تمرینات پیشگیری از آسیب لیگامان صلیبی قدامی ناشی از ریسک فاکتورهای درونی و قابل تعدیل در زنان ورزشکار (مقاله مروری)

نوع مقاله: مقاله مروری

نویسندگان

1 1. دانشجوی دکتری دانشکده تربیت بدنی وعلوم ورزشی، دانشگاه خوارزمی

2 2. دکترای بیومکانیک ورزشی، استاد تمام دانشکده تربیت بدنی وعلوم ورزشی، دانشگاه خوارزمی

10.22037/jrm.2014.1100080

چکیده

مقدمه و اهداف
مطالعات اپیدمیولوژیکی نشان داده­اند که زنان ورزشکار 2 تا 10 برابر بیشتر از مردان ورزشکار در معرض آسیب ACL قرار دارند. عوامل عصبی عضلانی و بیومکانیکی در آسیب لیگامان صلیبی قدامی جزء ریسک فاکتورهای قابل تعدیل هستند. هزینه های بالای درمان ، افزایش پتانسیل از دست دادن فصل مسابقه و ناتوانی­­های طولانی­مدت و همچنین ایجاد آسیب­های ثانویه­ای لزوم بکارگیری برنامه­های پیشگیری از آسیب را پررنگ­تر کرده­است. در این مطالعه مروری، پیشینه تحقیقات مرتبط با ریسک فاکتورهای قابل تعدیل و تمرینات پیشگیری از آسیب لیگامان صلیبی قدامی بررسی شده است.
مواد و روش ها
برای شناسایی تحقیقات از بانک های اطلاعاتیMedline Pubmed، Science Direct، SPORTDiscuss و SCOPUS با کلید واژه های  "ACL"، "Knee injuries"، "modifiable risk factor  "، "neuromuscular risk factor"، "biomechanical risk factor"، "training prevention program"استفاده شد. در مجموع 8500 مقاله یافته شد. بعد از خروج مقالات غیر انگلیسی، با نتایج کاملا مشابه، مقالات مشابه ایندکس شده، تحقیقات غیر انسانی، با نمونه های آسیب دیده، با اهداف درمانی، بدون مداخلات تمرینی، 60 مقاله  در این تحقیق مورد بررسی قرار گرفت.
یافته ها
ضعف در کنترل و ایمبالانس عصبی عضلانی تنه و اندام تحتانی در زنان موجب افزایش بروز آسیب لیگامان صلیبی قدامی می شود. تمرینات پیشگیری از آسیب نیز در دو سطح با هدف اصلاح ریسک فاکتورها و کاهش نرخ آسیب لیگامان صلیبی قدامی قرار دارند. بیشتر تمرینات مداخله ای تاثیر گذار، تمرینات چند جانبه، با شروع برنامه در پیش از فصل برای حداقل زمان شش هفته و به صورت مداوم در طول فصل با تعداد تکرار حداقل یک تا دو تکرار در هفته و با مربیان ناظر بر تمرین هستند.
نتیجه گیری
شناسایی ایمبالانسهای عصبی عضلانی می تواند در غربالگری ورزشکاران در خطر و طراحی تمرینات مداخله ای مورد استفاده قرار بگیرد. اگرچه، هنوز برنامه استانداردی با هدف پیشگیری برای هر یک از رشته های ورزشی خاص معرفی نشده است.

