Anterior Cruciate Trauma

Introduction: Anterior cruciate ligament (ACL) injuries of the knee are common in sports that require jumping and rotational movements such as, gymnastics, basketball, soccer, volleyball, football, and handball (Gilchrist, 2008). Treatment for an ACL injury is expensive, requires extensive amounts of rehabilitation, and increases the risk of early osteoarthritis in individuals (Meeuwisse & Emery, 2010; Waldén et al., 2012). The financial costs associated with ACL injuries are an estimated $3 billion a year (Sugimoto et al., 2012). In addition, recovering from an ACL injury comes at a physical, emotional, and mental cost and therefore, early prevention is important in reducing the rates of ACL injuries (Gilchrist, 2008). Health practitioners,
The incidence rate of ACL injuries is highest amongst female gymnasts but no current research has been conducted on this population of athletes in order to determine the effectiveness of NMT (Noyes & Westin, 2012; Sugimoto et al., 2012). Considering that current research amongst other populations of females shows RRR in ACL injury with NMT, a study to determine whether NMT could reduce ACL injury rates amongst female gymnasts would be beneficial. I. Literature Review- Definition of Neuromuscular Training: NMT focuses on incorporating components of the neuromuscular system such as proprioceptive and sensorimotor functioning, and neuromuscular coordination (Faude et al., 2015). Strength and conditioning activities are chosen in order to promote correct movement technique and competence by increasing postural control and body stability (Faude et al., 2015; Kiefer et al., 2015). A study conducted by Meeuwisse and Emery (2010) looked at 60 indoor soccer teams between the ages of 13-18 in order to assess the effects of implementing a NMT on prevention of lower limb (below the waist) injury. The training regime was implemented for the duration of one
Meeuwisse and Emery (2010) operationally defined injury as that which required medical attention and/or removal from a session and/or time loss. All studies mentioned above used health care practitioners (physiotherapists or athlete trainers) to assess injuries. Waldén et al. (2012) operationally defined injury as one that occurred during training or match play, had sudden onset, and led to play loss time. The primary outcomes were ACL injury, and secondary measures were severe knee injury that resulted in 4 weeks or more of absence. Likewise, a cluster randomized control trial done by Steffen, Myklebust, Olsen, Holme, and Bahr (2007) implemented a 15 minute warm-up that included 11 stability and strengthening exercises on female soccer players (control =1001, intervention =1091) and measured injury rates based on those that had sudden onset, but also included those that had a gradual onset without a known cause for the trauma. An experimental, objective study conducted by Myer, Ford, Brent, and Hewett (2007) implemented NMT 3x/week over a 7-week period on a group of 18 female soccer and basketball players, grouped on “high-risk” (n=12, controls =4) and “low-risk” (n=6, controls=7) of ACL injury. Risk of injury was determined by the biochemical measures of