In the present study, the warm-up intervention resulted in significantly lower incidence of match injuries. Any reduction in match injuries would be considered beneficial, as match injury incidences are consistently higher than those sustained during training [ 1 , 3 , 6 , 7 , 57 , 58 ]. While it is not possible to make definitive conclusions from the data collection in this study, improvements in neuromuscular control and fitness may have prepared players to withstand contacts that would otherwise have resulted in injuries.
However, we were not able to record the types and mechanisms of contact injuries that could be prevented by the programme as contact injuries are often multifactorial. The results of this study are in contrast with the studies conducted by Owoeye et al. However, these studies [ 34 , 38 ] reported poor compliance rates and it is possible that the neuromuscular benefits of the programme may not have been achieved.
The same studies [ 34 , 38 ] did not find significant reductions in training injury occurrences [ 34 , 38 ]. Further studies would be important to investigate the level of compliance required to prevent training injuries. Significantly lower incidences were observed in the intervention group for moderate and severe injuries, which is in accordance with the studies conducted by Silvers-Granelli et al. Reducing severe injuries has a major impact on the total time lost due to injuries.
Not only were the players in the intervention group less likely to suffer severe injury, injured players in the intervention group returned to play sooner than players in the control group. The intervention significantly reduced the incidence of lower extremity and ankle injuries, comparable with the other studies [ 38 , 39 ]. This is in line with the aspiration of the FIFA Medical Assessment and Research Centre that designed a programme targeting the reduction of lower limb injuries by including exercises to improve neuromuscular control with good posture and correct alignment of lower limb joints [ 37 ].
Analysing muscle activation, Nakase et al. Additionally, the rectus abdominis and hip adductor muscles were more active when performing part two of the programme [ 60 ]. The increase in abdominal, hip extensor and adductor neuromuscular control may assist with force distribution and proximal control while supporting optimal biomechanical alignment of the hip, knee and ankle joints [ 33 ].
However, we were not able to measure changes in specific intrinsic physical factors. We were therefore not able assess the contribution of intrinsic factors in preventing injuries. The increase in dynamic balance suitable soccer skill performance could lead to the physiological preparedness of the players that subsequently reduce the risk of injuries [ 61 ].
It is therefore important to investigate the possibility of extending the use of the preventive programmes to the wider soccer community in Rwanda.
Therefore, the recommended implementation rate of twice per week [ 63 ] was not only met, but exceeded with teams using the mean of 3. The high compliance rate may be partially attributed to the motivation levels of the coaches observed during training and follow up. Moreover, the training stimuli comprised of various didactic materials, and the extended practical sessions and regular team visits may have contributed to the conformity to the programme.
Coaches may have held beliefs that performing the programme as many times as possible would provide a greater increase in neuromuscular strength increased their motivation. The nature of the study required close monitoring and supervision of the coaches for compliance and therefore, it was not possible to blind the researcher or coaches to the group allocations.
However, the medical personnel and research assistants were blinded as to which team was allocated to the intervention or control groups as well as nature, type and organisation of the intervention, from training to follow-up.
Further, the study relied on the injury reports from the medical personnel of the teams using subjective and physical examination due to limited funding. It would be interesting to explore barriers and facilitators to the use of standardised injury reporting methods within this context; and to identify how acceptability of injury reporting methods and training loads could be improved.
Future studies may benefit from investigation of individual player compliance. Prior to this study there was no systematic recording of injuries and exposure in Rwanda, therefore recording this type of data was also new to both the coaches and medical personnel. This process placed an additional load to their usual work activities.
As a result, coaches were not willing to provide player compliance information as this was too time consuming. Further investigation of the perception of players and coaches could be performed for in-depth analysis of the awareness and opinion about injury prevention. More studies are also needed to assess the content of the usual warm up done by teams in the control group for further comparison.
Positive effects of the programme on contact and severe injuries are encouraging for reducing serious soccer injuries with consistent implementation. We thank all coaches and players who participated in this study.
Thanks to all the medical staff and research assistants that supported data collection. We also acknowledge the support from the national and international soccer governing bodies. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Soccer players incur injuries that typically affect their performance. Methods Twelve teams players were randomised in the intervention group and 12 teams players in the control group using a cluster randomized controlled trial with teams as the unit of randomization.
Introduction The incidence of injury in soccer players is high at all levels and ranges from 1. Methods Design and ethical approval A cluster-randomized controlled design was used in this study. Participants Soccer players from all the 24 Rwandan Second Division teams registered in the season were invited individually to participate in the study.
Randomisation and allocation of the participants Random sampling was used to allocate the 24 teams to the study groups. Inclusion criteria Players who had contracts and licenses from the teams enrolled to play in the second division were included in the study.
