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Proximal Risk Factors for ACL Injury: Role of Core Stability

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Book cover ACL Injuries in the Female Athlete

Abstract

This chapter reviews the role of the core and core stability in preventing ACL injuries. Core stability represents the ability of the core, or the muscles of the abdomen and lower back, to maintain or resume a relative position [or trajectory] of the trunk after a perturbation. Poor trunk control and core stability may place an athlete in a position that results in adverse loading of the knee, leading to injury. Training programs incorporating core-specific exercises have been successful at reducing ACL injury risk, but the extent to which the core-specific exercises influenced the reduction in injury risk is unknown. Reducing trunk angles, medializing the center of mass, and shifting the center of mass anteriorly more over the foot are all associated with reduced knee moments and may lead to reduced ACL injury risk.

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Notes

  1. 1.

    The published literature contains two definitions of the musculoskeletal “core” of the body. The classic description includes all of the muscles of the trunk and pelvis required for stability of the spine and pelvis during activities. The second definition includes all trunk musculature, along with the hip muscles, required for stabilization of the pelvis and trunk during activities. In this chapter, the first definition of core is used by the authors.

References

  1. Akuthota V, Nadler SF (2004) Core strengthening. Arch Phys Med Rehabil 85(3 Suppl 1):S86–S92

    Article  PubMed  Google Scholar 

  2. Besier TF, Lloyd DG, Ackland TR et al (2001) Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc 33(7):1176–1181

    PubMed  CAS  Google Scholar 

  3. Boden BP, Dean GS, Feagin JA Jr et al (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23(6):573–578

    PubMed  CAS  Google Scholar 

  4. Callaghan JP, McGill SM (2001) Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin Biomech (Bristol, Avon) 16(1):28–37

    Article  CAS  Google Scholar 

  5. Chaudhari AM, Hearn BK, Andriacchi TP (2005) Sport-dependent variations in arm position during single-limb landing influence knee loading: implications for anterior cruciate ligament injury. Am J Sports Med 33(6):824–830

    Article  PubMed  Google Scholar 

  6. Chaudhari AM, McKenzie CS, Borchers JR et al (2011) Lumbopelvic control and pitching performance of professional baseball pitchers. J Strength Cond Res 25(8):2127–2132

    Article  PubMed  Google Scholar 

  7. Childs JD, Teyhen DS, Benedict TM et al (2009) Effects of sit-up training versus core stabilization exercises on sit-up performance. Med Sci Sports Exerc 41(11):2072–2083

    Article  PubMed  Google Scholar 

  8. Childs JD, Teyhen DS, Casey PR et al (2010) Effects of traditional sit-up training versus core stabilization exercises on short-term musculoskeletal injuries in US Army soldiers: a cluster randomized trial. Phys Ther 90(10):1404–1412

    Article  PubMed  Google Scholar 

  9. Dempsey AR, Lloyd DG, Elliott BC et al (2007) The effect of technique change on knee loads during sidestep cutting. Med Sci Sports Exerc 39(10):1765–1773

    Article  PubMed  Google Scholar 

  10. Dempsey AR, Lloyd DG, Elliott BC et al (2009) Changing sidestep cutting technique reduces knee valgus loading. Am J Sports Med 37(11):2194–2200

    Article  PubMed  Google Scholar 

  11. Dempster WT, Gaughran RL (1967) Properties of body segments based on size and weight. Am J Anat 20(1):33–54

    Article  Google Scholar 

  12. Donnelly CJ, Lloyd DG, Elliott BC et al (2012) Optimizing whole-body kinematics to minimize valgus knee loading during sidestepping: implications for ACL injury risk. J Biomech 45(8):1491–1497

    Article  PubMed  CAS  Google Scholar 

  13. Emery CA, Rose MS, McAllister JR et al (2007) A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial. Clin J Sport Med 17(1):17–24

    Article  PubMed  Google Scholar 

  14. Fleming BC, Renstrom PA, Beynnon BD et al (2001) The effect of weightbearing and external loading on anterior cruciate ligament strain. J Biomech 34(2):163–170

    Article  PubMed  CAS  Google Scholar 

  15. Fredericson M, Moore T (2005) Muscular balance, core stability, and injury prevention for middle- and long-distance runners. Phys Med Rehabil Clin N Am 16(3):669–689

