A school-based neuromuscular training program and sport-related injury incidence: A prospective randomized controlled clinical trial

Kim D.Barber Foss, Staci Thomas, Jane C. Khoury, Gregory D. Myer, Timothy E. Hewett

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Context: An estimated 40 million school-Aged children (age range = 5-18 years) participate annually in sports in the United States, generating approximately 4 million sport-related injuries and requiring 2.6 million emergency department visits at a cost of nearly 2 billion. Objective: To determine the effects of a school-based neuromuscular training (NMT) program on sport-related injury incidence across 3 sports at the high school and middle school levels, focusing particularly on knee and ankle injuries. Design: Randomized controlled clinical trial. Setting: A total of 5 middle schools and 4 high schools in a single-county public school district. Patients or Other Participants: A total of 474 girls (222 middle school, 252 high school; age=14.0 ± 1.7 years, height= 161. ± 6 8.1 cm, mass = 55.4 ± 12.2 kg) were cluster randomized to an NMT (CORE; n = 259 athletes) or sham (SHAM; n=215 athletes) intervention group by team within each sport (basketball, soccer, and volleyball). Intervention(s): The CORE intervention consisted of exercises focused on the trunk and lower extremity, whereas the SHAM protocol consisted of resisted running using elastic bands. Each intervention was implemented at the start of the season and continued until the last competition. An athletic trainer evaluated athletes weekly for sport-related injuries. The coach recorded each athlete-exposure (AE), which was defined as 1 athlete participating in 1 coach-directed session (game or practice). Main Outcome Measure(s): Injury rates were calculated overall, by sport, and by competition level. We also calculated rates of specific knee and ankle injuries. A mixed-model approach was used to account for multiple injuries per athlete. Results: Overall, the CORE group reported 107 injuries (rate = 5.34 injuries/1000 AEs), and the SHAM group reported 134 injuries (rate = 8.54 injuries/1000 AEs; F1,578 = 18.65, P , .001). Basketball (rate = 4.99 injuries/1000 AEs) and volleyball (rate = 5.74 injuries/1000 AEs) athletes in the CORE group demonstrated lower injury incidences than basketball (rate = 7.72 injuries/1000 AEs) and volleyball (rate = 11.63 injuries/ 1000 AEs; F1,275 = 9.46, P = .002 and F1,149 = 11.36, P = .001, respectively) athletes in the SHAM group. The CORE intervention appeared to have a greater protective effect on knee injuries at the middle school level (knee-injury incidence rate = 4.16 injuries/1000 AEs) than the SHAM intervention (knee-injury incidence rate = 7.04 injuries/1000 AEs; F1,261 = 5.36, P = .02). We did not observe differences between groups for ankle injuries (F1,578 = 1.02, P = .31). Conclusions: Participation in an NMT intervention program resulted in a reduced injury incidence relative to participation in a SHAM intervention. This protective benefit of NMT was demonstrated at both the high school and middle school levels.

Original languageEnglish (US)
Pages (from-to)20-28
Number of pages9
JournalJournal of athletic training
Issue number1
StatePublished - Jan 2018


  • Epidemiology
  • High School Athletes
  • Injury Rates
  • Middle School Athletes
  • Sport Injuries

ASJC Scopus subject areas

  • General Medicine


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