Introduction: Ankle injuries are consistently one of the most common injuries in junior Australian Football (AF). Injury prevention programs have been successful in reducing ankle injuries in similar sporting codes; however, there is a need to explore whether such programs are effective in a junior AF environment. The aim of this study was to evaluate the implementation of an ankle injury risk reduction program in junior AF athletes. Methods: 214 healthy elite junior male (15-18 years) AF athletes from four clubs competing in a state level under-18 competition participated. The study was a non-randomised control trial using historical club control data from 2015-2021 for comparison. The program started in the pre-season and consisted of balance, agility and sport-specific exercises that increased in difficulty and intensity throughout the season. Club medical staff reported injuries that resulted in a missed game. Injury burden was the product of injury incidence (number of ankle injuries) and severity (missed games per ankle injury). Players performed a multiple hop test (MHT) at the start and end of preseason, and conclusion of the regular season to assess ankle function and stability. Program implementation was evaluated via exit interviews with club strength and conditioning coaches and exit surveys with players. Results: There were 12 new ankle injuries in the 2022 season compared to a mean of 12.5/season in the control years (IRR = 0.9 [95% CI = 0.5-1.7]; p=0.732). The burden in the 2022 season was 56 missed games compared to 40.5 missed games/season in the control years (IRR=1.6; 95% CI=0.8-3; P=0.159). There was a significant positive effect on ankle function and stability across the season (Hedge`s g range = 0.54-0.75; all p<0.05). Club strength and conditioning coaches perceived the program was important and beneficial, however, player adherence and engagement were commonly reported issues. 89% of players agreed that the program was a valuable use of training time, and 91% perceived their ankle stability improved by the end of the season. Discussion: Contrary to the success reported for similar programs in other sports, our findings demonstrated no significant difference in ankle injury incidence or burden between the control and intervention periods. It is not possible to determine whether improvements in ankle stability and function are due to the program, seasonal changes over time, or learning effects. The intervention program was largely seen as positive based on feedback from players and coaches, however, there were some recommendations made by coaches that should be considered in future versions of the program to improve adherence and engagement. Impact/Application to the field: Junior AF players and strength and conditioning coaches value the inclusion of targeted ankle injury prevention exercises in their regular training to improve ankle stability and function. However, this strategy alone does not translate to reduced ankle injury incidence and burden. Other injury prevention strategies specific to junior AF should be explored and a revised approach is likely required to address the multi-factorial nature of ankle injuries in AF.
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