Dual benefits of neuromuscular training in adolescent volleyball players: knee injury prevention and athletic performance share a common mechanistic foundation: a structured narrative review

Adolescent volleyball players face elevated knee injury risk. Anterior cruciate ligament (ACL) injuries and patellar tendinopathy are the two dominant conditions. Approximately 62% of ACL injuries occur during spike landings. During peak height velocity (PHV), patellar tendon strain reaches 7.6%-8.5%, approaching the microstructural damage threshold of 9.0%. This review evaluated whether neuromuscular training (NMT) reduces biomechanical injury risk and improves athletic performance. Multimodal NMT reduced overall injury rates by 40% and halved ACL injury risk (OR=0.54). The protective effect was strongest in females aged 14-18 (OR=0.28) and absent above age 18. NMT also improved vertical jump height (Cohen's d = 0.82) and dynamic stability (SMD = 0.63). Female players showed greater jump gains than males (ES = 1.3 vs. 0.5). Injury prevention and performance benefits share the same mechanistic foundation. Optimal dosing is 15-20 min per session, two to three times per week, for at least eight weeks. Maturity-stratified load management is essential for circa-PHV athletes. Volleyball-specific, maturity-indexed RCTs are needed to confirm these findings.