Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1979. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Includes bibliographical references. / by Donald L. Grimes. / Ph.D.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction ACL injuries are among the most serious injuries that professional and amateur sports men and women sustain. More than 120 000 ACL injuries occur annually in the USA alone. The highest incidence of ACL injuries are seen in multi-directional and multi-factorial sports such as soccer, basketball, lacrosse, American football, rugby and Australian rules football. It is hoped that the proposed review will clarify issues relating to the effect of fatigue on knee control, as it will focus on multiple movements found in different sporting codes. By including both studies on healthy adults as well as subjects who have sustained ACL injuries, a clearer picture can be formed on the global effect of fatigue on knee control. Objective The objective of this review was to identify, collate and analyse the current evidence on the effect of fatigue protocols on knee control during functional tasks, such as side-stepping, bilateral jumping/landing and crossover-cutting. Methodology A comprehensive search of electronic databases was conducted between April 2013 and August 2013 (updated in April 2014) for eligible articles for inclusion in the review. Methodological quality was assessed using a modified Downs and Black checklist. Results Ten studies met the eligibility criteria and were included in the review. The included studies reported a wide variety of fatigue protocols. Several different test movements were utilised in the studies. The test movements included cutting movements, drop jumps, stop jumps, vertical jumps, bilateral drop landing and rotational movements. The overall results indicated that fatigue had a negative impact on knee control. There were however studies which reported conflicting results. Gender differences were also highlighted in the results of included studies where it became evident that females tend to be more susceptible to knee injuries due to altered kinematics as a result of fatigue. Conclusion Fatigue generally seems to affect knee control negatively across various fatigue protocols. Future research should investigate using a standardised fatigue protocol to achieve more accurate and consistent results during the different functional activities. / AFRIKAANSE OPSOMMING: Nie beskikbaar

This quality study was carried out with seven semi-structured interviews and five of them were with elite women´s football coaches. What has been studied is how elite women’s football coaches are working with injury prevention training to their knees for the women’s football players. An anterior cruciate ligament injury in elite women’s football is both common and serious knee injury. This is a major problem area of ​​the anterior cruciate ligament injuries in women's football. In a squad of 20 women's football players occur an anterior cruciate ligament injury every two years. Injury prevention training is important to prepare the women's football players for the physical stresses that will arise during the season[1].  In this study includes, for example, theories of loss prevention training and risk factors for elite women’s football player to suffer an ACL injury. The interview guide has been focusing on the coach’s work and why they have chosen to use loss prevention training and how it can be planned and executed. This is to get information on how the elite women coaches working with the training to give the elite women football players the best position possible to prevent an ACL injury. The elite coaches have the help of physiotherapists, doctors and / or physiological coach with the loss prevention training must include for different exercises, and then determine the elite coaches themselves when it will be done during training week. In addition to interviews with the elite women coaches have also been interviewed by a physiotherapist and a doctor. This interview has been used to get information about the problem area with an ACL injury in elite women football. After that question I also touched on how and why the elite women’s football players should prevent this knee injury. The elite women’s football coaches all think the injury prevention training is important to use. This is to prepare women football players for the loads and stresses which will occur during the season. The loss prevention training is somewhat different in the five elite women´s football team that is part of my study. Any association uses a knee control program more than others, and cardio and strength training workouts vary in number. What unites them is that they all use a combination and the pulsation of the training. That is, they use both low and high intensity training and other training is a combination of different exercises and exercise. And they all have the injury prevention training scheduled throughout the season. [1] Martin Hagglund physiotherapist, interview February 8 2012, Markus Waldén orthopedic, interview  February 3 2012

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.

