Every year, Denmark spends around 40 million DKK on emergency room visits due to
sports injuries. Soccer is the most popular branch of sport and especially the knee is
at risk for injuries. It is of interest to prevent injuries in all age groups but especially
for adolescents due to the risk of early complications such as osteoarthritis in the knee.
Therefore, there is a need for reducing knee injuries in this age group, which can be done
effectively through warm-up programs. For example, a study shows a reduction in the
number of injuries by 46 % in soccer, handball and basketball combined by implementing
a warm-up program. The implementation is not straightforward, and problems occur in
the implementation of warm-up programs. The literature suggests that persistence to the
program results in a higher reduction.
The aim of this project is, therefore, to investigate whether a warm-up program is
cost-effective compared to no warm-up program in one year seen from a healthcare sector
perspective in adolescent soccer players with acute knee injuries and to investigate how a
warm-up program can be implemented.
The method used to determine the cost-effectiveness of a warm-up program is a
decision tree considering both the costs and effects from the literature. Interviews coupled
with classic implementation theory are used to investigate how a warm-up program can
be implemented.
The results shows that a warm-up program is cost-effective compared to no warmup
program with a saving of 310 DKK per player per year and a gain of 0,41 in the
International Knee Documentation Committee (IKDC) score. The probabilistic sensitivity
analysis shows that the warm-up program will be both less costly and more effective in
79,81% of the cases. Furthermore, it is seen that the healthcare sector can grant up to 16
hours of physiotherapy before the conclusion will change. According to the implementation
theory, it is important that the recipients start by seeing the need for change, which can
be done by considering the number of injuries in the sports club but it is important to
note that it is not all clubs who have the resources to change. Second, the implementation
process should include obtaining knowledge of the warm-up program, but it can be difficult
to take this knowledge. Furthermore, coaches often do not have the time to take courses in
the warm-up techniques. In the second step, the responsibility is placed and overall it is the
coach who has the responsibility for using and implementing the warm-up program, but
the player and the club also have a part of the responsibility. Third, the future state of the
club should be investigated which can be done through strength and weaknesses of a warmup
program. Especially, a strength is the reduction of injuries. The recognisability of the
program is both a strength and a weakness. Recognisability gives the coaches extra time in warming up, but it can remove the motivation, and 20 minutes is a long time to warm
up. It is suggested to vary some of the exercises. Overall it is thought that the strengths
can counterbalance the weaknesses. Fourth, it is suggested that the implementation should
start on one team and hereafter spread out to the club. At last, it is important to be clear
about the goal for having a warm-up program otherwise the motivation from the coach
and the players can drop.
Whether the costs for a warm-up program should be included can be discussed and
studies have not included them, but it is out of the health-care-sector perspective. A
strength in the model is that the probability of injury is calculated on the basis of four
studies. The probability for the different types of knee injuries is calculated on the basis
of one study which can be seen as a weakness and more literature could reduce the
uncertainties. The number of interviews and whether it is the right people who have been
interviewed can also be discussed. However, it is thought that more interviews would
not give another conclusion. Suggestions for implementation of a warm-up program is
presented in the project and it can be discussed whether it actually is the coach who
has the responsibility. The results from this project should be presented in different ways
dependent on the recipient, but overall everybody that works with or is playing soccer can
use the knowledge from this project.
It can be concluded that a warm-up program is cost-effective compared to no warmup
program in one year seen from a healthcare perspective. Several aspects should be
considered when implementing a warm-up program, among others who is responsible.