Primary anterior cruciate ligament (ACL) injury prevention programs effectively reduce ACL injury risk in the short term. Despite these programs, ACL injury incidence is still high, making it imperative to continue to improve cur- rent prevention strategies. A potential limitation of current ACL injury prevention training may be a deficit in the transfer of conscious, optimal movement strategies rehearsed during training sessions to automatic movements required for athletic activities and unanticipated events on the field. Instructional strategies with an internal focus of attention have traditionally been utilized, but may not be optimal for the acquisition of the control of complex motor skills required for sports. Conversely, external-focus instructional strategies may enhance skill acquisition more efficiently and increase the transfer of improved motor skills to sports activities. The current article will present in- sights gained from the motor-learning domain that may enhance neuromuscular training programs via improved skill development and increased reten- tion and transfer to sports activities, which may reduce ACL injury incidence in the long term.
Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.
Modifiable (biomechanical and neuromuscular) anterior cruciate ligament (ACL) injury risk factors have been identified in laboratory settings. These risk factors were subsequently used in ACL injury prevention measures. Due to the lack of ecological validity, the use of on-field data in the ACL injury risk screening is increasingly advocated. Though, the kinematic differences between laboratory and on-field settings have never been investigated. The aim of the present study was to investigate the lower-limb kinematics of female footballers during agility movements performed both in laboratory and football field environments. Twenty-eight healthy young female talented football (soccer) players (14.9 ± 0.9 years) participated. Lower-limb joint kinematics was collected through wearable inertial sensors (Xsens Link) in three conditions: (1) laboratory setting during unanticipated sidestep cutting at 40-50°; on the football pitch (2) football-specific exercises (F-EX) and (3) football games (F-GAME). A hierarchical two-level random effect model in Statistical Parametric Mapping was used to compare joint kinematics among the conditions. Waveform consistency was investigated through Pearson's correlation coefficient and standardized z-score vector. In-lab kinematics differed from the on-field ones, while the latter were similar in overall shape and peaks. Lower sagittal plane range of motion, greater ankle eversion, and pelvic rotation were found for on-field kinematics (p < 0.044). The largest differences were found during landing and weight acceptance. The biomechanical differences between lab and field settings suggest the application of context-related adaptations in female footballers and have implications in ACL injury prevention strategies. Highlights: Talented youth female football players showed kinematical differences between the lab condition and the on-field ones, thus adopting a context-related motor strategy. Lower sagittal plane range of motion, greater ankle eversion, and pelvic rotation were found on the field. Such differences pertain to the ACL injury mechanism and prevention strategies. Preventative training should support the adoption of non-linear motor learning to stimulate greater self-organization and adaptability. It is recommended to test football players in an ecological environment to improve subsequent primary ACL injury prevention programmes.
Despite the recognized benefits of running for promoting overall health, its widespread adoption faces a significant challenge due to high injury rates. In 2022, runners reported 660,000 injuries, constituting 13% of the total 5.1 million sports-related injuries in the Netherlands. This translates to a disturbing average of 5.5 injuries per 1,000 hours of running, significantly higher than other sports such as fitness (1.5 injuries per 1,000 hours). Moreover, running serves as the foundation of locomotion in various sports. This emphasizes the need for targeted injury prevention strategies and rehabilitation measures. Recognizing this social issue, wearable technologies have the potential to improve motor learning, reduce injury risks, and optimize overall running performance. However, unlocking their full potential requires a nuanced understanding of the information conveyed to runners. To address this, a collaborative project merges Movella’s motion capture technology with Saxion’s expertise in e-textiles and user-centered design. The result is the development of a smart garment with accurate motion capture technology and personalized haptic feedback. By integrating both sensor and actuator technology, feedback can be provided to communicate effective risks and intuitive directional information from a user-centered perspective, leaving visual and auditory cues available for other tasks. This exploratory project aims to prioritize wearability by focusing on robust sensor and actuator fixation, a suitable vibration intensity and responsiveness of the system. The developed prototype is used to identify appropriate body locations for vibrotactile stimulation, refine running styles and to design effective vibration patterns with the overarching objective to promote motor learning and reduce the risk of injuries. Ultimately, this collaboration aims to drive innovation in sports and health technology across different athletic disciplines and rehabilitation settings.
Sport injuries are a major reason for reduced participation and drop-out from sports and PE. Refraining from sport participation has negative bearing effects on mental and physical wellbeing, which tracks into adulthood. It is therefore important for youth to be facilitated into lifelong active participation in physical activity and sport, as the importance of physical activity for the health of youth is undisputed. Participation in physical education (PE) classes and membership of sports clubs and are essential for health enhancing physical activity. Despite the importance of sports injury prevention in youth, no broad scale approaches that work in real-life situations with significant positive effects exist. Main reasons for this are very poor uptake and maintenance of current sports injury prevention exercises. Sportscoaches and physical educators experience these exercises as not context specific, time consuming and not contributing to their training goals. Whereas youth perceives these exercises as not attractive, no fun and without any play or game component. These aspects cause lack of maintenance and thus no significant reduction of injuries. Recent scientific and practical insights promote more emphasis on motivation through autonomy and attractive exercise routines based on principles of motor learning which can be integrated in regular training sessions or physical education classes. Purpose: Therefore, the Move Healthy project develops ICT based support video material of routines for and with physical educators and sport coaches, which supports them to prevent sports injuries in youth. This material should be easy to integrate in regular training sessions or physical education classes.
