Abstract
Introduction
Despite the existence of various injury mitigation programmes (IMPs), there have not yet been
studies conducted which investigate the efficacy of Virtual Reality (VR) warm-up routines to
reduce risk of injury. This study aimed to investigate which intervention (FIFA11+S or VR) would
improve Functional Movement Screening (FMS) and Y Balance Test Upper Quarter (YBT-UQ)
scores, thereby reducing the risk of injury among adult tennis players.
Methodology
This randomised control trial (RCT) compares a VR warm-up routine with the FIFA11+S warm
up routine and a Control Group to ascertain which may have the greatest effect on FMS and YBTUQ
outcomes in a tennis-specific context. A mixed-methods RCT was conducted with three
groups: a Control Group (CG), a Resistance Band (FIFA11+S) group and a VR group. Each group
participated in a four-week long intervention. The FMS and YBT-UQ were used to measure
functional movement and upper quarter flexibility before and after the intervention. Quantitative
data were analysed using Shapiro-Wilk tests, Cohen's d and Kruskal-Wallis H tests, while
qualitative data were collected from the VR group through a series of open-ended questions.
Exercise adherence in the FIFA11+S group was determined using the Exercise Adherence Rating
Scale (EARS). Data was processed in SPSS (IBM, Version 29) with a level of significance set at
p<0.05. Additional data analysis was further conducted using Python (Version 3.12.0, Python
Software Foundation) with Jupyter Notebook (Version 7.2). Key libraries used for data
visualisation included Pandas (Version 2.2.2), NumPy (Version 1.25.1) and Matplotlib (Version
3.9.0).
Results
All groups exhibited improvements in their total FMS scores over the four-week intervention. The
FIFA11+S group showed the most significant improvement (+2.71 points), followed by the
Control Group (+1.43 points) and VR group (+1.42 points). However, individual exercise
improvements varied across groups, with the FIFA11+S group demonstrating consistent progress
in most FMS components, while the Control and VR groups showed mixed results, including some
reductions in specific measures. The VR group demonstrated the highest changes in strength
xvi
measures such as SQ (d = 0.9), UC (d = 0.64) and PU (d = 0.82), while the FIFA11+S group
achieved the highest change in mobility measures such as the ASLR (d = 0.81), HS (d = 0.69) and
SM (d = 0.79). The FIFA11+S warm up routine also resulted in the largest TS improvements (d =
1.79).
The YBT-UQ results showed distinct trends across the three groups. The CG exhibited moderate
improvements, with the most notable gains in ML reach. The left side improved by 3.47 cm (d =
0.48), and the right side by 4.32 cm (d = 0.44). Despite minor reductions in the SL reach on the
left side, overall total excursion increased on both the dominant (d = 0.3) and left sides (d = 0.2).
Conversely, the FIFA11+S Group experienced widespread declines, particularly in SL reach,
where the left side decreased by 2.08 cm (d = -0.21) and the right side by 2.22 cm (d = -0.2). This
resulted in a reduced total excursion, especially on the left side (d = -0.26). In contrast, the VR
Group showed consistent improvements, particularly in ML reach on the right side (d = 0.52) and
IF reach on the left side (d = 0.55). Both total excursion scores saw marked increases, with the
right side improving by 17.08 cm (d = 0.32) and the left side by 15.79 cm (d = 0.28).
These results suggest that the FIFA11+S may not be an ideal method to improve upper quarter
reach performance. The VR YBT-UQ results would suggest that performance of a VR warm-up
routine once per week may not significantly contribute to muscle tightening and reductions of
upper quarter mobility when compared to a resistance band programme.
Conclusion
The FIFA11+S was most effective in enhancing FMS scores, while the VR proved superior in
YBT-UQ reach performance. These findings suggest that the FIFA11+S has potential for injury
risk reduction across sports when risk of injury is measured by the FMS screening tool. Meanwhile,
a VR warm-up routine performed with low dosage may result in improvements in cognitive
measures rather than reducing the risk of injury. The results of this study also suggest that
performance in the FMS test does not appear to have an effect on performance of the YBT-UQ
test. These outcome measures ought to be implemented independently. Future studies using larger
sample sizes should be conducted to further study the usage, dose-response and application of VR
as a method for injury risk reduction over a longer intervention period.