Specialized training decreases injuries in elite athletes

Clinical Question

Can a specific warm-up exercise program decrease injuries in elite athletes?

Bottom Line

Injuries can be reduced by incorporating exercises specifically aimed at improving proprioception, strength, and balance. A 30-minute exercise program, performed 2 to 3 times per week, reduced the number of noncontact leg injuries by 66% (LOE = 1b)


Pasanen K, Parkkari J, Pasanen M, et al. Neuromuscular training and the risk of leg injuries in female floorball players: cluster randomised controlled study. BMJ 2008;337:a295.  [PMID:18595903]

Study Design

Randomized controlled trial (nonblinded)






Outpatient (primary care)


Neuromuscular training is an approach to preventing injuries by enhancing motor skills and body control while providing training for specific moves of a particular sport, especially moves that involve sudden turns or stops. These researchers developed a 30-minute training program to be performed before beginning regular practice. The researchers evaluated its effectiveness in 457 top-level female floorball players in Finland. (Floorball is hockey played indoors on a regular gymnasium surface.) The athletes were randomized (concealed allocation) by team to receive the specific training or no intervention. One or 2 team members were educated in the exercise program and were provided an instruction booklet, balance boards, balance pads, and other materials. The 30-minute program consisted of 5 minutes to 7 minutes of running exercise, balance and body control exercises, plyometrics (jumping, hopping, and other explosive movements), core and lower limb strengthening exercises, and stretching. The exercises were performed 2 to 3 times per week before the season and during a break, and once weekly during the season. After adjusting for the number of scheduled hours of training and play, there were significantly fewer noncontact injuries, defined as an injury requiring at least 1 day missed of practice or play, in the trained group: 20 in the trained group versus 52 in the control group (P <.001). This difference remained when all injuries were considered. Similar effectiveness has been shown in adolescents who play handball (BMJ 2005; 330:449-52).