The Influence of Neuromuscular Training on Whole-body Movement Strategies and Knee Mechanics During Change-of-direction Tasks in Sports Science Students

NCT05014009 | Completed

• 1 other identifier: 2107COD
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 1

Brief Summary

Background Knee injuries are common during sports that require fast change-of-direction (COD) movements such as sidestepping and pivoting during soccer, basketball, handball, and related sports. COD movements expose the knee joint to large external forces, particularly if players show a poor COD technique such as lateral trunk lean towards the plant foot or a strong knee valgus of the cutting leg. Larger external forces and moments that act on the knee joint are expected to result in larger strain of the anterior cruciate ligament (ACL) and thus a higher risk of ACL rupture. Consequently, during sports like soccer and basketball, many non-contact ACL injuries occur during COD tasks. While neuromuscular training (NMT) programs have been developed to effectively reduce the risk of sports injury including ACL tears, ACL injury rates have not declined in the last years. One of the reasons for this paradox may be that many NMT programs such as the FIFA11+ program, which were developed to protect from injury do not actually improve COD movement strategies. It may be assumed that FIFA11+ does reduce the overall risk of sports injury through general improvements in strength and balance as well as safer jump landing technique but not through safer COD technique. Further, if training interventions were successful in reducing 'high-risk' movement patterns and in developing knee-stabilizing muscle synergies during COD movements, it remains unclear whether the improved movement strategy, e.g. the reduction in external knee valgus moments, actually corresponds to reduced ACL strain. In consequence, there is the need for a comprehensive investigation to determine whether a NMT program focused on improving COD technique will improve COD movement and muscle activation strategies and whether these improvements are correlated with estimated ACL strain. A second reason for the paradox may be that current experimental protocols to investigate COD movement strategies in the laboratory are not a good indicator for actual player behavior on the field thus masking potential benefits of NMT on lateral movements. Therefore, the sports injury prevention community should aim to move the assessment of COD movement strategy onto the playing field and into a more realistic playing environment while characterizing the kinematics and kinetics of sidestepping based on wearable sensors. In consequence, novel analytical frameworks based on wearables need to be developed, which can capture full-body kinematics and the underlying forces during COD movements on the playing field. In the long run, such systems could facilitate real-time feedback with respect to COD technique on the playing field and thus enhance motor learning of the players as well as characterize real-world player agility. Research objectives \& hypotheses Objective 1: To determine the effect of an 8-week NMT and COD technique modification intervention (multidirection training, MD) on 1) COD movement strategies as characterized by the lateral trunk angle and knee valgus moment and 2) estimated ACL strain during 45- and 135-degree COD movements in comparison to an 8-week NMT and linear sprint training intervention (linear sprint training, LS) in sports science students. Hypothesis 1: There will be a larger reduction in lateral trunk angle and knee valgus moment and an associated reduction in ACL strain in the MD group compared to the LS group following the 8-week intervention, which will be retained four weeks later. Objective 2: To determine the effect of an 8-week NMT and COD technique modification intervention on leg muscle synergies as characterized by the number of muscles and the structure of the synergy vector for each identified muscle synergy in comparison to an 8-week NMT and linear sprint training intervention in sports science students. Hypothesis 2: One or multiple muscle synergy vectors will show an increased contribution of hip abductor muscle activity in the MD group following training and there will be a lower number of activated muscles per identified synergy, i.e. a more selective muscle activation in comparison to the LS group. These improvements will be retained four weeks later. Objective 3: To determine the validity of an analysis framework to estimate COD movement strategy (lateral trunk angle, foot progression angle, knee valgus moment) and ACL strain based solely on inertial motion capture data in comparison to the gold-standard of 3D optimal motion capture.

Conditions

Anterior Cruciate Ligament Injuries

Keywords

electromyography; inertial measurement unit; neuromuscular training; muscle activity; muscle synergy; sidestepping movement; side-cutting movement

Outcome Measures

Primary Outcomes (3)

• Peak knee abduction moment in Nm assessed through 3D optical motion capture

  Peak external knee moment in the frontal plane during the COD stance phase

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

• Peak lateral trunk lean in degrees assessed through 3D optical motion capture

  Peak angle of the trunk with respect to a vertical line in the frontal plane during the COD stance phase. Of interest is the angle opposite to the direction of intended travel.

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

• Peak ACL strain in % estimated through finite element simulation

  Peak ACL strain estimated from the EMG-informed musculoskeletal and FE simulation.

