Effectiveness of Injury Prevention Program Using a Global Systems Approach on High-Risk Movement Mechanics for Noncontact ACL Injury

Background: Injury prevention training using a global systems approach was designed to develop integrated trunk-lower extremity neuromuscular control using whole-body, rotational forces about the vertical Z-axis during simulated sports movements.

Hypothesis: Compared with traditional hip-focused exercises, injury prevention training using a global systems approach could improve kinetic and kinematic measures related to anterior cruciate ligament injury.

Study design: Controlled laboratory study.

Level of evidence: Level 3.

Methods: A total of 39 male and female athletes received 6 weeks of either global systems approach (n = 20), or hip-focused strengthening, balance, and plyometrics training (n = 19) exercises. Before and after the training program, participants performed a single-leg vertical drop jump task on their dominant leg. Peak vertical ground-reaction forces (GRFs), peak knee abduction, internal rotation moments, peak hip flexion, hip adduction, knee flexion, knee abduction, contralateral pelvic drop, and lateral trunk flexion angles were assessed. Biomechanical data were compared between the 2 groups using a random-intercept linear mixed-models analysis.

Results: A significant group × time interaction effect was found for vertical GRFs (P = 0.01; change difference relative to baseline: 4.5%), knee abduction moment (P = 0.01; 14.8%), hip adduction (P < 0.01; 16.7%), knee abduction (P < 0.01; 13.8%), contralateral pelvic drop (P < 0.01; change difference: 26.6%), and lateral trunk flexion (P = 0.04; 20.37%) angles, favoring the global systems approach group after 6 weeks of training.

Conclusion: Participants who trained using the global systems approach had significantly decreased lateral trunk flexion, hip adduction, knee abduction and contralateral pelvic drop angles, peak vertical GRFs, and peak knee abduction moment during a single-leg vertical drop jump compared with participants who trained with hip-focused exercises.

Clinical relevance: Incorporating additional external resistance at the proximal trunk results in improved biomechanics compared with conventional hip-focused exercises.