Anterior Cruciate Ligament (ACL) injuries are in the knee, and are the most common form of injury in high school and college students. This makes a study on the subject vitally important, in order to make athletes, coaches and trainers aware of the risks. Academic, peer-reviewed papers were consulted in determining the level of risk, and the need to conduct an investigation into proprioception training in high school in order to reduce knee injury. The Journal of Strength and Conditioning Research, as well as the Frontiers in Psychology were consulted in this study, and notes between the two papers were compared. The essay writer validity of these studies was assessed based on the authors’ credentials, and the mediums in which they were published. Two of the most comprehensive and insightful articles were included in the study, out of hundreds. It was also important that the studies were relatively recent, with these ones being from 2016 and 2017. “Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11-13 Year Old Female Netball Athletes: A Randomized Control Study” (2017) provided a solid understanding of the ways young people can prevent ACL injuries. “Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study” (2016) provides a deep insight into the destructive nature of ACL injuries, and how dangerous they are to a player’s career. The information provided in each article can help clinicians, and particularly trainers, provide better quality training, in order to ensure the athletes are performing in a way where they are taking every precaution necessary to avoid ACL injuries.
Proprioception Training in High School in Reducing Knee Injury
Knee injury is the most prevalent injury among college-going students. An injury occurs when the stress that is greater than a tissue’s ability to absorb it occurs. In contemporary sports such as basketball, power, and speed of competitors play crucial roles. Sports that register the highest incidence of ankle sprains include soccer, basketball, and volleyball. Anterior cruciate ligament (ACL) injury remains common in football and is the most common form of a knee injury.
On the contrary, ACL is not a common injury for soccer players, occurring in only between 0.5% to 6.0% of females and 0.6% to 8.5% of males, depending on the environment. (Riva, Bianchi, Rocca & Mamo, 2016). The risk factors associated with ACL are either environmental (extrinsic) and individuals (individual). One can further divide the risk factors, such as non-modifiable (age) and modifiable (body mass). Both the intensity and frequency of sports expose athletes to injurious forces. National Collegiate Athletic Association (NCAA) research and 16 years’ worth of data indicate that knee injury is the most common state that deters athletes from participating in sports for more than 10 days. Moreover, in sports such as soccer and basketball, the re-injury rates remain high at 80%, which results in chronic angle disability (Riva et al., 2016).
The common interventions for preventing ankle sprains include proprioceptive training, Evertor muscle strengthening, ankle braces and using tape. Although many studies suggesting various methods of preventing injury exists, proprioceptive training remains the most effective in decreasing ACL. Studies suggest that proprioceptive training reduces the chances for re-occurrence of ACL or knee injuries by an estimated 30% to 50% (Riva et al., 2016).
An interesting fact to note is that most studies have concentrated on ACL. However, the role of proprioceptive training in reducing knee remains controversial because of the lack of adequate information linking the regime with injury prevention. Proprioception plays a critical role in injury prevention and joint stability. Although most of the existing research strives to minimize injury to specific joints, studies should change their scope by trying to define proprioceptive programs that can prevent a particular type of injury. Proprioceptive remains conveyed in different levels of the nervous system, but only a few reach the conscious level. Both joint movement and sense form the critical components of the conscious component while postural control comes from the unconscious level. Therefore, proprioceptive control is the expression of effectiveness that responsible for stabilizing reflexes that control stability. Single instance stability finds its basis on proprioceptive control for guarantying the safety of essential movements such as jumping, running and walking and the performance of refined motor skills. The evidence of this assertion comes from the fact that most Olympic champions have refined motor proprioceptive control for a single stance.
