Purpose: The risk of anterior cruciate ligament (ACL) injuries in childhood has increased in recent decades and could be a major threat to a child's sports career. An increased risk of ACL injury is associated with dynamic knee valgus (DKV). Therefore, this study aimed to analyze the effect of an ACL injury protocol on the LESS, proprioception, and DKV of child soccer players. Methods: In this study, thirty male football players with DKV (mean ± SD: age 11.40 ± .72 years, weight 36.62 ± 4.68 kg, height 141.10 ± 3.98 m) were randomly assigned into two groups: control (n=15) and training (n=15). Single-leg landing, LESS, and knee joint proprioception tests were administered before and after the implementation of the training protocol. After identifying the variables, the training group performed the injury proprioception program for eight weeks, with three training sessions each lasting 20–25 minutes per week. The control group continued their normal warm-up routine. To examine the difference between the pre-test and post-test, repeated measures ANOVA was conducted using SPSS 26 software with a significance level of 0.05. Results: The results of the research showed that after eight weeks of the injury prevention program, there was a significant improvement in reducing the valgus angle of the knee (p=0.005, F=9.369, η²=0.251), reducing the LESS scores (p=0.002, F=12.374, η²=0.306) and improving proprioception (p=0.003, F=10.251, η²=0.268). Conclusion: According to the results of the research, it can be concluded that Stop-X injury prevention program can lead to improvements in knee valgus pattern, LESS and proprioception in child soccer players. Using the results of this research is recommended to soccer coaches and training experts.
Sadigursky D, Braid J A, De Lira D N L, Machado B A B, et al. The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC sports science, medicine and rehabilitation 2017; 9(1): 1-8.
Count F B. 270 million people active in football. FIFA Communications Division, Information Services 2006; 31:2007-2010.
Thorborg K, Krommes K K, Esteve E, Clausen M B, et al. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. British journal of sports medicine 2017; 51(7): 562-571.
Koga H, Muneta T, Bahr R, Engebretsen L, and Krosshaug T, ACL injury mechanisms: lessons learned from video analysis, in Rotatory Knee Instability. 2017; Springer: 27-36.
Jlid M C, Racil G, Coquart J, Paillard T, et al. Multidirectional plyometric training: Very efficient way to improve vertical jump performance, change of direction performance and dynamic postural control in young soccer players. Frontiers in physiology. 2019; 10:1462-1471.
Ford K R, Myer G D, and Hewett T E. Valgus knee motion during landing in high school female and male basketball players. Medicine and science in sports and exercise 2003; 35(10): 1745-1750.
Joseph A M, Collins C L, Henke N M, Yard E E, et al. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. Journal of athletic training 2013; 48(6): 810-817.
Filbay S R, Ackerman I N, Russell T G, and Crossley K M. Return to sport matters—longer‐term quality of life after ACL reconstruction in people with knee difficulties. Scandinavian journal of medicine & science in sports 2017; 27(5): 514-524.
Toomey C M, Whittaker J L, Nettel-Aguirre A, Reimer R A, et al. Higher fat mass is associated with a history of knee injury in youth sport. journal of orthopaedic & sports physical therapy 2017; 47(2): 80-87.
Boden B P, Dean G S, Feagin J A, and Garrett W E, Mechanisms of anterior cruciate ligament injury. SLACK Incorporated Thorofare, NJ 2000: 573-578.
Gabler C M, The Effectiveness of Neuromuscular Training on a Modifiable Anterior Cruciate Ligament Injury Risk Factor, Ohio University 2012; 34-75.
Ireland M L. The female ACL: why is it more prone to injury? Orthopedic Clinics 2002; 33(4): 637-651.
Dodwell E R, Lamont L E, Green D W, Pan T J, et al. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. The American journal of sports medicine 2014; 42(3): 675-680.
Christino M A, Tepolt F A, Sugimoto D, Micheli L J, and Kocher M S. Revision ACL reconstruction in children and adolescents. Journal of Pediatric Orthopaedics 2020; 40(3): 129-134.
Johnson D L. ACL prevention programs: fact or fiction? Orthopedics (Online). 2010; 33(1): 36-45.
Wilczyński B, Zorena K, and Ślęzak D. Dynamic knee valgus in single-leg movement tasks. Potentially modifiable factors and exercise training
options. A literature review. International Journal of Environmental Research and Public Health 2020; 17(21): 8208-8215.
Grassi A, Smiley S P, Roberti di Sarsina T, Signorelli C, et al. Mechanisms and situations of anterior cruciate ligament injuries in professional male soccer players: a YouTube-based video analysis. European Journal of Orthopaedic Surgery & Traumatology 2017; 27(7): 967-981.
Waldén M, Krosshaug T, Bjørneboe J, Andersen T E, et al. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. British journal of sports medicine 2015; 49(22): 1452-1460.
