A neuromuscular training programme was effective in preventing acute non-contact leg injuries in female floorball players. The programme, aimed to enhance motor skills and body control, reduced the risk of leg injury by 66%. The intervention focused on improving the players’ motor skills and body control as well as preparing the neuromuscular system for sports specific manoeuvres. The programme was designed to reduce the incidence of acute non-contact leg injuries, which are common in floorball. Compared with the control group that received usual training, the intervention group had significantly fewer injuries. A reduced injury rate was found overall for leg injuries as well as for acute non-contact leg injuries. The greatest effects were observed in non-contact injuries of the ankle ligament.
Some studies have indicated that neuromuscular training probably plays a crucial part in the prevention of injuries12 13 14 15 16 17 18
and this intervention study supports these findings. In one study a multiple training programme for six weeks in high school sports teams reduced the rate of serious knee ligament injuries as well as the rate of non-contact knee ligament injuries.13
Another study showed that a structured warm-up programme among young handball players reduced the risk of traumatic knee and ankle injuries and the overall risk for severe and non-contact injuries.17
We found similar reductions in the risk of non-contact leg injuries, but when we analysed injuries by location, the risk of only ankle injuries reached statistical significance. The 51% reduction in non-contact knee ligament injuries did not reach significance, but the trend was parallel to that of overall non-contact leg injuries.
Strengths and limitations of study
Our study had some limitations. Firstly, the potential for not achieving double blinding in this type of study limits the strength of the conclusions. The randomisation phase, data collection, and data analysis were blinded, but for obvious reasons the coaches and players could not be blinded. Secondly, the sample size was sufficient for analyses of non-contact leg injuries but too small for detailed analysis of anatomical subgroups.
The study had many strengths. The validity of the data was high as 86% of eligible players from 28 floorball teams could be recruited. In addition, the intervention and control groups were similar for baseline characteristics, dropout rate, and training and play during follow-up. Compliance in collecting the data on exposure and injuries was also good.
The neuromuscular training programme was a modified combination of interventions from previous studies, and the exercises were easy to learn. The programme was designed to reduce the incidence of acute non-contact leg injuries. Contact injuries, caused by contact with another player, stick, or ball, are also common in floorball24
although more difficult to prevent.
The training programme included many different exercise manoeuvres with several variations so it was not possible to determine which particular manoeuvre was effective in preventing injury. The determination of type of injury may not, however, be necessary, because floorball, as with all other team sports, includes a wide variety of fast and dynamic movements. To obtain proper body control and correct technique in sports specific manoeuvres, it would probably be wise to practise the required skills by noticeably varying the tasks. Also, standardisation of neuromuscular training is likely to be a key to injury prevention. To maintain the preventive effect we recommend the inclusion of varied neuromuscular exercises in weekly training programmes all year.
Five teams (36%) from the intervention group carried out the programme regularly through the season. Six teams (43%) had irregularities in training and three (21%) interrupted training. On the basis of information in the exercise diaries and players’ subjective estimation of participation, it seemed that training activity was highest during the first two training periods, after which it declined. The intervention teams were, however, included in analyses regardless of their intervention training activity and therefore the effect of the programme might be even higher than reported. The efficacy analysis confirmed that the risk of injury was lower among those teams that trained regularly.
Although severe knee ligament injuries, particularly injuries of the anterior cruciate ligament, are of concern in female floorball, this study could not analyse the effect of the neuromuscular warm-up programme on these injuries because there were too few such cases (three non-contact ruptures of the anterior cruciate ligament in both intervention and control groups). It is noteworthy, however, that none of these ruptures occurred among the five teams that trained regularly through the season.
During the study it became obvious that some players in the control group did similar exercises to players in the intervention group, because these exercises are commonly used in sports training. Training among these controls did not reach the level of the intervention group, however, and if this partial contamination of the controls biased the results of the study it erred on the side of underestimating rather than overestimating the effect of the neuromuscular training on the risk of injury.
In the intervention a strong emphasis was placed on proper technical performance of every exercise. We considered it important that the intervention coaches and players had good knowledge of the correct training technique, typical mistakes in each exercise manoeuvre, and appropriate methods for their correction. We emphasised that training with incorrect technique was likely to result in improper motor skills and body control and might increase the risk of injury.
This intervention study focused on women floorball players in three top level leagues in Finland. Because floorball players have a similar pattern of leg injuries and injury mechanisms, the training programme could be effective in floorball in general including players that are male, young, or play for recreational purposes. Further studies are needed to verify the training effect in these groups.
As it is easier to learn motor skills while young, we recommend that regular neuromuscular training of floorball players should begin no later than age 12. Correction of poor motor technique may be more difficult in adulthood—at least the learning process takes substantially more time and repetitions than that in childhood.
In conclusion, a neuromuscular training programme was effective in preventing acute non-contact injuries of the leg in female floorball players. Such training should be included in the weekly training of this sport.
What is already known on this topic
- Floorball players have an increased risk of ligament injuries of the ankle and knee, and about half of these injuries occur in non-contact situations
- Studies providing evidence for prevention of sports injuries have been methodologically limited
What this study adds
- A neuromuscular training programme to enhance the motor skills and body control of female floorball players reduced the risk of leg injury by 66%
- The risk of non-contact ankle and knee ligament injury could be reduced by 65%
- Neuromuscular training is recommended to be included in the weekly training programme of floorball