The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials
Four articles 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?
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.”)
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.
related content
- “The effects of exercise for the prevention of overuse anterior knee pain: a randomized controlled trial,” Coppack et al, American Journal of Sports Medicine, 2011.
- “Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load: a randomized controlled trial of 1020 army recruits,” Brushøj et al, American Journal of Sports Medicine, 2008.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- Is there a relationship between throbbing pain and arterial pulsations? Mirza 2012 J Neurosci.