Neuromuscular Training Effects on Athletes' Jumping and Lower Limb Injury: A Systematic Review.

This study assessed the impact of integrated neuromuscular training (INT) on athletes' jumping performance and lower limb injury prevention. A thorough search across multiple databases, including PubMed, Web of Science, Science Direct, and the Cochrane Library, identified a sample of 19,805 athletes aged between 8.5 and 27.7 years. Results showed that INT led to a significant improvement in jumping ability (SMD = 0.45, 95% CI 0.30-0.60, P = 0.000) and a reduction in lower limb injuries (SMD = 0.68, 95% CI 0.62-0.74, P = 0.000). The most effective interventions lasted at least 25 minutes, conducted 2-5 times per week, for a minimum of 9 weeks. This approach was particularly beneficial for children and adolescents, as it enhanced their countermovement jump (CMJ) ability and helped in the prevention of injuries.

Feasibility and Effects of a Neuromuscular Warm-Up Based on the Physical Literacy Model for 8-12-Year-Old-Children.

Background: Physical literacy and injury prevention strategies use similar movement-related constructs and can be connected to develop comprehensive interventions. We aimed to test the feasibility and effects of a neuromuscular warm-up based on physical literacy and injury prevention strategies for 8-12-year-old children. Methods: We conducted a cluster non-randomized controlled trial. We defined a priori feasibility criteria and studied the effects of the intervention on physical literacy constructs, movement competence, and neuromuscular performance. We used generalized linear mixed models controlling for covariates and clustering with a significance level of 0.001. Results: We recruited 18 groups (n = 363) and randomly allocated nine to intervention (n = 179; female = 63.7%, age = 9.8 ± 1 years) and nine to control (n = 184, female = 53.3%, age = 9.9 ± 0.9 years). We met four of seven feasibility criteria (i.e. recruitment, adherence, enjoyment, perceived exertion). The three feasibility criteria that were not met (i.e. compliance, fidelity, follow-up) were slightly below the predefined threshold (90%). Model-adjusted mean differences for physical literacy constructs, movement competence, vertical jump height, horizontal jump distance, 20-m sprint time, and dynamic balance favored the intervention (p < .001). Conclusion: The feasibility evidence indicates that the intervention should be slightly modified before implementing it in a larger study. The observed mean differences are promising and can be used in planning future interventions.

Integrated neuromuscular training intervention applied in schools induces a higher increase in salivary high molecular weight adiponectin and a more favorable body mass index, cardiorespiratory fitness and muscle strength in children as compared to the traditional physical education classes.

Background: High-molecular-weight adiponectin (HMW-adiponectin) is a cardio-metabolic health protector. Objectives: (1) to compare body mass index (BMI), cardiorespiratory fitness (CRF) and muscle strength (MS) in healthy school-children depending on their baseline salivary-HMW-adiponectin concentration; and (2) to apply a 3-month integrated neuromuscular training (INT) and evaluate its effects on salivary-HMW-adiponectin concentration, BMI, CRF and MS in the same children. Additional goal: to identify if any potential changes during the 3-month period may be related to a potential change in salivary-HMW-adiponectin concentration. Methods: Ninety children (7.4 ± 0.3 years) were recruited in primary schools and randomly allocated into control or intervention group. The intervention consisted of a 3-month INT applied during physical education (PE) classes, twice-weekly, while the control group had traditional PE classes. Body mass and height were measured, BMI was calculated and HMW-adiponectin was quantified in saliva. To assess CRF and MS, 800 m-run and hand-dynamometry were applied, respectively. All measurements were performed twice, at baseline and after 3 months. Results: Children with higher baseline salivary-HMW-adiponectin have more favorable BMI (p = 0.006) and slightly higher CRF (p = 0.017) in comparison to the children with lower baseline salivary-HMW-adiponectin. There were no big changes after the 3-month-period neither in the control, nor the INT group. However, it is worthy to note that the INT induced slightly higher increase in salivary-HMW-adiponectin (p = 0.007), and a slightly higher improvement in BMI (p = 0.028), CRF (p = 0.043) and MS (p = 0.003), as compared to the traditional PE classes. Finally, the INT-induced improvement in CRF was associated with the increased post-salivary-HMW-adiponectin concentration (p = 0.022). Conclusion: Main findings may suggest the potential utility of an INT as a cost-effective strategy that can be applied in schools to induce cardio-protective effects in school-children.

