Primary prevention of musculoskeletal sports injuries in Physical Education Teacher Education students

Sports injuries occur frequently to physical education teacher education (PETE) students. Sports injuries in PETE students imply potential health consequences and a potential long-term impact on the future professional career. Hence, sports injuries are highly disadvantageous for PETE students. Regarding the considerable incidence of sports injuries in PETE students and the diverse gamma of negative consequences these bring along, the development of an intervention for the prevention of sports injuries in PETE students is at issue. Therefore, in this dissertation a research project for sports injury prevention in PETE students following the TRIPP (Translating Research into Injury Prevention Practice) framework has been described. The main objective in this research project was to formulate evidence-based guidelines for structured prevention of musculoskeletal sports injuries in PETE students in Flanders. Separate study aims were to describe the problem and identify risk factors for musculoskeletal sports injuries in PETE students in Flanders, to develop a PETE population-specific preventive intervention based on the latter and a systematic review, to test the efficacy of the intervention in terms of injury incidence reductions and to process-evaluate the intervention through a broader implementation. In study one, first year bachelor PETE students in Flanders were found to be more prone to sports injuries than the general sports-active population in Flanders. Most injuries in PETE students involved the lower extremities, mainly the lower leg, knee and ankle. The majority of injuries were acute, first-time injuries and took place in non-contact situations. The severity of these injuries was considerable. A large proportion of these injuries occurred during the intracurricular sports classes but also a significant proportion occurred during unsupervised practice sessions. PETE students were more prone to injuries during the first weeks of each semester. Previous injury was a significant risk factor for having a subsequent injury. In study two, lower maximum eccentric hamstring strength and a lower score on the single leg hop for distance test were found to be significant risk factors for a hamstring injury. A systematic literature review revealed that warm-up, stretching, dynamic stabilization of the lower limbs, functional strength training, core stability training and injury awareness including technical training for correct performance are efficacious prevention strategies that are probably transferable to the context of PETE students. A combination of the latter elements in a multifactorial injury prevention program has the best opportunities to result in injury incidence reductions. In study three, relying on the latter results, a multifactorial sports injury prevention program No Gain With Pain (NGWP), existing of an awareness program and the implementation in the sports lessons of preventive strategies, was developed and embedded into a PETE program during one academic year. The PETE sports lecturers indicated a high implementation of the preventive strategies in the sports lessons. Students in the intervention group had a trend to significantly lower incidence rate than students in the control group, and a significant reduction was observed for injuries during unsupervised practice sessions. Students in the intervention group had significantly less acute, first-time and extracurricular injuries. In study four, a process evaluation of NGWP was performed in a randomized trial design and using the RE-AIM SSM (Reach-Effectiveness-Adoption-Implementation-Maintenance) framework as evaluation tool. The intervention seemed feasible to a large extent, but implementation of the awareness program by the curriculum managers was rather low. Some trends to effectiveness were found for self-reported behavior in sports lecturers and students, and a significant increase in knowledge was found in students, despite a very limited researcher delivered intervention. In conclusion, an intervention based on a general and non-individualized approach complemented with PETE-specific elements seemed feasible to a large extent and efficacious for the prevention of sports injuries in PETE students. Nevertheless, some improvements can be made to NGWP in order to enhance both efficacy and feasibility in PETE students. It is now time to start implementing injury prevention as an inherent aspect of standard PETE programs. Based on the results of the current findings, great hopes can be fostered that injury incidence in PETE students will diminish over time.