Effects of 16 weeks of plyometric training on knee biomechanics during the landing phase in athletes

This study investigated the effects of plyometric training on lower-limb muscle strength and knee biomechanical characteristics during the landing phase. Twenty-four male subjects were recruited for this study with a randomised controlled design. They were randomly divided into a plyometric training group and a traditional training group and underwent training for 16 weeks. Each subject was evaluated every 8 weeks for knee and hip isokinetic muscle strength as well as knee kinematics and kinetics during landing. The results indicated significant group and time interaction effects for knee extension strength (F = 74.942 and p = 0.001), hip extension strength (F = 99.763 and p = 0.000) and hip flexion strength (F = 182.922 and p = 0.000). For landing kinematics, there were significant group main effects for knee flexion angle range (F = 4.429 and p = 0.047), significant time main effects for valgus angle (F = 6.502 and p = 0.011) and significant group and time interaction effects for internal rotation angle range (F = 5.475 and p = 0.008). The group main effect for maximum knee flexion angle was significant (F = 7.534 and p = 0.012), and the group and time interaction effect for maximum internal rotation angle was significant (F = 15.737 and p = 0.001). For landing kinetics, the group main effect of the loading rate was significant (F = 4.576 and p = 0.044). Significant group and time interaction effects were observed for knee extension moment at the moment of maximum vertical ground reaction force (F = 5.095 and p = 0.010) and for abduction moment (F = 8.250 and p = 0.001). These findings suggest that plyometric training leads to greater improvements in hip and knee muscle strength and beneficial changes in knee biomechanics during landing compared to traditional training.

Effect of Strength and Plyometric Training on Kinematics in Female Novice Runners

ABSTRACT

Harrison, K, Williams, DSB III, Darter, BJ, Zernicke, RF, Shall, M, and Finucane, S. Effect of strength and plyometric training on kinematics in female novice runners. J Strength Cond Res 38(6): 1048-1055, 2024-Both running performance and injury have been associated with running kinematics. Plyometric training improves run performance and reduces injury risk in court-sport and field-sport athletes. The aim of this study was to assess longitudinal changes in kinematics in novice runners before and after a typical beginners' running program, compared with those who perform a plyometric intervention before running. Fifty-seven novice female runners were assigned to the control group (8 weeks walking +8 weeks running) or the intervention group (8 weeks strength or plyometric training +8 weeks running). Kinematics were assessed at baseline, 8 weeks, and 16 weeks. Joint angles throughout the stride of those who completed the training ( n = 21) were compared between groups and assessment time points using a statistical parametric mapping 2-way analysis of variance, with group and study time point as independent variables. There was no interaction effect of group and study time point ( p > 0.05), indicating that both training programs had similar effects on running kinematics. There was a main effect of time for sagittal plane knee and hip kinematics ( p < 0.001); after training, subjects ran with a more extended leg, particularly during swing. Programs of 8 weeks of preparatory training, followed by 8 weeks of running, resulted in altered sagittal plane biomechanics, which have previously been related to improved running economy. A greater volume of plyometric, run training or concurrent plyometric and run training may be required to elicit changes in running form associated with lower injury risk.

Postural Control During Single-Leg Landing in Female Athletes After Anterior Cruciate Ligament Reconstruction

Background

Secondary anterior cruciate ligament (ACL) injury is a complication of ACL reconstruction (ACLR), which may result from altered neuromuscular control affecting anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) required for maintaining balance during movement. However, it remains unclear how APAs and CPAs differ in single-leg landings post-ACLR compared to healthy subjects.

Purpose

The purpose of this study was to clarify the differences in muscle activities of APAs and CPAs, lower limb kinematics, and kinetics between athletes with a history of ACLR and healthy athletes during single-leg landing.

Study design

Cross-sectional study.

Methods

Eighteen female athletes were recruited and divided into ACLR (n = 9) and control groups (n = 9). The experimental task involved a single-leg landing from a 30 cm box. Joint angles and moments were determined using a 3-dimensional motion analysis system, while muscle activity was assessed using surface electromyography. Analysis intervals were divided into two phases: the APA phase (-150 ms to 50 ms) and the CPA phase (50 ms to 250 ms), with initial contact (0 ms) as the reference point. Muscle activity onset time was defined as the time when the baseline exceeded by the sum of mean values and 2 standard deviations.

