Biomechanical Effects of an Injury Prevention Program in Preadolescent Female Soccer Athletes

Abstract

Background Anterior cruciate ligament (ACL) injuries are common, and children as young as 10 years of age exhibit movement patterns associated with an ACL injury risk. Prevention programs have been shown to reduce injury rates, but the mechanisms behind these programs are largely unknown. Few studies have investigated biomechanical changes after injury prevention programs in children. Purpose/Hypothesis To investigate the effects of the F-MARC 11+ injury prevention warm-up program on changes to biomechanical risk factors for an ACL injury in preadolescent female soccer players. We hypothesized that the primary ACL injury risk factor of peak knee valgus moment would improve after training. In addition, we explored other kinematic and kinetic variables associated with ACL injuries. Study Design Controlled laboratory study. Methods A total of 51 female athletes aged 10 to 12 years were recruited from soccer clubs and were placed into an intervention group (n = 28; mean [±SD] age, 11.8 ± 0.8 years) and a control group (n = 23; mean age, 11.2 ± 0.6 years). The intervention group participated in 15 in-season sessions of the F-MARC 11+ program (2 times/wk). Pre- and postseason motion capture data were collected during preplanned cutting, unanticipated cutting, double-leg jump, and single-leg jump tasks. Lower extremity joint angles and moments were estimated using OpenSim, a biomechanical modeling system. Results Athletes in the intervention group reduced their peak knee valgus moment compared with the control group during the double-leg jump (mean [±standard error of the mean] pre- to posttest change, −0.57 ± 0.27 %BW×HT vs 0.25 ± 0.25 %BW×HT, respectively; P = .034). No significant differences in the change in peak knee valgus moment were found between the groups for any other activity; however, the intervention group displayed a significant pre- to posttest increase in peak knee valgus moment during unanticipated cutting (P = .044). Additional analyses revealed an improvement in peak ankle eversion moment after training during preplanned cutting (P = .015), unanticipated cutting (P = .004), and the double-leg jump (P = .016) compared with the control group. Other secondary risk factors did not significantly improve after training, although the peak knee valgus angle improved in the control group compared with the intervention group during unanticipated cutting (P = .018). Conclusion The F-MARC 11+ program may be effective in improving some risk factors for an ACL injury during a double-leg jump in preadolescent athletes, most notably by reducing peak knee valgus moment. Clinical Relevance This study provides motivation for enhancing injury prevention programs to produce improvement in other ACL risk factors, particularly during cutting and single-leg tasks.

Effect of the 11+ injury prevention programme on fundamental movement patterns in soccer players

“…Several studies have shown that the 11+ injury prevention programme can induce various positive adaptations in the long term that may potentially contribute to improving or preventing risky movement patterns [ 16 - 22 ]. For example, Daneshjoo et al [ 20 ] reported that, as compared to a control group, an eight-week 11+ programme increased concentric and eccentric hamstring strength in young male professional soccer players, which might reduce the susceptibility of a player to suffering hamstring muscle injuries.…”

“…A recent systematic review and meta-analysis on the efficacy of the 11+ concluded that the use of the F-MARC injury prevention programme can decrease the risk of non-contact injuries among soccer players by 20 to 50% in the long term [ 15 ]. Additionally, the FIFA 11+ has also been shown to produce positive changes in physical fitness [ 16 , 17 ], muscle activity contribution [ 18 ], motor performance [ 19 ], concentric hamstring strength [ 20 ], neuromuscular control [ 21 ], and peak knee valgus moment [ 22 ]; in the long term, all of these factors may potentially contribute to minimizing risky movement patterns.…”

Prevention of Primary ACL Injuries: A Novel, Innovative Approach

“…Also, the program reduced overall injury rates, but it remained unknown if it reduced ACL injuries in particular. 6,40 Many trials analyzed different neuromuscular training programs designed to reduce the risk for ACL tear in handball female players and showed to reduce in the incidence of overall ACL injury, even if the studies are underpowered. 41 The efficacy of prevention programs in decreasing the incidence of ACL tearing was sustained by the results of meta-analyses published by Hewett in 2010 20 , Yoo in 2010 36 , and Sadoghi in 2012.…”

OpenSim Moco: Musculoskeletal optimal control

“…Musculoskeletal simulations have shed light on movement disorders by, for example, discovering ways to walk that reduce knee loading [1], revealing that children with cerebral palsy exhibit simplified motor control when walking [2], and reproducing eye disorders that cause double vision [3]. Simulations provide insights to increase safety as we push the limits of human performance, whether that is designing exercise equipment for preserving bone density in low gravity [4], designing exoskeletons to reduce back injuries from heavy lifting [5], or assessing the effect of training programs on knee ligament injuries in soccer [6]. Beyond human health and performance, researchers use musculoskeletal simulations to understand how animals move, for example by studying dinosaur locomotion [7] and differences between human and chimpanzee strength [8].…”