کلیدواژه‌ها


عنوان مقاله [English]

ACL injury prevention programs due to intrinsic and modifiable risk factors in female Athletes

نویسندگان [English]

  • Naghmeh Gheidi 1
  • Heidar Sadeghi 2
1 1- PhD Candidate in sport biomechanics, Department of Sport Biomechanics, Faculty of physical education and Sport science, Kharazmi University, Tehran, Iran.
2 2- PhD in Sport Biomechanics, Full Professor of Faculity of physical education and Sport science, Department of Sport Biomechanics, Kharazmi University, Tehran, Iran
چکیده [English]

Background and Aim: Epidemiological studies have shown that female athletes are vulnerable to ACL injuries 2 to 10 times more than male athletes. Neuromuscular and biomechanical factors in anterior cruciate ligament injuries are among modifiable risk factors. The high cost of treatment, increasing the potential loss of the competitive season and long-term disability and secondary damage have made the application of injury prevention programs more prominent. In this literature review, related research regarding modifiable risk factors and ACL injury prevention training was studied.
Materials and Methods: To identify the research, databases such as Medline Pubmed, Science Direct, SPORTDiscuss and SCOPUS using the keywords "ACL", "Knee injuries", "modifiable risk factors", "neuromuscular risk factor", "biomechanical risk factor", "training prevention program " were used. Finally, 8500 studies were identified. After exclusion of non-English, duplicated, similar indexed studies, animal studies, studies with injured subjects, studies focused on clinical treatment, and studies without any intervention, 60 articles remained eligible for studying.
Results: Weakness and imbalance of the trunk and lower limb neuromuscular control increase prevalence of ACL injuries in female. Prevention training was categorized in two levels with the aim to modify the risk factors and reduce the rate of ACL injury.  Majority of the effective intervention training exercises are multilateral program for at least 6 weeks in advance of the season and continued throughout the season with a repetition of at least once or twice a week with a trainer in the practice.
Conclusion: Identifying neuromuscular imbalance can be used for screening the athletes at risk and designing the intervention training. However, a standard program aimed at preventing for a specific sport has not been introduced, yet.

کلیدواژه‌ها [English]