Effects of Instability Neuromuscular Training Using an Inertial Load of Water on the Balance Ability of Healthy Older Women: A Randomized Clinical Trial.

The reflexive responses to resist external forces and maintain posture result from the coordination between the vestibular system, muscle, tendon, and joint proprioceptors, and vision. Aging deteriorates these crucial functions, increasing the risk of falls. This study aimed to verify whether a training program with water bags, an Instability Neuromuscular training (INT) using the inertial load of water, could positively impact balance ability and dynamic stability. This study was conducted with twenty-two healthy older women aged ≥ 65 (mean age: 74.82 ± 7.00 years, height: 154.20 ± 5.49 cm, weight: 55.84 ± 7.46 kg, BMI: 23.55 ± 3.58 kg/m2). The participants were randomly allocated into two groups: a group that used water bags and a control group performing bodyweight exercises. The intervention training lasted 12 weeks, with 2 sessions per week totaling 24 sessions, each lasting 60 min. The pre- and post-tests were compared using t-tests to examine within- and-between-group differences. The effect size was examined based on the interaction between group and time using a two-way repeated measures ANOVA. The Modified Timed Up and Go manual (TUG manual), Sharpened Romberg Test (SRT), and Y-balance test (YBT) were conducted to assess dynamic stability, including gait function, static stability, and reactive ability. In comparison between groups, the waterbag training group showed a decrease in task completion time associated with an increase in walking speed in the TUG manual test (p < 0.05), and an increase in static stability and reaction time in the Sharpened Romberg test with eyes closed (p < 0.05), and an increase in single-leg stance ability in both legs in the Y-balance test (p < 0.05). All statistical confidence interval levels were set 95%. INT using the inertial load of water enhanced the somatosensory system and gait related to dynamic stability in older women. Therefore, the clinical application of this training program is expected to reduce the risk of falls in healthy older women, improving dynamic stability related to gait.

Independent data collectors decrease bias in the measurement of adherence to anterior cruciate ligament injury prevention programs.

OBJECTIVES: Studies on adherence to neuromuscular training (NMT) for anterior cruciate ligament (ACL) injury prevention are frequently biased due to the use of self-reporting by coaches or the athletes themselves. Few NMT studies use data collectors (aside from the athletes or the individuals administering the NMT program) to decrease bias when assessing the adherence of coaches and sports teams. We hypothesized that the use of a data collector who is independent of the team to evaluate adherence to NMT programs would be reliable. METHODS: In a prior a cluster-randomized controlled trial evaluating adherence to NMT training trial, twelve boys' and nine girls' high school athletic teams in a variety of sports were enrolled. Eight data collectors (unaffiliated with the NMT program) were hired specifically to record adherence of the athletes to the NMT exercises at each team's warm-ups 2-3 times a week, prior to practices and games. In addition to the data collectors, a control group of independent observers made visits throughout the season to also record adherence (solely for the purpose of this study, alongside the data collectors and in the same fashion) in order to evaluate the data collectors' performance and determine inter-observer reliability. The inter-observer reliability between data collectors and independent observers was measured using the Kappa statistic. RESULTS: A total of 399 warm-ups for practices or games were observed by data collectors to obtain adherence data. Independent observers also measured adherence at 58 practices or games for inter-observer reliability. Exercise instruction and alignment cues for 29 different exercises were analysed. The Kappa values ranged from 0.63 to 1.0, indicating substantial to perfect agreement. The overall Kappa values of 0.89 and 0.90 for exercise instruction and alignment cues, respectively, indicated almost perfect agreement. CONCLUSION: The use of a data collector who is independent of the team to evaluate adherence to NMT programs (rather than athlete or coach self-reporting), was shown to be a reliable method for measurement of adherence in studies of NMT for injury prevention. Avoiding self-reporting in adherence research to NMT training may decrease bias. LEVEL OF EVIDENCE: I.

