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Benjaminse A, Nijmeijer EM, Gokeler A, Broekhaar DC, Cortes N. Motivation Unraveled: Giving Choice to Football Players to Improve Anterior Cruciate Ligament Injury Prevention. J Strength Cond Res 2024:00124278-990000000-00537. [PMID: 39178101 DOI: 10.1519/jsc.0000000000004912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
ABSTRACT Benjaminse, A, Nijmeijer, EM, Gokeler, A, Broekhaar, DC, and Cortes, N. Motivation unraveled: giving choice to football players to improve anterior cruciate ligament injury prevention. J Strength Cond Res XX(X): 000-000, 2024-Providing athletes some control over a training session facilitates motor skill acquisition. This is a promising concept to use in anterior cruciate ligament (ACL) injury prevention, as the key for risk reduction is to improve quality of movement. The goal of this study was to better understand why improved motor learning occurred when football players had the opportunity to choose when to receive feedback when practicing sidestep cutting (SSC) movements. Healthy male recreational football players (n = 22, 22.9 ± 1.7 years, 185.5 ± 7.2 cm, 79.3 ± 9.2 kg) were included and assigned to the self-control (SC) or the yoked (YK) group. The players performed anticipated and unanticipated SSC. They received video instructions and were instructed to "copy the movement of the model to the best of their ability." During the training blocks, the SC group could ask for feedback, whereas the YK group could not. Cutting movement assessment scores (CMAS) were measured to test quality of movement and the Intrinsic Motivation Inventory was administered to measure constructs of motivation. In the anticipated condition, SC group showed better scores in immediate post and the retention test compared with pretest (p < 0.001), whereas the YK group showed worse scores in the retention test compared with immediate posttest (p = 0.001). Perceived competence (p = 0.017) and self-efficacy (p = 0.032) were consistent factors that correlated with improved CMAS in the SC group. This has given us innovative insights into underlying mechanisms optimizing the quality of movement, necessary to improve current ACL injury prevention approaches.
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Affiliation(s)
- Anne Benjaminse
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eline M Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alli Gokeler
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Paderborn University, Paderborn, Germany
- Faculty of Health, Master Performance Sport and Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Dara C Broekhaar
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nelson Cortes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom; and
- Department of Bioengineering, George Mason University, Fairfax, Virginia
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Nijmeijer EM, Kempe M, Elferink-Gemser MT, Benjaminse A. Observe, Practice, and Improve? Enhancing Sidestep Cutting Execution in Talented Female Soccer Players: A Four-Week Intervention Program With Video Instruction. J Strength Cond Res 2024; 38:e430-e439. [PMID: 38662706 PMCID: PMC11286158 DOI: 10.1519/jsc.0000000000004796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
ABSTRACT Nijmeijer, EM, Kempe, M, Elferink-Gemser, MT, and Benjaminse A. Observe, practice and improve? Enhancing sidestep cutting (SSC) execution in talented female soccer players: A four-week intervention program with video instruction. J Strength Cond Res 38(8): e430-e439, 2024-Implicit learning has the potential to improve movement execution and reduce injury risk. Previous research showed beneficial effects of short-term interventions with implicit learning in male athletes. However, research on long-term interventions in female athletes is lacking. The aim of this study was to examine the effects of a 4-week intervention with video instruction on movement execution of SSC, a task that is highly related with anterior cruciate ligament (ACL) injury risk, in female athletes. Twenty talented adolescent female soccer players were part of the control (CTRL, n = 10) or video instruction (VIDEO, n = 10) group. All subjects practiced 4 weeks and received general task instructions. In addition, the VIDEO group received expert video instruction during practice. Lower extremity kinematics and kinetics and vertical ground reaction force of SSC were examined during baseline, immediate post, and 1-week retention tests. After nonlinear registration, differences between each subject and the expert she had seen were determined. These differences were analyzed with SPM1D 2-way ANOVA. No interaction effects between time and group were found ( p > 0.05). Main effects of time were found in the frontal plane. In particular, smaller deviations of subjects compared with the seen expert of the knee adduction ( p = 0.005, 97.9-100% stance phase [SP]) and hip abduction ( p = 0.005, 11.5-13.8% SP) and adduction ( p < 0.001, 33.4-87.7% SP) moments were found in immediate post compared with baseline. These frontal plane short-term improvements, replicating earlier findings in both sexes, may lower ACL injury risk. The large observed interindividual differences over time may have concealed the long-term effects of video instruction at the group level.
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Affiliation(s)
- Eline M Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Asgari M, Alizadeh MH, Naderi M, Abshenas E, Sahebozamani M, Yazdani S, Nolte K, Alizadeh S, Mohammadi M, Kooroshfard N, Arghadeh R, Jaitner T. Little associations exist between the three commonly used functional screening tests in collegiate athletes. Sci Rep 2024; 14:13611. [PMID: 38871829 DOI: 10.1038/s41598-024-64518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 06/10/2024] [Indexed: 06/15/2024] Open
Abstract
Although an abundant number of studies have investigated the predictability of the commonly used functional screening tests and despite their popularity and applicability, the relationships between these tests have rarely been studied and have not been well established. This study aimed to examine the potential association between the Functional Movement Screen (FMS), Y Balance Test (YBT), and Landing Error Scoring System (LESS). Six hundred twenty-seven Iranian collegiate athletes (347 males, age = 22.63 ± 4.07, weight = 75.98 ± 13.79, height = 181.99 ± 10.15, BMI = 22.84 ± 3.16; and 280 females, age = 22.22 ± 3.37, weight = 60.63 ± 9.58, height = 166.55 ± 6.49, BMI = 21.81 ± 2.84) participated in this study. Following a 5-min warm-up, each participant underwent a standardized screening battery including the FMS, YBT, and LESS, and the scores were recorded and live coded for the statistical analysis, except for the LESS. The LESS tests were video recorded and scored by one expert examiner using an open-source 2D video analysis software (Kinovea- version 0.9.5), afterwards. The Spearman correlation was utilized as a measure for the correlation, and the Mann‒Whitney U test with a significance level of 0.05 was used to check the differences between male and female athletes. The statistical analysis was performed with RStudio 2023.03.0 using R 4.3.1. A small correlation (0.364) was observed between the FMS composite score and the YBT in male athletes. All other pairwise correlations were negligible among male and female athletes, ranging from - 0.096 to 0.294. Reducing the FMS to the component scores targeting the lower extremities did not alter the correlation to the other screening scores. The median FMS composite score in female athletes was significantly higher than that in males (p < 0.001). Negligible correlations exist between the FMS, LESS, and YBT; they do not measure the same values and therefore are irreplaceable with one another. A combination of these tests as a standardized screening battery may potentially better identify injury-predisposed athletes than the application of each test as a stand-alone screening test. Females outperformed males in the FMS test significantly, so sex must be considered a key variable in the FMS studies. Males had slightly higher LESS scores (median difference = 0.5) than females, but this difference is not clinically meaningful. Future research should continue to explore the relationships between various functional screening tests and identify the most effective combinations for comprehensive assessment in different populations and sports disciplines.
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Affiliation(s)
- Mojtaba Asgari
- Training and Movement Science Department, Institue for Sport and Sport Science, TU Dortmund University, Otto-Hahn Str.03, 44227, Dortmund, Germany.
| | - Mohammad Hossein Alizadeh
- Department of Health and Sport Medicine, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Mohsen Naderi
- Department of Health and Sport Medicine, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Ehsan Abshenas
- Department of Health and Sport Medicine, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Mansour Sahebozamani
- Department of Pathology and Corrective Exercise, Faculty of Sport Sciences, Shahid Bahonar University, Kerman, Iran
| | - Shirin Yazdani
- Department of Motor Control, Faculty of Physical Education and Sport Science, University of Tabriz, Tabriz, Iran
| | - Kevin Nolte
- Training and Movement Science Department, Institue for Sport and Sport Science, TU Dortmund University, Otto-Hahn Str.03, 44227, Dortmund, Germany
| | - Shahab Alizadeh
- Human Performance Lab, Kinesiology Department, University of Calgary, Calgary, AB, Canada
| | - Mohammadreza Mohammadi
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - Negar Kooroshfard
- Department of Physical Education and Sports Science, Faculty of Educational Sciences and Psychology, Shiraz University, Shiraz, Iran
| | - Ramin Arghadeh
- Department of Health and Sport Medicine, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Thomas Jaitner
- Training and Movement Science Department, Institue for Sport and Sport Science, TU Dortmund University, Otto-Hahn Str.03, 44227, Dortmund, Germany
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Pompa D, Carson HJ, Beato M, di Fronso S, Bertollo M. Attentional Focus Effects on Lower-Limb Muscular Strength in Athletes: A Systematic Review. J Strength Cond Res 2024; 38:419-434. [PMID: 38154026 DOI: 10.1519/jsc.0000000000004714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
ABSTRACT Pompa, D, Carson, HJ, Beato, M, di Fronso, S, and Bertollo, M. Attentional focus effects on lower-limb muscular strength in athletes: A systematic review. J Strength Cond Res 38(2): 419-434, 2024-Evidence links an athlete's focus of attention to enhancing strength performance. However, additional research is needed to investigate the applicability of studies beyond the tasks and population currently examined. Therefore, we aimed to systematically review studies concerning attentional focus effects on strength characteristics on lower-limb tasks in athletes. Scopus, Web of Science, and EBSCO databases were searched using PRISMA PERSIST guidelines and keywords related to the focus of attention, force production processes, and athletes. Subjects were categorized: world class (tier 5); elite (tier 4); highly trained (tier 3); trained/developmental (tier 2); nonathletes (tiers 1-0); and mixed (different levels). Fifteen of 296 studies met the inclusion criteria. Included studies investigated the focus of attention effects on performance ( n = 6), between skill levels ( n = 2), and for learning ( n = 5), with respect to subject preference ( n = 1); one study did not state the aim. Studies achieved an average risk of bias score of "excellent"; however, findings suffered in the assessment of certainty. Only 2 studies reported an advantage for one type of attentional focus (external focus) across conditions ( g = 0.13-0.42) with tier 2 and mixed tier athletes. Research does not address the needs of elite athletes, and there is limited evidence on each type of strength characteristics and muscle action. There is also a need to incorporate methodological steps to promote task-relevant instructions. Research should focus on contextualized information within professional practice to offer stronger translational implications for athletes and coaches.