  • Anterior Cruciate ligament
  • injury risk factors and internal modifiable risk factor
  • prevention training
  • female athletes
  1. Tik-Pui Fong D, Lam M, Lai P, Shu-Hang Yung P, Fung K Y, Chan K M. Effect of anticipation on knee kinematics during a stop-jump task. Gait & Posture 2014; 39: 75-79.
  2. Gabler CM. The Effectiveness of Neuromuscular Training on a Modifiable Anterior Cruciate Ligament Injury Risk Factor. [Thesis]. Ohio State. The College of Health Sciences and Professions of Ohio University; 2012.
  3. Sell TC, Ferris CM, Abt JP, Tsai YS, Myers JB, Fu FH, Lephart SM. Predictors of proximal tibia anterior shear force during a vertical stop-jump. Journal of Orthopaedic Research 2007; 25(12): 1589-1597.
  4. McNair P, Marshall R, Matheson J. Important features associated with acute anterior cruciate ligament injury. The New Zealand Medical Journal 1990; 103(901): 537.
  5. Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of anterior cruciate ligament injury. Orthopedics 2000; 23:573– 578.
  6. Sell TC, Ferris CM, Abt JP, Tsai YS, Myers JB, Fu FH, Lephart SM. The effect of direction and reaction on the neuromuscular and biomechanical characteristics of the knee during tasks that simulate the noncontact anterior cruciate ligament injury mechanism. The American Journal Sports Medicine 2006; 34:43–54.
  7. Kernozek TW, Torry MR, Vanhoof H, Cowley H, Tanner S. Gender differences in frontal and sagittal plane biomechanics during drop landings. Medicine and Science in Sports and Exercise 2005; 37(6): 1003-1012.
  8. Schmitz RJ, Shultz SJ, Nguyen AD. Dynamic valgus alignment and functional strength in males and females during maturation. Journal of Athletic Training 2009; 44(1): 26.
  9. Shultz SJ, Nguyen AD, Leonard MD, Schmitz RJ. Thigh strength and activation as predictors of knee biomechanics during a drop jump task. Medicine and Science in Sports and Exercise 2009; 41(4): 857- 866.
  10.  Sigward S, Pollard C, Powers C. The influence of sex and maturation on landing biomechanics: implications for anterior cruciate ligament injury. Scandinavian Journal of Medicine & Science in Sports 2012; 22(4):502-9.
  11. Hewett TE, Zazulak BT, Myer GD, Ford KR. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes. The American Journal of Sports Medicine. 2005: 33(4): 492-501.
  12.  Ford KR, Myer GD, Hewett TE. Valgus knee motion during landing in high school female and male basketball players. Medicine & Science in Sports & Exercise; 2003. 35(10): 1745-1750.
  13.  Myer GD, Ford KR, Hewett TE. Rationale and clinical techniques for anterior cruciate ligament injury prevention among female athletes. Journal of Athletic Training 2004; 39(4): 352-364.
  14. Ireland ML. The female ACL: why is it more prone to injury? Orthopedic Clinics of North America 2002; 33(4): 637–651.
  15. Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understandin and prevention ACL injuries: current biomechanical and epidemiological considerationd. North American Journal of Sport Physical Therapy 2010; 5(4): 234-51
  16. Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer. The American Journal of Sports Medicine 2005; 33(4):524-31.
  17. Hewett TE, Stroupe AL, Nance TA, Noyes, FR. Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. The American Journal of Sports Medicine 1996; 24:765–773.
  18.  Zazulak BT, Ponce P, Straub SJ, Medvecky MJ, Hewett TE. Gender comparison of hip muscle activity during single-leg landing. Journal of Orthopaedic & Sports Physical Therapy 2005; 35 :( 5):292-9.
  19.  DeMorat G, Weinhold P, Blackburn T, Chudik S, Garrett W. Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. The American Journal of Sports Medicine 2004; 32(2):477-83.
  20.  Chappell JD, Yu B, Kirkendall DT, Garrett WE. A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. The American Journal of Sports Medicine 2002; 30:261–7.
  21. Huston LJ, Wojtys EM. Neuromuscular performance characteristics in elite female athletes. The American Journal of Sports Medicine 1996; 24(4): 427-436.
  22. Shultz SJ, Nguyen AD, Schmitz RJ. Differences in lower extremity anatomical and postural characteristics in males and females between maturation groups. The Journal of Orthopaedic & Sports Physical Therapy 2008; 38(3): 137-149.
  23.  Besier TF, Lloyd DG, Cochrane JL, Ackland TR. External loading of the knee joint during running and cutting maneuvers. Medicine & Science in Sports & Exercise 2001; 33:1168–75.
  24. Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. The American Journal of Sports Medicine 2004; 32(4):1002-12.
