Acute effects of preventive warm-up exercises on modifiable risk factors for anterior cruciate ligament injuries: a three-arm randomized-controlled crossover trial

Associations Between Cognitive Function and ACL Injury-Related Biomechanics: A Systematic Review

CONTEXT

Does lower baseline cognitive function predispose athletes to ACL injury risk, especially when performing unplanned or dual-task movements?

OBJECTIVE

To evaluate the association between cognitive function and biomechanics related to ACL injuries during cognitively challenging sports movements.

DATA SOURCES

PubMed (MEDLINE), Web of Science, Scopus, and SciELO databases were searched; additional hand searching was also conducted.

STUDY SELECTION

The following inclusion criteria had to be met: participants completed (1) a neurocognitive test, (2) a cognitively challenging sport-related task involving lower limbs, and (3) a biomechanical analysis. The following criteria determined exclusion from the review: studies involving participants with (1) recent or current musculoskeletal injuries; (2) recent or current concussion; (3) ACL surgical reconstruction, reviews of the literature, commentary or opinion articles, and case studies.

STUDY DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement and registered at the International Prospective Register of Systematic Reviews (PROSPERO).

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two of authors independently extracted data and assessed the methodological quality of the articles with the Downs and Black and ROBINS-I checklists, to assess methodological quality and risk of bias, respectively.

RESULTS

Six studies with different methodologies and confounding factors were included in this review. Of these 6 studies, 3 were ranked as high-quality, 3 demonstrated a low risk of bias, 2 a moderate risk, and 1 a severe risk. Five studies found a cognitive-motor relationship, with worse cognitive performance associated with increased injury risk, with 1 study reporting the opposite directionality for 1 variable. One study did not identify any interaction between cognitive function and biomechanical outcomes.

CONCLUSION

Worse cognitive performance is associated with an increased injury risk profile during cognitively challenging movements.

Acute effects of a neuromuscular warm-up on potential re-injury risk factors associated with unanticipated jump landings after anterior cruciate ligament reconstruction: A crossover trial

OBJECTIVE

To investigate acute effects of a single bout of football specific neuromuscular injury preventive warm-up on potential anterior cruciate ligament (ACL) re-injury risk factors during anticipated and unanticipated jump-landings.

DESIGN

Crossover.

METHODS

Fourteen participants (mean ± SD age, 23.4 ± 4.1 years) 6-24 months after ACL reconstruction performed the Prevent Injury and Enhance Performance (PEP) and bicycle ergometer warm-up in a randomised sequence. Washout phase was one week. Countermovement jumps with anticipated and unanticipated single-leg-landings were assessed. Decision-making quality was measured using landing error count.

RESULTS

No carry-over effects occurred (p > 0.05). The unanticipated task produced significantly higher peak ground reaction forces (Δ+4%, F₍₁₁₎ = 3.46, p < 0.001, eta² = 0.21) after PEP warm-up compared to ergometer warm-up. A lower number of decision (Δ+12%, F ₍₅₎ = 17.1, p < 0.001, eta² = 0.57) and cumulated (Δ+15%, F ₍₃₎ = 17.2, p < 0.001, eta² = 0.57) errors were recorded during the unanticipated condition following PEP compared to ergometer warm-up.

CONCLUSIONS

Evaluating unanticipated jump-landing ability prior to return to sports clearance may provide information on potential re-injury risk factors. PEP warm-up may be superior to bicycle ergometer warm-up at improving unanticipated decision-making quality among athletes cleared to return to sports.

Acute effects of an injury preventive warmup programme on unanticipated jump-landing-task performance in adult football players: A crossover trial

HIGHLIGHTS

Adapting movements rapidly to unanticipated external stimuli (e.g. unexpected landings) is crutial to prevent injuries in footballIt is unclear wether popular neuromuscular injury preventive warmup programmes (e.g. Prevent injury and Enhance Performance (PEP)) adaquatly prepare athletes for these situationsOur study shows that the PEP warm up programme has acute effects on anticipated landing stability, but no influence on unanticipated landings or decision making qualityClassic neuromuscular warm up programmes may not be the optimal choice to prepare athletes properly for the upcoming motor-cognitive demands in a football match.

