High Compliance with the 11+ Injury Prevention Program Results in Better Win-Loss Records

# Background The 11+ injury prevention program (IPP) has been shown to decrease injury rates. However, few studies have investigated compliance and its overall relationship to team performance. # Hypothesis/Purpose To examine if level of compliance while implementing the 11+ would impact team performance outcomes (wins, losses and ties). The authors hypothesized that higher team compliance to the IPP would be consistent with improved overall team performance (more wins and fewer losses). # Study Design Prospective, cluster randomized controlled trial # Methods This study was conducted in NCAA men's soccer teams for one season and examined the efficacy of the 11+ IPP. The outcome variables examined were levels of compliance and team performance record: wins, losses, and ties. Twenty-seven teams (n=675 players) served as the intervention group (IG) and used the 11+ program while 34 teams (n=850 players) served as the control group (CG). Compliance and team performance were recorded. There were three compliance categories that were defined prospectively, low (LC, \1 and \2 doses/week). Descriptive and inferential tests were used to compare the CG, the IG, and compliance to team performance. Three independent t-tests were used to analyze outcome to group (IG vs. CG). A one way-MANOVA test was used to analyze compliance to win/loss/tie record, followed up by one-way ANOVA tests to analyze how compliance impacted wins, losses and ties, independently. Partial η2 measures were calculated to determine the effect size of level of compliance on outcome. A Tukey post-hoc analysis was used to analyze specific differences between levels of compliance and specific outcome measures. # Results There were significantly more wins (IG: 10.67±2.63 versus CG: 8.15±3.83, CI, 7.95 -- 9.69, p = 0.005) and fewer losses (IG: 5.56±1.97 versus CG: 8.12±3.59, CI, 5.66 to 7.43, p = 0.002) recorded for the teams using the 11+ program. There was a statistically significant difference between levels of compliance (high, moderate or low) on the dependent variables (wins, losses, and ties), F(3, 22) = 3.780, p =0.004; Wilks' Λ = .435; partial η2 = .340. # Conclusion The 11+ has the capacity to improve overall team performance in male collegiate soccer teams. The higher the compliance, the more favorable the team performance. This research may be a vital addition when attempting to persuade coaching staffs to adopt an IPP into their training regimen. # Level of Evidence Level

Biomechanical Changes During a 90º Cut in Collegiate Female Soccer Players With Participation in the 11+

# Background Valgus collapse and high knee abduction moments have been identified as biomechanical risk factors for ACL injury. It is unknown if participation in the 11+, a previously established, dynamic warm-up that emphasizes biomechanical technique and reduces ACL injury rates, reduces components of valgus collapse during a 90º cut. # Hypothesis/Purpose To determine whether participation in the 11+ during a single soccer season reduced peak knee abduction moment and components of valgus collapse during a 90º cut in collegiate female soccer players. # Study Design Prospective cohort study # Methods Forty-six participants completed preseason and postseason motion analysis of a 90º cut. During the season, 31 players completed the 11+ and 15 players completed their typical warm-up (control group). Peak knee abduction moment, components of valgus collapse (hip adduction, internal rotation, and knee abduction angles), and a novel measure of knee valgus collapse were analyzed with repeated-measures ANOVAs to determine differences between preseason and postseason. Smallest detectable change (SDC) and minimal important difference (MID) values were applied to contextualize results. # Results There was a significant main effect of time for non-dominant knee valgus collapse (p=0.03), but decreases in non-dominant knee valgus collapse only exceeded the SDC in the intervention team. # Conclusions Clinically meaningful decreases in knee valgus collapse may indicate a beneficial biomechanical effect of the 11+. Participation in the 11+ may lower ACL injury risk by reducing valgus collapse during a 90º cut. # Level of Evidence 2

Anterior Cruciate Ligament Rehabilitation for the 10- to 18-Year-Old Adolescent Athlete:Practice Guidelines Based on International Delphi Consensus

Background:There are 2 treatment options for adolescent athletes with anterior cruciate ligament (ACL) injuries—rehabilitation alone (nonsurgical treatment) or ACL reconstruction plus rehabilitation. However, there is no clear consensus on how to include strength and neuromuscular training during each phase of rehabilitation.Purpose:To develop a practical consensus for adolescent ACL rehabilitation to help provide care to this age group using an international Delphi panel.Study Design:Consensus statement.Methods:A 3-round online international Delphi consensus study was conducted. A mix of open and closed literature-based statements were formulated and sent out to an international panel of 20 ACL rehabilitation experts. Statements were divided into 3 domains as follows: (1) nonsurgical rehabilitation; (2) prehabilitation; and (3) postoperative rehabilitation. Consensus was defined as 70% agreement between panel members.Results:Panel members agreed that rehabilitation should consist of 3 criterion-based phases, with continued injury prevention serving as a fourth phase. They also reached a consensus on rehabilitation being different for 10- to 16-year-olds compared with 17- and 18-year-olds, with a need to distinguish between prepubertal (Tanner stage 1) and mid- to postpubertal (Tanner stages 2-5) athletes. The panel members reached a consensus on the following topics: educational topics during rehabilitation; psychological interventions during rehabilitation; additional consultation of the orthopaedic surgeon; duration of postoperative rehabilitation; exercises during phase 1 of nonsurgical and postoperative rehabilitation; criteria for progression from phase 1 to phase 2; resistance training during phase 2; jumping exercises during phase 2; criteria for progression from phase 2 to phase 3; and criteria for return to sports (RTS). The most notable differences in recommendations for prepubertal compared with mid- to postpubertal athletes were described for resistance training and RTS criteria.Conclusion:Together with available evidence, this international Delphi statement provides a framework based on expert consensus and describes a practice guideline for adolescent ACL rehabilitation, which can be used in day-to-day practice. This is an important step toward reducing practice inconsistencies, improving the quality of rehabilitation after adolescent ACL injuries, and closing the evidence-practice gap while waiting for further studies to provide clarity

