Effects of a Warm-Up Injury Prevention Protocol on Risk Factors for Anterior Cruciate Ligament Injury in Elite Basketball Players
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Abstract
Background: Athletes involved in sports requiring frequent cutting and pivoting movements are at increased risk of anterior cruciate ligament (ACL) injuries. This study investigates the effectiveness of neuromuscular warm-up exercises—including strength, balance, plyometric, and core stability training—in reducing ACL injury risk.
Methods: Thirty adolescent male basketball players (ages 13-18) were randomly assigned to either the control group (CON, n=15; age: 15.66 ± 1.7 years, height: 172.7 ± 9.6 cm, weight: 66.74 ± 11.2 kg) or the neuromuscular training (NMT) group (n=15; age: 14.73 ± 0.70 years, height: 174.0 ± 6.7 cm, weight: 64.79 ± 10.8 kg). The NMT group performed a structured injury prevention warm-up program three times a week for eight weeks before regular basketball training (20 minutes), while the CON group followed their usual basketball practice. Measurements of knee proprioception (including specific motion directions), knee valgus and flexion torque, trunk endurance via the Biering-Sorenson test, and isometric strength of various muscle groups were taken pre- and post-intervention.
Result: Significant improvements in isometric strength were observed in all assessed muscle groups in the NMT group (p < 0.05). However, no significant changes were found in knee valgus, flexion torque, trunk endurance, or knee proprioception (p > 0.05).
Conclusion: While the NMT protocol significantly improves isometric muscle strength in adolescent male basketball players, it does not show a direct effect on other ACL injury risk factors. Therefore, incorporating NMT into training routines may support strength development but should be combined with other targeted interventions to more effectively reduce ACL injury risk.
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2. Vaudreuil NJ, van Eck CF, Lombardo SJ, Kharrazi FD. Economic and performance impact of anterior cruciate ligament injury in national basketball association players. Orthop J Sports Med. 2021;9(9):23259671211026617.
3. Barden C, Thain PK. Injury surveillance in English youth basketball: a 5-season cohort study to inform injury prevention strategies. Phys Ther Sport. 2022;58:34-40.
4. Verschueren J, Tassignon B, De Pauw K, Proost M, Teugels A, Van Cutsem J, et al. Does acute fatigue negatively affect intrinsic risk factors of the lower extremity injury risk profile? A systematic and critical review. Sports Med. 2020;50:767-84.
5. Antoranz Y, Sáez de Villarreal E, del Campo Vecino J, Jiménez-Saiz SL. Sure Steps: Key strategies for protecting basketball players from injuries—a systematic review. J Clin Med. 2024;13(16):4912.
6. Lucas KCH, Kline PW, Ireland ML, Noehren B. Hip and trunk muscle dysfunction: implications for anterior cruciate ligament injury prevention. Ann Joint. 2017;2(5).
7. Titchenal MR, Chu CR, Erhart-Hledik JC, Andriacchi TP. Early changes in knee center of rotation during walking after anterior cruciate ligament reconstruction correlate with later changes in patient-reported outcomes. Am J Sports Med. 2017;45(4):915-21.
8. Leppänen M, Pasanen K, Kujala UM, Vasankari T, Kannus P, Äyrämö S, et al. Stiff landings are associated with increased ACL injury risk in young female basketball and floorball players. Am J Sports Med. 2017;45(2):386-93.
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10. Davis AC, Emptage NP, Pounds D, Woo D, Sallis R, Romero MG, et al. The effectiveness of neuromuscular warm-ups for lower extremity injury prevention in basketball: a systematic review. Sports Med Open. 2021;7:1-14.
11. Root HJ, Frank BS, Denegar CR, Casa DJ, Gregorio DI, Mazerolle SM, et al. Application of a preventive training program implementation framework to youth soccer and basketball organizations. J Athl Train. 2019;54(2):182-91.
12. Zebis MK, Andersen LL, Brandt M, Myklebust G, Bencke J, Lauridsen HB, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. Br J Sports Med. 2016;50(9):552-7.