The Hamstrings: Anatomic and Physiologic Variations and Their Potential Relationships With Injury Risk

The incidence and recurrence of hamstrings injuries are very high in sports, posing elevated performance and financial-related costs. Attempts to identify the risk factors involved in predicting vulnerability to hamstrings injury is important for designing exercise-based programs that aim to mitigate the rate and severity of hamstrings injuries and improve rehabilitation strategies. However, research has shown that non-modifiable risk factors may play a greater role than modifiable risk factors. Recognizing non-modifiable risk factors and understanding their implications will afford the prescription of better suited exercise programs, i.e., that are more respectful of the individual characteristics. In a nutshell, non-modifiable risk factors can still be acted upon, even if indirectly. In this context, an underexplored topic is how intra and inter- individual anatomic and physiologic variations in hamstrings (e.g., muscle bellies, fiber types, tendon length, aponeurosis width, attachment sites, sex- and age-related differences) concur to alter hamstrings injuries risk. Some anatomic and physiologic variations may be modifiable through exercise interventions (e.g., cross-sectional area), while others may not (e.g., supernumerary muscle bellies). This apparent dichotomy may hide a greater complexity, i.e., there may be risk factors that are partially modifiable. Therefore, we explored the available information on the anatomic variations of the hamstrings, providing a deeper insight into the individual risk factors for hamstrings injuries and contributing with better knowledge and potential applications toward a more individualized exercise prescription.

Perceptual-Cognitive Function and Unplanned Athletic Movement Task Performance: A Systematic Review

The performance of choice-reaction tasks during athletic movement has been demonstrated to evoke unfavorable biomechanics in the lower limb. However, the mechanism of this observation is unknown. We conducted a systematic review examining the association between (1) the biomechanical and functional safety of unplanned sports-related movements (e.g., jumps/runs with a spontaneously indicated landing leg/cutting direction) and (2) markers of perceptual–cognitive function (PCF). A literature search in three databases (PubMed, ScienceDirect and Google Scholar) identified five relevant articles. The study quality, rated by means of a modified Downs and Black checklist, was moderate to high (average: 13/16 points). Four of five papers, in at least one parameter, found either an association of PCF with task safety or significantly reduced task safety in low vs. high PCF performers. However, as (a) the outcomes, populations and statistical methods of the included trials were highly heterogeneous and (b) only two out of five studies had an adequate control condition (pre-planned movement task), the evidence was classified as conflicting. In summary, PCF may represent a factor affecting injury risk and performance during unplanned sports-related movements, but future research strengthening the evidence for this association is warranted.

Lower Extremity Open Skill Training Effects on Perception of Visual Stimuli, Cognitive Processing, and Performance

This study investigates if lower extremity open-skill training impacts perception and cognitive processing abilities or just influences task related motor abilities. Twenty-two participants (24.7 ± 2.4years; 11 males, 11 females) were randomly allocated either into the group that trained on a computerized device or to the control group. Prior to and following the 4-week study period, motor performance was assessed using drop jump, hexagon test, postural control and lower extremity choice reaction. Perception, cognitive processing and task inhibition were captured using validated neurocognitive tests. Repeated measurements analyses of co-variances (ANCOVAs) were performed. They revealed a time (before and after intervention) × group (training vs. control) effect on lower extremity choice reaction and hexagon (p < .05). No effects on group differences or between groups in cognitive performance were found. A detrimental effect of training on accuracy of task inhibition (lower percentage of correct inhibitions) was detected. Computerized open skill training affects specific movement patterns without increasing task-relevant cognitive or perceptual abilities. Indicated by the lower percentage of correct inhibitions, the training might further detrimentally influence the risk-taking behavior during choice reaction tasks.