Sport injury in athletes is almost inevitable and it can happens to the player for any games played particularly by athletes. According to Chalmers (2002), sport injury is, any accidental or intentional harm done to the body resulting from participation in games. As saying goes “injury is just part of the game” in sports but that does not mean it cannot be overcome. Through a varied range of sports, reduced risk of injury are associated with well-developed physical qualities. Obviously, for athletes to progress the physical capacities required to deliver a protective effect against injury, preparation for the injury training prevention is important for every athletes involve.
Anterior cruciate ligaments (ACL) tear among female athletes is set at an alarmingly higher percentage in certain sports which is basketball, team handball, and soccer. Girls that participate in sports has recently incline dramatically. This is possibly due to numbers of females participators has rapidly increasing showing the impacts the number of injuries. Nonetheless, the rates of ACL injuries in sports of basketball and soccer believed to be remained alarmingly high with changing of male-to-female fractions over the last 10 years. Other than that, incidence of female to male stands 3.5 times bigger in basketball plus 2.8 times greater in soccer (Satkunskien?, Vadopalas, Puk?nas, & Jürimäe, 2018).
Understanding the significance cause of sport injury itself is important because based on the causes or factors that contribute to injury of the athletes, it will very much relate to the solutions or may perhaps will be able to reduce the risk of injury on field by come out with proper injury prevention training. Having the correct outcome measure for preventive injury training will be able to put the athlete in a very high performance thus reducing the high risk of injury during games. Once we know the factors that put the athletes in high risk of injury, automatically we will be able to recognize the correct or suitable criteria needed on how to select the accurate injury prevention training.
Mechanism of injury in female athletes for ACL tear is somehow connected with rapid but awkward stop besides anticipation of lateral movements. Considering dynamic movement patterns are somehow shows a very important factors that contributes to ACL injury. It seems promising to identify sports specific at risk motions as well as encouraging the athletes to avoid at risk circumstances whenever possible. By this, encounter the at risk situations using strategies by activating protective neuromuscular responses is a possible prevention strategy (Satkunskien? et al., 2018).
Injury prevention programs (IPP) decreases injury rates, improve movement skill and develop measures of performance (Roberts & Diguiseppi, 1999) . There a several types of injury prevention training such as, strength training, neuromuscular training and plyometric training. Each types of training gives a different changes to body and what they can help in preventing injury and how they can help enhance performance in each athletes. Discussion about what at risk of anterior cruciate ligament tear and what types of injury prevention training can be used to match up with the suitability for female athletes becomes the primary purpose of this paper.
1. PRINCIPLE OF INJURY PREVENTION TRAINING
Physical conditioning is a strategic principle of injury prevention. Proper conditioning programmes will be able to decrease the risk of injury, occurrence of the injury, and can assist in prevent re-injury and it involves sufficient muscular strength, balance, power, endurance, flexibility, speed, and good neuromuscular coordination. By improving components as mention above, the chances to reduce the risk of injuries is obviously high (Taimela, Kujala, & Osterman, 1990). Baechle (1994) mention for each type of activity takes part in its own function, amount of risk exposed and the type of injuries that vary widely. Next page is (table 1) that shows how each one of components of physical conditioning and when to apply or application to injury prevention.
In having all of the components and its application, the types of exercise, activities and training methods will determine the particular adaptations and performance. The physical conditioning is associated with the FITT principle in working together to gain a good injury prevention training.
(Taimela, Kujala, & Osterman, 1990; Baechle, 1994; Raj, 2015)
Neuromuscular training is an exercise to improve motor response by stimulating the afferent and central mechanisms signal that leads to dynamic joint control function. Neurologic input that is insufficient or improperly processing that response at spinal, brain stem, or cognitive may lead to an insufficient response by the motor system consequently resulting in an injury. This neuromuscular training also has been defined as multi-intervention programs that combines balance, agility, strength, plyometric, as well as sport-specific exercises (Coughlan and Caulfield, 2007). In senses, if the player lacks in balance, agility, strength and shows the chance of unable to perform in games plus always more prone to injury due to lack of the conditioning, is very much suitable candidate to be focus on training for the neuromuscular injury prevention training. In addition, before keeping track with neuromuscular training, athletes must have a good physical conditioning as mention before to cope with the adaptations training progression program given.
Hence, it is important to take account of what type drills that is suitable to boost up the neuromuscular control into injury prevention training programs for sports (Etty Griffin, 2003; Raj, 2015).
Therefore, neuromuscular strengthening training is best to applied before in-season games because the process of joint adaptations is needed to give good conditioning to the player. As mention above, neuromuscular training involve the mechanoreceptors are generalised sensory receptors that forming an electric neural signal from transducing mechanical deformation. By this, it travels thru cortical and reflex pathways towards providing information pertinent to proprioception, which is to be exact, information that concern joint position and joint movement. Time to train for this types of intervention would be needed to re-establish this altered neurologic function in response to sudden alterations in joint positioning (Etty Griffin, 2003; Raj, 2015).
The time needed in completing the multi-intervention training programs( physical conditioning) ranged from 10 – 30 minutes. Mostly multi-intervention injury prevention training programs were performed usually during pe-practice warm up, during the pre- season and in-season schedule (Maeo et al., 2014).
