Strategies for enhancing proprioception and neuromuscular control of the knee

Neuromuscular Responses to 5 K Time Trial Load Carried by Spanish Army Marines

One of the physical requirements for marines involves covering a specific distance while carrying individual combat gear, supplies, or other military equipment across challenging terrain. Training for this physically and mentally demanding task is a routine component of their preparation. However, further research is needed to better understand the neuromuscular impact of such demanding efforts, strenuous maneuvers, and the recovery process in the subsequent days. Twenty-nine marines completed a 5 km time trial while carrying 24 kg of combat gear, undergoing evaluations at four time points: pre exercise, immediately post exercise, 24 h post exercise, and 48 h post exercise. Repeated measures ANOVA, paired samples t-test, and effect size (ES) analysis were conducted, presenting the results as the mean ± standard deviation (SD). The significance level was set at p ≤ 0.05. Several variables and their corresponding p-values demonstrated changes over time, including the following: the isometric mid-thigh pull (IMTP) (p = 0.001); countermovement jump height (VJ CMJ) (p ≤ 0.001); rating of fatigue scale (ROF) (p ≤ 0.001); blood lactate (BL) levels (p ≤ 0.001); maximum pull-ups (PUmax) (p ≤ 0.001); body mass (BM) (p ≤ 0.001); dominant hand grip strength (DHGS) (p = 0.406); and non-dominant hand grip strength (NDHGS) (p = 0.805). Incident reports and perceived effort (IRPE) revealed a progressive and significant increase between the first and last kilometer of the test, specifically in perceived variables of fatigue, muscle pain, joint pain, shortness of breath, palpitations, excessive sweating, and muscle tremors (all p ≤ 0.001). These findings may contribute to optimizing training programs to better align with operational demands, thereby improving task performance and overall mission effectiveness. In conclusion, the military test had a significant neuromuscular impact on the body, initially resulting in the potentiation of absolute global isometric strength and lower-limb power. However, these values declined below the baseline levels at 24 and 48 h post test.

Differences of simulated ankle dorsiflexion limitation on lower extremity biomechanics during long jump takeoff

The long jump is an athletic event that demands speed, power, force application, and balance, with each phase being critical to overall performance. However, previous research has neglected the limiting effect of the wedge pedals on ankle dorsiflexion range of motion. This cross-sectional study investigated biomechanical changes in the lower extremities during long jumps under varying degrees of ankle dorsiflexion. Thirty male Division II long jump athletes executed jumps under three conditions: no dorsiflexion, with 10° dorsiflexion restriction, and with 20° dorsiflexion restriction. A Vicon motion capture system with eight cameras and an AMTI force platform were used to collect biomechanical data simultaneously during the long jump. The angles, moments, and velocities of the ankle, hip, and knee joints during takeoff were simulated and calculated using a musculoskeletal model. Between-group variations were assessed using one-way repeated measures ANOVA, with statistical parametric mapping (SPM1D) applied for analysis. Results showed that as ankle restriction increased, vertical velocity gain increased: NW (3.34 ± 0.21 m/s), 10W (3.65 ± 0.14 m/s), and 20W (3.77 ± 0.12 m/s) (p < 0.001). Horizontal velocity loss was significantly higher only at 20W (p = 0.002). Peak extension angle, angular velocity, and power were highest at 10W for the knee and hip joints (p < 0.05). Joint forces at the ankle, knee, and hip were significantly affected by different pedal angles (p < 0.001). Athletes with a 10° ankle dorsiflexion limit showed increased vertical velocity with minimal horizontal velocity loss, potentially enhancing performance. This limit also increased muscle co-activation around the knee, possibly stabilizing it. Athletes should consider a 10° ankle dorsiflexion limit in training to improve performance and reduce injury risk.

Players in the Women's National Basketball Association Are More Likely to Tear Their Anterior Cruciate Ligament if They Are a Guard, Forward, or Driving to the Basket: A Case-Control Study

The Women's National Basketball Association (WNBA) has grown in popularity since its induction in 1996. Furthermore, it is well known that female athletes are at an increased risk of anterior cruciate ligament (ACL) tears compared with their male counterparts. The purpose was to examine the player positions and player movements during basketball games and practices that contribute to ACL tears in WNBA players. Player position and demographics from WNBA players who suffered an ACL tear from 1996 to 2021 were collected from publicly available sources. Entertainment and Sports Programming Network news reports and video analysis were reviewed to determine what movements each player was performing when the injury occurred. Injured players were matched with two noninjured players by age, position, height, and league experience. Performance statistics were collected one season prior to injury and compared with the matched controls. A total of 62 WNBA players with ACL injuries were identified with an average age of 26.7 (±3.9) years. More guards and forward were seen in the injured cohort and more players were injured while driving to the basket (p < 0.05). ACL injuries occurred more commonly during games than in practice (p < 0.05). Compared with controlled match cohort, the players who suffered ACL tears started more games (p = 0.007), had higher minutes played per game (p = 0.003), more field goals per game (p = 0.04), more field goal attempts per game (p = 0.03), more 3-point attempts per game (p = 0.04), more rebounds per game (p = 0.04), more steals per game (p = 0.02), and more points per game (p = 0.02). WNBA guards and forward were more likely to tear their ACL, especially while driving to the basket during real game play. Additionally, players with higher playing times, rebounds, and steals per game had higher rates of ACL tears. However, there was no impact on their performance on season statistics after returning to sport. LEVEL OF EVIDENCE:  III.

Biophysics of ACL Injuries

Anterior Cruciate Ligament (ACL) injuries rank among the most prevalent and severe types of injuries, significantly impacting both athletes and non-athletes alike. These injuries not only result in immediate physical impairment, such as intense pain, substantial swelling, and a marked loss of mobility, but also carry long-term health consequences that can alter a person's quality of life. Chronic pain, persistent instability, and an increased risk of developing osteoarthritis are among the lasting effects that can follow an ACL injury. An in-depth understanding of the biophysics behind ACL injuries is paramount for devising effective prevention and treatment protocols. Biophysics, which combines principles from physics with biological systems, provides crucial insights into the mechanical and structural integrity of the ACL and its susceptibility to injury under various conditions. This systematic review aims to collate and synthesize the current knowledge surrounding the biophysical mechanisms that underlie ACL injuries.

Unilateral Plyometric Jump Training Shows Significantly More Effective than Bilateral Training in Improving Both Time to Stabilization and Peak Landing Force in Single-Leg Lend and Hold Test: A Randomized Multi-Arm Study Conducted Among Young Male Basketball Players

Enhancing peak landing forces and ensuring faster stabilization in the lower limbs during jumping activities can significantly improve performance and decrease the risk of injury among basketball players. This study aimed to compare the effects of unilateral (uPJT) and bilateral plyometric jump training (bPJT) programs on various performance measures, including countermovement jump (CMJ), squat jump (SJ), and single-leg land and hold (SLLH) test outcomes, assessed using force plates. A randomized multi-arm study design was employed, comprising two experimental groups (n = 25; uPJT and n = 25; bPJT) and one control group (n = 25), conducted with youth male regional-level basketball players (16.3 ± 0.6 years old). Participants underwent assessment twice, both before and after an 8-week intervention training period. The uPJT program exclusively involved plyometric drills (e.g., vertical jump exercises; horizontal jump exercises) focusing on single-leg exercises, whereas the bPJT program utilized drills involving both legs simultaneously. The outcomes analyzed included CMJ peak landing force, CMJ peak power, SJ peak force, SJ maximum negative displacement, SLLH time to stabilization, and SLLH peak landing force. The control group exhibited significantly greater SLLH time to stabilization compared to both the uPJT (p < 0.001) and bPJT (p < 0.030) groups. Additionally, time to stabilization was also significantly higher in bPJT than in uPJT (p = 0.042). Comparisons between groups in regards SLLH peak landing force after intervention revealed that the value was significantly smaller in uPJT than in bPJT (p = 0.043) and control (p < 0.001). In the remaining outcomes of CMJ and SJ, both uPJT and bPJT showed significant improvement compared to the control group (p > 0.05), although there was no significant difference between them. In conclusion, our study suggests that utilizing uPJT is equally effective as bPJT in enhancing performance in bilateral jump tests. However, it significantly outperforms bPJT in improving time to stabilization and peak landing forces during single-leg land and hold test. uPJT could be advantageous not for maximizing performance but also for potentially decreasing injury risk by enhancing control and balance during single-leg actions, which are common in basketball.

