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How to Know if an Injury Prevention Program Works

Researchers devote a lot of time and effort to developing training programs that they hope will reduce sports injuries. However, proving the effectiveness of these programs can be challenging. Finnish researchers have listed four essential steps:

  1. Gather data to document the extent of the problem.
  2. Identify how the injury happens and the factors that increase the risk of it happening. Those factors may be both intrinsic—for example, personal factors such as age, gender, fitness or motivation—or they may be extrinsic, such as player position, training frequency, playing surface or footwear.
  3. Introduce a preventive measure. Design a program that attempts to reduce the risk by modifying factors that seem to lead to injury. The best test of a prevention program is a randomized trial that compares injury rates in similar groups of randomly selected people who are exposed to the same risk of injury over the same time period. One group receives the preventive measure and the other group does not.
  4. Repeat step #1. Document the number of injuries in each group and evaluate the program’s success or failure.

The details of each step matter. For example, proving that a program prevents an injury that occurs infrequently requires many more athletes than proving prevention of an injury that happens more often. To know with a high degree of certainty whether a training program is safe and can deter anterior cruciate ligament (ACL) injuries, a randomized trial would need to:

  • Enroll more than 8,000 athletes; no research team has done that, and none is likely to.
  • Achieve high participation levels. In a 2017 analysis of the FIFA 11 and 11+ programs, only 15% of recreational/sub-elite soccer teams performed the exercises at the recommended “dose” of at least two sessions per week.
  • Assess the injuries using providers who are unaware of whether the athlete was a member of the group receiving the prevention program or the group that is not.
  • Evaluate the program’s effectiveness using experts who are independent of the research team and free from conflicts of interest.
  • Collect data on adverse events during training to determine whether prevention programs cause problems of their own.

Until research and sports teams can meet these and other conditions, questions will remain about what works well and what doesn’t.