Research - Structured Warm-ups prevent 50% of all acute knee/ankle injuries

[illiniphase4]

Wasn't sure if I should post this article here or in the young athlete development forum.

According to a recent study conducted by Norwegian University of Sport and Physical Education, structured warm-ups were clinically effective at preventing knee and ankle injuries to youth athletes independent of gender or ability level. The study followed over 1800 handball youth athletes over the course of a competitive season. The 1800 athletes were divided into groups, with approximately half of the athletes participating in structured warm-ups, while the other half of the athletes participated in their standard sports training programs. Out of 1800 athletes, 129 acute injuries occurred; 91 of those athletes did not participate in a structured warm up, compared to only 48 acute injuries sustained in the group that did participate in a structured warm-up. This means that the structured warm-up was clinically effective at preventing nearly 50% of all acute injuries. The structured warm-up utilized in the study consisted of exercises that specifically targeted dynamic movement, balance, sport-specific technique, and strength and power.

The study can be found here: .

 

[Karky]

If this is what I think it is, then I've seen it performed and I have it on video (the program) and it's really more like an exercise session than a warm up since it lasts like 20-30 min. So I'd say the study isn't really about the effects warming up, but the effect of an exercise program with corrective exercises.

I'm not saying it's a bad study or anything, and I think it's awesome that they have done research on how to reduce injuries in sports! However, you can't separate the effect of warming up from the effects of the corrective exercises in the program.

The coaches were asked to use the programme at the beginning of every training session for 15 consecutive sessions and then once a week during the remainder of the season.

they didn't even do it before every session after the first 15 sessions..
I just don't get why they throw out the word "warm up".. I hope people aren't gonna use this study to justify warming up versus not warming up as I bet the effects from this program would be pretty much the same if it was done before the regular training or on a separate occasion.

 

[flyinfree]

i agree with Karky


and I will say-

25 jumping jacks, 10 pushups, 10 body weight squats, a couple toe touches and you're good to go. - depending on whther you are lifting that day, or in a cardio focus day. AND, whether you are trying to perform (compete) or train.

static stretching is best done post workout, or as an event of it's own.

Dynamic stretching is another topic all together. Such as Plyometrics.

I should stop talking now, because I am NOT WILLING to take the time to explain myself.

FF

 

[illiniphase4]

If this is what I think it is, then I've seen it performed and I have it on video (the program) and it's really more like an exercise session than a warm up since it lasts like 20-30 min. So I'd say the study isn't really about the effects warming up, but the effect of an exercise program with corrective exercises.

I think the "warm-up" actually only lasts about 11-12 minutes, based on the information provided in Box 2. I wouldn't necessarily not call it a warm up, as it does address specific dynamic movements that are often utilized in a dynamic warm-up. I would also not call the exercises "corrective." There certainly isn't any evidence from the research that would lead us to believe that there were specific neuromuscular deficiencies present, especially given the fact that there were a variety of ability levels in both the control and test groups. It is true that part of the "warm-up" consists of sport-specific exercises that are more akin to what you'd find in Nike's SPARQ training program, particularly the technique/strength and power sections of Box 2. But the study supports their inclusion into an overall training program.

they didn't even do it before every session after the first 15 sessions..
I just don't get why they throw out the word "warm up".. I hope people aren't gonna use this study to justify warming up versus not warming up as I bet the effects from this program would be pretty much the same if it was done before the regular training or on a separate occasion.

Not sure at what you're getting at here. If anything, the study supports some sort of dynamic movement warm-ups in order to prevent injury. Warm-up certainly doesn't have to be the typical 5-minute bout of cardio, which is particularly helpful in a sport setting where practice time is limited. The fact that they didn't do a structured warm-up during every session only strengthens the fact that even in limited quantity, the "warm-ups" were clinically significant at preventing 50% of injuries. It might be that the athletes were still warm-ing up before the other practice sessions, just not using the structured program. That's not bad thing, because it allows coaches to utilize the structured programs more occassionally while focusing more on mid-season issues, making it more likely that the structured program could be more easily implemented.

 

[flyinfree]

o totally do not blame you for ignoring me

 

[illiniphase4]

i agree with Karky


and I will say-

25 jumping jacks, 10 pushups, 10 body weight squats, a couple toe touches and you're good to go. - depending on whther you are lifting that day, or in a cardio focus day. AND, whether you are trying to perform (compete) or train.

static stretching is best done post workout, or as an event of it's own.

Dynamic stretching is another topic all together. Such as Plyometrics.

I should stop talking now, because I am NOT WILLING to take the time to explain myself.

FF

Not sure where you're going with this. Did you read the study? It's directed towards sport activities with a high occurance of acute knee and ankle injury, not the typical exerciser.

And dynamic stretching and plyometric exercises are very different activities. Plyometrics are dynamic power training exercises. Dynamic stretch consists of ballistic stretches, and dynamic movements that aid in stretching muscle tissue.

