22, 23 When performing single-leg landing tasks, female athletes demonstrated increased trunk flexion and lateral tilt. Subsequent studies evaluated more proximal neuromuscular control at the hip and trunk to help determine a potential contributing mechanism to high risk knee mechanics during landing. 20 Kernozek and colleagues also reported similar coronal plane gender differences in their investigation of drop landing from a greater height (60 cm). These differences in valgus measures and limb-to-limb asymmetries reflect neuromuscular deficits that may be indicative of decreased dynamic knee joint control in female athletes. Female athletes also had significant differences between dominant and non-dominant side in maximum valgus knee angle. ![]() This study determined that female athletes landed with a greater maximum valgus knee angle and greater total valgus knee motion than male athletes. 20 demonstrated similar gender differences during the performance of a drop vertical jump from a drop height of 31 cm. The results of this study demonstrated that peak landing forces were significantly predicted by valgus torque at the knee in females, females developed decreased relative knee flexor torque during landing compared to males, and females had greater side to side differences in normalized hamstrings peak torque. 10 tested the hypothesis that insufficient neuromuscular control of lower limb biomechanics, particularly the knee joint, lead to high risk patterns in female athletes during execution of common (albeit potentially hazardous) movements. Identification of Modifiable ACL Injury Mechanisms Associated With Landing Techniques The purpose of this report is to discuss the current evidence related to modifiable ACL injury mechanisms during landing and to present a novel “clinician-friendly” assessment and training technique that can be used to identify these mechanisms in high-risk female athletes. 5 - 7 The programs that have demonstrated ACL injury reduction are comprehensive, and include multiple training components that may induce the neuromuscular changes. 4, 10 More current techniques, developed from identified injury mechanism (dynamic knee valgus 11) and objective analysis of training methods, 12 - 19 may further reduce traumatic ACL injuries in female athletes. 4 - 9 Initial interventions aimed at reducing the incidence of ACL injuries in female athletes were developed based on empirical evidence from coaching and training female athletes and from performance enhancement research. This gender disparity in non-contact ACL injury risk, combined with evidence that the primary cause may be neuromuscular in nature, have lead to the development of neuromuscular interventions designed to prevent injury. ![]() 1 - 3 This greater risk of ACL injury, coupled with a dramatic increase in participation (doubling each decade), has led to a significant rise in the number of ACL injuries in female athletes. ![]() FEMALE ATHLETES demonstrate a 4 to 6 times higher incidence of non-contact anterior cruciate ligament (ACL) injury than male athletes participating in the same landing and pivoting sports.
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