Open Access Research article

Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study

Jari Parkkari15*, Henri Taanila125, Jaana Suni1, Ville M Mattila25, Olli Ohrankämmen3, Petteri Vuorinen4, Pekka Kannus15 and Harri Pihlajamäki2

Author Affiliations

1 Tampere Research Centre of Sports Medicine, UKK Institute, P.O. Box 30, 33501 Tampere, Finland

2 Research Department, Centre for Military Medicine, P.O. Box 2, 15701 Lahti, Finland

3 General Headquarters of Finnish Defence Forces, P.O. Box 919, 00131 Helsinki, Finland

4 Staff Department, Pori Brigade, P.O. Box 38, 27801 Säkylä, Finland

5 Research Unit of Pirkanmaa Hospital District and Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, P.O Box 2000, 33521 Tampere, Finland

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BMC Medicine 2011, 9:35  doi:10.1186/1741-7015-9-35

Published: 11 April 2011



The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service.


The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs.


In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04).


A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts. A similar programme could be useful for all young individuals by initiating a regular exercise routine.

Trial registration identifier number NCT00595816.