Dynamic balance testing and perturbation-based neuromuscular exercise training in healthy and ACL-injured adolescent females
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Date
2019
Authors
Bulow, Alison
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Abstract
Physically active adolescent females are at significantly greater risk for anterior cruciate ligament (ACL) injury than their male counterparts when participating in the same sports. While preventative neuromuscular (NM) exercise programs can reduce injury rates and improve function, they are not practical or safe for the ACL-injured individual. The effectiveness of a perturbation-based NM training program that is appropriate for the ACL-injured, physical active individual has been established for an adult population but has yet to be investigated in the adolescent female population. Scoring from two common clinical tools, the Star Excursion Balance Test (SEBT) and Y-Balance Test (YBT), are used to screen athletes at risk of injury, assess deficiencies after injury, and monitor progress in rehabilitation, are known to vary by age, sex and sport. Currently, there is little research examining performance and scoring on clinical dynamic balance tests in adolescent females who are healthy or ACL-injured and awaiting the standard of care, surgical reconstruction. This investigation used an evidence-based approach to investigate the utility of clinical dynamic balance testing and the effectiveness of a perturbation-based NM exercise program in healthy and ACL-injured adolescent females. Reach performance measures and injury classification of clinical dynamic balance tests should not be used interchangeably for physically active adolescent females as differences between the measured reach directions and injury classification were observed between the SEBT and YBT. Surprisingly, healthy and ACL-injured adolescent females demonstrate similar reach distances on the YBT. Although healthy adolescent females demonstrate a relationship between BMI, lower extremity strength, and the YBT, no such relationship exists for ACL-injured. Specific analysis of the YBT anterior reach direction indicates that both healthy and ACL-injured adolescent females demonstrate a variety of joint movement strategies to achieve a similar maximal reach distance. Finally, our results suggest that perturbation-based NM training is safe, but offers limited benefit for healthy adolescent females and no preoperative benefit to ACL-injured adolescent females. These findings provide researchers and clinicians with information which could potentially advance the current standard of care used in the assessment, prevention and pre-operative management of ACL-injured adolescent females.
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Keywords
Anterior cruciate ligament, Screening tool, Lower extremity kinematics, 2D video analysis, Injury prevention, Pre-operative rehabilitation, Star excursion balance test, Y-balance test