Effect of Neuromuscular Training and Neurodynamic Solutions for Asymptomatic Prolapsed Intervertebral Disc and Coexisting Piriformis Syndrome in a 19-Year-Old: A Comprehensive Case Report.

This case study examines the treatment journey of a 19-year-old male who presented with bilateral buttock pain, lower limb weakness, and instability caused by piriformis syndrome and asymptomatic Prolapsed intervertebral disc (PIVD) herniation. The intervention strategy was guided by clinical assessments, including neurological and musculoskeletal evaluations, as well as confirmatory magnetic resonance imaging (MRI) findings. The patient's treatment plan adopted a comprehensive approach that incorporated neuromuscular training and neurodynamic solutions. The former focused on strengthening the core and lower limb muscles to correct biomechanical imbalances associated with piriformis syndrome. Concurrently, neurodynamic solutions, such as targeted stretching and mobilization exercises, were employed to alleviate sciatic nerve compression related to asymptomatic PIVD. The results demonstrated significant improvement in symptoms, highlighting the effectiveness of the individualized rehabilitation program. This case report underscores the success of a multifaceted approach in addressing the intricate interaction between muscular and neural components in piriformis syndrome and asymptomatic PIVD. However, further research is necessary to validate the broader applicability of this combined therapeutic strategy.

E-health intervention for preventing recurrent ankle sprains: a randomised controlled trial in general practice.

BACKGROUND: Ankle sprains are frequent injuries in general practice. However, no effective treatment is available yet. AIM: To examine the effectiveness of an unsupervised e-health-supported neuromuscular training programme in combination with usual care compared with usual care alone in patients with acute lateral ankle sprains in general practice. DESIGN AND SETTING: Randomised controlled trial with 1-year follow-up among patients (14-65 years) who visited the GP with an acute lateral ankle sprain within 3 weeks of injury. METHOD: The intervention group received, in addition to usual care, an unsupervised e-health-supported neuromuscular training programme and the control group received usual care alone. The primary outcome was self-reported re-sprains during 52 weeks of follow-up. Secondary outcomes were ankle function, pain in rest and during activity, subjective recovery, and return to the same type and level of sport. RESULTS: In total, 165 participants (mean age 38.3 years and 69 [41.8%] male) were included. No statistically significant difference in the occurrence of a re-sprain were found between the intervention 20.7% (17/82) and control group 24.1% (20/83) (hazard ratio 1.14, 95% confidence interval = 0.59 to 2.21). Also, no statistically significant differences in secondary outcomes were found between groups. The adherence rate to the programme was low (6.1%, 5/82). CONCLUSION: The rate of re-sprains was relatively high and an unsupervised e-health-supported neuromuscular training programme does not yield meaningful effects and does not encourage adherence in preventing re-sprains in patients in general practice. More research is necessary to indicate the best treatment modality and way of delivery for these patients.

Adding Neurofeedback Training to Neuromuscular Training for Rehabilitation of Chronic Ankle Instability: A 3-Arm Randomized Controlled Trial.

BACKGROUND: Neurofeedback training (NFT) can aid in the treatment of the abnormal patterns of the brain brought on by physical injury, enhancing cognitive and behavioral abilities. The present study aimed to compare the effectiveness of combining neuromuscular training (NMT) and NFT (NMT+NFT) with NMT alone in rehabilitating athletes with chronic ankle instability (CAI). HYPOTHESIS: NMT+NFT will be more effective than NMT alone. STUDY DESIGN: A 3-arm, single-blind randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total number of 62 athletes, aged 18 to 25 years, with CAI, participated in this study. The study subjects were allocated randomly to 3 groups: 21 cases in the control group, 21 cases in the combination group (CG) receiving NMT+NFT, and 20 cases in the neuromuscular group (NG) practicing NMT alone, undergoing exercises related to their groups for 8 weeks. Data were recorded and analyzed before and after the 8-week training program. The primary outcome measures were postural sway indices; secondary outcomes included ankle proprioception and biopsychosocial indices. RESULTS: NMT+NFT was more effective than NMT alone in terms of improving postural control during single- and 2-legged standing positions under the conditions of eyes closed and eyes open, proprioception at 20° of plantar flexion, as well as anxiety and depression in athletes with CAI. However, the findings revealed that NMT+NFT and NMT alone could both improve such indices. CONCLUSION: NMT+NFT as a treatment protocol improved postural control, ankle proprioception, anxiety, and depression greater than NMT alone. CLINICAL RELEVANCE: A combined protocol of NFT and NMT led to greater improvement compared with NMT alone. NFT was recommended as an adjunct therapy in the rehabilitation of athletes suffering from CAI.

