Does an In-Season Only Neuromuscular Training Protocol Reduce Deficits Quantified by the Tuck Jump Assessment? Madelyn F. Klugman,* Jensen L. Brent,cscs.* Gregory D. Myer, to, cxcs**°** Kevin R. Ford, ero. Timothy €. Hewett, r0,2° ‘Adolescent female soccer players are 4 to 6 times more likely to sustain an anterior coruciate ligament (ACL) injury than are male soccer players." This sex disparity may be caused by decreased neuromuscular control during the execution of sports ‘movements, particulary in landing and pivoting movements. This results in lower limbs mechanies, which may increase ACL injury risk:**° Several injury prevention pro- ‘grams have been developed in order to reduce the risk of ACL as well as other lower extremity injuries.°-"® “The authors would like to acknowledge funding support from National institutes of Health (rants R01-AR049735, ROT-ARO55563, and RO'-ARO56259), ‘The Cincinnati Children’s Hospital Medical Center and Byram Hil High School Institutional Review Boards approved this stud. "Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA * Byram Mills High School, Armonk, NY 10504, USA «Department of Pediatrics and Orthopaedic Surgery, College of Medlin, University of Cincinnati, Cincinnati, OH 45221, USA "Departments of Physiology and Cell Blology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering, The Ohlo State University Sport Health & Performance institute, The Ohio State University, Columbus, OH 43221, USA * Departments of Athetic Training, Sports Orthopaedics, and Pediatric Science, Rocky Mountain University of Health Professions, Provo, UT 84606, USA * Corresponding author: Division of Sports Medicine Cincinnati, Children’s Hospital Medical Center, 3333 Burnet Avenue, ininnati, OH 45228. 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Preventing injures in female youth football a Cluster-randomized controled tral. Scand J Med Sct Sports 2008;18(6);605--14. 9, Petersen W, Braun C, Bock W, etal. A controlled prospective case control study of a provertion taining program in female team handball players: the German experience, ‘Atch Orthop Trauma Surg 2006;125(9):614~21. 10. Pratfor RP, Shea KG, Rober's D, et al. Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate garment injury. 41 Bone Joint Surg Am 2006;88(8):1769-74, 1, Olsen OE, Myklebust G, Engebretsen L, et a. Exercises to prevent lower limb injuries In youth sports: Guster randomised controlled trial. BMJ 2005;390(7489}:449, 12. Mandelbaum BR, Sivers HJ, Watanabe DS, etal. Effectiveness of a neuromuscular _and proprioceptive training program in preventing anterior cruciate ligament injuries in fernale athotes: 2-year follow-up. Am J Sports Med 2005;33(7) 1003-10. 49, Mykebust G, Engebrotson L, Braokken IH, et al. Prevention of anterior cruciate ligament injuries in fernalo team handball players: a prospective intervention study ‘ver three seasons. Can J Sport Med 2006;13(2):7 18. 14, Soderan k, Werner, PitlaT, otal. Balance board traning: prevention of traumatic Injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc 2000;8(6):356-8.18. 16. 17, 18, 19, 20. a 22. 23. 24, 26. 27. 28, 29. Neuromuscular Training Effects on the Tuck Jump Assessment Heidt RS Jr, Sweeterman LM, Carlonas AL, et al. Avoidance of soccer injuries wth preseason conditioning. Am J Sports Med 2000;28(6):659-62, Hewett TE, Lindenfeld TN, Riccobene JV, et al. The effect of neuromuscular training (onthe incidence of knee injury in female athletes. A prospective study. Am J Sports, Med 1999;27(6:699-708, Hewett TE, Myer GD, Ford KR, Reducing knee and anterior cruciate igament injuries ‘among female athletes: a systematic review of neuromuscular taining interventions. J Knee Surg 2005;18(1):82-8. Hewett TE, Ford KR, Myer GD. Anterior cruciate fgament injuries in female athletes Part 2, armeta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 2006;34(3)-490-8, Polard CD, Sigward SM, Ota S, et al. The infiuence of in-season injury prevention {raining on lower-extromity kinematics during landing in female soocer players. Cin J Sport Mad 2006;1 6(9):223-7. Zebis MK, Boncke J, Andorson LL, ot al. The effects of neuromuscular trating on knee joint motor control during sidecuting in female elite soccer anc handball players. iin J Sport Med 2008;18(4:320-37. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular ‘control and valgus loading of 8 knee precict anterior cruciate igament injury isk in ‘female athletes: a prospective study. Am J Sports Med 2006;39(4):492-501 Padua DA, Marshall SW, Bautler Al, etal. Prospective cohort study of biomechanical fisk factors of ACL injury: the JUMP-ACL Study. Presented at the American Ortho- ppaccic Sociaty of Sports Medicine Annual Meeting. Keystone, CO, 20089. p. 398-6. Hewett TE, Ford KR, Myer GD, etal. Gender differences in hip adduction motion and torque during a single lg aatlty maneuver. J Orthop Res 2006;24(3):416~21 Kemozek TW, Torry MR, et al. Gonder diferences in frontal and sagittal plane biomechanics during drop landings. Med Sci Sports Exero 2005;37(6):1003-12 [dscussion: 1013) Hewett TE, Myer GD, Ford KR, Decrease in neuromuscular control about the knee with maturation in female athietes. J Bone Joint Surg Am 2004;86-A(8):1001—€, McLean SG, Huang X, SuA, etal Sagittal plane biomechanios cannot injure the ACL. during sidestep cutting. Cin Biomech (Bristol, Avon) 2004;18:828-8, Zaller BL, MoCrory JL, Kibler WB, et al. Differences in kinematics and electromyo-, ‘graphic activity between men and women during the singlo-legged squat. Am J Sport Med 2003;31(3):449-56, ‘Chappel JD, Yu B, Kirkendall DT, et al. A comparison of knee kinetics between male ‘and female recreational athletes in stop-lump tasks. Am J Sports Med 2002;30(2 261-7. Malinzak RA, Colby SM, Kirkendall DT, et al. A comparison of knee joint motion pattems between men and women in eélected athletic tasks. Cin Biomech (Bristol, ‘Avon) 2001; 16(5):498 ~45, Krosshaug 7, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med 2007; 35(3):359--67. ‘Olsen OF, Mykdebust G, Engebretsen Let al Injury mechanisms for anterior cruciate ligament injures in team handbal: a systematic video analysis. Am J Sports Med 2004;32(4)1002-12. 2. Boden BP, Dean GS, Feagin JA, etal. Mechanisms of anterior cruciate igamentiniury, Orthopedics 2000;296):573-8. ‘Myer GD, Ford KR, Hewett TE. New method to identity athletes at high isk of ACL injury using cinic-based measurements and freeware computer analysis. Br J Sports Med 2011;45(4):238~44. 9Klugman et al 84, Myer GD, Ford KR, Khoury J ta. Three-dimensional motion analysis validation of Ciric-based nomogram designed to identiy high ACL injury risk in female athstes. Physician Sports Med 201 1;90(1:19-28, 35. Myer GD, Ford KR, Khoury J, t a. Development and validation of a clinc-based prediction tool to identity female athletes at high risk for anterior cruciate Igament injury. Am J Sports Med 2010;38(10) 2025-3. 86. Myer GD, Brent JL, Ford KR, et al. Real-time assessment and feedback techniques for use in neuromuscular training aimed to prevent ACL inury. Strength Cond J 2011;89(9;:21-95. ‘ 87. Myer GD, Ford KR, Hewett TE. Tuck ump assessment for redicng anterior cruciate ligament injury risk. Ath Ther Today 2008; 1345): 30~ 44 38, Myer GD, Bront JL, Ford KR, etal. Apiot stu to detorrine the effect of trunk andhip focused neuromuscular traning on hip and knoe isoknetc strength. Br.J Sports Med 2008; 42(7):614-9, 9, Myer GD, ChuDA, Brent JL eta Trunk andhip control neuromuscular traning forthe prevention of knee joint inary. Gin Sports Med 2008;27(8):425~48, 40. Hewett TE, Stroupe AL, Nance TA, et al. Pyometic traning in female athictos. Decreased impact forces and increased hamstring torques. Am J Sports Med 1906;24(6;765-73 41, Sugimoto D, Myer GD, Bush HM, eta. The effects of compkance with neuromuscular tralning on anterior cruciate tgament injury risk reduction in young female athietes: a meta-analysis, Presented at the National Athstic Training Association Annual Mact- ing, New Orleans, LA, 2011 42, Brent JL, Kugman MA, Myer GD, et al. The effects of preseason and in-season neuromuscular traning on the tuck jump assessment: atest used to identi risk of ‘ACL injury in female athletes. National Strength anc Conditioning Association Annual Meating. 2010. 49. Vescou! JD, Venkieest JL. Effects of an anterior crucate ligament injury prevention program on performance in adolescent female soccer players. Scand J Med Sci ‘Sports 2010;20(3):394 402. 4, Bien DP, Rationale and implementation of anterior cruciate igament injury prevention \warr-up programs in female athete. J Strengt* Cond Res 201 ;25(1)27 1-85. 4. Myor GD, Ford KR, Brent JL al Dilerentil nouromuscular trairng effects on ACL injury risk factors in high-risk" vrsus “low-risk” athletes. BMC Musculoskelet Disord 2007;8(00):1-7. The Libray(GRH) Gloucestershire Royal Hospital Gloucester GL1 3NN (68454) 226