Effects of augmented feedback on training jump landing tasks for ACL injury prevention: A systematic review and meta-analysis

Individualized Technique Feedback for Instant Technique Improvements and Knee Abduction Moment Reductions - A New Approach for 'Sidestepping' ACL Injuries?

Background

Sidestep cutting technique is highly individual and has been shown to influence knee joint loading. However, studies assessing whether individualized technique feedback improves technique and ACL injury-relevant knee joint loads instantly in a sport-specific task are lacking.

Purpose

To determine the instant effects of individualized augmented technique feedback and instructions on technique and the peak external knee abduction moment (pKAM) in a handball-specific sidestep cut. Additionally, to determine the effects of technique modifications on the resultant ground reaction force and its frontal plane moment arm to the knee joint center.

Study Design

Controlled laboratory cohort study.

Methods

Three-dimensional biomechanics of 48 adolescent female handball players were recorded during a handball-specific sidestep cut. Following baseline cuts to each side, leg-specific visual and verbal technique feedback on foot strike angle, knee valgus motion, or vertical impact velocity using a hierarchically organized structure accounting for the variables' association with performance was provided. Subsequently, sidestep cuts were performed again while verbal instructions were provided to guide technique modifications. Combined effects of feedback and instructions on technique and pKAM as well as on the resultant ground reaction force and its frontal plane moment arm to the knee joint center were assessed.

Results

On average, each targeted technique variable improved following feedback and instructions, leading to instant reductions in pKAM of 13.4% to 17.1%. High inter-individual differences in response to feedback-instruction combinations were observed. These differences were evident in both the adherence to instructions and the impact on pKAM and its components.

Conclusion

Most players were able to instantly adapt their technique and decrease ACL injury-relevant knee joint loads through individualized augmented technique feedback, thereby potentially reducing the risk of injury. More research is needed to assess the retention of these adaptations and move towards on-field technique assessments using low-cost equipment.

Level of Evidence

Level 3.

The impact of augmented feedback (and technology) on learning and teaching cricket skill: A systematic review with meta-analysis

Augmented feedback, including that provided using technology, can elicit multifaceted benefits on perceptual-motor learning and performance of sporting skills. However, current considerations of the applied value in supporting learning and teaching cricket skill is limited. This systematic review with meta-analysis aimed to understand the role and effectiveness of feedback-involved interventions on skill-based performance outcomes in cricket-related research. Six electronic databases were searched (SPORTDiscus, CINAHL, MEDLINE, Scopus, Web of Science and PsycINFO). Of 8,262 records identified, 11 studies met inclusion criteria; five of which were included in meta-analyses. Given no studies with an isolated feedback intervention-arm were identified, the two meta-analyses explored anticipation-based studies consisting of an intervention that included augmented feedback; positioned with respect to the key motor skill concepts of perception (anticipation accuracy) and action (performance success). Despite results highlighting improved performance outcomes for the feedback-involved intervention groups, with a large effect size for improved anticipation accuracy (Hedge's g = 1.21, 95% CIs [-0.37, 2.78]) and a medium effect size for overall performance success (Hedge's g = 0.55, 95% CIs [-0.39, 1.50]), results were not statistically significant and should be interpreted with caution given the wide confidence intervals. Considering the small number of studies available, in addition to the lack of isolated feedback protocols, further research is warranted to thoroughly explore the impact of augmented feedback on skill-based performance in cricket. Beyond the meta-analyses, the review also explored all included studies from an ecological dynamics perspective; presenting future avenues of research framed around evaluating the applied value of using augmented feedback (mediated with or without technology) for learning and teaching skill in cricket. Trial registration The protocol was preregistered with Open Science Framework (osf.io/384pd).

Can a knee sleeve influence ground reaction forces and knee joint power during a step-down hop in participants following anterior cruciate ligament reconstruction? A secondary analysis

PURPOSE

Elastic knee sleeves are often worn following anterior cruciate ligament (ACL) reconstruction. The study aimed to define immediate and 6-week effects of wearing a knee sleeve on ground reaction forces (GRF) and knee joint power during a step-down hop task.

