A soccer-specific balance training program for hamstring muscle and patellar and achilles tendon injuries: an intervention study in premier league female soccer

Am J Sports Med. 2009 Jul;37(7):1384-93. doi: 10.1177/0363546509333012.


Background: A soccer-specific balance training has been shown to decrease injury incidence of the anterior cruciate ligament and ankle sprains in randomized controlled trials. However, hamstring injuries and tendinopathy remain significant issues in soccer.

Hypothesis: Proprioceptive training can reduce the incidence of hamstring muscle injuries and tendinopathy in elite soccer. There is a dose-effect relationship between balance training duration and injury incidence.

Study design: Cohort study; Level of evidence, 3.

Methods: Twenty-four elite female soccer players (body mass index, 21.7 +/- 1.2; age, 21 +/- 4 years) of a German premier league soccer team were prospectively included. Starting in January 2004, an additional soccer-specific proprioceptive multistation training was initiated over 3 years. Injury data/1000 hours of exposure with documentation of all occurred injuries, detailed training, and match exposure data as well as time loss data were 100% complete.

Results: At the end of the 3-year proprioceptive balance training intervention, noncontact hamstring injury rates were reduced from 22.4 to 8.2/1000 hours (P = .021), patellar tendinopathy from 3.0 to 1.0/1000 hours (P = .022), and Achilles tendinopathy from 1.5 to 0.0/1000 hours (P = .035). There was no effect of balance training on contact injuries. Mean time loss of all assessed injuries significantly decreased from 14.4 days during the control period to 1.5 days during intervention periods (P = .003). The more minutes of balance training performed, the lower the rate of overall injuries (r = -0.185, P = .001), hamstring injuries (r = -0.267, P = .003), patellar tendinopathy (r = -0.398, P = .02), and gastrocnemius strains (r = -0.342, P = .002).

Conclusion: Soccer-specific balance training (protective balancing) can reduce noncontact hamstring injuries and patellar and Achilles tendinopathy. A dose-effect relationship between duration of balance training and injury incidence is evident. A proprioceptive training program reduced the rehabilitation time in noncontact injuries, which warrants further investigation.

MeSH terms

  • Achilles Tendon / injuries*
  • Adult
  • Cohort Studies
  • Exercise / physiology*
  • Female
  • Germany
  • Humans
  • Patellar Ligament / injuries*
  • Posture / physiology*
  • Proprioception
  • Soccer* / injuries
  • Tendinopathy / epidemiology
  • Tendinopathy / physiopathology
  • Tendinopathy / prevention & control*
  • Young Adult