13. Arumugam A, Björklund M, Mikko S, Häger CK. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ Open. 2021;11(5):e049226.
14. Jeong J, Choi DH, Shin CS. Core strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury. Am J Sports Med. 2021;49(1):183-92.
15. Sugimoto D, Myer GD, Barber Foss KD, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta-and sub-group analyses. Sports Med. 2014;44:551-62.
16. Hewett T. Effectiveness of neuromuscular training based on t. 2017.
17. Hewett TE, Ford KR, Xu YY, Khoury J, Myer GD. Utilization of ACL injury biomechanical and neuromuscular risk profile analysis to determine the effectiveness of neuromuscular training. Am J Sports Med. 2016;44(12):3146-51.
18. Emery CA, Pasanen K. Current trends in sport injury prevention. Best Pract Res Clin Rheumatol. 2019;33(1):3-15.
19. Stojanović E, Terrence Scanlan A, Radovanović D, Jakovljević V, Faude O. A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial. Phys Sportsmed. 2023;51(5):463-71.
20. Mohammad Ali Nasab Firouzjah E, Daneshmandi H, Norasteh AA. Effect of Core Stability Training on the Endurance and Strength of Core in Basketball Players with Trunk Dysfunction. J Rehabil Sci Res. 2020;7(2):80-6.
21. Mohammadi M, Alizadeh MH, Ebrahimi E, Shirzad E. The Influence of a Neuromuscular Exercise Program on Lower Limb Function and Knee 3D Alignment of Handball Male Players in Single Leg Landing. Stud Sport Med. 2015;6(16):13-32.
22. Beutler AI, de la Motte SJ, Marshall SW, Padua DA, Boden BP. Muscle strength and qualitative jump-landing differences in male and female military cadets: The jump-ACL study. J Sports Sci Med. 2009;8(4):663.
23. Bazett-Jones DM, Cobb SC, Joshi MN, Cashin SE, Earl JE. Normalizing hip muscle strength: establishing body-size-independent measurements. Arch Phys Med Rehabil. 2011;92(1):76-82.
24. Myer GD, Ford KR, Brent JL, Hewett TE. The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes. J Strength Cond Res. 2006;20(2):345-53.
25. Stillman BC. An investigation of the clinical assessment of joint position sense. 2000.
26. Shahjordi SH, Golpayegani M, Ghadeiri Y. The effect of proprioceptive training on joint position sense in athletes with knee valgus. Res Sport Rehabil. 2014;2(3):67-73.
27. Noyes FR, Barber-Westin SD, Fleckenstein C, Walsh C, West J. The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med. 2005;33(2):197-207.
28. Hewett T, Snyder-Mackler L, Spindler KP. The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med. 2007;35(1):145; author reply 6-7.
29. Mohammadi H, Daneshmandi H, Alizadeh M. Effect of corrective exercises program on strength, ROM, and performance in basketball players with dynamic knee valgus. Sci J Rehabil Med. 2019;8(3):29-41.
30. Nesser TW, Huxel KC, Tincher JL, Okada T. The relationship between core stability and performance in division I football players. J Strength Cond Res. 2008;22(6):1750-4.
31. Okada T, Huxel KC, Nesser TW. Relationship between core stability, functional movement, and performance. J Strength Cond Res. 2011;25(1):252-61.
32. Saki F, Shafiee H, Tahayori B, Ramezani F. The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction. Sci Rep. 2023;13(1):2202.
33. Petway AJ, Jordan MJ, Epsley S, Anloague P, Rimer E. Mechanisms of anterior cruciate ligament tears in professional national basketball association players: a video analysis. J Appl Biomech. 2023;39(3):143-50.
34. Bouisset S. Relationship between postural support and intentional movement: biomechanical approach. Arch Int Physiol Biochim Biophys. 1991;99(5):A77-92.
35. Petrofsky JS, Cuneo M, Dial R, Pawley AK, Hill J. Core strengthening and balance in the geriatric population. J Appl Res Clin Exp Ther. 2005;5(3):423.
