Question: Is a neuromuscular training program useful in preventing non-contact leg injuries in female floorball players? Design: Cluster randomised controlled trial. Setting: Twenty-eight elite level female floorball (indoor hockey) teams in Finland. Participants: 457 players (mean age: 24 years) without major injury at commencement of the study. Players in both groups were comparable at baseline with respect to age, body mass index, playing experience and number of previous injuries, operations or pre-season training volume. Interventions: The neuromuscular training program aimed to enhance players' sports-specific motor skills and body control, and consisted of four components: running techniques, balance and body control, plyometrics, and strengthening exercises. In addition, players who had difficulties with control of the lower back or limited flexibility did stretching exercises. Training was provided by the team's coach, physiotherapist, or a player who had been educated in the intervention. Equipment included balance boards, balance pads, medicine balls, exercise diaries, and instruction booklets. Training sessions of 20-30 minutes were carried out throughout the 6-month floorball season. Training was divided into four periods during the floorball season: two intensive periods, training 2-3 times per week at the start of the season and during the mid-season break, and two maintenance periods, training once per week during the competitive season. The control group participated in their usual training program. Outcomes: The primary outcome was the incidence of acute non-contact injuries of the legs. An acute injury was defined as an injury occurring during practice or competition, preventing the player from participating in a game or practice session for 24 hours. Results: During the season, 72 acute non-contact injuries occurred, 20 in the intervention group and 52 in the control group. The risk of injury was 66% lower in the intervention group (adjusted incidence rate ratio: 0.34; 95% CI 0.20 to 0.57). The greatest effect was on ankle ligament injuries: 27 ankle ligament injuries occurred in the control group and only 8 in the intervention group (adjusted incidence rate ratio: 0.28; 95% CI 0.12 to 0.67). Teams with high compliance and adherence to the neuromuscular training program had a greater reduction in overall injury risk, compared with the control group (adjusted incidence rate ratio: 0.19; 95% CI 0.06 to 0.64). Conclusion: Neuromuscular training in female floorball players has a large effect in reducing the incidence of acute non-contact leg injuries, which are common in this sport.