The Effect of Different Degrees of Ankle Dorsiflexion Restriction on the Biomechanics of the Lower Extremity in Stop-Jumping

Purpose

The functional status of the ankle joint is critical during dynamic movements in high-intensity sports like basketball and volleyball, particularly when performing actions such as stopping jumps. Limited ankle dorsiflexion is associated with increased injury risk and biomechanical changes during stop-jump tasks. Therefore, this study aims to investigate how restricting ankle dorsiflexion affects lower extremity biomechanics during the stop-jump phase, with a focus on the adaptive changes that occur in response to this restriction. Initially, 18 participants during stop-jumping with no wedge plate (NW), 10° wedge plate (10 W), and 20° wedge plate (20 W) using dominant leg data were collected to explore the relationship between limiting ankle mobility and lower extremity biomechanics. Following this, a musculoskeletal model was developed to simulate and calculate biomechanical data. Finally, one-dimensional parametric statistical mapping (SPM1D) was utilized to evaluate between-group variation in outcome variables using a one-way repeated measures analysis of variance (ANOVA).

Results

As the ankle restriction angle increased, knee external rotation angles, knee extension angular velocities, hip extension angle, and angular velocity increased and were significantly different at different ankle restriction angles (p  < 0.001 and p=0.001), coactivation of the peripatellar muscles (BF/RF and BF/VM) increased progressively, and patellofemoral joint contact force (PTF) increased progressively during the 3%-8% phase (p=0.015). These results highlight the influence of ankle joint restriction on lower limb kinematics and patellofemoral joint loading during the stop-jump maneuver.

Conclusion

As the angle of ankle restriction increased, there was an increase in coactivation of the peripatellar muscles and an increase in PTF, possibly because a person is unable to adequately adjust their body for balance when the ankle valgus angle is restricted. The increased coactivation of the peripatellar muscles and increased patellofemoral contact force may be a compensatory response to the body's adaptation to balance adjustments.

In elderly individuals, the effectiveness of sensorimotor training on postural control and muscular strength is comparable to resistance-endurance training

While classical resistance exercise is an effective way to improve strength and control postural sway, it may not be suitable for some elderly individuals with specific health disorders (e.g., aneurysms). Therefore, there is a need to explore alternative modalities. The study aimed to evaluate the effects of sensorimotor training on muscle strength and postural control in the female elderly population and subsequently compare these effects with a traditional combined resistance-endurance training program. A total of 34 healthy, active elderly women aged from 65 to 75 years, (average age 72.7 ± 4.4 years, height 161.6 ± 5.1 cm, and weight 66.9 ± 8.4 kg) were randomly assigned to three groups undergoing different 10-week interventions: the resistance-endurance training (RET, n = 11), the sensorimotor training (SMT, n = 12) and the control group (COG, n = 11). Prior to and after the interventions all participants underwent tests of maximal voluntary contraction of the dominant and non-dominant leg; postural sway tests with open and closed eyes; novel visual feedback balance test; 10-meter maximal walking speed (10 mMWS) and stair climb test. A T-test and repeated measures ANOVA were used, followed by the Bonferroni post hoc test, to compare the pre and post-measurements and assess differences in gains between groups. Results showed a significant main effect of time on strength (p < 0.001). In addition, significant differences in time × group interaction on strength (p < 0.01), postural control (p < 01), and ascendant and descended vertical speed (p < 0.001) were observed. Besides, the RET group improved significantly the maximal voluntary contraction of both dominant (16.3%, p ≤ 0.01) and non-dominant leg (10.9%, p ≤ 0.05). SMT group improved maximal voluntary contraction of both dominant (16.6%, p ≤ 0.001) and non-dominant leg (12.7%, p ≤ 0.01). In addition, they also improved mean velocity of the centre of pressure (COP) in postural sway test with eyes open (24.2%, p ≤ 0.05) as well as eyes closed (29.2%, p ≤ 0.05), mean distance of COP in novel visual feedback balance test (37.5%, p ≤ 0.001), ascendant and descended vertical velocity (13.6%, p ≤ 0.001 and 17.8%, p ≤ 0.001, respectively). Results show not only resistance training but sensorimotor intervention boosts strength too. This intervention also enhances postural control and functional abilities for both ascending and descending movements.

Neuromuscular fatigue and cognitive constraints independently modify lower extremity landing biomechanics in healthy and chronic ankle instability individuals

The purpose was to determine the impact of both cognitive constraint and neuromuscular fatigue on landing biomechanics in healthy and chronic ankle instability (CAI) participants. Twenty-three male volunteers (13 Control and 10 CAI) performed a single-leg landing task before and immediately after a fatiguing exercise with and without cognitive constraints. Ground Reaction Force (GRF) and Time to Stabilization (TTS) were determined at landing in vertical, anteroposterior (ap) and mediolateral (ml) axes using a force plate. Three-dimensional movements of the hip, knee and ankle were recorded during landing using a motion capture system. Exercise-induced fatigue decreased ankle plantar flexion and inversion and increased knee flexion. Neuromuscular fatigue decreased vertical GRF and increased ml GRF and ap TTS. Cognitive constraint decreased ankle internal rotation and increased knee and hip flexion during the flight phase of landing. Cognitive constraint increased ml GRF and TTS in all three axes. No interaction between factors (group, fatigue, cognitive) were observed. Fatigue and cognitive constraint induced greater knee and hip flexion, revealing higher proximal control during landing. Ankle kinematic suggests a protective strategy in response to fatigue and cognitive constraints. Finally, these two constraints impair dynamic stability that could increase the risk of ankle sprain.

Effectiveness of balance training on pain and functional outcomes in knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. Methods: "PubMed", "Scopus", "Web of Science", "Cochrane", and "Physiotherapy Evidence Database" were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. Results: This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [ I 2= 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity ( I 2) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the I 2 was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Conclusions: Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. Registration: The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674).

Anterior cruciate ligament injuries in female athletes

The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females' greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries.

The effect of dual-task on jump landing kinematics and kinetics in female athletes with or without dynamic knee valgus

It has been indicated that dual tasks may multiply the possibility of injuries due to divided attention. This study aimed to investigate the effect of dual-task on kinematics and kinetics of jump landing in female athletes with and without dynamic knee valgus. In this study, 32 recreational athletes between 18 and 30 years old were recruited and divided into with (n = 17) and without (n = 15) dynamic knee valgus groups. The 3-D positions of retroreflective markers were recorded at 200 Hz using a 8-camera Kestrel system (Motion Analysis Corporation, Santa Rosa, CA), while ground reaction forces were synchronously recorded at 1000 Hz using 2 adjacent force plates (FP4060-NC; Bertec Corporation, Columbus, OH). Kinematics and kinetics of jump landing were recorded while counting backward digits as a dual task, and also without counting backward digits as a single task. One-way repeated measures of variance were used to analyse data at the significant level of 95% (α < 0.05). The study found that the dual-task affected the angles and moments of hip, knee, and ankle joints (P < 0.05) in both groups. Additionally, the effect of the dual-task differed significantly between the two groups in the angles hip flexion (P < 0.001), knee abduction (P < 0.001), and ankle internal rotation (P = 0.001), as well as the moments hip flexion (P < 0.001), hip abduction (P = 0.011), knee flexion (P = 0.017), knee internal rotation (P < 0.001), ankle dorsiflexion (P = 0.046), ankle eversion (P < 0.001), and ankle internal rotation (P = 0.046). Athletes with dynamic knee valgus may have been less able to protect themselves during the landing and are more prone to lower extremities injuries. As a result, using kinematics and kinetics in athletes with dynamic knee valgus during landing may help identify potential mechanisms associated with risk factors of lower extremity injuries and ACL injuries as well.

Proprioception Analysis following Anterior Cruciate Ligament Reconstruction using Stabilometry: A Prospective, Longitudinal Study

Objective  Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods  One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results  There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p  < 0.001) and to the control group ( p  = 0.01). There was a significant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p  = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had a significant correlation (r = 0.46) with post-operative proprioception ( p  = 0.006). Conclusion  Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.

Dorsiflexion shoes affect joint-level landing mechanics related to lower extremity injury risk in females

Athletic shoes that induce dorsiflexion in standing can improve jump height compared to traditional athletic shoes that induce plantarflexion, but it is unknown if dorsiflexion shoes (DF) also affect landing biomechanics associated with lower extremity injury risk. Thus, the purpose of this study was to investigate if DF adversely affect landing mechanics related to patellofemoral pain and anterior cruciate ligament injury risk compared to neutral (NT) and plantarflexion (PF) shoes. Sixteen females (21.65 ± 4.7 years, 63.69 ± 14.3 kg, 1.60 ± 0.05 m) performed three maximum vertical countermovement jumps in DF (-1.5°), NT (0°) and PF (8°) shoes as 3D kinetics and kinematics were recorded. One-way repeated-measures ANOVAs revealed peak vertical ground reaction force, knee abduction moment and total energy absorption were similar between conditions. At the knee, peak flexion and joint displacement were lower in DF and NT, while relative energy absorption was greater in PF (all p < .01). Conversely, relative ankle energy absorption was greater in DF and NT compared to PF (p < .01). Both DF and NT induce landing patterns that may increase strain on passive structures in the knee, emphasising the need for landing mechanics to be considered when testing footwear as gains in performance could come at the cost of injury risk.

