The Protective Effect of Neuromuscular Training on the Medial Tibial Stress Syndrome in Youth Female Track-and-Field Athletes: A Clinical Trial and Cohort Study

in Journal of Sport Rehabilitation
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Context: Few reports have analyzed the effects of neuromuscular (NM) training programs on the injury incidence among youth female track-and-field athletes. Objective: To determine the effects of NM training on reducing lower limb injury incidence and to establish its effects on countermovement jump performance, balance, 30-m sprint, and joint position sense in youth female track-and-field athletes. Design: Single-blind, randomized controlled clinical trial. Setting:Sports research laboratory. Participants: Twenty-two female athletes were allocated into 2 groups: Conventional (CONV) training (n = 11; age = 15.3 [2.1] y) and NM training (n = 11; age = 15.0 [2.7] y). Interventions: Interventions were performed during the preseason of 6 weeks. The CONV training included anaerobic, strength, and aerobic training. The NM training consisted of a multicomponent program that integrated jumps, landings, and running with strength, endurance, agility, balance, and CORE training. Main Outcome Measures: A follow-up of the cohorts was carried out through the evaluation of lower limb injuries (main outcome) during a regular season (weeks 7–18). Secondary outcomes were measured before and after the intervention: Y-balance test, active joint repositioning, ground reaction force, and countermovement jump height. Results: The injury incidence rate was 17.89 injuries per 1000 hours athlete-exposure in CONV training, and 6.58 in NM training (relative risk = 0.38; 95% confidence interval,  0.18 to 0.82; P = .044). Particularly, the medial tibial stress syndrome incidence rate was 5.96 injuries per 1000 hours athlete-exposure in CONV training and 0.82 in NM training (relative risk = 0.17; 95% confidence interval, 0.02 to 1.12; P = .012). In addition, a significant training × time interaction was noted, favoring improvements in 30-m sprint and countermovement jump height after NM. Conclusion: The NM training may improve youth female athlete’s physical fitness and reduce their injury relative risk of medial tibial stress syndrome injury.

Mendez-Rebolledo and Guzmán-Muñoz are with the Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile. Mendez-Rebolledo, Figueroa-Ureta, Moya-Mura, and Guzmán-Muñoz are with the Magister en Ciencias de la Actividad Física y Deporte Aplicadas al Entrenamiento, Rehabilitación y Reintegro Deportivo, Facultad de Salud, Universidad Santo Tomás, Talca, Chile. Ramirez-Campillo is with the Human Performance Laboratory, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile; and the Center for Research in Exercise Physiology, Faculty of Sciences, Universidad Mayor, Santiago, Chile. Lloyd is with the Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom; the Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand; and the Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand.

Mendez-Rebolledo (guillermomendezre@santotomas.cl) is corresponding author.
  • 1.

    Knowles SB. Is there an injury epidemic in girls’ sports? Br J Sports Med. 2010;44(1):3844. PubMed ID: 19955161 doi:

  • 2.

    Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Renström P. Prevalence of musculoskeletal injuries in Swedish elite track and field athletes. Am J Sports Med. 2012;40(1):163169. PubMed ID: 22053325 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Lundberg ZA, Ivarsson A, Desai P, Karlsson J, Grau S. Athlete availability and incidence of overuse injuries over an athletics season in a cohort of elite Swedish athletics athletes—A prospective study. Inj Epidemiol. 2020;7(1):110. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Edouard P, Navarro L, Branco P, Gremeaux V, Timpka T, Junge A. Injury frequency and characteristics (location, type, cause and severity) differed significantly among athletics ('track and field’) disciplines during 14 international championships (2007–2018): implications for medical service planning. Br J Sports Med. 2020;54(3):159167. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    D’Souza D. Track and field athletics injuries—a one-year survey*. Br J Sports Med. 1994;28(3):197202. PubMed ID: 8000821 doi:

  • 6.

    Von Rosen P, Heijne A, Frohm A, Fridén C, Kottorp A. High injury burden in elite adolescent athletes: a 52-week prospective study. J Athl Train. 2018;53(3):262270. PubMed ID: 29412695 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Caine D, Maffulli N, Caine C. Epidemiology of njury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008;27(1):1950. PubMed ID: 18206567 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, Van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015;49(13):865870. PubMed ID: 26084526 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Martinez JC, Mazerolle SM, Denegar CR, et al. Female adolescent athletes’ attitudes and perspectives on injury prevention programs. J Sci Med Sport. 2017;20(2):146151. PubMed ID: 27544657 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Fort-Vanmeerhaeghe A, Benet A, Mirada S, Montalvo AM, Myer GD. Sex and maturation differences in performance of functional jumping and landing deficits in youth athletes. J Sport Rehabil. 2019;28(6):606613. PubMed ID: 30222476 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Martin AC, Heazlewood IT, Kitic CM, Lys I, Johnson L. Possible hormone predictors of physical performance in adolescent team sport athletes. J Strength Cond Res. 2019;33(2):417425. PubMed ID: 28570489 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911919. PubMed ID: 17193868 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Foss KDB, Thomas S, Khoury JC, Myer GD, Hewett TE. A school-based neuromuscular training program and sport-related injury incidence: a prospective randomized controlled clinical trial. J Athl Train. 2018;53(1):2028. PubMed ID: 29332470 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Emery CA, Pasanen K. Current trends in sport injury prevention. Best Pract Res Clin Rheumatol. 2019;33(1):315. PubMed ID: 31431273 doi:

  • 15.

    Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010;42(3):413421. PubMed ID: 19952811 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Bonato M, Benis R, La Torre A. Neuromuscular training reduces lower limb injuries in elite female basketball players. A cluster randomized controlled trial. Scand J Med Sci Sport. 2018;28(4):14511460. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Hewett TE, Lindenfeld T, Riccobene J, Noyes F. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. 1999;27(6):699706. PubMed ID: 10569353 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Sandrey MA, Mitzel JG. Improvement in dynamic balance and core endurance after a 6-week core-stability-training program in high school track and field athletes. J Sport Rehabil. 2013;22(4):264271. PubMed ID: 23799868 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Emery CA, Cassidy JD, Klassen TP, Rosychuk RJ, Rowe BH. Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomized controlled trial. CMAJ.. 2005;172(6):749754. PubMed ID: 15767608 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Read PJ, Oliver JL, Myer GD, Farooq A, Croix MDS, Lloyd RS. Utility of the anterior reach Y-balance test as an injury risk screening tool in elite male youth soccer players. Phys Ther Sport. 2020;45:103110. PubMed ID: 32726731 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Mirwald RL, Baxter-Jones ADG, Bailey DA, Beunen GP. An assessment of maturity from anthropometric measurements. Med Sci Sports Exerc. 2002;34(4):689694. PubMed ID: 11932580 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Mendez-Rebolledo G, Ramirez-Campillo R, Guzman-Muñoz E, Dabanch-Santis A, Diaz-Valenzuela F. Short-term effects of kinesio taping on muscle recruitment order during a vertical jump: a pilot study. J Sport Rehabil. 2018;27(4):319326. PubMed ID: 28513281 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Carroll KM, Wagle JP, Sole CJ, Stone MH. Intrasession and intersession reliability of countermovement jump testing in division-I volleyball athletes. J Strength Cond Res. 2019;33(11):29322935. PubMed ID: 31469764 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Benis R, Bonato M, La Torre A. Elite female basketball players’ body-weight neuromuscular training and performance on the Y-balance test. J Athl Train. 2016;51(9):688695. PubMed ID: 27824252 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Altmann S, Ringhof S, Neumann R, Woll A, Rumpf MC. Validity and reliability of speed tests used in soccer: a systematic review. PLoS One. 2019;14(8):138. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Loturco I, Kobal R, Kitamura K, et al. Predictive factors of elite sprint performance: influences of muscle mechanical properties and functional parameters. J Strength Cond Res. 2019;33(4):974986. PubMed ID: 30913203 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Pánics G, Tállay A, Pavlik A, Berkes I. Effect of proprioception training on knee joint position sense in female team handball players. Br J Sports Med. 2008;42(6):472476. PubMed ID: 18390919 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Romero-Franco N, Montaño-Munuera JA, Fernández-Domínguez JC, Jiménez-Reyes P. Validity and reliability of a digital inclinometer to assess knee joint position sense in an open kinetic chain. J Sport Rehabil. 2019;28(4):332338. PubMed ID: 29252090 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Guex KJ, Lugrin V, Borloz S, Millet G. Influence on strength and flexibility of a swing phase-specific hamstring eccentric program in sprinters’ general preparation. J Strength Cond Res. 2016;30(2):525532. PubMed ID: 26200198 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Caldemeyer LE, Brown SM, Mulcahey MK. Neuromuscular training for the prevention of ankle sprains in female athletes: a systematic review. Phys Sportsmed. 2020;48(4):1. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Riemann BL, Myers JB, Lephart SM. Comparison of the ankle, knee, hip, and trunk corrective action shown during single-leg stance on firm, foam, and multiaxial surfaces. Arch Phys Med Rehabil. 2003;84(1):9095. PubMed ID: 12589627 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Hewett TE, Patterno M, Myer G. Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop Relat Res. 2002;402(5):7694. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Sandrey MA, Chang Y-J, McCrory JL. The effect of fatigue on leg muscle activation and tibial acceleration during a jumping task. J Sport Rehabil. 2019;6:17. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Reinking MF, Austin TM, Bennett J, Hayes AM, Mitchell WA. Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study. Int J Sports Phys Ther. 2015;10(2):155167. PubMed ID: 25883864

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Reinking MF, Austin TM, Richter RR, Krieger MM. Medial tibial stress syndrome in active Individuals: a systematic review and meta-analysis of risk factors. Sports Health. 2017;9(3):252261. PubMed ID: 27729482 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk factors for medial tibial stress syndrome in active individuals: an evidence-based review. J Athl Train. 2016;51(12):10491052. PubMed ID: 27835043 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Naderi A, Moen MH, Degens H. Is high soleus muscle activity during the stance phase of the running cycle a potential risk factor for the development of medial tibial stress syndrome? A prospective study. J Sports Sci. 2020;38(20):19. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Baltich J, Emery CA, Stefanyshyn D, Nigg BM. The effects of isolated ankle strengthening and functional balance training on strength, running mechanics, postural control and injury prevention in novice runners: Design of a randomized controlled trial. BMC Musculoskelet Disord. 2014;15:407. PubMed ID: 25471989 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Steffen K, Bakka HM, Myklebust G, Bahr R. Performance aspects of an injury prevention program: A ten-week intervention in adolescent female football players. Scand J Med Sci Sport. 2008;18(5):596604. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Markovic G, Mikulic P. Neuro-musculoskeletal and performance adaptations to lower-extremity plyometric training. Sport Med. 2010;40(10):859895. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
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