METHODS

Using a cross-over design, we estimated GRF and knee kinematics and kinetics during a step-down hop for 30 participants following ACL reconstruction (median 16 months post-surgery) with and without wearing a knee sleeve. In a subsequent randomised clinical trial, participants in the 'Sleeve Group' (n = 9) wore the sleeve for 6 weeks at least 1 hour daily, while a 'Control Group' (n = 9) did not wear the sleeve. We compared the following outcomes using statistical parametric mapping (SPM): (1) GRF and knee joint power trajectories between three conditions at baseline (uninjured side, unsleeved injured and sleeved injured side); (2) GRF and knee joint power trajectories within-participant changes from baseline to follow-up between groups. We also compared discrete peak GRFs and power, rate of (vertical) force development, and mean knee joint power in the first 5% of stance phase.

RESULTS

SPM showed no differences for GRF for the (unsleeved) injured compared to the uninjured sides; when wearing the sleeve, injured side mean power in the first 5% of stance increased significantly from a concentric to an eccentric power. Discrete variables showed lower peak anterior (propulsive) GRF, mean power in the first 5% of stance, peak eccentric and concentric power for the injured compared to the uninjured sides. After six weeks, a directional change for vertical GRF differed showed slightly decreased forces for the Control Group and increased forces for the Sleeve Group.

CONCLUSION

Wearing a knee sleeve on the anterior cruciate ligament injured knee improved knee power during the first 5% of stance during the step-down hop. No consistent changes were observed for ground reaction forces for SPM and discrete variable analyses. Wearing the knee sleeve at least one hour daily for 6-weeks lead to a directional change of increased vertical GRF for the Sleeve Group at follow-up.

TRIAL REGISTRATION

The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry No: ACTRN12618001083280, 28/06/2018. https: //anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375347&isClinicalTrial=False.

The Safe Landing warm up technique modification programme: An effective anterior cruciate ligament injury mitigation strategy to improve cutting and jump-movement quality in soccer players

The objective of the study was to evaluate the effectiveness of the Safe Landing (SL), a 6-week technique-modification (TM) programme, on cutting and jump-landing movement quality in football players. In a non-randomized design, 32 male semi-professional football players from two Spanish clubs participated in the study: one served as the control group (CG, n = 11), while the other performed the SL (n = 15). Performance and movement quality of drop vertical jump and 70º change of direction (COD70) were evaluated through 2D video footage pre- and post-intervention. In such tasks, the Landing Error Scoring System for first (LESS1) and second (LESS2) landings, and the Cutting Movement Assessment Score (CMAS) were used for assessing movement quality. Pre-to-post changes and baseline-adjusted ANCOVA were used. Medium-to-large differences between groups at post-test were shown in CMAS, LESS1 and LESS2 (p < 0.082, ղ2 = 0.137-0.272), with small-to-large improvements in SL (p < 0.046, ES=0.546-1.307), and CG remaining unchanged (p > 0.05) pre-to-post. In COD70 performance, large differences were found between groups (p < 0.047, ղ2 = 0.160-0.253), with SL maintaining performance (p > 0.05, ES=0.039-0.420), while CG moderately decreasing performance (p = 0.024, ES=0.753) pre-to-post. The SL is a feasible and effective TM program to improve movement quality and thus potential injury risk in cutting and landing, while not negatively affecting performance.

Immediate and six-week effects of wearing a knee sleeve following anterior cruciate ligament reconstruction on knee kinematics and kinetics: a cross-over laboratory and randomised clinical trial

Background

Elastic knee sleeves are often worn following anterior cruciate ligament reconstruction (ACLR) but their effects on movement patterns are unclear.

Aim

To determine the immediate and six-week effects of wearing a knee sleeve on biomechanics of the knee during a step-down hop task.

Methods

Using a cross-over design, we estimated sagittal plane knee kinematics and kinetics and stance duration during a step-down hop for 31 participants (age 26.0 [SD 6.6] years, 15 women) after ACLR (median 16 months post-surgery) with and without wearing a knee sleeve. In a subsequent randomised clinical trial, participants in the ‘Sleeve Group’ (n = 9) then wore the sleeve for 6 weeks at least 1 h daily, while a ‘Control Group’ (n = 9) did not wear the sleeve. We used statistical parametric mapping to compare (1) knee flexion/extension angle and external flexion/extension moment trajectories between three conditions at baseline (uninjured side, unsleeved injured side and sleeved injured side); (2) within-participant changes for knee flexion angles and external flexion/extension moment trajectories from baseline to follow-up between groups. We compared discrete flexion angles and moments, and stance duration between conditions and between groups.

