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Exercise-Based Strategies to Prevent Muscle Injury in Elite Footballers: A Systematic Review and Best Evidence Synthesis

Fanchini, Maurizio; Steendahl, Ida Bo; Impellizzeri, Franco M.; Pruna, Ricard; Dupont, Gregory; Coutts, Aaron J.; Meyer, Tim; McCall, Alan


Maurizio Fanchini

Ida Bo Steendahl

Franco M. Impellizzeri

Ricard Pruna

Gregory Dupont

Aaron J. Coutts

Tim Meyer


Exercise-based strategies are used to prevent muscle injuries in football and studies on different competitive-level populations may provide different results.

To evaluate the effectiveness of exercise-based muscle injury prevention strategies in adult elite football.

A systematic search was conducted in PubMed (MEDLINE), Web of Science, Cochrane Library, and SPORTDiscuss (EBSCO). We considered only elite adult (> 16 year-old) football players with no distinction for gender; the intervention to be any exercise/s performed with the target to prevent lower-limb muscle injuries; the comparison to be no injury prevention exercise undertaken; the outcome to be the number of injuries, injury incidence, and severity. We searched systematic reviews, randomized-controlled trials (RCTs), and non-randomized-controlled trials (NRCTs), limited for English language. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, the Cochrane Collaboration’s Tool for assessing risk of bias in RCTs, and the Risk of Bias in NRCTs of Interventions tool.

15 studies were included. Three systematic reviews showed inconsistent results, with one supporting (high risk of bias) and two showing insufficient evidence (low risk of bias) to support exercise-based strategies to prevent muscle injuries in elite players. Five RCTs and seven NRCTs support eccentric exercise, proprioception exercises, and a multi-dimensional component to an injury prevention program; however, all were deemed to be at high/critical risk of bias. Only one RCT was found at low risk of bias and supported eccentric exercise for preventing groin problems.

We found limited scientific evidence to support exercise-based strategies to prevent muscle injury in elite footballers.

Trial Registration Number
PROSPERO CRD42017077705.


Fanchini, M., Steendahl, I. B., Impellizzeri, F. M., Pruna, R., Dupont, G., Coutts, A. J., Meyer, T., & McCall, A. (2020). Exercise-Based Strategies to Prevent Muscle Injury in Elite Footballers: A Systematic Review and Best Evidence Synthesis. Sports Medicine, 50, 1653-1666.

Journal Article Type Article
Online Publication Date Mar 18, 2020
Publication Date 2020-09
Deposit Date May 11, 2020
Journal Sports Medicine
Print ISSN 0112-1642
Electronic ISSN 1179-2035
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 50
Pages 1653-1666
Keywords Physical Therapy, Sports Therapy and Rehabilitation; Orthopedics and Sports Medicine
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