 

[Karky]

but was it because of the warm up or because of the adaptations associated with the exercises? For example, they strengthened their hams with the nordic hams. They also focused a lot on keeping their knees over their toes, which is important to prevent ACL injuries. That study simply provides no way of telling if it was the warming up effect of the program or the adaptations provided by the exercises in the program that makes up for the decreased injury risk.

They also state this for the nordic hams:

The programme also included a strength exercise, the "Nordic hamstring lower" exercise, which has been shown to be effective in improving eccentric hamstring muscle strength among adult male soccer players.21 Since the hamstrings can act as agonists to the anterior cruciate ligament during stop and jump tasks,20 22 23 it is possible that stronger hamstring muscles can prevent injuries to the ligament, but this theory has never been tested.

granted it has not been tested, but theoretically it is plausible that stronger hamstrings can reduce the risk of injury.
They also focused on landing on both feet instead of one after jumps.

And I think the program would last 14 min based on box 2. Which is shorter than they said in the video presenting what I believe to be this program, but the vid might have been modified and doesn't have to be exactly the same as that used in this study.
They do say this in the paper, though:

They were instructed to spend 4-5 minutes on each exercise group for a total duration of 15-20 minutes.

Anyways, the length of the program isn't really that important, but I think my other points are.

Again, I think it's great that they are focusing on reducing injuries, but you can't ascribe the reduced risk to being warm before training. To do that you'd have to have another group that does the program separately from their regular training. I don't know if the purpose of this study was to examine the effect of being warm before starting to exercise, but I doubt it, given the fact that they chose very specific exercises aimed at developing for example a "default" knees over toes position.
Also, the program involves progression, which pretty much means that it is designed for inducing training adaptations, and not just for getting warm before practice or games.

All I'm saying is that you can't separate the "being warm before practice" effects on injuries from the effects of the technique training (with regards to knees over toes in cutting and landing movements) and strength adaptations.

Also, in case I'm coming across as arguing against warming up, I'm not. I'm just saying that this particular study can't say anything about the warming up effect itself.

 

[illiniphase4]

Again, I think it's great that they are focusing on reducing injuries, but you can't ascribe the reduced risk to being warm before training.

They never specifically state that the goal was to associate being warm before training with preventing injury. Instead they say that the inclusion of structured "warm-up" exercises is shown to prevent injury. It's possible that the term "warm-up" is viewed differently in Norway, in that it contains exercises that we would not typically consider to be part of a traditional warm-up.

Also, in case I'm coming across as arguing against warming up, I'm not. I'm just saying that this particular study can't say anything about the warming up effect itself.

I know that you're not trying to knock on warm-ups. If anything, I think they use the term in order to differentiate the dynamic (warm-up) movements and plyometrics from the rest of the typical practice regiment, highlighting the fact that having the sport-specific movement, technique, balance, and plyometric exercises included as part of a practice regiment is clinically proven to prevent acute knee/ankle injury. I agree with you that they could have called it something else, but probably didn't because it was done at the beginning of the practice session, and included a dynamic movement portion which can be considered part of a traditional warm-up.

 

[Karky]

yeah, I see what you're saying.

When I think warm up I think just doing something to get warm before training. What they did here is something I'd call "prehab" or something like that.

But regardless if people read the study they shouldn't misinterpret it like I'm afraid they will.. but most people only read the headline about warm up and injury.. maybe even the abstract. I can just see this being brought up in future discussions about the actual effect of being warm before training.

 

[illiniphase4]

yeah, I see what you're saying.

When I think warm up I think just doing something to get warm before training. What they did here is something I'd call "prehab" or something like that.

But regardless if people read the study they shouldn't misinterpret it like I'm afraid they will.. but most people only read the headline about warm up and injury.. maybe even the abstract. I can just see this being brought up in future discussions about the actual effect of being warm before training.

I can see the confusion there. I didn't even think about it like that, mostly because I originally learned the term "warm-up" when I was 5 playing ice hockey and it consisted of drills and exercises just before practice. Definitely a little bit of a conflict depending on how you interpret the term.

 

[malkelly]

I'd agree with Karky on this one..
it does seem more like a preventative program than a warm up. I think it's important to use some form of injury prevention aimed at the supporting structures which are frequently placed under tremendous stress during sports. This is an area which is often overlooked when designing sports training programs.

While developing a periodized plan for a soccer midfielder, i came across a dutch study on preventing ankle sprain recurrence through structured, though unsupervised, use of balance boards. Though they focused on the financial side of things, it's still useful info
-- i don't have enough posts yet to put in the link but you can find it by googling:
The 2BFit study: is an unsupervised proprioceptive balance board training programme, given in addition to usual care, effective in preventing ankle sprain recurrences?
i found it on biomedcentral.com
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>>FlyinFree
As pointed out, Plyometrics isn't a form of dynamic stretching, its a method of transferring gains in strength into power (which is a combination of strength and speed). Plyometrics is very hard on the body, and really shouldn't be done in every training session, assuming 3 sessions a week.
hope this helps.

Mal