Revue de littérature : la rupture du ligament croisé antérieur : particularités féminines

We know that female athletes practicing pivoting sports have a higher risk of anterior cruciate ligament (ACL) injury compared to male. Many series confirm that the risk is four to seven times higher among female athletes at the same sporting level. Furthermore, most ACL injuries in female athletes occur during a noncontact episode, typically during deceleration, lateral pivoting or landing. A literature review confirms the higher incidence of ACL injuries among women in the pivot sports with or without contact. This sex difference can be explained by external and internal risk factors. The external risk factors are competition in games versus training, footwear and playing surfaces, protective equipment and physical preparation. The internal risk factors are anatomical risk factors: anatomy of the notch, posterior tibial slope, hyperlaxity, biomechanical factors: kinematics and kinetics of the knee, neuromuscular risk factors and hormonal risk factors. Indeed, the hormonal factors (estrogen, relaxin, progesterone and testosterone) seem to be responsible, especially during the ovulatory phase of the menstrual cycle. This study confirms that female athletes have a higher risk of ACL injuries compared to male athletes. A better knowledge of the external and internal risk factors, such as the injury mechanism and the hormonal factors may help in the future prevent these injuries.     

ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program

Female athletes are at 3.5 times risk of sustaining a non-contact ACL injury compared with males. Research has shown that this gender discrepancy results from differences in neuromuscular adaptations and biomechanics related to landing techniques. Studies have examined the preventative effect of ACL prevention programs, which have been designed to address these risky neuromuscular and biomechanical patterns. We review the key studies on ACL prevention in female athletes and summarize the critical components of ACL prevention strategies that have been shown to successfully decrease ACL injury risk. We also discuss recommendations and practical considerations in the implementation of ACL prevention programs in various community settings.     

ACL Injury Prevention: What Does Research Tell Us?

Purpose of Review

Mechanisms leading to anterior cruciate ligament (ACL) injury have been identified, yet re-injury or a secondary injury persists in the athletic population. The purpose of this review is to identify risk factors associated with ACL injury and investigate programs to prevent injury.

Recent Findings

Faulty mechanics during dynamic movement that cause excessive valgus force at the knee increases the risk of ACL injury. Faulty mechanics may be a result of lateral displacement of the trunk, unequal limb loading, and lack of control to avoid the valgus knee position. Altered movements that place the ACL at risk are best identified in a fatigued state; however, could be recognized in a standard dynamic assessment. The faulty movement patterns are modifiable and should be addressed in an injury prevention program. Prevention programs include various modes of exercise such as plyometrics, neuromuscular training, and strength training.

Summary

This review concludes that those programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries. An ongoing thorough dynamic examination is necessary for all athletes while adjusting the intervention program in order to decrease the risk of ACL injury.

     

改良运动损伤预防方案在前交叉韧带损伤预防中的应用

目的:分析优秀女橄榄球运动员(女橄)侧切跑中,下肢运动学和动力学特征,使用改良的运动损伤预防方案对女橄运动员ACL损伤进行预防性干预并评价其效果.方法:优秀女运动员14例,随机分为实验组(REF)与对照组(CON),每组7例,实验组进行12周的康复训练,对照组不干预.采集侧切跑生物力学数据和SEMG数据.结果:①着地时...     

An Anterior Cruciate Ligament (ACL) Injury Risk Screening and Reduction Program for High School Female Athletes: A Pilot Study

BackgroundAnterior cruciate ligament (ACL) injury causes physical, mental, and financial burdens. Therefore, it is imperative to screen, identify, and educate athletes who are at high-risk. The combination of screening and education could identify those at risk and potentially reduce future injuries.PurposeThe purpose was to conduct a feasible community pre-season screening program for high school female athletes for the presence of known modifiable risk factors that predispose them to sustaining a non-contact ACL injury.Study DesignNon-experimental prospective studyMethodsA convenience sample of 15 healthy female athletes were recruited from local high schools, consisting of 11 soccer players and four basketball players.  A pre-season screening program was designed encompassing four stations that addressed modifiable neuromuscular and biomechanical risk factors including range of motion (ROM), jump-landing technique, strength, and balance. Athletes were categorized into high-risk versus low-risk groups based on cutoff scores previously established in the literature.ResultsEvery athlete met the high-risk cutoff score for at least one extremity during the ROM screening, and some met high-risk cutoff scores for more than one ROM. Out of all four categories tested, lower extremity ROM demonstrated the greatest deficits.ConclusionThis study identified athletes as having multiple modifiable risk factors that can be addressed with training and exercises. This supports implementing a pre-season program aimed at screening for injury risk factors.Level of EvidenceLevel 3     

