Don’t Peak Too Early: Evidence for an ACL Injury Prevention Mechanism of the 11+ Program

Haraldur B. Sigurðsson*, Kristín Briem, Karin Grävare Silbernagel, Lynn Snyder-Mackler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background The 11+ program prevents anterior cruciate ligament (ACL) injuries in athletes through unknown mechanisms. Purpose The aim of the current study was to evaluate the effects of The 11+ intervention program, performed by female soccer players during a single season, on the frequency of Early Peaks during athletic tasks. Methods Three teams (69 players) of collegiate female soccer athletes (Divisions I and II) were recruited. Two teams (49 players) volunteered to perform The 11+ three times per week for one season (~22 weeks plus three weeks pre-season), and one team (20 players) served as controls. The athletes performed three repetitions of a cutting maneuver, side shuffle direction change, and forwards to backwards running direction change before and after the competitive season and were recorded using marker-based 3D motion capture. Knee valgus moment time series were calculated for each repetition with inverse kinematics and classified as either “Very Early Peak”, “Early Peak” or “other” using cluster analysis. The classification was based timing of the peak relative to the timing of ACL injuries. The effect of the intervention on the frequency of Very Early Peaks and Early Peaks was evaluated with a mixed Poisson regression controlling for the movement task and pre-season frequency. Results The 11+ intervention reduced the frequency of Early Peak knee valgus moment in one intervention team (coefficient =-1.16, p = 0.004), but not the other (coefficient =-0.01, p = 0.977). No effect was observed on the frequency of Very Early Peak knee valgus moment. Conclusions Reduced frequency of knee valgus moment Early Peak during athletic tasks may explain the mechanism by which The 11+ program decreases risk of ACL injury. Prospective studies with a much larger sample size are required to establish a link between Early Peak knee valgus moments and risk of ACL injury. Level of evidence 2b.

Original languageEnglish
Pages (from-to)823-831
Number of pages9
JournalInternational Journal of Sports Physical Therapy
Volume17
Issue number5
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number R01AR072034). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by grant R37-HD037985 from the National Institute of Health. This work was supported by the Ice-landic Research Fund, grant numbers 120410021, 903271305, 1203250031, and 185359051.

Funding Information:
Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number R01AR072034). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by grant R37-HD037985 from the National Institute of Health. This work was supported by the Icelandic Research Fund, grant numbers 120410021, 903271305, 1203250031, and 185359051.

Publisher Copyright:
© 2022, North American Sports Medicine Institute. All rights reserved.

Other keywords

  • biomechanics
  • Cluster analysis
  • injury prevention
  • knee
  • soccer

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