The efficacy of neuromuscular training, with minimal or no equipment, on performance of youth athletes: A systematic review with meta-analysis.

OBJECTIVES: To investigate the effects of neuromuscular training, with minimal or no equipment, on physical performance of youth athletes. DESIGN: Systematic review with meta-analysis. METHODS: MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro and SportDiscuss from inception to March/2022. SELECTION CRITERIA: youth athletes (15-24years), from Olympic team sports; used neuromuscular training 2-3 times/week for, at least, 6 weeks; had a control group/usual training group; physical performance as outcomes; randomized controlled trial. DATA SYNTHESIS: Pooled estimate of standardized mean difference (SMD), and 95% confidence interval (95%CI). RESULTS: Thirty-four studies (1111 participants) were included. Results showed that neuromuscular training improved power (SMD: 0.84 [95%CI: 0.58, 1.10]; n = 805; I2 = 64%), speed (SMD: -1.12 [95%CI: -1.68, -0.57]; n = 688; I2 = 90%) and agility (SMD: -1.21 [95%CI: -1.60, -0.83]; n = 571; I2 = 76%) compared to control group, but showed no difference between groups for muscle strength (Quadriceps SMD: 0.34 [95%CI: -0.02, 0.69]; n = 132; I2 = 0%, Hamstrings: SMD: 0.64 [95%CI: -0.04, 1.33]; n = 132; I2 = 71%), balance and flexibility. CONCLUSION: Clinically, neuromuscular training with minimal equipment may be useful for teams with limited resources to improve mainly athletes' power and agility, including those interventions that were designed to injury prevention. Future high-quality studies are likely to change these estimates.

Effect of Instability Training on Compensatory Muscle Activation during Perturbation Challenge in Young Adults.

Balance requires constant adjustments in muscle activation to attain force steadiness. Creating appropriate training can be challenging. The purpose of this study was to examine the effects of 2 weeks of front squat instability training using a water-filled training tube on force steadiness during an instability challenge. Control (CON, n = 13) and experimental (EXP, n = 17) subjects completed pre- and post-testing for EMG variability by completing one set of 10 repetitions with a stable and unstable training tube. Electrodes were placed bilaterally on the anterior deltoid, paraspinal, and vastus lateralis muscles. CON subjects completed 2 weeks of training using a stable training tube, while EXP subjects trained with a water-filled instability tube. EMG data were integrated for each contraction, and force steadiness was computed using the natural log of coefficient of variation. CON results showed no changes in force steadiness for any condition. EXP showed significant reductions in EMG activation variability across all muscles. These results indicate a significant training effect in reducing muscle activation variability in subjects training with a water-filled instability training device. Improvements seen in these healthy subjects support the development of training implements for a more clinical population to help improve force steadiness.

Knowledge and awareness of anterior cruciate ligament injury among Turkish professional athletes: an online survey.

The purpose of this study was to assess the awareness and knowledge of professional team sport athletes about ACL injuries, injury prevention programs, and the return to sports after ACL injuries. A total of 419 athletes representing soccer, basketball, volleyball and handball sports were included in the study. We utilized a 15-item self-report survey to assess the awareness of athletes about ACL injury, ACL injury prevention program, and return to sport after ACL injuries. Male and soccer players participated in prevention programs more than female athletes (p = 0.001). Participation in prevention programs was significantly higher in the ≥ 18 years old group than in the < 18 years old group (p = 0.040). Participants who were informed about ACL injuries were 8.4 times more likely to participate in the ACL injuries prevention program than others (OR: 8.38, 95% CI: 3.823-18.376, p < 0.001). The majority of participants believed that return to sport after ACL injury takes 6 months and 81.4% of them thought that it is not possible to do sport without an ACL. This study revealed that the awareness and performance of ACL prevention training programs among professional team sport athletes were insufficient. The athletes' knowledge regarding return to sports after ACL injuries was also inadequate. Improving athletes' knowledge of ACL injuries may lead to increased participation in ACL injury prevention programs. Thus, the provision of tailored educational interventions to athletes could potentially enhance their awareness and understanding of ACL injuries, consequently contributing towards the prevention of such injuries.