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Affiliation(s)
- Dario Pompa
- BIND-Behavioral Imaging and Neural Dynamics Center, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Howie J Carson
- Human Performance Science Research Group, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Selenia di Fronso
- BIND-Behavioral Imaging and Neural Dynamics Center, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maurizio Bertollo
- BIND-Behavioral Imaging and Neural Dynamics Center, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Ulman S, Loewen AM, Erdman AL, Õunpuu S, Chafetz R, Tulchin-Francis K, Wren TAL. Lower-extremity kinematics and kinetics differ based on drop vertical jump variation: An assessment of methodology for a return-to-play protocol using motion analysis. Gait Posture 2024; 108:132-138. [PMID: 38042067 DOI: 10.1016/j.gaitpost.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND The drop vertical jump (DVJ) is commonly used in return-to-play evaluations to assess movement quality and risk during a dynamic task. However, across biomechanics literature, a multitude of DVJ variations have been used, influencing the generalizability and potential interpretation of the reported findings. RESEARCH QUESTION The purpose of this study was to identify differences in lower extremity kinematics and kinetics between DVJ variations that differ based on horizontal jump distance, verbal instructions, and the use of a jump target. METHODS A single-group repeated measures design was used in a laboratory setting. Twenty participants were tested, and three-dimensional angles and moments of the pelvis, hip, knee, and ankle were computed. Wilcoxon signed rank tests were performed to determine differences between DVJ variations. RESULTS Reduced knee flexion at initial contact and greater knee extensor moments across the descent phase were observed with increased horizontal jump distance. Additionally, both verbal instructions and a jump target influenced movement strategies at the pelvis, hip, and knee. Ground reaction forces were found to be similar across conditions and jump height following the first landing increased with a target. SIGNIFICANCE Although subtle, the biomechanical differences observed between task variations emphasize the importance of standardizing motion analysis protocols for research and clinical decision-making. Given the findings of the current study, the authors recommend using the Half Height variation in patients treated for a knee injury as it will likely be the most indicative of movement quality.
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Affiliation(s)
| | | | | | - Sylvia Õunpuu
- Connecticut Children's Medical Center, Farmington, CT, USA
| | - Ross Chafetz
- Shriners Hospitals for Children - Philadelphia, Philadelphia, PA, USA
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Shin HJ, Kim SH, Cho HY. The effect of types of sensory feedback on the acquisition and retention of squat performance: A randomized, double-blind, controlled trial. Scand J Med Sci Sports 2024; 34:e14531. [PMID: 37916599 DOI: 10.1111/sms.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
Various sensory feedback methods are considered important for motor learning, but the effect of each sensory feedback method on effective squat learning still needs to be clarified. This study aimed to investigate the effect of sensory feedback types on the acquisition and retention of a squat. A double-blinded, randomized controlled trial was carried out. Thirty-healthy people were recruited and randomly assigned to the visual feedback group (VFG = 10), tactile feedback group (TFG = 10), and control group (CG = 10). VFG received visual feedback through video data of the participant performing squats, and TFG received tactile feedback through manual contact with a physical therapist. Both groups received feedback on the movements that needed correction after each set was completed. CG maintained rest without receiving any feedback. The retro-reflexive marker, force plate, and electromyography were used to measure body angle, foot center of pressure (COP), and muscle activity. All assessments were measured to confirm a squat acquisition. VFG and TFG showed significant differences in neutral knee position (NKP), trunk forward lean (TFL), anterior knee displacement (AKD), and anteroposterior (AP) foot COP (p < 0.050). In addition, the acquisition was retained until 3 days later for NKP and a week later for TFL, AKD, and AP foot COP in VFG (p < 0.050), while the acquisition was not retained in TFG (p > 0.050). There was no statistically significant change in CG (p > 0.050). This study demonstrated that visual feedback positively affects the acquisition and retention of squats. Therefore, we recommend the use of visual feedback for squat acquisition and retention in exercise novices.
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Affiliation(s)
- Ho-Jin Shin
- Department of Physical Therapy, Gachon University, Incheon, Republic of Korea
| | - Sung-Hyeon Kim
- Department of Physical Therapy, Gachon University, Incheon, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, Gachon University, Incheon, Republic of Korea
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Thieschäfer L, Klütz J, Weig J, Dos’Santos T, Büsch D. Development of a Cutting Technique Modification Training Program and Evaluation of its Effects on Movement Quality and Cutting Performance in Male Adolescent American Football Players. Sports (Basel) 2023; 11:184. [PMID: 37755861 PMCID: PMC10534889 DOI: 10.3390/sports11090184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
This study developed a cutting technique modification training program and investigated its effects on cutting performance and movement quality in adolescent American football players. For six weeks, an intervention group (IG) of 11 players participated in 25 min cutting technique modification training sessions integrated into team training twice a week, while a control group (CG) of 11 players continued their usual team training. Movement quality was assessed by evaluating 2D high-speed videos, obtained during preplanned 45° and 90° cutting tests, using the Cutting Movement Assessment Score (CMAS) qualitative screening tool. Cutting performance was assessed based on change of direction deficit (CODD). Significant interaction effects of time × group were found for CMAS in 45° and 90° cuttings (p < 0.001, ηp2 = 0.76, p < 0.001, ηp2 = 0.64, respectively), with large improvements in the IG (p < 0.001, g = -2.16, p < 0.001, g = -1.78, respectively) and deteriorations in the CG for 45° cuttings (p = 0.002, g = 1.15). However, no statistically significant differences in CODD were observed pre-to-post intervention. The cutting technique modification training was effective at improving movement quality without impairing cutting performance, and it can be used by practitioners working with adolescent athletes.
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Affiliation(s)
- Lutz Thieschäfer
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany (D.B.)
| | - Julius Klütz
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany (D.B.)
| | - Julian Weig
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany (D.B.)
| | - Thomas Dos’Santos
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester M1 7EL, UK;
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Dirk Büsch
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany (D.B.)
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Nijmeijer EM, Elferink-Gemser MT, McCrory S, Cortes N, Benjaminse A. How to improve movement execution in sidestep cutting? Involve me and I will learn. Hum Mov Sci 2023; 90:103115. [PMID: 37329711 DOI: 10.1016/j.humov.2023.103115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 03/29/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
Providing choices, i.e., autonomy, to athletes during practice increases intrinsic motivation and positively influences the motor learning process. The effects of autonomy on the timing of feedback (self-controlled timing of feedback) when optimizing the movement execution of sidestep cutting (SSC), a task that is highly related with ACL injury risk, are unknown. The aim of this study was to investigate the effect of self-controlled timing of video and EF-feedback on movement execution of SSC in team sport athletes. Thirty healthy ball team sport athletes (22.9 ± 1.7 years, 185.5 ± 7.2 cm, 79.3 ± 9.2 kg) were recruited from local sports clubs. Participants were alternately assigned to the self-control (SC) or the yoked (YK) group based on arrival and performed five anticipated and five unanticipated 45° SSC trials as pre-, immediate-post and one-week retention test. Movement execution was measured with the Cutting Movement Assessment Score (CMAS). Training consisted of three randomized 45° SSC conditions: one anticipated and two unanticipated conditions. All participants received expert video instructions and were instructed to 'try to do your best in copying the movement of the expert'. The SC group was allowed to request feedback whenever they wanted during training. The feedback consisted of 1) CMAS score, 2) posterior and sagittal videos of the last trial and 3) an external focus verbal cue on how to improve their execution. The participants were told to lower their score and they knew the lower the score, the better. The YK group received feedback after the same trial on which their matched participant in the SC group had requested feedback. Data of twenty-two participants (50% in SC group) was analyzed. Pre-test and training CMAS scores between groups were equal (p > 0.05). In the anticipated condition, the SC group (1.7 ± 0.9) had better CMAS scores than the YK group (2.4 ± 1.1) at the retention test (p < 0.001). Additionally, in the anticipated condition, the SC group showed improved movement execution during immediate-post (2.0 ± 1.1) compared to pre-test (3.0 ± 1.0), which was maintained during retention (p < 0.001). The YK group also improved in the anticipated condition during immediate-post (1.8 ± 1.1) compared to pre-test (2.6 ± 1.0) (p < 0.001) but showed decreased movement execution during retention compared to immediate-post test (p = 0.001). In conclusion, self-controlled timing of feedback resulted in better learning and greater improvements in movement execution compared to the control group in the anticipated condition. Self-controlled timing of feedback seems beneficial in optimizing movement execution in SSC and is advised to be implemented in ACL injury prevention programs.
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Affiliation(s)
- Eline M Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Marije T Elferink-Gemser
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Stuart McCrory
- Sports Medicine, Assessment, Research & Testing (SMART) Laboratory, School of Kinesiology, George Mason University, 9100 Freedom Center Blvd, Manassas, VA 20110, USA.
| | - Nelson Cortes
- School of Sport, Rehabilitation, and Exercise Science, University of Essex, Colchester CO4 3WA, United Kingdom of Great Britain and Northern Ireland; Department of Bioengineering, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
| | - Anne Benjaminse
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; School of Sport Studies, Hanze University of Applied Sciences, Zernikeplein 17, 9747 AS Groningen, The Netherlands.
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Bæktoft van Weert M, Skovdal Rathleff M, Eppinga P, Møller Mølgaard C, Welling W. Using a target as external focus of attention results in a better jump-landing technique in patients after anterior cruciate ligament reconstruction - A cross-over study. Knee 2023; 42:390-399. [PMID: 37230002 DOI: 10.1016/j.knee.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Improving jump-landing technique during rehabilitation is important and may be achieved through different feedback techniques, i.e., internal focus of attention (IF) or external focus of attention using a target (EF). However, there is a lack of evidence on the most effective feedback technique after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to investigate the potential difference in jump-landing techniques between IF and EF instructions in patients after ACLR. METHODS Thirty patients (12 females, mean age 23.26 ± 4.91 years) participated after ACLR. Patients were randomly assigned into two groups that each followed a different testing sequence. Patients performed a drop vertical jump-landing test after receiving instructions with varying types of focus of attention. The Landing Error Scoring System (LESS) assessed the jump-landing technique. RESULTS EF was associated with a significantly better LESS score (P < 0.001) compared with IF. Only EF instructions led to improvements in jump-landing technique. CONCLUSION Using a target as EF resulted in a significantly better jump-landing technique than IF in patients after ACLR. This indicates that increased use of EF could or might result in a better treatment outcome during ACLR rehabilitation.
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Affiliation(s)
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Centre for General Practice at Aalborg University, Aalborg, Denmark; Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Peter Eppinga
- Medisch Centrum Zuid (MCZ), Groningen, The Netherlands
| | - Carsten Møller Mølgaard
- Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Wouter Welling
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Groningen, The Netherlands; Pro-F Fysiotherapie, Enschede, The Netherlands.
