# Can neuromuscular or proprioceptive warm-up programmes prevent young basketball players from lower limb injuries?

> Students’ learning task for the BIP course on the topic of sport.

## Background: Evidence-Based Physical Therapy (EBP)
Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. In week 43 of 2024, a Blended Intensive Program (BIP) was held at Charles University in the Czech Republic regarding EBP. The program featured welcome words from the president of The European Network of Physiotherapy in Higher Education (ENPHE) and covered the foundations of EBP, highlighting challenges across different physical therapy fields.

Over 43 physiotherapy students and 8 teachers from five universities participated:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University Prague, Czech Republic
* Universidad Europea de Madrid, Spain
* CEERRF, France

Students collaborated on articles covering Evidence-Based practice in sport, prevention, injuries, neurological diseases, respiratory diseases, cardiovascular diseases, and care for children and older adults.

## Neuromuscular Training (NMT) in Basketball
Neuromuscular training (NMT) programs consist of aerobic, balance, strength, and agility exercises, typically lasting 10–15 minutes. Originally developed to reduce non-contact lower extremity injuries, these programs have been shown to reduce injury rates by up to 60% compared to standard warm-ups (Lutz et al. 2024).

## Objective and Methodology
The objective of this review was to determine if neuromuscular or proprioceptive warm-up programs reduce the frequency of lower limb injuries in basketball players aged 11 to 25.

A systematic review was conducted using PubMed and PEDro. The search focused on terms including “sports,” “injury,” “training,” “warm-up,” “lower limb injuries,” and “basketball players,” with a filter for “Randomized Controlled Trials.”

**Inclusion Criteria:**
* Randomized controlled trials.
* Intervention based on a neuromuscular warm-up program.
* Participants aged 11 to 25 (non-elite).

**Exclusion Criteria:**
1. Intervention did not align with the definition of neuromuscular training.
2. Study published before 2004.
3. Participants over 25 years old.
4. Participants were not basketball players.
5. Injury prevention was not measured.
6. Study was not a Randomized Controlled Trial.

## Results and Discussion
After screening 104 articles, six studies were included in the final analysis:
* Emery et al. 2022
* Foss et al. 2018
* LaBella et al. 2011
* Lim et al. 2009
* Stojanović et al. 2022
* Eils et al. 2010

The analysis indicates that implementing a neuromuscular warm-up for young basketball players effectively helps prevent lower limb injuries. Five studies showed positive results, while one showed neither positive nor negative outcomes. Evidence suggests that the effectiveness of these programs may be reduced if participants practice alone at home rather than under supervision.

## Authors
* **Natálie Hvězdová**, physiotherapy student, Charles University, Czech Republic
* **Markéta Řehoušková**, physiotherapy student, Charles University, Czech Republic
* **Julie Baštová**, physiotherapy student, Charles University, Czech Republic
* **Vero Guerra Fandiño**, physiotherapy student, University of A Coruña, Spain
* **Élodie Samson**, physiotherapy student, CEERRF, France
* **Alejandro Ramón**, physiotherapy student, Universidad Europea de Madrid, Spain
* **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
* **Marja Äijö**, PT, PhD Principal Lecturer of gerontology and rehabilitation. Savonia, University of Applied Sciences, Kuopio, Finland
* **Veronica Robles García**, PhD. PT. OT. Lecturers at University of A Coruña, A Coruña, Spain
* **Lorena Canosa Carro**, PT, MSc, PhD. Lecturer at Universidad Europea de Madrid, Spain
* **Adrien Pallot**, PT, MSc, Lecturer at CEERRF, France
* **Ivana Vláčilová**, Physiotherapist, PhD. Charles University, Czech Republic
* **Beatriz Martínez Toledo**, PT. Lecturer at University of A Coruña, A Coruña, Spain.
* **Montserrat Fernández Pereira**, PT, Lecturer at University of A Coruña, A Coruña, A Coruña, Spain.

## References
* Lutz, D., Van Den Berg, C., Räisänen, A. M., Shill, I. J., Kim, J., Vaandering, K., Hayden, A., Pasanen, K., Schneider, K. J., Emery, C. A., & Owoeye, O. B. A. (2024). Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review. British Journal Of Sports Medicine, bjsports-106906. https://doi.org/10.1136/bjsports-2023-106906
* Emery, C. A., Owoeye, O. B., Räisänen, A. M., Befus, K., Hubkarao, T., Palacios-Derflingher, L., & Pasanen, K. (2022). The “SHRed Injuries Basketball” Neuromuscular Training Warm-up Program Reduces Ankle and Knee Injury Rates by 36% in Youth Basketball. Journal Of Orthopaedic And Sports Physical Therapy, 52(1), 40-48. https://doi.org/10.2519/jospt.2022.10959
* Foss, K. D. B., Thomas, S., Khoury, J. C., Myer, G. D., & Hewett, T. E. (2018). A School-Based Neuromuscular Training Program and Sport-Related Injury Incidence: A Prospective Randomized Controlled Clinical Trial. Journal Of Athletic Training, 53(1), 20-28. https://doi.org/10.4085/1062-6050-173-16
* LaBella, C. R., Huxford, M. R., Grissom, J., Kim, K., Peng, J., & Christoffel, K. K. (2011). Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools. Archives Of Pediatrics And Adolescent Medicine, 165(11), 1033. https://doi.org/10.1001/archpediatrics.2011.168
* Lim, B., Lee, Y. S., Kim, J. G., An, K. O., Yoo, J., & Kwon, Y. H. (2009). Effects of Sports Injury Prevention Training on the Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Players. The American Journal Of Sports Medicine, 37(9), 1728-1734. https://doi.org/10.1177/0363546509334220
* Eils, E., Schröter, R., Schröder, M., Gerss, J., & Rosenbaum, D. (2010). Multistation Proprioceptive Exercise Program Prevents Ankle Injuries in Basketball. Medicine & Science In Sports & Exercise, 42(11), 2098-2105. https://doi.org/10.1249/mss.0b013e3181e03667
* Stojanović, E., Scanlan, A. T., Radovanović, D., Jakovljević, V., & Faude, O. (2022). A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial. The Physician And Sportsmedicine, 51(5), 463-471. https://doi.org/10.1080/00913847.2022.2133978