  25. Rozzi SL, Lephart SM, Gear WS, Fu FH. Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players. The American journal of sports medicine 1999; 27:312–19.
  26. Myer GD, Ford KR, Hewett T. The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position. Journal of Electromyography & Kinesiology 2005; 15: (2):181-9.
  27.  Fleming BC, Ohlen G, Renstrom PA, Peura GD, Beynnon BD, Badger GJ. The effects of compressive load and knee joint torque on peak anterior cruciate ligament strains. The American Journal of Sports Medicine 2003; 31:701-707.
  28.  Hewett TE, Torg JS, Boden BP. 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. British Journal of Sports Medicine 2009; 43(6):417-22.
  29.  Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. The effects of core proprioception on knee injury. The American Journal of Sports Medicine. 2007; 35 (3):368-73.
  30. Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. The American Journal of Sports Medicine 2010; 38:1968–1978.
  31. Leetun DT, Ireland ML, Willson JD, Ballantyne BT, DAVIS I. Core stability measures as risk factors for lower extremity injury in athletes. Medicine & Science in Sports & Exercise 2004;36(6):926-34
  32. Chaudhari AM, Andriacchi TP. The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury. Journal of Biomechanics 2006; 39:330-8.
  33. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. British Journal of Sports Medicine 2008; 42:394–412.
  34.  Malinzak RA, Colby SM, Kirkendall DT, Yu B, Garrett WE. A. Comparison of knee joint motion patterns between men and women in selected athletic tasks. Clinical Biomechanics 2001; 16:438-45.
  35.  Padua DA, Marshall SW. Evidence supporting ACL-injury prevention exercise programs: a review of the literature. Athletic Therapy Today 2006; 11:11–23.
  36. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin, LY, Kirkendall, DT, Garrett WJ. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. The American Journal of Sports Medicine 2005; 33:1003–1010.
  37. Heidt RS Jr, Sweeterman LM, Carlonas RL, Traub JA, Tekulve FX. Avoidance of soccer injuries with preseason conditioning. The American Journal of Sports Medicine 2000; 28:659–662.
  38. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. The American Journal of Sports Medicine 1999; 27:699–706.
  39. Petersen W, Braun C, Bock W, Schmidt K, Weimann A, Drescher W, Eiling E, Stange R, Fuchs T, Hedderich J, Zantop T. A controlled prospective case control study of a prevention training program in female team handball players: the German experience. Archives of Orthopeadic & Trauma Surgeon 2005; 125:614–621.
  40. Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R. Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. British Medical Journal 2005; 330(7489):449.
  41. Myklebust G, Engebretsen L, Braekken IH, Skjølberg A, Olsen OE, Bahr R. Prevention of noncontact anterior cruciate ligament injuries in elite and adolescent female team handball athletes. Instructional Course Lectures 2007; 56:407–418.
  42. Soligard T, Myklebust G, Steffen K, Holme, I, Silvers, H,  Bizzini M, Junge A, Dvorak J, Bahr, R, Andersen TE. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomized controlled trial. British Medical Journal 2008; 337:a2469.
  43. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. The sequence of prevention: a systematic approach to prevent anterior cruciate ligament injury. Clinical Orthopedic Related Research 2012; 470:2930–2940.
  44. Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY, Watanabe DS, Dick RW, Dvorak J. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. The American Journal of Sports Medicine 2008; 36:1476–1483.
  45. Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R. Mechanisms of anterior cruciate ligament injury in basketball: Video analysis of 39 cases. The American Journal of Sports Medicine 2007; 35: 359–367.
  46.  Hurd WJ, Chmielewski TL, Snyder-Mackler L. Perturbationenhanced neuromuscular training alters muscle activity in female athletes. Knee Surgery Sports Traumatology, Arthroscopy 2006; 14: 60–69.
  47.  Chimera NJ, Swanik KA, Swanik CB, Straub SJ. Effects of plyometric training on muscle-activation strategies and performance in female athletes. Journal of Athletic Training 2004; 39: 24–31.
  48.  Paterno MV, Myer GD, Ford KR, Hewett TE. Neuromuscular training improves single-limb stability in young female athletes. Journal of Orthopeadic Sports Physical Therapy 2004; 34: 305-16.
  49. Lephart SM, Abt JP, Ferris CM, Sell TC, Nagai T, Myers JB, Irrgang JJ. Neuromuscular and biomechanical characteristic changes in high school athletes: a plyometric versus basic resistance program. British Journal of Sports Medicine 2005; 39: 932-8.