Sports-related knee injuries in female athletes: what gives?

Knee injuries occur commonly in sports, limiting field and practice time and performance level. Although injury etiology relates primarily to sports specific activity, female athletes are at higher risk of knee injury than their male counterparts in jumping and cutting sports. Particular pain syndromes such as anterior knee pain and injuries such as noncontact anterior cruciate ligament (ACL) injuries occur at a higher rate in female than male athletes at a similar level of competition. Anterior cruciate ligament injuries can be season or career ending, at times requiring costly surgery and rehabilitation. Beyond real-time pain and functional limitations, previous injury is implicated in knee osteoarthritis occurring later in life. Although anatomical parameters differ between and within the sexes, it is not likely this is the single reason for knee injury rate disparities. Clinicians and researchers have also studied the role of sex hormones and dynamic neuromuscular imbalances in female compared with male athletes in hopes of finding the causes for the increased rate of ACL injury. Understanding gender differences in knee injuries will lead to more effective prevention strategies for women athletes who currently suffer thousands of ACL tears annually. To meet the goal in sports medicine of safely returning an athlete to her sport, our evaluation, assessment, treatments and prevention strategies must reflect not only our knowledge of the structure and innervations of the knee but neuromuscular control in multiple planes and with multiple forces while at play.     

Recommendations for Plyometric Training after ACL Reconstruction – A Clinical Commentary

This paper presents a four-stage plyometric program to be undertaken as part of criterion-based rehabilitation for athletes with anterior cruciate ligament reconstruction (ACLR). After ACLR, the patient experiences alterations of joint mobility, gait and movement patterns, neuromuscular function and general physical fitness. Plyometric training is an important component for neuromuscular and movement re-conditioning after ACLR. Effective use of plyometrics can support enhancements in explosive sporting performance, movement quality and lower risk of injury. Plyometric training, as a component of the ACL functional recovery process, can aid in restoring function and supporting timely return to sport. However, few patients undertake or complete a plyometric program prior to return-to-sport. To truly impact individual patients, a stronger focus on research implementation is needed from researchers to translate efficacious interventions into practice. In designing a plyometric program, it is important to match the specific plyometric tasks to the functional recovery status of the ACLR patient. To do this, it is important to understand the relative intensity of plyometrics tasks, align these tasks to the ACL functional recovery process and monitor the athlete as part of criterion based rehabilitation. Plyometric intensity is based on the intensity of efforts, the vertical and/or horizontal momentum prior to ground contact, the ground contact time and the surface or environment on which they are performed on/in. Furthermore, how the person technically performs the task will influence joint loading. There should be a gradual increase in task intensity and specificity throughout the program, with all tasks used for both neuromuscular and motor control re-conditioning. The aim of this paper is to provide recommendations to clinicians on how to design and implement plyometric training programs for the ACLR patient, as part of the functional recovery process.Level of evidence5     

Sex Differences in Common Sports Injuries

Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation.

Is There a Potential Relationship Between Prior Hamstring Strain Injury and Increased Risk for Future Anterior Cruciate Ligament Injury?