Efficacy of Proprioceptive Training on Plantar Pressure and Jump Performance in Volleyball Players: A Proof-of-Principle Study

Volleyball players are often subject to micro-traumatisms of the heel fat pad and ankle injuries. Recently, mat-based proprioceptive training has assumed a key role in recovery from these disorders. Therefore, this proof-of-principle study aimed to assess the efficacy of proprioceptive mat training on plantar pressures and athletic performance in volleyball players. The participants included adult semi-professional volleyball players allocated into two groups: an experimental group, with mat-based proprioceptive and balance training, and a control group, with a sham protocol. For the outcome, we evaluated the barefoot plantar pressure, performing an analysis on a baropodometric resistive platform. The countermovement jump and squat jump were measured using an inertial measurement unit. Nineteen subjects were included in the two groups: the active proprioceptive group (n = 10) or the control group (n = 9). The results show a more uniform redistribution of loads with pressure hindfoot relief in the experimental group compared to the control group (p = 0.021, RBC = 0.67). Moreover, we observed a significant increase in peak landing force and high concentric power development in the experimental group compared to the controls. Focused proprioceptive management provided hindfoot load attenuation by stimulating higher peaks of concentric force in the experimental group compared to the sham group. Even though the study included a small sample, the results obtained in this proof-of-principle study suggest a positive role of proprioceptive stimulation in the inter-seasonal scenario for volleyball players to improve their jump performance and reduce the micro-traumatisms of the heel fat pad and the ankle injury rate. However, further studies performed on larger samples are needed to confirm these preliminary results.

Effects of blood flow restriction on spine postural control using a robotic platform: A pilot randomized cross-over study

BACKGROUND

Blood flow restriction (BFR) training improves muscle strength and functional outcomes, but the proprioceptive implications of this technique in the rehabilitation field are still unknown.

OBJECTIVE

The present study aimed at assessing the effects of BFR in terms of stabilometric and balance performance.

METHODS

In this pilot randomized cross-over study, healthy young adults were included and randomly assigned to Groups A and B. Both groups underwent a postural assessment with and without wearing a BFR device. Study participants of Group A underwent postural baseline assessment wearing BFR and then removed BFR for further evaluations, whereas subjects in Group B performed the baseline assessment without BFR and then with BFR. Stabilometric and balance performance were assessed by the robotic platform Hunova, the Balance Error Scoring System (BESS), the self-reported perceived balance (7-point Likert scale), and discomfort self-rated assessment. Moreover, the safety profile was recorded.

RESULTS

Fourteen subjects were included and randomly assigned to Group A (n: 7) and Group B (n: 7). Significant differences were shown in balance tests in static conditions performed on the Hunova robot platform in terms of average distance RMS (root-mean-square) with open eyes (OE), anteroposterior (AP) trunk oscillation range with OE, mediolateral (ML) average speed of oscillation with OE, and total excursion AP range with closed eyes (CE) (BFR: 3.44 ± 1.06; without BFR: 2.75 ± 0.72; p= 0.041). Moreover, elastic balance test showed differences in Romberg index (BFR: 0.16 ±0.16; without BFR: 0.09 ± 0.07; p= 0.047). No adverse events were reported.

CONCLUSION

Taken together, our data showed that BFR affects balance performance of healthy subjects. Further studies are needed to better characterize the possible role of BFR treatment in the context of a specific rehabilitation protocol.

Neuromuscular and balance adaptations following basketball-specific training programs based on combined drop jump and multidirectional repeated sprint versus multidirectional plyometric training

Multidirectional jumping and repeated sprint ability are crucial performance factors in basketball. The main aim of this investigation was to examine the neuromuscular performance and body balance adaptations following basketball-specific combined training programs based on drop jump and multidirectional repeated sprint versus multidirectional plyometric training. Forty-two professional basketball male players participated in the current investigation and were randomly assigned to three groups: a combined group (COMB; n = 14), a multidirectional jump group (MJG; n = 14) and an active control group (CON; n = 14). The COMB and the MJG groups completed the 8-week training programs with two weekly sessions while the CON continued their usual training. The static and dynamic balance tests, the repeated sprint ability test (IRSA5COD), the T-change of direction (CoD) test, the vertical jump tests, the five time-jump test (FJT) were performed by participants before and after the intervention period. The results showed a significant main effect of time with remarkable improvements at the end of the intervention (P < 0.001, effect size small/moderate) except the physiological parameters for IRSA5COD. Only, significant group × time interactions for body balance, T-CoD test, IRSA5COD (total time and best time), and jump tests were found (P < 0.001, effect size from trivial to moderate). Bonferroni corrected post-hoc tests revealed significantly greater improvement in favor of COMB compared to MJG for body balance, CoD and IRSA5COD (P < 0.005, effect size small/moderate). Otherwise, no significant differences between COMB and MJG concerning jump performances were found. Combined drop jump and multidirectional repeated sprint training program lead to significantly better neuromuscular performance, body balance and CoD in professional basketball players when compared with an usual training.

Effects of Combined Upper and Lower Limb Plyometric Training Interventions on Physical Fitness in Athletes: A Systematic Review with Meta-Analysis

Objective: We aimed to meta-analyze the effects of combined upper and lower limb plyometric training (ULLPT) on physical fitness attributes in athletes. Methods: A systematic literature search was conducted in Web of Science, SPORTDiscus, PubMed, and SCOPUS, for up to 13 August 2022. Controlled studies with baseline and follow-up measures were included if they examined the effects of ULLPT on at least one measure of physical fitness indices in athletes. A random effects meta-analysis was performed using the Comprehensive Meta-Analysis software. Results: Fifteen moderate-to-high-quality studies with 523 participants aged 12−22.4 years were included in the analyses. Small to large (ES = 0.42−1.66; p = 0.004 to <0.001) effects were noted for upper and lower body muscle power, linear sprint speed, upper and lower body muscle strength, agility, and flexibility, while no significant effects on static and dynamic balance were noted (ES = 0.44−0.10; all p > 0.05). Athletes’ sex, age, and training program variables had no modulator role on the effects of ULLPT in available data sets. Conclusions: ULLPT induces distinct neuro-muscular adaptations in the upper and lower body musculature and is an efficient method for enhancing athletes’ physical fitness.

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.

Females with knee osteoarthritis use a detrimental knee loading strategy when squatting

BACKGROUND

The purpose of this study was to identify sex differences in lower limb kinematics, kinetics, and muscle activation patterns between individuals with osteoarthritis and healthy controls during a two-legged squat.

METHOD

Thirty OA (15 females) and 30 healthy (15 females) participants performed three 2-legged squats. Sagittal and frontal plane hip, knee, and ankle kinematics and kinetics were calculated. Two-way ANOVAs (Sex X OA Status) were used to characterize differences in squatting strategies between sexes and between those with and without knee OA.

RESULTS

A greater decrease in sagittal hip, knee, and ankle range of motion and knee joint power was observed in the OA participants compared to the healthy controls. Females with OA had significantly reduced hip and knee adduction angles compared to the healthy females and males with OA. Females also had decreased hip power, hip flexion, and hip adduction moments and knee adduction moments compared to their male counterparts, with the greatest deficits observed in the females with OA. Females with OA also had the highest magnitude of muscle activation for the quadriceps, hamstrings, and gastrocnemius throughout the squat, while males with OA showed increased activation of the vastus lateralis and medial gastrocnemius compared to the healthy males.

CONCLUSIONS

OA significantly altered biomechanics and neuromuscular control during the squat, with males employing a hip-dominant strategy, allowing them to achieve a greater lower limb range of motion.

Impact of combined versus single-mode training programs based on drop jump and specific multidirectional repeated sprint on bio-motor ability adaptations: a parallel study design in professional basketball players

Background

Jumping and specific multidirectional repeated sprint ability are important in basketball. The objective of this study was to assess the contributions of 8-week combined versus single-mode training programs based on drop jump (DJ) and specific multidirectional repeated sprint (MRSA) on repeated sprint ability performances, body balance and lower limbs power in male professional basketball players.