36. Lephart SM, Ferris CM, Riemann BL, Myers JB, Fu FH. Gender differences in strength and lower extremity kinematics during landing. Clin Orthop Relat Res. 2002;401:162-9.
37. Carroll TJ, Riek S, Carson RG. Neural adaptations to resistance training: implications for movement control. Sports Med. 2001;31:829-40.
38. Shelburne KB, Torry MR, Pandy MG. Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exerc. 2005;37(11):1948-56.
39. Myer GD, Ford KR, Foss KDB, Liu C, Nick TG, Hewett TE. The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin J Sport Med
2. Vaudreuil NJ, van Eck CF, Lombardo SJ, Kharrazi FD. Economic and performance impact of anterior cruciate ligament injury in national basketball association players. Orthop J Sports Med. 2021;9(9):23259671211026617.
3. Barden C, Thain PK. Injury surveillance in English youth basketball: a 5-season cohort study to inform injury prevention strategies. Phys Ther Sport. 2022;58:34-40.
4. Verschueren J, Tassignon B, De Pauw K, Proost M, Teugels A, Van Cutsem J, et al. Does acute fatigue negatively affect intrinsic risk factors of the lower extremity injury risk profile? A systematic and critical review. Sports Med. 2020;50:767-84.
5. Antoranz Y, Sáez de Villarreal E, del Campo Vecino J, Jiménez-Saiz SL. Sure Steps: Key strategies for protecting basketball players from injuries—a systematic review. J Clin Med. 2024;13(16):4912.
6. Lucas KCH, Kline PW, Ireland ML, Noehren B. Hip and trunk muscle dysfunction: implications for anterior cruciate ligament injury prevention. Ann Joint. 2017;2(5).
7. Titchenal MR, Chu CR, Erhart-Hledik JC, Andriacchi TP. Early changes in knee center of rotation during walking after anterior cruciate ligament reconstruction correlate with later changes in patient-reported outcomes. Am J Sports Med. 2017;45(4):915-21.
8. Leppänen M, Pasanen K, Kujala UM, Vasankari T, Kannus P, Äyrämö S, et al. Stiff landings are associated with increased ACL injury risk in young female basketball and floorball players. Am J Sports Med. 2017;45(2):386-93.
9. Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med. 2023;57(21):1395-9.
10. Davis AC, Emptage NP, Pounds D, Woo D, Sallis R, Romero MG, et al. The effectiveness of neuromuscular warm-ups for lower extremity injury prevention in basketball: a systematic review. Sports Med Open. 2021;7:1-14.
11. Root HJ, Frank BS, Denegar CR, Casa DJ, Gregorio DI, Mazerolle SM, et al. Application of a preventive training program implementation framework to youth soccer and basketball organizations. J Athl Train. 2019;54(2):182-91.
12. Zebis MK, Andersen LL, Brandt M, Myklebust G, Bencke J, Lauridsen HB, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. Br J Sports Med. 2016;50(9):552-7.
13. Arumugam A, Björklund M, Mikko S, Häger CK. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ Open. 2021;11(5):e049226.
14. Jeong J, Choi DH, Shin CS. Core strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury. Am J Sports Med. 2021;49(1):183-92.
15. Sugimoto D, Myer GD, Barber Foss KD, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta-and sub-group analyses. Sports Med. 2014;44:551-62.
16. Hewett T. Effectiveness of neuromuscular training based on t. 2017.
17. Hewett TE, Ford KR, Xu YY, Khoury J, Myer GD. Utilization of ACL injury biomechanical and neuromuscular risk profile analysis to determine the effectiveness of neuromuscular training. Am J Sports Med. 2016;44(12):3146-51.
18. Emery CA, Pasanen K. Current trends in sport injury prevention. Best Pract Res Clin Rheumatol. 2019;33(1):3-15.
19. Stojanović E, Terrence Scanlan A, Radovanović D, Jakovljević V, Faude O. A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial. Phys Sportsmed. 2023;51(5):463-71.