Hamstring strain injuries (HSIs) are the most prevalent injury in a number of sports, and while anterior cruciate ligament (ACL) injuries are less common, they are far more severe and have long-term implications, such as an increased risk of developing osteoarthritis later in life. Given the high incidence and severity of these injuries, they are key targets of injury preventive programs in elite sport. Evidence has shown that a previous severe knee injury (including ACL injury) increases the risk of HSI; however, whether the functional deficits that occur after HSI result in an increased risk of ACL injury has yet to be considered. In this clinical commentary, we present evidence that suggests that the link between previous HSI and increased risk of ACL injury requires further investigation by drawing parallels between deficits in hamstring function after HSI and in women athletes, who are more prone to ACL injury than men athletes. Comparisons between the neuromuscular function of the male and female hamstring has shown that women display lower hamstring-to-quadriceps strength ratios during isokinetic knee flexion and extension, increased activation of the quadriceps compared with the hamstrings during a stop-jump landing task, a greater time required to reach maximal isokinetic hamstring torque, and lower integrated myoelectrical hamstring activity during a sidestep cutting maneuver. Somewhat similarly, in athletes with a history of HSI, the previously injured limb, compared with the uninjured limb, displays lower eccentric knee flexor strength, a lower hamstrings-to-quadriceps strength ratio, lower voluntary myoelectrical activity during maximal knee flexor eccentric contraction, a lower knee flexor eccentric rate of torque development, and lower voluntary myoelectrical activity during the initial portion of eccentric contraction. Given that the medial and lateral hamstrings have different actions at the knee joint in the coronal plane, which hamstring head is previously injured might also be expected to influence the likelihood of future ACL. Whether the deficits in function after HSI, as seen in laboratory-based studies, translate to deficits in hamstring function during typical injurious tasks for ACL injury has yet to be determined but should be a consideration for future work.     

Periodization in Anterior Cruciate Ligament Rehabilitation: A Novel Framework

More than 250,000 anterior cruciate ligament (ACL) injuries occur each year in the USA, and approximately 65% of these injuries undergo reconstructive surgery. Appropriate rehabilitation after ACL reconstruction can yield predictably good outcomes, with return to previous levels of activity and high knee function. At present, periodization is used at all levels of sports training. Whether conceptualized and directed by coaches, or by athletes themselves, competitors structure their training in a cyclic fashion, enabling athletes to best realize their performance goals. In practical application, sport physical therapists use periodization: postoperative “protocols” serve as rudimentary forms of periodization, albeit implemented over shorter time frames than that typically employed in preparation for competition. An ACL injury should not be considered a “simple” musculoskeletal pathology with only local mechanical or motor dysfunctions. Together with the psychological trauma and reduction in physical capacity, there is a cascade of events, including neurological insult to the central nervous system and reduction in afferences to the sensorimotor system. Rehabilitation should consider all these issues, and periodization would allow to better define and to plan aims and objectives to return athletes to their sport. Technological resources including advanced neuroimaging methods, virtual reality for injury risk screening and return to sport assessment, and interactive artificial reality-based neuromuscular training methods offer new approaches and tools to address this important biomedical problem. The cost and availability of many of these technologies will continue to decrease, providing greater availability, scientific rigor, and ultimately, utility for cost-effective and data-driven assessments.     

Reconstruction du LCA chez le sportif de compétition. Évaluation, à court terme,après reprise du sport

Background

Most studies have observed satisfactory outcome after anterior cruciate ligament (ACL) reconstruction. The best series report 80 to 90% success, irrespective of the type of operation. The purpose of this work was to investigate resumption of sports activities after ACL reconstruction. We studied the impact of the conditions of sports activity after the operation, gender, type of sport, presence of an extra-articular reinforcement and time since surgery.

Material and method

In order to search for significant differences between the postoperative and follow-up scores, a questionnaire with a subjective IKDC grid was addressed 12 months after their hospitalization to all athletes who had undergone ACL reconstruction at the CERS from 1^st January, 2003 through 31^st October, 2004.