Despite the consideration laid above, a specific proprioceptive exercise definition concerning neuromuscular training lacks. A broad array of exercise exists, but what are the characteristics that an exercise should have for its classification to fall under proprioceptive exercises. An excellent way of answering the question on the type of exercise that falls under the proprioceptive is by introducing the concept of instability. The primary purpose of the proprioceptive exercise is to manage instability. The challenge in defining the concept is that every posture and movement can take the definition of proprioceptive because all of them generate a ‘proprioceptive flow.’ Consequently, the classification of an exercise should take the form of analyzing the mechanical typology of instability and its frequency. The tasks assigned by the subjects should then follow quantifiable outcomes. In this study, the expected outcome is how proprioceptive training can play a significant role in reducing or alleviating knee injury.
The primary purpose of this study is to assess the effectiveness of proprioceptive training programs in reducing knee injuries among high school athletes. The research hypothesis is that enduring and refined proprioceptive control would minimize injurious force and enhance the capability of absorbing them by allowing improved interaction with the ground.
Research Question
Does the use of proprioceptive training in high school athletes decrease the incidence of injuries?
- Population (P): High school students engaged in active 13 to 17 years engaged in active sports who have had a clinical diagnosis of knee injury in the past year. High school athletes who have not had a knee injury in the past year will not take place in the study.
- Intervention (I): The subjects who have had knee injury would undergo proprioceptive training for eight weeks. The subjects will undergo the same exercise regime as the control group to prove that non- proprioceptive exercise has a significant contribution to the occurrence of a knee injury.
- Comparison (C): A standardized and supervised exercise regime would apply to all active control groups. All the subjects, irrespective of the group would undergo the same exercise regime for eight weeks. The method would minimize non-specific reasons for therapy and attending a clinic.
- Outcome (O): Changes in the re-occurrence rate of knee injury and pain
- Time (T): The measurement of the outcome of the knee injury would take place weekly for eight weeks.
Clinical Question Critique
Although many studies exist on the qualification and measurement of knee proprioception, few research exits on targeted training for alleviating injuries. Although studies indicate that proprioceptive training yields positive results in alleviating knee injuries, it is ideal for identifying a specific training program that will effect positive results in the alleviation and rehabilitation of knee injuries or ACL. Proprioceptive training hypothesizes that it increases joint stability relying on various mechanisms such as kinesthesia, muscle strength, and tone. The studies that exist on proprioceptive training focus on rehabilitation of people with knee injuries but does not emphasize the prevention of the injury from occurring.
Moreover, injuries that arise because of chronic diseases such as arthritis remain unmentioned. However, one can argue that chronic conditions that chronic disease that cause the disease is rare among high school students. Based on this assertion, the most appropriate research question should find its basis on the specific mechanism and proprioceptive training that reduce
Part II: The Literature
The search strategy used for identifying data involved the use of medical libraries such as the US National Library of Medicine Institutes of Health (NCBI) and the use of peer-reviewed articles available online using basic search-engines. Academic sites such as Google Scholar and ProQuest also played a critical role in gathering the necessary information. The authenticity of sources played a critical role in determining the type of information applied in the research. Only reliable sources whose authors have shown extensive knowledge on the subject matters have their content utilized in this paper. The identifiable keywords during the search include proprioceptive training, knee injury, and high school athletes. Moreover, during the search for relevant articles, the research question, “Does the use of proprioceptive training in high school athletes decreases the incidence of injuries?” was copy-pasted into the search engine. Although the search engine would reveal many solutions, the article picked and utilized came after scrutiny and the authenticity of the authors and their sources of information.
Conducting research involves a systematic approach that requires diligent execution and planning. Authentic research requires predefined components such as population, aims, techniques, statistical considerations, and outcomes. For clinical research such as testing for a knee injury, a homogenous patient is required. Exclusion and inclusion criteria are necessary to define what one can exclude or include in their study. The inclusion criteria for the study involve the identity of a population in an objective, reliable, uniform, and consistent manner.
