Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review Pedro L Valenzuela ,1,2 Romana Brunner,3 Adrián Castillo-García ,4 Bernd Friesenbichler,3 Nicola C Casartelli ,3,5 Javier S Morales ,6 Nicola A Maffiuletti ,3 Mario Bizzini,3 Karin Nierdermann7 Valenzuela PL, et al. Br J Sports Med Month 2019 Vol 0 No 0 1 Br J Sports Med: first published as 10.1136/bjsports-2019-101354 on 25 October 2019. Downloaded from http://bjsm.bmj.com/ on October 27, 2019 at UC Santa Barbara UC Consortia. Protected by copyright. Infographic The incidence of sports injuries has been reported to reach ~26 and 34 injuries per 1000 persons in the USA1 and the European Union,2 respectively, with the majority of these injuries occurring in the lower extremity (eg, ankle and knee sprains, hamstring strains, ACL tears).1 Sports injuries have important negative physical, psychological and medical consequences for the athlete, as well as technical, tactical and economical consequences for the team. Moreover, sports injuries have relevant implications for healthcare systems associated with the treatment costs.3 4 Exercise-based programmes are frequently implemented in team sports as a preventive measure to reduce the risk of injury, particularly for the lower extremity. However, it remains unclear which combination of exercise elements is most effective for this purpose. In this context, an umbrella review was performed to identify the most effective combinations of exercise elements to prevent lower extremity injuries in teamsport athletes (figure 1).4 There were overall 11 combinations of exercise elements that were effective in reducing lower extremity injury incidences/rates. Strength and balance exercises were included in 10 programmes, while agility, stretching and warm-up exercises were present in seven effective injury prevention programmes. Plyometrics or technique exercises (eg, lower limb control while landing from a jump) were just present in ≤5 effective prevention programmes. Interestingly, no combination of exercise elements was found to be effective for the prevention of groin injuries. 2 In summary, the present umbrella review suggests that multicomponent training interventions are effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries—but not of groin injuries—in different team sports (ie, soccer, floorball, Australian and American football, basketball, handball and volleyball). The most frequent exercise elements included in effective training interventions were strength and balance exercises. In contrast, stretching, agility, warm-up and particularly plyometrics and technique were less frequently implemented in effective interventions. 1 Department of Systems Biology, University of Alcalá, Madrid, Spain 2 Department of Sport and Health, Agencia Española para la Protección de la Salud en el Deporte, Madrid, Spain 3 Human Performance Lab, Schulthess Clinic, Zurich, Switzerland 4 Fissac - Physiology, Health and Physical Activity, Madrid, Spain 5 Laboratory of Exercise and Health, ETH Zurich, Zurich, Switzerland 6 Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain 7 Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland Correspondence to Pedro L Valenzuela, Department of Systems Biology, University of Alcalá, Madrid, Spain; pedrol.valenzuela@edu.uah.es Twitter Pedro L Valenzuela @Fissac_es, Nicola C Casartelli @NicCasartelli and Javier S Morales @ javi_salud Contributors PLV conceived the original idea. PLV and AC-G performed the design and editing of the infographic. RB, BF, NCC, NAM, KN and MB are the authors of the original study, and contributed to the design and editing of the infographic. JSM contributed to the design and editing of the infographic. Funding PLV is supported by a predoctoral contract granted by the University of Alcalá (FPI2016). JSM is supported by a predoctoral contract granted by the Ministry of Education, Culture and Sport (FPU14/03435). Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. To cite Valenzuela PL, Brunner R, Castillo-García A, et al. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bjsports-2019-101354 Accepted 11 October 2019 Br J Sports Med 2019;0:1–2. doi:10.1136/bjsports-2019-101354 ORCID iDs Pedro L Valenzuela http://orcid.org/0000-0003-1730- 3369 Adrián Castillo-García http://orcid.org/0000-0002- 0098-0235 Nicola C Casartelli http://orcid.org/0000-0002-1280- 866X Javier S Morales http://orcid.org/0000-0002-3255- 3246 Nicola A Maffiuletti http://orcid.org/0000-0001-5670- 286X References 1. Sheu Y, Chen LH, Hedegaard H. Sports- and recreationrelated injury episodes in the United States, 2011-2014. Natl Health Stat Report 2016:1–12. 2. EuroSafe. Injuries in the European Union. summary on injury statistics 2012-2014. Available: http:// www.bridge-health.eu/sites/d efault/files/EuropeSafe_ Master_R4_SinglePage_1 2102016%20%281%29.pdf [Accessed 24 Jul 2019]. 3. Cumps E, Verhagen E, Annemans L, et al. Injury rate and socioeconomic costs resulting from sports injuries in Flanders: data derived from sports insurance statistics 2003. Br J Sports Med 2008;42:767–72. 4. Junge A, Lamprecht M, Stamm H, et al. Countrywide campaign to prevent soccer injuries in Swiss amateur players. Am J Sports Med 2011;39:57–63. 5. Brunner R, Friesenbichler B, Casartelli NC, et al. Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review. Br J Sports Med 2019;53:282–8. Valenzuela PL, et al. Br J Sports Med Month 2019 Vol 0 No 0 Br J Sports Med: first published as 10.1136/bjsports-2019-101354 on 25 October 2019. Downloaded from http://bjsm.bmj.com/ on October 27, 2019 at UC Santa Barbara UC Consortia. Protected by copyright. Infographic
