What is Neuromuscular Training?

NMT is a dynamic warm-up training method that includes aerobic, balance, strength, and agility exercises to enhance motor programming and prepare the body for functional work. NMT involves training the connection between the muscular and neurological systems to work optimally together to activate our muscles and support joint control and stability. Research has demonstrated a 35-70% reduction in sport and recreation injury rates when NMT warm-up programs were implemented as a coach/teacher-delivered warm-up at the beginning sport sessions and physical education (PE) classes, compared to traditional warm-up programs that typically include only aerobic, static, and dynamic stretching exercises.^1-3

Injury Prevention Through NMT

Each year, an estimated 35% of youth in Alberta sustain an injury requiring medical attention from participating in sport and recreation.^4,5 The implementation of neuromuscular training (NMT) warm-up programs before sport and physical activity has been recommended by the International Olympic Committee consensus statement on youth athlete development as an effective injury prevention strategy for youth sport.⁶

Implementing NMT

Standard of practice includes an NMT warm-up program coach/teacher practical workshop, taught by an NMT warm up program expert. A key to NMT warm-up programs involves a focus on performing the exercises with correct technique and to perform these programs regularly (e.g., ≥3x/week). Static stretching is no longer recommended as the primary focus of injury prevention warm-up programs.

NMT warm-up programs can be implemented as a 10-minute warm-up at the beginning of PE classes. These programs can also be adapted to fit the needs of the school environment including time, age, class size, and PE unit. In a recent study in Canadian junior high schools, students and teachers reported positive attitudes towards implementation of the NMT warm-up at the beginning of their PE classes.⁷

There are different ways to introduce the NMT warm-up program to students for the first time. Teachers who have implemented these warm-ups previously have structured them in different ways:

• students completed the warm-up together as a class,
• students completed the warm-up in stations as smaller groups, or
• the warm-up was facilitated by student leaders.

Some teachers spent a full class period teaching each exercise in detail, allowing for particular focus on correct technique. Others prefer to begin with introducing one new exercise from each category (aerobic, balance, strength, and agility) and adding one additional exercise each day. Partnering students together to observe each other performing the exercises, particularly for the strength and agility components, is an excellent way to incorporate peer learning while helping students develop confidence and self-efficacy in performing the exercises.

With support from available resources such as posters and videos, these warm-up programs can be facilitated in PE classes by generalist teachers and PE specialists alike.

¹ Emery CA, van den Berg C, Richmond SA, Palacios-Derflingher L, McKay CD, Doyle-Baker PK, McKinlay M, Toomey CM, Nettel-Aguirre A, Verhagen E, Belton K, Macpherson A, Hagel BE. Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT). Br J Sports Med. 2019;0:1-8.
² Emery C, Tyreman H. Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools. Paediatr Child Health. 2009;14(7):439-44.
³ Richmond SA, Kang J, Doyle-Baker PK, Nettel-Aguirre A, Emery CA. A school-based injury prevention program to reduce sport injury risk and improve healthy outcomes in youth: a pilot cluster-randomized controlled trial. Clin J Sport Med. 2015;0:1-8.
⁴ Emery CA, Roy T, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015;49:865-870.
⁵ Emery CA, Meeuwisse WH, McAllister JR. Survey of sport participation and sport injury in Calgary and area high schools. Clin J Sport Med. 2006;16(1):20-6.
⁶ Bergeron MF, Mountjoy M, Armstrong N, Chia M, Cote J, Emery CA, Faigenbaum A, Hall G, Kriemler S, Leglise M, Malina RM, Pensgaard AM, Sanchez A, Soligard T, SundgotBorgen J, van Mechelen W, Weissensteinder JR, Engebresten L. International Olympic Committee consensus statement of youth athletic development. Br J Sports Med. 2015;49:843-851.
⁷ Richmond SA, Donaldson A, Macpherson A, Bridel W, van den Berg C, Finch CF, Hagel B, Emery CA. Facilitators and barriers to the implementation of iSPRINT: A sport injury prevention program in junior high schools. Clin J Sport Med. 2018;0:1-8.