Injury Risk Factors Integrated Into Self-Guided Real-Time Biofeedback Improves High-Risk Biomechanics

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Context: Existing anterior cruciate ligament (ACL) injury prevention programs have failed to reverse the high rate of ACL injuries in adolescent female athletes. Objective: This investigation attempts to overcome factors that limit efficacy with existing injury prevention programs through the use of a novel, objective, and real-time interactive visual feedback system designed to reduce the biomechanical risk factors associated with ACL injuries. Design: Cross-over study. Setting: Medical center laboratory. Participants: A total of 20 females (age = 19.7 [1.34] y; height = 1.74 [0.09] m; weight = 72.16 [12.45] kg) participated in this study. Methods: Participants performed sets of 10 bodyweight squats in each of 8 training blocks (ie, 4 real-time and 4 control blocks) and 3 testing blocks for a total of 110 squats. Feedback conditions were blocked and counterbalanced with half of participants randomly assigned to receive the real-time feedback block first and half receiving the control (sham) feedback first. Results: Heat map analysis revealed that during interaction with the real-time feedback, squat performance measured in terms of key biomechanical parameters was improved compared with performance when participants squatted with the sham stimulus. Conclusions: This study demonstrates that the interactive feedback system guided participants to significantly improve movement biomechanics during performance of a body weight squat, which is a fundamental exercise for a longer term ACL injury risk reduction intervention. A longer training and testing period is necessary to investigate the efficacy of this feedback approach to effect long-term adaptations in the biomechanical risk profile of athletes.

Bonnette, DiCesare, Kiefer, Barber Foss, Thomas, Kitchen, Diekfuss, and Myer are with the Division of Sports Medicine, SPORT Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. Kiefer is with the Department of Pediatrics, University of Cincinnati, Cincinnati, OH. Kiefer and Riley are with the Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA. Kiefer and Myer are with the College of Medicine, University of Cincinnati, Cincinnati, OH, USA. Myer is also with the Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; and the Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA.

Bonnette (scott.bonnette@cchmc.org) is corresponding author.
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