Studies in Sport Medicine

The effect of German Knee Association training program (STOP X program) on knee condition and balance of adolescent soccer players with dynamic knee valgus

Document Type : Research Paper

Authors

University of Guilan

Abstract
This study aimed to determine the effect of the German Knee Association training program on knee alignment and balance of adolescent soccer players with dynamic knee valgus. In this study, 30 adolescent soccer players with dynamic knee valgus defects were randomly divided into control and training groups. In this study, the squat test, landing-jump test, bass stick, and Y balance test were used to evaluate the variables. After determining the variables in the pre-test, the subjects in the training group performed Stop X exercises for 8 weeks, and the control group participated in the team's physical fitness program during this period. To investigate the differences, the paired t-test, ANCOVA test was used at a significance level of 0.05. In terms of intergroup comparison, a significant difference was observed between the control and training groups in all variables (except for the knee flexion variable at the moment of impact) (p ≤ 0.05). According to the results, it can be concluded that Stop X exercises have affected these people. Instructors and specialists are recommended to use this program to prevent injuries.

Keywords

  1. Thorborg K, Krommes KK, Esteve E, Clausen MB, Bartels EM, Rathleff MS. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. British journal of sports medicine. 2017;51(7):562-71. doi: 10.1136/bjsports-2017-097591.
  2. Jlid MC, Racil G, Coquart J, Paillard T, Bisciotti GN, Chamari K. Multidirectional plyometric training: very efficient way to improve vertical jump performance, change of direction performance and dynamic postural control in young soccer players. Frontiers in physiology. 2019;10:1462. https://doi.org/10.3389/fphys.2019.01462.
  3. De Bleecker C, Vermeulen S, De Blaiser C, Willems T, De Ridder R, Roosen P. Relationship between jump-landing kinematics and lower extremity overuse injuries in physically active populations: a systematic review and meta-analysis. Sports Medicine. 2020;50:1515-32. https://doi.org/10.1007/s40279-020-01296-7.
  4. Ford KR, Myer GD, Hewett TE. Valgus knee motion during landing in high school female and male basketball players. Medicine & Science in Sports & Exercise. 2003;35(10):1745-50. DOI:10.1249/01.MSS.0000089346.85744.D9.
  5. Dai B, Layer JS, Bordelon NM, Critchley ML, LaCroix SE, George AC, et al. Longitudinal assessments of balance and jump-landing performance before and after anterior cruciate ligament injuries in collegiate athletes. Research in Sports Medicine. 2021;29(2):129-40. https://doi.org/10.1080/15438627.2020.1721290.
  6. Gonell AC, Romero JAP, Soler LM. Relationship between the Y balance test scores and soft tissue injury incidence in a soccer team. International journal of sports physical therapy. 2015;10(7):955. PMCID: PMC4675196.
  7. Werner BC, Yang S, Looney AM, Gwathmey FW. Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. Journal of Pediatric Orthopaedics. 2016;36(5):447-52. https://doi.org/10.1097/BPO.0000000000000482.
  8. Christino MA, Tepolt FA, Sugimoto D, Micheli LJ, Kocher MS. Revision ACL reconstruction in children and adolescents. Journal of Pediatric Orthopaedics. 2020;40(3):129-34. doi: 10.1097/BPO.0000000000001155
  9. Kianifar R, Lee A, Raina S, Kulić D. Automated assessment of dynamic knee valgus and risk of knee injury during the single leg squat. IEEE journal of translational engineering in health and medicine. 2017;5:1-13. DOI: 10.1109/JTEHM.2017.2736559.
  10. Myer GD, Brent JL, Ford KR, Hewett TE. Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength and conditioning journal. 2011;33(3):21. doi: 10.1519/SSC.0b013e318213afa8.
  11. Lima YL, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion range of motion and dynamic knee valgus: A systematic review with meta-analysis. Physical Therapy in Sport. 2018;31:e4. https://doi.org/10.1016/j.ptsp.2017.07.003
  12. Suzuki H, Omori G, Uematsu D, Nishino K, Endo N. The influence of hip strength on knee kinematics during a single-legged medial drop landing among competitive collegiate basketball players. International journal of sports physical therapy. 2015;10(5):592. PMCID: PMC4595912.
  13. Taylor JB, Waxman JP, Richter SJ, Shultz SJ. Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis. British journal of sports medicine. 2015;49(2):79-87. http://dx.doi.org/10.1136/bjsports-2013-092358.
  14. Herman K, Barton C, Malliaras P, Morrissey D. The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC medicine. 2012;10(1):1-12. https://doi.org/10.1177/0363546507311602.
  15. Lagas IF, Meuffels DE, Visser E, Groot FP, Reijman M, Verhaar JA, et al. High knee loading in male adolescent pre-professional football players: Effects of a targeted training programme. Journal of science and medicine in sport. 2019;22(2):164-8. https://doi.org/10.1016/j.jsams.2018.06.016.
  16. Read PJ, Oliver JL, De Ste Croix M, Myer GD, Lloyd RS. A prospective investigation to evaluate risk factors for lower extremity injury risk in male youth soccer players. Scandinavian journal of medicine & science in sports. 2018;28(3):1244-51. doi: 10.1519/JSC.0000000000001438.
  17. Padua DA, DiStefano LJ, Hewett TE, Garrett WE, Marshall SW, Golden GM, et al. National Athletic Trainers' Association position statement: prevention of anterior cruciate ligament injury. Journal of athletic training. 2018;53(1):5-19. https://doi.org/10.4085/1062-6050-99-16.
  18. Nessler T, Denney L, Sampley J. ACL injury prevention: what does research tell us? Current reviews in musculoskeletal medicine. 2017;10(3):281-8. https://doi.org/10.1007/s12178-017-9416-5.
  19. Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee surgery, sports traumatology, arthroscopy. 2017;25(1):192-9. DOI 10.1007/s00167-016-4246-3
  20. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. journal of orthopaedic & sports physical therapy. 2010;40(2):42-51. https://www.jospt.org/doi/10.2519/jospt.2010.3337.
  21. Chappell JD, Yu B, Kirkendall DT, Garrett WE. A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. The American journal of sports medicine. 2002;30(2):261-7. https://doi.org/10.1177/03635465020300021901.
  22. Bell DR, Oates DC, Clark MA, Padua DA. Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. Journal of athletic training. 2013;48(4):442-9. https://doi.org/10.1016/j.math.2015.09.010.
  23. Nagano Y, Ida H, Akai M, Fukubayashi T. Biomechanical characteristics of the knee joint in female athletes during tasks associated with anterior cruciate ligament injury. The Knee. 2009;16(2):153-8. https://doi.org/10.1016/j.knee.2008.10.012.
  24. Mohammadinia Samakosh H, Shojaedin SS, Hadadnezhad M. Comparison of effect of hopping and combined balance - strength training on balance and lower extremity selected muscles strength of soccer men with chronic ankle instability. Journal of Gorgan University of Medical Sciences. 2019;21(3):69-78. http://goums.ac.ir/journal/article-1-3387-en.html.
  25. Shaffer SW, Teyhen DS, Lorenson CL, Warren RL, Koreerat CM, Straseske CA, et al. Y-balance test: a reliability study involving multiple raters. Military medicine. 2013;178(11):1264-70. https://doi.org/10.7205/MILMED-D-13-00222.
  26. Niederer D, Keller M, Achtnich A, Akoto R, Ateschrang A, Banzer W, et al. Effectiveness of a home-based re-injury prevention program on motor control, return to sport and recurrence rates after anterior cruciate ligament reconstruction: study protocol for a multicenter, single-blind, randomized controlled trial (PReP). Trials. 2019;20(1):1-10. https://doi.org/10.1186/s13063-019-3610-2
  27. Kachouri H, Borji R, Baccouch R, Laatar R, Rebai H, Sahli S. The effect of a combined strength and proprioceptive training on muscle strength and postural balance in boys with intellectual disability: An exploratory study. Research in developmental disabilities. 2016;53:367-76.https://doi.org/10.1016/j.ridd.2016.03.003
  28. Grooten WJA, Karlefur O, Conradsson D. Effects of verbal knee alignment instructions on knee kinematics, kinetics and the performance of a single-leg jump in female adolescent soccer players. European Journal of Physiotherapy. 2020;22(2):106-14. https://doi.org/10.1080/21679169.2019.1578823.
  29. Podraza JT, White SC. Effect of knee flexion angle on ground reaction forces, knee moments and muscle co-contraction during an impact-like deceleration landing: implications for the non-contact mechanism of ACL injury. The Knee. 2010;17(4):291-5. https://doi.org/10.1016/j.knee.2010.02.013.
  30. Schwameder H. Schwameder H. Effect of a neuromuscular home training program on dynamic knee valgus (DKV) in lateral single-leg landings. ISBS Proceedings Archive. ISBS Proceedings Archive. 2020;38(1):736. https://commons.nmu.edu/isbs/vol38/iss1/186.
  31. Mohammadi H, Daneshmandi H, Alizadeh MH. Effect of Corrective Exercises Program on Strength، ROM, and Performance in Basketball Players with Dynamic Knee Valgus. J Rehab Med. 2019;8(3):29-41. DOI: 10.22037/jrm.2019.111286.1887.
  32. Corl-Baietti B. The Effects of 6 Weeks of Hip-Strengthening Exercises on Drop Jump Performance in Middle School Students. 2020. https://cedar.wwu.edu/wwuet/958.
  33. Sasaki S, Tsuda E, Yamamoto Y, Maeda S, Kimura Y, Fujita Y, et al. Core-muscle training and neuromuscular control of the lower limb and trunk. Journal of athletic training. 2019;54(9):959-69. doi: 10.22080/JAEP.2019.15101.1818.
  34. Myer GD, Ford KR, McLean SG, Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. The American journal of sports medicine. 2006;34(3):445-55. https://doi.org/10.1186/1471-2474-8-39.
  35. Lopes TJA, Simic M, Myer GD, Ford KR, Hewett TE, Pappas E. The effects of injury prevention programs on the biomechanics of landing tasks: a systematic review with meta-analysis. The American journal of sports medicine. 2018;46(6):1492-9. https://doi.org/10.1177/0363546517716930.
  36. Chappell JD, Herman DC, Knight BS, Kirkendall DT, Garrett WE, Yu B. Effect of fatigue on knee kinetics and kinematics in stop-jump tasks. The American journal of sports medicine. 2005;33(7):1022-9. https://doi.org/10.1177/03635465020300021901.
  37. Decker MJ, Torry MR, Wyland DJ, Sterett WI, Steadman JR. Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clinical biomechanics. 2003;18(7):662-9. https://doi.org/10.1016/S0268-0033(03)00090-1.
  38. Shultz SJ, Beynnon BD, Schmitz RJ. Sex differences in coupled knee motions during the transition from non‐weight bearing to weight bearing. Journal of Orthopaedic Research. 2009;27(6):717-23. https://doi.org/10.4085/1062-6050-50.10.06.
  39. Norcross MF, Blackburn JT, Goerger BM, Padua DA. The association between lower extremity energy absorption and biomechanical factors related to anterior cruciate ligament injury. Clinical biomechanics. 2010;25(10):1031-6. https://doi.org/10.1016/j.clinbiomech.2010.07.013.
  40. Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. Journal of orthopaedic research. 1995;13(6):930-5.org/10.1002/jor.1100130618.
  41. Dempsey AR, Elliott BC, Munro BJ, Steele JR, Lloyd DG. Can technique modification training reduce knee moments in a landing task? Journal of applied biomechanics. 2014;30(2):231-6. DOI: https://doi.org/10.1123/jab.2013-0021.
  42. Imaoka K, Murase H, Fukuhara M. Collection of data for healthy subjects in stabilometry. Equilibrium Research. 1997;56(12Supplement):1-84.https://doi.org/10.3757/jser.56.12Supplement_1
  43. Shumway-Cook A, Woollacott MH. Controle motor: teoria e aplicações práticas: Manole; 2003.

 

  1. Oshima T, Nakase J, Kitaoka K, Shima Y, Numata H, Takata Y, et al. Poor static balance is a risk factor for non-contact anterior cruciate ligament injury. Archives of orthopaedic and trauma surgery. 2018;138(12):1713-8. https://doi.org/10.1007/s00402-018-2984-z.
  2. Imai A, Kaneoka K, Okubo Y, Shiraki H. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. International journal of sports physical therapy. 2014;9(1):47. PMCID: PMC3924608.
  3. Mehl J, Diermeier T, Herbst E, Imhoff AB, Stoffels T, Zantop T, et al. Evidence-based concepts for prevention of knee and ACL injuries. 2017 guidelines of the ligament committee of the German Knee Society (DKG). Archives of orthopaedic and trauma surgery. 2018;138(1):51-61. https://doi.org/10.1007/s00402-017-2809-5.
  4. Powers CM, Fisher B. Mechanisms underlying ACL injury-prevention training: the brain-behavior relationship. Journal of athletic training. 2010;45(5):513-5. https://www.jospt.org/doi/10.2519/jospt.2010.3337.
  5. Mizner RL, Kawaguchi JK, Chmielewski TL. Muscle strength in the lower extremity does not predict postinstruction improvements in the landing patterns of female athletes. journal of orthopaedic & sports physical therapy. 2008;38(6):353-61. https://www.jospt.org/doi/10.2519/jospt.2008.2726.

Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: 49 systematic review. Medicine & Science in Sports & Exercise. 2010;42(3):413-21. DOI: 10.1249/MSS.0b013e3181b88d3.

Studies in Sport Medicine
Volume 13, Issue 30 - Serial Number 30
February 2022
Pages 231-254

  • Receive Date 10 October 2021
  • Revise Date 30 December 2021
  • Accept Date 08 January 2022

Home

Publication Ethics

Submit Manuscript

news

Journal Metrics

Contact Us