Mauntel T C, Begalle R L, Cram T R, Frank B S, et al. The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. The Journal of Strength & Conditioning Research 2013; 27(7)1813-1823.
Lagas I F, Meuffels D E, Visser E, Groot F P, et al. High knee loading in male adolescent pre-professional football players: Effects of a targeted training programme. Journal of science and medicine in sport 2019; 22(2): 164-168.
Rostami M, Sedaghati P, and Daneshmandi H. The effectiveness of the STOP-X training program on the knee valgus angle and balance in female basketball players with dynamic knee valgus: a randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation 2024; 16(1): 52-64.
Parsons J L, Sylvester R, and Porter M M. The effect of strength training on the jump-landing biomechanics of young female athletes: results of a randomized controlled trial. Clinical Journal of Sport Medicine 2017; 27(2): 127-132.
Lopes M, Lopes S, Patinha T, Araújo F, et al. Balance and proprioception responses to FIFA 11+ in amateur futsal players: Short and long-term effects. Journal of sports sciences 2019; 37(20): 2300-2308.
Read P J, Oliver J L, De Ste Croix M, Myer G D, and Lloyd R S. A prospective investigation to evaluate risk factors for lower extremity injury risk in male youth soccer players. Scandinavian journal of medicine & science in sports 2018; 28(3): 1244-51.
Nessler T, Denney L, and Sampley J. ACL injury prevention: what does research tell us? Current reviews in musculoskeletal medicine 2017; 10(3): 281-288.
Gokeler A, Welling W, Zaffagnini S, Seil R, and Padua D. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee surgery, sports traumatology, arthroscopy 2017; 25(1): 192-199.
Babagoltabar samakoush h and Norasteh A A. The effect of German Knee Association training program (STOP X program) on knee condition and balance of adolescent soccer players with dynamic knee valgus. Studies in Sport Medicine 2022; 13(30): 231-254.
Herrington L, Alenezi F, Alzhrani M, Alrayani H, and Jones R. The reliability and criterion validity of 2D video assessment of single leg squat and hop landing. Journal of Electromyography and Kinesiology 2017; 34: 80-85.
Hamdan M, Ismail S I, Hassan H, Ismail H, et al. How reliable is kinovea vs. templo in knee and hip kinematics assessment during side cutting tasks. Knee 2017; 2(1): 1-2.
Koorosh-fard N, Rajabi R, and Shirzad E. Effect of feedback corrective exercise on knee valgus and electromyographic activity of lower limb muscles in single leg squat. Archives of Rehabilitation 2015; 16(2): 138-47.
Read P J, Oliver J L, Croix M B D S, Myer G D, and Lloyd R S. A review of field-based assessments of neuromuscular control and their utility in male youth soccer players. The Journal of Strength & Conditioning Research 2019; 33(1): 283-99.
Padua D A, DiStefano L J, Beutler A I, De La Motte S J, et al. The landing error scoring system as a screening tool for an anterior cruciate ligament injury–prevention program in elite-youth soccer athletes. Journal of athletic training 2015; 50(6): 589-95.
Beutler A I, Sarah J, Marshall S W, Padua D A, and Boden B P. Muscle strength and qualitative jump-landing differences in male and female military cadets: The jump-ACL study. Journal of sports science & medicine 2009; 8(4):663-671.
Read P J, Oliver J L, Croix M B D S, Myer G D, and Lloyd R S. A review of field-based assessments of neuromuscular control and their utility in male youth soccer players. Journal of strength and conditioning research 2019; 33(1): 283-291.
Panics G, Tallay A, Pavlik A, and Berkes I. Effect of proprioception training on knee joint position sense in female team handball players. British journal of sports medicine 2008; 42(6): 472-476.
Li L, Ji Z-Q, Li Y-X, and Liu W-T. Correlation study of knee joint proprioception test results using common test methods. Journal of physical therapy science 2016; 28(2): 478-482.
Niederer D, Keller M, Achtnich A, Akoto R, et al. Effectiveness of a home-based re-injury prevention program on motor control, return to sport and recurrence rates after anterior cruciate ligament reconstruction: study protocol for a multicenter, single-blind, randomized controlled trial (PReP). Trials 2019; 20: 1-10.
Petersen W, Zantop C, Achtnich A, Zantop T, and Stöhr A. Return to Sports Following Anterior Cruciate Ligament Reconstruction: Recommendations of the German Knee Society (Deutsche Kniegesellschaft, DKG). Return to Play in Football: An Evidence-based Approach. 2018: 159-172.
McLean S G, Huang X, Su A, and Van Den Bogert A J. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clinical biomechanics. 2004; 19(8): 828-838.