2. HOW THE ACTIVITIES WORK ON ATHLETE’S BODY AND WHAT CHANGES
Numerous researchers have proven that female athletes exist at a higher risk of having an ACL injury between their male counterparts (Bowerman, Smith, Carlson, ; King, 2006). ACL injury prevention program for strength, and jump training with additional exercises and drills to enhance speed, agility and aerobic conditioning. We assumed that this sports specific drill program would top to significant improvements in neuromuscular as well as performance indices(Oyes, Estin, Mith, ; Ampbell, 2012).
The neuromuscular training could be well-defined as training to increase unconscious response via stimulating together afferent signals plus central mechanisms that responsible for dynamic joint control. This is importance for neuromuscular training to enhance the nervous systems capability to produce fast and optimal muscle firing configuration to improve or increase joint stability through co- contraction, to reduce joint forces, in addition to relearn movement patterns and skills.
The Injuries of the player often cause brief loss of ability to triggered particular muscles or muscle groups (Ellennecker and robert, 1999). The complex movement patterns, movements related with functional as well as sport specific activities is impaired because of muscle inhibition after injury or due to muscle weakness that leads to declination in performance plus increasing the risk of re-injury (Etty Griffin, 2003; Raj, 2015).
Etty Griffin (2003) and Raj (2015) also stated postural exercises improve the brain stem level of motor function at whereas repeating motor patterns in converting conscious toward unconscious motor patterns correspondingly is helpful in enhancing neuromuscular control. In addition, Isokinetic exercises can be performed to enhance joint position sense that might assist in neuromuscular control whereas enhancing the sense of joint motion (kinesthesia) can be helpful by doing the motion of various positions in the athlete’s joint with normal the range of motion.
In identify relevant cues within player environment during games, able to make the correct resolution and rapidly able to speed up out of the directional change is determined by an athlete’s ability through agility manoeuvres (Spiteri, Newton, ; Nimphius, 2015). By this, efficient neuromuscular control is necessary to accomplish a coordinated motor response between cortically-programmed plus reflex-mediated muscle actions. As a result, performance of slower agility are frequently characterized by a delay in processing speed, affecting both neuromuscular control, causing in a longer decision-making phase, as well as compromising performance outcomes. Whereas, producing a faster reaction to a stimulus while changing direction, can cause in muscle pre-activation, that shown to protect against injury besides increase subsequent movement execution (Oyes et al., 2012; Spiteri et al., 2015).
3. TYPES OF INJURY PREVENTION TRAINING
ACL injury demonstrate the importance muscular strength, endurance, power, agility, speed and jumping or plyometric training ability. A training program including balance, plyometrics, resistance training, core strengthening and speed training did reduce knee valgus plus varus torques in female athletes (Myer et al., 2005).Therefore, all of the component above are important as to be in injury prevention training program.
• Harmstring strengthening (muscle activation to reduce tibial translation of knee)
Female athlete are proved to have more anterior tibial laxity and less muscle strength as well as endurance. They take significantly slower time to generate all-out hamstring torque throughout isokinetic testing than males. This shows how weakness of the female athletes’s hamstrings to activate for initial knee stabilization(Trainers, 2016). Therefore, strengthening of the harmstring is proven to be effective measure to reduce risk of acl injury in gaining normal muscle stabilization between quads and harmstring contraction. The example of the exercises are lying leg curls, one leg deadlift, gluteus harmstring rise and more.
• Abdominal core strengthening
Act as primary stabilizer for the trunk, and promotes lumbo pelvic stability for maximal function
(Trainers, 2016). It is also act as an improvement for the lower limb alignment, during a drop jump to neutral position from valgus position.(Oyes et al., 2012). If the core muscle is weak whereas the extremity muscle is strong, there will be no efficient movement produce to outstand with abnormal or external forces receive, and by this weakness, the injury more prone to happen(Trainers, 2016).
• Eccentric muscle actions
This exercise may enhance joint stability in providing an antagonistic energy that resists the joint translation and can be used as the component in neuromuscular training(Raj, 2015).
Drills is where athletes practiced neuromuscular control while stopping quickly, landing, or cutting and this is where the high chance of injury may occur (Etty Griffin, 2003). This is why and multi directional speed and agility training every so often close to resembles the actual sporting activity.
• dynamic stability and proprioception
It is a part of posture, movement, thus changes in equilibrium as well as position, and objects as resistance in relation to the body (Cook, 1997). In promoting a suitable dynamic muscular stabilization thru functional activities, it focuses on body posture and positioning, hence it allows for the abnormal joint translation to be controlled (Raj, 2015).
A good thorough exercise would be accommodates in preventing the injury during games, hence in knowing the correct method of what types of exercise that is suitable for each athletes is quite important. As discuss, the neuromuscular training is a matter of fact is the most suitable method to apply in the ACL injury for the prevention training. It contains speed, agility, strength, power, balance, interval speed training, plyometric at the same time. This is because the neuromuscular training has the effectiveness in refining the joint control and stability thus the proprioception also kinesthesia are essential for appropriate joint function in sports as well as designed for reflex stabilization (Raj, 2015). With the information discuss, this can be used to develop targeted interventions aimed in gaining the maximum performance. Like example basketball athletes would require a lot of form horizontal movement during dribbling, agility, balance, speed as well as strength will become a great assistant in helping out from having an injury. In addition, in basketball games player may possibly spraining or straining their ligament and muscle during jumping to score a goal, with the help of training in balance, interval speed training with extra plyometric effects, those injury may be prevented. By all counts and with the proven evidence based stated, it is no argue that neuromuscular training would be the perfect interventions use to prevent the ACL form injury and at the same time able to enhance or improves athletes performance.