Floorball has become a popular sport in Finland during the past decade. The game is associated with sudden accelerations, decelerations, and twisting turns, and thus it is not surprising that lower limb injuries are common in floorball. Studies from other sports have reported that neuromuscular training can reduce injury risk in athletes. However, no previous study has assessed possibilities for preventing floorball injuries.
The purpose of this dissertation was to investigate epidemiology of sports injuries in female athletes, and examine whether a neuromuscular warm-up program, designed to enhance body control and motor skills, was effective in preventing non-contact lower extremity injuries in female floorball players.
First, the occurrence of cruciate ligament injuries of the knee among Finnish adolescents and young adults was examined. The total cohort of 46 472 was followed for an average of nine years. The analysis was based on longitudinal data of the Adolescent Health and Lifestyle Surveys linked to the National Hospital Discharge Register and Cause-of-Death Statistics. The results indicated that young people who participate in structured sports had a clearly higher risk for cruciate ligament injury than their less active counterparts. In highest activity level, that is participation ≥ 4 times a week in organized sports, the injury risk increased substantially in females than males.
The following two studies investigated the epidemiology of floorball injuries in female players. In the first of them, 374 licensed players from the three Finnish top leagues were observed prospectively for one competitive season (6-month). The outcome variable was a floorball-related time-loss injury. The practice and game hours were recorded on an exercise diary and all injuries were registered with a structured questionnaire and verified by a physician.
During the floorball season, a total of 172 time-loss injuries occurred in these 374 female players. Injury rate was strikingly higher in floorball games (40.3 injuries / 1000 game hours) than in practice (1.8 / 1000 training hours). Most commonly injured body sites were the knee (27%), ankle (22%), and thigh (12%). 121 of the injuries were acute and 51 were from overuse. Most of the acute injuries involved the ankle and knee (29% and 28%), and about half of acute ankle and knee injuries (59% and 46%) occurred in non-contact circumstances.
The second epidemiological study on floorball injuries examined the interaction between playing surface and injury risk. The data was based on the previous study including players from two top level leagues (n=331). The outcome variable was an acute game-related time-loss injury. Information on the floor type (parquet or artificial floor) at each game was given by the Finnish Floorball Association. This study suggested that the risk for acute injury was two-fold higher on artificial than wooden floors. Moreover, the risk for non-contact and severe injury was clearly increased on artificial surfaces.
Thereafter, an intervention study was constructed according to the findings from the previous three studies. This randomized controlled trial assessed the effects of neuromuscular warm-up program on injury risk of female floorball players. The main outcome variable was an acute non-contact injury of lower extremity. 28 Finnish female floorball teams (n=457) participated, and stratified cluster randomization to the intervention and control group was performed at each league level (elite league, 1st division, and 2nd division). Teams in the intervention group attended in a structured warm-up program that consisted of running technique, balance, jumping, and strength exercises. Results showed that the neuromuscular warm-up program reduced the injury risk considerably: 66% fewer non-contact lower extremity injuries occurred in the intervention group compared with the control group.
Related to the above noted intervention, the final study described the effects of the warm-up program on muscle power, balance, speed and agility of the players. Outcomes were the follow-up test results from five field tests: static jump, countermovement jump, jumping over a bar, standing on a bar, and figure-of-eight running. All players who participated in baseline and follow-up tests (n=222) were included in the analyses. Results from this study attested that, in contrast to control group, the intervention group improved significantly static balance and sideways jumping speed.
Altogether, the findings of this dissertation indicate that injuries to lower extremities, especially those involving ankle and knee joint in non-contact circumstances, are common among female floorball players. However, a neuromuscular warm-up program designed to enhance motor skills and body control can clearly reduce the injury risk. Additionally, the warm-up program improves the players’ static balance and sideways jumping speed. Hence, neuromuscular warm-up exercises can be recommended to be included in the weekly training of female athletes who participate in pivoting and cutting sports.