Results

For the period considered, 2248 athletes were hospitalized at the CERS for ACL reconstruction. The response rate was 43% (969 responses at 12 months). There was no significant difference between the hospitalized population and the responders in terms of type of sports activity or type of graft. There was however a significant female predominance among responders (p = 0.01). Mean follow-up was 13.9 ± 2.9 months. Reconstruction methods were: hamstring graft 54%, free patellar graft 43%, MacIntosh fascia lata 2%, MacIntosh quadriceps 1%. The main activity was a pivot sport for 74% of the athletes. Male gender predominated: 77%. There was no difference regarding postoperative training, but competition level was achieved more readily by males (65% versus 54%, p = 0.0038), since more females stated resumption of competition was not an objective. It was also noted that resumption of training occurred earlier for gliding sports than for pivot–contact sports (7.32 ± 2.09 months versus 8.23 ± 2.66 months, p = 0.021). The presence of a lateral reinforcement did not have a significant impact on resumption of sports activities which was more frequent in the hamstring group than the patellar group (16% versus 7%, p < 0.0001) and more frequent in the pivot–contact sports (p = 0.0039). Regarding the role of the surgical technique, resumption of training and competition was better after hamstring plasty compared with patellar tendon plasty for follow-up less than or equal to 12 months (p = 0.0009 and 0.0001 respectively). The subjective IKDC score was also significantly better in the hamstring group for the period considered (p = 0.0006). The differences observed early in the follow-up resolved over time and no significant difference was observed at 18 and 22 months. Regarding the MacIntosh fascia lata plasty, resumption of competition was significantly earlier (7.67 ± 1.87 months) compared with hamstring plasty (9.69 ± 2.58 months) and patellar tendon plasty (9.65 ± 3 months). Resumption of training (90%) and competition (76%) was also better with the MacIntosh fascia lata plasty compared with the two other techniques but the difference was not significant. These differences, in favor of the MacIntosh fascia lata plasty, might have been due to a recruitment bias since the level of the sports activities was significantly higher in the MacIntosh population than in the populations of the other two methods.

Conclusion

This study is of particular interest because of the size of the homogeneous study population resulting from the highly selective recruitment of athletes at the CERS. This study is generally in agreement with prior data in the literature, particularly concerning the rate of resumed training one year after surgery. This study shows that the patellar tendon plasty reaches maturity more slowly than the hamstring plasty although the two techniques yielded comparable results at 18 months for all criteria studied.     

ACL tears in female athletes

With the growing number of female athletes, an increase is occurring in the number of sports-related injuries, which can cause physical, psychological, academic, and financial suffering. Female athletes are reported to be two to eight times more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Further research on risk factors and preventative strategies for the female ACL is needed, because the cause of the disparity in injury rates remains equivocal and controversial. Individualized treatment for the injured knee is necessary and can include either conservative treatment or reconstructive surgery.     

EFFECT OF INJURY PREVENTION TRAINING ON KNEE MECHANICS IN FEMALE ADOLESCENTS DURING PUBERTY

Purpose/Background:

Female adolescents change their landing mechanics during puberty. It is unknown whether implementation of anterior cruciate ligament (ACL) injury prevention training reduces the loss of knee control in female athletes during puberty. The purpose of this study was to evaluate the effect of injury prevention training on dynamic knee alignment in female basketball players specifically when the knee mechanics were changing during puberty.

Methods:

Sixty female junior high school basketball players participated and were divided into two groups: a training group (n = 32) and a control group (n = 28). The training group underwent an injury prevention program for 6 months, whereas the control group maintained a regular training routine. The knee valgus motion and knee flexion range of motion during a drop vertical jump were measured before and after the training period. The probability of a high knee abduction moment (pKAM) was also evaluated using an ACL injury prediction algorithm.

Results:

The knee valgus motion was significantly increased in the control group (p < 0.001), whereas it did not change in the training group (p = 0.64). Similarly, the knee flexion range of motion was significantly decreased in the control group (p < 0.001), whereas it was not changed in the training group (p = 0.55). The pKAM was significantly increased in the control group (p < 0.001), but not in the training group (p = 0.06).

Conclusions:

Implementation of injury prevention training was effective in limiting the loss of knee control in female athletes during puberty. Lowering the risk of ACL injury might be possible in this population.