On the other hand, the exclusion criteria involve looking at characteristics or factors that make a population ineligible for the research. The factors can consist of confounders for the outcome variable or parameters. An excellent example of the study, a patient who suffers from chronic diseases such as arthritis and bone diseases will not take part in the study. From the search, studies that talk about knee injury fell under the exclusion category. An example of such an article that was excluded from the study includes the one talking of knee injuries among soldiers. The primary reason for the inclusion of the article concerning soldiers comes from the fact that the intensity of training that soldier undergoes remains intense as compared to that of high school athletes.
Search Results
Image 1: Search Results using Proprioceptive Training and Knee Injury as Key Words
Appropriate Articles
Hopper, A. J., Haff, E. E., Joyce, C., Lloyd, R. S., & Haff, G. G. (2017). Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11-13 Year Old Female Netball Athletes: A Randomized Control Study. Frontiers in physiology, 8, 883. DOI:10.3389/fphys.2017.00883
Riva, D., Bianchi, R., Rocca, F., & Mamo, C. (2016). Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study. Journal of strength and conditioning research, 30(2), 461–475. DOI:10.1519/JSC.0000000000001097
Level of Evidence for Individual Study
Image 2: The Criteria for Appraising Articles
Sample Article
Bianchi, R, Mamo, C and Riva, D analyze injury prevention and proprioceptive training in a professional basketball team for six years. The study focuses on looking at the effect of instability with lower extremity injury. Based on this assertion, Bianchi et al. argue that proprioceptive training can play a crucial role in preventing knee injury. The study took place for six years and integrated systematic proprioceptive training as part of the routine for the players. The purpose of this study was to assess the proprioceptive training effectiveness using quantifiable instability to reduce knee injuries and back pains. The research used proprioceptive training in the long-term. The appraisal of the article comes from the fact that the sample for the study remained homogenous consisting of 55 professional basketball players. Although high school athletes do not compete at the same level as professional players, they both remain active and highly skeptical about acquiring an injury.
Methods
This study aimed at determining the effect of quantifiable proprioceptive training proposals that can have to reduce injury rates among high school athletes. The purpose of this research is to critically appraise and comprehensively review available literature that examines the efficacy of proprioceptive training during knee and ankle rehabilitation. One such study involves the monitoring of 55 basketball players for six years. The subjects of the study had reported having a knee injury, particularly those with chronic conditions. The study took place by collecting data on single-stance stability and injury exposures that occurred during organized competition and practice. The injuries considered in the study included knee sprains and ACL. In this study, the research method appropriated for the division of the six years into four parts consisting of two weeks each. Each part had a different proprioceptive training regime or program.
The preventive training program used for the first part found its basis on the class that utilized unstable surfaces and rock surfaces. The second phase involved the use of interactive and quantifiable proprioceptive training regime or program using electronic postural stations. Proprioceptive control and single-stance intensity became the primary focus of the third and fourth phases of the experiment. Moreover, in the last two phases of the experiment, proprioceptive training intensity increased with the recovery time between sessions drastically minimized.
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Appraisal Methods for the Article
The study used a homogenous sample that consisted of 55 basketball players that played actively in the Italian Basketball Federation. Moreover, the study had the approval of the local ethics committee with all subjects that participated in the study, signing an informed and written consent. The methodology section involved the use of scientific research in informing clinical decisions. The appropriateness of the study that involves increased pressure on the body sections increases the use of the risks of a knee injury.
Moreover, increased instability during exercise finds its basis from much proven scientific research that involves back pain and knee injury. The study plays attempts to answer the research question that involves the role of proprioceptive training in reducing knee injury. The study question, “A broad typology of exercises is proposed as proprioceptive, but which characteristics should an exercise have to be classified as proprioceptive?” The article remains relevant because many studies have attempted to identify the reasons why proprioceptive training can alleviate issues related to a knee injury. However, few studies that exist the specific types of exercise exist.