Methods

This study followed a randomized parallel study design. Fifty-two professional male basketball players from the Tunisian first division participated in this study. The players were randomly assigned to 4 groups: DJ group (JG; n = 13), MRSA group (RSG; n = 13), combined group (COMB; n = 13) and an active control group (CON; n = 13). The JG, RSG and COMB groups completed the 8-week training programs with 2 sessions per week while the CON continues their regular basketball training. Training volume was similar between groups all over the experimental period. Before and after the intervention, the four groups were evaluated for the stork test, Y-balance test, the repeated sprint ability test (IRSA_5COD), the squat jump (SJ) and countermovement jump (CMJ) tests, the single leg drop jump test, the five time-jump test and T—change of direction (CoD) test.

Results

All measures displayed significant main effect, (medium/small) magnitude (effect size) improvements for time (post-test > pre-test) except the physiological parameters for IRSA_5COD. Significant time × group interactions were revealed for body balance, T test, IRSA_5COD (total time and best time) and jump tests (vertical/horizontal). Bonferroni corrected post-hoc tests revealed significant greater improvement in favor of RSG and COMB compared to JG for body balance, CoD and IRSA_5COD. Moreover, greater improvement in CMJ, SJ and single leg DJ in favor of JG compared to the RSG. In addition, a greater CoD improvement was observed in favor of COMB when compared to the RSG.

Conclusion

Combined and single-mode training programs based on DJ and MRSA contributed to a significantly better performance in specific basketball physical fitness parameters with results favoring combined interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00551-w.

Concurrent Validity of Movement Screening Criteria Designed to Identify Injury Risk Factors in Adolescent Female Volleyball Players

Anterior cruciate ligament (ACL) injuries in female adolescent athletes occur at disproportionately high levels compared to their male counterparts. However, limited prospective data exist on the validity of low-cost screening tools that can proactively identify ACL injury risk, specifically for female athletes. The purpose of this study was to assess the concurrent validity of a three-task injury risk factor assessment by comparing visually derived outcome scores from two-dimensional (2D) video data with dichotomized three-dimensional (3D) biomechanical variables collected using motion capture technology. A total of 41 female club volleyball athletes (14.7 ± 1.4 years) were tested and asked to perform three tasks: double-leg vertical jump (DLVJ), single-leg squat (SLS), and single-leg drop landing (SLDL). One rater was trained on the scoring criteria for the 2D data and independently scored one forward-facing and one side-facing video for each task. Risk factors identified included poor knee position, lateral trunk lean, and excessive trunk flexion/extension. In addition, 3D joint angles were calculated for the trunk and knee in the sagittal and frontal planes and converted to dichotomous variables based on biomechanical thresholds of injury risk. For comparison of 2D and 3D outcomes, percent agreement and Cohen's kappa were calculated for each risk factor individually. Overall, 2D scores were found to exhibit moderate to excellent percent agreement with 3D outcomes for trunk position (69.1–97.1%). Specifically, ipsilateral trunk lean during single-leg tasks exhibited the highest agreement (85.3–88.2%) with moderate reliability (κ = 0.452–0.465). In addition, moderate to substantial reliability was found for trunk flexion during double-leg tasks (κ = 0.521–0.653); however, an evaluation of single-leg tasks resulted in only fair reliability (κ = 0.354). Furthermore, 2D scores were not successful in identifying poor knee position as percent agreement fell below 50% for both the single-leg tasks and averaged 60% agreement across both the phases of the DLVJ. Kappa coefficients further emphasized these trends indicating no to slight concurrent validity (κ = −0.047–0.167) across tasks. Overall, these findings emphasize the potential for valid, low-cost screening tools that can identify high-risk movement patterns. Further study is needed to develop improved assessment guidelines that may be employed through visual assessment in sports environments.

Sex Moderates the Relationship between Perceptual-Motor Function and Single-Leg Squatting Mechanics

To examine the isolated and combined effects of sex and perceptual-motor function on single-leg squatting mechanics in males and females. We employed a cross-sectional design in a research laboratory. Fifty-eight females (22.2 ± 3.5 yrs, 1.60 ± .07 m, 64.1 ± 13.0 kg) and 35 males (23.5 ± 5.0 yrs, 1.80 ± .06m, 84.7 ± 15.3 kg) free from time-loss injury in the six months prior, vertigo, and vestibular conditions participated in this study. Independent variables were sex, perceptual-motor metrics (reaction time, efficiency index, conflict discrepancy), and interaction effects. Dependent variables were peak frontal plane angles of knee projection, ipsilateral trunk flexion, and contralateral pelvic drop during single-leg squatting. After accounting for the sex-specific variance and perceptual-motor function effects on frontal plane squatting kinematics, female sex amplified the associations of: higher reaction time, lower efficiency index, and higher conflict discrepancy with greater right ipsilateral peak trunk lean (R² = .13; p = .05); higher reaction time, lower efficiency index, and higher conflict discrepancy with decreased right contralateral pelvic drop (R² = .22; p < .001); higher reaction time and lower conflict discrepancy with greater right frontal plane knee projection angle (R² = .12; p = .03); and higher reaction time with greater left frontal plane knee projection angle (R² = .22; p < .001). Female sex amplified the relationship between perceptual-motor function and two-dimensional frontal plane squatting kinematics. Future work should determine the extent to which perceptual-motor improvements translate to safer movement strategies.

Effects of Plyometric Exercises versus Flatfoot Corrective Exercises on Postural Control and Foot Posture in Obese Children with a Flexible Flatfoot

BACKGROUND

Obesity contributes to the acquired flatfoot deformity which in turn impairs balance.

AIM

The purpose of the current study was to compare the effect of plyometric exercises with flatfoot corrective exercises on balance, foot posture, and functional mobility in obese children with a flexible flatfoot.

METHODS

Forty-seven children participated in the study. Their age ranged from 7 to 11 years. Participants were randomly divided into 3 groups: experimental group I (EGI), experimental group II (EGII), and the control group (CG). The EGI received plyometric exercises and the EGII received corrective exercises, 2 sessions weekly for 10 weeks. The control group did not perform any planned physical activities. The Prokin system was used to assess balance, the timed up and go test (TUG) was used to assess functional mobility, and the navicular drop test (NDT) was used to assess foot posture.

RESULTS

EGI showed significant improvement in all balance parameters, foot posture, and TUG. EGII showed improvement in the ellipse area and perimeter in addition to foot posture and TUG.

CONCLUSION

Plyometric exercises and foot correction exercises had a positive effect on foot posture, balance, and functional mobility in obese children with flatfeet.

Proprioceptive Training for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention. Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA. Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses. Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = -1.28, 95%CI: [-1.64, -0.92], I 2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = -0.76, 95%CI: [-1.33, -0.18], I 2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = -1.54, 95%CI: [-2.74, -0.34], I 2 = 79%, P = 0.01), physical function (SMD = -0.34, 95%CI: [-0.56, -0.12], I 2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = -0.95, 95%CI: [-1.73, -0.18], I 2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group. Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.

Effects of Plyometric Jump Training on Balance Performance in Healthy Participants: A Systematic Review With Meta-Analysis

Background: Postural balance represents a fundamental movement skill for the successful performance of everyday and sport-related activities. There is ample evidence on the effectiveness of balance training on balance performance in athletic and non-athletic population. However, less is known on potential transfer effects of other training types, such as plyometric jump training (PJT) on measures of balance. Given that PJT is a highly dynamic exercise mode with various forms of jump-landing tasks, high levels of postural control are needed to successfully perform PJT exercises. Accordingly, PJT has the potential to not only improve measures of muscle strength and power but also balance. Objective: To systematically review and synthetize evidence from randomized and non-randomized controlled trials regarding the effects of PJT on measures of balance in apparently healthy participants. Methods: Systematic literature searches were performed in the electronic databases PubMed, Web of Science, and SCOPUS. A PICOS approach was applied to define inclusion criteria, (i) apparently healthy participants, with no restrictions on their fitness level, sex, or age, (ii) a PJT program, (iii) active controls (any sport-related activity) or specific active controls (a specific exercise type such as balance training), (iv) assessment of dynamic, static balance pre- and post-PJT, (v) randomized controlled trials and controlled trials. The methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. This meta-analysis was computed using the inverse variance random-effects model. The significance level was set at p <0.05. Results: The initial search retrieved 8,251 plus 23 records identified through other sources. Forty-two articles met our inclusion criteria for qualitative and 38 for quantitative analysis (1,806 participants [990 males, 816 females], age range 9-63 years). PJT interventions lasted between 4 and 36 weeks. The median PEDro score was 6 and no study had low methodological quality (≤3). The analysis revealed significant small effects of PJT on overall (dynamic and static) balance (ES = 0.46; 95% CI = 0.32-0.61; p < 0.001), dynamic (e.g., Y-balance test) balance (ES = 0.50; 95% CI = 0.30-0.71; p < 0.001), and static (e.g., flamingo balance test) balance (ES = 0.49; 95% CI = 0.31-0.67; p < 0.001). The moderator analyses revealed that sex and/or age did not moderate balance performance outcomes. When PJT was compared to specific active controls (i.e., participants undergoing balance training, whole body vibration training, resistance training), both PJT and alternative training methods showed similar effects on overall (dynamic and static) balance (p = 0.534). Specifically, when PJT was compared to balance training, both training types showed similar effects on overall (dynamic and static) balance (p = 0.514). Conclusion: Compared to active controls, PJT showed small effects on overall balance, dynamic and static balance. Additionally, PJT produced similar balance improvements compared to other training types (i.e., balance training). Although PJT is widely used in athletic and recreational sport settings to improve athletes' physical fitness (e.g., jumping; sprinting), our systematic review with meta-analysis is novel in as much as it indicates that PJT also improves balance performance. The observed PJT-related balance enhancements were irrespective of sex and participants' age. Therefore, PJT appears to be an adequate training regime to improve balance in both, athletic and recreational settings.