  50. Myer GD, Ford KR, McLean SG, Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. The American Journal of Sports Medicine 2006; 34:445–455.
  51. Herman DC, Weinhold PS, Guskiewicz KM, Garrett WE, Yu B, Padua DA. The effects of strength training on the lower extremity biomechanics of female recreational athletes during a stop-jump task. The American Journal of Sports Medicine 2008; 36: 733-40.
  52. Chappell JD, Limpisvasti O. Effect of a neuromuscular training program on the kinetics and kinematics of jumping tasks. The American Journal of Sports Medicine 2008; 36:1081-6.
  53. Myer GD, Ford KR, Palumbo JP, Hewett TE. Neuromuscular training improves performance and lower extremity biomechanics in female athletes. The Journal of Strength & Conditioning Research 2005; 19:51–60.
  54.  Pollard CD, Sigward SM, Ota S, Langford K, Powers CM. The influence of in-season injury prevention training on lowerextremity kinematics during landing in female soccer players. Clinical Journal of Sport Medicine 2006; 16:223–227.
  55.  Holcomb WR, Rubley MD, Lee HJ, Guadagnoli MA. Effect of hamstring-emphasized resistance training on hamstring: quadriceps strength ratios. The Journal of Strength & Conditioning Research 2007; 21: 41–47.
  56. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, La´zaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surgery Sports Traumatology, Arthroscopy 2009; 17(7):705-29.
  57. Myer GD, Ford KR, Brent JL, Hewett TE. Differential neuromuscular training effects on ACL injury risk factors in ‘‘high-risk’’ versus ‘‘low-risk’’ athletes. BioMed Central Musculoskeletal Disorders 2007;  8:39
  58.  Zebis MK, Bencke J, Andersen LL, Dossing S, Alkjaer T, Magnusson SP, Kjaer M, Aagaard P. The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players. Clinical Journal of Sport Medicine 2008; 18:329–337.
  59. Leporace G , Praxedes, J, Ribeiro Pereira, G, Medeiros Pinto, S, Chagas, D, Metsavaht, L, Chame, F, Alberto Batista, L. Influence of a preventive training program on lower limb kinematics and vertical jump height of male volleyball athletes. Physical Therapy in Sport 2013; 14: 35e43.
  60. Blackburn JT, Norcross MF, Cannon LN, Zinder SM. Hamstring’s stiffness and landing biomechanics linked to anterior cruciate ligament loading. Journal of Athletic Training 2013; 48(4):000–000.
  61.  Blackburn JT, Norcross MF. The effects of isometric and isotonic training on hamstring stiffness and anterior cruciate ligament loading mechanisms. Journal of Electromyography and Kinesiology 2014; 24 98–103.
  62. Caraffa A, Cerulli G, Projetti M, Aisa, G. Rizzo, A. Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surgery Sports Traumatology Arthroscopy. 1996; 4(1):19–21.
  63.  Voskanian N. ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Current Reviews in Musculoskeletal Medicine 2013; 6:158–163
  64. Soderman K, Werner S, Pietilla T, Engström B, Alfredson H. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surgery Sports Traumatology, Arthroscopy 2000; 8:356–63.
  65. Wedderkopp N, Kaltoft M, Holm R,  Froberg K. Comparison of two intervention programmes in young female players in European handball: With and without ankle discs. Scandinavian Journal of Medicine and Science in Sports 2003; 35: 371-376
  66. Pasanen K, Parkkari J, Pasanen M, Hiilloskorpi H, Mäkinen T, Järvinen M, Kannus P. Neuromuscular training and the risk of leg injuries in female floorball players: cluster randomised controlled study. British Medical Journal 2008; 337, a295.
  67. Pfeiffer RP, Shea KG, Roberts D, Grandstrand S, Bond L. Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury. The Journal of Bone & Joint Surgery American volume 2006; 88: 1769-74.
  68.  Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R. Preventing injuries in female youth football—a cluster-randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports 2008; 18(5):605-14.
  69. LaBella CR, Huxford MR, Grissom J, Kim KY, Peng J, Christoffel KK. Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial. Archives of Pediatrics & Adolescent Medicine 2011; 165:1033–40.
  70. Waldén M, Atroshi I, Magnusson H, Wagner P, Hägglund M. Prevention of acute knee injuries in adolescent female football players: cluster randomized controlled trial. British Medicine Journal 2012; 344: e3042.
  71. Kiani A, Hellquist E, Ahlqvist K, Gedeborg R, Michaëlsson K, Byberg L. Prevention of Soccer-Related Knee Injuries in Teenaged Girls. Archives of Internal Medicine 2010; 170; 43-9.