Results

No significant differences were observed in muscle activity or onset time between the ACLR and control groups. However, an increased hip external rotation moment was observed during the CPA phase in the ACLR group.

Conclusion

These findings suggest that APAs and CPAs of athletes who returned to sports more than 1 year post-ACLR may be similar. The increased hip external rotation moment in the ACLR group during the CPA phase could represent a specific compensatory strategy to decrease the hip internal rotation angle post-ACLR.

Level of Evidence

III.

Injury Prevention Programmes Fail to Change Most Lower Limb Kinematics and Kinetics in Female Team Field and Court Sports: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND

One mechanism by which exercise interventions may be effective in reducing anterior cruciate ligament (ACL) injury risk is through changes in lower limb biomechanics. Understanding how training programmes affect lower-limb kinematics and kinetics may help refine injury prevention programmes.

OBJECTIVE

The aim of this systematic review and meta-analysis was to assess the effect of injury prevention programmes on kinematics and kinetics during tasks related to ACL injury in female team field and court sports.

DATA SOURCES

Five databases were searched in October 2022.

ELIGIBILITY CRITERIA

Randomised controlled trials assessing the effect of injury prevention programmes compared with usual training/no training on lower limb kinematics and kinetics in female team field and court sports were eligible for review.

RESULTS

Sixteen studies were included. A total of 976 female athletes were included. Most of the studies included interventions with multiple components (12/16). Commonly used components were plyometrics (12/16), strength (8/16), and balance/stability (7/16). Thirteen studies had routine training or sham interventions as the control group and three studies had no training. Very low certainty evidence suggests that injury prevention programmes increase knee flexion angles (mean difference = 3.1° [95% confidence interval 0.8-5.5]); however, very low to low certainty evidence suggests no effect on hip flexion angles/moments, knee flexion moments, hip adduction angles/moments, knee adduction angles/moments, hip internal rotation angles/moments, ankle dorsiflexion angles, and ground reaction forces, compared with usual training/no training.

CONCLUSION

Injury prevention programmes may be effective in increasing knee flexion angles during dynamic landing and cutting tasks but may have no effect on other lower limb biomechanical variables. As such, the benefits of injury prevention programmes may be mediated by factors other than altered biomechanics and/or may happen through other biomechanical measures not included in this review.

The Effects of FIFA 11+ Kids Prevention Program on Kinematic Risk Factors for ACL Injury in Preadolescent Female Soccer Players: A Randomized Controlled Trial

This study aimed to investigate the effects of the 8-week FIFA 11+ Kids program on kinematic risk factors for ACL injury in preadolescent female soccer players during single-leg drop landing. For this, 36 preadolescent female soccer players (10-12 years old) were randomly allocated to the FIFA 11+ Kids program and control groups (18 players per group). The intervention group performed the FIFA 11+ Kids warm-up program twice per week for 8 weeks, while the control group continued with regular warm-up. Trunk, hip, and knee peak angles (from initial ground contact to peak knee flexion) were collected during the single-leg drop landing using a 3D motion capture system. A repeated measure ANOVA was used to analyze groups over time. Significant group × time interactions were found for the peak knee flexion, with a medium effect size (p = 0.05; effect size = 0.11), and peak hip internal rotation angles, with a large effect size (p < 0.01; effect size = 0.28). We found that the FIFA 11+ Kids program was effective in improving knee flexion and hip internal rotation, likely resulting in reducing ACL stress during single-leg drop landing in young soccer players.

Correlation between core stability and the landing kinetics of elite aerial skiing athletes

Core stability is critical for improving athletic performance, reducing injury risks and is one of the most important elements of athletic training. However, the effect of core stability on landing kinetics during aerial skiing remains unclear, making relevant analysis and discussion an urgent issue to address. To enhance core stability training and landing performance aerial athletes, this study proposed a correlation analysis to investigate the effect of core stability on landing kinetics. Previous studies on aerial athletes have overlooked landing kinetics and lacked correlation analyses, leading to unsatisfactory analysis outcomes. The correlation analysis can be integrated with core stability training indices to analyze the effect of core stability on vertical and 360° jump landings. Therefore, this study can provide guidance for core stability training and athletic performance in aerial athletes.