20. Mohammad Ali Nasab Firouzjah E, Daneshmandi H, Norasteh AA. Effect of Core Stability Training on the Endurance and Strength of Core in Basketball Players with Trunk Dysfunction. J Rehabil Sci Res. 2020;7(2):80-6.
21. Mohammadi M, Alizadeh MH, Ebrahimi E, Shirzad E. The Influence of a Neuromuscular Exercise Program on Lower Limb Function and Knee 3D Alignment of Handball Male Players in Single Leg Landing. Stud Sport Med. 2015;6(16):13-32.
22. Beutler AI, de la Motte SJ, Marshall SW, Padua DA, Boden BP. Muscle strength and qualitative jump-landing differences in male and female military cadets: The jump-ACL study. J Sports Sci Med. 2009;8(4):663.
23. Bazett-Jones DM, Cobb SC, Joshi MN, Cashin SE, Earl JE. Normalizing hip muscle strength: establishing body-size-independent measurements. Arch Phys Med Rehabil. 2011;92(1):76-82.
24. Myer GD, Ford KR, Brent JL, Hewett TE. The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes. J Strength Cond Res. 2006;20(2):345-53.
25. Stillman BC. An investigation of the clinical assessment of joint position sense. 2000.
26. Shahjordi SH, Golpayegani M, Ghadeiri Y. The effect of proprioceptive training on joint position sense in athletes with knee valgus. Res Sport Rehabil. 2014;2(3):67-73.
27. Noyes FR, Barber-Westin SD, Fleckenstein C, Walsh C, West J. The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med. 2005;33(2):197-207.
28. Hewett T, Snyder-Mackler L, Spindler KP. The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med. 2007;35(1):145; author reply 6-7.
29. Mohammadi H, Daneshmandi H, Alizadeh M. Effect of corrective exercises program on strength, ROM, and performance in basketball players with dynamic knee valgus. Sci J Rehabil Med. 2019;8(3):29-41.
30. Nesser TW, Huxel KC, Tincher JL, Okada T. The relationship between core stability and performance in division I football players. J Strength Cond Res. 2008;22(6):1750-4.
31. Okada T, Huxel KC, Nesser TW. Relationship between core stability, functional movement, and performance. J Strength Cond Res. 2011;25(1):252-61.
32. Saki F, Shafiee H, Tahayori B, Ramezani F. The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction. Sci Rep. 2023;13(1):2202.
33. Petway AJ, Jordan MJ, Epsley S, Anloague P, Rimer E. Mechanisms of anterior cruciate ligament tears in professional national basketball association players: a video analysis. J Appl Biomech. 2023;39(3):143-50.
34. Bouisset S. Relationship between postural support and intentional movement: biomechanical approach. Arch Int Physiol Biochim Biophys. 1991;99(5):A77-92.
35. Petrofsky JS, Cuneo M, Dial R, Pawley AK, Hill J. Core strengthening and balance in the geriatric population. J Appl Res Clin Exp Ther. 2005;5(3):423.
36. Lephart SM, Ferris CM, Riemann BL, Myers JB, Fu FH. Gender differences in strength and lower extremity kinematics during landing. Clin Orthop Relat Res. 2002;401:162-9.
37. Carroll TJ, Riek S, Carson RG. Neural adaptations to resistance training: implications for movement control. Sports Med. 2001;31:829-40.
38. Shelburne KB, Torry MR, Pandy MG. Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exerc. 2005;37(11):1948-56.
39. Myer GD, Ford KR, Foss KDB, Liu C, Nick TG, Hewett TE. The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin J Sport Med
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Neuromuscular training Athletic injuries Anterior cruciate ligament injuries Basketball Muscle strength Adolescent | ||
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How to Cite
1.
Honarvar A, Mazloum V, Soleymanfallah MA. Effects of a Warm-Up Injury Prevention Protocol on Risk Factors for Anterior Cruciate Ligament Injury in Elite Basketball Players. jmr. 2025;(-).
