Bakgrund: Knäskador är vanligt bland fotbollsspelande flickor och kan avsluta en karriär i förtid. Studier har gjorts där skadeförebyggande träning visat på god effekt, dock saknas studier som följer upp användningen av träningsprogrammen. Syfte: Beskriva och utvärdera användandet av det skadeförebyggande träningsprogrammet Knäglädje. Metod: En deskriptiv, komparativ design. Totalt 37 fotbollstränare till flicklag i åldrarna 13-19 år svarade på en webbaserad enkät. Resultat: viktigaste faktorerna för användandet av träningsprogrammet var : minskad skaderisk för spelarna, enkelt att lägga in i ordinarie träning och det var kostnadsfritt. De viktigaste faktorerna för att inte använda programmet var: tid försvann från ordinarie träning, tog tid att lära sig programmet samt följde ett annat skadeförebyggande program. Ingen signifikant skillnad sågs vad gäller användandet av träningsprogrammet i förhållande till tränarerfarenhet och tränarutbildning. Tränare som fått utbildning i träningsprogrammet använde det i högre utsträckning än de som inte fått någon utbildning. Skillnaden var signifikant. Konklusion: Viktiga faktorer för användandet av Knäglädje var den minskande skaderisken, att det var kostnadsfritt samt enkelt att lägga in i träningen. Programmet användes i större utsträckning av tränare som fått utbildning i det. Det framkom i studien att de flesta tränare visade en medvetenhet om vikten av skadeförebyggande träning för att minska risken för skador.

Recorded by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / This is a Systematic Review Presentation titled - "Neuromuscular Training & ACL Injury Prevention: A Systematic Review", created by Master of Physical Therapy Graduating Students, University of British Columbia - 2006, Presented on September 14-15, 2006 , Vancouver, BC, Canada

The anterior cruciate ligament (ACL) originates from posterior part of the medial side of the lateral condyle of femur to anterior intercondylar notch between a transverse meniscal ligament and medial side of medial meniscus of tibia. Once ACL is disrupted, pain, effusion and atrophy are commonly observable and cause functional disability. Because of the functional limitations, athletic participation is severely restricted. ACL injury is more prevalent in physically active females compared to their male counterparts in the sports of basketball and soccer in high school and collegiate levels. Several attributes of females are considered risk factors for the higher ACL injury incidences and include: anatomy, physiology and neuromuscular/biomechanics. Among them, neuromuscular/biomechanics is the only modifiable risk factor. Performing neuromuscular training may change muscular strength profiles, which may lead to reduction in ACL injury incidence in female athletes. However, this principle was not fully examined. Also, neuromuscular compliance may play a role in muscular strength development and ACL injury incidences. Thus, the purpose of this dissertation was to investigate the effects of neuromuscular training compliance on muscular strength development and ACL injury incidence. The influence of hip abductor, hamstrings and quadriceps strength was examined in this project. The results of these studies indicate neuromuscular training is an effective intervention to reduce ACL injury incidence in female athletes, and there is an inverse dose-response relationship between compliance of the neuromuscular training and number of ACL incidences in female athletes. The effect of compliance on muscular strength development was inconsistent. The results of these studies support that compliance of neuromuscular training is a key to reduce ACL injury incidences; however, more studies are need to conclude neuromuscular training compliance effects on muscular strength development in female athletes.

