scholarly journals What Is the Most Effective Training Approach for Preventing Noncontact ACL Injuries in High School–Aged Female Athletes?

2019 ◽  
Vol 28 (1) ◽  
pp. 94-98 ◽  
Author(s):  
Erica M. Willadsen ◽  
Andrea B. Zahn ◽  
Chris J. Durall
Keyword(s):  
Knee Flexion ◽  
Female Athletes ◽  
Balance Training ◽  
Core Stability ◽  
Knee Valgus ◽  
Plyometric Training ◽  
Acl Injuries ◽  
Training Approach ◽  
Effective Training ◽  
Stability Training

Clinical Scenario: A variety of training approaches have been adopted in anterior cruciate ligament (ACL) prevention programs, including neuromuscular control training, core stability training, balance training, and plyometric exercise. This review was conducted to determine if current evidence supports one of these training approaches over the others for reducing noncontact ACL injuries in adolescent female athletes. Focused Clinical Question: What is the most effective training approach for preventing noncontact ACL injuries in adolescent and/or high school–aged female athletes? Summary of Key Findings: A literature search generated 2 level 1b randomized control trials and 1 level 2b cohort study. Plyometric training resulted in decreased knee valgus during landing in 3 studies and increased knee flexion at landing in 2 studies. Balance training or neuromuscular training led to decreased knee valgus and increased knee-flexion angles with landing in 2 studies. Core stability training had conflicting effects on knee valgus and knee-flexion angles at landing, with 1 study reporting no effect and another reporting an undesirable decrease in knee joint flexion angle at landing. Clinical Bottom Line: Based on this review, plyometric training, balance training, and neuromuscular training approaches appear sensible to include in ACL prevention programs for female athletes to help decrease knee valgus and knee flexion during landing. Core stability training may be somewhat beneficial for decreasing knee valgus angles at landing, although may have nominal or even deleterious effects on knee-flexion angle at landing, and thus should be implemented with caution. Strength of Recommendation: Our recommendations were derived from the results of 2 level 1b randomized control trials and 1 level 2b cohort study.

scholarly journals Different Exercise Training Interventions and Drop-Landing Biomechanics in High School Female Athletes

2013 ◽  
Vol 48 (4) ◽  
pp. 450-462 ◽  
Author(s):  
Kate R. Pfile ◽  
Joseph M. Hart ◽  
Daniel C. Herman ◽  
Jay Hertel ◽  
D. Casey Kerrigan ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Internal Rotation ◽  
Confidence Intervals ◽  
Knee Flexion ◽  
Female Athletes ◽  
Neuromuscular Control ◽  
Core Stability ◽  
Neuromuscular Training ◽  
Control Group

Context: Anterior cruciate ligament (ACL) injuries are common in female athletes and are related to poor neuromuscular control. Comprehensive neuromuscular training has been shown to improve biomechanics; however, we do not know which component of neuromuscular training is most responsible for the changes. Objective: To assess the efficacy of either a 4-week core stability program or plyometric program in altering lower extremity and trunk biomechanics during a drop vertical jump (DVJ). Design: Cohort study. Setting: High school athletic fields and motion analysis laboratory. Patients or Other Participants: Twenty-three high school female athletes (age = 14.8 ± 0.8 years, height = 1.7 ± 0.07 m, mass = 57.7 ± 8.5 kg). Intervention(s): Independent variables were group (core stability, plyometric, control) and time (pretest, posttest). Participants performed 5 DVJs at pretest and posttest. Intervention participants engaged in a 4-week core stability or plyometric program. Main Outcome Measure(s): Dependent variables were 3-dimensional hip, knee, and trunk kinetics and kinematics during the landing phase of a DVJ. We calculated the group means and associated 95% confidence intervals for the first 25% of landing. Cohen d effect sizes with 95% confidence intervals were calculated for all differences. Results: We found within-group differences for lower extremity biomechanics for both intervention groups (P ≤ .05). The plyometric group decreased the knee-flexion and knee internal-rotation angles and the knee-flexion and knee-abduction moments. The core stability group decreased the knee-flexion and knee internal-rotation angles and the hip-flexion and hip internal-rotation moments. The control group decreased the knee external-rotation moment. All kinetic changes had a strong effect size (Cohen d > 0.80). Conclusions: Both programs resulted in biomechanical changes, suggesting that both types of exercises are warranted for ACL injury prevention and should be implemented by trained professionals.

scholarly journals Instruction and Jump-Landing Kinematics in College-Aged Female Athletes Over Time