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Gholami F, Letafatkar A, Moghadas Tabrizi Y, Gokeler A, Rossettini G, Ghanati HA, Schöllhorn WI. Comparing the Effects of Differential and Visuo-Motor Training on Functional Performance, Biomechanical, and Psychological Factors in Athletes after ACL Reconstruction: A Randomized Controlled Trial. J Clin Med 2023; 12:2845. [PMID: 37109182 PMCID: PMC10142379 DOI: 10.3390/jcm12082845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Variation during practice is widely accepted to be advantageous for motor learning and is, therefore, a valuable strategy to effectively reduce high-risk landing mechanics and prevent primary anterior cruciate ligament (ACL) injury. Few attempts have examined the specific effects of variable training in athletes who have undergone ACL reconstruction. Thereby, it is still unclear to what extent the variations in different sensor areas lead to different effects. Accordingly, we compared the effects of versatile movement variations (DL) with variations of movements with emphasis on disrupting visual information (VMT) in athletes who had undergone ACL reconstruction. Forty-five interceptive sports athletes after ACL reconstruction were randomly allocated to a DL group (n = 15), VT group (n = 15), or control group (n = 15). The primary outcome was functional performance (Triple Hop Test). The secondary outcomes included dynamic balance (Star Excursion Balance Test (SEBT)), biomechanics during single-leg drop-landing task hip flexion (HF), knee flexion (KF), ankle dorsiflexion (AD), knee valgus (KV), and vertical ground reaction force (VGRF), and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)) assessed before and after the 8 weeks of interventions. Data were analyzed by means of 3 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. Significant group × time interaction effects, main effect of time, and main effect of group were found for the triple hop test and all eight directions, SEBT, HF, KF, AD, KV, VGRF, and TSK. There was no significant main effect of group in the HF and triple hop test. Additionally, significant differences in the triple hop test and the seven directions of SEBT, HF, KF, KV, VGRF, and TSK were found between the control group and the DL and VMT groups. Between group differences in AD and the medial direction of SEBT were not significant. Additionally, there were no significant differences between VMT and the control group in the triple hop test and HF variables. Both motor learning (DL and VMT) programs improved outcomes in patients after ACL reconstruction. The findings suggest that DL and VMT training programs lead to comparable improvements in rehabilitation.
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Affiliation(s)
- Fatemeh Gholami
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran; (F.G.); (H.A.G.)
| | - Amir Letafatkar
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran; (F.G.); (H.A.G.)
| | - Yousef Moghadas Tabrizi
- Department of health and sport medicine, Faculty of Sport Sciences and health, University of Tehran, Tehran 1439813141, Iran;
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, 33098 Paderborn, Germany
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, 1105 Amsterdam, The Netherlands
| | | | - Hadi Abbaszadeh Ghanati
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran; (F.G.); (H.A.G.)
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Schulte S, Heil J, Büsch D. Videogestütztes Feedbacktraining als präventives Techniktraining – Eine exploratorische Studie. PHYSIOSCIENCE 2023. [DOI: 10.1055/a-1963-6545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Zusammenfassung
Hintergrund Im Sport wird angenommen, dass ein dynamischer Knievalgus bei einbeinigen Landungen einen relevanten Verletzungsmechanismus des vorderen Kreuzbands darstellt. Während bestehende effektive Präventionsprogramme zur Reduktion des Knievalgus primär auf die Verbesserung allgemeiner konditioneller und/oder koordinativer Einflussgrößen ausgerichtet sind, fokussiert ein Video-Feedback-Training die Korrektur individueller Defizite in der sportlichen Technik, um u. a. ein potenzielles Verletzungsrisiko zu reduzieren.
Ziel Evaluation der kurz- und insbesondere mittel- und langfristigen Wirksamkeit eines Video-Feedback-Trainings zur Veränderung des frontalen Kniewinkels bei einbeinigen Landungen.
Methode Im Rahmen einer exploratorischen Studie wurden 10 sportlich aktive Personen (Alter: 25 ± 5 Jahre, Größe: 170,8 ± 4,5 cm) getestet. Diese führten in Anlehnung an das Landing Error Scoring System (LESS-Test) einbeinige Drop-Jumps in einem Pretest, in einer Aneignungsphase mit Video-Feedback und 2 Retentionstests 2 und 6 Wochen nach der Aneignungsphase ohne Video-Feedback aus. Das Video-Feedback wurde in der Aneignungsphase bei jedem zweiten Sprung und zusätzlich selbstbestimmt auf Nachfrage über ein Expertenmodell mit neutraler Kniestellung im Overlay-Modus aus der Frontalperspektive gegeben.
Ergebnisse Die Ergebnisse wurden nach Sprung- und Nichtsprungbein der Proband*innen differenziert. Sie zeigen eine bedeutsame Verringerung des frontalen Kniewinkels für das Sprungbein (F1, 9 = 10,43, p = 0,01, η2
p = 0,54, 95 % CI [0,04; 0,74]) bei einbeinigen Landungen in der Aneignungsphase, jedoch keine statistisch bedeutsame Verringerung für das Nichtsprungbein (F1, 9 = 4,07, p = 0,08, η2
p = 0,31, 1-β = 0,44). Im Retentionstest nach 6 Wochen nähert sich der frontale Kniewinkel beidseitig dem Ausgangsniveau aus dem Pretest wieder an.
Schlussfolgerung Ein Video-Feedback-Training bietet sich als einfach durchzuführendes, alternatives Verletzungspräventionsprogramm an. Eine fehlende mittel- und langfristige Veränderung und hohe Variabilität des frontalen Kniewinkels lassen eine mehrfache und/oder regelmäßige Durchführung eines Video-Feedback-Trainings sinnvoll erscheinen. In weiteren Studien mit Kontrollgruppendesign und unterschiedlichen Feedback-Prozeduren wird systematisch zu prüfen sein, ob eine längerfristige Reduktion eines potenziellen Verletzungsrisikos des vorderen Kreuzbands erreicht werden kann.
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Affiliation(s)
- Sarah Schulte
- Institut für Sportwissenschaft, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Jessica Heil
- Institut für Sportwissenschaft, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Dirk Büsch
- Institut für Sportwissenschaft, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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12
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ÖZALTIN GE, TALU B, ÖKTEM U. Functional Outcomes of Motor Learning Interventions in Anterior Cruciate Ligament Injuries. ARŞIV KAYNAK TARAMA DERGISI 2023. [DOI: 10.17827/aktd.1169499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Anterior cruciate ligament injury is one of the pathologies that affect the daily and professional life of the majority of athletes. When the treatment options are examined, there are two options surgical treatment and conservative treatment. Rehabilitation is essential in both cases, with or without surgery. Especially for returning to sports, long-term rehabilitation after surgery has become essential. While many different exercise methods have been tried in the prevention of anterior cruciate ligament injury and rehabilitation after reconstructive surgery, many have focused on strength training. The abnormal movement pattern that occurs with the somatosensory loss seen after anterior cruciate ligament injury results in a functional loss in the injured extremity and the contralateral extremity in the long term. Considering the incidence of injury, studies to establish the normal movement pattern and restore motor control are very important. For this reason, motor learning-based interventions that support neuroplasticity are of great interest today. This review aims to examine the functional results of current motor learning-based interventions in anterior cruciate ligament rehabilitation in line with the literature.
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Bakal DR, Morgan JJ, Lyons SM, Chan SK, Kraus EA, Shea KG. Analysis of limb kinetic asymmetry during a drop vertical jump in adolescents post anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2022; 100:105794. [PMID: 36270179 DOI: 10.1016/j.clinbiomech.2022.105794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limb asymmetry after ACL reconstruction is often cited as a risk factor for ACL reinjury. We assessed ground reaction forces on each limb during a drop vertical jump, and compared kinetic symmetry between limbs in adolescents post-ACL reconstruction versus healthy controls. METHODS Forty-four participants who underwent an ACL reconstruction (16 male/28 female, mean age 16.1 ± 1.5, mean 7.3 ± 0.9 months post-ACL reconstruction) and 34 controls (20 male/14 female, mean age 14.9 ± 1.1) completed a drop vertical jump captured on a Vicon system and Bertec force plates. Kinetic variables were calculated individually for each limb. Inter-limb asymmetry was calculated as an index between each limb (involved versus uninvolved for the ACL reconstruction group, and left versus right for controls), and was compared between groups using independent t-tests. FINDINGS Asymmetry was significantly more pronounced in the ACL reconstruction group versus the controls for peak contact ground reaction force (11.6% vs 4.4%, p = 0.009), eccentric impulse (8.8% vs 3.8%, p = 0.009), eccentric mean force (8.0% vs 3.4%, p = 0.006), concentric peak ground reaction force (4.1% vs 0.8%, p = 0.003), concentric impulse (5.1% vs 1.1%, p = 0.001), and peak landing ground reaction force (12.7% vs 1.7%, p < 0.001). INTERPRETATION Limb kinetic asymmetry during a drop vertical jump was more pronounced in adolescents post-ACL reconstruction versus controls for both eccentric- and concentric-phase variables, which may indicate the use of compensatory strategies to offload the post-operative limb. Targeted interventions to produce more symmetric loading and unloading during jumping tasks should be developed, tested, and monitored to determine the impact on rehabilitation programs, return-to-sport evaluations, and injury prevention outcomes.
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Affiliation(s)
- David R Bakal
- Stanford University, Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, USA.
| | - Jeffery J Morgan
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Samuel M Lyons
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Salinda K Chan
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Emily A Kraus
- Stanford University, Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, USA; Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
| | - Kevin G Shea
- Stanford Children's Health, Department of Orthopedics & Sports Medicine, Motion and Sports Performance Laboratory, USA
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Williams AM, Hogg JA, Diekfuss JA, Kendall SB, Jenkins CT, Acocello SN, Liang Y, Wu D, Myer GD, Wilkerson GB. Immersive Real-Time Biofeedback Optimized With Enhanced Expectancies Improves Motor Learning: A Feasibility Study. J Sport Rehabil 2022; 31:1023-1030. [PMID: 35728805 PMCID: PMC11148808 DOI: 10.1123/jsr.2021-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT An Optimizing Performance through Intrinsic Motivation and Attention for Learning theory-based motor learning intervention delivering autonomy support and enhanced expectancies (EE) shows promise for reducing cognitive-motor dual-task costs, or the relative difference in primary task performance when completed with and without a secondary cognitive task, that facilitate adaptive injury-resistant movement response. The current pilot study sought to determine the effectiveness of an autonomy support versus an EE-enhanced virtual reality motor learning intervention to reduce dual-task costs during single-leg balance. DESIGN Within-subjects 3 × 3 trial. METHODS Twenty-one male and 24 female participants, between the ages of 18 and 30 years, with no history of concussion, vertigo, lower-extremity surgery, or lower-extremity injuries the previous 6 months, were recruited for training sessions on consecutive days. Training consisted of 5 × 8 single-leg squats on each leg, during which all participants mimicked an avatar through virtual reality goggles. The autonomy support group chose an avatar color, and the EE group received positive kinematic biofeedback. Baseline, immediate, and delayed retention testing consisted of single-leg balancing under single- and dual-task conditions. Mixed-model analysis of variances compared dual-task costs for center of pressure velocity and SD between groups on each limb. RESULTS On the right side, dual-task costs for anterior-posterior center of pressure mean and SD were reduced in the EE group (mean Δ = -51.40, Cohen d = 0.80 and SD Δ = -66.00%, Cohen d = 0.88) compared with the control group (mean Δ = -22.09, Cohen d = 0.33 and SD Δ = -36.10%, Cohen d = 0.68) from baseline to immediate retention. CONCLUSIONS These findings indicate that EE strategies that can be easily implemented in a clinic or sport setting may be superior to task-irrelevant AS approaches for influencing injury-resistant movement adaptations.
