A coach-controlled rehabilitation program reduces the risk of reinjury among amateur soccer players

Question

Among amateur soccer players with a recent injury, can a rehabilitation program that is implemented by coaches according to an algorithm with return-to-play criteria reduce the risk of reinjury?

Design

Cluster-randomised controlled trial with blinded outcome assessment and intention-to-treat analysis.

Setting

Sixth highest division of amateur male soccer competition in Sweden.

Participants

Twenty-four teams (582 players) were randomised to use a rehabilitation program with injured players before returning them to match play, or to a control arm.

Interventions

The rehabilitation program involved graded return to individual training, team training, and match play. Decisions about progression through the program were made by coaches with reference to an algorithm with criteria to determine when to recommence progressively more taxing training drills and match play. The criteria for progressing through the rehabilitation program related to pain and swelling in response to training and the severity of the injury.

Outcomes

The primary outcome was the rate of reinjury throughout the season, with subsequent analyses of the risk of reinjury during the first week, the first month, the second month, and more than two months after the initial injury. Lower limb injuries were also analysed separately. Compliance with the rehabilitation program was recorded.

Results

Two teams from each arm of the trial withdrew after randomisation. Ninety players (37%) in the intervention group incurred 132 injuries and 79 players (33%) in the control group incurred 134 injuries. Reinjury occurred in 11% of the injuries in the intervention group – significantly fewer than the 30% of the injuries that recurred in the control group. This indicates that for every 5 injuries managed with the rehabilitation program, a reinjury would be prevented (95% CI 4 to 10). For lower limb injuries, only 4 injuries would need to be managed with the program to prevent a reinjury (95% CI 3 to 7). The majority of the reinjuries occurred early after the initial injury, with 44% occurring within the first week, and 80% within the first month. Compliance with the program was 68% in the intervention group. All three reinjuries within the first week of returning to match play in the intervention group were cases where the coach did not comply with the program.

Conclusion

A rehabilitation program implemented by coaches with return-to-play criteria reduces the reinjury rate in amateur soccer players.