2013 ◽  
Vol 48 (2) ◽  
pp. 161-171 ◽  
Author(s):  
Jena Etnoyer ◽  
Nelson Cortes ◽  
Stacie I. Ringleb ◽  
Bonnie L. Van Lunen ◽  
James A. Onate
Keyword(s):  
Lower Extremity ◽  
Retention Test ◽  
Knee Flexion ◽  
Female Athletes ◽  
Initial Contact ◽  
Knee Valgus ◽  
Drop Jump ◽  
Jump Landing ◽  
Peak Knee ◽  
Hip Flexion

Context: Instruction can be used to alter the biomechanical movement patterns associated with anterior cruciate ligament (ACL) injuries. Objective: To determine the effects of instruction through combination (self and expert) feedback or self-feedback on lower extremity kinematics during the box–drop-jump task, running–stop-jump task, and sidestep-cutting maneuver over time in college-aged female athletes. Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or Other Participants: Forty-three physically active women (age = 21.47 ± 1.55 years, height = 1.65 ± 0.08 m, mass = 63.78 ± 12.00 kg) with no history of ACL or lower extremity injuries or surgery in the 2 months before the study were assigned randomly to 3 groups: self-feedback (SE), combination feedback (CB), or control (CT). Intervention(s): Participants performed a box–drop-jump task for the pretest and then received feedback about their landing mechanics. After the intervention, they performed an immediate posttest of the box–drop-jump task and a running–stop-jump transfer test. Participants returned 1 month later for a retention test of each task and a sidestep-cutting maneuver. Kinematic data were collected with an 8-camera system sampled at 500 Hz. Main Outcome Measure(s): The independent variables were feedback group (3), test time (3), and task (3). The dependent variables were knee- and hip-flexion, knee-valgus, and hip- abduction kinematics at initial contact and at peak knee flexion. Results: For the box–drop-jump task, knee- and hip-flexion angles at initial contact were greater at the posttest than at the retention test (P < .001). At peak knee flexion, hip flexion was greater at the posttest than at the pretest (P = .003) and was greater at the retention test than at the pretest (P = .04); knee valgus was greater at the retention test than at the pretest (P = .03) and posttest (P = .02). Peak knee flexion was greater for the CB than the SE group (P = .03) during the box–drop-jump task at posttest. For the running–stop-jump task at the posttest, the CB group had greater peak knee flexion than the SE and CT (P ≤ .05). Conclusions: Our results suggest that feedback involving a combination of self-feedback and expert video feedback with oral instruction effectively improved lower extremity kinematics during jump-landing tasks.

scholarly journals Stiff Landings, Core Stability, and Dynamic Knee Valgus: A Systematic Review on Documented Anterior Cruciate Ligament Ruptures in Male and Female Athletes

2021 ◽  
Vol 18 (7) ◽  
pp. 3826
Author(s):  
Joseph Larwa ◽  
Conrad Stoy ◽  
Ross S. Chafetz ◽  
Michael Boniello ◽  
Corinna Franklin
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Core Stability ◽  
Knee Valgus ◽  
Acl Injuries ◽  
Male And Female ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year. ACL injuries occur via contact and non-contact mechanisms, with the former being more common in males and the later being more common in females. These injuries typically require surgical repair and have relatively high re-rupture rates, resulting in a significant psychological burden for these individuals and long rehabilitation times. Numerous studies have attempted to determine risk factors for ACL rupture, including hormonal, biomechanical, and sport- and gender-specific factors. However, the incidence of ACL injuries continues to rise. Therefore, we performed a systematic review analyzing both ACL injury video analysis studies and studies on athletes who were pre-screened with eventual ACL injury. We investigated biomechanical mechanisms contributing to ACL injury and considered male and female differences. Factors such as hip angle and strength, knee movement, trunk stability, and ankle motion were considered to give a comprehensive, joint by joint analysis of injury risk and possible roles of prevention. Our review demonstrated that poor core stability, landing with heel strike, weak hip abduction strength, and increased knee valgus may contribute to increased ACL injury risk in young athletes.

Knee Valgus Versus Knee Abduction Angle: Comparative Analysis of Medial Knee Collapse Definitions in Female Athletes

2020 ◽  
Vol 142 (12) ◽  
Author(s):  
Taylor Oldfather ◽  
Michael Zabala ◽  
Michael Goodlett ◽  
William (Hank) Murrah
Keyword(s):  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Reference Plane ◽  
Abduction Angle ◽  
Knee Valgus ◽  
Acl Injuries ◽  
Valgus Angle ◽  
Anterior Cruciate

