Based on relative burden, the focus of much of the evidence surrounding injury prevention in youth sport has been on reducing the risk of lower extremity injuries and concussions. Until the past decade, there has been a relative paucity of scientifically rigorous evaluation studies examining the efficacy of injury prevention strategies in youth sport [32, 33]. Historically, epidemiological research focused on the evaluation of prevention strategies in elite adult amateur and professional athlete populations where injury surveillance practice was established more commonly with the presence of medical staff within the sport structure [32, 33]. As a result, previous recommendations for injury prevention practice in youth sport have relied heavily on studies in adult elite sport populations [32, 33].

Injury prevention strategies may be developed to target intrinsic risk factors including previous injury, decreased strength, endurance, flexibility, and neuromuscular control including balance. Alternatively, prevention strategies may be developed to address extrinsic risk factors including changes in the rules of the sport and protective equipment. To inform this book chapter, the literature evaluating injury prevention strategies in youth sport has been systematically reviewed and has demonstrated an increasing body of literature in the youth athlete population. Studies selected and summarized in Table 15.2 included only studies which (1) were based on original data with full-text paper published; (2) included only youth sport participants under age 19; (3) evaluated an injury prevention intervention with a primary outcome of sport injury; (4) study design was prospective and included randomized controlled trials (RCT), quasi-experimental, or cohort designs. In addition, review articles are also considered. In total, 31 studies have been identified and categorized by sport (Table 15.2) [34–64]. Seventeen studies are RCTs with the remainder being primarily quasi-experimental (non-randomized experimental design) and cohort studies [34–64]. The studies included are in youth soccer (11), ice hockey (2), European handball (3), American Football (3), basketball (2), rugby (1), Australian football (1), baseball (1), multisport (5), and school physical education (2). A diversity of at risk sport-specific and school-based youth sport populations have been targeted for injury prevention strategy evaluations. The greatest proportion of these strategies have targeted modifiable intrinsic risk factors (e.g., strength, endurance, balance) through exercise interventions, primarily neuromuscular training interventions [34–44, 47–51, 53, 54, 56, 58–61, 63, 64]. In addition, extrinsic risk factors have been addressed through rule modification [45, 46] and equipment strategies [52, 55, 57, 62] in some youth sports. Additionally, 17 review articles (including systematic reviews and meta-analyses) and relevant studies in adult populations and studies using retrospective (case-control or historical cohort) or cross-sectional designs are discussed [32, 33, 65–91].