The article plays a critical role in eliminating the misunderstanding of surrounding proprioceptive training. The identification of proprioceptive training is challenging because everybody’s movement forms part of “proprioceptive.” Consequently, the article plays a critical role in identifying specific proprioceptive training that will play a crucial role in preventing knee injury. Moreover, the fact that the article is timed allows researchers to analyze different timeframes for the effects of proprioceptive training to occur.
Most scientific research relies on previous work as they form the basis for the development of new studies. The research utilizes evidence from peer-reviewed articles and renowned scientists. Moreover, the classification of the research comes from pre-determined studies of proprioceptive training in the prevention and treatment of knee injuries. The study increases the validity of previous studies that indicate that proprioceptive training can play a crucial role in the treatment and prevention of knee injury using single stance exercises. The study classifies exercises using mechanical typology relating to instability. The enhancing feature of the instability frequency and quantifiable outcomes adds to already existing research. The use of subjects for a specified period lasting six years plays a critical role in ascertains the period required for various levels of impacts.
The study failed to acknowledge potential sources and forms of bias that can surround the study. However, it is essential to note that in epidemiological terms, the existence of bias does not indicate the preconception by the researcher. The bias indicates that the results of the study deviated from the truth. Errors may have existed because of the use of the experimental approach by collecting data concerning exposures and injuries and measuring the occurrence of single stability.
Sample Article 2 Appraisal
The second article, “Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11–13-Year-Old Female Netball Athletes (Hopper, Haff, Joyce, Lloyd & Haff, 2017). A Randomized Control Study “is appropriate to the research question because it answers it gives the effects of proprioceptive training among young people below the age of 18, which forms the bulk of college athletes. The study uses a homogenous population consisting of 23 youth female basketball players. Moreover, the choosing of the sample size came as a result of power analysis (β = 0.829), which implies that the minimum number of people required for the study was 16 (Hopper et al., 2017). The exclusion criterion for the study was that of people who had reported the previous injury on the lower limb or had taken part in a similar study. Moreover, the study acknowledged the potential limitation that would have affected the research findings. One of the limitations involved the inability to control the frequency and volume of netball training, which can have to affect the results because they have a direct correlation with a knee injury.
Summary of Table of Articles
| Author: Study Title: | Bianchi, R, Mamo, C, and Riva Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study | Amanda J. Hopper, Erin E. Haff, Christopher Joyce Rhodri S. Lloyd, and G. Gregory Haff Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11–13-Year-Old Female Netball Athletes: A Randomized Control Study |
| Study Participants | 55 basketball players aged between 18 to 45. New Users 66.7% to 75% No significant consideration of body weight, age, and height 85% of participants indicated a history of ankle sprain | 11 to 13 years old Female Netball Athletes The number of participants for the study was 16 |
| Inclusion/Exclusion Criteria Outcome measures | The inclusion criteria involved recording data on previous injuries, including re-occurring ones. The exclusion criteria for the study were eliminating athletes who did not actively participate in the competition did not take part in the study. | The exclusion criteria for the study involved participants who reported lower limb injury. No significant changes occurred in age, height, and body weight. |
| Results | Single stance test: EC = eyes closed. Mean ± SD; ****p < 0.001; *p ≤ 0.05. New Entries vs. Veterans (mean 3.6 ± 1.8 vs. 2.1 ± 1.0; p < 0.001) Adjusted RR=0.82(95% Cl=00.75-0.90) Ages 11-13=0.89(0.74-0.91) | Adjusted OR=0.99(95% Cl=0.94-1.04) Ages 11-13=0.82(0.75-0.91) |
| Level of Evidence | 2 | 2 |
| Support for Answer | Yes | Yes |
Comparing Data
Both studies indicate that proprioceptive training plays a crucial role in knee injury prevention and treatment. The article, “Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study,” indicates that proprioceptive control is necessary The clinical meaningfulness of the study came from the practice missed and similar decrease in the related games (72 from 294 coupled with an overall decrease of 75.5%). Apart from the benefits of a reduced knee injury, the athletes also reported improved technical skills, movement control, and stability. A significant factor to note is that the study took place with control experiments that involved participants that did not participate in Proprioceptive training. Therefore, the results of the effectiveness of Proprioceptive had a direct comparison with those that did not use the training regime. Based on the results of this study, a single static experiment or test is reliable and functional to basketball players. The study further suggests that the introduction of evidence-based study for the prevention and treatment of knee injury.