Effects of Multicomponent Injury Prevention Programs on Children and Adolescents' Fundamental Movement Skills: A Systematic Review With Meta-Analyses

OBJECTIVE

Fundamental movement skills (FMS) are essential to participate in physical activity. Understanding the effects of multicomponent injury prevention programs (MIPP) on FMS may help promote safe physical activity. Our objective was to synthesize the evidence on the effects of MIPP on biomechanical outcomes and neuromuscular performance measured on children and adolescents while performing FMS.

DATA SOURCE

We searched PubMed, SPORTDiscus, Web of Science, and SCOPUS.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included peer-reviewed randomized controlled trials, published in English, that analyzed the effects of MIPP on biomechanics and neuromuscular performance of FMS in participants under 18 years of age.

DATA EXTRACTION

Two reviewers screened the articles, assessed the quality of the evidence using the Physiotherapy Evidence Database (PEDro) scale, and synthesized the data.

DATA SYNTHESIS

We conducted meta-analyses and reported the characteristics, outcomes, and risk of bias of studies.

RESULTS

We included 27 articles that reported data from 1,427 participants. Positive effects on FMS were reported in 23 of the 27 included articles. Vertical Jump, running speed, acceleration, and dynamic balance presented positive-significant pooled effect sizes. Dribbling and horizontal jump presented non-significant pooled effect sizes.

CONCLUSION

MIPP can positively affect FMS in children and adolescents in sports-related settings. Lack of participant compliance and implementation fidelity may affect MIPP effectiveness. Including MIPP in physical literacy interventions, physical education classes, and organized physical activity may lead to functional adaptations that help promote safe physical activity.

The effects of plyometric jump training on physical fitness attributes in basketball players: A meta-analysis

BACKGROUND

There is a growing body of experimental evidence examining the effects of plyometric jump training (PJT) on physical fitness attributes in basketball players; however, this evidence has not yet been comprehensively and systematically aggregated. Therefore, our objective was to meta-analyze the effects of PJT on physical fitness attributes in basketball players, in comparison to a control condition.

METHODS

A systematic literature search was conducted in the databases PubMed, Web of Science, and Scopus, up to July 2020. Peer-reviewed controlled trials with baseline and follow-up measurements investigating the effects of PJT on physical fitness attributes (muscle power, i.e., jumping performance, linear sprint speed, change-of-direction speed, balance, and muscle strength) in basketball players, with no restrictions on their playing level, sex, or age. Hedge's g effect sizes (ES) were calculated for physical fitness variables. Using a random-effects model, potential sources of heterogeneity were selected, including subgroup analyses (age, sex, body mass, and height) and single training factor analysis (program duration, training frequency, and total number of training sessions). Computation of meta-regression was also performed.

RESULTS

Thirty-two studies were included, involving 818 total basketball players. Significant (p < 0.05) small-to-large effects of PJT were evident on vertical jump power (ES = 0.45), countermovement jump height with (ES = 1.24) and without arm swing (ES = 0.88), squat jump height (ES = 0.80), drop jump height (ES = 0.53), horizontal jump distance (ES = 0.65), linear sprint time across distances ≤10 m (ES = 1.67) and >10 m (ES = 0.92), change-of-direction performance time across distances ≤40 m (ES = 1.15) and >40 m (ES = 1.02), dynamic (ES = 1.16) and static balance (ES = 1.48), and maximal strength (ES = 0.57). The meta-regression revealed that training duration, training frequency, and total number of sessions completed did not predict the effects of PJT on physical fitness attributes. Subgroup analysis indicated greater improvements in older compared to younger players in horizontal jump distance (>17.15 years, ES = 2.11; ≤17.15 years, ES = 0.10; p < 0.001), linear sprint time >10 m (>16.3 years, ES = 1.83; ≤16.3 years, ES = 0.36; p = 0.010), and change-of-direction performance time ≤40 m (>16.3 years, ES = 1.65; ≤16.3 years, ES = 0.75; p = 0.005). Greater increases in horizontal jump distance were apparent with >2 compared with ≤2 weekly PJT sessions (ES = 2.12 and ES = 0.39, respectively; p < 0.001).

CONCLUSION

Data from 32 studies (28 of which demonstrate moderate-to-high methodological quality) indicate PJT improves muscle power, linear sprint speed, change-of-direction speed, balance, and muscle strength in basketball players independent of sex, age, or PJT program variables. However, the beneficial effects of PJT as measured by horizontal jump distance, linear sprint time >10 m, and change-of-direction performance time ≤40 m, appear to be more evident among older basketball players.

