Volume 21, Issue 26 (12-2023)                   RSMT 2023, 21(26): 141-158 | Back to browse issues page


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Barzegar M, Hadadnezhad M, Shojaedin S, Letafatkar A, fouladi R. Comparison Of The Effect Of 8-Week Of Neuromuscular Exercises With And Without Cognitive-Dual Tasks On Proprioception And Balance Of Athletes With Anterior Cruciate Ligament Deficiency. RSMT 2023; 21 (26) :141-158
URL: http://jsmt.khu.ac.ir/article-1-591-en.html
Kharazmi Of University , msdbarzegar@gmail.com
Abstract:   (2699 Views)
The aim of this research was effect of eight weeks of neuromuscular training (NMT) with and without cognitive-dual tasks (DTs) on proprioception and balance of athletes with ACL deficiency (ACL-D). 39 soccer players with ACL-D were selected purposefully and randomly divided into three groups of 13 (control group, neuromuscular training group and neuromuscular training with dual tasks group). Two training groups performed the exercises for eight weeks and three sessions per week. cognitive-motor dual tasks were performed in one of the groups along with neuromuscular exercises in the form of counting down numbers, memorizing numbers, calculating unexpected equations, specialized football skill movements.  The results of the current study indicated that there was no significant difference in knee joint proprioception in the open and closed kinetic chain after applying the intervention between the three groups, but there was a significant difference in lower extremity performance of the athletes based on the Y balance test in the anterior and posterior-lateral direction between the three groups (p<0.05). It seems that providing neuromuscular exercises along with cognitive-dual tasks can probably be considered as a useful approach to improve lower extremity performance based on the Y balance test in athletes with anterior cruciate ligament deficiency.

 
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Type of Study: Applicable | Subject: آسیب شناسی و حرکات اصلاحی
Received: 2023/06/14 | Accepted: 2023/12/19 | Published: 2023/12/31

References
1. 1. Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S, et al. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. British journal of sports medicine. 2020;54(23):1423-32. [DOI:10.1136/bjsports-2019-101247]
2. Ekstrand J, Spreco A, Bengtsson H, Bahr R. Injury rates decreased in men's professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play. British journal of sports medicine. 2021;55(19):1084-92. [DOI:10.1136/bjsports-2020-103159]
3. Diermeier TA, Rothrauff BB, Engebretsen L, Lynch A, Svantesson E, Senorski EAH, et al. Treatment after ACL injury: panther symposium ACL treatment consensus group. British journal of sports medicine. 2021;55(1):14-22. [DOI:10.1136/bjsports-2020-102200]
4. Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt Jr RS, et al. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. Journal of athletic training. 2019;54(5):472-82. [DOI:10.4085/1062-6050-407-16]
5. Nagelli C, Di Stasi S, Tatarski R, Chen A, Wordeman S, Hoffman J, et al. Neuromuscular training improves self-reported function and single-leg landing hip biomechanics in athletes after anterior cruciate ligament reconstruction. Orthopaedic Journal of Sports Medicine. 2020;8(10):2325967120959347. [DOI:10.1177/2325967120959347]
6. Di Stasi S, Myer GD, Hewett TE. Neuromuscular training to target deficits associated with second anterior cruciate ligament injury. journal of orthopaedic & sports physical therapy. 2013;43(11):777-A11. [DOI:10.2519/jospt.2013.4693]
7. Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular function of the knee joint following knee injuries: does it ever get back to normal? A systematic review with meta-analyses. Sports medicine. 2021;51:321-38. [DOI:10.1007/s40279-020-01386-6]
8. Campbell CJ, Carson JD, Diaconescu ED, Celebrini R, Rizzardo MR, Godbout V, et al. Canadian academy of sport and exercise medicine position statement: neuromuscular training programs can decrease anterior cruciate ligament injuries in youth soccer players. Clinical journal of sport medicine. 2014;24(3):263-7. [DOI:10.1097/JSM.0000000000000068]
9. Kaya D, Guney-Deniz H, Sayaca C, Calik M, Doral MN. Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction. BioMed research international. 2019;2019. [DOI:10.1155/2019/1694695]