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Affiliation(s)
| | - Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Jed A Diekfuss
- Emory Sport Performance and Research Center, Flowery Branch, GA,USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA,USA
- Emory Sports Medicine Center, Atlanta, GA,USA
| | | | | | - Shellie N Acocello
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Yu Liang
- Department of Computer Science and Engineering, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Dalei Wu
- Department of Computer Science and Engineering, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, GA,USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA,USA
- Emory Sports Medicine Center, Atlanta, GA,USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA,USA
| | - Gary B Wilkerson
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN,USA
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Werner I, Peer-Kratzer M, Mohr M, van-Andel S, Federolf P. Intervention for Better Knee Alignment during Jump Landing: Is There an Effect of Internally vs. Externally Focused Instructions? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10763. [PMID: 36078475 PMCID: PMC9518031 DOI: 10.3390/ijerph191710763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Externally focused attention is known to induce superior results in the movement outcome, whereas focusing attention on the moving body (internal focus) causes conscious control and constrains action. The study investigated effects on knee trajectory and whole-body movement complexity when addressing knee alignment using externally (EF) vs. internally (IF) focused instructions. Young ski racers, n = 24 (12 male), performed landings with subsequent jumps to submaximal height. Movements were tracked and analyzed during the ground contact phase. Sets of jumps were executed without instruction (CON), followed by EF and IF instructions on knee alignment in a random order. Medial-lateral displacement of the knee in landing quantified task achievement, and whole-body principal component analysis was used to compute movement complexity. Knee alignment instructions led to a significantly lower medial knee displacement compared to CON (p = 0.001, ηp2 = 0.35). EF vs. IF did not reach significance. EF, as well as IF instructions increased the prominence of the first movement pattern (p = 0.01, ηp2 = 0.22) with a reduction of higher-order patterns (p = 0.002, W = 0.11), suggesting a strategy of freezing degrees of freedom. Both instructions addressing the movement form positively influenced knee displacement during landing, and both led to a freezing strategy, simplifying whole-body coordination.
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Affiliation(s)
- Inge Werner
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Maurice Mohr
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Steven van-Andel
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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16
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Ghanati HA, Letafatkar A, Shojaedin S, Hadadnezhad M, Schöllhorn WI. Comparing the Effects of Differential Learning, Self-Controlled Feedback, and External Focus of Attention Training on Biomechanical Risk Factors of Anterior Cruciate Ligament (ACL) in Athletes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610052. [PMID: 36011685 PMCID: PMC9408147 DOI: 10.3390/ijerph191610052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 05/13/2023]
Abstract
The current study aimed to compare the possible effects of differential learning strategy, self-controlled feedback, and external focus of attention on kinetic and kinematic risk factors of anterior cruciate ligament (ACL) injury in athletes. Forty-eight male athletes from three sports of handball, volleyball and basketball were selected for this study and were randomly divided into four groups: differential learning (n = 12), self-control feedback (n = 12), external focus (n = 12), and control (n = 12) group. All groups followed the intervention for eight weeks with three sessions per week. Data were analyzed by means of 4 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. A significant group × time interaction and the main effect of time was found for most kinetic and kinematic variables. The main effect of the group was significant only at the knee abduction angle. Differential learning and external focus of attention methods positively reduced the kinetic and kinematic variables that are considered risk factors for ACL injury. However, the effect sizes (Cohen's d) for the changes in most of the variables were larger for the differential learning group. Tailoring the boundary conditions that are based on the manipulations created in the exercise through variability and variety of movements associated with differential learning methods rather than repeating movements could reduce the risk of ACL injury.
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Affiliation(s)
- Hadi Abbaszadeh Ghanati
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
| | - Amir Letafatkar
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
| | - Sadredin Shojaedin
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
| | - Malihe Hadadnezhad
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
| | - Wolfgang I. Schöllhorn
- Department for Training and Movement Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
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Semjonova G, Davidovica A, Kozlovskis N, Okss A, Katashevs A. Smart Textile Sock System for Athletes’ Self-Correction during Functional Tasks: Formative Usability Evaluation. SENSORS 2022; 22:s22134779. [PMID: 35808274 PMCID: PMC9268753 DOI: 10.3390/s22134779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
(1) Background: The development of a lightweight, easy-to-use system that measures the foot’s plantar pressure is becoming an increasingly important area of research in physiotherapy. For further development of the smart sock system, a formative usability study was conducted, where the smart textile sock sensor system was used for self-correction during functional tasks; (2) Methods: Five athletes from the football school participated in the formative usability study. Athletes performed pre-defined functional tasks for self-correction when interacting with the smart textile sock system. Formative usability evaluation methods: effectiveness (task success rate, error rate), efficiency (time-based), satisfaction evaluated by System Usability Scale (SUS); (3) Results: Formative usability indicators: task completeness effectiveness ranged from 40% to 100% in the first- and second-stage tasks. Completed task efficiency time: Stage 1, from 4.2 s (SD 1.3) to 88.8 s (SD 19.8); Stage 2, from 7.2 s (SD 1.9) to 9.6 s (SD 2.1). Satisfaction was assessed by the SUS system user group with 76 points (SD 7.42), which indicates “good” satisfaction; (4) Conclusions: formative usability indicators showed the need for technical improvements to the smart textile sock pressure sensor system. The SUS results indicate “good” satisfaction with the smart textile sock pressure sensor system and its application.
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Affiliation(s)
- Guna Semjonova
- Department of Rehabilitation, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
- Correspondence:
| | - Anna Davidovica
- Department of Rehabilitation, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
| | - Nikita Kozlovskis
- Institute of Applied Computer Systems, Riga Technical University, LV-1658 Riga, Latvia;
| | - Aleksandrs Okss
- Institute of Design Technologies, Riga Technical University, LV-1048 Riga, Latvia;
| | - Aleksejs Katashevs
- Institute of Biomedical Engineering and Nanotechnology, Riga Technical University, LV-1048 Riga, Latvia;
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Waite L, Stewart M, Sackiriyas KSB, Jayawickrema J, Almonroeder TG. Female Athletes Exhibit Greater Trial-to-Trial Coordination Variability When Provided with Instructions Promoting an External Focus. J Mot Behav 2022; 54:686-693. [PMID: 35477341 DOI: 10.1080/00222895.2022.2067517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to examine how instructions promoting different attentional foci influence joint coordination patterns and trial-to-trial coordination variability during landing. Sixteen females performed drop landings with their typical technique (baseline) and after receiving instructions promoting an internal focus and an external focus. The coordination patterns, and trial-to-trial coordination variability, of the sagittal plane hip-knee, hip-ankle, and knee-ankle angle pairings were compared across conditions. While there was no difference in the joint coordination patterns among the conditions, subjects exhibited greater hip-ankle and knee-ankle trial-to-trial coordination variability for the external focus condition, vs. the baseline and internal focus conditions, which may help to explain the improved motor learning outcomes for athletes who train with an external focus.
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Affiliation(s)
- Lindsey Waite
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Molly Stewart
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | | | - Jithmie Jayawickrema
- College of Health Professions, Trine University, Fort Wayne, IN, USA.,Outpatient Physical Therapy, Parkview TherapyONE, Fort Wayne, IN, USA
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Forsyth L, Bonacci J, Childs C. A pilot randomised control trial of the efficacy of stability-based training with visualisation for people with chronic ankle instability. Med Biol Eng Comput 2022; 60:1199-1209. [PMID: 35247167 PMCID: PMC8933360 DOI: 10.1007/s11517-022-02533-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
Abstract
Chronic ankle instability (CAI) is associated with recurring symptoms that inhibit daily activity. Stability-based rehabilitative training is recommended for CAI. Visualisation (VIS) produces real-time feedback using motion capture and virtual reality. This pilot study aimed to determine the feasibility, adherence, safety, and efficacy of incorporating VIS into stability training for people with CAI. Efficacy was examined through effect of VIS training on dynamic stability, perception of stability, and rehabilitative experience. Individuals with CAI completed a 4-week stability-based training programme with VIS, or without visualisation (NO-VIS). Participants completed the Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT) prior to, and after training. Enjoyment of training was recorded using the Physical Activity Enjoyment Scale (PACES-8). Of 17 participants (VIS = 10, NO-VIS = 7), there were 2 drop outs (VIS = 1, NO-VIS = 1). No adverse events were reported, and participant drop-out was due to injury unrelated to the study. The VIS group showed a significantly greater increase in average SEBT reach distance (d = 1.7, p = 0.02). No significant differences were reported for the CAIT or PACES-8. This study supports the feasibility and safety of stability-based training with VIS in those with CAI. The enhanced performance outcome on the SEBT suggests VIS may enhance stability-based training.
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Affiliation(s)
- L Forsyth
- Faculty of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
| | - J Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - C Childs
- Faculty of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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20
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Utility of Gait Biofeedback Training to Improve Walking Biomechanics in Patients With Chronic Ankle Instability: A Critically Appraised Topic. J Sport Rehabil 2022; 31:819-825. [DOI: 10.1123/jsr.2021-0395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Chronic ankle instability (CAI) is a condition that involves feelings of the ankle “giving way,” pain, and decreased self-reported function. Individuals with CAI often demonstrate persistent biomechanical impairments during gait that are associated with repetitive lateral ankle sprains (LAS) and the development of early onset ankle posttraumatic osteoarthritis (OA). Traditional rehabilitation strategies have not successfully improved these reported aberrant gait biomechanics; thus, traditional rehabilitation may not effectively reduce the risk of recurrent LAS and ankle OA among individuals with CAI. Conversely, targeted gait training with biofeedback may be effective at decreasing the risk of recurring LAS and ankle OA if these rehabilitation strategies can promote individuals with CAI to develop a gait strategy that protects against subsequent LAS and ankle OA. Clinical Question: Can targeted gait biofeedback interventions cause individuals with CAI to implement a walking gait pattern that is not associated with recurrent LAS and ankle OA? Summary of Findings: Five studies assessed gait biofeedback interventions targeting plantar pressure and/or ankle kinematics involving visual biofeedback (n = 3), auditory biofeedback (n = 1), and haptic biofeedback (n = 1). Plantar pressure was medially shifted during a single session while receiving biofeedback (n = 2), immediately after biofeedback (n = 1), and 5 minutes after receiving biofeedback (n = 1) in 3 studies. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training. One study did not substantially improve plantar pressure while receiving visual feedback. Clinical Bottom Line: Targeted gait training strategies appear effective in acutely altering gait biomechanics in individuals with CAI while receiving, and immediately after, biofeedback has been removed. Long-term outcomes are not currently established for gait training strategies in those with CAI. Strength of Recommendation: Limited evidence (grade B) suggests that targeted gait biofeedback strategies can alter specific CAI gait biomechanics to a strategy not associated with recurrent LAS, and ankle OA immediately, and after, multiple sessions of gait training.