Plyometrics Did Not Improve Jump-Landing Biomechanics in Individuals With a History of Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Second anterior cruciate ligament (ACL) injury has similar biomechanical risk factors as primary injury. Standard of care rehabilitation does not adequately mitigate these biomechanical risks. This study examined the effectiveness of a 4-week plyometric intervention on biomechanical risk factors of second ACL injury versus no intervention in patients with a history of ACL reconstruction. Thirty adults post-ACL reconstruction received 12 sessions of plyometric (age: 19.9 ± 1.62 years; body mass index: 23.9 ± 2.6 kg/m2; months postoperative: 35.7 ± 24.2) or no (age: 21.3 ± 3.5 years; body mass index: 27.7 ± 4.8 kg/m2; months postoperative: 45.3 ± 25.4) exercise intervention. Hip and knee biomechanics were quantified during a jump-landing task before and after the intervention. Individual response to the intervention was evaluated via minimal detectable change. Hip flexion angle had the greatest response to plyometric training. Overall, focused plyometric intervention did not adequately mitigate biomechanical risk factors of second ACL injury; thus, development of interventions capable of modifying biomechanics known to contribute to ACL injury risk remains necessary.

Differences in strength and landing biomechanics between female jumpers and swimmers

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

Increased core stability is associated with reduced knee valgus during single-leg landing tasks: Investigating lumbar spine and hip joint rotational stiffness

Knee valgus during landing has been identified as a strong correlate of ACL injury. Inappropriate trunk control during landing contributes to high knee valgus, with neuromuscular factors related to core stability postulated as the mechanism. This investigation probed the influence of trunk and hip mechanics, including joint stiffness, on knee mechanics, particularly high knee valgus. Specifically, this study quantified lumbar spine and hip joint rotational stiffness (a proxy for mechanical joint stability) during single-leg landing tasks known to be associated with injury risk, particularly in females. Kinematics, kinetics, and 24 channels of electromyography spanning the trunk and hip musculature were measured in 18 healthy female participants. Anatomically detailed EMG-driven musculoskeletal models quantified lumbar spine and hip joint rotational stiffness. The links between peak knee abduction angle and moment with lumbar spine and hip joint rotational stiffness were measured. Hip joint rotational stiffness influenced knee abduction across tasks (correlation coefficient ranging from -0.48 to -0.70, p < 0.05) to reduce valgus deviation. Similarly, transverse plane hip joint rotational stiffness during landings reduced knee abduction moment (R = -0.50, P = 0.03; R = -0.49, P = 0.04), and lumbar spine joint rotational stiffness reduced knee abduction angle and moment but did not consistently reach statistical significance. The control system uses stiffness to control motion. This study demonstrates the importance of proximal (lumbar spine and hip) joint rotational stiffness (i.e. core control stability) during single-leg landing to prevent knee abduction motion. Instantaneous core stability is achieved with the coordinated activation and stiffness of both trunk and hip muscles.

Effects of pelvic and core strength training on biomechanical risk factors for anterior cruciate ligament injuries

BACKGROUND

Little is known about the changes in biomechanical risk factors for an anterior cruciate ligament (ACL) injury after participation in a pelvic and core strength training (PCST) program in female team players.

METHODS

This is a randomized controlled trial for which a total of 29 female soccer players were recruited from a soccer club and split into two groups, namely, experimental group (EG, N.=18; mean [SD] age, 17.8 [2.0 years], weight 64.0 [6.6] kg and height 1.7 [0.0] m) and control group (control, N.=11; mean [SD] age, 16.2 [1.2] years, weight 61.6 [7.3] kg and height 1.7 [0.0] m). The EG participated in an in-season 8-week PCST program (twice/week). Participants in the CG performed their normal training without additional pelvic and core strengthening. Pre- and postintervention knee frontal plane projection angle (FPPA), hip, knee and ankle peak flexion angles and jump height were collected during bilateral and unilateral drop jumps.

RESULTS

PCST significantly reduced FPPA at dynamic landing, in both dominant (-7.1º) and non-dominant lower extremities (-8º). Further, this training significantly increased the peak hip (24.4º) and knee flexion angles (14.94º), but not the peak ankle dorsiflexion angle (P>0.05) which, significantly decreased in the CG (-3.5º). Following the intervention, EG significantly increased measures obtained for both bilateral (2.84 cm) and unilateral jumps (1.33 cm for the dominant leg and 1.22 cm for the non-dominant leg) (P<0.05), not so for CG (P<0.05).

