Neuromuscular Training and Lower-Limb Injury Prevention: What This Soccer Focused Meta-Analysis Really Means for Podiatrists, Runners, and Clinicians

Introduction

Can structured neuromuscular training genuinely reduce lower-limb injuries, and what does this mean beyond soccer, for running performance and podiatric care? A 2025 systematic review and meta-analysis published in Journal of Clinical Medicine tackles this question by evaluating neuromuscular training (NMT) programmes such as FIFA 11+ for injury prevention in soccer players  .

For podiatrists and sports clinicians working with athletes, this paper provides strong (but not flawless) evidence that movement-based warm-ups influence injury risk across the kinetic chain.

Structured neuromuscular training: Short, repeatable routines improve compliance and outcomes

What the Paper Did Well

1. Strong Support for Neuromuscular Training as Injury Prevention

Across 11 studies and more than 10,000 athletes, neuromuscular training consistently reduced overall lower-limb injury rates, particularly:

• Knee injuries (notably ACL)

• Ankle sprains

• Overuse injuries

For clinicians, this reinforces what is often seen in practice: injury risk is not just tissue-specific, but movement-specific. Improved neuromuscular control upstream influences foot loading patterns, ankle stability, and knee mechanics.

2. Adherence Matters More Than Perfection

One of the most clinically relevant findings is that compliance predicts outcomes more strongly than program complexity. Athletes who performed neuromuscular warm-ups regularly experienced significantly fewer injuries than those with poor adherence.

From a podiatry and running-performance perspective, this mirrors real-world outcomes:

• Perfect orthoses or exercise prescriptions fail without adherence

• Shorter, simpler interventions may outperform “ideal” programmes that athletes do not follow

Notably, a 10-minute version of FIFA 11+ was as effective as the 20-minute protocol, challenging the assumption that longer is better.

3. Female Athletes Benefit Disproportionately

The review confirms that female players experienced greater reductions in ACL and knee injury rates than males. This has implications well beyond soccer. Female runners and field athletes often demonstrate:

• Different lower-limb kinematics

• Higher valgus loading

• Reduced hip-knee-ankle coordination under fatigue

Neuromuscular training appears to address these deficits more effectively than strength work alone an important point for clinicians designing injury-prevention strategies.

Where the Paper Falls Short (and Why It Matters Clinically)

1. Limited Foot- and Ankle-Specific Analysis

Despite podiatry being central to lower-limb injury management, the review largely treats the leg as a knee-centric system. Ankle sprains are reported, but there is little exploration of:

• Foot posture

• Load distribution

• Plantar control

• Interaction with footwear or orthoses

For podiatrists, this is a missed opportunity. Neuromuscular training likely modifies foot strike stability, pronation velocity, and ankle stiffness, yet these mechanisms remain unexplored.

2. Soccer Bias Limits Transferability

All included studies focus on soccer. While many injury mechanisms overlap with running and other field sports, soccer involves:

• Cutting and pivoting

• Frequent deceleration

• Unpredictable contact

Clinicians should be cautious when extrapolating directly to endurance runners, where repetitive loading, fatigue, and surface interaction dominate injury risk. That said, principles of neuromuscular control still apply, particularly for runners with recurrent ankle, Achilles, or knee injuries.

3. No Long-Term Follow-Up

Most studies only measured injury outcomes during the intervention period. There is no evidence that benefits persist once neuromuscular training stops. From a clinical standpoint, this reinforces the idea that:

• Injury prevention is not a “programme” but a habit

• Neuromuscular capacity must be maintained, not temporarily trained

Practical Takeaways for Podiatrists, Athletes, and Sports Clinicians

For Clinicians

• Neuromuscular warm-ups should be treated as core injury-prevention tools, not optional extras

• Short, repeatable routines improve compliance and outcomes

• Pair NMT with foot-ankle strengthening and load management strategies for best results

For Athletes and Runners

• Injury prevention is about how you move, not just how strong you are

• Ten minutes of focused neuromuscular work before training may reduce time lost to injury more than extra mileage or stretching

For Podiatry Practice

• Orthoses and footwear should complement not replace neuromuscular capacity

• Screening for movement control deficits may be as important as structural assessment

Final Verdict

This systematic review provides strong evidence that neuromuscular training reduces lower-limb injury risk, particularly when adherence is high and coaches (or clinicians) are properly educated.

However, from a podiatry and running-performance perspective, the paper underplays the role of the foot and ankle and does not address long-term sustainability. Neuromuscular training should therefore be viewed not as a standalone solution, but as a foundational component of integrated lower-limb care.

Citation

Stergiou M, Lorenzo Calvo A, Forelli F. Effectiveness of Neuromuscular Training in Preventing Lower Limb Soccer Injuries: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2025;14:1714.

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