Intended for healthcare professionals


Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial

BMJ 2005; 330 doi: (Published 24 February 2005) Cite this as: BMJ 2005;330:449
  1. Odd-Egil Olsen (odd-egil.olsen{at}, research fellow1,
  2. Grethe Myklebust, research fellow1,
  3. Lars Engebretsen, professor1,
  4. Ingar Holme, professor1,
  5. Roald Bahr, professor1
  1. 1 Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, 0806 Oslo, Norway
  1. Correspondence to: O E Olsen
  • Accepted 30 November 2004


Objective To investigate the effect of a structured warm-up programme designed to reduce the incidence of knee and ankle injuries in young people participating in sports.

Design Cluster randomised controlled trial with clubs as the unit of randomisation.

Setting 120 team handball clubs from central and eastern Norway (61 clubs in the intervention group, 59 in the control group) followed for one league season (eight months).

Participants 1837 players aged 15-17 years; 958 players (808 female and 150 male) in the intervention group; 879 players (778 female and 101 male) in the control group.

Intervention A structured warm-up programme to improve running, cutting, and landing technique as well as neuromuscular control, balance, and strength.

Main outcome measure The rate of acute injuries to the knee or ankle.

Results During the season, 129 acute knee or ankle injuries occurred, 81 injuries in the control group (0.9 (SE 0.09) injuries per 1000 player hours; 0.3 (SE 0.17) in training v 5.3 (SE 0.06) during matches) and 48 injuries in the intervention group (0.5 (SE 0.11) injuries per 1000 player hours; 0.2 (SE 0.18) in training v 2.5 (SE 0.06) during matches). Fewer injured players were in the intervention group than in the control group (46 (4.8%) v (76 (8.6%); relative risk intervention group v control group 0.53, 95% confidence interval 0.35 to 0.81).

Conclusion A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.


  • Contributors OEO, GM, LE, IH, and RB contributed to study conception and design. OEO coordinated the study and managed all aspects of the trial, including developing, testing, and finalising the intervention, and data collection. IH conducted and initialised the blinded data analyses, which were planned and checked with OEO. OEO and RB wrote the first draft of the paper, and all authors contributed to the final manuscript. OEO is guarantor.

  • Funding The Oslo Sports Trauma Research Center has been established at the Norwegian University of Sport and Physical Education through generous grants from the Royal Norwegian Ministry of Culture, the Norwegian Olympic Committee and Confederation of Sport, Norsk Tipping, and Pfizer. In addition, this study was supported by grants from the Norwegian Sports Medicine Foundation, the Norwegian Handball Federation, and If insurance.

  • Ethical approval Ethical approval was not required by the regional committee for medical research ethics.

  • Accepted 30 November 2004
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