CONCLUSIONS

PCST resulted in improvements on ACL injury risk factors and vertical drop jump performance, suggesting that strengthening this body part warrants not only injury prevention, but increases jumping performance.

Knee Kinetics in Baseball Hitting and Return to Play after ACL Reconstruction

The purpose of this study was to describe the knee kinetics of baseball hitting, develop a tool to predict knee kinetics from easily obtainable measures, and to compare knee kinetics to other exercises along the rehabilitation continuum to determine a timeline for when hitting may resume after ACL reconstruction. Nineteen high school baseball athletes (16.3±0.8 yrs, 180.6±5.7 cm, 78.4±10.8 kg) participated. Participants took ten swings off a tee. Kinetic data were recorded using an electromagnetic tracking system. Data from swings with the top three exit velocities were averaged for analysis. Linear regressions were used to determine if predictors of height, mass, age and exit velocity could predict the following torques: bilateral knee net, extension, internal and external rotation, valgus and varus torque; and anterior force. Backwards regression models revealed independent variables could significantly predict front knee net, internal and external rotation, extension, and varus torque, and anterior force; and back knee net and valgus torque. Based on the kinetics of baseball hitting compared to those of rehabilitation exercises, if the involved knee is the front, we suggest tee hitting may be initiated at 13 weeks after ACL reconstruction. If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction.

Is the Rear Foot Elevated Split Squat Unilateral? An Investigation Into the Kinetic and Kinematic Demands

Helme, M, Emmonds, S, and Low, C. Is the rear foot elevated split squat unilateral? An investigation into the kinetic and kinematic demands. J Strength Cond Res XX(X): 000-000, 2020-The purpose of the study was to determine the unilateral nature of the rear foot elevated split squat (RFESS). Specifically, the production of force by the rear leg was examined to better understand its role, if any, toward successful completion of the exercise. Male volunteers were recruited (n = 26, age = 23.8 ± 4.6 years, body mass = 88.1 ± 10.7 kg, and height = 1.79 ± 0.1 m), who were recreationally trained and engaged in a structured strength and conditioning program, including both bilateral and unilateral exercises, and had at least 2 years supervised training experience. Subjects participated in an incremental 5 repetition maximum protocol after familiarization. Kinetic data were recorded through 2 independent force plates, 1 integral to the floor and the second mounted on top of solid weightlifting blocks. Kinematic data were captured through 3-dimensional motion analysis. A total of 715 repetitions were analyzed, and the mean contribution of the lead foot to total vertical force production was 84.36 ± 3.6%. An almost certainly small positive correlation (rho = 0.25, confidence interval [CI] 0.18-0.33) was found between the percentage of force produced by the lead foot, with increasing exercise intensity. A most likely trivial, nonsignificant correlation (rho = -0.01, CI -0.09 to 0.06) with rear foot force production, representing the mass of the rear leg. Data from this study do not indicate that the rear foot contributes to the kinetic demands of the exercise and therefore suggests that the RFESS is a valid unilateral exercise.

Effects of plyometric jump training in female soccer player's vertical jump height: A systematic review with meta-analysis

To assess the effects of plyometric jump training (PJT) in female soccer player's vertical jump height, a review was conducted using the data sources PubMed, MEDLINE, Web Of Science and SCOPUS. Only peer-review articles were included. To qualify for inclusion in the meta-analysis, studies must have included (i) a PJT programme of at least 2 weeks, (ii) cohorts of healthy female soccer players with no restriction for age, (iii) a control group, (iv) a measure of countermovement jump (CMJ). The inverse variance random-effects model for meta-analyses was used. From 7,136 records initially identified through database searching, 8 were eligible for meta-analysis, comprising 9 training groups (n = 99) and 9 control groups (n = 94). The magnitude of the main effect was moderate (ES = 1.01 [95%CI = 0.36-1.66], Z = 3.04, p = 0.002). Sub-group analyses were performed (i.e., PJT frequency, duration and total number of sessions), revealing no significant subgroup differences (p = 0.34-0.96). Among the studies included in this review, none reported injury or other adverse effects. In conclusion, PJT is effective in female soccer players for the improvement of vertical jump height. In future, research must identify specific dose-response relationships following PJT, particularly in the long term.