Bakgrund: Skada på främre korsbandet är vanligt hos unga kvinnliga fotbollsspelare. Det finns evidens för att neuromuskulär träning kan reducera risken att drabbas av främre korsbandsskada med 64–88 %. Knäkontroll är ett neuromuskulärt träningsprogram som Svenska Fotbollförbundet (SvFF) implementerade i sin tränarutbildning år 2010. Syfte: Syftet med studien var att kartlägga hur väl rekommendationerna för utförande av knäkontrollträning följs i flickfotbollslag i åldrarna 12–17 år samt om förekomst av knäkontrollträning var högre i de flickfotbollslag där lagledaren genomfört tränarutbildning efter år 2010. Metod: Studiens design var en kvantitativ, icke-experimentell tvärsnittsstudie. Data samlades in via en egenkomponerad enkät som besvarades via mejl av 33 lagledare för flickfotbollslag. Deltagarna var ett stickprov ur en större population med geografisk spridning över Sverige. Resultat: Studiens resultat blev att fyra (12 %) lagledare bedömdes tillhöra kategorin Följer helt rekommendationerna, 21 (64 %) lagledare bedömdes tillhöra kategorin Följer delvis rekommendationerna och åtta (24 %) lagledare bedömdes tillhöra kategorin Följer inte rekommendationerna. Någon skillnad i utförande av programmet Knäkontroll beroende på om lagledare hade genomfört tränarutbildning efter 2010 eller om lagledare saknade tränarutbildning kunde inte ses. Slutsats: Slutsatsen av studien blev att majoriteten av lagledare för flickfotbollslag i åldrarna 12–17 delvis följde rekommendationerna för utförande av programmet Knäkontroll. Inga skillnader kunde ses i hur väl programmet Knäkontroll följdes beroende på lagledarens tränarutbildning. / Background: Anterior cruciate ligament (ACL) injuries are common in young female soccer players. There is evidence that neuromuscular training can reduce the risk of ACL injury with 64–88 %. Knee control is a neuromuscular training programme that was implemented in the national education for soccer coaches in 2010. Aim: The aim of the study was to examine how well girl soccer teams, ages 12–17, follow the existing recommendations regarding knee control training to prevent ACL injuries and if adherence was higher in teams where the coach was educated later than 2010. Method: The study design was a quantitative, non experimental cross-sectional study. A self-composed questionnaire was answered through e-mail by 33 coaches for girl soccer teams. Participants were a random sample of a larger population with a geographical spread across Sweden. Results: The result of the study was that four (12 %) coaches were placed in the category Following the recommendations fully, 21 (64 %) coaches in the category Following the recommendations partly and eight coaches in the category Do not follow recommendations. A difference in adherence to the programme Knee control could not be seen based on if the coach had completed the national education for soccer coaches later than 2010 or lacked this education. Conclusion: The conclusion of the study was that the majority of coaches for girl soccer teams, ages 12–17, followed the recommendations partly for performance of the programme Knee control. No difference could be seen in adherence to the programme Knee control based on the coach’s education.

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Purpose: ACL-injuries are comon in female soccer. Preventative intervention has a positive effect on its prevalence. The purpose of this study is to investigate active leader experience of prophylactic neuromuscular exercise and its effect on ACL-rupture in female soccer between 14-16 years. Design and method: A descriptive, qualitative design using semi-structured interviews with active soccer coaches. Qualitative content analysis was employed for data interpretation.  Results: The results contain six categories and fourteen subcategories showing the leaders all had knowledge of neuromuscular exercise (NMT); but that a variety of factors lead to low implementation. Knowledge of NMT was insufficient to support full implementation coupled to a lack of guidelines describing how NMT should be implemented and why. Knowledge of NMT did not reach key people. Courses should include more detailed information with guidance on the design of training, with more information about prophylactic exercise and NMT. Conclusions: Leaders are aware of NMT but there is a lack of knowledge. It is important to supplement course material to include NMT. More guidelines, education and information needs to reach key people for sustainable implementation. Without necessary education, it will not be possible to achieve sufficient compliance to ensure a significant decrease in ACL-ruptures.

