Ball sports such as football, handball, and basketball are popular forms of physical activity among children and adolescents. These sports involve movements such as rapid changes of direction, jumping, and landing, which can expose young athletes to lower limb injuries. Ankle and knee injuries are among the injuries reported in youth ball sports (Olsen et al. 2005; LaBella et al. 2011; Hilska et al. 2021). In addition, ankle sprains are common musculoskeletal injuries among athletes (McGuine & Keene 2006).

Preventing lower limb injuries is important, as sports injuries can lead to time away from training and competition. Previous injury may also increase the risk of sustaining another injury. For example, McGuine and Keene (2006) found that athletes with a previous ankle sprain had more than twice the risk of sustaining another ankle sprain compared with athletes without a previous ankle injury.

Exercise-based injury prevention can include balance, strength, and neuromuscular training, as well as exercises focusing on running, cutting, landing, and movement control. These exercises can be incorporated into regular warm-up routines and have been associated with a reduced risk of lower limb injuries in young athletes (Olsen et al. 2005; LaBella et al. 2011; Owoeye et al. 2014; Hilska et al. 2021). Balance training alone has also been shown to reduce the risk of ankle sprains among high school athletes (McGuine & Keene 2006).

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.

This blog article is based on a mini literature review conducted by our group, in which we examined the effects of exercise-based interventions on the prevention of lower limb injuries in youth ball-sport athletes. The aim of this blog article is to provide evidence-based information on how exercise-based interventions can help prevent lower limb injuries among young ball-sport athletes.

Methods

The studies included in the review were retrieved from the PubMed database. The literature search was structured using the PICO framework. In this review, the population (P) consisted of youth ball-sport athletes, the intervention (I) was exercise-based injury prevention, the comparison (C) was usual training or warm-up, and the outcome (O) was the incidence of lower limb injuries. Based on the PICO framework, the research question was: Does exercise-based injury prevention reduce the incidence of lower limb injuries in youth ball-sport athletes compared with usual training or warm-up? Search terms used in PubMed included lower limb injuries, injury prevention, youth athletes, ball sports, exercise, neuromuscular training, and balance training.

The inclusion criteria were randomized controlled trials (RCTs), youth athletes participating in ball sports, exercise-based injury prevention interventions, and studies reporting injury-related outcomes. Studies were excluded if they involved adult athletes, were not related to ball sports, did not include an exercise-based injury prevention intervention, did not report injury outcomes, or were not randomized controlled trials. The PubMed search identified 9 articles in total. After screening the articles according to the inclusion and exclusion criteria, five studies were selected for the mini literature review.

The methodological quality of the selected studies was assessed using the PEDro Scale. The PEDro Scale consists of 11 assessment criteria, 10 of which contribute to the total score. The scale assesses methodological aspects such as random allocation, baseline comparability between groups, blinding, follow-up, between-group statistical comparisons, and reporting of point estimates and variability (PEDro 2026).

Results

Overall, the five selected studies examined balance training, neuromuscular training, and structured warm-up programmes for preventing lower limb injuries in youth ball-sport athletes. Despite differences in sports, age groups, and interventions, the findings generally supported the use of exercise-based injury prevention. Positive effects were reported particularly for ankle and knee injuries and non-contact lower limb injuries (McGuine & Keene 2006; Olsen et al. 2005; LaBella et al. 2011; Owoeye et al. 2014; Hilska et al. 2021). The studies received PEDro scores ranging from 6 to 8 out of 10.

McGuine and Keene (2006) found that ankle sprains occurred less frequently among young athletes who participated in balance training than among those in the control group (6.1% vs. 9.9%). Similarly, Olsen et al. (2005) found that a structured warm-up programme reduced knee and ankle injuries among young handball players, with injuries occurring in 4.8% of players in the intervention group compared with 8.6% in the control group. Their programme included balance and strength training as well as running, cutting, and landing exercises.

Neuromuscular warm-up programmes also showed positive results. LaBella et al. (2011) reported fewer non-contact lower limb injuries among young female football and basketball athletes who participated in a neuromuscular warm-up programme. Similarly, Hilska et al. (2021) found that neuromuscular warm-up training reduced acute non-contact lower limb injuries in children’s football.