Results

Without sleeves, knee flexion was lower for the injured than the uninjured sides during mid-stance phase. When wearing the sleeve on the injured side, knee flexion increased during the loading phase of the stance phase. Discrete initial and peak knee flexion angles increased by (mean difference, 95% CIs) 2.7° (1.3, 4.1) and 3.0° (1.2, 4.9), respectively, when wearing the knee sleeve. Knee external flexion moments for the unsleeved injured sides were lower than the uninjured sides for 80% of stance phase, with no change when sleeved. The groups differenced for within-group changes in knee flexion trajectories at follow-up. Knee flexion angles increased for the Control group only. Stance duration decreased by 22% for the Sleeve group from baseline to follow-up (-89 ms; -153, -24) but not for the Controls.

Conclusions

Application of knee sleeves following ACLR is associated with improved knee flexion angles during hop landing training. Longer term (daily) knee sleeve application may help improve hop stance duration, potentially indicating improved hop performance.

Trial registration

The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry No: ACTRN12618001083280, 28/06/2018. ANZCTR

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05488-2.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

A Reporting Quality Assessment of Systematic Reviews and Meta-Analyses in Sports Physical Therapy: A Review of Reviews

This review of reviews aimed to evaluate the reporting quality of published systematic reviews and meta-analyses in the field of sports physical therapy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review of reviews included a literature search; in total, 2047 studies published between January 2015 and December 2020 in the top three journals related to sports physical therapy were screened. Among the 125 identified articles, 47 studies on sports physical therapy were included in the analysis (2 systematic reviews and 45 meta-analyses). There were several problems areas, including a lack of reporting for key components of the structured summary (10/47, 21.3%), protocol and registration (18/47, 38.3%), risk of bias in individual studies (28/47, 59.6%), risk of bias across studies (24/47, 51.1%), effect size and variance calculations (5/47, 10.6%), additional analyses (25/47, 53.2%), and funding (10/47, 21.3%). The quality of the reporting of systematic reviews and meta-analyses of studies on sports physical therapy was low to moderate. For better evidence-based practice in sports physical therapy, both authors and readers should examine assumptions in more detail, and report valid and adequate results. The PRISMA guideline should be used more extensively to improve reporting practices in sports physical therapy.

Biomechanical Characteristics between Bionic Shoes and Normal Shoes during the Drop-Landing Phase: A Pilot Study

With the development of unstable footwear, more research has focused on the advantages of this type of shoe. This type of shoe could improve the muscle function of the lower limb and prevent injury risks in dynamic situations. Therefore, the purpose of this study was to investigate differences in lower-limb kinetics and kinematics based on single-leg landing (SLL) using normal shoes (NS) and bionic shoes (BS). The study used 15 male subject volunteers (age 23.4 ± 1.14 years, height 177.6 ± 4.83cm, body weight (BW) 73.6 ± 7.02 kg). To ensure the subject standardization of the participants, there were several inclusion criteria used for selection. There were two kinds of experimental shoes used in the landing experiment to detect the change of lower limbs when a landing task was performed. Kinetics and kinematic data were collected during an SLL task, and statistical parametric mapping (SPM) analysis was used to evaluate the differences between NS and BS. We found that the flexion and extension angles of the knee (p = 0.004) and hip (p = 0.046, p = 0.018) joints, and the dorsiflexion and plantarflexion of ankle (p = 0.031) moment were significantly different in the sagittal planes. In the frontal plane, the eversion and inversion of the ankle (p = 0.016), and the abduction and adduction of knee (p = 0.017, p = 0.007) angle were found significant differences. In the horizontal plane, the external and internal rotation of hip (p = 0.036) and knee (p < 0.001, p = 0.029) moment were found significant differences, and knee angle (p = 0.043) also. According to our results, we conclude that using BS can cause bigger knee and hip flexion than NS. Also, this finding indicates that BS might be considered to reduce lower-limb injury risk during the SLL phase.

