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W.S.A Al Attar1,2,3, J. Bakhsh1, E. Khaledi1, O. Faude2, H. Ghulam4, R. Sanders3
1Umm Al Qura University, Department of Physical Therapy, Faculty of Applied Medical Science, Makkah, Saudi Arabia, 2University of Basel, Department of Sport, Exercise and Health, Faculty of Medicine, Basel, Switzerland, 3The University of Sydney, Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, Sydney, Australia, 4Najran University, Department of Physical Therapy, Faculty of Applied Medical Science, Najran, Saudi Arabia
Background: The ankle is one of the most common sites of injuries among soccer players. There is evidence that ankle injury incidence can be reduced by improving proprioception and ankle stability via balance training exercises.
Purpose: The purpose of this systematic review and meta-analysis was to investigate how the ankle injury rates among soccer players are influenced by an injury prevention program that includes balance training.
Methods: Two investigators independently searched for relevant studies published during the period from 1985 - 2020 using the following databases: Cochrane Library, PubMed, Web of Science, MEDLINE and PEDro. The keywords used in the search strategy were ‘balance training’, ‘proprioceptive training’, ‘neuromuscular training’, ‘injury prevention programs’, ‘FIFA’, ‘ankle injury’, ‘foot injury’, ‘soccer’, ‘football’, ‘athlete’, and variations of these search terms. To be included studies had to be randomized controlled trials using injury prevention programs that included balance training of soccer players with the primary outcome being ankle injury rate. There were no restrictions of age or playing level. The random effects model was used in analyzing the extracted data by the Comprehensive Meta-Analysis software version 3 (CMA V3).
Results: The initial search resulted in 5372 articles, which were filtered to nine articles that met the inclusion criteria. The pooled results of injury prevention programs that include balance training exercises showed a 36% ankle injury reduction per 1000 h of exposure compared to the control group with an Injury Risk Ratio [IRR] of 0.64 (95% confidence interval [CI] 0.54–0.77, P = 0.000). Moreover, the pooled results of the FIFA injury prevention programs showed 37% ankle injury reduction per 1000 h of exposure compared to the control group [IRR 0.63, 95% CI= 0.48–0.84, p = 0.002]. The pooled results of balance training exercises alone showed 42% ankle injury reduction per 1000 h of exposure compared to the control group [IRR 0.58, 95% CI= 0.41–0.84, p = 0.004]. Ankle injury reduction among males was 42% [IRR 0.58 (95% CI 0.45-0.76), p = 0.000], while females showed 15% injury reduction [IRR 0.85 (95% CI 0.59–1.22), p = 0.38], and 41 % injury reduction in both males and females [IRR 0.59; (95 % CI 0.42-0.83), p = 0.002].
Conclusion(s): This systematic review and meta-analysis demonstrates that injury prevention programs that include balance training decrease the risk of ankle injuries, particularly among male soccer players. Therefore, policymakers should include balance training within injury prevention programs, aimed at preventing ankle injuries in soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42017054450).
Implications: Implementing injury prevention programs that include balance training exercises for soccer players to decrease ankle injury risk factors, and therefore reducing healthcare costs and players' absenteeism.
Funding, acknowledgements: The authors received no specific funding for this work.
Keywords: Injury Prevention Programs, Balance Training, Ankle Injury
Topic: Sport & sports injuries
Did this work require ethics approval? No
Institution: UMM AL QURA UNIVERSITY
Committee: The College of Applied Medical Science Ethical Committee
Reason: A systematic review
All authors, affiliations and abstracts have been published as submitted.
