An ounce of prevention . . .

University of Calgary researchers evaluate the economic impact of a youth neuromuscular training strategy on health-care costs.

By Leanne Yohemas
April 14, 2016

Sport is the leading cause of injury in youth, accounting for more than 30 per cent of all injuries. A new study by University of Calgary researchers published in the British Journal of Sports Medicine found that not only does a neuromuscular training warm-up program prevent injury in youth soccer, it also saves millions of dollars in health-care costs.

“Injuries in youth sport and recreation are a significant public burden in Alberta,” says the paper’s senior author, Carolyn Emery, PhD, of the Faculty of Kinesiology.

“There is the immediate impact of injury preventing youth from participating in the sport which they love and they are at risk of re-injury and long-term consequences of injury including early osteoarthritis, weight gain and depression,” she says.

This study, focusing on youth soccer, is the first to evaluate the cost-effectiveness of this type of injury prevention program, considering both the reduction in burden of injuries and the reduction in costs, says lead author Deborah Marshall, PhD, of the Cumming School of Medicine.

Training can reduce health-care costs by 43 per cent

More than 60 per cent of youth soccer injuries are lower extremity injuries. Of these, more than 60 per cent are ankle and knee injuries. The researchers studied male and female soccer players between ages 13 and 18.

One group participated in a neuromuscular training warm-up program, which included a variety of different exercises including aerobic, strength, agility, and balance components, as well as a home-based balance training regime. The other control group followed a standard practice warm-up routine that is most typical on the soccer fields across the country which includes aerobic and stretching components.

“We found that the neuromuscular training prevention group had a 38 per cent reduction in injury rate, and at the same time, health-care costs were reduced by 43 per cent. Projecting the results provincially, implementing a neuromuscular training prevention program would save $2.7 million in one season of soccer,” says Marshall.

The analysis included direct costs to the health-care system and out-of-pocket costs incurred by players and their families.

Costs calculated from Alberta Health Services Calgary Zone included health-care professionals, specific treatments, services, quantities of supplies, and equipment, for instance surgery, X-rays, scans and casts as well as fees for physiotherapy, athletic and massage therapy, chiropractic, splints, braces, crutches and tensors.

Goal: reduce the risk of injury by 20 per cent by 2020

“We have the solution to reduce the burden of injury in youth sport and we need to get on with it. Engaging sport associations, coaches, teachers and players to implement neuromuscular training warm-up programs in youth sport across the country will have a significant impact globally,” says Emery.

Researchers are already starting to work very closely with community partners, local and national soccer associations, educators, and FIFA (Fédération Internationale de Football Association) in order to create a way to best roll out and evaluate neuromuscular training programs.

The ultimate goal of researchers is to reduce the risk of injury in youth sport and recreation by 20 per cent by 2020. An initiative, called the Alberta Program in Youth Sport and Recreational Injury Prevention, is funded by Alberta Innovates Health Solutions Collaborative Research and Innovation Opportunities. It allows researchers to examine sports that have high-participation rates and the greatest opportunity to reduce injury. Activities include soccer, youth ice hockey, downhill skiing and snowboarding.

“Research underpins health improvements, and the research conducted by Drs. Emery and Marshall is an excellent example of this,” says Pamela Valentine, interim CEO of Alberta Innovates – Health Solutions. “The focus on a very real problem that can cause a lifetime of suffering, and the use of evidence to inform a solution to the problem, ultimately leads to improved health both in Alberta and around the world.”

Research paper authors and affiliations

Carolyn Emery, PhD, is a researcher at the Faculty of Kinesiology with a joint appointment with the Cumming School of Medicine, associate professor in the departments of paediatrics and community health sciences. She's also a member of the Hotchkiss Brain Institute; the Alberta Children’s Hospital Research Institute, O’Brien Institute for Public Health and the McCaig Institute for Bone and Joint Health. She holds the Alberta Children’s Hospital Foundation Chair in Paediatric Rehabilitation.

Deborah Marshall, PhD, is a professor in the Department of Community Health Sciences at the Cumming School of Medicine, Arthur J.E. Child Chair of Rheumatology Outcomes Research in the McCaig Institute for Bone and Joint Health, and director of Health Technology Assessment and Research for Alberta Bone and Joint Health Institute. She is also a member of the university’s O’Brien Institute for Public Health.

Dr. Elena Lopatina, is a researcher and master’s student in the Department of Community Health Sciences at the Cumming School of Medicine.

Sarah Lacny, MSc, is a first-year medical student at the Cumming School of Medicine.

More information

The University of Calgary Sport Injury Prevention Research Centre, one of nine International Research Centres for the Prevention of Injury and Protection of Athlete Health, is supported by the International Olympic Committee. It is the only one in North and South America.

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