Abstract / Summary
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 organizations) during recruit training. DESIGN: Intervention systematic review with meta-analysis. 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: Studies were included if they were quasi-experimental and randomized 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 (Log OR) and 95% confidence intervals (CI). RESULTS: Thirty-three studies (n = 49,062 participants) were included, and outcomes were of very low-certainty. Neuromuscular training interventions delivered during recruit training reduced medical-attention injuries (Log OR = 0.520, 95% CI = 0.226 to 0.815), but not attrition (Log OR = 0.525, 95% CI = -0.292 to 1.342). Neuromuscular training interventions delivered before commencing recruit training did not reduce medical-attention injuries (Log OR = 0.487, 95% CI = -2.216 to 3.190) but could have significantly increased attrition (Log OR = -0.982, 95% CI = -1.874 to -0.090). Training load management interventions did not reduce medical-attention injuries (Log OR = 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. J Orthop Sports Phys Ther 2026;56(10):642-656. Epub 18 August 2026. doi:10.2519/jospt.2026.14272.