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Singh H, Gokeler A, Benjaminse A. Effective Attentional Focus Strategies after Anterior Cruciate Ligament Reconstruction: A Commentary. Int J Sports Phys Ther 2021; 16:1575-1585. [PMID: 34909262 PMCID: PMC8637244 DOI: 10.26603/001c.29848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Individuals after anterior cruciate ligament reconstruction (ACLR) have a high rate of reinjury upon return to competitive sports. Deficits in motor control may influence reinjury risk and can be addressed during rehabilitation with motor learning strategies. When instructing patients in performing motor tasks after ACLR, an external focus of attention directed to the intended movement effect has been shown to be more effective in reducing reinjury risk than an internal focus of attention on body movements. While this concept is mostly agreed upon, recent literature has made it clear that the interpretation and implementation of an external focus of attention within ACLR rehabilitation needs to be better described. The purpose of this commentary is to provide a clinical framework for the application of attentional focus strategies and guide clinicians towards effectively utilizing an external focus of attention in rehabilitation after ACLR. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Harjiv Singh
- Kinesiology and Nutrition Sciences, University of Nevada Las Vegas
| | - Alli Gokeler
- Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn; Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center; OCON Centre of Orthopaedic Surgery and Sports Medicine
| | - Anne Benjaminse
- Human Movement Sciences, Center for Human Movement Sciences, University of Groningen; School of Sport Studies, Hanze University Groningen
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Heinert B, Rutherford D, Cleereman J, Lee M, Kernozek TW. Changes in landing mechanics using augmented feedback: 4-Week training and retention study. Phys Ther Sport 2021; 52:97-102. [PMID: 34450562 DOI: 10.1016/j.ptsp.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT Non-contact ACL injuries are common in female athletes during landing tasks. Post-trial performance-based feedback may be an effective method to reduce landing forces and knee valgus during landing. Information regarding the retention of these changes based on such training is generally lacking for weekly and monthly retention. OBJECTIVE To determine the effectiveness of post-trial feedback training to promote and retain changes in vertical ground reaction force (vGRF) and knee to ankle (K:A) ratio during a dual task drop landing in female collegiate athletes. DESIGN Repeated measures; SETTING: University campus. PARTICIPANTS 22 female collegiate athletes. MATERIALS AND METHODS Dual task drop landings were performed over 4 successive weeks with immediate post trial feedback on peak vGRF, symmetry, and K:A ratio. K:A ratio was a surrogate measure for knee valgus in drop landing. RESULTS Significant decreases in vGRF and increases in K:A ratio were found within training sessions (p = .000). Both variables were retained each week over the 4 weeks. CONCLUSION Using a custom portable clinical feedback system may be an effective tool in reducing peak vGRFs and knee abduction angles during a drop landing over a 4-week period in female collegiate athletes.
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Affiliation(s)
- Becky Heinert
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA; Gundersen Health System, La Crosse, WI, 54601, USA
| | - Drew Rutherford
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA
| | - Jacqueline Cleereman
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA
| | - Maria Lee
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA.
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Stewart MA, Waite LA, Jayawickrema JG, Almonroeder TG. Neuromuscular training programs predominantly include instructions that promote an internal focus. J Sports Med Phys Fitness 2021; 61:1020-1026. [PMID: 34296842 DOI: 10.23736/s0022-4707.20.11505-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuromuscular training programs that include movement pattern retraining and strengthening, plyometric, and balance exercises are recommended for anterior cruciate ligament injury prevention. Recent evidence suggests that the effectiveness of these programs may be enhanced when athletes train with an external focus; however, clinicians typically rely predominantly on instructions encouraging an internal focus. The aim of this study was to examine the types of instructions provided as part of popular neuromuscular training programs used for anterior cruciate ligament injury prevention. The technique-related instructions provided as part of the FIFA 11+, HarmoKnee, Knakontroll, and Prevent Injury and Enhance Performance programs were categorized as either promoting an internal focus or an external focus. Instructions provided during movement pattern retraining tasks and strengthening, plyometric, and balance training exercises were specifically examined. Next, the percentage of technique-related instructions that promoted an internal focus, versus the percentage that promoted an external focus, were compared for the various program components. Across all programs examined, the vast majority of technique-related instructions for the movement pattern re-training tasks (≥83.3%) and the strengthening, balance, and plyometric exercises (≥75.0%) appeared to promote an internal focus. Despite evidence suggesting that the effectiveness of neuromuscular training programs may be enhanced by encouraging an external focus, most technique-related instructions provided as part of popular neuromuscular training programs appear to promote an internal focus. Modifying neuromuscular training programs to promote a more external focus could help to improve the effectiveness of these programs for anterior cruciate ligament injury prevention.
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Affiliation(s)
- Molly A Stewart
- Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Lindsey A Waite
- Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | | | - Thomas G Almonroeder
- Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA -
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Sheikhi B, Letafatkar A, Thomas AC, Ford KR. Altered trunk and lower extremity movement coordination after neuromuscular training with and without external focus instruction: a randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:92. [PMID: 34404477 PMCID: PMC8369650 DOI: 10.1186/s13102-021-00326-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/07/2021] [Indexed: 11/11/2022]
Abstract
Background This study sought to determine the effects of a 6-week neuromuscular training (NMT) and NMT plus external focus (NMT plus EF) programs on trunk and lower extremity inter-segmental movement coordination in active individuals at risk of injury. Methods Forty-six active male athletes (controls = 15, NMT = 16, NMT plus EF = 15) participated (age = 23.26 ± 2.31 years) in this controlled, laboratory study. Three-dimensional kinematics were collected during a drop vertical jump (DVJ). A continuous relative phase (CRP) analysis quantified inter-segmental coordination of the: (1) thigh (flexion/extension)—shank (flexion/extension), (2) thigh (abduction/adduction)—shank (flexion/extension), (3) thigh (abduction/adduction)—trunk (flexion/extension), and (4) trunk (flexion/extension)—pelvis (posterior tilt/anterior tilt). Analysis of covariance compared biomechanical data between groups. Results After 6 weeks, inter-segmental coordination patterns were significantly different between the NMT and NMT plus EF groups (p < 0.05). No significant differences were observed in CRP for trunk-pelvis coupling comparing between NMT and NMT plus EF groups (p = 0.134), while significant differences were observed CRP angle of the thigh-shank, thigh-trunk couplings (p < 0.05). Conclusions Trunk and lower extremity movement coordination were more in-phase during DVJ in the NMT plus EF compared to NMT in active individuals at risk of anterior cruciate ligament injury. Trial registration: The protocol was prospectively registered at UMIN_RCT website with ID number: UMIN000035050, Date of provisional registration 2018/11/27. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00326-9.
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Affiliation(s)
- Bahram Sheikhi
- Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran
| | - Amir Letafatkar
- Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran.
| | - Abbey C Thomas
- Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA
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Quílez-Maimón A, Rojas-Ruiz FJ, Delgado-García G, Courel-Ibáñez J. The Q-Pass Index: A Multifactorial IMUs-Based Tool to Assess Passing Skills in Basketball. SENSORS 2021; 21:s21134601. [PMID: 34283154 PMCID: PMC8271510 DOI: 10.3390/s21134601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Despite being a key sport-specific characteristic in performance, there is no practical tool to assess the quality of the pass in basketball. The aim of this study is to develop a tool (the quality-pass index or Q-Pass) able to deliver a quantitative, practical measure of passing skills quality based on a combination of accuracy, execution time and pass pattern variability. Temporal, kinematics and performance parameters were analysed in five different types of passes (chest, bounce, crossover, between-the-leg and behind-the-back) using a field-based test, video cameras and body-worn inertial sensors (IMUs). Data from pass accuracy, time and angular velocity were collected and processed in a custom-built excel spreadsheet. The Q-pass index (0–100 score) resulted from the sum of the three factors. Data were collected from 16 young basketball players (age: 16 ± 2 years) with high (experienced) and low (novice) level of expertise. Reliability analyses found the Q-pass index as a reliable tool in both novice (CV from 4.3 to 9.3%) and experienced players (CV from 2.8 to 10.2%). Besides, important differences in the Q-pass index were found between players’ level (p < 0.05), with the experienced showing better scores in all passing situations: behind-the-back (ES = 1.91), bounce (ES = 0.82), between-the-legs (ES = 1.11), crossover (ES = 0.58) and chest (ES = 0.94). According to these findings, the Q-pass index was sensitive enough to identify the differences in passing skills between young players with different levels of expertise, providing a numbering score for each pass executed.
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Affiliation(s)
- Arturo Quílez-Maimón
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain; (A.Q.-M.); (F.J.R.-R.); (G.D.-G.)
| | - Francisco Javier Rojas-Ruiz
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain; (A.Q.-M.); (F.J.R.-R.); (G.D.-G.)
| | - Gabriel Delgado-García
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain; (A.Q.-M.); (F.J.R.-R.); (G.D.-G.)
| | - Javier Courel-Ibáñez
- Department of Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, 30720 Murcia, Spain
- Correspondence:
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Kal E, Ellmers T, Diekfuss J, Winters M, van der Kamp J. Explicit motor learning interventions are still relevant for ACL injury rehabilitation: do not put all your eggs in the implicit basket! Br J Sports Med 2021; 56:63-64. [PMID: 33589469 PMCID: PMC8762022 DOI: 10.1136/bjsports-2020-103643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Elmar Kal
- College of Health, Medicine and Life Sciences; Department of Health Sciences, Brunel University London, London, UK .,College of Health, Medicine and Life Sciences; Centre for Cognitive Neuroscience, Brunel University London, London, UK
| | - Toby Ellmers
- College of Health, Medicine and Life Sciences; Centre for Cognitive Neuroscience, Brunel University London, London, UK.,School of Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Jed Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marinus Winters
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University Faculty of Health Sciences, Aalborg, Denmark
| | - John van der Kamp
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research Centre for Exercise, School and Sport, Windesheim University of Applied Sciences, Zwolle, The Netherlands
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Targeted Application of Motor Learning Theory to Leverage Youth Neuroplasticity for Enhanced Injury-Resistance and Exercise Performance: OPTIMAL PREP. ACTA ACUST UNITED AC 2021. [DOI: 10.1007/s42978-020-00085-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Training athletes with an external attentional focus enhances athletic performance during countermovement jump. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Restricting ankle dorsiflexion does not mitigate the benefits of external focus of attention on landing biomechanics in healthy females. Hum Mov Sci 2020; 74:102719. [PMID: 33232855 DOI: 10.1016/j.humov.2020.102719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns in the presence of a mechanical restriction on the ankle. Therefore, our purpose was to determine whether restricting ankle dorsiflexion by use of bracing mitigated the effects of attentional foci on landing biomechanics in healthy females. METHODS We used a crossover design to investigate lower extremity biomechanics in 19 healthy females between the ages of 18-35 during a series of jump-landing tasks. Participants completed 6 blocks of 3 jump-landings on separate force platforms in a randomized order based on brace condition (brace, no brace) and mode of attentional foci (neutral, internal focus [IF], external focus [EF]). Attentionally focused instructions were provided immediately prior to 3 practice jump-landings, followed by 5 test jump-landings with self-controlled feedback only. RESULTS Ankle bracing decreased peak dorsiflexion and sagittal range of motion (ROM) (mean difference: 5.7-5.8°), and peak inversion and frontal ROM (mean difference: 2.4-3.0°). However, hip flexion ROM (mean difference: 1.8°) increased compared to the no brace condition. Regardless of ankle bracing, EF instruction increased peak hip flexion (mean difference: 4.9°) and hip flexion range of motion (mean difference: 3.8-4.6°), while decreasing peak knee valgus (mean difference: 0.8-1.0°) and knee valgus moment (mean difference: 0.04 Nm/kg). Additionally, EF instruction increased peak hip abduction to a similar degree when braced (mean difference: 3.6-4.0°) and not braced (mean difference: 2.1-2.5°). Lastly, EF instruction increased hip abduction ROM only when braced (mean difference: 2.3-2.4°), but decreased peak knee valgus power only when not braced (mean difference: 0.18 W/kg). CONCLUSIONS Our findings indicate that mechanically restricting ankle dorsiflexion does not mitigate the ability of EF instruction to enhance jump-landing performance by means of improving hip and knee biomechanics in healthy females. However, our findings suggest an improved ability to control the rate of knee valgus loading when not braced. Therefore, we conclude that EF instruction remains a viable clinical strategy to improve landing patterns in the presence of restricted ankle dorsiflexion, yet this approach may be ineffective to reduce the rate of knee joint loading.