Landing Kinematics, Sports Performance, and Isokinetic Strength in Adolescent Male Volleyball Athletes: Influence of Core Training

CONTEXT

Core control and strength are important for reducing the risk of lower-extremity injury. Current evidence on the effect of core training in male adolescent athletes is limited, and other investigations into the effects of core training often emphasized core strength only.

OBJECTIVE

To examine whether core training emphasizing both control and strength of the trunk and hip would improve joint kinematics during landing, sports performance, and lower-extremity muscle strength in adolescent male volleyball athletes.

DESIGN

Single group pretest and posttest design.

SETTING

University laboratory.

PARTICIPANTS

Sixteen male participants (age: 13.4 [1] y, height: 167.8 [8.6] cm, mass: 58.6 [13.9] kg, and volleyball experience: 3.8 [1.5] y) from a Division I volleyball team at a junior high school.

MAIN OUTCOME MEASUREMENTS

Kinematics of the trunk and lower-extremity during box landing and spike jump landing tasks, volleyball-related sports performance, and isokinetic strength of hip and knee muscles were assessed before and after a 6-week core training program.

RESULTS

After training, the participants demonstrated decreased trunk flexion angle (P = .01, Cohen's d = 0.78) during the box landing task and reduced the maximum knee internal rotation angle (P = .04, Cohen's d = 0.56) during the spike jump landing task. The average isokinetic strength of hip flexors and external rotators, and knee flexors and extensors also significantly increased (P = .001, Cohen's d = 0.98; P = .04, Cohen's d = 0.57; P = .02, Cohen's d = 0.66; P = .003, Cohen's d = 0.87, respectively); however, sports performance did not show significant changes.

CONCLUSIONS

A more erect landing posture following training suggests that the core training program may be beneficial for improving core stability. The long-term effect of core training for knee injury prevention needs further investigation.

Integrative Neuromuscular Training in Young Athletes, Injury Prevention, and Performance Optimization: A Systematic Review

The aim of this systematic review was to evaluate the current evidence by assessing the effectiveness of integrative neuromuscular training programs in injury prevention and sports performance in young athletes. Different data sources were analyzed up to January 2018. Eligible studies contained information on population (young athletes), intervention (neuromuscular training), comparator (control group or another exercise intervention), outcomes (injury prevention or sport performance), and study design (randomized trials or prospective studies). The trials were restricted based on the language (English) and for publication date (after January 1st, 2007). Fourteen randomized controlled trials were included: Seven included dynamic stability-related outcomes. Three assessed the coordination performing fundamental movements and sport-specific skills, while other five studies analyzed muscle strength and two assessed plyometric tests. Agility was evaluated in three studies and speed tests were also considered by four studies. Finally, fatigue resistance in three studies and injury risk in four were assessed. This review provides evidence that integrative neuromuscular training programs can enhance performance and injury prevention in young athletes, taken into account that adherence to the training program is adequate. Collectively, well-designed, randomized studies are necessary to collaborate with the present findings.

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

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

Effects of an 8-Week Body-Weight Neuromuscular Training on Dynamic Balance and Vertical Jump Performances in Elite Junior Skiing Athletes: A Randomized Controlled Trial

Vitale, JA, La Torre, A, Banfi, G, and Bonato, M. Effects of an 8-week body-weight neuromuscular training on dynamic balance and vertical jump performances in elite junior skiing athletes: a randomized controlled trial. J Strength Cond Res 32(4): 911-920, 2018-The aim of the present randomized controlled trial was to evaluate the effects of an 8-week neuromuscular training program focused on core stability, plyometric, and body-weight strengthening exercises on dynamic postural control and vertical jump performance in elite junior skiers. Twenty-four Italian elite junior male skiers were recruited and randomized to either an experimental group (EG), performing neuromuscular warm-up exercises, (EG; n = 12; age 18 ± 1 years; body mass 66 ± 21 kg; height 1.70 ± 0.1 m) or a control group (CG) involved in a standard warm-up (CG; n = 12; age 18 ± 1 years; body mass 62 ± 14 kg; height 1.73 ± 0.1 m). lower quarter Y-Balance Test (YBT), countermovement jump (CMJ), and drop jump (DJ) at baseline (PRE) and at the end (POST) of the experimental procedures were performed. No significant differences between EG and CG were observed at baseline. Results showed that EG achieved positive effects from PRE to POST measures in the anterior, posteromedial, posterolateral directions, and composite score of YBT for both lower limbs, whereas no significant differences were detected for CG. Furthermore, 2-way analysis of variance with Bonferroni's multiple comparisons test did not reveal any significant differences in CMJ and DJ for both EG and CG. The inclusion of an 8-week neuromuscular warm-up program led to positive effects in dynamic balance ability but not in vertical jump performance in elite junior skiers. Neuromuscular training may be an effective intervention to specifically increase lower limb joint awareness and postural control.