Seyedi M, Zarei M, Daneshjoo A, Rajabi R, et al. Effects of FIFA 11+ warm-up program on kinematics and proprioception in adolescent soccer players: a parallel‑group randomized control trial. Scientific Reports 2023; 13(1): 5527-5532.
Alikhani R, Shahrjerdi S, Golpaigany M, and Kazemi M. The effect of a six-week plyometric training on dynamic balance and knee proprioception in female badminton players. The Journal of the Canadian Chiropractic Association 2019; 63(3):144-153.
Babagoltabar Samakoush H, Norasteh A. Effect of a Neuromuscular Training on Knee Valgus, Range of Motion and Muscle Strength of Soccer Players With Dynamic Knee Valgus. The Scientific Journal of Rehabilitation Medicine 2023; 12(3): 486-503.
Pfile K R, Gribble P A, Buskirk G E, Meserth S M, and Pietrosimone B G. Sustained improvements in dynamic balance and landing mechanics after a 6-week neuromuscular training program in college women’s basketball players. Journal of sport rehabilitation 2016; 25(3): 233-240.
Zareei M, Rahmani N, and Ghorbani A. The Effect of FIFA 11+ KIDS on the Jump-Landing Biomechanics of Adolescent Soccer Players. Journal of Applied Exercise Physiology 2018; 14(27): 195-207.
Myer G D, Ford K R, PALUMBO O P, and Hewett T E. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. The Journal of Strength & Conditioning Research 2005; 19(1): 51-60.
Rössler R, Donath L, Verhagen E, Junge A, et al. Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis. Sports medicine 2014; 44(12): 1733-1748.
Forrest M R, Hebert J J, Scott B R, Brini S, and Dempsey A R. Risk factors for non-contact injury in adolescent cricket pace bowlers: a systematic review. Sports medicine 2017; 47(12): 2603-2619.
Read P J, Oliver J L, Dobbs I J, Wong M A, et al. The effects of a four-week neuromuscular training program on landing kinematics in pre-and post-peak height velocity male athletes. Journal of Science in Sport and Exercise 2021; 3(1): 37-46.
Vocke A and Schmid A. Osseous overgrowth after post-traumatic amputation of the lower extremity in childhood. Archives of orthopaedic and trauma surgery 2000; 120(7): 452-454.
Rössler R, Donath L, Bizzini M, and Faude O. A new injury prevention programme for children’s football–FIFA 11+ Kids–can improve motor performance: a cluster-randomised controlled trial. Journal of sports sciences 2016; 34(6): 549-556.
Imai A, Kaneoka K, Okubo Y, and Shiraki H. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. International journal of sports physical therapy 2014; 9(1): 47-55.
Williams G N, Chmielewski T, Rudolph K S, Buchanan T S, and Snyder-Mackler L. Dynamic knee stability: current theory and implications for clinicians and scientists. Journal of orthopaedic & sports physical therapy 2001; 31(10): 546-566.
Hewett T E, Ford K R, Hoogenboom B J, and Myer G D. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations-update 2010. North American journal of sports physical therapy: NAJSPT 2010; 5(4): 234-241.
Powers C M. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. journal of orthopaedic & sports physical therapy 2010; 40(2): 42-51.
Bscher M, Zech A, Pfeifer K, Nsel F, et al. Neuromuscular training for sports injury prevention: a systematic review. Medicine and science in sports and exercise 2010; 42(3): 413-421.
Eslami, A., Sahebozamani, M., & Bahiraei, S. (2024). Effect of Stop-X Injury Prevention Program on LESS and Proprioception of Child Soccer Players with Dynamic Knee Valgus. Journal of Paramedical Sciences & Rehabilitation, 13(2), 17-29. doi: 10.22038/jpsr.2024.75713.2565
MLA
A Eslami; M Sahebozamani; S Bahiraei. "Effect of Stop-X Injury Prevention Program on LESS and Proprioception of Child Soccer Players with Dynamic Knee Valgus", Journal of Paramedical Sciences & Rehabilitation, 13, 2, 2024, 17-29. doi: 10.22038/jpsr.2024.75713.2565
HARVARD
Eslami, A., Sahebozamani, M., Bahiraei, S. (2024). 'Effect of Stop-X Injury Prevention Program on LESS and Proprioception of Child Soccer Players with Dynamic Knee Valgus', Journal of Paramedical Sciences & Rehabilitation, 13(2), pp. 17-29. doi: 10.22038/jpsr.2024.75713.2565
VANCOUVER
Eslami, A., Sahebozamani, M., Bahiraei, S. Effect of Stop-X Injury Prevention Program on LESS and Proprioception of Child Soccer Players with Dynamic Knee Valgus. Journal of Paramedical Sciences & Rehabilitation, 2024; 13(2): 17-29. doi: 10.22038/jpsr.2024.75713.2565