The Effectiveness of Neuromuscular Warmups for Lower Extremity Injury Prevention in Basketball: A Systematic Review

Background Neuromuscular warmups have gained increasing attention as a means of preventing sports-related injuries, but data on effectiveness in basketball are sparse. The objective of this systematic review was to evaluate evidence of the effectiveness of neuromuscular warmup-based strategies for preventing lower extremity injuries among basketball athletes. Methods PubMed and Cochrane Library databases were searched in February 2019. Studies were included if they were English-language randomized controlled, non-randomized comparative, or prospective cohort trials, tested neuromuscular and/or balance-focused warmup interventions among basketball players, and assessed at least one type of lower extremity injury as a primary outcome. Criteria developed by the USPSTF were used to appraise study quality, and GRADE was used to appraise the body of evidence for each outcome. Due to heterogeneity in the included studies, meta-analyses could not be performed. Results In total, 825 titles and abstracts were identified. Of the 13 studies which met inclusion criteria for this review, five were balance interventions (3 randomized controlled trials) and eight were multicomponent interventions involving multiple categories of dynamic neuromuscular warmup (5 randomized controlled trials). Authors of four of the studies were contacted to obtain outcome data specific to basketball athletes. Basketball specific results from the studies suggest significant protective effects for the following lower extremity injuries: ankle injuries (significant in 4 out of the 9 studies that assessed this outcome); ACL injuries (2 of 4 studies); knee injuries generally (1 of 5 studies); and overall lower extremity injuries (5 of 7 studies). All but one of the non-significant results were directionally favorable. Evidence was moderate for the effect of multicomponent interventions on lower extremity injuries generally. For all other outcomes, and for balance-based interventions, the quality of evidence was rated as low. Conclusion Overall, the evidence is supportive of neuromuscular warmups for lower extremity injury prevention among basketball players. However, most studies are underpowered, some used lower-quality research study designs, and outcome and exposure definitions varied. Due to the nature of the study designs, effects could not be attributed to specific intervention components. More research is needed to identify the most effective bundle of warmup activities. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00355-1.

Each team assigned a student team manager and a team therapist. Team therapist attended 1 session per week. Team manager attended every team session and recorded participation on an exposure sheet.

Eils et al., 2010 (4)
Balance training: Six-station rotation, performed twice, with each station lasting 45 secs followed by 30 sec break and transition to next station. 1) Walking slowly back and forth on a balance beam, with contralateral leg swinging through and nearly touching the ground.
-adapt by walking faster -adapt by holding a stance on the beam and using the contralateral leg to move a basketball in circles on the ground. 2) Single leg stance on exercise mat with other leg flexed. Lower and raise the body. -adapt by working opposite a partner and passing a basketball back and forth with controlled position -adapt by balancing a ball on the dorsum of the elevated foot 3) jump from one leg to the other on an exercise mat and control landing for 4 secs, raising the contralateral leg -adapt by working with a partner and disturbing each other during the flight phase -adapt by working on a soft mat 4) Walk up and down an inclined surface and dribble a ball -adapt by adding an elastic strap around the knees and focusing on wide steps -adapt by passing a ball with a partner working opposite and doing the same 5) maintain balance in single-leg stance, elevating contralateral leg against a resistance band -adapt by doing with eyes closed -adapt by moving the contralateral leg sideways and everting the lateral edge of the contralateral foot 6) maintain balance in single-leg stance on a tilt board. Contralateral leg is rested on an inclined surface without being loaded -adapt by passing a ball with a partner -adapt by elevating the contralateral leg Balance training program used balance beams, tilt boards, and inclined surfaces.
Study team contacted coaches on a regular basis to encourage and motivate. Physiotherapist provided on-site instruction three times during the intervention period. Coach was given a printed manual that included background information on posture and proprioception.

Duration of intervention period
Adaptation over time Strength, plyometrics, balance, 15 minutes: -Jumping: vertical 3 x 15 secs; lateral 3 times along major diameter of court; box 3 times along major diameter of court -Bending with both legs 10 x 3 -Nordic hamstring lower 10 x 3 -Squats: heels raised 2 x 30 secs; walking lunges 2 x 30 secs; 1-leg squats 2 x10 (each leg) -Single leg balance: holding ball 2 (each leg); throwing ball with partner 3 (each leg); testing partner 3 (each 20 mins Teams in both groups practiced 6x per week during the first month, followed by 3-4 practices per week in subsequent months.

Non-warmup components of the intervention and/or special equipment
The IG used the FIFA11 warmup at each practice session in the first month, and at least 2x per week in the subsequent months. They also One 9-month season NA coaches and team captains participated in a 1 day instruction course; coaches and each player received a poster explaining every exercise

Duration of intervention period
Adaptation over time

Non-warmup components of the intervention and/or special equipment leg)
Dynamic warmup: Running exercises, 1 min and 40 sec (along major diameter of court) -Running over pitch x 3 -Bounding run x 3 -Running and cutting x3 did the running exercises before match play.
The CG teams were told to use their normal warmup strategy throughout, generally 3-4x per week. Personalized visit by a sports physiotherapist who was part of the research team to each coach, to inform them about the intervention. Coaches were given a CD with specific information including pictures, videos, and coach's instructions on who to perform the exercises. teams also received a poster illustrating the exercises and a handout with written instructions.
Used existing gym equipment such as benches and balls.
Researchers observed each session to document whether the program was being executed. They did not interfere with the intervention but did answer questions if asked.   Bosu ball, band