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Diekfuss JA, Bonnette S, Hogg JA, Riehm C, Grooms DR, Singh H, Anand M, Slutsky-Ganesh AB, Wilkerson GB, Myer GD. Practical Training Strategies to Apply Neuro-Mechanistic Motor Learning Principles to Facilitate Adaptations Towards Injury-Resistant Movement in Youth. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-020-00083-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hanzlíková I, Athens J, Hébert-Losier K. Factors influencing the Landing Error Scoring System: Systematic review with meta-analysis. J Sci Med Sport 2020; 24:269-280. [PMID: 32951976 DOI: 10.1016/j.jsams.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Systematically review the literature addressing age, sex, previous injury, and intervention program as influencing factors of the Landing Error Scoring System. DESIGN Systematic review with meta-analysis. METHODS Three databases (PubMed, Web of Science®, and Scopus®) were searched on 1 April 2020. Original studies using the Landing Error Scoring System as primary outcome and exploring age, sex, previous injury, and intervention program were included, assessed for risk of bias, and critically appraised. Three meta-analyses were performed using one random and two mixed effect models with dependent variables: sex, previous injury and intervention program, respectively. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the strength of the evidence. PROSPERO registration number CRD42018107210. RESULTS Fifty-two studies were included. Pooled data indicated that females have higher Landing Error Scoring System scores than males (p<0.001, mean difference=0.6 error). Participants with previous anterior cruciate ligament injury have higher LESS scores than healthy controls (p=0.004, mean difference 1.2 error). Neuromuscular training programs lasting a minimum of six weeks and other intervention programs decrease Landing Error Scoring System scores (p<0.001, mean difference 1.2 error and p=0.042, mean difference 0.5 error, respectively). There is limited evidence suggesting that age may influence Landing Error Scoring System scores in clinically meaningful manner. Overall, Grading of Recommendations Assessment, Development and Evaluation ratings suggest very low strength of evidence. CONCLUSIONS History of anterior cruciate ligament injury and undertaking neuromuscular training for a minimum of six weeks meaningfully altered Landing Error Scoring System scores. These findings, however, should be interpreted cautiously considering the very low Grading of Recommendations Assessment, Development and Evaluation rating of the evidence.
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Affiliation(s)
- Ivana Hanzlíková
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, New Zealand.
| | - Josie Athens
- Department of Preventive and Social Medicine, University of Otago, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, New Zealand
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Landing Error Scoring System scores change with knowledge of scoring criteria and prior performance. Phys Ther Sport 2020; 46:155-161. [PMID: 32942243 DOI: 10.1016/j.ptsp.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine if the knowledge of scoring criteria and prior performance influence Landing Error Scoring System (LESS) outcomes. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Thirty individuals. MAIN OUTCOME MEASURES The LESS was tested at Baseline and one week later under two conditions: Pre and Post information. For the Post condition, LESS items were explained to participants, as were their individual Baseline scores. Mean LESS scores and number of individuals categorized at high and low risk were compared between Pre and Post using paired t-tests and McNemar's tests, respectively. McNemar's tests were also used to compare proportions of specific LESS errors between Pre and Post conditions. RESULTS Mean LESS Post scores (4.7 ± 1.2 errors) were significantly lower than Pre scores (6.6 ± 2.0 errors, p < 0.001) as was the number of individuals at high risk (25 vs 10 participants, p < 0.001). A significantly lower proportion of participants scored an error for the joint displacement item of LESS Post compared to Pre condition (p < 0.001). CONCLUSION When using the LESS, it is important that tested individuals have no knowledge of scoring criteria or previous errors for a valid assessment of innate jump-landing movement patterns and injury risk.
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The Effects of Attentional Focus Instructions Specific to Body Movements on Movement Quality and Performance. J Sport Rehabil 2020; 30:422-429. [PMID: 32820133 DOI: 10.1123/jsr.2019-0344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 04/28/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022]
Abstract
Contexts: Directing an individual's attention to the effect of the movements (external focus) has been shown to improve performance than directing attention to body movements (internal focus). However, the effect of attentional focus instructions specific to movement quality has not been investigated thoroughly. OBJECTIVE To compare the effects of internal and external focus instructions specific to body movements. DESIGN Mixed design, 2 (sex) × 2 (instructions). SETTINGS Laboratory setting. PARTICIPANTS A total of 40 participants (males, n = 20; mean [SD]; age = 22.0 [2.19] y; height = 179.33 [5.90] cm; mass = 77.7 [13.04] kg; females, n = 20; age = 22.0 [3.87] y; height = 164.84 [5.80] cm; mass = 71.48 [20.66] kg) were recruited. INTERVENTION Participants completed 2 consecutive jumps (ie, a forward jump from a height and then a maximal vertical jump) with internal focus and external focus instructions. External focus was elicited by placing pieces of tape on the participants' legs. MAIN OUTCOME MEASURES Landing quality was measured by the Landing Error Scoring System to assess movement quality, and the vertical jump height was measured by Vertec. RESULTS The performance results showed that the external focus condition resulted in superior vertical jump height compared with the internal focus condition (P < .05). Although landing quality did not show significant differences between 2 conditions, the effect size (η2 = .09) indicated that landing quality was better when participants adopted an external, rather than an internal focus of attention (P = .07). CONCLUSIONS The body-oriented instructions can be provided externally by adding artificial external cues and directing attention to them. Importantly, the findings were evident in a qualitative assessment that can be adopted by practitioners. The results suggest that practitioners should adopt an external focus cue for performance and also consider using an external focus for movement quality.
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Hanzlíková I, Athens J, Hébert-Losier K. Clinical implications of Landing Error Scoring System calculation methods. Phys Ther Sport 2020; 44:61-66. [PMID: 32416583 DOI: 10.1016/j.ptsp.2020.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore whether final Landing Error Scoring System (LESS) scores differ between calculation methods used in literature. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS 328 individuals. MAIN OUTCOME MEASURES LESS scores from 984 drop-jumps were extracted. Final LESS scores were calculated for every participant according to five methods: mean of 3 jumps, 1st jump score, 3rd jump score, best jump score, and sum of errors present in at least 2 jumps. The influence of the calculation method on group mean LESS score and group-level risk categorization using threshold of 5 errors was estimated using Generalized Estimating Equations, with the mean of 3 jumps score set as the reference method. The agreement in individual-level risk categorization was assessed using odds ratios and McNemar's tests. RESULTS Compared to the reference, estimated group mean LESS score was 0.92 errors lower (p < 0.001) using the best jump method, as was group-level risk categorization (odds ratio: 0.50, p < 0.001). Individual-level risk categorization between calculation methods was inconsistent for 8-15% of participants compared to the reference method, significantly different from reference for the best jump score method (p < 0.001). CONCLUSIONS Calculation method meaningfully influences final LESS scores and risk categorization.
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Affiliation(s)
- I Hanzlíková
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, 52 Miro Street, Mount Maunganui, 3116, New Zealand.
| | - J Athens
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - K Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, 52 Miro Street, Mount Maunganui, 3116, New Zealand.
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Gokeler A, Neuhaus D, Benjaminse A, Grooms DR, Baumeister J. Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. Sports Med 2020; 49:853-865. [PMID: 30719683 PMCID: PMC6548061 DOI: 10.1007/s40279-019-01058-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Athletes who wish to resume high-level activities after an injury to the anterior cruciate ligament (ACL) are often advised to undergo surgical reconstruction. Nevertheless, ACL reconstruction (ACLR) does not equate to normal function of the knee or reduced risk of subsequent injuries. In fact, recent evidence has shown that only around half of post-ACLR patients can expect to return to competitive level of sports. A rising concern is the high rate of second ACL injuries, particularly in young athletes, with up to 20% of those returning to sport in the first year from surgery experiencing a second ACL rupture. Aside from the increased risk of second injury, patients after ACLR have an increased risk of developing early onset of osteoarthritis. Given the recent findings, it is imperative that rehabilitation after ACLR is scrutinized so the second injury preventative strategies can be optimized. Unfortunately, current ACLR rehabilitation programs may not be optimally effective in addressing deficits related to the initial injury and the subsequent surgical intervention. Motor learning to (re-)acquire motor skills and neuroplastic capacities are not sufficiently incorporated during traditional rehabilitation, attesting to the high re-injury rates. The purpose of this article is to present novel clinically integrated motor learning principles to support neuroplasticity that can improve patient functional performance and reduce the risk of second ACL injury. The following key concepts to enhance rehabilitation and prepare the patient for re-integration to sports after an ACL injury that is as safe as possible are presented: (1) external focus of attention, (2) implicit learning, (3) differential learning, (4) self-controlled learning and contextual interference. The novel motor learning principles presented in this manuscript may optimize future rehabilitation programs to reduce second ACL injury risk and early development of osteoarthritis by targeting changes in neural networks.
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Affiliation(s)
- Alli Gokeler
- Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany. .,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg. .,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Dorothee Neuhaus
- Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands
| | - Dustin R Grooms
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany.,Exercise Neuroscience and Health Lab, Institute of Health, Nutrition and Sport Sciences, University of Flensburg, Flensburg, Germany.,Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Faculty of Medicine and Health, Stellenbosch University, Stellenbosch, South Africa
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36
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The Effects of Instruction Exercises on Performance and Kinetic Factors Associated With Lower-Extremity Injury in Landing After Volleyball Blocks. J Sport Rehabil 2020; 29:51-64. [PMID: 30526280 DOI: 10.1123/jsr.2018-0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/15/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Female volleyball players are more predisposed to anterior cruciate ligament injury in comparison with their male counterparts. Recent research on anterior cruciate ligament injury prevention strategies has shown the positive results of adopting the external focus (EF) of attention in sports. OBJECTIVE To determine the effect of 6-week EF instruction exercises on performance and kinetic factors associated with lower-extremity injury in landing after the volleyball blocks of female athletes. DESIGN Pretest and posttest control study. SETTING University research laboratory. PARTICIPANTS Thirty-two female volleyball players (18-24 y old) from the same team randomly divided into experimental (n = 16) and control (n = 16) groups. INTERVENTION The experimental group performed a 6-week exercise program with EF instructions. The control group continued its regular volleyball team schedule. MAIN OUTCOME MEASURES To assess function, single-leg triple hop test for distance was used. A force plate was used to evaluate kinetic variables including vertical ground reaction forces, the rate of loading, and dynamic postural stability index. All data were assessed at baseline and after the intervention. RESULTS There was a significant increase in single-leg triple hop test (P < .05) and in the first and second peak ground reaction force, rate of loadings, dynamic postural stability index (P < .05). CONCLUSION According to the results of this study, anterior cruciate ligament injury prevention programs should incorporate EF instruction exercises to enhance the kinetics and to increase athletes' functional performance.
