External vs Combined Focus Effects on Landing in Female Athletes

NCT07367308 | Recruiting DMC

• 1 other identifier: PSCSULB-2026
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

Female athletes are at higher risk of knee injuries, particularly non-contact anterior cruciate ligament (ACL) injuries, often caused by dynamic knee valgus during landing. Proper landing techniques and neuromuscular training are crucial for injury prevention. Attentional focus strategies, such as external focus (EF) and internal focus (IF), can influence movement patterns, muscle activation, and skill transfer during landing tasks. EF generally promotes safer and more controlled landings, while IF offers certain kinematic benefits. However, real-world sports often require a combination of attentional strategies, and the effects of combined EF + IF instructions on landing mechanics and muscle activation have not been fully studied. This study will investigate the effects of EF and combined attentional focus instructions on lower extremity and trunk movement, muscle activation, and skill transfer in young female athletes with asymptomatic dynamic knee valgus. The investigators aim to determine whether combined attentional focus training provides greater improvements in landing mechanics, muscle activation, and skill transfer than EF training alone.

Conditions

Valgus Deformity, Not Elsewhere Classified, Knee; Injury, Knee

Keywords

cue; Motor Learning; skill transfer

Outcome Measures

Primary Outcomes (1)

• 3D motion analyses

  3D motion analysis will be used to evaluate lower extremity and trunk kinematics and kinetics during a single-leg drop vertical jump task. Retroreflective markers will be placed on anatomical landmarks of the foot, shank, thigh, pelvis, trunk, upper extremity, and head using a standardized whole-body marker set. Marker trajectories will be captured using a multi-camera motion capture system synchronized with force platforms to record ground reaction forces. Following a static calibration trial, participants will perform three trials of a single-leg drop vertical jump from a 20-cm platform using the limb demonstrating dynamic knee valgus. Kinematic variables will include peak joint angles of the hip, knee, and ankle in sagittal, frontal, and transverse planes, as well as trunk motion. Kinetic variables will include hip and knee joint moments and peak vertical ground reaction force. Outcome measures will be averaged across trials for pre-, post-, and retention assessments.

  baseline, immediately after the intervention, one week after the baseline

Secondary Outcomes (2)

• Gluteal muscle activation (EMG)

  baseline, immediately after the intervention, one week after the baseline

• Forward Step-Down Test

  baseline, immediately after the intervention, one week after the baseline

Other Outcomes (1)

• manipulation check

  baseline, immediately after the intervention, one week after the baseline

Study Arms (3)

Combined Focus of Attention Group (CFAG)

EXPERIMENTAL

After participants meet the inclusion criteria are randomized and assigned to the combined attentional focus group. They will perform training blocks consisting of 5 repetitions and 2 sets of single-leg drop jump landings before and after the evaluations. During the jumps, instructions will focus on combined attentional focus and will be repeated for each jump. A 1-minute rest period will be provided between training blocks.

Other: Single-Leg Drop Vertical Jump; Other: Combined Focus of Attention Instruction

External Focus o Attention Group (EFAG)

EXPERIMENTAL

After participants meet the inclusion criteria are randomized and assigned to the external attentional focus group. They will perform training blocks consisting of 5 repetitions and 2 sets of single-leg drop jump landings before and after the evaluations. During the jumps, instructions will focus on external attentional focus and will be repeated for each jump. A 1-minute rest period will be provided between training blocks.

Other: Single-Leg Drop Vertical Jump; Other: External Focus of Attention Instruction

Control Group

ACTIVE COMPARATOR

After participants meet the inclusion criteria are randomized and assigned to the control group. They will perform training blocks consisting of 5 repetitions and 2 sets of single-leg drop jump landings before and after the intervention. During the jumps, no instructions will be given. A 1-minute rest period will be provided between training blocks.

Other: Single-Leg Drop Vertical Jump; Other: No instruction

Interventions

Single-Leg Drop Vertical Jump OTHER

Single-Leg Drop Vertical Jump test will be performed with the dynamic knee valgus leg.

Combined Focus of Attention Group (CFAG); Control Group; External Focus o Attention Group (EFAG)

Combined Focus of Attention Instruction OTHER

\- Combined focus group: "When you land, keep your knee over your toes while directing your knee toward the cone."

Combined Focus of Attention Group (CFAG)

External Focus of Attention Instruction OTHER

\- External focus group: "When you land, direct your movement toward the cone placed on your side."

External Focus o Attention Group (EFAG)

No instruction OTHER

Control group: No specific instructions.

Control Group

Eligibility Criteria

• Age: 18 Years - 30 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Females aged between 18-30 years old
• BMI between 18.5-25 kg/m²
• Dynamic knee valgus \>10° during single-leg squat test (Richardson et al., 2020)
• Being recreationally active (engage in moderate physical activities at least 3 times a week, with each session lasting at least 30 minutes in the past 4 weeks) (Heinert, 2008)

You may not qualify if:

• Trunk, lower back, or lower extremity pain greater than 3/10 on numeric pain rating scale (0-10) in the past 6 months
• History of surgeries in the lower extremity or lower back that may affect the landing mechanism
• Currently participating in any lower extremity biomechanics modification program
• Any medical or physical condition that would prevent safe jumping from a 20-cm box

Sponsors & Collaborators

• Bahçeşehir University: lead
• California State University, Long Beach: collaborator

Study Sites (1)

California State University, Long Beach

Long Beach, California, 90840, United States

RECRUITING

MeSH Terms

Conditions

Knee Injuries

Condition Hierarchy (Ancestors)

Leg Injuries; Wounds and Injuries

Study Officials

• Pelin Pişirici, PT, PhD

  Bahçeşehir University

  PRINCIPAL INVESTIGATOR

• Sharon Teng, PT, PhD

  California State University, Department of Physical Therapy

  STUDY CHAIR

Central Study Contacts

Pelin Pişirici, PT, PhD

CONTACT

05055016076; pelinpisirici@gmail.com

Berkay Eren Pehlinaoglu, PT, PhD

CONTACT

+902123819154; berkayeren.pehlivanoglu@bau.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor, PT, PhD

Model Details: Female athletes meeting the inclusion criteria will be randomized into the combined attentional focus group, the external attentional focus group, and the control group.

Study Record Dates

• First Submitted: January 18, 2026
• First Posted: January 26, 2026
• Study Start: February 17, 2026
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): May 31, 2026
• Last Updated: April 15, 2026

Record last verified: 2026-04

Locations

US (1)