Abstract The knee valgus angle (KVA) is heavily researched as it has been shown to correlate to anterior cruciate ligament (ACL) injuries when measured during jumping activities. Many different methods of KVA calculation are often treated as equivalent. The purpose of this study is to elucidate differences between these commonly used angles within and across activities to determine if they can indeed properly be treated as equivalent. The kinematics of 23 female athletes, D1 soccer, D1 basketball, and club soccer (height = 171.2 ± 88.9 cm, weight = 66.3 ± 8.6 kg, age = 19.8 ± 1.9 years), was analyzed using a motion capture system during activities related to their sport and daily living. The abduction KVA, measured using body fixed axes, only correlated to the two-dimensional (2D) global reference frame angle (KVA 2G) in three of the six activities (walking, squatting, and walking down stairs), and one out of six in the three-dimensional (3D) measurements (jogging). This suggests that the abduction KVA does not always relate to other versions of KVA. The KVA with reference to the pelvis coordinate system (KVA 2P) correlated to the KVA 2G in six out of six activities (r = 0.734  ±  0.037, P << 0.001) suggesting the pelvis can be utilized as a reference plane during rotating tasks, such as run-to-cut, when a fixed global system is less meaningful. Not all measures of KVA are equivalent and should be considered individually. A thorough understanding of the equivalence or nonequivalence of various measures of KVA is essential in understanding ACL injury risk.

scholarly journals Six Weeks of Core Stability Training Improves Landing Kinetics Among Female Capoeira Athletes: A Pilot Study

2015 ◽  
Vol 45 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Simone Araujo ◽  
Daniel Cohen ◽  
Lawrence Hayes
Keyword(s):  
Effect Size ◽  
Repeated Measures ◽  
Injury Risk ◽  
Female Athletes ◽  
Loading Rate ◽  
Core Stability ◽  
Jump Height ◽  
Drop Jump ◽  
Post Intervention ◽  
Stability Training

Abstract Core stability training (CST) has increased in popularity among athletes and the general fitness population despite limited evidence CST programmes alone lead to improved athletic performance. In female athletes, neuromuscular training combining balance training and trunk and hip/pelvis dominant CST is suggested to reduce injury risk, and specifically peak vertical ground reaction forces (vGRF) in a drop jump landing task. However, the isolated effect of trunk dominant core stability training on vGRF during landing in female athletes had not been evaluated. Therefore, the objective of this study was to evaluate landing kinetics during a drop jump test following a CST intervention in female capoeira athletes. After giving their informed written consent, sixteen female capoeira athletes (mean ± SD age, stature, and body mass of 27.3 ± 3.7 years, 165.0 ± 4.0 cm, and 59.7 ± 6.3 kg, respectively) volunteered to participate in the training program which consisted of static and dynamic CST sessions, three times per week for six weeks. The repeated measures T-test revealed participants significantly reduced relative vGRF from pre- to post-intervention for the first (3.40 ± 0.78 vs. 2.85 ± 0.52 N·NBW-1, respectively [p<0.05, effect size = 0.60]), and second landing phase (5.09 ± 1.17 vs. 3.02 ± 0.41 N·NBW-1, respectively [p<0.001, effect size = 0.87]). The average loading rate was reduced from pre- to post-intervention during the second landing phase (30.96 ± 18.84 vs. 12.06 ± 9.83 N·NBW·s-1, respectively [p<0.01, effect size = 0.68]). The peak loading rate was reduced from pre- to postintervention during the first (220.26 ± 111.51 vs. 120.27 ± 64.57 N· NBW·s-1 respectively [p<0.01, effect size = 0.64]), and second (99.52 ± 54.98 vs. 44.71 ± 30.34 N· NBW·s-1 respectively [p<0.01, effect size = 0.70]) landing phase. Body weight, average loading rate during the first landing phase, and jump height were not significantly different between week 0 and week 6 (p=0.528, p=0.261, and p=0.877, respectively). This study provides evidence that trunk dominant core stability training improves landing kinetics without improving jump height, and may reduce lower extremity injury risk in female athletes.

scholarly journals Single-Leg Landings Following a Volleyball Spike May Increase the Risk of Anterior Cruciate Ligament Injury More Than Landing on Both-Legs

2020 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Datao Xu ◽  
Xinyan Jiang ◽  
Xuanzhen Cen ◽  
Julien S. Baker ◽  
Yaodong Gu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Ligament Injury ◽  
Time Range ◽  
Acl Injuries ◽  
Volleyball Players ◽  
Anterior Cruciate

