背景:当前最好的证据支持神经肌肉训练在降低受伤风险方面的有效性;但是,前交叉韧带(ACL)损伤的发生率仍然很高。神经认知训练(NT)已经成功地改善了生物力学的危险因素,但是只有少数研究考虑过它们。
目的:回顾文献,以确定NT对运动员ACL损伤相关生物力学危险因素的影响。
方法:我们搜索了PubMed,谷歌学者,Scopus,科学直接,和物理治疗证据数据库从开始到2011年8月。我们纳入了使用运动学习方法和损伤预防计划来调查与ACL损伤相关的运动学和动力学风险因素的随机对照试验。通过物理治疗证据数据库量表评估每个临床试验研究的质量。资格标准是根据PICOS(人群,干预,比较,结果,和研究类型)框架。
结果:共有9项研究纳入最终分析。运动学习方法包括内部和外部关注焦点,双重任务,视觉运动训练,自我控制反馈,差分学习,线性和非线性教学法,结合锻炼计划。在大多数使用NT的研究中,膝关节外翻显著减少;胫骨外展和外旋;地面反作用力;膝盖增加,主干-,hip-,并观察到膝关节屈曲力矩。
结论:在经典NT中,与理想运动模式的偏差,尤其是强调变异性和自我发现过程在预防损伤中起作用,并可能减轻运动员ACL损伤的生物力学风险因素。建议从业者将运动特定的认知任务与神经肌肉训练相结合,以模拟竞争环境的负荷。这可以改善ACL损伤风险降低和康复计划。
BACKGROUND: The best current evidence supports the effectiveness of neuromuscular training in reducing the risk of injury; however, the rate of anterior cruciate ligament (ACL) injuries is still high. Neurocognitive training (NT) has successfully improved biomechanical risk factors, but they have been considered in only a few studies.
OBJECTIVE: To review the literature to determine the effect of NT on biomechanical risk factors related to ACL injury in athletes.
METHODS: We searched PubMed, Google Scholar, Scopus, Science Direct, and the Physiotherapy Evidence Database from inception to August 2011. We included randomized controlled trials that used motor learning approaches and injury prevention programs to investigate kinematic and kinetic risk factors related to ACL injury. The quality of each clinical trial study was evaluated by the Physiotherapy Evidence Database scale. The eligibility criteria were checked based on the PICOS (population, intervention, comparison, outcome, and study type) framework.
RESULTS: A total of 9 studies were included in the final analysis. Motor learning approaches include internal and external focus of attention, dual tasks, visual motor training, self-control feedback, differential learning, and linear and nonlinear pedagogy, combined with exercise programs. In most of the studies that used NT, a significant decrease in knee valgus; tibial abduction and external rotation; ground reaction force; and an increase in knee-, trunk-, hip-, and knee-flexion moment was observed.
CONCLUSIONS: In classical NT, deviation from the ideal movement pattern especially emphasizing
variability and self-discovery processes is functional in injury prevention and may mitigate biomechanical risk factors of ACL injuries in athletes. Practitioners are advised to use sport-specific cognitive tasks in combination with neuromuscular training to simulate loads of the competitive environment. This may improve ACL injury risk reduction and rehabilitation programs.