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Welling W, Benjaminse A, Lemmink K, Dingenen B, Gokeler A. Progressive strength training restores quadriceps and hamstring muscle strength within 7 months after ACL reconstruction in amateur male soccer players. Phys Ther Sport 2019; 40:10-18. [DOI: 10.1016/j.ptsp.2019.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
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Harry JR, Lanier R, Nunley B, Blinch J. Focus of attention effects on lower extremity biomechanics during vertical jump landings. Hum Mov Sci 2019; 68:102521. [PMID: 31610993 DOI: 10.1016/j.humov.2019.102521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
This study examined biomechanical differences between external and internal foci of attention during vertical jump landings in males and females. Twenty-four healthy adults performed eight vertical jump landings using both internal and external foci while three-dimensional kinematic and ground reaction force (GRF) data were obtained. Two (focus) by two (sex) analyses of variance (α = 0.05) and Cohen's d effect sizes (ES) were used to compare differences in vertical GRF, joint angular positions and displacements, and lower limb joint angular work between foci and between sexes. Significantly greater knee contributions to total angular work occurred during external versus internal focus landings regardless of sex (p = .013; ES = 0.30). Significantly smaller plantarflexion angles (p = .019; ES = 0.53) and significantly greater knee flexion angles were observed at ground contact (p < .001; ES = 1.11) in males during external focus landings. Females exhibited significantly smaller knee flexion angles at both ground contact during external versus internal focus landings (p = .031; ES = 0.20) and compared to males during external focus landings (p < .001; ES = 1.76). Both peak vertical GRF (p = .003; ES = 1.54) and the ankle contributions to total angular work during loading (p = .026; ES = 1.07) were greater in females versus males regardless of foci, whereas the knee contributions to total angular work during loading were smaller in women (p = .026; ES = 1.07). Males and females might consider adopting an external focus during vertical jump landings to increase knee joint contributions to lower limb energy absorption. Females, in particular, might consider external focus use to decrease peak vertical GRF and increase the knee joint's contribution to total energy absorption to magnitudes similar to those exhibited by males.
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Affiliation(s)
- John R Harry
- Human Performance & Biomechanics Laboratory, Dept. of Kinesiology & Sport Management, Texas Tech University, 3204 Main Street, Lubbock, TX 79409, United States of America.
| | - Ryan Lanier
- Human Performance & Biomechanics Laboratory, Dept. of Kinesiology & Sport Management, Texas Tech University, 3204 Main Street, Lubbock, TX 79409, United States of America
| | - Brandon Nunley
- Human Performance & Biomechanics Laboratory, Dept. of Kinesiology & Sport Management, Texas Tech University, 3204 Main Street, Lubbock, TX 79409, United States of America
| | - Jarrod Blinch
- Motor Behavior Laboratory, Dept. of Kinesiology & Sport Management, Texas Tech University, 3204 Main Street, Lubbock, TX 79409, United States of America
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39
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Dos'Santos T, McBurnie A, Comfort P, Jones PA. The Effects of Six-Weeks Change of Direction Speed and Technique Modification Training on Cutting Performance and Movement Quality in Male Youth Soccer Players. Sports (Basel) 2019; 7:sports7090205. [PMID: 31489929 PMCID: PMC6783855 DOI: 10.3390/sports7090205] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022] Open
Abstract
Cutting manoeuvres are important actions associated with soccer performance and a key action associated with non-contact anterior cruciate ligament injury; thus, training interventions that can improve cutting performance and movement quality are of great interest. The aim of this study, therefore, was to determine the effects of a six-week change of dire[ction (COD) speed and technique modification training intervention on cutting performance and movement quality in male youth soccer players (U17s, n = 8) in comparison to a control group (CG) (U18s, n = 11) who continued ‘normal’ training. Cutting performance was assessed based on completion time and COD deficit, and the field-based cutting movement assessment score (CMAS) qualitative screening tool was used to assess cutting movement quality. Significant main effects for time (pre-to-post changes) (p ≤ 0.041, η2 = 0.224–0.839) and significant interaction effects of time and group were observed for cutting completion times, COD deficits, and CMASs. Improvements in completion time (p < 0.001, g = 1.63–1.90, −9% to −11% vs. −5% to 6%) and COD deficit (p ≤ 0.012, g = −1.63 to −2.43, −40–52% vs. −22% to −28%) for the COD intervention group (IG) were approximately two-times greater than the CG. Furthermore, lower CMASs (i.e., improved cutting movement quality) were only observed in the IG (p ≤ 0.025, g = −0.85 to −1.46, −23% to −34% vs. 6–19%) compared to the CG. The positive changes in CMASs were attributed to improved cutting technique and reduced incidences of high-risk deficits such as lateral trunk flexion, extended knee postures, knee valgus, hip internal rotation, and improved braking strategies. The results of this study indicate that COD speed and technique modification training, in addition to normal skills and strength training, improves cutting performance and movement quality in male youth soccer players. Practitioners working with male youth soccer players should implement COD speed and technique modification training to improve cutting performance and movement quality, which may decrease potential injury-risk.
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Affiliation(s)
- Thomas Dos'Santos
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
| | - Alistair McBurnie
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
| | - Paul Comfort
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
| | - Paul A Jones
- Directorate of Sport, Exercise & Physiotherapy, University of Salford, Salford, Greater Manchester M6 6PU, UK.
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40
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Neilson V, Ward S, Hume P, Lewis G, McDaid A. Effects of augmented feedback on training jump landing tasks for ACL injury prevention: A systematic review and meta-analysis. Phys Ther Sport 2019; 39:126-135. [DOI: 10.1016/j.ptsp.2019.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/16/2022]
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41
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Raisbeck LD, Yamada M. The effects of instructional cues on performance and mechanics during a gross motor movement. Hum Mov Sci 2019; 66:149-156. [PMID: 31029836 DOI: 10.1016/j.humov.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
Externally focused instructions specific to performance have shown to improve body mechanics (Gokeler et al., 2015; Welling, Benjaminse, Gokeler, & Otten, 2016). However, the effect of using an external focus instruction may have been more profound if the content of the instruction had been relevant to mechanics. Therefore, the present study examined the effects of externally focused instructions specific to performance and externally focused instructions specific to body mechanics on mechanics and performance. Twenty-four adults (n = 12 males; n = 12 females) performed a series of drop jumps following external focus cues that were specific to performance and landing mechanics. Participants completed a drop jump followed by a maximal effort vertical jump. The initial contact, maximal angle, and range of motion at the knee in the sagittal and frontal plane motion were measured for mechanics and the height of the second vertical jump was measured for performance. The results suggest external focus instructions specific to performance are beneficial for performance, but not for improving landing mechanics. This suggests that external focus instructions must be specific to the contents of the instruction.
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42
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Grooms DR, Diekfuss JA, Ellis JD, Yuan W, Dudley J, Foss KDB, Thomas S, Altaye M, Haas L, Williams B, Lanier JM, Bridgewater K, Myer GD. A Novel Approach to Evaluate Brain Activation for Lower Extremity Motor Control. J Neuroimaging 2019; 29:580-588. [PMID: 31270890 DOI: 10.1111/jon.12645] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to assess the consistency of a novel MR safe lower extremity motor control neuroimaging paradigm to elicit reliable sensorimotor region brain activity. METHODS Participants completed multiple sets of unilateral leg presses combining ankle, knee, and hip extension and flexion movements against resistance at a pace of 1.2 Hz while lying supine in a 3T MRI scanner. Regions of Interest (ROI) consisted of regions primarily involved in lower extremity motor control (right and left primary motor cortex, primary somatosensory cortex, premotor cortex, secondary somatosensory cortex, basal ganglia, and the cerebellum). RESULTS The group analysis based on mixed effects paired samples t-test revealed no differences for brain activity between sessions (P > .05). Intraclass correlation coefficients in the sensorimotor regions were good to excellent for average percent signal change (.621 to .918) and Z-score (.697 to .883), with the exception of the left secondary somatosensory cortex percent signal change (.165). CONCLUSIONS These results indicate that a loaded lower extremity force production and attenuation task that simulates the range of motion of squatting, stepping, and landing from a jump is reliable for longitudinal neuroimaging applications and support the use of this paradigm in further studies examining therapeutic interventions and changes in dynamic lower extremity motor function.
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Affiliation(s)
- Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH
| | - Jed A Diekfuss
- the SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jonathan D Ellis
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH
| | - Weihong Yuan
- College of Medicine, University of Cincinnati, Cincinnati, OH.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kim D Barber Foss
- the SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Staci Thomas
- the SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lacey Haas
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Brynne Williams
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John M Lanier
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kaley Bridgewater
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gregory D Myer
- the SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,College of Medicine, University of Cincinnati, Cincinnati, OH.,Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH.,The Micheli Center for Sports Injury Prevention, Waltham, MA
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43
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Widenhoefer TL, Miller TM, Weigand MS, Watkins EA, Almonroeder TG. Training rugby athletes with an external attentional focus promotes more automatic adaptions in landing forces. Sports Biomech 2019; 18:163-173. [DOI: 10.1080/14763141.2019.1584237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Mark Steven Weigand
- Rinker-Ross School of Health Sciences, Trine University, Fort Wayne, IN, USA
| | - Emily Ann Watkins
- Rinker-Ross School of Health Sciences, Trine University, Fort Wayne, IN, USA
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Critchley ML, Davis DJ, Keener MM, Layer JS, Wilson MA, Zhu Q, Dai B. The effects of mid-flight whole-body and trunk rotation on landing mechanics: implications for anterior cruciate ligament injuries. Sports Biomech 2019; 19:421-437. [PMID: 30945626 DOI: 10.1080/14763141.2019.1595704] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose was to quantify the effects of mid-flight whole-body and trunk rotation on knee mechanics in a double-leg landing. Eighteen male and 20 female participants completed a jump-landing-jump task in five conditions: no rotation, testing leg ipsilateral or contralateral (WBRC) to the whole-body rotation direction, and testing leg ipsilateral (TRI) or contralateral to the trunk rotation direction. The WBRC and TRI conditions demonstrated decreased knee flexion and increased knee abduction angles at initial contact (2.6 > Cohen's dz > 0.3) and increased peak vertical ground reaction forces and knee adduction moments during the 100 ms after landing (1.7 > Cohen's dz > 0.3). The TRI condition also showed the greatest knee internal rotation angles at initial contact and peak knee abduction and internal rotation angles and peak knee extension moments during the 100 ms after landing (2.0 > Cohen's dz > 0.5). Whole-body rotation increased contralateral knee loading because of its primary role in decelerating medial-lateral velocities. Trunk rotation resulted in the greatest knee loading for the ipsilateral knee due to weight shifting and mechanical coupling between the trunk and lower extremities. These findings may help understand altered trunk motion in anterior cruciate ligament injuries.
