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Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies
  1. I Vriend1,
  2. V Gouttebarge1,
  3. W van Mechelen2,
  4. E A L M Verhagen2
  1. 1Consumer Safety Institute (VeiligheidNL), Amsterdam, The Netherlands
  2. 2Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Department of Public & Occupational Health and EMGO+ Institute, VU University Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Dr EALM Verhagen, Department of Public and Occupational Health, VUmc, Van der Boechorststraat 7, Amsterdam 1081BT, The Netherlands; e.verhagen{at}


Importance Ankle sprains are the most common sports-related injuries for which effective preventive measures exist. This review summarises the preventive effectiveness of this neuromuscular training (NMT), culminating in an overview of effective exercise components.

Objective To assess the preventive effect of NMT for first-time and recurrent ankle sprains in sports.

Evidence review An electronic literature search of PubMed, SPORTDiscus and EMBASE was conducted (until 24 March 2016) to identify published randomised controlled trials (RCTs), controlled trials (CTs) and time trend analyses related to NMT as a preventive measure for ankle sprains. Methodological quality of relevant studies was assessed using a predefined set of 19 criteria. Meta-analyses were performed on comparable populations and intervention content.

Findings A total of 30 studies met the inclusion criteria and were analysed (24 RCTs, 3 CTs and 3 time interventions). Studies showed a great diversity in preventive effects and methodological quality (quality score ranged between 47% and 100%). The diversity in preventive effect was independent of study quality and design. A total of 14 studies focussed solely on the effectiveness of balance training, and 16 studies evaluated the effect of balance training combined with adjunct interventions. Pooled data showed a significant reduction in the occurrence of ankle sprains (relative risk (RR) 0.60; 95% CI 0.51 to 0.71). Single-component interventions specifically targeted at ankle sprains achieved preventive effects (RR=0.58; 95% CI 0.48 to 0.72) as opposed to multicomponent interventions (RR 0.67; 95% CI 0.37 to 1.24). With respect to interventions targeted at general injuries, significant effects were found using both single-component (RR=0.71; 95% CI 0.52 to 0.97) and multicomponent interventions (RR=0.55; 95% CI 0.41 to 0.74). Pooled data showed a significant reduction of NMT on ankle sprains in studies including participants regardless of their injury history (RR=0.59; 95% CI 0.49 to 0.71), and in athletes with a previous ankle sprain (RR=0.69; 95% CI 0.49 to 0.98).

Conclusions and relevance NMT is effective at reducing ankle sprains in a sporting population, and in athletes with a previous ankle sprain. The evidence for an effect on first-time ankle sprains remains inconclusive. A key element of NMT to prevent ankle sprains is balance training, irrespective of the use of balance boards or other balance devices. Since both single-component and multicomponent NMT interventions are effective at reducing ankle sprains, the type most fitting to the context should be chosen for implementation efforts.

Level of evidence Level 1.

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