scholarly journals Poor Motor Coordination Elicits Altered Lower Limb Biomechanics in Young Football (Soccer) Players: Implications for Injury Prevention through Wearable Sensors

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4371
Author(s):  
Stefano Di Paolo ◽  
Stefano Zaffagnini ◽  
Nicola Pizza ◽  
Alberto Grassi ◽  
Laura Bragonzoni
Keyword(s):  
Injury Prevention ◽  
Lower Limb ◽  
Motor Coordination ◽  
Inertial Sensors ◽  
Cruciate Ligament ◽  
Vertical Jump ◽  
Wearable Sensors ◽  
Acl Injury ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Motor coordination and lower limb biomechanics are crucial aspects of anterior cruciate ligament (ACL) injury prevention strategies in football. These two aspects have never been assessed together in real scenarios in the young population. The present study aimed to investigate the influence of motor coordination on lower limb biomechanics in young footballers during an on-the-pitch training. Eighteen juvenile football players (10 y ± 2 m) were enrolled. Each player performed a training drill with sport-specific movements (vertical jump, agility ladders, change of direction) and the Harre circuit test (HCT) to evaluate players’ motor coordination. Wearable inertial sensors (MTw Awinda, Xsens) were used to assess lower limb joint angles and accelerations. Based on the results of the HCT, players were divided into poorly coordinated (PC) and well-coordinated (WC) on the basis of the literature benchmark. The PC group showed a stiffer hip biomechanics strategy (up to 40% lower flexion angle, ES = 2.0) and higher internal-external hip rotation and knee valgus (p < 0.05). Significant biomechanical limb asymmetries were found only in the PC group for the knee joint (31–39% difference between dominant and non-dominant limb, ES 1.6–2.3). Poor motor coordination elicited altered hip and knee biomechanics during sport-specific dynamic movements. The monitoring of motor coordination and on-field biomechanics might enhance the targeted trainings for ACL injury prevention.

Effect of Fatigue Protocols on Lower Limb Neuromuscular Function and Implications for Anterior Cruciate Ligament Injury Prevention Training: A Systematic Review

2017 ◽  
Vol 45 (14) ◽  
pp. 3388-3396 ◽  
Author(s):  
Sue D. Barber-Westin ◽  
Frank R. Noyes
Keyword(s):  
Systematic Review ◽  
Injury Prevention ◽  
Lower Limb ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Inclusion Criteria ◽  
Acl Injuries ◽  
Prevention Training ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Background: Approximately two-thirds of anterior cruciate ligament (ACL) tears are sustained during noncontact situations when an athlete is cutting, pivoting, decelerating, or landing from a jump. Some investigators have postulated that fatigue may result in deleterious alterations in lower limb biomechanics during these activities that could increase the risk of noncontact ACL injuries. However, prior studies have noted a wide variation in fatigue protocols, athletic tasks studied, and effects of fatigue on lower limb kinetics and kinematics. Purpose: First, to determine if fatigue uniformly alters lower limb biomechanics during athletic tasks that are associated with noncontact ACL injuries. Second, to determine if changes should be made in ACL injury prevention training programs to alter the deleterious effects of fatigue on lower limb kinetics and kinematics. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature using MEDLINE was performed. Key terms were fatigue, neuromuscular, exercise, hop test, and single-legged function tests. Inclusion criteria were original research studies involving healthy participants, use of a fatigue protocol, study of at least 1 lower limb task that involved landing from a hop or jump or cutting, and analysis of at least 1 biomechanical variable. Results: Thirty-seven studies involving 806 athletes (485 female, 321 male; mean age, 22.7 years) met the inclusion criteria. General fatigue protocols were used in 20 investigations, peripheral protocols were used in 17 studies, and 21 different athletic tasks were studied (13 single-legged, 8 double-legged). There was no consistency among investigations regarding the effects of fatigue on hip, knee, or ankle joint angles and moments or surface electromyography muscle activation patterns. The fatigue protocols typically did not produce statistically significant changes in ground-reaction forces. Conclusion: Published fatigue protocols did not uniformly produce alterations in lower limb neuromuscular factors that heighten the risk of noncontact ACL injuries. Therefore, justification does not currently exist for major changes in ACL injury prevention training programs to account for potential fatigue effects. However, the effect of fatigue related to ACL injuries is worthy of further investigation, including the refinement of protocols and methods of analysis.

scholarly journals The Use of Augmented Information for Reducing Anterior Cruciate Ligament Injury Risk During Jump Landings: A Systematic Review