The maintenance of the trunk muscles strength presents great importance in the elderly’s health, since it is related to a better performance during the daily activities. However, scientific literature limitations are found when analyzing the tests to measure the strength of these muscles and, in addition, the importance of these muscles in functional performance in the elderly people is not clear. Therefore, the objective of this dissertation was: I) to evaluate the reproducibility of the maximal isometric trunk strength test in the elderly women; II) to verify the association between strength and endurance in the trunk muscles on measures of functional performance in elderly women; and III) to analyze the effects of functional and traditional training on maximal isometric strength and endurance in elderly women. Study I verified the reproducibility of the maximal strength test of the trunk muscles in the elderly, in two days of evaluations, through Interclass Correlation Coefficient, Coefficient of Variation, Minimum Detectable Change, Standard Error of Measure, as well as graphical analysis of Bland-Altman. The study results showed high to very high interclass correlation (extensors = 0.93, flexors = 0.86, respectively); low variation (9% for both muscle groups); and minimal detectable change acceptable (extensors = 51.1 N, flexors = 48.9 N). Furthermore, the Bland-Altman analysis reveals low bias and values within the limits of agreement. In study II, a multiple linear regression was performed with the purpose of explaining to what magnitude the strength and endurance of the trunk muscles contribute to functional performance in elderly women. Thus, there was a participation of the trunk extensor muscles endurance that ranged from 17.9% to 24.4% in functional performance in the elderly. In study III, a randomized and controlled clinical trial was conducted with three groups: functional training, traditional training and control group. The intervention groups performed a training with functional and progressive characteristics, so that the traditional training group performed the exercises in analytical machines and the functional training group, exercises with characteristics of movement patterns in a multiplanar and coordinated manner, incorporating multiple joints. The groups were evaluated before and after 12 training weeks through trunk muscles maximal strength test. After 12 training weeks, it was verified that the functional training group obtained a statistically significant improvement for all variables analyzed: maximum strength test, trunk extensor and flexor muscles strength and endurance ratio. The traditional training group was superior only in the variable of trunk extensor muscles strength development rate. Accordingly, it is concluded that the trunk muscles maximal strength test in elderly women presents high reproducibility; there is a great association between the trunk muscles endurance in the functional performance and the functional training seems more effective than the traditional training in relation to the increase of the trunk muscles maximal strength and endurance, in addition to the rate of trunk flexor muscles strength development. / A manutenção da força dos músculos do tronco apresenta grande importância na saúde em idosos, uma vez que está relacionada com um melhor desempenho durante as atividades de vida diária. Entretanto, limitações são encontradas na literatura científica ao analisar os testes para mensurar a força desses músculos e, além disso, não está clara a importância desses músculos no desempenho funcional em idosos. Diante disso, o objetivo desta dissertação foi: I) avaliar a reprodutibilidade do teste de força isométrica máxima do tronco em idosas; II) verificar a associação entre a força e a endurance do tronco sobre as medidas de desempenho funcional em idosas; e III) analisar os efeitos dos treinamentos funcional e tradicional sobre a força isométrica máxima e a endurance do tronco em idosas. O estudo I verificou a reprodutibilidade do teste de força máxima dos músculos do tronco em idosas em dois dias de avaliações, através do Coeficiente de Correlação Interclasse, do Coeficiente de Variação, da Mínima Mudança Detectável, do Erro Padrão de Medida e também da análise gráfica de Bland-Altman. Os achados desse estudo revelaram correlação interclasse alta a muita alta (extensores=0,93; flexores=0,86, respectivamente); baixa variação (9% para os dois grupos musculares); e mínima mudança detectável aceitável (extensores=51,1 N; flexores=48,9 N). Além disso, a análise de Bland-Altman revela baixo viés e valores dentro dos limites de concordância. No estudo II, foi realizada uma regressão linear múltipla com o intuito de explicar em que magnitude a força e a endurance dos músculos do tronco contribuem no desempenho funcional em idosas. Dessa forma, houve uma participação da endurance dos músculos extensores do tronco, que variou entre 17,9% a 24,4% no desempenho funcional em idosas. Já no estudo III, foi realizado um ensaio clínico randomizado e controlado com três grupos: treinamento funcional, treinamento tradicional e grupo controle. Os grupos de intervenção realizaram um treinamento com características funcional e progressiva, de forma que o grupo treinamento tradicional realizou os exercícios em máquinas analíticas e o grupo treinamento funcional, exercícios com características de padrões de movimentos de maneira multiplanar e coordenada, incorporando múltiplas articulações. Aplicadas 12 semanas de treinamento, foi constatado que o grupo treinamento funcional obteve melhora significativa para todas as variáveis analisadas: teste de força máxima, taxa de desenvolvimento de força e endurance dos músculos extensores e flexores do tronco. O grupo treinamento tradicional foi superior apenas na variável de taxa de desenvolvimento de força dos músculos extensores do tronco. Assim, conclui-se que o teste de força máxima para os músculos do tronco em idosas apresenta alta reprodutibilidade; há associações entre a endurance dos músculos do tronco e desempenho funcional, e o treinamento funcional parece mais eficaz que o treinamento tradicional em relação ao aumento de força máxima e endurance dos músculos do tronco, além da taxa de desenvolvimento de força dos músculos flexores do tronco. / São Cristóvão, SE

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