Study on the Influence of Proprioceptive Control versus Visual Control on Reaction Speed, Hand Coordination, and Lower Limb Balance in Young Students 14-15 Years Old

Currently, sports activities require a high reaction speed, coordination, and balance, highlighting the relationship between proprioceptive control, visual control, and hand–eye coordination in youth. The present research assessed the proprioceptive control, reaction speed, and lower limb balance of youth from five different schools to identify the level of physical preparation of children in this direction. This prospective study was conducted between 1 January 2020 and 29 February 2020. A total of 107 healthy children (33 females and 74 males) with appropriate medical conditions, aged between 14 and 15 years, from five Romanian schools were included in the experiment. All children were assessed for visual control and reaction speed with the ruler drop test, and for lower limb balance, the standing stork test was used. Statistical analysis included descriptive statistics, data series distribution, and comparison of means and medians using specific statistical programs. Comparison of medians highlighted significant statistical differences in the standing stork test with eyes closed and the dominant leg compared with the nondominant leg (p = 0.0057). Males were compared to females at the nondominant leg (p = 0.0179); closed eyes were compared with opened eyes for the nondominant leg (p = 0.0175 and 0.0006) for the ruler drop test comparing the dominant hand with the nondominant hand (p = 0.0212). Children who engage in sports activities better integrated sensory information in motor action execution based on reaction speed and coordination with the nondominant hand.

Resisted Sprint Training in Youth: The Effectiveness of Backward vs. Forward Sled Towing on Speed, Jumping, and Leg Compliance Measures in High-School Athletes

ABSTRACT

Uthoff, A, Oliver, J, Cronin, J, Winwood, P, Harrison, C, and Lee, JE. Resisted sprint training in youth: the effectiveness of backward vs. forward sled towing on speed, jumping, and leg compliance measures in high-school athletes. J Strength Cond Res 35(8): 2205-2212, 2021-Resisted sprinting (RS) is a popular training method used to enhance sprinting performance in youth. However, research has only explored the effects of forward RS (FRS) training. We examined the effects of FRS and backward RS (BRS) and compared these with a traditional physical education curriculum (CON). One hundred fifteen boys (age 13-15 years) were matched for maturity and allocated to either an FRS (n = 34), BRS (n = 46), or CON (n = 35) group. Training groups towed progressively overloaded sleds (20-55% body mass) 2 d·wk-1 for 8 weeks. Pre-training and post-training data were collected for sprinting times over 10 and 20 m, countermovement jump (CMJ) height, and leg stiffness (KN). Performance remained unchanged for the CON group (all p > 0.05), whereas all variables significantly improved (p < 0.05) after BRS, and all but 10-m performance improved after FRS. Compared with the CON, BRS and FRS significantly (p > 0.05) improved CMJ (Effect size [ES] = 0.67 and 0.38) and KN (ES = 0.94 and 0.69), respectively. No differences were found between training groups. The probabilities of improving sprinting performance after BRS (∼70%) were on average ∼10 and ∼8% better than the FRS and CON groups, respectively. The BRS and FRS showed similar probabilities of improving CMJ (75 and 79%) and KN (80 and 81%), respectively, over the CON group. It seems that BRS may be a means to improve sprint performance, and regardless of direction, RS seems to be a beneficial method for improving jumping height and leg stiffness in youth male athletes.

Properties of Knee Joint Position Sense Tests for Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis

Background:

Knee proprioception is believed to be deficient after anterior cruciate ligament (ACL) injury. Tests of joint position sense (JPS) are commonly used to assess knee proprioception, but their psychometric properties (PMPs) are largely unknown.

Purpose:

To evaluate the PMPs (reliability, validity, and responsiveness) of existing knee JPS tests targeting individuals with ACL injury.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

PubMed, Allied and Complementary Medicine, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL, and ProQuest databases were searched to identify studies that assessed PMPs of knee JPS tests in individuals with ACL injury. The risk of bias for each included study was assessed and rated at the outcome level for each knee JPS test. Overall quality and levels of evidence for each PMP were rated according to established criteria. Meta-analyses with mean differences were conducted using random effects models when adequate data were available.

Results:

Included were 80 studies covering 119 versions of knee JPS tests. Meta-analyses indicated sufficient quality for known-groups and discriminative validity (ACL-injured knees vs knees of asymptomatic controls and contralateral noninjured knees, respectively), owing to significantly greater absolute errors for ACL-injured knees based on a strong level of evidence. A meta-analysis showed insufficient quality for responsiveness, which was attributed to a lack of significant change over time after diverse interventions with a moderate level of evidence. Statistical heterogeneity (I² > 40%) was evident in the majority of meta-analyses. All remaining PMPs (reliability, measurement error, criterion validity, convergent validity, and other PMPs related to responsiveness) were assessed qualitatively, and they failed to achieve a sufficient quality rating. This was a result of either the study outcomes not agreeing with the statistical cutoff values/hypotheses or the level of evidence being rated as conflicting/unknown or based on only a single study.

Conclusion:

Knee JPS tests appear to have sufficient validity in differentiating ACL-injured knees from asymptomatic knees. Further evidence of high methodologic quality is required to ascertain the reliability, responsiveness, and other types of validity assessed here. We recommend investigations that compare the modifiable methodologic components of knee JPS tests on their PMPs to develop standardized evidence-based tests.

The Protective Effect of Neuromuscular Training on the Medial Tibial Stress Syndrome in Youth Female Track-and-Field Athletes: A Clinical Trial and Cohort Study

CONTEXT

Few reports have analyzed the effects of neuromuscular (NM) training programs on the injury incidence among youth female track-and-field athletes.

OBJECTIVE

To determine the effects of NM training on reducing lower limb injury incidence and to establish its effects on countermovement jump performance, balance, 30-m sprint, and joint position sense in youth female track-and-field athletes.

DESIGN

Single-blind, randomized controlled clinical trial.

SETTING

Sports research laboratory.

PARTICIPANTS

Twenty-two female athletes were allocated into 2 groups: Conventional (CONV) training (n = 11; age = 15.3 [2.1] y) and NM training (n = 11; age = 15.0 [2.7] y).

INTERVENTIONS

Interventions were performed during the preseason of 6 weeks. The CONV training included anaerobic, strength, and aerobic training. The NM training consisted of a multicomponent program that integrated jumps, landings, and running with strength, endurance, agility, balance, and CORE training.

MAIN OUTCOME MEASURES

A follow-up of the cohorts was carried out through the evaluation of lower limb injuries (main outcome) during a regular season (weeks 7-18). Secondary outcomes were measured before and after the intervention: Y-balance test, active joint repositioning, ground reaction force, and countermovement jump height.

RESULTS

The injury incidence rate was 17.89 injuries per 1000 hours athlete-exposure in CONV training, and 6.58 in NM training (relative risk = 0.38; 95% confidence interval,  0.18 to 0.82; P = .044). Particularly, the medial tibial stress syndrome incidence rate was 5.96 injuries per 1000 hours athlete-exposure in CONV training and 0.82 in NM training (relative risk = 0.17; 95% confidence interval, 0.02 to 1.12; P = .012). In addition, a significant training × time interaction was noted, favoring improvements in 30-m sprint and countermovement jump height after NM.

