Background Exercise-based training programs are a popular injury prevention measure to prevent sports injuries but there have been few trials of their effectiveness in real-world sports settings.

Methods A clustered randomised controlled trial was undertaken in 18 community-level (non-elite) Australian Football (AF) clubs in two states with multiple teams of adult male players. Clubs/teams were randomly allocated to either a neuromuscular control (NMC) (intervention n = 679 players) or standard-practice (control n = 885 players) exercise training program delivered as part of regular team training sessions (twice weekly over an 8-week pre-season and 18-week regular-season). All game-related injuries and hours of game participation were recorded. Training attendance was recorded as a proxy for compliance with the allocated program. Generalised estimating equations, adjusted for clustering (club), were used to compute injury incidence rates (IIR) for all injuries, lower limb injuries (LLI) and knee injuries only. Using an intention-to-treat analysis, the IIRs were compared across groups with cluster-adjusted injury rate ratios (IRR).

Results A total of 773 game injuries was recorded, of which 50% (n = 386) were LLI and 12% (n = 96) were to the knee. Compared with control players, NMC players had both a reduced overall LLI rate (IRR: 0.78 (95% CI: 0.56 to 1.08), p = 0.14) and knee IRR (IRR: 0.50 (95% CI: 0.24 to 1.05), p = 0.07). Variation in player training attendance across the season influenced exposure to the implemented programs.

Conclusions Injury reductions can be achieved from implementing targeted training programs in men’s community sport. While nearly statistically significant, reducing the knee injury rate by half and the LLI rate by 22% is still a clinically important outcome. Further injury reductions could be achieved with improved training attendance and participation in the program.