports-2022-105425.

 PubMed Web of Science ®Google Scholar

Wedderkopp N, Kaltoft M, Lundgaard B, et al. Prevention of injuries in young female players in European team handball. A prospective intervention study. Scand J Med Sci Sports. 1999;9(1):41–47. doi: 10.1111/j.1600-0838.1999.tb00205.x.

 PubMed Web of Science ®Google Scholar

Zarei M, Abbasi H, Daneshjoo A, et al. Long-term effects of the 11+ warm-up injury prevention programme on physical performance in adolescent male football players: a cluster-randomised controlled trial. J Sports Sci. 2018;36(21):2447–2454. doi: 10.1080/02640414.2018.1462001.

 PubMed Web of Science ®Google Scholar

Zarei M, Abbasi H, Namazi P, et al. The 11+ kids warm-up programme to prevent injuries in young Iranian male high-level football (soccer) players: a cluster-randomised controlled trial. J Sci Med Sport. 2020;23(5):469–474. doi: 10.1016/j.jsams.2019.12.001.

 PubMed Web of Science ®Google Scholar

Zouita S, Zouita ABM, Kebsi W, et al. Strength training reduces injury rate in elite young soccer players during one season. J Strength Cond Res. 2016;30(5):1295–1307. doi: 10.1519/JSC.0000000000000920.

 PubMed Web of Science ®Google Scholar

Data availability statement

R codes are publicly available on https://data.mendeley.com/datasets/hg4m522fc5/2. Additional data may be accessed upon reasonable request.