Original paper
Preventing lower limb injuries: Is the latest evidence being translated into the football field?

https://doi.org/10.1016/j.jsams.2008.04.002Get rights and content

Abstract

There is accumulating international evidence that lower limb injuries in sport can be prevented through targeted training but the extent to which this knowledge has been translated to real-world sporting practice is not known. A semi-structured questionnaire of all coaches from the nine Sydney Australian Football League Premier Division teams was conducted. Information was sought about their knowledge and behaviours in relation to delivering training programs, including their uptake of the latest scientific evidence for injury prevention. Direct observation of a sample of the coach-delivered training sessions was also undertaken to validate the questionnaire. Coaches ranked training session elements directly related to the game as being of most importance. They strongly favoured warming-up and cooling-down as injury prevention measures but changing direction and side-stepping training was considered to be of little/no importance for safety. Only one-third believed that balance training had some importance for injury prevention, despite accumulating scientific evidence to the contrary. Drills, set play, ball handling and kicking skills were all considered to be of least importance to injury prevention. These views were consistent with the content of the observed coach-led training sessions. In conclusion, current football training sessions do not give adequate attention to the development of skills most likely to reduce the risk of lower limb injury in players. There is a need to improve the translation of the latest scientific evidence about effective injury prevention into coaching practices.

Introduction

Lower limb injuries (LLI) are common in many sports and there is accumulating international evidence from both randomised controlled trials and biomechanical studies that they can be prevented through targeted training that incorporates structured warm-up, balance training, side-stepping/cutting skills and jump/landing training.1, 2, 3, 4, 5 Indeed, players who have participated in pre-season training programs or received specialist coaching are significantly less likely to be injured than other players.6 This suggests that coaches could play a pivotal role in the provision of specific training programs to reduce injury risk in players.

Given the accumulation of knowledge about preventing LLI, it is of interest to determine the extent to which this scientific evidence base has informed the content of training programs led by coaches. This information is needed to develop future injury prevention programs, as only research that is adopted as standard sporting practice can actually prevent injuries.7

A detailed understanding of the context of sport delivery is needed before research findings can be translated into real world injury prevention practice.7 Given this, it is somewhat surprising that coaches’ attitudes to sports injury prevention have not been well explored in the peer-review literature. Exploration of coaches’ knowledge of the benefits of mouthguards found that the majority believed they were important, but did not feel adequately informed to provide advice to their players.8 Another study found that coaches were less convinced of the efficacy of rugby headgear than players and believed that its use could actually increase injury rates, so again did not promote it widely to players.9 As coaches are critical to the implementation and adoption of sports injury prevention strategies, it is important to understand their attitudes and existing knowledge as determinants of their safety orientated behaviours and that of the players they coach.

The aim of this study was to determine the knowledge, attitudes and behaviours of coaches towards LLI prevention in Australian football. This information was collected as a necessary precursor to the development of a LLI prevention program, to be delivered during coach-led training sessions.

Section snippets

Methods

Each coach of the first division teams from all nine clubs in the Premier Division (i.e. the highest level of competition) of the Sydney Australian Football League (SAFL) agreed to participate. Approval for the study was obtained from the Human Research Ethics Committee at the University of New South Wales.

Coaches were surveyed for 10–15 min during a nominated training session. A broad qualitative approach was adopted and a semi-structured questionnaire was developed. Written responses were

Results

Coaches’ ratings of the importance of including various elements in a training session, and their subsequent impact on team performance and injury prevention are shown in Table 1. Coaches generally ranked the elements directly related to the game as being of most importance to training session content. The most important elements for team performance were considered to be game-related skills of ball handling and kicking skills, as well as warm-up and cool-down. There was more variability in the

Discussion

To our knowledge, this is the first study to assess the extent to which recent scientific evidence about LLI prevention has been specifically incorporated into coaches’ beliefs and practices in relation to training programs in any football code. In developing training programs for their players, our study has found that Australian football coaches generally rank injury prevention lower than general training session needs and team performance. Furthermore, it would seem that the accumulating

Practical implications

  • Coaches are eager to become better equipped for lower limb injury prevention.

  • Coaches would be most receptive towards implementing a training program if it concurrently improves player performance and maximises injury prevention.

  • There is a need for improved processes for translating the latest scientific evidence about the most effective injury prevention strategies to coaches’ knowledge base and practice.

Acknowledgements

This study was funded by a University of New South Wales GoldStar Award. Caroline Finch was supported by an NHMRC Principal Research Fellowship. Prof. Bruce Elliott is thanked for his input in the planning stage of this study.

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