10. Fleming JD, Ritzmann R, Centner C. Effect of an anterior cruciate ligament rupture on knee proprioception within 2 Years after conservative and operative treatment: A systematic review with meta-analysis. Sports Medicine. 2022;1-12. [DOI:10.1007/s40279-021-01600-z]
11. Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthopaedic journal of sports medicine. 2020;8(6):2325967120930829. [DOI:10.1177/2325967120930829]
12. Ford KR, Nguyen A-D, Dischiavi SL, Hegedus EJ, Zuk EF, Taylor JB. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus. Open access journal of sports medicine. 2015;291-303. [DOI:10.2147/OAJSM.S72432]
13. Ness BM, Zimney K, Kernozek T, Schweinle WE, Schweinle A. Incorporating a dual-task assessment protocol with functional hop testing. International journal of sports physical therapy. 2020;15(3):407. [DOI:10.26603/ijspt20200407]
14. Negahban H, Hadian MR, Salavati M, Mazaheri M, Talebian S, Jafari AH, et al. The effects of dual-tasking on postural control in people with unilateral anterior cruciate ligament injury. Gait & Posture. 2009;30(4):477-81. [DOI:10.1016/j.gaitpost.2009.07.112]
15. Moksnes H, Snyder-Mackler L, Risberg MA. Individuals with an anterior cruciate ligament-deficient knee classified as noncopers may be candidates for nonsurgical rehabilitation. journal of orthopaedic & sports physical therapy. 2008;38(10):586-95. [DOI:10.2519/jospt.2008.2750]
16. Taylor JB, Nguyen A-D, Shultz SJ, Ford KR. Hip biomechanics differ in responders and non-responders to an ACL injury prevention program. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28:1236-45. [DOI:10.1007/s00167-018-5158-1]
17. Dischiavi SL, Wright AA, Hegedus EJ, Thornton EP, Bleakley CM. Framework for optimizing ACL rehabilitation utilizing a global systems approach. International Journal of Sports Physical Therapy. 2020;15(3):478. [DOI:10.26603/ijspt20200478]
18. Welling W, Benjaminse A, Lemmink K, Dingenen B, Gokeler A. Progressive strength training restores quadriceps and hamstring muscle strength within 7 months after ACL reconstruction in amateur male soccer players. Physical Therapy in Sport. 2019;40:10-8. [DOI:10.1016/j.ptsp.2019.08.004]
19. Buckthorpe M, Della Villa F, Della Villa S, Roi GS. On-field rehabilitation part 1: 4 pillars of high-quality on-field rehabilitation are restoring movement quality, physical conditioning, restoring sport-specific skills, and progressively developing chronic training load. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(8):565-9. [DOI:10.2519/jospt.2019.8954]
20. Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Medicine. 2019;49(7):1043-58. [DOI:10.1007/s40279-019-01102-z]
21. Lion A, Gette P, Meyer C, Seil R, Theisen D. Effect of cognitive challenge on the postural control of patients with ACL reconstruction under visual and surface perturbations. Gait & posture. 2018;60:251-7. [DOI:10.1016/j.gaitpost.2017.12.013]
22. Abdallat R, Sharouf F, Button K, Al-Amri M. Dual-task effects on performance of gait and balance in people with knee pain: A systematic scoping review. Journal of Clinical Medicine. 2020;9(5):1554. [DOI:10.3390/jcm9051554]
23. Miko SC, Simon JE, Monfort SM, Yom JP, Ulloa S, Grooms DR. Postural stability during visual-based cognitive and motor dual-tasks after ACLR. Journal of Science and Medicine in Sport. 2021;24(2):146-51. [DOI:10.1016/j.jsams.2020.07.008]
24. Wohl TR, Criss CR, Grooms DR. Visual perturbation to enhance return to sport rehabilitation after anterior cruciate ligament injury: a clinical commentary. International Journal of Sports Physical Therapy. 2021;16(2):552. [DOI:10.26603/001c.21251]
25. Chaput M, Onate JA, Simon JE, Criss CR, Jamison S, McNally M, et al. Visual cognition associated with knee proprioception, time to stability, and sensory integration neural activity after ACL reconstruction. Journal of Orthopaedic Research®. 2022;40(1):95-104. [DOI:10.1002/jor.25014]
26. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. Journal of athletic training. 2012;47(3):339-57. [DOI:10.4085/1062-6050-47.3.08]
27. Myers H, Christopherson Z, Butler RJ. Relationship between the lower quarter Y-balance test scores and isokinetic strength testing in patients status post ACL reconstruction. International journal of sports physical therapy. 2018;13(2):152. [DOI:10.26603/ijspt20180152]
28. Nasseri N, Hadian MR, Bagheri H, Olyaei STG. Reliability and accuracy of joint position sense measurement in the laboratory and clinic; utilising a new system. Acta Medica Iranica. 2007;395-404.
