Neuromuscular Training Improves Self-Reported Function and Single-Leg Landing Hip Biomechanics in Athletes After Anterior Cruciate Ligament Reconstruction (original) (raw)
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Clinical Journal of Sport Medicine, 2018
Patients and intervention: Fifteen male athletes following ACL-R using patellar tendon and 11 using hamstrings autograft at the time of return to sport were recruited. Fifteen healthy athletes served as control group. Participants performed 4 different single-leg landing tasks arriving onto a force plate. Main outcome measures: Electromyographic (EMG) activity of knee extensors and flexors, normalized vertical ground reaction force and knee angular displacement were recorded. Results: In all the tasks pre-impact EMG duration was longer in ACL-R (112±28 ms in the knee extensors; 200±34 ms in the knee flexors) compared to healthy participants (74±19 ms in the knee extensors; 153±29 ms in the knee flexors; P<0.05). Initial Contact and Maximum Post-Impact knee angle were lower in ACL-R (9±7 degrees at Initial Contact; 39±12 degrees at maximum flexion) compared to healthy participants (17±9 degrees at Initial Contact; 52±15 degrees at maximum flexion; P<0.05). Normalized vertical GRF was higher in ACL-R compared to healthy participants (3.4±0.5 and 2.7±0.6; P<0.05). Conclusion: At the time of return to sport ACL-R subjects showed altered motor control strategies of single-leg landings. These alterations may lead to uncoordinated movement, hence increasing the risk of re-injury.
Neuromuscular Training to Target Deficits Associated With Second Anterior Cruciate Ligament Injury
Journal of Orthopaedic & Sports Physical Therapy, 2013
A nterior cruciate ligament (ACL) rupture is one of the most physically, financially, and emotionally devastating sport-related knee injuries. Return to activity is highly desired and expected for many athletes following ACL reconstruction (ACLR) and postsurgical rehabilitation, but reported success rates range from 43% to 93%. 4,17,19,76,88,138 Unfortunately, for those who do resume their previous level of activity, the risk of a second ACL injury may range from 6% to as high as 30% and can be associated with several factors, including surgical technique, 16,65,79,84 age, 65,84,136,150 activity level, 16,133 sex, 125,136 time since surgery, 75,133,150 and biomechanical adaptations during dynamic tasks. Although several of these factors are nonmodifiable, the biomechanical components of second-ACL injury risk may be effectively addressed with targeted neuromuscular training prior to unrestricted sports participation.
BMC Musculoskeletal Disorders, 2007
Background: Neuromuscular training may reduce risk factors that contribute to ACL injury incidence in female athletes. Multi-component, ACL injury prevention training programs can be time and labor intensive, which may ultimately limit training program utilization or compliance. The purpose of this study was to determine the effect of neuromuscular training on those classified as "high-risk" compared to those classified as "low-risk." The hypothesis was that high-risk athletes would decrease knee abduction moments while low-risk and control athletes would not show measurable changes.
Journal of Strength and Conditioning Research, 2008
Surgical intervention and early-phase rehabilitation after anterior cruciate ligament (ACL) reconstruction have undergone a relatively rapid and global evolution over the past 25 years. Despite the advances that have significantly improved outcomes, decreases in healthcare coverage (limited visits allowed for physical therapy) have increased the role of the strength and conditioning specialist in the rehabilitation of athletes returning to sport after ACL reconstruction. In addition, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safely return to sport. The purpose of this Scientific Commentary is to present an example of a progressive, end-stage return to sport protocol that is targeted to measured deficits of neuromuscular control, strength, power, and functional symmetry that are rehabilitative landmarks after ACL reconstruction. The proposed return to sport training protocol incorporates quantitative measurement tools that will provide the athlete with objective feedback and targeted goal setting. Objective feedback and targeted goal setting may aid the strength and conditioning specialist with exercise selection and progression. In addition, a rationale for exercise selection is outlined to provide the strength and conditioning specialist with a flexible decision-making approach that will aid in the modification of return to sport training to meet the individual athlete's abilities and to target objectively measured deficits. This algorithmic approach may improve the potential for athletes to return to sport after ACL reconstruction at the optimal performance level and with minimized risk of reinjury.
This study investigated lower limb muscular activation strategies following an 8-week body-weight based training intervention focused on the dynamic control of the hip/trunk. Muscle activation, support moment and frontal plane knee moments of elite female hockey players (n=13) were measured during unplanned sidestepping pre/post training. Post-training, gluteal muscle activation increased (+10%;p=0.006). There was no change in support moment or frontal plane knee moments however, the contribution of hip extension to total support moment increased (+10%;d=0.56) following training. Hip/trunk neuromuscular training is effective in improving hip neuromuscular activation, allowing athletes to more effectively utilise their hip to generate their support moment, which may prevent dangerous ‘dynamic valgus’ knee postures during sidestepping sporting tasks.