The plyometric treatment effects on change of direction speed and reactive agility in young tennis players: a randomized controlled trial.

Aim: The aim of this paper is to determine the effect of 6 weeks of plyometric training on speed, explosive power, pre-planned agility, and reactive agility in young tennis players. Methods: The participants in this study included 35 male tennis players (age 12.14 ± 1.3 years, height 157.35 ± 9.53 cm and body mass 45.84 ± 8.43 kg at the beginning of the experiment). The biological age was calculated and determined for all participants. 18 of the participants were randomly assigned to the control group, and 17 were assigned to the experimental group. Running speed (sprints at 5, 10, and 20 m), change of direction speed (4 × 10, 20 yards, t-test, TENCODS), reactive agility (TENRAG), and explosive power (long jump, single leg triple jump, countermovement jump, squat jump, and single leg countermovement jump) were all tested. The Mixed model (2 × 2) ANOVA was used to determine the interactions and influence of a training program on test results. Furthermore, Bonferroni post hoc test was performed on variables with significant time*group interactions. Results: The results of this research indicate that an experimental training program affected results in a set time period, i.e. 5 out of total 15 variables showed significant improvement after experimental protocol when final testing was conducted. The experimental group showed significantly improved results in the 5 m sprint test in the final testing phase compared to the initial testing phase, this was also the case in comparison to the control group in both measurements. Furthermore, the experimental group showed significant improvement in the single leg countermovement jump in the final test, as well as in comparison to the control group in both measurements. The change of direction speed and reactive agility test also exhibited significant improvement in the final testing phase of the experimental group. Conclusion: The results of this research indicated that a 6-week program dominated by plyometric training can have a significant effect on the improvement of specific motor abilities within younger competitive categories. These results offer valuable insights for coaches in designing diverse tennis-specific scenarios to enhance overall performance, particularly focusing on the neuromuscular fitness of their players.

New Neuromuscular Training for Peripheral Nerve Disorders Using an Ankle Joint Hybrid Assistive Limb: A Case Series.

Peripheral nerve disorder of the lower extremities causes drop foot and disturbs the daily living activities of patients. The ankle joint hybrid assistive limb (HAL) provides voluntary ankle joint training using surface bioelectrical signals from the muscles of the lower extremities. We investigated the neurological effects of ankle joint HAL training in three patients. Sensory nerve action potentials (SNAPs) and compound muscle action potentials (CMAPs) were analyzed for the peroneal and tibial nerves prior to the first ankle joint HAL training session. Integrated surface electromyography EMG signals were recorded before and after the HAL training sessions to evaluate the effects of training for neuromuscular disorders. The patients were hospitalized to receive rehabilitation with HAL training for 2 weeks. The HAL training was performed daily with two 60 min sessions. All cases demonstrated severe neuromuscular impairment according to the result of the CMAP. All integrated EMG measurements of antagonistic muscle activities decreased after the ankle joint HAL training. The manual muscle testing (MMT) scores of each muscle were slightly increased after the HAL intervention for Case 2(tibialis anterior, from 2 to 2+; gastrocnemius muscles, from 2- to 2; extensor digitorum longus, and extensor hallucis longus, from 1 to 3). The MMT scores were also slightly increased except for gastrocnemius muscle for Case 3 (tibialis anterior, extensor digitorum longus, and extensor hallucis longus, from 2- to 2). These two patients demonstrated voluntary muscle contractions and nerve signals in the CMAP before the HAL training. Even though the amplitude of CMAPs was low, the HAL training may provide voluntary ankle joint movements by reducing the antagonistic muscle contraction via computer processing. The HAL training may enhance muscle movement and coordination through motor learning feedback.

