ACL Injury Prevention Education Improves Implementation of Neuromuscular Training Among High School Sports Coaches: A Cross-Sectional Survey Study

Background: Neuromuscular training (NMT) programs delivered by trained personnel have demonstrated protective effects against anterior cruciate ligament (ACL) injury among high school sports participants, but few studies have investigated the impact of education on high school sports coaches' knowledge and incorporation of NMT programs into daily practice sessions.Purpose: We sought to evaluate changes in knowledge and behavior among high school sports coaches who completed an NMT-based injury prevention training program.Methods: High school sports coaches were invited to complete a free online training course in incorporating NMT into daily practice sessions. Anonymized surveys were administered before and after education and at 3 months to evaluate knowledge level and program effectiveness.Results: Of the 13,640 coaches who enrolled in the training course in 2019, 1641 submitted pre- and post-education and 3-month follow-up surveys. Prior to training, 4.4% reported incorporating NMT into daily training sessions and the mean knowledge score was 1.89 +/- 1.55. After training, 92.7% of participants reported that they intended to incorporate NMT into their daily training sessions and the mean knowledge score was 4.87 +/- 1.11. At 3-month follow-up, 88.9% of participants reported incorporating NMT into daily training sessions. A chi-square test revealed a significant association between pre- and post-education incorporation of NMT into daily practice sessions, and a multiple regression analysis resulted in a significant model with intent to incorporate NMT into daily practice sessions identified as a significant behavior predictor.Conclusion: These survey results show that completion of a training course significantly improved ACL injury prevention knowledge among a cohort of high school sports coaches and likely contributed to the sustained incorporation of NMT into their daily practice sessions.