Owoeye et al. (2014) examined the FIFA 11+ warm-up programme among male youth football players and found a reduction in lower limb injuries. Taken together, the findings indicate that regularly performed exercise-based injury prevention programmes, particularly those including balance and neuromuscular exercises, may reduce the risk of lower limb injuries among youth ball-sport athletes.

Conclusions

Based on the mini literature review, exercise-based injury prevention appears to be an effective approach for reducing lower limb injuries in youth ball-sport athletes. The studies suggest that balance training, neuromuscular training, and structured warm-up programmes can reduce the risk of ankle, knee, and other lower limb injuries. For example, balance training was associated with a lower occurrence of ankle sprains in young athletes (McGuine & Keene 2006), while structured warm-up programmes combining balance, strength, and movement-control exercises reduced knee and ankle injuries in youth handball players (Olsen et al. 2005).

Similar findings were reported for neuromuscular warm-up programmes. LaBella et al. (2011) found a reduction in non-contact lower limb injuries among young female football and basketball players, while Hilska et al. (2021) reported fewer acute non-contact lower extremity injuries among children participating in football. In addition, the FIFA 11+ programme was shown to reduce lower limb injuries among male youth football players (Owoeye et al. 2014). Together, these findings suggest that injury-prevention exercises do not necessarily need to be separate from regular sports training but can be incorporated into warm-up routines.

From a physiotherapy perspective, these findings are relevant because physiotherapists can support coaches and young athletes in selecting and implementing appropriate injury-prevention exercises. Particular attention can be given to balance, strength, neuromuscular control, and movement techniques such as landing and changing direction. Regular implementation may help reduce injuries and consequently decrease injury-related absence from training and competition.

However, the results should be interpreted with some caution. The studies included athletes of different ages and sports and used different exercise programmes, which makes direct comparison between the studies difficult. Although the overall findings support exercise-based injury prevention, further research is needed to determine which types of exercises, programme duration, and training frequency are most effective for different groups of young ball-sport athletes.

References

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. Orthopaedic Journal of Sports Medicine 9(4), 23259671211005769. https://journals.sagepub.com/doi/10.1177/23259671211005769. Accessed 30.9.2026.

LaBella, C. R., Huxford, M. R., Grissom, J., Kim, K-Y., Peng, J. & Christoffel, K. K. 2011. Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: Cluster randomized controlled trial. Archives of Pediatrics & Adolescent Medicine 165(11), 1033–1040. https://doi.org/10.1001/archpediatrics.2011.168. Accessed 30.9.2026

McGuine, T. A. & Keene, J. S. 2006. The effect of a balance training program on the risk of ankle sprains in high school athletes. The American Journal of Sports Medicine 34(7), 1103–1111. https://doi.org/10.1177/0363546505284191. Accessed 28.9.2026.

Olsen, O-E., Myklebust, G., Engebretsen, L., Holme, I. & Bahr, R. 2005. Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ 330(7489), 449. https://doi.org/10.1136/bmj.38330.632801.8F. Accessed 28.9.2026

Owoeye, O. B. A., Akinbo, S. R. A., Tella, B. A. & Olawale, O. A. 2014. Efficacy of the FIFA 11+ Warm-Up Programme in Male Youth Football: A Cluster Randomised Controlled Trial. Journal of Sports Science and Medicine 13(2), 321–328. https://www.jssm.org/volume13/iss2/cap/jssm-13-321.pdf. Accessed 30.9.2026

PEDro. 2026. PEDro scale. Physiotherapy Evidence Database. https://pedro.org.au/english/resources/pedro-scale/. Accessed 2.10.2026.

Artificial intelligence was used to support text organization and the search for relevant source materials.

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Authors

Jasmina Kuhanen, Physiotherapy student, Savonia University of Applied Sciences

Elisa Sairanen, Physiotherapy student, Savonia University of Applied Sciences

Lasse Mäkelä, Physiotherapy student, Savonia University of Applied Sciences

Cristian Petre, Physiotherapy student, Savonia University of Applied Sciences

Juho Pyykönen, Physiotherapy student, Savonia University of Applied Sciences

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

This article was prepared with the help of AI.