gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Advice after injury is like medicine after death! A multi-pronged approach to injury prevention in adolescents

Meeting Abstract

  • corresponding author presenting/speaker Tom Loney - Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
  • author Kirill Micallef-Stafrace - Institute for Physical Education & Sport, University of Malta, Msida, Malta
  • author James Carter - Optimal Performance Limited, Bristol, United Kingdom
  • author Mouza Al Shehhi - Health and Sports Medicine Centre, United Arab Emirates Armed Forces, Abu Dhabi, United Arab Emirates

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm002

doi: 10.3205/11esm002, urn:nbn:de:0183-11esm0022

Published: October 24, 2011

© 2011 Loney et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Injury prevention is vital to adolescents aiming to reap the physical, mental, and social benefits associated with a physically active lifestyle. Risk factors (RF) that increase the likelihood of adolescent musculoskeletal (MSK) injuries during sport and exercise include genetic anatomical abnormalities, obesity, low physical fitness, poor nutrition, and a lack of health education [1]. The aim of this study was to evaluate the effect of a multi-pronged injury prevention programme (IPP) on reducing injury RF in Emirati adolescents.

Material/Methods: One-hundred and ninety-seven adolescent males (age 14.0±0.2 yr) participated in the nine-month IPP at a weekday residential school in the United Arab Emirates. The IPP involved the synergy of three components: Physical Training, Screening, and Rehabilitation (PTSR); Nutrition and Dietetics (ND); and Health Education (HE). The PTRS entailed all participants completing a paediatric Gait, Arms, Legs, and Spine (pGALS; [2]) MSK screening examination. Abnormal cases attended specialist prehabilitation exercise classes which focussed on reducing the negative effects of the abnormality and facilitating the functionality of the condition. Participants completed anthropometric (i.e. body mass, stature) and physical performance (i.e. one-mile run; 1MR) screening. Body size data was used to classify participants into underweight, healthy weight, overweight, and obese categories taken from the World Health Organisation’s BMI-for-age reference standards for boys [3]. Subjects participated in two progressive 45-minute physical training sessions per week and pre-IPP 1MR data was utilised to assign participants to an ability group suitable for their fitness level to minimise injury risk whilst maximising training efficacy. Heart rate monitors were used to record the duration and intensity of all training sessions, with daily feedback provided to the instructors to ensure that the sessions were appropriate for the ability group. The purpose of ND was to enhance the nutritional quality and balance the energy content of all food served to the participants. Weekly food menus were monitored using a nutritional analysis program and a traffic light food labelling system was implemented to educate the participants to make healthy food choices. Overweight and obese subjects attended weekly weight-management appointments with a registered dietician and received portion-controlled meals in a separate area of the restaurant. The objective of HE was to equip all participants with the knowledge to enhance their health and fitness whilst minimising the risk of injury. Participants received twenty 45-minute lessons and topics included: anatomy and physiology, principles of training, dehydration and heat stress, and the importance of balanced nutrition. Anthropometric and physical performance measures were repeated at the end of the nine-month study and health knowledge was assessed by questionnaire pre- and post-IPP.

Results: The pGALS MSK screening revealed that 57% of participants were classified with mild-to-severe pes planus and 6% with mild-to-moderate scoliosis. Proportion of overweight/obese participants decreased from 39% pre-IPP to 23% post-IPP and mean change (± SD) in body mass was -3.8 kg ± 4.7 kg for this group. Over 80% of participants decreased their 1MR time and mean improvement (± SD) was 01:23 ± 01:28 min:s (14% improvement). Self-reported fruit and vegetable consumption (>three portions/day) increased from 34% of participants pre-IPP to 50% post-IPP and health education also improved during the study (e.g. knowledge that a warm-up reduces injury increased from 33% of participants pre-IPP to 78% post-IPP).

Conclusion: The IPP was effective at reducing some of the RF associated with MSK injuries in adolescents. Tracking of anthropometric, physical performance, and injury prevalence data is vital for long-term injury prevention in adolescents, particularly for obese patients and cases with underlying MSK abnormalities.


Kolt GS, Snyder-Mackler L. Physical therapies in sport and exercise. 2nd ed. London: Churchill Livingstone; 2007.
Foster HE, Kay LJ, Friswell M, Coady D, Myers A. pGALS – a paediatric musculoskeletal screening examination for school aged children based on the adult GALS screen. Arthritis Care Res. 2006;55:709-16.
De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:649-732.