29. Lee D-H, Lee J-H, Ahn S-E, Park M-J. Effect of time after anterior cruciate ligament tears on proprioception and postural stability. PloS one. 2015;10(9):e0139038. [DOI:10.1371/journal.pone.0139038]
30. Miura K, Ishibashi Y, Tsuda E, Okamura Y, Otsuka H, Toh S. The effect of local and general fatigue on knee proprioception. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2004;20(4):414-8. [DOI:10.1016/j.arthro.2004.01.007]
31. Ghaderi M, Letafatkar A, Almonroeder TG, Keyhani S. Neuromuscular training improves knee proprioception in athletes with a history of anterior cruciate ligament reconstruction: A randomized controlled trial. Clinical Biomechanics. 2020;80:105157. [DOI:10.1016/j.clinbiomech.2020.105157]
32. Niespodziński B, Kochanowicz A, Mieszkowski J, Piskorska E, Żychowska M. Relationship between joint position sense, force sense, and muscle strength and the impact of gymnastic training on proprioception. BioMed research international. 2018;2018. [DOI:10.1155/2018/5353242]
33. Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL Research retreat VII: an update on anterior cruciate ligament injury risk factor identification, screening, and prevention: March 19-21, 2015 [DOI:10.4085/1062-6050-50.10.06]
34. Greensboro, NC. Journal of athletic training. 2015;50(10):1076-93.
35. Sugimoto D, Myer GD, Foss KDB, Hewett TE. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. British journal of sports medicine. 2015;49(5):282-9. [DOI:10.1136/bjsports-2014-093461]
36. Zebis MK, Andersen LL, Brandt M, Myklebust G, Bencke J, Lauridsen HB, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. British journal of sports medicine. 2016;50(9):552-7. [DOI:10.1136/bjsports-2015-094776]
37. Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S, et al. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. British journal of sports medicine. 2020;54(23):1423-32. [DOI:10.1136/bjsports-2019-101247]
38. Ekstrand J, Spreco A, Bengtsson H, Bahr R. Injury rates decreased in men's professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play. British journal of sports medicine. 2021;55(19):1084-92. [DOI:10.1136/bjsports-2020-103159]
39. Diermeier TA, Rothrauff BB, Engebretsen L, Lynch A, Svantesson E, Senorski EAH, et al. Treatment after ACL injury: panther symposium ACL treatment consensus group. British journal of sports medicine. 2021;55(1):14-22. [DOI:10.1136/bjsports-2020-102200]
40. Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt Jr RS, et al. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. Journal of athletic training. 2019;54(5):472-82. [DOI:10.4085/1062-6050-407-16]
41. Nagelli C, Di Stasi S, Tatarski R, Chen A, Wordeman S, Hoffman J, et al. Neuromuscular training improves self-reported function and single-leg landing hip biomechanics in athletes after anterior cruciate ligament reconstruction. Orthopaedic Journal of Sports Medicine. 2020;8(10):2325967120959347. [DOI:10.1177/2325967120959347]
42. Di Stasi S, Myer GD, Hewett TE. Neuromuscular training to target deficits associated with second anterior cruciate ligament injury. journal of orthopaedic & sports physical therapy. 2013;43(11):777-A11. [DOI:10.2519/jospt.2013.4693]
43. Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular function of the knee joint following knee injuries: does it ever get back to normal? A systematic review with meta-analyses. Sports medicine. 2021;51:321-38. [DOI:10.1007/s40279-020-01386-6]