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Affiliation(s)
- Meghan L Critchley
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Daniel J Davis
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Michaela M Keener
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Jacob S Layer
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Margaret A Wilson
- Department of Theatre and Dance, University of Wyoming , Laramie, WY, USA
| | - Qin Zhu
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
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45
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Harry JR, James CR, Dufek JS. Weighted vest effects on impact forces and joint work during vertical jump landings in men and women. Hum Mov Sci 2018; 63:156-163. [PMID: 30553141 DOI: 10.1016/j.humov.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
Weighted vest (WV) use during vertical jump landings (VJL) does not appear to alter peak vertical ground reaction forces (GRF) or peak joint torques. However, WV effects on joint work and sex differences during VJL are not well understood. This study assessed WV effects on vertical GRF and sagittal joint work during VJL in men and women. Twelve men and 12 women performed VJL wearing a WV with zero added mass (unloaded) and with 10% body mass (loaded) while GRF and kinematic data were obtained. Mixed-model analyses of variance (α = 0.05) and effect sizes (ES) were used to assess differences between sexes and/or load conditions. Regardless of sex, greater landing height (p < 0.001; ES = 0.37) and peak vertical GRF (p = 0.001; ES 0.51) occurred when unloaded, while greater landing time (p = 0.001; ES = 0.46) and negative lower extremity work (p < 0.001; ES = 0.41) occurred when loaded through greater negative work about the hip (p = 0.001; ES = 0.27) and ankle (p = 0.020; ES = 0.27). No differences in hip (p = 0.753; ES = 0.03), knee (p = 0.588; ES = 0.07), or ankle (p = 0.580; ES = 0.09) joint displacement were detected between loaded and unloaded conditions. Men exhibited greater landing heights (p < 0.001; ES = 2.49) and greater peak vertical GRF than women (p = 0.007; ES = 1.18), though women exhibited greater negative lower extremity work (p < 0.001; ES = 1.98) than men through greater negative knee (p < 0.001; ES = 1.98) and ankle (p = 0.032; ES = 0.94) work. No sex differences were detected for joint angular displacement about the hip (p = 0.475; ES = 0.30), knee (p = 0.666; ES = 0.18), or ankle (p = 0.084; ES = 0.71). These data revealed a unique load accommodation strategy during VJL with a WV characterized by greater lower extremity joint work performed via increased joint torque despite lesser landing height and peak vertical GRF. Women appear to perform greater lower extremity joint work than men during VJL despite lesser landing height and peak vertical GRF. Current and prospective WV users should be aware of their load accommodation strategy during VJL with an external load. Women may consider developing more refined load accommodation strategies for VJL regardless of whether external loading is applied to avoid performing excessive amounts of lower extremity work.
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Affiliation(s)
- John R Harry
- Department of Kinesiology & Sport Management, Texas Tech University, 3204 Main Street, Lubbock, TX 79409, USA.
| | - C Roger James
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA
| | - Janet S Dufek
- Department of Kinesiology & Nutrition Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 3034, Las Vegas, NV 89154, USA
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46
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Hinshaw TJ, Davis DJ, Layer JS, Wilson MA, Zhu Q, Dai B. Mid-flight lateral trunk bending increased ipsilateral leg loading during landing: a center of mass analysis. J Sports Sci 2018; 37:414-423. [DOI: 10.1080/02640414.2018.1504616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Taylour J. Hinshaw
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Daniel J. Davis
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Jacob S. Layer
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Margaret A. Wilson
- Department of Theatre and Dance, University of Wyoming, Laramie, WY, USA
| | - Qin Zhu
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
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47
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Harry JR, Freedman Silvernail J, Mercer JA, Dufek JS. Bilateral Comparison of Vertical Jump Landings and Step-off Landings From Equal Heights. J Strength Cond Res 2018; 32:1937-1947. [DOI: 10.1519/jsc.0000000000002093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Gokeler A, Seil R, Kerkhoffs G, Verhagen E. A novel approach to enhance ACL injury prevention programs. J Exp Orthop 2018; 5:22. [PMID: 29916182 PMCID: PMC6005994 DOI: 10.1186/s40634-018-0137-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Efficacy studies have demonstrated decreased anterior cruciate ligament (ACL) injury rates for athletes participating in injury prevention programs. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. Unfortunately, improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills as needed in complex sports environments. In the motor learning domain, these types of instructions are defined as an internal attentional focus. An internal focus, on one's own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes' behavior.
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Affiliation(s)
- Alli Gokeler
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg. .,Department of Applied Neuroscience in Sports and Exercise, Institute of Sports Medicine, University of Paderborn, Paderborn, Germany. .,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, Netherlands.
| | - Romain Seil
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - Gino Kerkhoffs
- Academic Center for Evidence based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Academic Medical Center/VU Medical Center, Amsterdam, Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Academic Medical Center/VU Medical Center, Amsterdam, Netherlands.,Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, Netherlands.,Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
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49
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Elias ARC, Harris KJ, LaStayo PC, Mizner RL. Clinical Efficacy of Jump Training Augmented With Body Weight Support After ACL Reconstruction: A Randomized Controlled Trial. Am J Sports Med 2018; 46:1650-1660. [PMID: 29558161 DOI: 10.1177/0363546518759052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited knee flexion and increased muscle co-contraction during jump landing are believed to diminish outcomes after anterior cruciate ligament (ACL) reconstruction. The efficacy of jump training to improve patients' mechanical and neuromuscular deficits is understudied. HYPOTHESIS Jump training will improve functional, mechanical, and neuromuscular outcomes and higher repetition training augmented by body weight support will result in better retention of gains. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Thirty athletes (18 months after surgery) were screened, and 19 with mechanical deficits and limited clinical outcomes were enrolled in the trial. Testing included the International Knee Documentation Committee (IKDC) questionnaire, leg landing mechanics via motion analysis, knee joint effusion using a stroke test, and a surface electromyography-generated co-contraction index during a single-legged landing. Participants were randomly assigned to 1 of 2 groups: jump training with normal body weight (JTBW) and high-repetition jump training with body weight support (JTBWS). Knee effusion grading throughout training was used to assess joint tolerance. Changes in outcomes over time were analyzed with mixed-effects modeling. Immediate outcomes were compared with retention testing at 8 weeks after training by use of 2-way analyses of variance with effects of time and group. RESULTS Significant effects of time were found during the training phase for all outcome measures, but no effects of group or sex were found. IKDC score (pooled; mean ± SD) increased from 76 ± 12 to 87 ± 8 ( P < .001). Knee flexion during single-legged landing increased from 57° ± 11° to 73° ± 9° ( P < .001). Average co-contraction index decreased from 37 ± 15 to 19 ± 6 ( P < .001). All measures were retained over the retention period in both groups. The relative risk of knee effusion of the JTBW group versus the JTBWS group was 4.2 (95% CI, 2.25-7.71; P < .001). CONCLUSION Jump training mitigated some risk factors for second injury and osteoarthritis in patients after ACL reconstruction. Training made lasting improvements in physical function measures as well as mechanical and neuromuscular coordination deficits. Higher repetitions used with body weight support did not improve retention but substantially reduced risk for effusion. CLINICAL RELEVANCE Jump training is an efficacious intervention for athletes with poor outcomes after ACL reconstruction, and training with body weight support lessens the risk for excessive joint stress during practice. Registration: NCT02148172 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Audrey R C Elias
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Kari J Harris
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Paul C LaStayo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Ryan L Mizner
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
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50
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Popovic T, Caswell SV, Benjaminse A, Siragy T, Ambegaonkar J, Cortes N. Implicit video feedback produces positive changes in landing mechanics. J Exp Orthop 2018; 5:12. [PMID: 29721781 PMCID: PMC5931948 DOI: 10.1186/s40634-018-0129-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implicit (IF) and explicit (EF) feedback are two motor learning strategies demonstrated to alter movement patterns. There is conflicting evidence on which strategy produces better outcomes. The purpose of this study was to examine the effects of reduced IF and EF video feedback on lower extremity landing mechanics. METHODS Thirty participants (24 ± 2 years, 1.7 ± 0.1 m, 70 ± 11 kg) were randomly assigned to three groups: IF (n = 10), EF (n = 10), and control (CG) (n = 10). They performed twelve box-drop jumps three times a week on the training sessions for six weeks. Only IF and EF groups received video feedback on the training sessions. IF was cued to focus their attention on the overall jump, while EF was cued to focus on position of their knees. 3D lower extremity biomechanics were tested on testing sessions with no feedback. All sessions were at least 24 h apart from another. Testing sessions included baseline testing (pretest), testing after 3 training sessions with 100% feedback (pst1), testing after 6 training sessions with 33.3% feedback (pst2), testing after 6 training sessions with 16.6% feedback (Pst3), and testing 1 month after with no feedback (retention - ret). ANOVA compared differences between groups and time at initial contact and peak for hip flexion (HF, °) and abduction angle (HA, °), hip abduction moment (HAM, Nm/kgm), knee flexion (KF, °) and abduction angle (KA, °), knee abduction moment (KAM, Nm/kgm) and VGRF (N) (p < 0.05). RESULTS A significant main effect for group was found between IF and EF groups for HA (IF = - 6.7 ± 4; EF = - 9.4 ± 4.1) and KAM (IF = 0.05 ± 0.2; EF = - 0.07 ± 0.2) at initial contact, and peaks HA (IF = - 3.5 ± 4.5; EF = - 7.9 ± 4.7) and HAM (IF = 1.1 ± 0.6; EF = 0.9 ± 0.4). A significant main effect for time at initial contact for HF (pre = 32.4 ± 3.2; pst2 = 36.9 ± 3.2; pst3 = 37.9 ± 3.7; ret. = 34.1 ± 3.7), HAM (pre = 0.1 ± 0.1; pst1 = 0.04 ± 0.1; pst3 = 0.1 ± 0.01), KA (pre = 0.7 ± 1.1; pst1 = 0.2 ± 1.2; pst3 = 1.7 ± 1), and KAM (pre = 0.003 ± 0.1; pst3 = 0.01 ± 0.1) was found. DISCUSSION/CONCLUSION We found that implicit feedback produced positive changes in landing mechanics while explicit feedback degraded motor learning. Our results indicate that implicit feedback should be used in programs to lower the ACL injury risk. We suggest that implicit feedback should be frequent in the beginning and not be reduced as much following the acquisition phase.
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Affiliation(s)
- Tijana Popovic
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA.,Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, Lobby 6, Suite 391, San Francisco, CA, 94107, USA
| | - Shane V Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA
| | | | - Tarique Siragy
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA.,School of Human Kinetics, Faculty of Health Sciences at the University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Jatin Ambegaonkar
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA
| | - Nelson Cortes
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA.
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