An alternative on-field warm-up program reduced the risk of anterior cruciate ligament injury in collegiate female soccer players, especially those with a previous history of such injuries.
The Prevent Injury and Enhance Performance (PEP) program consists of warm-up, stretching, strengthening, plyometrics, and sports-specific agility exercises intended to address potential deficits in the stabilizing muscles around the knee joint.
The study tested the PEP program during the fall 2002 soccer season and involved 69 participating Division I National Collegiate Athletic Association women's soccer teams.
A certified athletic trainer for each team supervised each training session and communicated the results, including participation and injury reports. A total of 34 interventional teams (583 athletes) performed the PEP program regimen, and 35 control teams (852 athletes) performed their regular warm-up routine; 8 interventional programs dropped out of the study before completion and were not included in the analysis, wrote Dr. Julie Gilchrist of the Centers for Disease Control and Prevention and her colleagues.
An anterior cruciate ligament (ACL) injury was counted only if the certified athletic trainer reported confirmation by magnetic resonance imaging, arthroscopy, or direct visualization during repair. A contact injury was defined as an ACL injury sustained as a result of direct contact to the knee or another body part during play. A noncontact injury was one resulting without extrinsic contact with another player or object (Am. J. Sports Med. 2008;36:1476–83).
A comparison of noncontact ACL injury rates between the interventional and control groups showed the most substantial differences in injury rates. The ACL injury rates tended to be lower for all interventional and control comparisons.
The researchers attributed the lack of significant differences in other areas of injury, despite the downward trend, to the fact that it takes time for the benefits of neuromuscular training to manifest, which would explain why differences in ACL injury rates were more pronounced toward the end of the season. Overall, the program seems to reduce the risk of noncontact ACL injuries, especially in athletes with a history of ACL injury, they concluded.
Several authors of this paper participated in the development of the PEP program but had no financial interests in it.
Athletes with a history of ACL injury stand to benefit in particular from the program. ©Sirena Designs/