Football is popular form of exercise among children and adolescents. Although regular physical activity has many health benefits, football also involves a risk of injury. Running, jumping, sudden changes of direction and physical contact place considerable demands on the body. Lower extremity injuries are particularly common among young football players (Robles-Palazón et al., 2022). Injuries can also interrupt training and competition and affect future participation in physical activity (Emery et al., 2015).

From a physiotherapy perspective one of the possible ways to prevent lower extremity injuries in football is including neuromuscular training in their training program. Neuromuscular training is a combination of training that includes muscular strength-, balance-, coordination, movement control and agility. Neuromuscular training can be included into team´s usually performed warm-up programme in which case arrangements can be easily done. (Hilska et al., 2021; Walden et al., 2012)

The topic is important to discuss and bring to the daylight because effective injury prevention of young athletes’ lower extremity injuries may reduce the rate of absence in training and competition. Effective injury prevention strategies may support safe participation and continuous activity in hobbies. (Emery et al., 2015) For example there are previous research which have been showing promising results in adolescent players reducing knee injuries with neuromuscular training (Walden et al., 2012).

This article was prepared within the Professional in Physiotherapy course included in the physiotherapy degree programme. The article represents students’ work completed as part of the evidence-based physiotherapy component of the course. During the course, students work collaboratively in small groups to practice the key stages of a systematic review process by conducting a mini review. This includes systematic literature searching, critical appraisal using the PEDro scale, data synthesis, and reporting the findings in the form of a scientific manuscript (PEDro, n.d.).

Purpose of the mini review was to examine if there would be reduction in lower extremity injuries in children and adolescents when they were doing neuromuscular training compared to their usual training.

Methods

The aim of the mini literature review was to investigate the effects of neuromuscular training on prevention of lower extremity injuries in 9-17 -years old football players. The research question was structed by using the PICO framework. Population was 9-17-years old players. Intervention was neuromuscular warm-up or training programme. Comparison was to basic warm-up programme without neuromuscular training. Outcome was the prevention of lower extremity injuries. The studies were search from Pubmed database. The main search terms included neuromuscular training, injuries and adolescent soccer players. The search strategy combined terms related to children and adolescents, soccer, football, injury prevention, neuromuscular training, warm-up and lower extremity injuries.

Five studies were included: Waldén et al. (2012), Soligard et al. (2008), Zebis et al. (2016), Hilska et al. (2021) and Hammami et al. (2025). Their methodological quality was considered using PEDro Scale scores ranging from 0 to 10, where higher scores indicate better methodological quality (PEDro, n.d.). Chosen studies were selected based on their titles and abstracts. Studies were considered if they met the inclusion criteria, including adolescent soccer players, neuromuscular training and injury prevention.

Results

The review included five studies investigating the effects of neuromuscular and injury-prevention training programmes in young football players (Waldén et al., 2012; Soligard et al., 2008; Zebis et al., 2015; Hilska et al., 2021; Hammami et al., 2025). Although the studies differed in their participants, training protocols, and outcome measures, all examined whether incorporating structured exercises into the warm-up could improve injury prevention, neuromuscular control, physical performance, or mental well-being.

Waldén et al. (2012) conducted a cluster-randomised controlled trial involving 4,564 female football players aged 12–17 years. The intervention group performed a 15-minute neuromuscular warm-up programme twice per week throughout the competitive season. The programme focused on core stability, balance, and correct knee alignment. In contrast, the control group was instructed to continue their usual training and match routines without any changes. The intervention resulted in a significantly lower rate (64%) of anterior cruciate ligament (ACL) injuries compared with the control group. However, no statistically significant reductions were observed for severe knee injuries or all acute knee injuries. The study received a PEDro score of 7/10, indicating relatively good methodological quality. This strengthens confidence in the findings regarding the prevention of ACL injuries.

Soligard et al. (2008) investigated 1,892 female football players aged 13–17 years from 125 football clubs. The intervention group used a comprehensive warm-up programme designed to improve strength, awareness, and neuromuscular control during static and dynamic movements. The programme was performed as part of the teams regular training throughout the season. The control group continued with their usual training routines. The intervention group showed a lower overall injury risk, as well as significantly lower risks of overuse and severe injuries. Although the reduction in lower-extremity injuries did not reach statistical significance for the primary outcome, the findings supported the use of a structured warm-up programme for injury prevention in young female football players. The study received a PEDro score of 5/10, indicating moderate methodological quality. Therefore, the results should be interpreted with some caution.

Zebis et al. (2015) investigated 40 adolescent female football and handball players aged 15–16 years who were randomly allocated to either a neuromuscular training group or a control group. The neuromuscular training group performed an evidence-based injury-prevention programme as part of the warm-up three times per week for 12 weeks, added in to their usual training and match activities. The control group performed their regular warm-up programme. The researchers assessed neuromuscular and biomechanical factors associated with non-contact ACL injury, including muscle activation and knee movement during a side-cutting task. However, no significant between-group differences were found in the measured kinematic and kinetic variables. The study received a PEDro score of 8/10, indicating good methodological quality. The findings suggest that neuromuscular training may improve muscle activation patterns associated with ACL injury prevention.

Hilska et al. (2021) examined 1,403 youth football players aged 9–14 years from 20 Finnish football clubs. The intervention group replaced its standard warm-up with a neuromuscular training warm-up performed 2-3 times per week. The programme was implemented by the teams’ coaches and was designed to improve neuromuscular control and reduce injury risk. The control group continued to perform its standard warm-up. The overall incidence of acute lower-extremity injuries was not significantly different between the groups. However, the intervention was associated with a significant reduction in acute non-contact lower-extremity injuries, indicating that neuromuscular warm-up training may be particularly beneficial for preventing non-contact injuries in young football players. The study received a PEDro score of 8/10, indicating good methodological quality. Its findings provide relatively strong evidence for the effectiveness of neuromuscular warm-up training in preventing acute non-contact lower extremity injuries.

