Preventive efficiency of neuromuscular training in reducing lower limb injuries among youth soccer athletes: a systematic review and meta-analysis of randomized controlled trials.

UNLABELLED: Lower-limb injuries are common in youth soccer. Neuromuscular training (NMT) warm-ups are used, but the preventive effects across injury types in young players are unclear. This review quantified NMT effectiveness for lower-limb injury prevention in 8-18-year-old soccer players. A PRISMA-guided systematic review and meta-analysis of randomized controlled trials was conducted. Four databases were searched up to October 2025 using keywords including soccer/football, neuromuscular training, balance, proprioception, plyometrics, injury prevention, ACL, ankle sprain, and hamstring strain. English-language RCTs (January 2000-present) in youth soccer comparing NMT with standard warm-up or no intervention were included; adult (>18 years), non-soccer, and non-RCT studies were excluded. The primary outcome was the incidence of all lower-limb injuries; secondary outcomes were knee, ankle, ligament, and muscle injuries. Incidence rate ratios (IRRs) were pooled using random-effects models with the Hartung-Knapp adjustment for outcomes in which at least two trials reported exposure time; the remaining outcomes were summarised using a structured narrative synthesis. Heterogeneity was assessed with I2. Five RCTs (2012-2025; n = 6,447) were included. Two outcomes had sufficient exposure data for meta-analysis: NMT was associated with non-significant reductions in all lower-limb injuries (IRR = 0.54, 95% CI 0.20-1.45; I2 = 83.7%) and knee injuries (IRR = 0.86, 95% CI 0.62-1.19; I2 = 0%). For ankle, ligament and muscle injuries only one trial reported exposure time, precluding pooling; in that trial NMT was associated with significantly lower ankle (IRR = 0.59, 95% CI 0.40-0.88), ligament (IRR = 0.62, 95% CI 0.43-0.90) and muscle (IRR = 0.66, 95% CI 0.47-0.93) injury rates, with the remaining trials reporting fewer injuries in the NMT group. NMT warm-ups may reduce ankle injuries in youth soccer, while evidence for overall and knee injury prevention is inconclusive and heterogeneous. Implementation with adherence support is clinically relevant. Future trials should standardize injury definitions, report exposure/compliance, and evaluate programme dose and components across age and sex groups.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251207720, identifier CRD420251207720.