Bakgrund: Fotboll är en av dom största sporterna i världen och en av de främsta i Sverige. Skador är relativt vanligt inom sporten där knäskador är en av de mest förekommande. Det finns mycket forskning som visar på att skadeförebyggande träning minskar skadeincidensen men få studier är gjorda på svenska fysioterapeuters syn gällande skadeförebyggande träning inom fotboll. Syfte: Syftet var att undersöka fysioterapeuters syn och erfarenheter av skadeförebyggande träning för knäskador inom fotboll hos fysioterapeuter anställda av svenska fotbollslag. Metod: En kvalitativ design användes. Fem semistrukturerade intervjuer genomfördes. Kvalitativ innehållsanalys användes vid bearbetning av data. Resultat:  Studiens resultat visar att deltagarna har en varierad syn på skadeförebyggande träning.  Fysioterapeuterna beskriver vikten av en god träningsplanering, träning av stabilitet och kontroll, neuromuskulär påkoppling samt tid till återhämtning. Vidare bör kunskap förmedlas till spelare och tränare kring skadeförebyggande träning för att öka implementeringen.  Mental förberedelse ses också som en viktig faktor för att minska risken för skador. Fysioterapeuterna i studien kände alla till knäkontroll programmet och ansåg att det är ett väl utformat program med bra och lätta övningar men att det dock kan förkortas. Konklusion: Knäkontrollprogrammet, neuromuskulär uppvärmning och att spelarna har en god knäkontroll ses som viktiga aspekter inom skadeförebyggande träning. Fysioterapeuterna belyste mental förberedelse som en viktig faktor, vilket inte belysts i tidigare studier. Vidare studier behövs för att ytterligare undersöka betydelsen av mental förberedelse. / Background: Soccer is one of the largest sports in the world and one of the foremost in Sweden. Injuries are common in the sport where knee injuries are one of the most common. Research shows that injury prevention reduces the injury incidence, but few studies have explored Swedish physiotherapists views on injury prevention in soccer. Purpose: The purpose was to investigate physiotherapists views and experiences of injury prevention for knee injuries, among physiotherapists employed by Swedish soccer teams. Method: A qualitative design was used. Five semi-structured interviews were conducted. Qualitative content analysis was used in data processing. Results: The result shows that the participants have a varied view of injury prevention. The physiotherapists describe the importance of good training planning, training of stability and control, neuromuscular control and time for recovery. Furthermore, knowledge should be communicated to players and coaches about injury prevention to increase implementation. Mental preparation is also seen as an important factor in reducing the risk of injury. The physiotherapists in the study all knew about the knee control program and felt that it is a well-designed program with good and simple exercises, but the program can be shortened. Conclusion: The knee control program, neuromuscular warm up and that players have good knee control are an important aspects of injury prevention. The physiotherapists emphasized mental preparation as an important factor, which was not emphasized in previous studies. Further studies are needed to investigate the importance of mental preparation.

Bakgrund: Knäkontroll är ett svenskt skadeförebyggande träningsprogram som visat sig ha god effekt för prevention mot främre korsbandsskador vilket är en vanlig knäskada inom fotboll både på herr- och damsidan. Idag finns det studier som utforskat tränares syn och erfarenheter av Knäkontroll och generell skadeförebyggande träning, i nuläget finns det dock en kunskapslucka om vad fotbollsspelare själva har för upplevelser och erfarenheter av att genomföra träningsprogrammet Knäkontroll.  Syfte: Att undersöka fotbollsspelande unga vuxnas upplevelser och erfarenheter av att genomföra SISU:s skadeförebyggande träningsprogram Knäkontroll. Syftet var dessutom att få kännedom om hindrande och underlättande faktorer för genomförande av programmet för att möjliggöra utveckling. Metod: Kvalitativ design i form av en semistrukturerad intervjustudie med fem deltagare från ett bekvämlighetsurval. Databearbetningen genomfördes med kvalitativ innehållsanalys.   Resultat: Fem kategorier presenterades; Hur programmet används av lagen, Vikten av kunskap, Programmets positiva påverkan på kroppen, Spelarnas roll och ansvar och Klubbarnas möjligheter och ansvar. Varje kategori bestod av två till fem subkategorier där några av de mest prominenta var; Timing på när Knäkontroll utförs, Tidsaspekten och Utbildning är essentiellt.  Slutsats: Deltagarnas upplevelser av att utföra Knäkontroll var både positiva och negativa. Deltagarna beskrev även flertalet hindrande och underlättande faktorer för att programmet skulle utföras. I linje med tidigare forskning lyftes det upp att implementering av Knäkontroll i uppvärmningen, kunskap, utbildning och tydliga instruktioner sågs som de viktigaste faktorerna för att underlätta användning av programmet. / Background: Knee control is a Swedish injury prevention training program that has been shown to have good effects on preventing anterior cruciate ligament injuries which is a common Knee injury in both men's and women's football. Today there are studies which have explored football coaches´ views and experiences of Knee control, however there is a knowledge gap on views and experiences of the program from the football players themselves.   Objective: To explore football playing young adults' experiences of utilizing Knee control from SISU to get information about facilitating factors and barriers for implementation of the program for further development. Method: A qualitative method in the form of semi-structured interviews with five participants from a convenience sample. Data processing consisted of qualitative content analysis.  Results: Five categories were presented; How the programme is used by the teams, The importance of knowledge, The programme’s positive impact on the body, The role and responsibilities of the players and The club’s opportunities and responsibilities. Every category consisted of two to five subcategories where some of the most prominent were; Timing on when Knee Control is performed, The time aspect and Education is essential. Conclusion: The participants' experiences of performing Knee control was both positive and negative. The participants also highlighted the most hindering and facilitating factors for the program to be carried out. In line with previous research, it was highlighted that implementation of Knee control in the warm-up, knowledge, education and instructions was seen as the most important factors in facilitating use of the program.