Core and Back Rehabilitation for High-speed Rotation Sports: Highlight on Lacrosse

Lacrosse is a fast-paced game that incorporates elements from multiple sports, such as soccer, basketball, baseball, tennis, and hockey. The sport involves rapid changes of direction, endurance, sprinting, physical contact, rotational movement, passing, and shooting. Passing and shooting are further complicated by having a weighted object (ball) at the end of a long moment arm (crosse) which places increased stress on the body segments. Thus, it is important to properly prepare for sport participation by improving strength, endurance, and dynamic stability of the postural and core stability muscles. Because high mechanical loads are experienced during play, (re)establishment of symmetric strength and flexibility is essential for rehabilitation and injury prevention. This article will focus on the musculoskeletal demands placed on the body in lacrosse, the importance of core strength and dynamic stability to prevent injury, and the elements of both prehabilitation and rehabilitation programs to properly prepare the athlete for participation.

The Effects of Injury Prevention Programs on the Biomechanics of Landing Tasks: A Systematic Review With Meta-analysis

BACKGROUND

Anterior cruciate ligament (ACL) tear is a common injury in sports and often occurs during landing from a jump.

PURPOSE

To synthesize the evidence on the effects of injury prevention programs (IPPs) on landing biomechanics as they relate to the ligament, quadriceps, trunk, and leg dominance theories associated with ACL injury risk.

STUDY DESIGN

Meta-analysis.

METHODS

Six electronic databases were searched for studies that investigated the effect of IPPs on landing task biomechanics. Prospective studies that reported landing biomechanics at baseline and post-IPP were included. Results from trunk, hip, and knee kinematics and kinetics related to the ACL injury theories were extracted, and meta-analyses were performed when possible.

RESULTS

The criteria were met by 28 studies with a total of 466 participants. Most studies evaluated young females, bilateral landing tasks, and recreational athletes, while most variables were related to the ligament and quadriceps dominance theories. An important predictor of ACL injury, peak knee abduction moment, decreased ( P = .01) after the IPPs while other variables related to the ligament dominance theory did not change. Regarding the quadriceps dominance theory, after the IPPs, angles of hip flexion at initial contact ( P = .009), peak hip flexion ( P = .002), and peak knee flexion ( P = .007) increased, while knee flexion at initial contact did not change ( P = .18). Moreover, peak knee flexion moment decreased ( P = .005) and peak vertical ground-reaction force did not change ( P = .10).

CONCLUSION

The exercises used in IPPs might have the potential to improve landing task biomechanics related to the quadriceps dominance theory, especially increasing peak knee and hip flexion angles. Importantly, peak knee abduction moment decreased, which indicates that IPPs influence a desired movement strategy to help athletes overcome dangerous ligament dominance loads arising from lack of frontal plane control during dynamic tasks. The lack of findings for some biomechanical variables suggests that future IPPs may be enhanced by targeting participants' baseline profile deficits, highlighting the need to deliver an individualized and task-specific IPP.

Exploring individual adaptations to an anterior cruciate ligament injury prevention programme

BACKGROUND

Individual responses to anterior cruciate ligament injury prevention programmes (ACL IPPs) have received little attention. This study examined the effects of an ACL IPP on neuromuscular control and lower limb biomechanics during landing at the group and individual levels.

METHODS

Sixteen female athletes were randomly allocated to training (n=8) or control (n=8) groups. Electromyography, and three-dimensional kinematic and kinetic data were collected during landing at two testing sessions. Repeated measures ANOVA and effect sizes (Cohen's d) examined the effect of the IPP at the group and individual levels. A sub-group analysis comparing the effect of the IPP on 'high-' (i.e. large peak knee abduction moment at baseline) versus 'low-risk' individuals was also conducted.

