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ABSTRACT:We examined the effect of a 2-week anterior-to-posterior ankle joint mobilization intervention on weight-bearing dorsiflexion range of motion (ROM), dynamic balance, and self-reported function in subjects with chronic ankle instability (CAI). In this prospective cohort study, subjects received six Maitland Grade III anterior-to-posterior joint mobilization treatments over 2 weeks. Weightbearing dorsiflexion ROM, the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test (SEBT), and self-reported function on the Foot and Ankle Ability Measure (FAAM) were assessed 1 week before the intervention (baseline), prior to the first treatment (pre-intervention), 24-48 h following the final treatment (post-intervention), and 1 week later (1-week follow-up) in 12 adults (6 males and 6 females) with CAI. The results indicate that dorsiflexion ROM, reach distance in all directions of the SEBT, and the FAAM improved (p < 0.05 for all) in all measures following the intervention compared to those prior to the intervention. No differences were observed in any assessments between the baseline and pre-intervention measures or between the postintervention and 1-week follow-up measures (p > 0.05). These results indicate that the joint mobilization intervention that targeted posterior talar glide was able to improve measures of function in adults with CAI for at least 1 week. ß

Since previous numbers-needed-to-treat (NNT) and relative risk reduction (RRR) report, a few studies were published to evaluate prophylactic effectiveness of neuromuscular training for anterior cruciate ligament (ACL) injury in female athletes. The purpose of the current analyses was to determine the effectiveness of neuromuscular training interventions in reducing both non-contact and overall ACL injury risk in female athletes through RRR and NNT. The keywords ‘knee’, ‘anterior cruciate ligament’, ‘ACL’, ‘prospective’, ‘neuromuscular’, ‘training’, ‘female’ and ‘prevention’ were searched to find studies published from 1995 to 2011 in PubMed and EBSCO (CINAHL, Health source, MEDLINE and SPORT Discus). Inclusion criteria required that relevant studies: recruited physically active young girls as subjects, documented the number of ACL injuries, employed a neuromuscular training intervention, and used a prospective controlled study design. The numbers of non-contact and overall ACL injuries, subjects and observation time period were used to calculate RRR and NNT for each study. A total of 12 studies met the inclusion criteria. There was a 73.4% (95% CI 62.5% to 81.1%) and 43.8% (95% CI 28.9% to 55.5%) of RRR for non-contact and overall ACL injuries. From the NNT analysis, it was determined that, respectively, 108 (95% CI 86 to 150) and 120 (95% CI 74 to 316) individuals would need to be trained to prevent one non-contact or one overall ACL injury over the course of one competitive season. Although the RRR analysis indicated prophylactic benefits of neuromuscular training, the relatively large NNT indicated that many athletes are needed to prevent one ACL injury. A future direction to reduce NNT and improve the efficiency of ACL injury-prevention strategies is to develop a screening system for identifying at-risk athletes.

Context:No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury.Objective: To systematically review and synthesize the published literature to determine if compliance with neuromuscular training is associated with reduced incidence of ACL injury in young female athletes.Data Sources: We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective knee prevention, neuromuscular training, and neuromuscular intervention.Study Selection: Criteria for inclusion required that (1) the number of ACL injuries was reported, (2) a neuromuscular training program was used, (3) females were included as participants, (4) the study design was prospective and controlled, and (5) compliance data for the neuromuscular training program were provided.Data Extraction: Extracted data included the number of ACL injuries, total number of participants per group, observation time period, number of participants who completed each session, number of sessions completed by an entire team, and number of total sessions. Attendance was calculated as the number of participants who completed each session converted into a percentage of the total number of participants. Intervention completion was calculated as the number of sessions completed by an entire team converted into a percentage of the total number of training sessions. These data were used to calculate an overall rate of compliance.Data Synthesis: Six of 205 identified studies were included. Incidence rates of ACL injury were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance rates (incidence rate ratio ¼ 0.27 [95% confidence interval ¼ 0.07, 0.80]). Tertile analysis indicated rates of ACL injury incidence were lower in studies with high compliance rates than in studies with moderate and low compliance rates (incidence rate ratio ¼ 0.18 [95% confidence interval ¼ 0.02, 0.77]).Conclusions: A potential inverse dose-response relationship exists between compliance with neuromuscular training and incidence of ACL injury. Attending and completing recommended neuromuscular sessions appears to be an important factor for preventing ACL injuries.Key Words: knee, injury prevention, exercises Key PointsHigher rates of compliance with neuromuscular training programs were associated with lower rates of anterior cruciate ligament (ACL) injury incidence among physically active young females. A potential inverse dose-response relationship exists between compliance with neuromuscular training and the incidence of ACL injury in young female athletes. Attending and completing prescribed neuromuscular training sessions seem to be integral components of preventing ACL injuries in young female athletes.

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Progressive activation levels were documented for muscles acting on the hip joint during 3 functional lower extremity exercises. The authors recommend using this exercise progression when targeting the hip muscles during lower extremity strengthening.

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Context: A discrepancy in anterior cruciate ligament (ACL) injury rates exists between men and women. Structural differences between the sexes often are implicated as a factor in this discrepancy. Researchers anecdotally assume that men and women tend to display different normative values for certain lower extremity alignments, but published information about these values is limited.Objective: To evaluate the effect of sex on 6 measures of lower extremity alignment and to report representative values of these measures from a sample of active adults and elite athletes.Design: Descriptive cohort design. Setting: University research laboratory. Patients or Other Participants: A total of 118 healthy adults (57 men: age 5 21.1 6 3.0 years, height 5 179.1 6 7.3 cm, mass 5 79.8 6 13.0 kg; 61 women: age 5 20.0 6 1.6 years, height 5 167.7 6 6.7 cm, mass 5 62.7 6 5.5 kg) volunteered.Main Outcome Measure(s): Six common measures of lower extremity posture (navicular drop, tibial varum, quadriceps angle, genu recurvatum, anterior pelvic tilt, femoral anteversion) were collected using established methods. One measurement was taken for each participant for each lower extremity alignment. We measured the right lower extremity only.Results: Compared with men, women demonstrated larger quadriceps angles, more genu recurvatum, greater anterior pelvic tilt, and more femoral anteversion.Conclusions: We observed differences between men and women for 4 of the 6 lower extremity alignments that we measured. Future researchers should focus on identifying how sex and skeletal alignment affect biomechanical performance of functional tasks and what these differences specifically mean regarding the discrepancy in anterior cruciate ligament injury rates between the sexes.Key Words: malalignment, femoral anteversion, genu recurvatum, anterior pelvic tilt, quadriceps angle Key Points N Women demonstrated larger quadriceps angles, more genu recurvatum, greater anterior pelvic tilt, and more femoral anteversion compared with men.N We found no sex difference for navicular drop or tibial varum. N Because the sex differences for 4 measures of alignment were small, we cannot decisively conclude that alignment contributes to lower extremity injury.N Further investigation is needed to determine how lower extremity alignment affects the rate of lower extremity injuries.