There are existing reviews of balance training for injury prevention. How does your review differ?

None of the previous reviews assessed in isolation the effect of injury prevention programs that include balance training on reducing ankle injuries.

Moreover, the previous meta-analyses relied on the number of ankle injuries without considering the athletes’ exposure time, while our meta-analysis relied on the exposure-based ankle injury rates.

In addition, our study was done on a particular population (soccer players only).

What evidence did you find with your searches?

From the nine included studies, pooled data from 9,633 participants with 775,606 exposure hours identified 529 ankle injuries.

The pooled results showed a 36 per cent reduction in overall ankle injuries per 1000 hours of exposure in the group using injury prevention programs that included balance training exercises compared with control (IRR 0.64, 95 per cent CI 0.54 to 0.77).

Wesam Al Attar and colleagues' review focuses on balance training for soccer injury prevention.

The inconsistency statistic indicated no heterogeneity between studies (I2 = zero per cent).

Are injury prevention programs based on balance training effective for ankle injury prevention in soccer?

Absolutely.

The effectiveness of injury prevention programs based on balance training was proved by our meta-analysis as the result showed a 36 per cent reduction in ankle injury risk among a diverse population of soccer players.

Moreover, balance training exercises alone produced a 42 per cent reduction in ankle injury risk.

Did you examine any specific balance-based injury prevention programs in isolation?

It was difficult to conduct a systematic review to assess the effect of balance exercises alone on reducing the risk of ankle injuries due to the paucity of studies.

However, our review analysed a subgroup of trials that evaluated the preventive effect of balance exercises in isolation to overcome this problem.

Are there specific subgroups of players for whom balance-based injury prevention programs seem more effective?

The subgroup analyses suggested that injury prevention programs that include balance training exercises might be more effective at reducing ankle injuries in male soccer players than in female soccer players.

However, the non-significant reduction in ankle injuries detected in the pooled studies with only female participants should be interpreted with caution because the confidence interval does not exclude the possibility that the intervention is ineffective.

Where do you see research in this area heading?

Sports injury prevention research is a neoteric field of research currently being explored by many trials that identify injury risk factors and how to overcome them in a specific sports population.

This kind of evidence attracts coaches and stakeholders and helps them with the implementation of these types of training within their programs in order to lower the wastage of players and funding resources.

>> Wesam Al Attar is an associate professor of sports physiotherapy in the Department of Physiotherapy, Umm Al Qura University, Saudi Arabia and a research fellow in the Discipline of Exercise and Sport Science, University of Sydney, Australia and in the Department of Sport, Exercise and Health, University of Basel, Switzerland.