44. Campbell CJ, Carson JD, Diaconescu ED, Celebrini R, Rizzardo MR, Godbout V, et al. Canadian academy of sport and exercise medicine position statement: neuromuscular training programs can decrease anterior cruciate ligament injuries in youth soccer players. Clinical journal of sport medicine. 2014;24(3):263-7. [DOI:10.1097/JSM.0000000000000068]
45. Kaya D, Guney-Deniz H, Sayaca C, Calik M, Doral MN. Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction. BioMed research international. 2019;2019. [DOI:10.1155/2019/1694695]
46. Fleming JD, Ritzmann R, Centner C. Effect of an anterior cruciate ligament rupture on knee proprioception within 2 Years after conservative and operative treatment: A systematic review with meta-analysis. Sports Medicine. 2022;1-12. [DOI:10.1007/s40279-021-01600-z]
47. Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthopaedic journal of sports medicine. 2020;8(6):2325967120930829. [DOI:10.1177/2325967120930829]
48. Ford KR, Nguyen A-D, Dischiavi SL, Hegedus EJ, Zuk EF, Taylor JB. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus. Open access journal of sports medicine. 2015;291-303. [DOI:10.2147/OAJSM.S72432]
49. Ness BM, Zimney K, Kernozek T, Schweinle WE, Schweinle A. Incorporating a dual-task assessment protocol with functional hop testing. International journal of sports physical therapy. 2020;15(3):407. [DOI:10.26603/ijspt20200407]
50. Negahban H, Hadian MR, Salavati M, Mazaheri M, Talebian S, Jafari AH, et al. The effects of dual-tasking on postural control in people with unilateral anterior cruciate ligament injury. Gait & Posture. 2009;30(4):477-81. [DOI:10.1016/j.gaitpost.2009.07.112]
51. Moksnes H, Snyder-Mackler L, Risberg MA. Individuals with an anterior cruciate ligament-deficient knee classified as noncopers may be candidates for nonsurgical rehabilitation. journal of orthopaedic & sports physical therapy. 2008;38(10):586-95. [DOI:10.2519/jospt.2008.2750]
52. Taylor JB, Nguyen A-D, Shultz SJ, Ford KR. Hip biomechanics differ in responders and non-responders to an ACL injury prevention program. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28:1236-45. [DOI:10.1007/s00167-018-5158-1]
53. Dischiavi SL, Wright AA, Hegedus EJ, Thornton EP, Bleakley CM. Framework for optimizing ACL rehabilitation utilizing a global systems approach. International Journal of Sports Physical Therapy. 2020;15(3):478. [DOI:10.26603/ijspt20200478]
54. Welling W, Benjaminse A, Lemmink K, Dingenen B, Gokeler A. Progressive strength training restores quadriceps and hamstring muscle strength within 7 months after ACL reconstruction in amateur male soccer players. Physical Therapy in Sport. 2019;40:10-8. [DOI:10.1016/j.ptsp.2019.08.004]
55. Buckthorpe M, Della Villa F, Della Villa S, Roi GS. On-field rehabilitation part 1: 4 pillars of high-quality on-field rehabilitation are restoring movement quality, physical conditioning, restoring sport-specific skills, and progressively developing chronic training load. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(8):565-9. [DOI:10.2519/jospt.2019.8954]
56. Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Medicine. 2019;49(7):1043-58. [DOI:10.1007/s40279-019-01102-z]
57. Lion A, Gette P, Meyer C, Seil R, Theisen D. Effect of cognitive challenge on the postural control of patients with ACL reconstruction under visual and surface perturbations. Gait & posture. 2018;60:251-7. [DOI:10.1016/j.gaitpost.2017.12.013]
