Injury prevention neuromuscular training (NMT) programs reduce the risk for anterior cruciate ligament (ACL) injury. However, variation in program characteristics limits the potential to delineate the most effective practices to optimize injury risk reduction. To evaluate the common and effective components included in ACL NMT programs and develop an efficient, user-friendly tool to assess the quality of ACL NMT programs. Systematic review and meta-analysis. Study inclusion required (1) a prospective controlled trial study design, (2) an NMT intervention aimed to reduce incidence of ACL injury, (3) a comparison group, (4) ACL injury incidence, and (5) female participants. The following data were extracted: year of publication, study design, sample size and characteristics, and NMT characteristics including exercise type and number per session, volume, duration, training time, and implementer training. Analysis entailed both univariate subgroup and meta-regression techniques using random-effects models. Eighteen studies were included in the meta-analyses, with a total of 27,231 participants, 347 sustaining an ACL injury. NMT reduced the risk for ACL injury from 1 in 54 to 1 in 111 (odds ratio [OR], 0.51; 95% CI, 0.37-0.69]). The overall mean training volume was 18.17 hours for the entire NMT (24.1 minutes per session, 2.51 times per week). Interventions targeting middle school or high school–aged athletes reduced injury risk (OR, 0.38; 95% CI, 0.24-0.60) to a greater degree than did interventions for college- or professional-aged athletes (OR, 0.65; 95% CI, 0.48-0.89). All interventions included some form of implementer training. Increased landing stabilization and lower body strength exercises during each session improved prophylactic benefits. A meta-regression model and simple checklist based on the aforementioned effective components (slope = −0.15, P = .0008; intercept = 0.04, P = .51) were developed to allow practitioners to evaluate the potential efficacy of their ACL NMT and optimize injury prevention effects. Considering the aggregated evidence, we recommend that ACL NMT programs target younger athletes and use trained implementers who incorporate lower body strength exercises (ie, Nordic hamstrings, lunges, and heel-calf raises) with a specific focus on landing stabilization (jump/hop and hold) throughout their sport seasons. Clinicians, coaches, athletes, parents, and practitioners can use the developed checklist to gain insight into the quality of their current ACL NMT practices and can use the tool to optimize programming for future ACL NMT to reduce ACL injury risk.

Plosive strength and is derived by evaluating jump height divided by ground contact time during the depth jump (DJ). At present, the RSI is typically used to evaluate DJ performance, because it is the only plyometric exercise with an identifiable ground contact time. The purpose of this study was to introduce a modification of the RSI (RSImod) that can be used to evaluate the explosive power of any vertical plyometric exercise. This study will also assess the reliability of the RSImod, evaluate the RSImod of a variety of plyometric exercises, and examine gender differences. Twenty-six men and 23 women served as subjects. Subjects performed 3 repetitions for each of 5 plyometric exercises including the countermovement jump (CMJ), tuck jump, single-leg jump, squat jump, and dumbbell CMJ. Data were analyzed using a 2-way analysis of variance to evaluate differences in RSImod between the plyometric exercise and the interaction between plyometric exercise RSImod and gender. The analysis of RSImod revealed significant main effects for plyometric exercise type (p ≤ 0.001) but not for the interaction between plyometric exercise type and gender (p > 0.05). Results of pairwise comparisons indicate that the RSImod is statistically different between all plyometric exercises studied. Intraclass correlation coefficients indicate that RSImod is highly reliable for all of the exercises studied. The RSImod offers a highly reliable method of assessing the explosiveness developed during a variety of plyometric exercises....

Objective: Neuromuscular injury prevention programs (IPP) can reduce injury rate by about 40% in youth sport. Multimodal IPP include, for instance, balance, strength, power, and agility exercises. Our systematic review and meta-analysis aimed to evaluate the effects of multimodal IPP on neuromuscular performance in youth sports. Methods: We conducted a systematic literature search including selected search terms related to youth sports, injury prevention, and neuromuscular performance. Inclusion criteria were: (i) the study was a (cluster-)randomized controlled trial (RCT), and (ii) investigated healthy participants, up to 20 years of age and involved in organized sport, (iii) an intervention arm performing a multimodal IPP was compared to a control arm following a common training regime, and (iv) neuromuscular performance parameters (e.g., balance, power, strength, sprint) were assessed. Furthermore, we evaluated IPP effects on sport-specific skills. Results: Fourteen RCTs (comprising 704 participants) were analyzed. Eight studies included only males, and 5 only females. Seventy-one percent of all studies investigated soccer players with basketball, field hockey, futsal, Gaelic football and hurling being the remaining sports. The average age of the participants ranged from 10 years up to 19 years and the level of play from recreational to professional. Intervention durations ranged from 4 weeks to 4.5 months with a total of 12 to 57 training sessions. We observed a small overall effect in favor of IPP for balance/stability (Hedges´g=0.37; 95%CI 0.17,0.58), leg power (g=0.22; 95%CI 0.07,0.38) and isokinetic hamstring and quadriceps strength as well as hamstrings-to-quadriceps ratio (g=0.38; 95%CI 0.21,0.55). We found a large overall effect for sprint abilities (g=0.80; 95%CI 0.50,1.09) and sport-specific skills (g=0.83; 95%CI 0.34,1.32). Subgroup analyses revealed larger effects in high-level (g=0.34-1.18) compared to low-level athletes (g=0.22-0.75), in boys (g=0.27-1.02) compared to girls (g=0.09-62 0.38), in older (g=0.32-1.16) compared to younger athletes (g=0.18-0.51) and in studies with high (g=0.35-1.16) compared to low (g=0.12-0.38) overall number of training sessions. Conclusion: Multimodal IPP beneficially affect neuromuscular performance. These improvements may substantiate the preventative efficacy of IPP and may support the wide-spread implementation and dissemination of IPP.