CONCLUSION

The NM training may improve youth female athlete's physical fitness and reduce their injury relative risk of medial tibial stress syndrome injury.

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

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

Relationship of Anterior Cruciate Ligament Volume and T2* Relaxation Time to Anterior Knee Laxity

Background:

High anterior knee laxity (AKL) has been prospectively identified as a risk factor for anterior cruciate ligament (ACL) injuries. Given that ACL morphometry and structural composition have the potential to influence ligamentous strength, understanding how these factors are associated with greater AKL is warranted.

Hypothesis:

Smaller ACL volumes combined with longer T2* relaxation times would collectively predict greater AKL.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

College-aged active male (n = 20) and female (n = 30) participants underwent magnetic resonance imaging (MRI) and AKL testing. T2-weighted MRI scans were used to assess ACL volumes, and T2* relaxation times were used to assess ACL structural composition. AKL was measured via a commercial knee arthrometer. Forward stepwise linear regression with sex and weight (first step; suppressor variables) as well as ACL volume and T2* relaxation time (second step; independent variables) was used to predict AKL (dependent variable).

Results:

After initially adjusting for sex and weight (R² = 0.19; P = .006), smaller ACL volumes combined with longer T2* relaxation times collectively predicted greater AKL (R² = 0.52; P < .001; R²_Δ = 0.32; P_Δ < .001). A smaller ACL volume was the primary predictor of greater AKL (R²_Δ = 0.28; P < .001), with a longer T2* relaxation time trending toward a significant contribution to greater AKL (R²_Δ = 0.04; P = .062). After adjusting for ACL volume and T2* relaxation time, sex (partial r = 0.05; P = .735) and weight (partial r = 0.05; P = .725) were no longer significant predictors.

Conclusion:

AKL was largely predicted by ACL volume and to a lesser extent by T2* relaxation time (and not a person’s sex and weight). These findings enhance our understanding of how AKL may be associated with a structurally weaker ACL. The current study presents initial evidence that AKL is a cost-effective and clinically accessible measure that shows us something about the structural composition of the ACL. As AKL has been consistently shown to be a risk factor for ACL injuries, work should be done to continue to investigate what AKL may tell a clinician about the structure and composition of the ACL.

Development of supine and standing knee joint position sense tests

OBJECTIVES

We aimed to assess the test-retest reliability of a supine and standing knee joint position sense (JPS) test, respectively, and whether they discriminate knees with anterior cruciate ligament (ACL) injury from asymptomatic knees.

DESIGN

Repeated measures and cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

For test-retest reliability, 24 persons with asymptomatic knees. For discriminative analysis: 1) ACLR - 18 persons on average 23 months after unilateral ACL reconstruction, 2) CTRL - 23 less-active persons, and 3) ATHL - 21 activity level-matched athletes.

MAIN OUTCOME MEASURES

Absolute error (AE) and variable error (VE).

RESULTS

Test-retest reliability was generally highest for AE of the standing test (ICC 0.64-0.91). Errors were less for the standing compared to the supine test across groups. CTRL had greater knee JPS AE (P = 0.005) and VE (P = 0.040) than ACLR. ACLR knees showed greater VE compared to the contralateral non-injured knees for both tests (P = 0.032), albeit with a small effect size (η_p² = 0.244).

CONCLUSIONS

Our standing test was more reliable and elicited lesser errors than our supine test. Less-active controls, rather than ACLR, produced significantly greater errors. Activity level may be a more predominant factor than ACLR for knee JPS ∼2 years post-reconstruction.

Agility training in volleyball: a systematic review

BACKGROUND

Volleyball is an intermittent, extremely dynamic and open-skill team sport in which players perform a variety of acyclic movements while constantly changing game situation. The purpose of this systematic review was to provide a summary of the research that has examined intervention strategies to improve agility performance in volleyball and to synthesise the tests used to evaluate agility in volleyball.

METHODS

A systematic review was performed in PubMed, Scopus, Web of Science and Google Scholar with titles, abstracts, and full texts that were analysed according to predefined inclusion criteria to find relevant studies. Moreover, the methodological quality of the studies selected was assessed.

RESULTS

Twelve studies (n = 348 participants) were included. The selected studies had a methodological quality rated poor-to-moderate (average score of 3.9, range: 1 to 6). Results showed that of all the training interventions, plyometric-based training present the greatest improvement in agility (average of 7.7%). Moreover, the agility T-test was the most used test.

CONCLUSIONS

In light of the poor-to-moderate methodological quality, there is a need for developing specific longitudinal and controlled studies with the aim of studying the effect of diversified training interventions on the development of agility in volleyball players.

THE NEW INJURIES' RISK AFTER ACL RECONSTRUCTION MIGHT BE REDUCED WITH FUNCTIONAL TRAINING

Objective:

The objective of our study was to evaluate if functional training with the Functional Movement Screen (FMS) can reduce the risk of a new injury for patients that underwent an anterior cruciate ligament reconstruction (ACLR). Our hypothesis was that the functional training might reduce the risk of a new injury.

Methods:

Our training protocol consisted of six phases, each one lasting six weeks. It began two months after surgery. The study group was composed of 10 individuals that completed our protocol after ACLR. The control group consisted of 10 people that completed a regular ACLR rehabilitation protocol. The FMS was used to compare the study and control group performance. Patients with a score of 14 or less on the FMS were considered more likely to suffer an injury than those with a score higher than 14.

Results:

The study group average FMS score was 16.6 compared to the control group at 12.3. Functional training for ACLR rehabilitation added a statistically significant benefit (p < 0.0002) to reduce the risk of a new injury compared to regular protocol.

Conclusion:

Functional training may be considered an alternative to the regular ACLR rehabilitation to reduce the risk of a new injury before returning to sports. Level of Evidence III, Case control study.

Proprioception in Action: A Matter of Ecological and Social Interaction

The aim of this paper is to provide a theoretical and formal framework to understand how the proprioceptive and kinesthetic system learns about body position and possibilities for movement in ongoing action and interaction. Whereas most weak embodiment accounts of proprioception focus on positionalist descriptions or on its role as a source of parameters for internal motor control, we argue that these aspects are insufficient to understand how proprioception is integrated into an active organized system in continuous and dynamic interaction with the environment. Our strong embodiment thesis is that one of the main theoretical principles to understand proprioception, as a perceptual experience within concrete situations, is the coupling with kinesthesia and its relational constitution-self, ecological, and social. In our view, these aspects are underdeveloped in current accounts, and an enactive sensorimotor theory enriched with phenomenological descriptions may provide an alternative path toward explaining this skilled experience. Following O'Regan and Noë (2001) sensorimotor contingencies conceptualization, we introduce three distinct notions of proprioceptive kinesthetic-sensorimotor contingencies (PK-SMCs), which we describe conceptually and formally considering three varieties of perceptual experience in action: PK-SMCs-self, PK-SMCs-self-environment, and PK-SMC-self-other. As a proof of concept of our proposal, we developed a minimal PK model to discuss these elements in detail and show their explanatory value as important guides to understand the proprioceptive/kinesthetic system. Finally, we also highlight that there is an opportunity to develop enactive sensorimotor theory in new directions, creating a bridge between the varieties of experiences of oneself and learning skills.

Altered Dynamic Postural Stability and Joint Position Sense Following British Army Foot-Drill

Impaired proprioceptive acuity negatively affects both joint position sense and postural control and is a risk factor for lower-extremity musculoskeletal injury in athletes and military personnel. British Army foot-drill is an occupational military activity involving cyclical high impact loading forces greater than those observed in athletes during high level plyometrics. Foot-drill may contribute to the high rates of lower-extremity overuse injuries observed in recruits during basic training. There is limited research investigating foot-drill specific injury risk factors in women, despite greater incidences of musculoskeletal injury reported in women (522 vs. 417 per 1,000 personnel, OR: 1.53) when compared to men during basic training. This study aimed to quantify changes in ankle joint proprioception and dynamic postural stability following a period of British Army foot-drill. Fourteen women of similar age to British Army female recruits underwent pre-post foot-drill measures of frontal plane ankle joint position sense (JPS) and dynamic postural stability using the dynamic postural stability index (DPSI). Passive ankle JPS was assessed from relative test angles of inversion 30% (IN30%) and eversion 30% (EV30%) and IN60% of participants range of motion using an isokinetic dynamometer. The DPSI and the individual stability indices (medio-lateral [MLSI], anterior-posterior [APSI], and vertical [VSI]) were calculated from lateral and forward jump-landing conditions using force plates. Foot-drill was conducted by a serving British Army drill instructor. Significantly greater absolute mean JPS error for IN30% and EV30% was observed post foot-drill (p ≤ 0.016, d ≥ 0.70). For both the lateral and forward jump-landing conditions, significantly greater stability index scores were observed for MLSI, APSI, and DPSI (p ≤ 0.017, d ≥ 0.52). Significantly greater JPS error and stability index scores are associated with the demands of British Army foot-drill. These results provide evidence that foot-drill negatively affects lower-extremity proprioceptive acuity in recruit age-matched women, which has implications for increased injury risk during subsequent military physical activity, occurring in a normal training cycle.