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

Secondary Outcomes (4)

• Muscle synergy size (number of muscles per synergy) assessed through non-negative matrix factorization of the surface EMG data

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

• Hip muscle contribution in % assessed through non-negative matrix factorization of the surface EMG data

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

• Linear sprint performance in seconds assessed through a timing gate system

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

• COD performance in seconds assessed through a timing gate system

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

Other Outcomes (1)

• Peak knee abduction moment in Nm assessed through inertial motion capture

  Assessed in October (baseline), December (follow-up), February (retention) over a total duration of 5 months.

Study Arms (2)

FIFA11+ and multidirectional training (MD)

EXPERIMENTAL

Participants in the MD group will take part in an 8-week NMT intervention known to reduce the risk of sports injury and expected to improve COD movement strategies.

Behavioral: FIFA11+ and multidirectional training (MD)

FIFA11+ and linear sprint training (LS)

ACTIVE COMPARATOR

Participants in the LS group will take part in an 8-week NMT intervention, which is known to reduce the risk of sports injury but is unlikely to improve COD movement strategies and is expected to improve linear sprint performance.

Behavioral: FIFA11+ and linear sprint training (MD)

Interventions

FIFA11+ and multidirectional training (MD) BEHAVIORAL

This intervention initially contains a shortened version of the FIFA11+ injury prevention program including running (straight, hip out, hip in, jump-run-ups), strengthening (planks, squats, nordic hamstring curls), and single-leg balance exercises. The initial part is followed by COD technique modification training, which contains exercises aimed at improving COD technique (safer and more effective body re-direction, use of penultimate step, avoiding knee valgus) and COD braking and re-acceleration impulse. The duration of each training session is 25-30 minutes. The training is carried out twice per week under supervision with supervisors providing feedback to participants regarding their COD technique. Participants are encouraged to complete a third training session in their own time.

FIFA11+ and multidirectional training (MD)

FIFA11+ and linear sprint training (MD) BEHAVIORAL

This intervention initially contains a shortened version of the FIFA11+ injury prevention program including running (straight, hip out, hip in, jump-run-ups), strengthening (planks, squats, nordic hamstring curls), and single-leg balance exercises. The initial part is followed by a linear sprint training, which contains exercises aimed at improving sprint technique (e.g. sagittal arm and leg movement, trunk lean), use of the stretch-shortening cycle, leg stiffness and propulsive impulse . The duration of each training session is 25-30 minutes. The training is carried out twice per week under supervision with supervisors providing feedback to participants regarding their sprinting technique. Participants are encouraged to complete a third training session in their own time.

FIFA11+ and linear sprint training (LS)

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Enrolled as a student at the Department of Sport Science in Innsbruck

You may not qualify if:

• Clinical diagnosis of a lower extremity muscle or joint injury within the last six months that led to a disruption of sport participant by at least two weeks
• Clinical diagnosis of a balance disorder

Sponsors & Collaborators

• Universitaet Innsbruck: lead
• University of Erlangen-Nürnberg: collaborator

Study Sites (1)

Department of Sport Science, University of Innsbruck

Innsbruck, Tyrol, 6020, Austria

Location

Related Publications (19)

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Related Links

• FIFA11+ Manual \[in GERMAN\]

MeSH Terms

Conditions

Anterior Cruciate Ligament Injuries

Condition Hierarchy (Ancestors)

Knee Injuries; Leg Injuries; Wounds and Injuries

Study Officials

• Maurice Mohr, PhD

  University of Innsbruck, Austria

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Masking Details: While the study team will not point participants to the specific differences between the two training programs (MD vs. LS), an exchange between participants about the training elements in each group cannot be avoided given that the participants are all students at the same faculty. Given that the study team will supervise the training sessions, collect the data, and assess the outcomes, blinding of investigators will not be possible but the analysis will be designed to minimize sources of investigator bias.
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Participants will be assigned to multidirectional training group (MD) or a linear sprint training group (LS) in a quasi-randomized way. Both groups will complete an 8-week training program and will complete baseline, follow-up, and retention testing (4 weeks post follow-up).

Study Record Dates

• First Submitted: August 6, 2021
• First Posted: August 20, 2021
• Study Start: October 4, 2021
• Primary Completion: December 20, 2021
• Study Completion: December 20, 2021
• Last Updated: June 18, 2023

Record last verified: 2023-06

Data Sharing

• IPD Sharing: Will share
• Time Frame: Data will be shared via an open access data repository along with the publications that present the study results.
• Access Criteria: Open access

Locations

AU (1)