**3. Which prevention program should be used?**

The previous review of literature presented in this book chapter and describing the different methods of prevention strategies, should help the coach, the technical staff and the medical staff to reduce the injury occurrence. They have to adapt the prevention program according to the sport, the athletes' morphology, age, gender, their injury history, and the period of the season.

First of all, all players should to be tested at the beginning of the pre-season in order to detect what prevention program they eventually need. They should be tested in isokinetic, functional strength, mobility (lumbar-pelvic, ankle, knee, hip), flexibility, balance and theirs morpholo‐ gies. These results have to be combined to their injury history. All of these information will allow to draw the needs for each player, and therefore designing individual specific prevention programs.

A Cochrane review by Goldman and Jones (2010) on such interventions concluded that there was insufficient evidence from randomized controlled trials to draw conclusions as to the effectiveness of interventions used to prevent injuries. This current lack of evidence for interventions and the current high incidence of injuries seen in the game could also suggest that injuries should be considered multifactorial in their etiology. Therefore, we have yet to understand how works the interplay between all of the intrinsic and extrinsic factors that may contribute to each specific injury. It could also be suggested that there is some element, be it intrinsic or extrinsic, in the day to day management of the players that maybe a significant contributing factor in the aetiology of these injuries and we have yet to establish what this might be.

For example, a recent large scaled randomized controlled trial by Petersen et al (2011) ad‐ dressed the efficacy of the Nordic hamstring exercise program for preventing acute hamstring injuries in soccer players. They found that introducing this ten weeks program to reduce eccentric weakness, a common intrinsic factor associated with hamstring injuries, reduced the incident of these injuries by 70%. This backed up previous findings by Arnason et al (2008). Using a larger sample size Arnason's study looked at a total of 24 teams, with over 650 soccer players, over a four years period. These players were from professional soccer teams in the Icelandic and Norwegian leagues. The study showed that teams combining the Nordic eccentric exercise protocol and the stretching program were on average seeing 65% fewer hamstring injuries. However, when we look closely at the Nordic hamstring exercise it's clear to see that it only involves movement at one joint-the knee. We know that the hamstrings work over two joints, the hip and knee, and when we consider the mechanism of hamstring injuries then the Nordic hamstring exercise clearly doesn't replicate any of the functional activities used in football specific training.

Each player needs a specific program according to his injury risks (Table 4) which has been determined by the pre-season tests, his injury history, morphology, and his playing positions. Indeed, Mallo and Dellal (2012) have showed that the frequency of injuries was not uniformly distributed by playing positions with forwards and central defenders sustaining the greatest number of injury episodes and the highest match absence. Consequently, it is important to link the prevention program in taking in consideration the playing positions of each player in team sports.


**Table 4.** Prevention exercises to applied for decrease the injury risk.
