Effectiveness of Neuromuscular Training and Training Load Management Interventions for Reducing Injury and Attrition in Tactical Recruits: A Systematic Review With Meta-Analysis

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OBJECTIVE: To estimate the effectiveness of neuromuscular training and training load management interventions for reducing injury and attrition in tactical personnel (military, law enforcement, and other first responder organisations) during recruit training. DESIGN: Systematic review with meta-analysis of intervention studies. LITERATURE SEARCH: PubMed, CINAHL Plus with full text, EMBASE, CENTRAL, Web of Science, and SPORTDiscus were searched from January 1, 2000, to March 14, 2025. STUDY SELECTION CRITERIA: Quasi-experimental and randomised controlled trials examining neuromuscular training interventions conducted during or before commencing recruit training, or with training load management interventions, on medical-attention and time-loss injuries, and attrition, in tactical recruits aged at least 16 years. DATA SYNTHESIS: Inverse-variance, random effects meta-analyses provided Log Odds Ratio (OR) and 95% confidence intervals (CI). RESULTS: Thirty-three studies (n = 49,062) were included, and outcomes were of very-low certainty evidence. Neuromuscular training interventions during recruit training reduced medical-attention 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 did not reduce medical-attention injuries (LogOR = 0.487, 95%CI = −2.216 to 3.190) but could have significantly increased attrition (LogOR = −0.982, 95%CI = −1.874 to −0.090). Training load management interventions did not reduce medical-attention injuries (LogOR = 0.286, 95%CI = −0.183 to 0.755). CONCLUSION: Neuromuscular training interventions during recruit training may reduce medical-attention injury probability, without increasing attrition. The lack of specificity and progressive overload for included interventions may have limited further protective effects against injury. Delivering neuromuscular training interventions before commencing recruit training may increase attrition during recruit training, without affecting injury probability. However, findings should be interpreted cautiously due to the very-low certainty of the evidence.

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