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Joerg Teichmann, Rachel Tan, Kim Hébert-Losier, Yeo Wee Kian, Shabana Jalal Din, Ananthi Subramaniam, Dietmar Schmidtbleicher, and C. Martyn Beaven

Context: Sensorimotor, proprioceptive, and neuromuscular programs are critical for the successful rehabilitation of injured athletes, and these decrease reinjury rates. Objective: To investigate the effects of an unexpected disturbance program (UDP) on balance and unilateral strength metrics in athletes with unilateral knee ligament injury. Design: A 3-week parallel-group experimental design consisting of 9 rehabilitation sessions. Setting: National Sports Institute. Participants: Twenty-one national-level athletes (age 21.4 [4.4] y, body mass 63.9 [10.8] kg, height 169.0 [10.2] cm) who had sustained a unilateral knee ligament injury. Intervention: An UDP program designed to evoke rapid sensorimotor responses was compared with traditional training and a nonexercise control group. Main Outcome Measures: Unilateral total, anteroposterior, and mediolateral sway with eyes open and closed and unilateral isometric strength. Results: Traditional exercises tended to outperform the UDP when unilateral balance testing was performed with eyes open; however, balance improvement following UDP tended to be greater in the eyes-closed condition. Significant strength gains in both the injured and uninjured legs were only observed following the UDP. This increase in unilateral isometric strength was 23.4 and 35.1 kg greater than the strength improvements seen in the traditional rehabilitation and control groups (P < .05). Conclusions: UDP could improve neural aspects of rehabilitation to improve rehabilitation outcomes by improving strength, sensorimotor function, and proprioception. Given the complementary adaptations, an UDP could provide an effective adjunct to traditional rehabilitation protocols and improve return-to-play outcomes.