RESULTS

At the group level; the IPP increased activation of the medial hamstrings prior to landing (p<0.001; d=0.264) and the medial gastrocnemius at landing (p<0.001; d=0.426), and increased hip external rotation early after initial contact (p<0.001; d=0.476). Variable adaptations were seen across individuals within the training group for all variables (p<0.001). The IPP had a large effect in reducing frontal plane knee moments for 'high-risk' individuals (d>0.91), however these results did not reach statistical significance (p>0.05).

CONCLUSIONS

The IPP induced adaptations during landing, however, individual data revealed dissimilar responses to the programme. Individuals displaying a pre-existing high-risk strategy may incur greater benefits from IPPs, yet only if the programme targets the relevant high-risk strategy.

Biomechanical Comparison of Single- and Double-Leg Jump Landings in the Sagittal and Frontal Plane

BACKGROUND

Double-leg forward or drop-jump landing activities are typically used to screen for high-risk movement strategies and to determine the success of neuromuscular injury prevention programs. However, research suggests that these tasks that occur primarily in the sagittal plane may not adequately represent the lower extremity biomechanics that occur during unilateral foot contact or non-sagittal plane movements that are characteristic of many multidirectional sports.

PURPOSE

To examine the extent to which lower extremity biomechanics measured during a jump landing on a double leg (DL) after a sagittal plane (SAG) movement is representative of biomechanics measured during single-leg (SL) or frontal plane (FRONT) jump landing tasks.

STUDY DESIGN

Controlled laboratory study.

METHODS

Lower extremity biomechanics were measured in 15 recreationally active females (mean age [±SD], 19.4 ± 2.1 years; mean height, 163.3 ± 5.9 cm; mean weight, 61.1 ± 7.1 kg) while performing SAGDL, SAGSL, FRONTDL, and FRONTSL jump landing tasks. Repeated-measures analyses of variance examined differences in lower extremity biomechanics between the 4 tasks, and linear regressions examined the extent to which an individual's biomechanics during SAGDL were representative of their biomechanics during SAGSL, FRONTDL, and FRONTSL.

RESULTS

Lower extremity kinematics and kinetics differed by condition, with the SAGDL task generally eliciting greater hip and knee flexion angles and lower hip and knee forces than the other tasks (P < .05). Although biomechanics during the SAGDL task were strongly associated with those during the FRONTDL task (R (2), 0.41-0.82), weaker associations were observed between SAGDL and single-leg tasks for hip kinematics (R (2), 0.03-0.25) and kinetics (R (2), 0.05-0.20) and knee abduction moments (R (2), 0.06-0.18) (P < .05).

CONCLUSION

Standard double-leg sagittal plane jump landing tasks used to screen for ACL injury risk and the effectiveness of ACL injury prevention programs may not adequately represent the lower extremity biomechanics that occur during single-leg activities.

CLINICAL RELEVANCE

These results support further investigation of single-leg multidirectional landings to identify high-risk movement strategies in female athletes playing multidirectional sports.

A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk

BACKGROUND

Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings.

OBJECTIVE

The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings.

DATA SOURCES

An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken.

STUDY SELECTION

Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies.

RESULTS

Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified.

LIMITATIONS

Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk.

CONCLUSIONS

Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

Effect of unilateral, bilateral, and combined plyometric training on explosive and endurance performance of young soccer players

The aim of the study was to compare the effects of bilateral, unilateral, or combined bilateral and unilateral plyometric training (PT) on muscle power output, endurance, and balance performance adaptations in young soccer players. Four groups of young soccer players (age 11.4 ± 2.2 years) were divided into control group (CG; n = 14), bilateral group (BG; n = 12), unilateral group (UG; n = 16), and bilateral + unilateral group (B + UG; n = 12). Players were measured in unilateral and bilateral countermovement jump with arms, 5 multiple bounds test, 20-cm drop jump reactive strength index, maximal kicking velocity, sprint and agility test time, endurance, and balance performance. The PT was applied during 6 weeks, 2 sessions per week, for a total of 2,160 jumps. After intervention, all PT groups showed a statistically significant (p ≤ 0.05) change in all performance measures, with no statistically significant differences between treatments. Among the 21 performance measures, the B + UG showed a significantly (p ≤ 0.05) higher performance change in 13 of them vs. the CG, whereas the UG and BG showed only 6 and 3, respectively. The current study showed that bilateral, unilateral, and combined bilateral and unilateral PT ensured significant improvement in several muscular power and endurance performance measures in young soccer players. However, the combination of unilateral and bilateral drills seems more advantageous to induce superior performance improvements.