Hammami et al. (2025) investigated the effects of different warm-up approaches in highly trained pubertal male football players. The study compared three groups: a neuromuscular training group, a stretching training group, and a control group. The neuromuscular training group performed structured neuromuscular exercises during the warm-up, whereas the stretching group performed stretching-based exercises. The control group followed its usual training routine. The study assessed several measures of physical fitness and mental well-being. The results showed significant improvements in the neuromuscular training group across the measured physical fitness and mental well-being outcomes, whereas similar improvements were not observed in the stretching and control groups. These findings suggest that neuromuscular exercises incorporated into the warm-up may provide broader benefits than stretching-based warm-up activities for highly trained adolescent male football players. The study received a PEDro score of 8/10, indicating good methodological quality. However, the study focused on physical fitness and mental well-being rather than directly measuring injury incidence.

Conclusions

Based on our mini literature review, neuromuscular training (NMT) appears to be a promising method for preventing certain lower extremity injuries in young football players. The strongest findings were related to ACL injuries and acute non-contact lower extremity injuries (Waldén et al., 2012; Hilska et al., 2021). Other studies also showed benefits related to muscle activation, physical performance and overall injury prevention.

The PEDro scores ranged from 5/10 to 8/10, suggesting differences in methodological quality. Although most studies received relatively high scores, not all showed significant reductions in injury rates. The studies also differed in their participants, training programmes and measured outcomes, which makes direct comparisons difficult.

One of the main advantages of NMT is that it can be included in a team’s regular warm-up. Exercises focusing on strength, balance, coordination and movement control can be performed without separate training sessions. From a physiotherapy perspective, physiotherapists can support coaches and players by teaching correct techniques and adapting exercises to the athletes’ age and development.

Overall, NMT may be a useful part of injury prevention in youth football, although it cannot prevent every injury. More research is needed to understand its long-term effects and how training programmes should be adapted to different age groups and stages of the football season.

References

Emery, C., Roy, T., Whittaker, J., Nettel-Aguirre, A. & van Mechelen, W. (2015). Neuromuscular training injury prevention strategies in youth sport: A systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/26084526/. Referred 6.10.2026.

Hammami, A., Mahmoudi, A., Selmi, W., Negra, Y., Rebai, H., Granacher, U. & Hammami, R. (2025). Effects of neuromuscular versus plyometric training on physical fitness and mental well-being in male pubertal soccer players. https://pmc.ncbi.nlm.nih.gov/articles/PMC12689855/. Referred 6.10.2026.

Hilska, M., Leppänen, M., Vasankari, T., Aaltonen, S., Kannus, P., Parkkari, J., Steffen, K., Kujala, U. M., Konttinen, N., Räisänen, A. M. & Pasanen, K. (2021). Neuromuscular training warm-up prevents acute noncontact lower extremity injuries in children’s soccer: A cluster randomized controlled trial. https://pmc.ncbi.nlm.nih.gov/articles/PMC8822004/. Referred 7.10.2026.

OpenAI. (2026). ChatGPT . https://chatgpt.com/. Referred 12.10.2026.

PEDro. (n.d.). PEDro scale. PEDro – PEDro scale. Referred 10.9.2026.

Planet_fox. (n.d.). Ball, soccer, youth football. Pixabay. https://pixabay.com/photos/ball-soccer-youth-football-football-8048205/. Referred 8.10.2026.

Robles-Palazón, F., López-Valenciano, A., De Ste Croix, M., Oliver, J., García-Gómez, A., Sainz de Baranda, P. & Ayala, F. (2022). Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/34700052/. Referred 7.10.2026.

Savonia University of Applied Sciences. (2026). AI in courses: Student guidance [PDF]. https://www.savonia.fi/app/uploads/2026/09/AI_Audittrail_guidlines-for-students_082026_Final.pdf. Referred 12.10.2026.

Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., Junge, A., Dvorak, J., Bahr, R. & Andersen, T. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: Cluster randomised controlled trial. https://pmc.ncbi.nlm.nih.gov/articles/PMC2600961/. Referred 8.10.2026.

Waldén, M., Atroshi, I., Magnusson, H., Wagner, P. & Hägglund, M. (2012). Prevention of acute knee injuries in adolescent female football players: Cluster randomised controlled trial. https://pubmed.ncbi.nlm.nih.gov/22556050/. Referred 8.10.2026.

Zebis, M. K., Andersen, L. L., Brandt, M., Myklebust, G., Bencke, J., Lauridsen, H. B., Bandholm, T., Thorborg, K., Hölmich, P. & Aagaard, P. (2016). Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: A randomised controlled trial. https://pubmed.ncbi.nlm.nih.gov/26400955/. Referred 7.10.2026.

---

Authors

Anna-Sofia Kumpulainen, physiotherapy student, Savonia University of Applied Sciences

Milla Nissinen, physiotherapy student, Savonia University of Applied Sciences

Laura Mykkänen, physiotherapy student, Savonia University of Applied Sciences

Essi Hirvensalo, physiotherapy student, Savonia University of Applied Sciences

Oona Jäppinen, physiotherapy student, Savonia University of Applied Sciences

Marja Äijö PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences

Use of Artificial Intelligence

ChatGPT (OpenAI) was used to assist with finding relevant literature and to improve the language, structure and readability of this blog article. It was also used to help summarise and revise parts of the text. The literature review was based on the selected research articles, and the authors are responsible for checking the sources, interpreting the findings and approving the final content.