Level of Evidence:

2b     

Influence of relative injury risk profiles on anterior cruciate ligament and medial collateral ligament strain during simulated landing leading to a noncontact injury event

BackgroundAthletes have traditionally been subdivided into risk classifications for ACL injury relative to the biomechanical traits they display during landing. This investigation aimed to discern whether these separate risk classifications elicit strain differences on the ACL and MCL during landing. It was hypothesized that the higher risk simulation profiles would exhibit greater ACL strain and that the ACL would exhibit greater strain than the MCL under all conditions.MethodThe mechanical impact simulator was used to simulate landing on a cohort of 46 cadaveric specimens. The simulator applied external joint loads to the knee prior to impulse delivery. These loads were organized into a series of profiles derived from in vivo motion capture previously performed on a cohort of 44 athletes and represented various risk classifications. Strain gauges were implanted on the ACL and MCL and simulations performed until a structural failure was elicited. Differences were assessed with Kruskal-Wallis tests.FindingsThe highest-risk profiles tended to exhibit greater peak ACL strain and change in ACL strain than the baseline- and moderate-risk profiles. Specimens that failed during lower-risk simulations expressed greater strain at these loads than specimens that completed higher-risk simulations. The ACL recorded greater strain than the MCL throughout all simulation profiles.InterpretationThis behavior justifies why neuromuscular interventions have greater impact on higher-risk athletes and supports the continued screening and targeted training of those athletes that express greater injury risk. The loading disparity between ACL and MCL justifies their limited concomitant injury rate.     

RELATIONSHIPS BETWEEN CORE ENDURANCE,HIP STRENGTH,AND BALANCE IN COLLEGIATE FEMALE ATHLETES

Purpose/Background:

Lower extremity injuries such as Anterior Cruciate Ligament (ACL) tears remain a concern in collegiate female athletes. Core endurance and hip strength reportedly influence ACL and lower extremity injury risk. Good neuromuscular control, as measured by the Star Excursion Balance Test (SEBT) test is associated with decreased lower extremity injuries. The exact relationships between core endurance, hip strength, and balance (SEBT scores), and how they impact one another in the female collegiate athlete remain unclear. Thus, the purpose of this study was to investigate relationships between core endurance, hip strength, and balance in collegiate female athletes.

Methods:

Forty collegiate female athletes (19.6±1.1yrs, 163.1±7.8cm, 61.3±6.5kgs) performed the SEBT in anterior, posterolateral, and posteromedial directions bilaterally (% leg length), McGill''s anterior, posterior, and left and right plank core endurance tests (seconds), and hip abductor, flexor, extensor, and external rotator isometric strength tests bilaterally (N) using handheld dynamometry. Pearson''s product moment correlations examined relationships between core endurance, hip strength, and balance. A linear regression analysis examined whether core endurance and hip strength influenced balance (p≤0.05).

Results:

Anterior SEBT scores were fairly positively correlated with hip flexor and extensor strength. Posterolateral SEBT scores were fairly positively correlated with hip abductor, extensor, and flexor strength (p=0.02‐to‐0.004; r=0.26‐to‐0.45). Fair positive correlations existed between posterior core endurance and hip extensor strength bilaterally (right: p=0.02, r=0.37; left: p=0.003, r=0.47). Core endurance and SEBT scores were not correlated (p>0.05). Core endurance and hip strength did not influence SEBT scores (p=0.47).

Conclusions:

Overall, hip strength, but not core endurance was related to SEBT scores in collegiate female athletes. Females with greater hip flexor, extensor, and abductor strength also had better anterior and posterolateral SEBT scores. Having females participate in hip muscle strengthening programs may help improve their SEBT balance scores, as a measure of their neuromuscular control and influence their ACL and lower extremity injury risk.

