Injury Prevention in the Athlete: Investigation of the Efficacy and the Biomechanics of a Neuromuscular Training Program in Collegiate Soccer Player

Background.;Soccer related injuries are a relatively common occurrence across gender, age and level of competition. The impact of sports related injury is complex and far-reaching; inflicting potential long-term physical, emotional and financial consequences for the athlete to contend with long after their athletic career has finished.;Purpose.;The purpose of this body of work was to 1) evaluate the efficacy of the FIFA 11+ program in a randomized controlled trial, 2) identify how the FIFA 11+ program may impact the rate of anterior cruciate ligament injury, 3) identify how program compliance affects injury rate and overall soccer team performance, 4) and to analyze the kinetic and kinematic biomechanical changes associated with the utilization of the FIFA 11+ over a competitive season.;Methods.;A prospective randomized controlled trial was performed in NCAA male collegiate soccer players to analyze the efficacy of the FIFA 11+ program over the course a soccer season. Injury rate and time loss due to injury were analyzed and compared to a skill and age matched control group. Anterior cruciate ligament injury rates were specifically analyzed to determine if the FIFA 11+ program could effectively decrease the rate of ACL injury in soccer players.;A secondary analysis of the data was performed to analyze the role of team compliance on the overall effectiveness of the FIFA 11+ program. Compliance data from the intervention group was stratified into three tertiles (high, moderate and low) to analyze how the variability in compliance may impact overall injury rate. Overall team performance was also assessed. A record of each team's wins, losses and ties was recorded and analyzed based on the level of compliance.;A biomechanical analysis of kinetic and kinematic variables was conducted to analyze the biomechanical changes in female soccer players using the FIFA 11+ compared to a control group. Two functional tests were analyzed: a single leg squat and a single leg trip hop test. The subjects were analyzed at two time points; a pre-test analysis prior to the season and a post-test analysis at the culmination of the season.;Clinical Significance.;The information obtained in this dissertation supports the importance of the consistent implementation of injury prevention protocols in sport. The FIFA 11+ program has demonstrated its' ability to decrease injury rate, including ACL injury rate, and improve overall team performance. Compliance is a critical component to the overall impact of the program; teams utilizing the program more consistently demonstrated lower injury rates and more success with respect to team performance.;By prospectively analyzing changes in soccer specific movement patterns across the course of a competitive season in females, we are now able to more fully understand how the program is beneficial to the athlete with respect to injury reduction and how the program imparts' a protective benefit. The pre/post season analysis revealed favorable biomechanical changes in the hip, including increases in hip flexion angle, increase in hip extensor moment increases in hip abduction moment and decreases in hip internal rotation angle. This information will guide future researcher on how to optimize injury prevention efforts, improve the content and efficiency of therapeutic prevention interventions, and to potentially identify high-risk athletes prospectively prior to a deleterious injury occurring. If these methods are implemented with optimal compliance and consistency early in an athlete's career, the overall risk of injury may be significantly reduced and the long-term health and athletic career longevity may be extended through the later decades of life. Furthermore, the physical and financial longitudinal impact(s) of many sports related injuries may be significantly mitigated, thus improving overall quality of life of the athlete, extending well past the tenure of a collegiate athletic career.