Volleyball players often land on a single leg following a spike shot due to a shift in the center of gravity and loss of balance. Landing on a single leg following a spike may increase the probability of non-contact anterior cruciate ligament (ACL) injuries. The purpose of this study was to compare and analyze the kinematics and kinetics differences during the landing phase of volleyball players using a single leg (SL) and double-leg landing (DL) following a spike shot. The data for vertical ground reaction forces (VGRF) and sagittal plane were collected. SPM analysis revealed that SL depicted a smaller knee flexion angle (about 13.8°) and hip flexion angle (about 10.8°) during the whole landing phase, a greater knee and hip power during the 16.83–20.45% (p = 0.006) and 13.01–16.26% (p = 0.008) landing phase, a greater ankle plantarflexion angle and moment during the 0–41.07% (p < 0.001) and 2.76–79.45% (p < 0.001) landing phase, a greater VGRF during the 5.87–8.25% (p = 0.029), 19.75–24.14% (p = 0.003) landing phase when compared to DL. Most of these differences fall within the time range of ACL injury (30–50 milliseconds after landing). To reduce non-contact ACL injuries, a landing strategy of consciously increasing the hip and knee flexion, and plantarflexion of the ankle should be considered by volleyball players.

scholarly journals Differences in strength and landing biomechanics between female jumpers and swimmers

2021 ◽  
pp. 1-11
Author(s):  
Mianfang Ruan ◽  
Qiang Zhang ◽  
Xin Zhang ◽  
Jing Hu ◽  
Xie Wu
Keyword(s):  
Muscle Force ◽  
Female Athletes ◽  
Young Female ◽  
Single Component ◽  
Plyometric Training ◽  
Isokinetic Testing ◽  
Female College ◽  
Landing Biomechanics ◽  
Drop Landing ◽  
Landing Mechanics

BACKGROUND: It remains unclear if plyometric training as a single component could improve landing mechanics that are potentially associated with lower risk of ACL injury in the long term OBJECTIVE: The purpose of this study was to investigate the influence of experience undertaking plyometrics on landing biomechanics in female athletes. METHODS: Non-jumpers with little experience in plyometric training (12 female college swimmers) and jumpers with five years of experience in plyometric training (12 female college long jumpers and high jumpers) were recruited to participate in two testing sessions: an isokinetic muscle force test for the dominant leg at 120∘/s and a 40-cm drop landing test. An independent t test was applied to detect any significant effects between cohorts for selected muscle force, kinematic, kinetic, and electromyography variables. RESULTS: While female jumpers exhibited greater quadriceps eccentric strength (P= 0.013) and hamstring concentric strength (P= 0.023) during isokinetic testing than female swimmers, no significant differences were observed in kinematics, kinetics, and muscle activities during both drop landing and drop jumping. CONCLUSIONS: The results suggest that the female jumpers did not present any training-induced modification in landing mechanics regarding reducing injury risks compared with the swimmers. The current study revealed that plyometric training as a single component may not guarantee the development of low-risk landing mechanics for young female athletes.

Hip and ankle strength and range of motion in female soccer players with dynamic knee valgus

2021 ◽  
pp. 1-6
Author(s):  
Young Jin Jo ◽  
Young Kyun Kim
Keyword(s):  
Range Of Motion ◽  
Female Athletes ◽  
External Rotation ◽  
Preventive Measure ◽  
Control Group ◽  
Knee Valgus ◽  
Strength Ratio ◽  
Flexion Extension ◽  
Hip Abduction ◽  
Single Leg Squat

BACKGROUND: Dynamic knee valgus (DKV) is a known risk factor for acute and chronic knee injuries and is more frequently diagnosed in females. A real-time single-leg squat test (SLST) could screen for DKV to prevent injuries. OBJECTIVE: To compare the differences in lower extremity strength and range of motion (ROM) in female soccer athletes with and without DKV during an SLST. METHODS: Eighteen subjects with DKV (DKV group) and 18 subjects without DKV (control group) during a single-leg squat were included. Hip strength (flexion, extension, abduction, adduction, internal rotation, and external rotation) was measured with a hand-held dynamometer. Hip ROM (internal and external rotation), and ankle ROM (dorsiflexion with the knee flexed and extended) were measured. Independent t-test was used to compare the averages of the groups. RESULTS: There were significant differences in hip abduction to adduction strength ratio (DKV: 1.48 ± 0.3, control: 1.22 ± 0.26, p< 0.01) and ankle dorsiflexion with knee flexed (DKV: 17.22 ± 6.82, control: 21.22 ± 4.55, p< 0.05) and extended (DKV: 10.14 ± 4.23, control: 14.75 ± 3.40, p< 0.001) between the groups. CONCLUSION: The hip abduction to adduction strength ratio and gastrocnemius and soleus flexibility may be associated factors in dynamic knee valgus and therefore should be assessed and treated, if indicated, as a possible preventive measure in female athletes with this variation.

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