Over the past 4 decades, the number of female atbletesinthe United States has substantially increased at the professional, collegiate, and youth levels due, in large part, to Title IX of the Education Amendments of 1972. Despite the push forequality of participation in sports between men and women, a major discrepancy remains: female athletes_ demonstrate a fonr to eight fold higher incidence of anterior crnciate ligament (ACL) injury compared to male athletes participating in the same sports (Casey, & Hawkins, 2010). While advances have been made in the surgical repair of ACL tears, many short\xad termand long"term effects remain. Itis estimated that the annual cost to treat ACL_ injuries is between one and two billion dollars (Casey, & Hawkins, 2010). The surgical and rehabilitative costs exceed $640 million annually insolely female high school and collegiate athletes (Myer, Ford, & Hewett, 2004). Injured individuals who undergo surgical intervention face a lengthy rehabilitative process, which_ can.range from 6 months to 36 months (Evans, Chew, & Stanish 2001). Moreover, only 75% of these individuals will retnrn to their previous levels of activity (Evans, Chew, & Stanish, 2001). In addition to healthcare costs, a loss of playing time, and a decrease in activity levels, ACLjajnry also results in a higher inci deuce of knee osteoarthritis. One study reports that individuals who suffer an acute knee injury are 7.4 times more likely to develop knee osteoarthritis than those withno history of knee injury {Wilder, Hall, Barrett, & Lemrow, 2002). Other studies have shown that 50% to 100% of women with an ACLjajnry will demonstrate significant pain, functional 1imitati ous, and radiographic signs of knee osteoarthritis within 12 to 20 years of their initial injury (Lohmander, Ostenberg, Englund, & Roos, 2004; Myklebust, & Bahr, 2005). These findings constitute astrong rationale to direct increased efforts toward the prevention of ACL injury in female athletes. Statistics show that 70% of all ACL injuries occur without contact (Conn, Annest,_ & Gilchrist, 2003). Moreover, injured individuals frequently report that the injury occurred while performing a movement they had performed numerous times before without incidence (Conn, Annest, & Gilchrist, 2003). Non-contact events include landingfrom a jump, cutting, and decelerating_ Researchers have investigated the influence of anthropometric factors, such as an increased Q-angle and decreased width of the femoral intercondylar notch,and hormonal factors, such as higher blood estrogen concentrations, on ACL loading during the aforementioned maneuvers and their role in the increased risk of ACL injury among female athletes_ While these identified factors may play a role in ACL injury, they are not under the functional control of an athlete, and therefore they are not easily modified to reduce the riskof injury lllllDngfemale athletes. Studies have found that neuromuscular strategies for the aforementioned maneuvern differ between male and female athletes. Female athletes tend to land fmm a jump with increased frontal plane motion, such as valgus at the knee, which increases the load.on the.ACL. They also tend to demonstrate quadriceps dominance, which can be defined as an imbalance between knee extensor and flexor strength, recruitment, and coordination (Myer,.Ford, & Hewett, 2004)_ An increased quadriceps to hamstring.ratio also increases the amount of knee extension and the load placed on the ACL during dynamic movements, suchasJanding from ajump. Female.athletes may also exhibitleg. dominance or an imbalance between the two lower extremities instrength, coordination,_ and control, and as a result, may increase one's risk of injury (Myer, Ford, & Hewett, 2004). While anatomical and hormonal differences between men and women have been identified, prevention programs are aimed at altering the neuromuscular strategies in_ female landing and cutting patterns in order to reduce the strain placed on the ACL and, potentially, to prevent ACL injury. As females continue to participate in sports, at any level, it is imperative for physical therapists, coaches, and trainers to provide them with optimal prevention strategies in order to minimize the inherent short-term andJong-term risks associated with competitive physical activity. In order to do so, they must use valid research to guide their decisions. _ The. purpose of this analysis isto.evaluate the current. literature to determine whether neuromuscular training aimed at altering landing mechanics is more effective than conventionaLinterventions in preventingnon,.c onJ:acL ACL injuries in female athletes


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Neuromuscular Training, Landing Mechanics/ACL Injury, female athletes

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