2020
Injury to the anterior cruciate ligament (ACL) is considered one of the most debilitating knee injuries which could occur in any young athlete. ACL injuries have short and longterm morbidity consequences, with all the negative impact in the individual wellbeing and health-system. Mitigation of the risk factors (e.g., knee valgus) through training are key in reducing the risk of an ACL injury. However, the majority of neuromuscular training programs require a time-intensive commitment and have a considerable level of complexity and intensity, thus reducing compliance to the programs AposTherapy is a unstable foot-worn biomechanical device which aims to alter alignment and enhance neuromuscular control but has the advantage as a simpler intervention. The purpose of this study was to investigate the effect of implementing an unstable footwear device, AposTherapy system, on lower limb biomechanics in recreational female athletes The study identified a significant reduction in knee valgu...
2011
The aim of this study was to determine if anterior cruciate ligament reconstructed (ACL-R) female athletes exhibit altered lower limb kinematic profiles during jump landing when compared to a non-injured age, sex, and activity matched control group. Fourteen ACL-R and 14 non-injured control subjects performed 3 vertical drop jump (DVJ) trials. Lower limb kinematics were recorded at 200 Hz. Peak and time-averaged angular displacements were quantified and utilized for between-group analysis. The ACL-R group displayed altered hip joint frontal and transverse plane kinematic alterations, and knee joint frontal and sagittal plane kinematic alterations. Specifically the ACL-R group displayed an increased adducted (p < 0.05) and internally rotated (p < 0.05) hip joint position, both peak and time-averaged, following landing. The ACL-R group also displayed a decreased adducted (p < 0.05) and flexed (p < 0.05) position of the knee joint following landing. The observed aberrant lower limb kinematics could pre-dispose ACL-R athletes to potential future knee joint injuries. Further studies are required to determine in a prospective manner whether such deficits increase the incidence of recurrent ACL injury, and whether specific sensorimotor protocols following ACL reconstruction can minimize these kinematic deficits. ß
Journal of Orthopaedic Research, 2014
Despite the intense focus on outcomes following an anterior cruciate ligament (ACL) reconstruction, it is not yet known whether unresolved abnormal hip and trunk neuromuscular control exists. The purpose of this study was to compare trunk and hip kinematics during running, hip abductor and external rotator strength, and trunk control between females who had undergone an ACL reconstruction and healthy control participants. We compared 20 ACL reconstructed females to 20 healthy individuals, measuring abduction and external rotation strength, a trunk control test, and performed an instrumented gait evaluation during running. Comparisons between groups were made for non-sagittal peak hip angles, forward trunk lean, trunk ipsilateral lean at initial contact, trunk control and hip abduction, and external rotation strength. We found no significant differences in hip abduction (p ¼ 0.25), hip external rotation strength (p ¼ 0.63), peak hip adduction (p ¼ 0.11) or hip internal rotation angle (p ¼ 0.47). The ACL group did have a significantly greater ipsilateral trunk lean (p ¼ 0.028), forward lean (p ¼ 0.004), and had higher errors on the trunk stability test (p ¼ 0.007). We found significant differences in trunk control, suggesting further attention should be devoted to this component of rehabilitation. ß
Knee Surgery, Sports Traumatology, Arthroscopy, 2008
The hamstrings musculature is a vital component of an intricate dynamic knee joint restraint mechanism. However, there is evidence based on research studies suggesting potential deficits to this complex mechanism due to donor site morbidity resulting from harvest of the ipsilateral semitendinosus and gracilis autograft (ISGA) for anterior cruciate ligament reconstruction (ACLR). The purpose of this retrospective research study was to investigate the effects of ISGA ACLR on neuromuscular and biomechanical performance during a single-leg vertical drop landing (VDL), a functional task and associated mechanism of anterior cruciate ligament disruption during physical activity. Fourteen physically active participants 22.5 ± 4.1 years of age and 21.4 ± 10.7 months post ISGA ACLR underwent bilateral neuromuscular, biomechanical and isokinetic strength and endurance evaluations matched to 14 control participants by sex, age, height and mass. Kinetic and kinematic data was obtained with 3-D motion analyses utilizing inverse dynamics while performing single-leg VDLs from a height of 30 cm. Integrated surface electromyography (SEMG) assessments of the quadriceps, hamstrings and gastrocnemius musculature were also conducted. Additionally, knee joint flexion strength (60°s -1 ) and endurance (240°s -1 ) measurements were tested via isokinetic dynamometry. No significant differences existed in hip and net summated extensor moments within or between groups. The ISGA ACLR participants recorded significantly decreased peak vertical ground reaction force (VGRF) landing upon the involved lower extremity compared to uninvolved (P = 0.028) and matched (P \ 0.0001) controls. Participants having undergone ISGA ACLR also displayed greater peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.020) and matched (P = 0.026) controls at initial ground contact. The ISGA ACLR group furthermore exhibited increased peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.019) and matched (P = 0.007) controls at peak VGRF. Moreover, ISGA ALCR participants demonstrated greater peak knee (P = 0.005) and ankle (P = 0.017) joint flexion angles when landing upon the involved lower extremity compared to the matched control at peak VGRF. The ISGA ACLR group produced significantly greater reactive muscle activation of the vastus medialis (P = 0.013), vastus lateralis (P = 0.008) and medial hamstrings (P = 0.024) in the involved lower extremity compared to the matched control. The ISGA ACLR participants also exhibited greater preparatory (P = 0.033) and reactive (P = 0.022) co-contraction muscle activity of the quadriceps and hamstrings landing upon the involved lower extremity compared to the matched control. In addition, the