58. Abdallat R, Sharouf F, Button K, Al-Amri M. Dual-task effects on performance of gait and balance in people with knee pain: A systematic scoping review. Journal of Clinical Medicine. 2020;9(5):1554. [DOI:10.3390/jcm9051554]
59. Miko SC, Simon JE, Monfort SM, Yom JP, Ulloa S, Grooms DR. Postural stability during visual-based cognitive and motor dual-tasks after ACLR. Journal of Science and Medicine in Sport. 2021;24(2):146-51. [DOI:10.1016/j.jsams.2020.07.008]
60. Wohl TR, Criss CR, Grooms DR. Visual perturbation to enhance return to sport rehabilitation after anterior cruciate ligament injury: a clinical commentary. International Journal of Sports Physical Therapy. 2021;16(2):552. [DOI:10.26603/001c.21251]
61. Chaput M, Onate JA, Simon JE, Criss CR, Jamison S, McNally M, et al. Visual cognition associated with knee proprioception, time to stability, and sensory integration neural activity after ACL reconstruction. Journal of Orthopaedic Research®. 2022;40(1):95-104. [DOI:10.1002/jor.25014]
62. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. Journal of athletic training. 2012;47(3):339-57. [DOI:10.4085/1062-6050-47.3.08]
63. Myers H, Christopherson Z, Butler RJ. Relationship between the lower quarter Y-balance test scores and isokinetic strength testing in patients status post ACL reconstruction. International journal of sports physical therapy. 2018;13(2):152. [DOI:10.26603/ijspt20180152]
64. Nasseri N, Hadian MR, Bagheri H, Olyaei STG. Reliability and accuracy of joint position sense measurement in the laboratory and clinic; utilising a new system. Acta Medica Iranica. 2007;395-404.
65. Lee D-H, Lee J-H, Ahn S-E, Park M-J. Effect of time after anterior cruciate ligament tears on proprioception and postural stability. PloS one. 2015;10(9):e0139038. [DOI:10.1371/journal.pone.0139038]
66. Miura K, Ishibashi Y, Tsuda E, Okamura Y, Otsuka H, Toh S. The effect of local and general fatigue on knee proprioception. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2004;20(4):414-8. [DOI:10.1016/j.arthro.2004.01.007]
67. Ghaderi M, Letafatkar A, Almonroeder TG, Keyhani S. Neuromuscular training improves knee proprioception in athletes with a history of anterior cruciate ligament reconstruction: A randomized controlled trial. Clinical Biomechanics. 2020;80:105157. [DOI:10.1016/j.clinbiomech.2020.105157]
68. Niespodziński B, Kochanowicz A, Mieszkowski J, Piskorska E, Żychowska M. Relationship between joint position sense, force sense, and muscle strength and the impact of gymnastic training on proprioception. BioMed research international. 2018;2018. [DOI:10.1155/2018/5353242]
69. Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL Research retreat VII: an update on anterior cruciate ligament injury risk factor identification, screening, and prevention: March 19-21, 2015 [DOI:10.4085/1062-6050-50.10.06]
70. Greensboro, NC. Journal of athletic training. 2015;50(10):1076-93.
71. Sugimoto D, Myer GD, Foss KDB, Hewett TE. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. British journal of sports medicine. 2015;49(5):282-9. [DOI:10.1136/bjsports-2014-093461]
72. Zebis MK, Andersen LL, Brandt M, Myklebust G, Bencke J, Lauridsen HB, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. British journal of sports medicine. 2016;50(9):552-7. [DOI:10.1136/bjsports-2015-094776]

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