Insoles, External Joint Supports, and Multi-Intervention Training Programs Reduce Sports Injuries

Question: What are the effects of interventions designed to prevent sports injuries? Data sources: MEDLINE, PubMed, the Cochrane Central Register of Controlled Trials, SPORTDiscus, CINAHL, PEDro (to 2005), personal files, and reference lists of retrieved articles and relevant reviews. Selection criteria: Randomized or quasirandomized controlled studies were selected if they evaluated the effects of any preventive intervention on sports injuries, were fully published in peer-reviewed journals before January 1, 2006, reported injury rates, and described explicitly the intervention protocol and outcome measures. Thirty-two studies (24,931 participants) met the selection criteria. The quality of study methods was assessed with use of an 11-point scoring criteria (score range, 0 = low to 11 = high). Quality scores ranged from 1 to 8 points (mean 3.8 points). Main outcome measure: Injury. Main results: Insoles: 5 studies (6 comparisons, n = 2446) compared the use of custom-made or prefabricated insoles with the use of no insoles to reduce lower extremity injuries. Five of the 6 comparisons showed a benefit for insoles (odds ratio [OR] range, 0.10 to 0.70). One study (n = 874) compared different types of orthoses and found no difference among groups. External joint supports: Seven studies (n = 10,300) evaluated the use of external joint supports. Three of 4 studies showed that ankle orthoses or ankle stabilizers reduced injury (OR range, 0.16 to 0.60). One study of outside-the-boot braces showed no statistical difference between groups. In 1 study of prophylactic knee braces and 2 studies of wrist protectors, the use of supports reduced injury (OR range, 0.12 to 0.43). Training programs; balance board: Two of 4 studies (n = 1799) showed a benefit for balance-board training programs (OR range, 0.16 to 0.24), whereas 2 studies showed a nonsignificant increase in injuries with balance-board training. Training programs; multi-interventions with balance board: Two studies (n = 400) showed that multi-interventions that included the use of balance-board training reduced injuries (OR range, 0.20 to 0.29). Training programs; other multi-interventions: Four studies (n = 2409) showed that multi-intervention programs that included exercise and rehabilitation (without balance-board training) reduced injuries (OR range, 0.18 to 0.53; 1 study did not report data for calculating an OR). Stretching and warm-up programs: Three studies (n = 3052) showed that stretching and warm-up exercises did not reduce injuries. Mouth guards: One of 2 studies (n = 947) showed that custom-made mouth guards reduced head and/ or facial injuries (relative risk 0.56, 95% confidence interval 0.32 to 0.97). Modified shoes: Three studies (n = 1402) showed that modified basketball shoes did not prevent injury. Videos: Of 2 studies (n = 1034), 1 showed that an instructional ski video reduced sports injuries. In the other study, a video-based awareness program did not reduce sports injuries. Conclusion: The use of insoles, external joint supports, and multi-intervention training programs can reduce sports injuries. Stretching and warm-up programs and modified shoes did not reduce injuries. The evidence was mixed for balance-board training programs, mouth guards, and videos.