Adherence to Injury Prevention Exercise Programmes in Amateur Adolescent and Adult Football: A Detailed Description of Programme Use from a Randomised Study.

BACKGROUND: Injury prevention exercise programmes (IPEPs) efficaciously reduce injuries. However, it is challenging to achieve sufficient adherence across a season. The main aim was to describe adherence to IPEPs in three groups of coaches and players partaking in a cluster randomised trial. Secondary aims were to describe perceptions of IPEPs, use of programme material, and overall preventive strategies. METHODS: This is a sub-study analysing data from a three-armed randomised trial with teams randomised to use either a comprehensive IPEP (extended Knee Control) or an adductor strength programme, and non-randomised teams that already used a self-chosen IPEP regularly at study start (comparison group). Teams were instructed to use their respective intervention across the 2020 football season. Male and female, adolescent (≥ 14 years of age), and adult amateur players took part. Coaches and players responded to weekly and end-of-season questionnaires. Data were presented descriptively. RESULTS: Weekly player data were reported by 502 players (weekly response rate 65%), 289 (58%) responded to end-of-season questionnaires. Teams in the extended Knee Control and comparison group used their respective IPEP in 483/529 (91%) and 585/641 (91%) of training sessions, and teams in the adductor group in in 199/315 (63%) sessions. Regarding utilisation fidelity, 42-52% of players in each group used 1-10 repetitions per exercise. Seven out of 17 teams in the adductor group had progressed as recommended in terms of number of repetitions. Two teams (10%) in the extended Knee Control group, and 7/24 of comparison teams used the same exercises across the season. Coaches accessed the IPEPs by different means (printed material, films, workshops, etc.), but half did not use the provided digital material. The players appreciated that the IPEPs could reduce injury risk and that they improved their exercise performance, but disliked that they had less time for football and that the exercises were boring. Forty-nine players had experienced pain during IPEP performance. CONCLUSIONS: Adherence with the IPEPs was generally high. To meet different coach needs, programme material should be available via different digital and printed resources. The number of players reporting pain during IPEP performance is a noteworthy finding. TRIAL REGISTRATION: Clinical Trials gov identifier: NCT04272047. Registered February 17, 2020. https://clinicaltrials.gov/ct2/show/NCT04272047 .

The effect of mindfulness and motivational interviewing along with neuromuscular exercises on pain, function, and balance of women affected by knee osteoarthritis: a rater-blinded randomized controlled clinical trial.

PURPOSE: This study aimed to evaluate the effect of motivational interviewing (MI) and mindfulness (MF) added to neuromuscular (NM) exercises on improving pain, function, balance, and quality of life in patients with knee osteoarthritis (KOA). METHODS: This randomized clinical trial was conducted on sixty patients who were randomly assigned to the MI + NM, MF + NM, and NM groups. The groups received four training sessions for six weeks. Physical function with Western Ontario and McMaster Universities Arthritis Index timed up and go, going up and down eight stairs, pain with visual analogue scale, quality of life with SF36, and balance with Biodex were evaluated before and after interventions. RESULTS: Within-group comparisons showed that NM + MI, NM + MF, and NM groups experienced significant improvement in all factors after six-week (p < 0.05). However, between groups, comparisons in the post-test revealed that the MI + NM group had a more significant effect on pain, function, and static balance than the MF + NM group. Nevertheless, the MF + NM group improved the quality of life better than the MI + NM and NM groups (p < 0.05). CONCLUSION: Adding psychological interventions to physical exercises had a better effect on improving the symptoms of patients. Additionally, the MI showed more effectiveness in improving the symptoms of patients.IMPLICATIONS FOR REHABILITATIONAdding motivational interviewing to neuromuscular exercises has shown to reduce pain intensity and improved function, balance and quality of life in adults with knee osteoarthritis.Adding mindfulness intervention to neuromuscular exercises has shown to reduce pain intensity and improved function, balance and quality of life in adults with knee osteoarthritis.Among the psychological interventions used, the motivational interviewing significantly showed more effectiveness in improving the pain, function, balance, and quality of life of patients with osteoarthritis.

Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs among Saudi Athletes.

BACKGROUND: Anterior cruciate ligament (ACL) tear is a common medical condition that entails a stretch or sprain of the ACL, which is present in the knee joint. The incidence of ACL injury in the Kingdom of Saudi Arabia is estimated to be 31.4%. Prevention training programs (PTPs) can be used to reduce ACL injuries sustained during physical activity, as they primarily focus on improving strength, balance, and lower limb biomechanics and reducing landing impact. This study aimed to assess Saudi athletes' awareness of ACL injury PTPs. METHODS: A cross-sectional survey in the form of a self-administered questionnaire in the Arabic language was carried out from 22 December 2022 to 7 March 2023 and included 1169 Saudi athletes. Statistical analyses were performed on the collected data using frequency and percentages. Binary logistic regression was used for the adjusted analysis and determining associations between athletes playing high- and low-risk sports. RESULTS: Overall, 52% of participants were female athletes, and 48% were male athletes. The western region of the country had the highest response rate (28.9%). The most common sport played was football at 36.6%. Most participants (70.97%) reported that their information on ACL injury was taken by their coaches. When assessing whether participants were familiar with the concept of an ACL injury PTP, the majority of the participants answered no, representing 971 (662 high-risk, 309 low-risk), compared to those who answered yes, representing only 198 (167 high-risk, 31 low-risk), with a statistically significant difference (adjusted OR: 2.106; 95% confidence interval: 1.544-2.873; p-value < 0.001). CONCLUSION: In general, the level of awareness of ACL injury PTPs among Saudi athletes was poor.

Higher Adherence to Anterior Cruciate Ligament Injury Prevention Programs Is Associated With Lower Injury Rates: A Meta-Analysis and Meta-Regression.

Background: Athletes who participate in sports that involve cutting and pivoting movements are particularly susceptible to anterior cruciate ligament (ACL) injury. Preventing this injury is the best way to combat its health consequences and costs. There may be a dose-response relationship between adherence and injury reduction. Purpose: We sought to examine whether athletes' adherence to injury prevention programs (IPPs) is associated with reductions in ACL and lower extremity (LE) injuries. Methods: We conducted a systematic review of the PubMed, EMBASE, and Cochrane Library databases, searching for studies published between 2011 and 2021. Studies were included if they reported on the use of an ACL IPP compared with a control group and recorded the rate of injuries to calculate a rate ratio, as well as adherence to the program as a percentage of sessions performed. For the meta-analysis, the rate ratios were pooled using the DerSimonian-Laird random-effects model. Results: For the 15 studies included (11 randomized controlled trials and 4 cohort studies), the random-effects model grouped athletes' adherence to an IPP as high (76% or more of the sessions), moderate (51%-75% of the sessions), and low (50% or fewer of the sessions). We found that athletes with the highest level of IPP adherence had a significantly lower incidence of ACL injury. The rate ratios for moderate and low adherence did not demonstrate a reduced incidence of ACL injury. Injury prevention program participation was also associated with a decrease in LE injury rates. Conclusion: This systematic review and meta-analysis found that athletes with high adherence to IPPs had reduced rates of ACL and LE injuries. Our findings suggest that educating coaches and athletes on the dose-dependent benefits of IPPs may promote the routine incorporation of these programs into warm-up sessions to decrease the risk of ACL and LE injuries.

Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study.