Instruments Four forms were used to collect data. Demographic data: A self-designed form was developed to gather demographic data and information pertaining to the coaching or playing experience. Training exposure registration form: Coaches were provided a standardised exposure form developed by FIFA 2 to record detailed information related to duration of training and player involvement. Any form of physical activities supervised by the coach was recorded as training exposure time in minutes.
The duration of the training was recorded from the start of the warm up to the end of the cool down session [ 46 ]. The research team collected the forms every two weeks. Match exposure time was defined as the amount of time the player was involved while the team played against another team.
Injury report form: An injury report form was completed by the team medical personnel to collect data pertaining to the incidence of injuries [ 47 ]. Definitions of the type, anatomical location, severity and circumstance of injury were provided at the back page of the form. The form was developed and used during major FIFA tournaments and Olympic games [ 48 ] and has been extensively used in other studies [ 49 ].
For example an injury is defined as any physical complaint that resulted from soccer participation whether in training or match. It does not necessarily mean that there is a need of medical attention. The severity of injury was classified according to the number of days of absence from full soccer participation due to injury.
Intervention Control group. Experimental group. Compliance and follow up The instructor and the principal investigator visited the intervention group coaches once a week for the first month of the season, followed by monthly visits to foster implementation and compliance. Statistical analyses Descriptive statistics were used to present baseline characteristics. Results Of the 25 teams that participated in the second division league, 24 players agreed to participate in the study and were randomised intervention 12 teams, players; control 12 teams, Fig 1.
Download: PPT. Characteristics of players in the intervention and control group The independent t-test was conducted after assessing the normality of data and adjusting for clustered teams.
Table 1. Demographic characteristics of players in the intervention and control groups. Training and match exposures Players in the intervention group completed hours of training and match hours, with total exposure hours in the season. Table 2.
Effect of the intervention on the incidence of overall, training and match injuries. Table 3. Effect of the intervention on the risk of injuries between study groups. Table 4. Effectiveness of the intervention on the severity of injuries. Limitations of the study The nature of the study required close monitoring and supervision of the coaches for compliance and therefore, it was not possible to blind the researcher or coaches to the group allocations.
Supporting information. S1 Checklist. S1 Protocol. Study protocol. S1 File. S1 Appendix. Acknowledgments We thank all coaches and players who participated in this study. References 1. J strength Cond Res. Injuries in Youth Soccer During the Preseason. Clin J Sport Med. Am J Sports Med.
Drawer S, Fuller CW. Perceptions of retired professional soccer players about the provision of support services before and after retirement. Stand on one leg, with your knee and hip slightly bent, and hold a ball in both hands. Hold your balance and keep your body weight on the ball of your foot. Hold for 30 seconds, and repeat on the other leg.
Do two sets on each leg. Stand on one leg and face a partner at a distance of two to three meters. Keep your balance while you throw the ball to each another. Hold in your stomach and keep your weight on the ball of your foot. Continue for 30 seconds and repeat on the other leg. Exercise can be made more difficult by lifting the heel from the ground slightly. Keep your balance while you and your partner in turn try to push the other off balance in different directions.
Stand with your feet hip-width apart, hands on your hips. Keep your upper body straight and your pelvis horizontal. Slowly bend your hips, knees and ankles until your knees are flexed to 90 degrees. Lean your upper body forward. Then straighten your upper body, hips and knees, and stand up on your toes. Slowly lower down again and straighten up slightly more quickly. Repeat for 30 seconds for two sets. Lunge forward slowly at an even pace. Bend hips and knees slowly until your leading knee is flexed to 90 degrees.
The bent knee should not extend beyond the toes. Do ten lunges on each leg, for two sets. Slowly bend your knee, if possible until it is flexed to 90 degrees, and straighten up again. Bend slowly then straighten slightly more quickly. Repeat on the other leg. Keep repeating the drill, running two cones forward and one cone backward.
Take small, quick steps. Starting Position: Lie on your front, supporting your forearms and feet. Your elbows should be directly under your shoulders. Exercise : Lift your body up, supported on your forearms.
Pull your stomach in and hold the position for seconds. Your body should be in a straight line. Try not to sway or arch your back. Do three sets.
Starting Position: Lie on your side with the knee of your lowermost leg bent to 90 degrees. Support your upper body by resting on your forearm and knee.
The elbow of your supporting arm should be directly under your shoulder. Exercise : Lift your uppermost leg and hips until your shoulder, hip and knee are in a straight line. Hold the position for sec. Take a short break, change sides and repeat. Do three sets on each side. Starting Position: Kneel on a soft surface.
Ask your partner to firmly hold down your ankles. Exercise : Your body should be completely straight from the shoulder to the knee throughout the exercise. Lean forward as far as you can, controlling the movement with your hamstrings and your gluteal muscles. When you can no longer hold the position, gently put your weight on your hands, falling into a push-up position.
Do one set.
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