The reliability of electromyographic (EMG) data has been examined for isometric and slow dynamic tasks, but little is known about the repeatability of this data for ballistic movements. The purpose of this study was to examine the within-session, trial-to-trial reliability of a variety of quadriceps and hamstrings muscles during isometric and ballistic activities. Data were analyzed by way of intraclass correlation coefficients (ICC), intersubject coefficients of variation (CVinter), and intrasubject coefficients of variation (CVintra). Twenty-four subjects performed 3 repetitions each of 2 randomly ordered test exercises, including landing from a depth jump (J) and cutting after a 10-m sprint (C). Data were acquired and processed with root mean square EMG for the muscles assessed, and data were analyzed for each exercise using a repeated measures analysis of variance. Results revealed that all ICC values were greater than 0.80, with most values greater than 0.90, CVinter values ranged from 5.4% to 148.7%, and CVintra values ranged from 11.5% to 49.3%. This study indicates that EMG is a reliable method for assessing the reproducibility of both the quadriceps and hamstrings muscle activation during either isometric or ballistic exercises.

This study evaluated gender differences in the magnitude and timing of hamstring and quadriceps activation during activities that are believed to cause anterior cruciate ligament (ACL) injuries. Twelve men (age = 21.0 +/- 1.2 years; body mass = 81.61 +/- 13.3 kg; and jump height = 57.61 +/- 10.15 cm) and 12 women (age = 19.91 +/- 0.9 years; body mass = 64.36 +/- 6.14 kg; and jump height = 43.28 +/- 7.5) performed 3 repetitions each of the drop jump (jump) normalized to the subject's vertical jump height, and a sprint and cut at a 45-degree angle (cut). Electromyography (EMG) was used to quantify rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), lateral hamstring (LH), and medial hamstrings (MH) activation, timing, activation ratios, and timing ratios before and after foot contact for the jump and cut and normalized to each subject's hamstring and quadriceps maximum voluntary isometric contraction. Data were analyzed using an analysis of variance with results demonstrating that during the postcontact phase of the cut, men demonstrated greater LH and MH activation than women. In the precontact phase of the jump, men showed earlier activation of the VL and VM, than women. Women produced longer RF and VM muscle bursts during the postcontact phase of the cut. Additionally, men showed a trend toward higher hamstring to quadriceps activation ratio than women for the postcontact phase of the cut. This study provides evidence that men are LH dominant during the postcontact phase of the cut compared with women, whereas women sustain RF activation longer than men during this phase. Men activate quadriceps muscles earlier than women in the precontact phase of the jump. Training interventions may offer the potential for increasing the rate and magnitude of hamstring muscle activation. These outcomes should be evaluated using EMG during movements that are similar to those that cause ACL injuries to determine if gender differences in muscle activation can be reduced.

Ebben, WP, Wurm, B, VanderZanden, TL, Spadavecchia, ML, Durocher, JJ, Bickham, CT, and Petushek, EJ. Kinetic analysis of several variations of push-ups. J Strength Cond Res 25(10): 2891–2894, 2011—Push-ups are a common and practical exercise that is used to enhance fitness, including upper body strength or endurance. The kinetic characteristics of push-ups and its variations are yet to be quantified. Kinetic quantification is necessary to accurately evaluate the training load, and thus the nature of the training stimulus, for these exercise variations. This study assessed the peak vertical ground reaction forces (GRFs) of push-up variations including the regular push-up and those performed with flexed knee, feet elevated on a 30.48-cm box, and a 60.96-cm box, and hands elevated on a 30.48-cm box and a 60.96-cm box. Twenty-three recreationally fit individuals (14 men, 9 women) performed each of the 6 push-up variations in a randomized order. Peak GRF and peak GRF expressed as a coefficient of subject body mass were obtained with a force platform. Push-ups with the feet elevated produced a higher GRF than all other push-up variations (p ≤ 0.05). Push-ups with hands elevated and push-ups from the flexed knee position produced a lower GRF than all other push-up variations (p ≤ 0.05). No gender differences in response to these push-up variations were found (p > 0.05). Additionally, subject height was not related to the GRF for any of the push-up conditions (p > 0.05) other than the condition where hands were elevated on a 60.96-cm box (p ≤ 0.05; r = 0.63). These data can be used to progress the intensity of push-ups in a program and to quantify the training load as a percentage of body mass.