BACKGROUND: Youth participation in team ball sports is associated with a risk of both acute and gradual onset injuries but today there are several efficacious injury prevention exercise programmes (IPEPs). However, there is limited research about how to implement those programmes and the perceived barriers and facilitators among end-users. OBJECTIVE: To investigate perceptions of the IPEP Knee Control and facilitators and barriers to programme use among coaches and youth floorball players, and explore factors associated with planned maintenance of Knee Control. METHODS: This cross-sectional study is a sub-analysis of data from the intervention group of a cluster randomised controlled trial. Perceptions about Knee Control and facilitators and barriers to programme use were evaluated with surveys pre-intervention and post-season. 246 youth floorball players aged 12-17 years, and 35 coaches that reported no use of IPEPs during the preceding year were included. Descriptive statistics and univariate and multivariate ordinal logistic regression models were undertaken with the dependent variables: coaches' planned maintenance and players' opinions of maintenance of Knee Control. Independent variables were perceptions, facilitators and barriers regarding use of Knee Control and other potential influencing factors. RESULTS: 88% of the players believed that Knee Control can reduce injury risk. Common facilitators to Knee Control use among coaches were support, education and high player motivation, and common barriers were that injury prevention training was time-consuming, lack of space to execute the exercises and lack of player motivation. Players who planned to maintain use of Knee Control had higher outcome expectancies and belief in one's ability to use Knee Control (action self-efficacy). Coaches who planned to maintain Knee Control had higher action self-efficacy and to a lesser extent considered that Knee Control takes too much time. CONCLUSIONS: Support, education, and high player motivation are key facilitators, while lack of time and space for injury prevention training and boring exercises are key barriers for coaches and players to use Knee Control. High action self-efficacy among coaches and players seems to be a prerequisite for maintained use of IPEPs.

The effects of different rehabilitation training modalities on isokinetic muscle function and male athletes' psychological status after anterior cruciate ligament reconstructions.

BACKGROUND: Previously, researchers reported performance enhancements following long-term plyometric training in athletes with anterior cruciate ligament reconstruction (LCA). However, the effects of combined eccentric and plyometric training on measures of isokinetic strength and psychological statues in male athletes have not been examined yet. Knowledge on the effects of combined eccentric and plyometric training help to better plan and program rehabilitations sessions and thus return-to-sports. OBJECTIVE: This study sought to compare the effects of three different rehabilitation training programs, eccentric training (ECC), plyometric training (PLYO), or combined eccentric and plyometric training (COMB), on psychological measures (kinesiophobia [TSK-CF], functional knee assessment, knee injury and osteoarthritis outcome score [KOOS], international knee documentation committee 2000 questionnaire [IKDC], and knee flexor and extensor isokinetic muscle performance (peak torque [PT], total work, ratio [R-HQ], and ratio of total work [R-TW]) at different angular velocities post ACL surgery in male elite athletes. METHODS: Forty elite male athletes from different sports (e.g., athletics, team sports) with ACL reconstruction participated in this study. The study started after a 14-weeks post-surgery rehabilitation program, which was identical for all subjects. After this initial rehabilitation period, athletes were randomly assigned to three experimental groups, ECC (n = 10), PLYO (n = 10), and COMB (n = 10), and a control group (CON: n = 10). Testing was conducted pre- and post-the 6-weeks intervention period and included the TSK-CF, KOOS, and IKDC. Peak torque of the knee extensors/flexors was tested at 90, 180, 240 °/s, after the 6-weeks training program only. RESULTS: Participants' adherence rate was 100% across all groups and none reported any training or test-related injury. No significant between-group baseline differences (pre-6-weeks intervention) were observed for any of the reported psychological and muscle strength parameters. Significant group-by-time interactions were found for TSK-CF (p = 0.001, d = 2.85), KOOS (p = 0.001, d = 1.31), and IKDC (p = 0.001, d = 1.07). The post-hoc analyses indicated that COMB showed larger pre-post improvements for all psychological variables (p < 0.001, d = 2.95 to 13.15), compared with PLYO, ECC, and CON. Contrast analyses demonstrated that COMB yielded significantly greater improvements compared with CON, PLYO, ECC for all isokinetic parameters at all three angular velocities (all p < 0.001, d = 0.99 to 4.61). CONCLUSION: The results showed that COMB induced greater gains for measures of psychological status and isokinetic muscle strength compared with single-mode PLYO and ECC in elite male athletes during a post-surgery ACL rehabilitation period. Accordingly, it is recommended to implement COMB as an effective rehabilitation means to improve knee function in male elite athletes. TRIAL REGISTRATION: This study does not report results related to health care interventions using human participants and therefore it was not prospectively registered.

Corrigendum: Effect of neuromuscular training program on quality of life after COVID-19 lockdown among young healthy participants: A randomized controlled trial.

[This corrects the article DOI: 10.3389/fpsyg.2022.844678.].