Coach Education Improves Adherence to Anterior Cruciate Ligament Injury Prevention Programs: A Cluster-Randomized Controlled Trial.

Neuromuscular training programs can reduce injury risk for young athletes, but only if coaches actually deliver them properly, and getting coaches to do that consistently is a known challenge. This trial compared high school coaches who attended a 60-minute workshop on how to run these training exercises against coaches who only received printed materials, then observed hundreds of practices and games across two seasons to see what coaches actually did on the field. Coaches who got the workshop were more likely to give athletes cues about correcting their movement alignment during exercises, and more of them completed the full training program compared with coaches who only had handouts. There was no clear difference between groups in whether coaches gave basic exercise instructions at all.

The main limitation is that this measures coach behavior and program delivery, not whether injuries themselves were reduced, so it tells us about implementation rather than proven injury prevention.

If you're a parent, coach, or athlete wondering why some teams seem better at sticking with injury-prevention warm-up routines than others, this study offers a clue: how coaches are trained matters. Researchers compared high school coaches who attended a short, one-hour workshop on delivering a knee-injury-prevention exercise program with coaches who only received written instructions. Coaches who went through the workshop were more likely to correct athletes' form during the exercises and were more likely to complete the entire program as intended.

Interestingly, both groups were about equally likely to simply give instructions on how to do the exercises, so the workshop's real edge showed up in follow-through and coaching quality rather than just explaining the moves. It's worth understanding that this study measured coach behavior, not whether athletes actually experienced fewer injuries. It shows that better coach training can improve how consistently these programs are delivered, which is an important first step, but it doesn't directly prove fewer injuries resulted.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This trial addresses a practical implementation question: does adding structured coach education to standard printed materials actually change how neuromuscular training programs get delivered on the field, rather than just whether coaches have access to instructions? Twenty-one high school teams across eight schools were cluster-randomized, with coaches in the intervention arm attending a 60-minute in-person workshop plus receiving the same print materials as controls. Across 399 observed practices and games, coaches in the intervention group provided alignment cues to correct technique in a significantly greater proportion of sessions than controls (difference 0.04, 95% CI 0.01 to 0.07, P = 0.006), and were substantially more likely to complete the full program (OR 4.62, 95% CI 1.22 to 17.50, P = 0.02). Notably, there was no significant difference in whether coaches simply delivered exercise instructions, suggesting the workshop's benefit was specific to correcting technique and program fidelity rather than basic content delivery. This is an adherence and implementation outcome, not an injury outcome, so the findings speak to how education might improve program fidelity rather than to any measured reduction in ACL injuries.

The cluster design and observational fidelity checks are reasonable for this question, but findings are specific to high school sports settings and to the particular training program and workshop format used.