Efficacy of integrated neuromuscular training intervention on concurrent reduction of anterior cruciate ligament and hamstring injury risks in adolescent footballers

Background and Study Aim. Football is a physically demanding sport with a high risk of injuries, particularly anterior cruciate ligament (ACL) and hamstring strain injuries (HSIs). These injuries often lead to re-injury, prolonged rehabilitation, and reduced career longevity. Although various preventive strategies are applied, their relative effectiveness in reducing such risks among adolescent male footballers remains a matter of practical concern. This study aimed to determine the effects of integrated neuromuscular training on key injury-related risk factors. Material and Methods. Sixty-eight male adolescent footballers aged 16–18 years from two academies in Lakki Marwat were recruited for the study. Sixty-two participants completed the intervention, while six withdrew for personal reasons. The intervention group (n = 31) followed an eight-week INT program, consisting of four sessions per week, each lasting 80–90 minutes. The control group (n = 31) continued their routine football training. Pre- and post-test assessments were conducted to evaluate the effects of INT on the dependent variables. The Tuck Jump Assessment (TJA) was used to analyze landing biomechanics, a key risk factor for ACL injury. Isokinetic dynamometry was used to assess hamstring strength and calculate the conventional (Hcon:Qcon) and functional (Hexc:Qcon) hamstring-to-quadriceps ratios. The Active Knee Extension (AKE) test was used to assess hamstring flexibility. Results. The most significant result in the INT group was a 51% reduction in the TJA score, supported by a large effect size (d = 2.41). Overall, large effect sizes (d = 1.56–1.73) confirmed the intervention’s potential effectiveness, as the INT group showed significant improvements from pre- to post-test in all tested variables. Conclusions. Significant positive changes were observed in TJA scores, indicating improved landing mechanics and a lower risk of ACL injury. Additionally, the intervention group demonstrated significant improvements in muscle peak torque, Hcon:Qcon ratio, Hexc:Qcon ratio, and AKE range of motion. These findings confirm that INT can simultaneously reduce key risk factors related to both movement mechanics and muscle strength for ACL and HSIs in adolescent male footballers.