Related Research Publications
Mandelbaum BR. ACL prevention strategies in the female athlete and soccer: implementation of a neuromuscular training program to determine its efficacy on the incidence of ACL injury. The American Orthopaedic Society for Sports Medicine Speciality Day, February 16, 2002, Dallas, Texas.
This study showed a decreased number of ACL injuries in athletes that participating in a proprioceptive and neuromuscular training program. It is their position that targeting the biomechanical differences found in female athletes is the most feasible means of intervention.
Johnson RJ. The ACL Injury in Female Skiers. In Prevention of Noncontact ACL Injuries. L. Y. Griffin. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2001: 107-111.
This article describes how an injury prevention program containing feedback and education can reduce injuries in a group of skiers.
Hewett TE, Myer GD & Ford KR (2001) Prevention of Anterior Cruciate Ligament Injuries. Current Women's Health Reports, 1: 218-224.
Review Article
Numerous studies have found that female athletes who participate in jumping and pivoting sports are four to six times more likely to sustain a knee ligament injury, such as anterior cruciate ligament (ACL) injury, than male athletes participating in the same sports. A widening gender gap in the number of serious knee ligament injuries exists based on geometric growth in female athletic participation, coupled with the four to six-fold higher injury rate. More than fifty thousand serious knee injuries are projected to occur in female intercollegiate and high school athletics each year. The majority of ACL injuries occur by non-contact mechanisms, often during landing from a jump or making a lateral pivot while running. Knee instability, due to ligament dominance (decreased dynamic medial-lateral neuromuscular control of the joint), quadriceps dominance (increased quadriceps recruitment and decreased hamstring strength) and leg dominance (side-to-side differences in strength, flexibility and coordination) are possible contributing factors to the increased incidence of knee injury in female athletes. In this review, dynamic neuromuscular analysis (DNA) training programs are defined and a rationale is presented for correcting the neuromuscular imbalances that may result in dynamic knee instability during sports play. Dynamic neuromuscular training has been shown to increase knee stability and decease knee injury rates in female athletes. Preliminary research on athlete screening and injury prediction based on the three aforementioned imbalances also is presented with recommendations for developing screening protocols for the identification of high-risk athletes.
Griffin LY: The Henning Program. In Prevention of Noncontact ACL Injuries. L. Y. Griffin. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2001: 93-96.
This article describes an ACL injury prevention program that contains sport-specific movements and should be taught to young children during development.
Hewett TE. (2000) Neuromuscular and hormonal factors associated with knee injuries in female athletes: strategies for intervention. Sports Medicine, 29 (5) 313-327.
Review Article
Female athletes who participate in jumping and cutting sports are 4 to 6 times more likely to sustain a serious knee injury than male athletes participating in the same sports. More than 30,000 serious knee injuries are projected to occur in female intercollegiate and high school athletics in the US each year. The majority of these injuries occur by non-contact mechanisms, most often during landing from a jump or making a lateral pivot while running. Knee instability, due possibly to decreased neuromuscular strength and coordination or increased ligamentous laxity, may underlie the increased incidence of knee injury in females. Dynamic neuromuscular training can significantly increase dynamic knee stability in female athletes. Female sex hormones (i.e. estrogen, progesterone and relaxin) fluctuate radically during the menstrual cycle and are reported to increase ligamentous laxity and decrease neuromuscular performance and, thus, are a possible cause of decreases in both passive and active knee stability in female athletes.
Hewett TE et al. (1999) The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. American Journal of Sports Medicine, 27 (6) 699-706.
This prospectively evaluated the effect of dynamic neuromuscular training on the incidence of knee injury in female athletes. The knee injury incidence per 1000 athlete-exposures was 0.43 in untrained female athletes, 0.12 in trained female athletes, and 0.09 in male athletes. Untrained female athletes had a 3.6 times higher incidence of knee injury than trained female athletes and 4.8 times higher than male athletes. The incidence of knee injury in trained female athletes was not significantly different from that in untrained male athletes. The difference in the incidence of noncontact injuries between the female groups was also significant. This study demonstrated that dynamic neuromuscular training decreased incidence of knee injury in female athletes.
Hewett TE et al. (1996) Plyometric training in female athletes: decreased impact forces and increased hamstring torques. American Journal of Sports Medicine, 24 (6) 765-773.
The first purpose of this study was to determine the biomechanical differences between male and female athletes. The second purpose of this study was to test the effect of a dynamic neuromuscular training program on these biomechanical differences. The study demonstrated that significant differences existed between male and female athletes and these differences could be significantly decreased with dynamic neuromuscular training. This dynamic neuromuscular training was shown to have a significant effect on knee stabilization and the study suggested the possibility for using similar training programs for the prevention of serious knee injury among female athletes.
Caraffa A, et al. Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surgery, Sports Traumatology, Arthroscopy 1996, 4: 19-21.
This study shows a decrease in knee injuries in athletes participating in preseason balance and proprioceptive training.
Prevention of ACL Injuries in Female Team Handball Players - A Prospective Intervention Study. G.Myklebust, L.Engebretsen, I.H.Br\aekken, A.Skj\olberg, O.E.Olsen, R.Bahr FACSM. Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, Oslo, Norway.
This study examined the effects of a program with three different balance exercises focusing on neuromuscular control and planting/landing skills on ACL injury in handball players. This study shows that ACL injuries among female team handball players can be prevented with specific balance training. It also seems that a greater reduction of ACL injuries is possible through better compliance with the training program.