On the other hand, the article, “Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11–13 Year Old Female Netball Athletes: A Randomized Control Study,” took place in six periods unlike the six years of the previous article. The research hypothesizes that neuromuscular training (NMT), which forms part of the proprioceptive exercise, has the capability of reducing knee injury on young female netballers. Six athletes underwent NMT while the remaining served as the control experiment. The study measured vertical ground reaction force (VGRF) and lower-extremity kinematics. The experimental group displayed an increase in bilateral knee-marker during landing tasks with a reduction in the range of knee flexion (p ≤ 0.05, g > 1.00). The experimental group displayed a significant reduction in peak vertical-ground reaction in the landing tasks. Participants in the control experiment did not display any significant changes during the entire six weeks of the study. The study ascertains claims that proprioceptive training, particularly NMT, can improve knee injury by enhancing landing biomechanics. The studies have CIs overlap.
Part IV: Clinical Bottom-line
The study indicates that clinicians should use evidence-based practice in the prevention of knee injury. The systems introduced in the study using portable devices such as postural reader and rocking base enables athletes to take proprioceptive programs beyond their training facilities. The implementation of NMT programs has a high success rate among athletes below the age of 18, which forms the bulk of high school participants. The studies support previous studies by Myer et a, (2013) that practical proprioceptive training particularly NMT, is adequate for younger athletes in helping reduce the risks associated with ACL. The primary reason why proprioceptive programs remain effective is that they play a critical role in increasing the strength, knee-flexion extension, knee external rotation angles and decreasing the landing force. However, clinicians should acknowledge that the studies indicate that proprioceptive training offers long-term solutions as opposed to short-term remedies. Based on this fact, clinicians should contextualize the training exercise as long-term solutions for preventing or treating re-occurring knee injury.
The use of proprioceptive training showed a significant improvement in the reduction of knee injuries, mainly ankle sprains by 81% during the first stages of incorporating the exercise in the workout regimes. Moreover, more improvement occurs between the first and third regime (p < 0.001). The emerging evidence shows that proprioceptive training is critical for prevention, but the information still lacks the use of actual treatment or mitigation of risks. More research is necessary to ascertain the exact impact of each exercise on different limp and bones in preventing knee injury.
The strengths of the recommendations based on body o content are SORT Grade=B. The CAT kill date should be after five years when the knowledge base has increased, and other studies have emerged. The reason for the extended CAT date is that studies involving knee injury may take a long period to conduct and complete.
The implication for Practice, Research, and Education
Although both articles strive to demonstrate the effectiveness of proprioceptive training in preventing and treating knee injury, they lack measures that factor in the volume and frequency of training. Riva et al., the article gives evidence of the effect of single stance training but does not give the mechanism it affects the body. The only limitation for Hopper et al., the article is that it does not account for the frequency and volume of training involved. The clinical question remains generalized and does not identify a specific proprioceptive training that would have the most impact in reducing injury among high school athletes. More research is necessary to connect specific proprioceptive training with body effects that reduce knee injury.
References
Hopper, A. J., Haff, E. E., Joyce, C., Lloyd, R. S., & Haff, G. G. (2017). Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11-13 Year Old Female Netball Athletes: A Randomized Control Study. Frontiers in physiology, 8, 883. DOI:10.3389/fphys.2017.00883
Riva, D., Bianchi, R., Rocca, F., & Mamo, C. (2016). Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study. Journal of strength and conditioning research, 30(2), 461–475. DOI:10.1519/JSC.0000000000001097
