EFFECTIVENESS OF NEUROMUSCULAR TRAINING AND LOAD MANAGEMENT FOR REDUCING INJURY AND ATTRITION IN TACTICAL RECRUITS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

INTRODUCTION/AIMS: At least one-in-five tactical personnel (military and law enforcement) sustain an injury during recruit training, requiring medical attention, modified training, and risking drop out. Developing a single recruit is costly (~$175,000AUD, Australian Defence Force; ~$250,000AUD, Western Australia Police Force), making it critical for tactical organisations to reduce injuries and attrition during recruit training. This study aimed to investigate the effectiveness of neuromuscular training and load management interventions for reducing injury and attrition in tactical personnel during recruit training. METHODS: Searches of six electronic databases identified records examining neuromuscular training and load management interventions, conducted during or before commencing recruit training, on injuries and attrition in tactical personnel. Interventions were critically appraised to determine if individualised prescription guidelines for improving muscular strength were met. Study bias and certainty were assessed using Cochrane RoB 2.0 and GRADE. Inverse-variance, random effects meta-analyses were conducted, providing Log Odds Ratio (OR) and 95% confidence intervals (CI). RESULTS: Thirty-three studies (n=49,062) were included, and all meta-analyses results were of very-low certainty. Neuromuscular training interventions during recruit training appear to reduce injuries (LogOR=0.520, 95%CI=0.226 to 0.815) but not attrition (LogOR=0.525, 95%CI=-0.292 to 1.342). Neuromuscular training interventions before commencing recruit training do not appear to reduce injuries (LogOR=0.487, 95%CI=-2.216 to 3.190), and may increase attrition (LogOR=-0.982, 95%CI=-1.874 to -0.090). Load management interventions did not reduce injuries (LogOR=0.286, 95%CI=-0.183 to 0.755). CONCLUSION: Very low-certainty evidence indicates that injury incidence in tactical personnel appears to be reduced by neuromuscular training interventions conducted during, but not before commencing recruit training. Load management does not appear to reduce injury incidence. The lack of specificity and progressive overload for included interventions may have limited protective effects against injury. Neuromuscular training interventions before commencing recruit training may also increase attrition during recruit training, which could be explained by greater intakes of ‘low-fitness’ recruits.