Injury prevention in the athlete: investigation of the efficacy and the biomechanics of a neuromuscular training program in collegiate soccer players

Snyder-Mackler, LynnBackground: Soccer related injuries are a relatively common occurrence across gender, age and level of competition. The impact of sports related injury is complex and far-reaching; inflicting potential long-term physical, emotional and financial consequences for the athlete to contend with long after their athletic career has finished. ☐ Purpose: The purpose of this body of work was to 1) evaluate the efficacy of the FIFA 11+ program in a randomized controlled trial, 2) identify how the FIFA 11+ program may impact the rate of anterior cruciate ligament injury, 3) identify how program compliance affects injury rate and overall soccer team performance, 4) and to analyze the kinetic and kinematic biomechanical changes associated with the utilization of the FIFA 11+ over a competitive season. ☐ Methods: A prospective randomized controlled trial was performed in NCAA male collegiate soccer players to analyze the efficacy of the FIFA 11+ program over the course a soccer season. Injury rate and time loss due to injury were analyzed and compared to a skill and age matched control group. Anterior cruciate ligament injury rates were specifically analyzed to determine if the FIFA 11+ program could effectively decrease the rate of ACL injury in soccer players. ● A secondary analysis of the data was performed to analyze the role of team compliance on the overall effectiveness of the FIFA 11+ program. Compliance data from the intervention group was stratified into three tertiles (high, moderate and low) to analyze how the variability in compliance may impact overall injury rate. Overall team performance was also assessed. A record of each team’s wins, losses and ties was recorded and analyzed based on the level of compliance. ● A biomechanical analysis of kinetic and kinematic variables was conducted to analyze the biomechanical changes in female soccer players using the FIFA 11+ compared to a control group. Two functional tests were analyzed: a single leg squat and a single leg trip hop test. The subjects were analyzed at two time points; a pre-test analysis prior to the season and a post-test analysis at the culmination of the season. ☐ Clinical Significance: The information obtained in this dissertation supports the importance of the consistent implementation of injury prevention protocols in sport. The FIFA 11+ program has demonstrated its’ ability to decrease injury rate, including ACL injury rate, and improve overall team performance. Compliance is a critical component to the overall impact of the program; teams utilizing the program more consistently demonstrated lower injury rates and more success with respect to team performance. ● By prospectively analyzing changes in soccer specific movement patterns across the course of a competitive season in females, we are now able to more fully understand how the program is beneficial to the athlete with respect to injury reduction and how the program imparts’ a protective benefit. The pre/post season analysis revealed favorable biomechanical changes in the hip, including increases in hip flexion angle, increase in hip extensor moment increases in hip abduction moment and decreases in hip internal rotation angle. This information will guide future researcher on how to optimize injury prevention efforts, improve the content and efficiency of therapeutic prevention interventions, and to potentially identify high-risk athletes prospectively prior to a deleterious injury occurring. If these methods are implemented with optimal compliance and consistency early in an athlete’s career, the overall risk of injury may be significantly reduced and the long-term health and athletic career longevity may be extended through the later decades of life. Furthermore, the physical and financial longitudinal impact(s) of many sports related injuries may be significantly mitigated, thus improving overall quality of life of the athlete, extending well past the tenure of a collegiate athletic career.Ph.D.University of Delaware, Biomechanics and Movement Science Progra

ACL injury prevention: Where have we come from and where are we going?

Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three‐plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence

Incidence of Injury for Professional Soccer Players in the United States: A 6-Year Prospective Study of Major League Soccer

BackgroundDespite an abundance of injury research focusing on European professional soccer athletes, there are limited injury data on professional soccer players in the United States.PurposeTo describe the epidemiology of injury across multiple years in Major League Soccer (MLS) players.Study designDescriptive epidemiology study.MethodsA web-based health management platform was used to prospectively collect injury data from all MLS teams between 2014 and 2019. An injury was defined as an incident that required medical attention and was recorded into the health management platform anytime over the course of the 2014-2019 seasons. Injuries and exposure data were recorded in training and match settings to calculate injury incidence.ResultsA total of 9713 injuries were recorded between 2014 and 2019. A mean 1.1 injuries per year per player were identified, with midfielders sustaining the largest number of injuries. The most common injuries were hamstring strains (12.3%), ankle sprains (8.5%), and adductor strains (7.6%). The mean time missed per injury was 15.8 days, with 44.2% of injuries resulting in no days missed. Overall injury incidence was 8.7 per 1000 hours of exposure, declining over the course of the investigation, with a 4.1-times greater mean incidence during matches (14.0/1000 h) than training (3.4/1000 h).ConclusionBetween 2014 and 2019, the most commonly reported injuries in MLS players were hamstring strains, ankle sprains, and adductor strains. Injury incidence during matches was 4.1 times greater when compared with training, while overall injury incidence was found to decline during the course of the study period

Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to meniscus and articular cartilage lesions

RECOGNITION PROBLEM OF FRONTAL SINGULARITIES

A natural class of mappings, frontal mappings, is explained from both geometric and algebraic aspects. Several results on the recognition of frontal singularities, in particular, cuspidal edges, folded umbrellas, swallowtails, Mond singularities, Shcherbak singularities, and their openings are surveyed