REF-861 · Lauersen et al., 2013 · British Journal of Sports Medicine, Vol. · Paper · PubMed

The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials

A-fairly strong evidenceMeasured on a mixed groupWritten before October 2026, being re-checked

Randomised controlled trials of exercise programmes to prevent sports injuries were pooled after a search of four databases, with trials that ignored clustering adjusted. Across 25 trials and 26 610 participants, stretching showed no benefit, while programmes with multiple exposures, proprioception training and above all strength training reduced injuries.

Both acute and overuse injuries were reduced. The authors conclude that strength training reduced sports injuries to less than a third and that overuse injuries could be almost halved.

Participants

25 randomised controlled trials including 26 610 participants with 3464 injuries (from 3462 search results in PubMed, EMBASE, Web of Science and SPORTDiscus).

Protocol

Two independent authors selected RCTs; quality assessed with the Cochrane collaboration domain-based tool.
Twelve studies that neglected to account for clustering effects were adjusted.
Stratified analyses by exposure (strength training, stretching, proprioception, multiple exposures) and by acute vs overuse injury; heterogeneity (I2) and publication bias (Harbord's small-study effects) tested; intention-to-treat sensitivity analyses.

Key Results

Exposure / outcomeRelative risk (confidence interval)
Stretching0.963 (0.846-1.095) — no benefit
Multiple exposures0.655 (0.520-0.826)
Proprioception training0.550 (0.347-0.869)
Strength training0.315 (0.207-0.480)
Acute injuries0.647 (0.502-0.836)
Overuse injuries0.527 (0.373-0.746)
The overall effect estimate on injury prevention was heterogeneous.
Intention-to-treat sensitivity analyses consistently gave even more robust estimates.

Practical Application

Pooling 25 randomised trials (26 610 participants, 3464 injuries) across sports, strength-training programmes cut sports injuries to about a third (RR 0.315, 0.207-0.480), proprioception and multi-component programmes also helped, and stretching did not (RR 0.963, 0.846-1.095). To "what actually prevents injuries — stretching or strength work?": strength work; stretching for injury prevention is not supported.
Overuse injuries, the typical endurance injuries, were also reduced (RR 0.527). Inference, not tested here: the trials are not endurance-specific, so treat the size of the effect for runners and cyclists as uncertain, while the direction (strength yes, stretching no) is consistent with the base's running evidence.
Not from this paper; the base's own practice: the runner's gym programme and its dose are in SYNTH-44; a hamstring-specific option with its own meta-analysis is the Nordic hamstring exercise REF-766.
Stretching may still be done for range of motion or comfort; this paper only shows it did not prevent injuries.

Limitations

Heterogeneous overall estimate; the number of trials in each stratum and the sports involved are not given in the abstract.
Trials are general sports populations, not endurance athletes specifically.
The content, load and duration of the strength programmes are not described in the abstract.
Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level

meta-analysis of 25 RCTs with 26 610 participants, but the overall estimate was heterogeneous