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

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

FUNCTIONAL MEASURES DO NOT DIFFER IN LATE STAGE REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION ACCORDING TO MECHANISM OF INJURY

Background

Anterior cruciate ligament injuries are among the most common knee injuries. Mechanism of injury is classified as contact or non-contact. The majority of anterior cruciate ligament ruptures occur through a non-contact mechanism of injury. Non-contact anterior cruciate ligament ruptures are associated with biomechanical and neuromuscular risk factors that can predispose athletes to injuries and may impact future function. Non-contact mechanism of injury may be preceded by poor dynamic knee stability and therefore those with a non-contact mechanism of injury may be prone to poor dynamic knee stability post-operatively. Understanding how mechanism of injury affects post-operative functional recovery may have clinical implications on rehabilitation.

Purpose

The purpose of this study was to determine if mechanism of injury influenced strength, functional performance, patient-reported outcome measures, and psychological outlook in athletes at four time points in the first two years following anterior cruciate ligament reconstruction.

Study Design

Secondary analysis of a clinical trial.

Methods

Seventy-nine athletes underwent functional testing at enrollment after impairment resolution. Quadriceps strength, hop testing, and patient-reported outcome measures were evaluated post-operatively at enrollment, following return-to-sport training and one year and two years after anterior cruciate ligament reconstruction. Participants were dichotomized by mechanism of injury (29 contact, 50 noncontact). Independent t-tests were used to compare differences between groups.

Results

There were no meaningful differences between contact and non-contact mechanism of injury in any variables at enrollment, post-training, one year, or two years after anterior cruciate ligament reconstruction.

Conclusion

Function did not differ according to mechanism of injury during late stage rehabilitation or one or two years after anterior cruciate ligament reconstruction.

Level of Evidence

III.

Return to Play and Performance in the Women's National Basketball Association After Anterior Cruciate Ligament Reconstruction

Background:

The incidence of anterior cruciate ligament (ACL) injuries in Women’s National Basketball Association (WNBA) athletes continues to increase. There is a paucity of data regarding return-to-play (RTP) rates and performance after ACL reconstruction in these athletes.

Purpose:

To quantify RTP rates and performance after ACL reconstruction in WNBA athletes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All ACL tears sustained in the WNBA from 1997 through 2018 were identified. Body mass index (BMI), age, and position at the time of injury were collected for each player. RTP rates were calculated, and performance data were collected for each player before and after injury to determine changes in playing time and statistical performance. Players who successfully returned to play after ACL reconstruction were compared with a group of healthy controls who were matched by age, years of experience, position, height, and BMI. Statistics at 1 and 3 years after injury were compared to assess acute and longitudinal changes in performance relative to preinjury baseline.

Results:

A total of 59 WNBA players sustained ACL tears during the study period, and 41 (69.5%) were able to successfully RTP. Players played a mean of 7.5 ± 12.8 fewer games, played 5.0 ± 9.2 fewer minutes per game, and scored 3.7 ± 5.0 fewer points per game in their first year after RTP compared with the year before injury. Athletes with ACL reconstruction demonstrated significantly decreased performance measures regarding games played, games started, minutes, rebounds, assists, and blocks per game in their first season after RTP compared with control athletes in the same indexed year; however, these differences resolved by year 3 after surgery.

Conclusion:

WNBA athletes have a high RTP rate after ACL reconstruction. Players may experience an initial decrease in playing time and performance when returning to play; however, these variables were found to return to baseline over time.

The effect of silicone ankle sleeves and lace-up ankle braces on neuromuscular control, joint torque, and cutting agility

Objective

To evaluate the effects of silicone ankle sleeves (SASs) and lace-up ankle braces (LABs) on neuromuscular control, net joint torques, and cutting agility in healthy, active individuals.

Design

Markerless motion-capture technology tracked subjects fitted with SASs, LABs, or no brace while they performed the movements: Y-excursion, left cutting, right cutting, single-leg drop vertical jump (SLDVJ), 45-degree bound, and single-leg squat (SLS).

Setting

University Laboratory.

Participants

Ten healthy, active individuals (5 males and 5 females, mean ± SD 23.60 ± 1.43 years of age).

Main outcome measures

Degrees of joint range of motion (ROM), Newton-meters of joint torque, time to perform a cutting maneuver.

Results

SASs and LABs resulted in significantly different knee and ankle ROM and hip internal rotation in the SLDVJ, SLS, Y-excursion, cutting maneuver, and 45-degree bound when compared to control (p < .05). Both ankle and knee torque were significantly reduced in the 45-degree bound and cutting movements with both types of PABs (p < .05). There were minimal differences between the SASs and LABs for all conditions. There were no statistically significant differences in cutting times for any of the 3 conditions.

Conclusion

Both SAS and LAB positively impacted neuromuscular control, reduced net joint torque, and neither impaired cutting agility when compared to control.

Postural control is altered in females with excessive medial knee displacement

Knee valgus motion observed during landing tasks has been proposed as a predictor of future knee injury. It mainly involves excess motion in the frontal plane and is known to be greater in individuals with excessive medial knee displacement (MKD). This affects postural control during sports manoeuvres. Previous sports medicine-related research suggests that the nature of these fluctuations provide rich and more sensitive information to identify risk of (re)injury. We aimed to investigate the fluctuations of the centre of pressure (CoP) in individuals with and without excessive MKD. Twenty females (12 controls; 8 excessive MKD) were instructed to perform single-leg landing tasks from three different directions. The participants landed on a force plate and stayed still for 20 seconds. The fluctuations of the anterior-posterior and medial-lateral directions of the CoP were determined through the calculation of Sample Entropy. Mixed-model ANOVAs (3 [Landing Direction] x 2 [Group]) were used. We have found that only the entropy of the medial-lateral direction was different between groups. Individuals with excessive MKD exhibited an increase in entropy values, indicating greater randomness in CoP fluctuations. This suggests a decreased ability to adapt to environmental demands that likely result in an increased risk of injury.

Symmetries in Muscle Torque and Landing Kinematics Are Associated With Maintenance of Sports Participation at 5 to 10 Years After ACL Reconstruction in Young Men

Background:

Long-term maintenance of sports participation is important for young men undergoing anterior cruciate ligament (ACL) reconstruction. Identifying biomechanical characteristics in patients who achieve this goal can assist in elaborating rehabilitation programs and in identifying successful recovery, but this has rarely been investigated.

Purpose:

To test the association between maintenance of sports participation at 5 to 10 years after ACL reconstruction and measures of force production and landing biomechanics in men.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 30 men who underwent isolated ACL reconstruction were examined. At 5- to 10-year follow-up, associations were tested between reported outcomes of sports maintenance and objective biomechanical measures. The biomechanical tests included isokinetic knee torque and lower limb kinetics and kinematics during landing tasks. Measurements for each limb were conducted separately, and side-to-side symmetry indices (SI) were calculated. Subgroups included SI greater than +10% (ie, extreme positive), SI lower than –10% (ie, extreme negative), and SI between –10% and +10% (ie, symmetric).

Results:

At follow-up, concentric knee torque in the operated limb correlated with Tegner and Marx scores (r = 0.42-0.47; P ≤ .05). Regarding the SI of knee torque, the highest Tegner, Marx, and KOOS (Knee injury and Osteoarthritis Outcome Score) results were associated with symmetry, as opposed to patients with extreme positive or extreme negative SIs (P < .05). As for landing kinematics, Tegner score negatively correlated with knee range of motion (ROM) in the operated limb (r = –0.38; P ≤ .05). With regard to SI, hip and knee ROM correlated with Tegner, IKDC, and KOOS scores (r = 0.41-0.51; P ≤ .05). Specifically, the highest sports participation levels were associated with achieving symmetric hip and knee ROM but also with extreme positive SIs, as opposed to patients with extreme negative SIs (P < .03), indicating substantially higher ROM in the uninjured limb as compared with the operated limb.

