Anterior Cruciate Ligament Injury Prevention Exercises: Could a Neuromuscular Warm-Up Improve Muscle Pre-Activation before a Soccer Game? A Proof-of-Principle Study on Professional Football Players

Abstract

Neuromuscular warm-up has been shown to decrease the risk of anterior cruciate ligament (ACL) injury improving muscular firing patterns. All preventive training programs described in the literature have a duration of several weeks. To date, no studies have explored the immediate effect of a neuromuscular warm-up exercise on pre-activation time of the knee stabilizer muscles. Thus, this proof-of-principle study aimed at evaluating the acute effects of a neuromuscular warm-up exercises on the electromyographic activation of knee stabilizer muscles’ activation pattern. We included 11 professional football players, mean aged 23.2 ± 4.5 years, from a Southern Italy football team. All of them underwent a standard warm-up exercise protocol at the first day of the evaluation. At 1 week, they underwent a structured neuromuscular warm-up exercise protocol. We assessed as outcome measure the pre-activation time (ms) of rectus femoris (RF), vastus medialis (VM), biceps femoris (BF), and medial hamstrings (MH) upon landing. Outcomes were assessed before and after the standard warm-up and neuromuscular warm-up. Pre-activation time of RF, VM, BF and MH significantly improved only after neuromuscular warm-up (p < 0.05); moreover, there was a significant (p < 0.05) between-group difference in pre-activation time of all muscles after the neuromuscular warm-up compared with the standard warm-up. These findings suggested that physical exercise consisting of a structured injury prevention neuromuscular warm-up might have an immediate effect in improving the activation time of the knee stabilizer muscles, thus potentially reducing the risk of ACL injury.

Heterogeneous effects of eccentric training and nordic hamstring exercise on the biceps femoris fascicle length based on ultrasound assessment and extrapolation methods: A systematic review of randomised controlled trials with meta-analyses

“…The hamstring muscles are important contributors for stabilizing the knee joint, and a more balanced hamstring to quadriceps force ratio is shown to reduce lower limb injury [ 10 – 12 ]. The majority of HSIs occur during running activities [ 13 , 14 ].…”

Asymmetries in Dynamic Valgus Index After Anterior Cruciate Ligament Reconstruction: A Proof-of-Concept Study

“…In addition, DVI assessment could potentially contribute to ACL injury prevention programs as neuromuscular and proprioception programs have been shown to reduce ACL injury risk by 50.7%, particularly in female athletes [39]. Neuromuscular warm-up exercise has been shown to immediately increase pre-activation of knee stabilizer muscles, which could potentially decrease ACL load and dynamic valgus [40]. Since late neuromuscular timing, specifically of the vastus medialis, has been correlated to increased dynamic knee valgus [13,14], incorporation of the DVI assessment with neuromuscular training could potentially provide a more in-depth measure of the effects of this training.…”

Biopotential Signal Monitoring Systems in Rehabilitation: A Review

“…Surface EMG is becoming a popular research tool in sport and rehabilitation sciences. In athletes' rehabilitation, EMG is useful to analyze muscle dysfunction, to detect not-correct muscle activation patterns and to assist in establishing and assessing treatment outcomes [57][58][59]. The correct utilization of muscles and the rapid identification of anomalous muscle pattern activation help the athletes to improve their activities and to prevent the risk of injury [60].…”