The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials

PainSci » bibliography » Lauersen et al 2014
updated Jun 9, 2018

Tags: injury, exercise, stretch, prevention, strength, pain problems, self-treatment, treatment, muscle

Five pages on PainSci cite Lauersen 2014: 1. Quite a Stretch 2. The Complete Guide to Muscle Strains 3. Strength Training for Pain & Injury Rehab 4. Does Hip Strengthening Work for IT Band Syndrome? 5. Can strength training prevent overuse injuries?

PainSci commentary on Lauersen 2014: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This meta-analysis is the best reference available to support the general claim that resistance training will prevent overuse injuries. Unfortunately, “the best” is not very good: the authors’ conclusion about injury prevention is based on data from just four studies of questionable/limited relevance, and there is contrary evidence.

All the 4 studies are of the lower limb, two of them about hamstrings and eccentric training, both of which have limited applicability to the question of preventing overuse injuries (most injuries of the hamstrings are not overuse injuries, and eccentric training is not typical resistance training). The third was a study of ACL injuries, which are traumatic, not overuse, so that doesn’t contribute to the case for preventing overuse injuries. And the final one was for patellofemoral pain, which does count, but its results are hardly decisive (see Coppack et al).

Strengthening might prevent overuse injuries, but that’s an untested hypothesis, and this citation simply does not provide meaningful support for it. Not even remotely.

(Meanwhile, it does provide adequate support for the conclusion that stretching is useless for injury prevention. The overly optimistic conclusions were not enough for good news about that: “consistently favourable estimates were obtained for all injury prevention measures except for stretching.”)

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Physical activity is important in both prevention and treatment of many common diseases, but sports injuries can pose serious problems.

OBJECTIVE: To determine whether physical activity exercises can reduce sports injuries and perform stratified analyses of strength training, stretching, proprioception and combinations of these, and provide separate acute and overuse injury estimates.

MATERIAL AND METHODS: PubMed, EMBASE, Web of Science and SPORTDiscus were searched and yielded 3462 results. Two independent authors selected relevant randomised, controlled trials and quality assessments were conducted by all authors of this paper using the Cochrane collaboration domain-based quality assessment tool. Twelve studies that neglected to account for clustering effects were adjusted. Quantitative analyses were performed in STATA V.12 and sensitivity analysed by intention-to-treat. Heterogeneity (I(2)) and publication bias (Harbord's small-study effects) were formally tested.

RESULTS: 25 trials, including 26 610 participants with 3464 injuries, were analysed. The overall effect estimate on injury prevention was heterogeneous. Stratified exposure analyses proved no beneficial effect for stretching (RR 0.963 (0.846-1.095)), whereas studies with multiple exposures (RR 0.655 (0.520-0.826)), proprioception training (RR 0.550 (0.347-0.869)), and strength training (RR 0.315 (0.207-0.480)) showed a tendency towards increasing effect. Both acute injuries (RR 0.647 (0.502-0.836)) and overuse injuries (RR 0.527 (0.373-0.746)) could be reduced by physical activity programmes. Intention-to-treat sensitivity analyses consistently revealed even more robust effect estimates.

CONCLUSIONS: Despite a few outlying studies, consistently favourable estimates were obtained for all injury prevention measures except for stretching. Strength training reduced sports injuries to less than 1/3 and overuse injuries could be almost halved.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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