    Article  PubMed  Google Scholar 

  16. Gallagher S, Marras WS, Litsky AS et al (2005) Torso flexion loads and the fatigue failure of human lumbosacral motion segments. Spine (Phila Pa 1976) 30(20):2265–2273

    Article  Google Scholar 

  17. Gilchrist J, Mandelbaum BR, Melancon H et al (2008) A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med 36(8):1476–1483

    Article  PubMed  Google Scholar 

  18. Hemmerly-Brown A (2011) Soldiers try new PT test at Benning. United States Army. http://www.army.mil/article/56445/. Accessed 7 Feb 2012

  19. Hewett TE, Lindenfeld TN, Riccobene JV et al (1999) The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med 27(6):699–706

    PubMed  CAS  Google Scholar 

  20. Hewett TE, Myer GD, Ford KR et al (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33(4):492–501

    Article  PubMed  Google Scholar 

  21. Hewett TE, Ford KR, Myer GD (2006) Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 34(3):490–498

    Article  PubMed  Google Scholar 

  22. Hewett TE, Torg JS, Boden BP (2009) Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism. Br J Sports Med 43(6):417–422

    Article  PubMed  CAS  Google Scholar 

  23. Hodges PW, Richardson CA (1997) Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther 77(2):132–142; discussion 142–134

    PubMed  CAS  Google Scholar 

  24. Jamison ST, Chaudhari AM (2010) Influence of trunk neuromuscular control on run-to-cut maneuver: a risk factor for ACL rupture. In: 56th annual meeting of the orthopaedic research society. AAOS, New Orleans, p 1892

    Google Scholar 

  25. Jamison ST, McNeilan RJ, Young GS et al. (2012) RCT of the effects of a trunk stabilization program on trunk control and knee loading. Med Sci Sports Exerc http://www.ncbi.nlm.nih.gov/pubmed/22525777Med Sci Sports Exerc. 2012 Oct; 44(10):1924–1934

  26. Jamison ST, Pan X, Chaudhari AM (2012) Knee moments during run-to-cut maneuvers are associated with lateral trunk positioning. J Biomech 45(11):1881–1885

    Article  PubMed  Google Scholar 

  27. Kanamori A, Zeminski J, Rudy TW et al (2002) The effect of axial tibial torque on the function of the anterior cruciate ligament: a biomechanical study of a simulated pivot shift test. Arthroscopy 18(4):394–398

    Article  PubMed  Google Scholar 

  28. Kibler WB, Press J, Sciascia A (2006) The role of core stability in athletic function. Sports Med 36(3):189–198

    Article  PubMed  Google Scholar 

  29. Leetun DT, Ireland ML, Willson JD et al (2004) Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc 36(6):926–934

    Article  PubMed  Google Scholar 

  30. Mandelbaum BR, Silvers HJ, Watanabe DS et al (2005) Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 33(7):1003–1010

    Article  PubMed  Google Scholar 

  31. Markolf KL, Burchfield DM, Shapiro MM et al (1995) Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res 13(6):930–935

    Article  PubMed  CAS  Google Scholar 

  32. McGill SM (1995) The mechanics of torso flexion: situps and standing dynamic flexion manoeuvres. Clin Biomech (Bristol, Avon) 10(4):184–192

    Article  Google Scholar 

  33. McGill SM, Childs A, Liebenson C (1999) Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 80(8):941–944

    Article  PubMed  CAS  Google Scholar 

  34. McGill SM (2009) Ultimate back fitness and performance. Backfitpro, Inc., Waterloo

    Google Scholar 

  35. Merriam-Webster (2012) Stability. Encyclopaedia Britannica. http://www.merriam-webster.com/dictionary/stability. Accessed 7 Feb 2012

  36. Mills JD, Taunton JE, Mills WA (2005) The effect of a 10-week training regimen on lumbo-pelvic stability and athletic performance in female athletes: a randomized-controlled trial. Phys Ther Sport 6(2):60–66

    Article  Google Scholar 

  37. Myer GD, Ford KR, Palumbo JP et al (2005) Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. J Strength Cond Res 19(1):51–60

