Neuromuscular training and sport injury prevention in different types of sports—What we know and what we do not know?

Neuromuscular exercises are essential components of successful sport injury prevention and rehabilitation programs. Neuromuscular training (NMT) aims to improve neuromuscular control and functional joint stability, and above all, it aims to enhance or relearn sportspecific movement patterns and skills. Typically, NMT programs consist of strength training, balance exercises, jump training, and sportspecific exercises (such as running, change of direction technique, and agility drills). Neuromuscular training has been shown to be effective in injury prevention in youth and adult team sports.1,2 Across different team sports, regular NMT has reduced the occurrence of both acute and overuse musculoskeletal injuries. In addition, a recent study in youth rugby suggested that NMT can also decrease the risk of concussion.3 According to recent systematic reviews, the vast majority of sport injury prevention studies have focused on team sports.1,2,4 The most frequently studied sports are soccer, rugby, American football, basketball, and ice hockey.4 Injuries in team sports primarily affect the lower extremities (LE). Sudden changes of direction while running, sidestep cutting, and jump landings are typical situations in which acute LE injuries, specifically ankle and knee ligament injuries, may occur. Overuse LE injuries, such as Achilles and patellar tendinopathies are also common in team sports, most likely because players frequently make sudden sidecuts, stops, direction changes, and jump landings— all producing intensive, repetitive loading on the Achilles and patellar tendons. Consequently, the primary aim of NMT injury prevention programs in team sports is to improve athletes’ movement control, movement quality, and ultimately reduce highrisk loading of joints and tendons during highintensity cutting, direction change, and landing maneuvers. Despite high levels of evidence in favor of NMT in team sports, research of NMT for many popular and injuryprone individual sports is still lacking. Since injury prevention in running and pivoting team sports is successful by weekly NMT participation, this prevention strategy is likely to also be effective in running and pivoting individual sports as well (eg, dance, gymnastics, running, badminton, tennis). A recently published randomized controlled trial (RCT) investigated injury prevention by NMT in adult recreational tennis players.5 This study revealed that this tennisspecific NMT program was not effective in injury prevention. However, the NMT program used in this study was unsupervised and adherence to NMT was not optimal. NMT and other sport injury prevention strategies can reduce the number of injuries, but only if they are properly used by athletes. Another recently published RCT revealed that a novel footcore muscle strengthening program was effective in prevention of runningrelated injuries in recreational runners.6 Runners randomized to the footcore strengthening group had 2.4fold lower rate of runningrelated injuries within oneyear study period than runners in the control group. Nevertheless, there are still many unexplored areas in the field of sport injury prevention. For example, no RCTs have been undertaken to explore the impact of NMT on prevention of badminton or table tennis injuries, both being extremely popular racket sports played by youth and adults alike. To conclude, using NMT reduces the risk of injury across various sports. Still, more research is required. Highquality RCTs are needed to gain a better understanding of injury prevention by NMT in the large population of competitive and recreational athletes in different types of individual sports.