Level of Evidence:

2b     

Sex and Age Comparisons in Neuromuscular And Biomechanical Characteristics of the Knee in Young Athletes

BackgroundThe identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs.Hypothesis/PurposeThis study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes.Study DesignCross-sectionalMethodsForty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic knee flexion and extension strength tests, single-leg static balance and single-leg vertical stop jump tasks.ResultsHigh school athletes were significantly stronger (~67% and 35% stronger for males and females, respectively) and jumped higher (regardless of sex) compared to school age athletes. High school males had worse balance (~28%) compared to their younger counterparts. High school females had lower strength (~23%) compared to males but had better balance (~46%). Conclusion: Maturation had different effects on the variables analyzed and sex differences were mainly observed after maturation. These differences may be minimized through appropriate age and sex specific training programs.Levels of Evidence3aClinical RelevanceNeuromuscular and biomechanical differences between sex and age groups should be accounted for in injury prevention and rehabilitation. Inadequate training may be a primary factor contributing to injuries in a young athletic population. When designing training programs for long term athlete development, programs should be dependent on decrements seen at specific time points throughout maturation.What is known about the subject: Generally, both males and females get stronger and jump higher as they get older but the results comparing balance and biomechanics between genders or across age groups have been mixed.What this study adds to existing knowledge: The current study looks at multiple neuromuscular and biomechanical variables in male and female participants at different maturation statuses. The current data supports the significant changes observed in strength and jump height, as both genders age, but the data also demonstrates significant differences in balance between age groups in males and between genders in balance and knee flexion angles.     

Incidence des ruptures du LCA chez le jeune rugbyman et intérêt de la prévention

We followed two teams of young rugby players for two seasons to determine the incidence of anterior cruciate ligament (ACL) tears in these young athletes (2.45/1000 playing hours). Risk factors were quality of the playing field and insufficient physical training. In light of the data in the literature, we consider that prevention based on awareness of the risk factors can and should play a crucial role in decreasing the incidence of these serious sports accidents.     

Multicenter trial of motion analysis for injury risk prediction: lessons learned from prospective longitudinal large cohort combined biomechanical - epidemiological studies

Our biodynamics laboratory group has conducted large cohort biomechanical-epidemiological studies targeted at identifying the complex interactions among biomechanical, biological, hormonal, and psychosocial factors that lead to increased risk of anterior cruciate ligament (ACL) injuries. The findings from our studies have revealed highly sensitive and specific predictors for ACL injury. Despite the high incidence of ACL injuries among young athletes, larger cohorts are needed to reveal the underlying mechanistic causes of increased risk for ACL injury. In the current study, we have outlined key factors that contribute to the overall success of multicenter, biomechanical-epidemiological investigations designed to test a larger number of athletes who otherwise could not be recruited, screened, or tested at a single institution. Twenty-five female volleyball players were recruited from a single high school team and tested at three biodynamics laboratories. All athletes underwent three-dimensional motion capture analysis of a drop vertical jump task. Kinematic and kinetic variables were compared within and among laboratories. Reliability of peak kinematic variables was consistently rated good-to-excellent. Reliability of peak kinetic variables was consistently rated goodto-excellent within sites, but greater variability was observed between sites. Variables measured in the sagittal plane were typically more reliable than variables measured in the coronal and transverse planes. This study documents the reliability of biomechanical variables that are key to identification of ACL injury mechanisms and of athletes at high risk. These findings indicate the feasibility of executing multicenter, biomechanical investigations that can yield more robust, reliable, and generalizable findings across larger cohorts of athletes.     

The effectiveness of balance training programs on reducing the incidence of ankle sprains in adolescent athletes

Ankle sprains are one of the most common sport-related injuries treated by rehabilitation professionals. These injuries often result in lost participation and can lead to subsequent injury episodes. Therefore, it is important to determine appropriate means of preventing these injuries. There has recently been an increase in the popularity of balance training programs for the prevention of knee anterior cruciate ligament (ACL) injury, with some thought that starting these programs in younger athletes may be most beneficial. However, there is the potential that these types of training programs may also be beneficial for decreasing the risk of other lower extremity injuries, including ankle sprains in the adolescent athlete.     

Critical review of the impact of core stability on upper extremity athletic injury and performance

BACKGROUND:

Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered.

OBJECTIVES:

1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance.

DISCUSSION:

Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance.

CONCLUSIONS:

A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes.