Transfer of improved movement technique after receiving verbal external focus and video instruction.

PURPOSE: It is unknown how movement patterns that are learned carry over to the field. The objective was to determine whether training during a jump-landing task would transfer to lower extremity kinematics and kinetics during sidestep cutting. METHODS: Forty healthy athletes were assigned to the verbal internal focus (IF, n = 10), verbal external focus (EF, n = 10), video (VI, n = 10) or control (CTRL, n = 10) group. A jump-landing task was performed as baseline followed by training blocks (TR1 and TR2) and a post-test. Group-specific instructions were given in TR1 and TR2. In addition, participants in the IF, EF and VI groups were free to ask for feedback after every jump during TR1 and TR2. Retention was tested after 1 week. Transfer of learned skill was determined by having participants perform a 45° unanticipated sidestep cutting task. 3D hip, knee and ankle kinematics and kinetics were the main outcome measures. RESULTS: During sidestep cutting, the VI group showed greater hip flexion ROM compared to the EF and IF groups (p < 0.001). The EF (p < 0.036) and VI (p < 0.004) groups had greater knee flexion ROM compared to the IF group. CONCLUSIONS: Improved jump-landing technique carried over to sidestep cutting when stimulating an external attentional focus combined with self-controlled feedback. Transfer to more sport-specific skills may demonstrate potential to reduce injuries on the field. Clinicians and practitioners are encouraged to apply instructions that stimulate an external focus of attention, of which visual instructions seem to be very powerful. LEVEL OF EVIDENCE: II.

Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial.

PURPOSE: Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during unexpected sidestep cutting in female and male athletes and how these effects remained over time. METHODS: Ninety experienced basketball athletes performed sidestep cutting manoeuvres in three sessions (S1, S2 and S3). In this randomized controlled trial, athletes were allocated to three groups: visual (VIS), verbal (VER) and control (CTRL). Kinematics and kinetics were collected at the time of peak knee frontal plane moment. RESULTS: Males in the VIS group showed a larger vertical ground reaction force (S1: 25.4 ± 3.1 N/kg, S2: 25.8 ± 2.9 N/kg, S3: 25.2 ± 3.2 N/kg) and knee flexion moments (S1: -3.8 ± 0.9 Nm/kg, S2: -4.0 ± 1.2 Nm/kg, S3: -3.9 ± 1.3 Nm/kg) compared to the males in the VER and CTRL groups and to the females in the VIS group (p < 0.05). Additionally, the males in the VIS group reduced knee valgus moment and the females in the VER group reduced knee varus moment over time (n.s.). CONCLUSION: Male subjects clearly benefit from visual feedback. Females may need different feedback modes to learn a correct movement pattern. Sex-specific learning preferences may have to be acknowledged in day by day practice. Adding video instruction or feedback to regular training regimens when teaching athletes safe movement patterns and providing individual feedback might target suboptimal long-term results and optimize ACL injury prevention programmes. LEVEL OF EVIDENCE: I.

What is the true evidence for gender-related differences during plant and cut maneuvers? A systematic review.

PURPOSE: Female athletes have a significantly higher risk of sustaining an anterior cruciate ligament (ACL) injury than male athletes. Biomechanical and neuromuscular factors have been reported as the main cause. The purpose of this review was to critically review results of the published literature on gender differences regarding biomechanical and neuromuscular movement patterns during plant and cutting maneuvers. METHODS: MEDLINE (1966 to December 2008), EMBASE (1947 to December 2008) and CINAHL (1981 to December 2008) searches were performed. The seven studies meeting the inclusion criteria were analyzed. RESULTS: Biomechanical gender differences were of questionable clinical relevance. Quadriceps dominance was not found in women. CONCLUSION: The question raises whether ACL injuries during plant and cutting maneuvers are purely gender related and whether women do have to move like men in order to reduce injury risk? Caution is warranted in making inferences as studies were heterogeneous in terms of subject and study characteristics and had low statistical power as a result of insufficient number of subjects. It is advised that future research moves beyond the isolated gender comparison and that larger sample sizes will be included. This review may aid in improving experiments to draw valid conclusions, in order to direct future ACL injury prevention programs, which might need to be more individualized.