Knee Injury Outcomes and Prevention: Focus on Anterior Cruciate Ligament
Trunk and Hip Control Neuromuscular Training for the Prevention of Knee Joint Injury

https://doi.org/10.1016/j.csm.2008.02.006Get rights and content

This article provide evidences to outline a novel theory used to define the mechanisms related to increased risk of ACL injury in female athletes. In addition, this discussion will include theoretical constructs for the description of the mechanisms that lead to increased risk. Finally, a clinical application section will outline novel neuromuscular training techniques designed to target deficits that underlie the proposed mechanism of increased risk of knee injury in female athletes.

Section snippets

Biomechanics Related to Increased Risk of Anterior Cruciate Ligament Injury in Female Athletes

Altered or decreased neuromuscular control during the execution of sports movements, which result in excessive resultant lower limb joint motions and loads, may increase risk of ACL injury in female athletes [7]. Hewett and colleagues [7] prospectively demonstrated that measures of lower extremity valgus, including knee abduction motion and torque, during jump-landing tasks, predicted ACL injury risk in young female athletes with high sensitivity and specificity. Females also exhibit increased

The Relationship of Growth and Maturation to Development of High-Risk Mechanisms

Contrary to the findings of sex differences in ACL injury risk in the adolescent female athlete, there is no evidence that a sex difference in ACL injury rates is present in prepubescent athletes [30], [31], [32], [33]. Although knee injuries do occur in the preadolescent athlete, with up to 63% of the sports-related injuries in children aged 6 to 12 years reported as joint sprains, and with the majority of these sprains occurring at the knee [33], specific sprains such as injuries to the

Neuromuscular Training Targeted to the Trunk

Table 1 presents a neuromuscular training protocol to be instituted with female athletes to target deficits in trunk and hip control [46]. Five exercise phases are used to facilitate progressions designed to improve the athlete's ability to control the trunk and improve core stability during dynamic activities (Table 1). All exercises in each phase progressively increase the intensity of the exercise techniques. End-stage progressions incorporate lateral trunk perturbations that force the

Effects of Trunk Neuromuscular Training on Hip Abduction Peak Torque

Pilot studies that used the proposed neuromuscular training targeted to the trunk (TNMT) protocol indicate that increased standing hip abduction strength can be improved in female athletes (Table 3, Table 4, Table 5, Table 6, Table 7, Table 8, Table 9, Table 10, Table 11, Table 12, Table 13, Table 14, Table 15) [46]. Hip abduction strength and recruitment may improve the ability of female athletes to increase control of lower extremity alignment and decrease knee abduction motion and loads

Summary

Dynamic neuromuscular analysis-oriented training appears to reduce ACL injuries in adolescent and mature female athletes [17], [47], [49], [50]. Targeted neuromuscular training, at or near the onset of puberty, simultaneously may improve lower extremity strength and power, reduce dangerous biomechanics related to ACL injury risk, and improve single-leg balance [21], [52]. Neuromuscular training could be advocated in pre- and early pubertal children to help prevent the development of high-risk

Acknowledgements

The authors would like to thank the Mason School Volleyball Program, especially head coach Tiann Keesling, and Mason School Athletic Director Scott Stemple, Principal Dr. Dave Allen, and Superintendent Kevin Bright for their support to this project.

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    The authors would like to acknowledge funding support from National Institutes of Health/NIAMS Grant R01-AR049735 and R01-AR055563.

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