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Exercise-Based Strategies to Prevent Muscle Injury in Elite Footballers: A Systematic Review and Best Evidence Synthesis

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Abstract

Background

Exercise-based strategies are used to prevent muscle injuries in football and studies on different competitive-level populations may provide different results.

Objectives

To evaluate the effectiveness of exercise-based muscle injury prevention strategies in adult elite football.

Methods

A systematic search was conducted in PubMed (MEDLINE), Web of Science, Cochrane Library, and SPORTDiscuss (EBSCO). We considered only elite adult (> 16 year-old) football players with no distinction for gender; the intervention to be any exercise/s performed with the target to prevent lower-limb muscle injuries; the comparison to be no injury prevention exercise undertaken; the outcome to be the number of injuries, injury incidence, and severity. We searched systematic reviews, randomized-controlled trials (RCTs), and non-randomized-controlled trials (NRCTs), limited for English language. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, the Cochrane Collaboration’s Tool for assessing risk of bias in RCTs, and the Risk of Bias in NRCTs of Interventions tool.

Results

15 studies were included. Three systematic reviews showed inconsistent results, with one supporting (high risk of bias) and two showing insufficient evidence (low risk of bias) to support exercise-based strategies to prevent muscle injuries in elite players. Five RCTs and seven NRCTs support eccentric exercise, proprioception exercises, and a multi-dimensional component to an injury prevention program; however, all were deemed to be at high/critical risk of bias. Only one RCT was found at low risk of bias and supported eccentric exercise for preventing groin problems.

Conclusion

We found limited scientific evidence to support exercise-based strategies to prevent muscle injury in elite footballers.

Trial Registration Number

PROSPERO CRD42017077705.

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Author information

Authors and Affiliations

  1. Performance Department, AS Roma Football Club, Piazzale Dino Viola, 1, 00128, Rome, RM, Italy

    Maurizio Fanchini

  2. Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

    Maurizio Fanchini

  3. Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany

    Ida Bo Steendahl & Tim Meyer

  4. DFB-Akademie (Deutscher Fußball-Bund), Think Tank, Frankfurt, Germany

    Ida Bo Steendahl

  5. Faculty of Health, Sport and Exercise Discipline Group, University of Technology Sydney, Sydney, Australia

    Franco M. Impellizzeri & Aaron J. Coutts

  6. Medical Services Ciutat Esportiva Barcelona, FC Barcelona, Barcelona, Spain

    Ricard Pruna & Alan McCall

  7. Federation de Football Francaise, Paris, France

    Gregory Dupont

  8. Arsenal Performance and Research Team, Arsenal Football Club, London, UK

    Alan McCall

  9. School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK

    Alan McCall

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  1. Maurizio Fanchini
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  8. Alan McCall
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Contributions

MF, AM, and IBS: concept, design, and assessment of the risk of bias, and writing the manuscript. FMI and AJC: writing and editing the manuscript. RP, GD, and TM: controlling and editing the manuscript.

Corresponding author

Correspondence to Maurizio Fanchini.

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Funding

The authors did not receive any specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest relevant to the content of this review.

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Fanchini, M., Steendahl, I.B., Impellizzeri, F.M. et al. Exercise-Based Strategies to Prevent Muscle Injury in Elite Footballers: A Systematic Review and Best Evidence Synthesis. Sports Med 50, 1653–1666 (2020). https://doi.org/10.1007/s40279-020-01282-z

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