Conclusion:

At 5 to 10 years after ACL reconstruction, maintenance of sports participation was associated with symmetric side-to-side concentric knee torque and with producing greater attenuation of hip and knee ROM during the drop jump landing in the operated limb. Therefore, eccentric load programs that can improve attenuation-phase kinematics during landing tasks may be valuable in addition to concentric training and may facilitate enhanced long-term outcomes.

The Effect of Divided Attention with Bounce Drop Jump on Dynamic Postural Stability

This study determined the effect of divided attention on controlling postural stability during a drop vertical jump task. In total, 30 participants were tested for drop vertical jumps from a 30-cm high platform and landing on a single leg with or without divided attention tasks. Three-dimensional marker trajectories and ground reaction forces were collected simultaneously. Vertical ground reaction force, loading rate, and dynamic postural stability index were analyzed with or without divided attention tasks. The paired sample t test indicated a significantly low knee flexion angle, high vertical ground reaction force, and increased loading rate in the divided attention task. Moreover, participants showed an increased vertical stability index and dynamic postural stability index in the divided attention task than in the nondivided attention task. Thus, results demonstrated that the divided attention task could affect posture control, leading to poor dynamic posture stability and possibly increasing lower extremity injury risk. The influence of the divided attention task on movement quality likely indicates that an athlete can no longer focus his attention on the bounce drop jump maneuver. Therefore, the bounce drop jump combined with dynamic postural stability index could be used in posture stability screening.

Proprioception deficiency in articular cartilage lesions of the knee

Purpose

The purpose of this study is to investigate the proprioceptive function of patients with isolated articular cartilage lesions of the knee as compared to normal controls.

Methods

The Cartilage group consisted of eight subjects with radiologically and arthroscopically confirmed, isolated, unilateral, articular cartilage lesions of the knee (Outerbridge grade III or IV). They were compared to 50 normal controls. Knee proprioception was assessed by dynamic postural stabilometry using the Biodex Balance SD System. Patient-reported outcome measures (PROMs) were used to evaluate all subjects.

Results

Proprioception of the injured knee of the Cartilage group was significantly poorer compared to that of the control group (p < 0.001). A significant proprioceptive deficit also was observed when the uninjured knees of the Cartilage group were compared to those in the Control group (p = 0.003). There was no significant proprioceptive difference between the injured and the contra-lateral uninjured knee of the Cartilage group (p = 0.116). A significant correlation was found between the proprioception measurements of the injured and uninjured knee of the Cartilage group (r = 0.76, p = 0.030). A significant difference was observed in all PROMs (p < 0.001) between the Cartilage and Control groups.

Conclusions

Patients with isolated articular cartilage lesions of the knee had a significant proprioceptive deficit as compared to normal controls. The deficiency was profound and even affected the proprioceptive function of the contra-lateral uninjured knee. This study has shown that articular cartilage lesions have a major influence on knee proprioception. However, it remains uncertain as to whether a proprioceptive deficit leads to osteoarthritis or is a consequence of it.

Effects of in Season Multi-Directional Plyometric Training on Vertical Jump Performance, Change of Direction Speed and Dynamic Postural Control in U-21 Soccer Players

The aim of the study was to assess the effects of multi-directional plyometric training (MPT) on vertical jump height, change of direction speed (CODS), and dynamic postural control (DPC) of soccer players under 21 year (U-21). Twenty-seven male soccer players were randomly allocated to either an experimental group (EG; n = 14; age: 19.0 ± 0.9 years) or a control group (CG; n = 13; age: 19.0 ± 0.7 years). The EG introduced 6 weeks MPT, 2 days per week into their in-season training, while CG continued training without change. Measurements of vertical jump height, CODS and DPC were completed at the beginning and end of the 6 week MPT. ANOVA demonstrated a significant group × time interaction for SJ (F = 6.03, p = 0.021), CMJ (F = 9.10, p = 0.006), and T-Test (F = 10.46, p = 0.002). The Bonferroni Post Hoc test demonstrated significant increase for the three tests in both group (EG and CG). For SJ (EG: p < 0.001; CG: p < 0.001), CMJ (EG: p < 0.001; CG: p = 0.005) and T-Test (EG: p < 0.001; CG: p = 0.02). For DPC on the dominant leg, there was a significant group × time interaction for four axes [anterior (F = 5.48, p = 0.028), antero-lateral (F = 4.82, p = 0.038), postero-lateral (F = 4.82, p = 0.038), and medial (F = 6.77, p = 0.015)]. The Bonferroni Post Hoc test demonstrated significant increase in EG (p < 0.001), but no significant change in CG in four axes (anterior, antero-lateral, postero-lateral and medial). Furthermore DPC on the non-dominant leg, there was a significant group × time interaction for three axes [lateral (F = 8.09, p = 0.009), postero-lateral (F = 11.92, p = 0.002), and medial (F = 5.84, p = 0.023)]. The Bonferroni Post Hoc test demonstrated significant increase in EG (p < 0.001), but no significant change in CG in three axes (lateral, postero-lateral, and medial). In conclusion, incorporating MPT into the in-season regimen of under 21 soccer players improved performance of various indices related to soccer activity (i.e., CMJ, CODS, and DPC). MPT has the potential to be appealing to coaches, as it requires little time while yielding valuable results in the physical preparation of soccer players.

Alterations in medial-lateral postural control after anterior cruciate ligament reconstruction during stair use

BACKGROUND

Dynamic postural control during everyday tasks is poorly understood in people following anterior cruciate ligament reconstruction (ACLR). Understanding dynamic postural control can provide insight into potentially modifiable impairments in people following ACLR who are at increased risk for second ACL injury and/or knee osteoarthritis.

RESEARCH QUESTION

Determine whether measures indicative of dynamic postural control differ between individuals with and without ACLR during stair ascent and descent.

METHODS

Seventeen individuals with ACLR (>1 yr post-surgery) and 16 age and sex-matched healthy controls participated. Centre of pressure (COP) measures included: i) COP excursion, ii) COP velocity, and iii) dynamic time-toboundary (TTB). Mixed linear models were used to compare COP measures for the ACLR leg, non-ACLR leg, and healthy controls during stair ascent and stair descent.

RESULTS

There were no statistically significant differences observed during stair ascent (all p > 0.05). Several statistical differences were found during stair descent for individual with ACLR, but not between those with ACLR and healthy controls. The ACLR leg had higher medial-lateral COP excursion (mean difference 1.06 cm, [95 %CI 0.08-2.06 cm], p = 0.036; effect size = 0.38) compared to the non-ACLR leg during stair descent. In addition, the ACLR leg had a lower medial-lateral TTB (mean difference -13 ms [95 %CI -38 to 2 ms], p = 0.005; effect size = 0.49) and medial-lateral TTB normalized to stance time (mean difference -5.8 % [95 %CI -10.3 to 1.3 %], p = 0.012; effect size = 0.80) compared to the non-ACLR leg during stair descent. No statistical differences were observed for anterior-posterior measures during stair descent (all p > 0.05).

SIGNIFICANCE

Taken together, findings indicate that there are small to large differences in medial-lateral postural control in the ACLR leg compared to the non-ACLR leg during stair descent. Further work is required to understand clinical implication of these novel observations.

Multidirectional Plyometric Training: Very Efficient Way to Improve Vertical Jump Performance, Change of Direction Performance and Dynamic Postural Control in Young Soccer Players

The aim of the study was to assess the effects of multidirectional plyometric training (MPT) on vertical jump height, change of direction performance (CODP), and dynamic postural control (DPC) in young soccer players. Twenty-eight young male soccer players were randomly assigned to an experimental group (EG, n = 14; age: 11.8 ± 0.4 years) and a control group (CG, n = 14; age: 11.6 ± 0.5 years). The EG introduced 8-week MPT, two days per week into their in-season training, while CG continued training without change. Measurements of vertical jump height, CODP, and DPC were completed at the beginning and end of the 8-week MPT. A significant group × time interaction was observed for Squat-Jump (p < 0.05), for Counter-Movement Jump (p < 0.05), and for CODP test (p < 0.05). In addition, a significant group × time interaction was observed for DPC in seven axes for the dominant- (anterior, lateral, postero-lateral, posterior, postero-medial, medial, and antero-medial; p < 0.05 for all) and in seven axes for the non-dominant- (anterior, antero-lateral, lateral, posterior, postero-medial, medial and antero-medial; p < 0.05 for all) legs. The rest of the axes of both legs did not show any significant group × time interaction (p > 0.05). In conclusion, incorporating MPT into the in-season regimen of young male soccer players improved performance of various indices related to soccer activity (i.e., vertical jump height, CODP, and DPC). MPT has the potential to be appealing to coaches, as it requires little time while yielding valuable results in the physical preparation of young soccer players.