2018 ◽  
Vol 53 (9) ◽  
pp. 844-859
Author(s):  
Cortney N. Armitano ◽  
Justin A. Haegele ◽  
Daniel M. Russell
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Injury Prevention ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Prevention Programs ◽  
Factors Associated ◽  
Methodologic Quality ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Context:  A comprehensive systematic review of the literature on the use of augmented information in anterior cruciate ligament (ACL) injury-prevention programs to improve jump-landing technique was conducted. The use of motor-learning concepts could provide more robust means of preventing ACL injuries. Objective:  To systematically summarize the effectiveness of augmented information in improving the biomechanical factors associated with an increased risk for ACL injury. Data Sources:  Articles were retrieved using the electronic databases of PubMed, MEDLINE, CINAHL, and Google Scholar and 3 lines of truncated search words: (a) lower extremity, knee, ACL, and anterior cruciate ligament; (b) prevention, injury prevention, and prehab; and (c) augmented information, augmented feedback, feedback, cue, and instruction. We also performed a hand search of the reference lists of the screened articles. Data Extraction:  We independently assessed the methodologic quality using the Cochrane Group on Screening and Diagnostic Test Methods list. Articles were placed in 1 of 3 augmented-information categories: prescriptive, feedback, or transition. Articles were also categorized based on whether the information likely encouraged an internal or external focus of attention. Data Synthesis:  The searches identified a total of 353 studies, of which 18 were included. Most researchers found that augmented information could lead to technique changes to reduce the biomechanical risk factors associated with ACL injury. The average methodologic quality of the studies was 11.8 out of 17, with a range from 8 to 15. The authors of only 7 studies examined retention of the improved techniques. Conclusions:  The evidence suggests that augmented information can be used to significantly improve the biomechanical indicators associated with ACL injury and to enhance current ACL injury-prevention programs. Combined prescriptive and feedback information that encouraged both internal and external foci led to the largest retention effect sizes.

scholarly journals Latest Trends in Neuromuscular Training to Prevent Anterior Cruciate Ligament Injury: A Literature Review

2021 ◽  
Vol 30 (4) ◽  
pp. 412-418
Author(s):  
Kwang-Jin Lee ◽  
Keun-Ok An
Keyword(s):  
Injury Prevention ◽  
Prevention Program ◽  
Training Programs ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Neuromuscular Training ◽  
Warm Up ◽  
Injury Prevention Program ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

PURPOSE: Anterior cruciate ligament (ACL) injuries are the most common in sports and have doubled in the past 20 years. This study aimed to analyze the latest trends and changes in training programs for ACL injury prevention.METHODS: In this study, literature was searched using academic search sites, such as ‘PubMed’, ‘Google Scholar’, and ‘Wiley Online Library’. The literature published between 2015 and 2021 was used.RESULTS: Eleven papers were selected based on the literature selection criteria. Five warm-up exercise papers and six ACL injury prevention training program papers emphasized neuromuscular training.CONCLUSIONS: The ACL injury prevention program can be applied in warm-up exercises and training programs. It consists of an exercise form that includes multidimensional components such as plyometrics, muscle strength, balance, and agility. The key to the ACL injury prevention program is to reflect multidimensional components in neuromuscular training and to obtain a significant effect, and it is recommended to participate in regular training for 12-18 sessions and at least 6 months. In addition, it is suggested to utilize the ACL injury prevention program presented in this study until an individual study for ACL injury prevention by sports type is conducted.

scholarly journals Anterior cruciate ligament injury: towards a gendered environmental approach

2021 ◽  
pp. bjsports-2020-103173
Author(s):  
Joanne L Parsons ◽  
Stephanie E Coen ◽  
Sheree Bekker
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Prevention ◽  
Cruciate Ligament ◽  
Injury Rate ◽  
Acl Injury ◽  
Ligament Injury ◽  
Sex And Gender ◽  
Anterior Cruciate ◽  
And Gender ◽  
Acl Injury Prevention

BackgroundThe anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3–6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are ‘entangled’ and influence each other.ObjectiveThis paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment.ApproachWe draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field.ConclusionOver 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable ‘entanglement’ of sex and gender, and inform more effective approaches to ACL injury prevention and treatment.

scholarly journals Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2331
Author(s):  
Stefano Di Paolo ◽  
Nicola Francesco Lopomo ◽  
Francesco Della Villa ◽  
Gabriele Paolini ◽  
Giulio Figari ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Excellent Agreement ◽  
High Speed ◽  
Cruciate Ligament ◽  
Wearable Sensors ◽  
Return To Sport ◽  
Acl Injury ◽  
Wearable Sensor ◽  
Anterior Cruciate ◽  
Full Body

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.

scholarly journals Biomechanically-Informed Training: The Four Pillars for Knee and ACL Injury Prevention Built Upon Behavior Change and Motivation Principles

2020 ◽  
Vol 10 (13) ◽  
pp. 4470
Author(s):  
Cyril J. Donnelly ◽  
Ben S. Jackson ◽  
Daniel F. Gucciardi ◽  
Jeff Reinbolt
Keyword(s):  
Behavior Change ◽  
Injury Prevention ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Musculoskeletal Injury ◽  
Rehabilitation Outcomes ◽  
Anterior Cruciate ◽  
Physics Based Simulation ◽  
And Behavior

