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Effectiveness of warm-up intervention programs to prevent sports injuries among children and adolescents: a systematic review and meta-analysis

Review written by Adam Johnson info

Key Points

  1. Implementation of a warm-up program is an effective method of reducing the risk of injury within a children and adolescent cohort.
  2. Through reduction of injury risk, it would be hoped that these children can remain in sport and therefore achieve more of the desirable benefits associated with participation.
  3. The most effective warm-up intervention is neuromuscular control and balance.

BACKGROUND & OBJECTIVE

Sports participation is to be encouraged among children and adolescents due to its association with obesity reduction, cardiovascular health and skill development. Also associated with this sports participation is an increased risk of injury, with some research suggesting that one in five injuries sustained within these age groups can be traced back to sports participation.

If we want to ensure that children are to continue to obtain the benefits of sporting participation, then it is important that we understand the effectiveness of warm-up intervention programs (WIP) on reducing the associated risks.

The purpose of this study was to provide insights and guide the implementation of the most effective WIPs in preventing sports injuries for children and adolescents

One in five injuries sustained within the children and adolescent age groups can be traced back to sports participation.
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Better injury reduction results can be obtained through understanding the specific needs and injury patterns of the exact cohort that you are working with.

METHODS

  • The initial phase of the study involved completing a literature search to ensure that all appropriate and relevant articles were identified and contained within the subsequent systematic review and meta-analysis.
  • All studies identified as part of the search were then run against a series of inclusion and exclusion criteria to ensure that they were relevant.
  • These papers were then all independently identified by two authors to assess their methodological quality.
  • All data extracted from the studies was calculated for an injury rate ratio by dividing the sum of number of injuries in the intervention group/hours of total exposure by the sum of number of injuries in control group/hours of total exposure.

RESULTS

  • The extensive literature search presented the researchers with only 15 papers which they could include within the meta-analysis.
  • This pooled data comprised of 21,576 participants suffering from 3910 injuries over a period of 110.5 months of intervention.
  • The injury risk ratio as described in the previous section was calculated as 0.64, which implied that there was a 36% reduction in sports injury following the implementation of WIP.
  • The authors were also able to reject their null hypothesis which means that a conclusion was made that WIP significantly reduced the risk of injury in children and adolescents.

LIMITATIONS

The key strength of this study is also its main limitation. With the wide range of data included within the analysis (meaning that a conclusion can be made that introduction of a warm-up intervention program is helpful), we cannot draw stronger conclusions around specific sports and cohorts. We also cannot determine which specific interventions are the most important to include within programs.

CLINICAL IMPLICATIONS

Before discussing the clinical implications of this trial, it is important to truly understand exactly what is defined as a WIP by the authors and the research that they analyze. They define a WIP as “a series of physical exercises performed before more vigorous exercise”. This study only included active warmups which could then be sub-categorized as either general or specific.

All passive warmups, which were defined as increasing body or muscle temperature by external means were excluded.

Although the specifics of the research are difficult to go through in depth, it is shown that the most common grouping of interventions (used in 14 out of the 15 papers analyzed) was strength-based exercises. Also 11 of the 15 WIPs included aerobic exercise. Only 4 of the studies included balance-based exercises, which warrants further discussion.

The authors of this paper found in a subgroup analysis that neuromuscular/balance exercise interventions had better outcomes than comprehensive programs. I would propose that these findings are in keeping with previous research into peak height velocity (PHV).

Sheehan and Lienhard (1) demonstrated that there was a decrease in motor competence immediately following the PHV stage. Taking this in combination with the findings that the foot and knee were the most injured sites in elite adolescent athletes (2), it can be understood why specifically targeting balance in a WIP would have the greatest effect.

These adolescent athletes are going through the greatest changes in their physical make up than at any other time in their lives. Therefore, providing a comprehensive program such as the FIFA 11+ (3) will help reduce injury risk, as supported by this paper’s meta-analysis. However, their sub-group analysis made it clear that you can achieve better injury reduction results by tailoring the warm-up to the specific needs of the group.

+STUDY REFERENCE

Ding L, Luo J, Smith D, Mackey M, Fu H, Davis M, Yanping H (2022) Effectiveness of Warm-Up Intervention Programs to Prevent Sports Injuries among Children and Adolescents: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19, 6336-6353.

SUPPORTING REFERENCE

  1. Sheehan, D.P. & Lienhard, K. (2019). Gross Motor Competence and Peak Height Velocity in 10- to 14- Year-Old Canadian Youth: A Longitudinal Study. Measurement in Physical Education and Exercise Science, 23, 89-98.
  2. Von Rosen, P., Heijne, A., Frohm, A., Friden, C. & Kottorp, A. (2018). High Injury Burden in Elite Adolescent Athletes: A 52-Week Prospective Study. Journal of Athletic Training, 53(3), 262-270.
  3. Sadigursky, S., Braid, J.A., De Lira, D.N.L., Machado, B.A.B., Carneiro, R.J.F. & Colavolpe, P.O. (2017). The Fifa 11+ injury prevention program for soccer players: a systematic review. BMC Sports Science, Medicine and Rehabilitation, 9, 18.