    PubMed  Google Scholar 

  38. Myklebust G, Engebretsen L, Braekken IH et al (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13(2):71–78

    Article  PubMed  Google Scholar 

  39. Oxland TR, Panjabi MM (1992) The onset and progression of spinal injury: a demonstration of neutral zone sensitivity. J Biomech 25(10):1165–1172

    Article  PubMed  CAS  Google Scholar 

  40. Pedersen MT, Randers MB, Skotte JH et al (2009) Recreational soccer can improve the reflex response to sudden trunk loading among untrained women. J Strength Cond Res 23(9):2621–2626

    Article  PubMed  Google Scholar 

  41. Petersen W, Braun C, Bock W et al (2005) A controlled prospective case control study of a prevention training program in female team handball players: the German experience. Arch Orthop Trauma Surg 125(9):614–621

    Article  PubMed  Google Scholar 

  42. Sahrmann S (2002) Diagnosis and treatment of movement impairment syndromes. Mosby, Philadelphia

    Google Scholar 

  43. Schuler L (2011) The six-pack fast track. Men’s health. Rodale, Inc., Emmaus

    Google Scholar 

  44. Sheehan FT, Sipprell WH 3rd, Boden BP (2012) Dynamic sagittal plane trunk control during anterior cruciate ligament injury. Am J Sports Med 40(5):1068–1074

    Article  PubMed  Google Scholar 

  45. Shin CS, Chaudhari AM, Andriacchi TP (2009) The effect of isolated valgus moments on ACL strain during single-leg landing: a simulation study. J Biomech 42(3):280–285

    Article  PubMed  Google Scholar 

  46. Shin CS, Chaudhari AM, Andriacchi TP (2011) Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone. Med Sci Sports Exerc 43(8):1484–1491

    Article  PubMed  Google Scholar 

  47. Soligard T, Myklebust G, Steffen K et al (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 337:a2469

    Article  PubMed  Google Scholar 

  48. Stanton R, Reaburn PR, Humphries B (2004) The effect of short-term Swiss ball training on core stability and running economy. J Strength Cond Res 18(3):522–528

    PubMed  Google Scholar 

  49. Taimela S, Kankaanpaa M, Luoto S (1999) The effect of lumbar fatigue on the ability to sense a change in lumbar position. A controlled study. Spine (Phila Pa 1976) 24(13):1322–1327

    Article  CAS  Google Scholar 

  50. The President’s Council on Fitness SN (2012) Curl-ups. The President’s Challenge https://www.presidentschallenge.org/challenge/physical/activities/curl-ups.shtml. Accessed 8 Feb 2012

  51. Tse MA, McManus AM, Masters RS (2005) Development and validation of a core endurance intervention program: implications for performance in college-age rowers. J Strength Cond Res 19(3):547–552

    PubMed  Google Scholar 

  52. van Mechelen W (1992) Running injuries. A review of the epidemiological literature. Sports Med 14(5):320–335

    Article  PubMed  Google Scholar 

  53. Whiting WC, Sugg S, Coleman A et al (1999) Muscle activity during sit-ups using abdominal exercise devices. J Strength Cond Res 13(4):339–345

    Google Scholar 

  54. Willson JD, Dougherty CP, Ireland ML et al (2005) Core stability and its relationship to lower extremity function and injury. J Am Acad Orthop Surg 13(5):316–325

    PubMed  Google Scholar 

  55. Zazulak BT, Hewett TE, Reeves NP et al (2007) The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. Am J Sports Med 35(3):368–373

    Article  PubMed  Google Scholar 

  56. Zazulak BT, Hewett TE, Reeves NP et al (2007) Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-­epidemiologic study. Am J Sports Med 35(7):1123–1130

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors would like to thank Steve McConoughey, Ph.D. for his editorial assistance with this manuscript.

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Correspondence to Ajit M. W. Chaudhari Ph.D. .

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Chaudhari, A.M.W., Jamison, S.T., Best, T.M. (2012). Proximal Risk Factors for ACL Injury: Role of Core Stability. In: Noyes, F., Barber-Westin, S. (eds) ACL Injuries in the Female Athlete. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32592-2_9

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  • DOI: https://doi.org/10.1007/978-3-642-32592-2_9

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