Injury prevention frameworks are critical for preventing musculoskeletal injury and improving rehabilitation outcomes. However, their relative successes in translation arguably rely on two interlinked components: (1) the quality of the empirical evidence used to develop the intervention (content), and (2) the effective application of behavior change and motivation principles to optimise participant adherence and engagement (delivery). The purpose of this commentary is to develop an injury prevention and rehabilitation framework using the best available physics-based simulation, biomechanics, and behavior change research. The intervention as a whole is entitled biomechanically-informed training (BIT). While investigators have previously examined the relative merits of different training genres (e.g., plyometric, balance, resistance), what makes BIT novel is that it explicitly targets the biomechanical mechanisms that mitigate musculoskeletal injury risk (i.e., force) in ways that are underpinned by established behavior change principles. The four pillars of BIT refer to focused exercise use, irrespective of the training genre, to improve an individual’s: (1) knee flexion dynamics, (2) dynamic trunk control, (3) gastrocnemius muscle strength, and (4) hip muscular strength. We also present experimental data from two independent training studies verifying the efficacy of BIT for the prevention of knee and anterior cruciate ligament (ACL) injury.

scholarly journals Implementing ACL Injury Prevention in Daily Sports Practice—It’s Not Just the Program: Let’s Build Together, Involve the Context, and Improve the Content

2021 ◽  
Author(s):  
Anne Benjaminse ◽  
Evert Verhagen
Keyword(s):  
Injury Prevention ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Health Impact ◽  
Acl Injuries ◽  
Differential Learning ◽  
Implicit Motor Learning ◽  
Prevention Programmes ◽  
The Individual ◽  
Acl Injury Prevention

AbstractAlthough the benefits of current anterior cruciate ligament (ACL) injury prevention programmes have been demonstrated in efficacy studies, they, unfortunately, have had limited public health impact to date. For example, the incidence of ACL injuries continues to rise in adolescent athletes. Raising awareness and educating coaches and athletes is not enough to facilitate the widespread, sustained use of these programmes in the real-world setting. Considering the profound burden of ACL injuries, it is necessary to continue to improve the current ACL injury prevention programmes through co-creation. First, the uptake of the programmes should be optimized by a better appreciation and understanding of the individual, socio-cultural and environmental context (i.e., community). Second, the content of the programmes should be optimized to better reflect the demands of the sport by creating more ownership and increasing motivation (incorporating challenging, sport-specific and fun elements) with the end-users. In addition, implicit motor learning, random practice and differential learning are concepts that should be integrated when practising to obtain the most optimal results when learning or finetuning skills.

scholarly journals The Effect of External Focus Attention Exercise On the Kinetic Risk Factors Associated With ACL Injury

2021 ◽  
Vol 10 (3) ◽  
pp. 470-485
Author(s):  
Nazanin Dalvandpour ◽  
◽  
Mostafa Zarei ◽  
Behrouz Abdoli ◽  
Hamed Abbasi ◽  
...  
Keyword(s):  
Injury Prevention ◽  
Ground Reaction Force ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Acl Injury ◽  
Control Group ◽  
External Focus ◽  
Time To Stabilization ◽  
Internal Focus ◽  
Anterior Cruciate

Background and Aims One of the most common and dangerous injuries in sports is an Anterior Cruciate Ligament (ACL) injury. Today, despite the ACL injury prevention programs, the prevalence of this injury remains high. Most of the instructions used in injury prevention programs are based on internal focus, while studies have shown that using external focus can improve performance in individuals. The purpose of this study was to investigate the effect of focus of attention on eight weeks of anterior cruciate ligament injury prevention training on landing skill kinetic variables in soccer players. Methods The current methodology included 35 players from 3 premier league teams in Tehran province. The teams were randomly divided into three groups of Prevent injury and Enhance Performance (PEP) exercises based on the External Focus (EF) (12 people), Internal Focus (IF) (12 people), and control group (11 people). In the pretest of ground reaction force, rate of loading, and time to stabilization during landing skill. The training groups performed pep injury prevention exercises for eight weeks and related instructions instead of warm-up exercises. Control group players were performing the regular activities. ANOVA with repeated measures and one-way ANOVA and Tukey post hoc tests were used to evaluate changes Results The test results showed significant changes in vertical, anterior-posterior ground reaction force and rate of loading in the external focus group (P≤0.05). But there was no critical difference in time to stabilization and internal-external ground reaction force. Conclusion According to the results, external focus instruction has positive effects on kinetic components. Therefore, it is recommended that exercises based on these instructions be used to reduce the risk of ACL injury and to repair this injury.

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