Getting Warmed Up

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When you ask the parent of athletic children if they've ever had any injuries, a common response is, "Where do I start?"

Researchers have often studied injury rates for student athletes, but a new Northwestern University study looked at female athlete injuries in urban, lower-income areas and found that many of the problems resulted from a lack of properly warming up.

Incorporating a neuromuscular warm-up from a trained coach led to a 66 percent reduction in ankle sprains, a 70 percent reduction in knee sprains and an 80 percent reduction in anterior cruciate ligament, or ACL, injuries in female soccer and basketball players, the study determined. Findings are published in the Nov. 7 issue of the Archives of Pediatrics and Adolescent Medicine.

Cynthia LaBella, MD, lead author of the study, is the medical director at the Institute for Sports Medicine at Children's Memorial Hospital and also an associate professor of pediatrics at Northwestern's Feinberg School of Medicine.

Cynthia LaBella, MDCynthia LaBella, MDWhat was involved in the neuromuscular warm-up?

The key components of the warm-up are core and lower extremity strengthening exercises (e.g., squats, lunges, planks and prone lifts) to balance strength evenly between quadriceps and hamstrings and between right and left legs, and progressive plyometric (rapidly stretching and contracting the muscles) jumping exercises, to improve neuromuscular control of knee motion during landing and cutting maneuvers.

Why did the study focus on female athletes?

We know from many other studies that high-school-age female athletes are at a greater risk for sports-related knee injuries than their male counterparts. Some of the key reasons: women often land differently from a jump, they tend to favor their quadriceps more than their hamstrings, which creates uneven force on the knee, and women tend to rely on bones and ligaments rather than muscles. The theory is that as young men go through puberty, they get a burst of testosterone that helps them with muscle strength and evenly distributing weight put on muscles. Females don't have that. They also tend to favor one leg.

How was the study done?

We contacted all 258 Chicago Public School high school soccer and basketball coaches and asked them to take part. Ninety-five agreed, which allowed us to research 1,500 female athletes. Before the school year started, we trained the coaches with a neuromuscular warm-up routine to be done before practices and games. Half the coaches were in an intervention group, meaning they were using this warm-up routine. The other half was in a control group and told to continue what they had always been doing. At the end of the school year, the intervention group had 50 injuries and the control group had 96 injuries, so nearly double.

Why did you study Chicago Public Schools, or CPS?

This is the first study on a specific population of predominantly low-income, urban female athletes. We know that there are very few resources in public schools, and these schools don't have athletic trainers to evaluate injuries and advise coaches about proper warm-up techniques. We also know that this is a huge benefit, because training a coach is inexpensive, about $80 each, versus one knee surgery which typically costs $20,000.

Where do you go from here?

We are doing a similar study in elementary schools to compare the results. We're also trying out an online training version to see if it's as effective as in person. If so, we could train more coaches. We'll have those results soon.

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