Distance Motor Learning during the COVID-19 Induced Confinement: Video Feedback with a Pedagogical Activity Improves the Snatch Technique in Young Athletes

The purpose of the present study was to investigate which of two strategies, Video Feedback with Pedagogical Activity (VF-PA) or Video Feedback (VF), would be more beneficial for the remote error correction of the snatch weightlifting technique during the confinement period. Thirty-five school aged children with at least three months of weightlifting experience were randomized to one of three training conditions: VF-PA, VF or the Control group (CONT). Subjects underwent test sessions one week before (T0) and one day after (T1) a six-session training period and a retention test session a week later (T2). During each test session, the Kinovea version 0.8.15 software measured the kinematic parameters of the snatch performance. Following distance learning sessions (T1), the VF-PA improved various kinematic parameters (i.e., barbell horizontal displacements, maximum height, looping and symmetry) compared with T0 (p < 0.5; Cohen's d = 0.58-1.1). Most of these improvements were maintained during the retention test (T2) (p<0.01, Cohen's d = 1.2-1.3) when compared withT0. However, the VF group improved only twoparameters (i.e., barbell symmetry and horizontal displacement) at T1 (p < 0.05; Cohen's d = 0.9), which were not maintained at T2. Better horizontal displacement and looping values were registered during the retention test in the VF-PA group compared with theCONT group (p < 0.05, Cohen's d = 1.49-1.52). The present findings suggest combining video feedback with pedagogical activity during the pandemic induced online coaching or physical education to improve movement learning in school aged children.

Simple verbal instructions are able to improve quality of movement during the lateral step-down test in healthy females

INTRODUCTION

Altered movement patterns during weight-bearing activities have been associated with knee injuries and can be clinically assessed using the lateral step-down test (LSD). It is possible that verbal feedback can improve movement patterns, but it remains unknown whether verbal feedback can improve movement quality during the LSD.

PURPOSE

To investigate whether verbal feedback can immediately improve visual movement quality and trunk, pelvis and lower limb kinematics in healthy females during the LSD.

METHODS

34 healthy females were assessed visually and with 3D kinematics while performing the LSD. Participants were divided into Good Movement Group (GG; n = 18) and Poor Movement Group (PG; n = 16) based on the LSD score. The feedback involved verbal instructions aimed at improving trunk, pelvis, hip and knee alignment during the test. Lower limb flexibility and strength were assessed for group comparisons and to investigate associations between all variables. Data analyses were performed using repeated-measures two-way ANOVAs and Spearman correlation tests.

RESULTS

Feedback immediately improved movement quality, especially in participants of the GG [mean difference (MD) = 2.2 points; P < 0.001]. The PG showed greater pelvic drop (MD = 5.1°; P = 0.012), greater hip adduction (MD = 5.4°; P = 0.028) and less hip flexion (MD = 8.4°; P = 0.016) than the GG. Quality of movement had positive correlations with pelvic drop (r = 0.39; P = 0.02), hip adduction (r = 0.45; P = 0.01) and hip flexion (r = 0.49; P < 0.01) kinematics.

CONCLUSIONS

Verbal feedback improved movement quality during the LSD in healthy females. Females with worst movement quality showed greater pelvic drop and hip adduction, which are often found in individuals with knee disorders.

Landing Error Scoring System scores change with knowledge of scoring criteria and prior performance

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.

Falling as a strategy to decrease knee loading during landings: Implications for ACL injury prevention

Anterior cruciate ligament (ACL) injuries often occur when individuals land primarily on a single leg. Falling has been proposed as a potential strategy to decrease knee loading during landings. The purpose of this study was to compare impact forces, knee angles, and knee moments during natural landings, soft landings, and landings followed by falling after forward and vertical jumps, each under single or double-leg conditions. Sixteen male and sixteen female participants (age: 22.0 ± 2.9 years) completed each landing condition while kinematics and ground reaction forces were collected. In the natural landing condition, participants landed as they would in a sport setting. In the soft landing condition, participants landed as softly as possible with increased knee and hip flexion. In the falling condition, participants landed softly and then fell forward or backward onto a mat after forward and vertical jumps, respectively. The falling condition demonstrated the greatest initial and peak knee flexion angles, the least peak vertical ground reaction forces, and the least peak knee extension and adduction moments compared to the natural landing and soft landing conditions. The soft landing condition resulted in similar changes in landing mechanics compared to the natural landing, but the effect was limited for single-leg landings compared to double-leg landings. When the sports environment allows, falling appears to be a potential strategy to decrease knee loading when individuals must land on a single leg with sub-optimal body postures. Future studies are needed to develop progressive training of effective and safe falling techniques.