Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study

Jari Parkkari, Henri Taanila, Jaana Suni, Ville M Mattila, Olli Ohrankämmen, Petteri Vuorinen, Pekka Kannus, Harri Pihlajamäki, Jari Parkkari, Henri Taanila, Jaana Suni, Ville M Mattila, Olli Ohrankämmen, Petteri Vuorinen, Pekka Kannus, Harri Pihlajamäki

Abstract

Background: The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service.

Methods: The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs.

Results: In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04).

Conclusions: A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts. A similar programme could be useful for all young individuals by initiating a regular exercise routine.

Trial registration: ClinicalTrials.gov identifier number NCT00595816.

Figures

Figure 1
Figure 1
Flowchart of companies and participants through the study during the randomised intervention.
Figure 2
Figure 2
Neuromuscular training exercises performed by the intervention group. Exercises 1 through 9 and their specific aims are described in Table 2. The images were obtained in the Pori Brigade for the purposes of this study, and the individuals shown gave their consent to publish them.

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