Attention Feedback Techniques for ACL Injury Prevention

Overseen By Abbey Thomas, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of North Carolina, Charlotte

Disqualifiers: Obesity, Lower extremity surgery, ACL tear, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 15

Duration: 4 weeks

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to find better ways to prevent ACL injuries by studying how feedback on movement can help change jumping and landing techniques. It compares three types of feedback: visual feedback from a mirror (visual internal focus of attention feedback), visual feedback from a laser, and auditory feedback (auditory external focus of attention feedback). Participants will engage in exercises over four weeks, with movement analysis conducted before and after. Individuals who exercise regularly for at least 30 minutes three times a week and have no history of serious leg injuries may be eligible to join. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could improve injury prevention techniques.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these attention feedback techniques are safe for ACL injury prevention?

Research has shown that sound-based feedback can help people improve movement and reduce injury risk. This method uses sounds to direct attention to movements. It is safe and well-received by participants in previous studies.

Studies have indicated that visual feedback effectively enhances movement, reducing the risk of injuries like ACL tears. This method uses visual cues, such as lights or targets, to guide movement. It is reported to be safe and typically free of negative effects.

Both feedback methods have been used in other studies without major safety concerns, making them promising options for preventing knee injuries. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these techniques for ACL injury prevention because they offer innovative ways to enhance movement feedback, which is crucial for preventing injuries. Unlike traditional methods that may rely heavily on verbal instructions, the auditory external focus of attention feedback provides real-time sound cues to guide movement. Meanwhile, the visual external focus uses a laser to offer immediate visual feedback, helping participants adjust their movements more accurately. Lastly, the internal focus of attention feedback allows individuals to see their movement patterns in a mirror, promoting self-awareness and correction. These novel feedback methods have the potential to significantly improve movement efficiency and reduce injury risk, offering a fresh approach to ACL injury prevention.

What evidence suggests that this trial's treatments could be effective for ACL injury prevention?

Research has shown that focusing on external elements, such as sounds or sights, can enhance movement and reduce the risk of ACL injuries. In this trial, participants will receive various types of feedback to improve movement patterns. Some participants will receive auditory external focus of attention feedback, which studies have found can quickly enhance knee and hip movement, reducing factors that lead to ACL injuries. Others will receive visual external focus of attention feedback, where observing visual cues, like targets, can improve landing techniques from a jump, crucial for ACL injury recovery. Both auditory and visual feedback can lead to safer movements, potentially preventing ACL injuries. These findings suggest that focusing on external elements during movement can effectively prevent injuries. ^{2 3 4 5 6}

Are You a Good Fit for This Trial?

This trial is for physically active individuals who exercise over 30 minutes at least three times a week. It's not suitable for those with a BMI over 40, history of lower limb fractures or surgeries, smokers, recent musculoskeletal injuries, neurological disorders affecting brain activity, past major knee or ankle injuries, or significant visual/hearing impairments.

Inclusion Criteria

Exercise 30+ minutes 3+ days/week

Exclusion Criteria

I do not have severe visual or hearing problems that would affect my participation.

History of musculoskeletal injury sustained in the 6 months prior to enrollment

I have had a concussion or a neurological disorder that could affect brain wave tests.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Assessment

Participants undergo a movement analysis in a research laboratory while performing tasks such as landing from a box and running and cutting.

1 day

1 visit (in-person)

Treatment

Participants are randomly allocated to one of 3 treatment groups and perform exercises to change the way they land from a jump.

4 weeks

12 sessions (in-person, 3x/week)

Follow-up

Participants report for follow-up movement analysis testing to assess changes in biomechanics and cortical activity.

4 weeks

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Auditory external focus of attention feedback
• Internal focus of attention feedback
• Visual internal focus of attention feedback

Trial Overview

The study tests three types of feedback during movement exercises to prevent ACL injury: internal focus (thinking about the body), and external focus using either visual cues or sounds. Participants will be randomly placed in one group and do specific jump-landing exercises for four weeks.

How Is the Trial Designed?

Group I: Visual external focus of attention feedback Experimental Treatment 1 Intervention

Participants will complete 12 sessions over 3 weeks receiving visual feedback of their movement patterns from a laser.

Group II: Auditory external focus of attention feedback Experimental Treatment 1 Intervention

Participants will complete 12 sessions over 3 weeks receiving auditory feedback of their movement patterns.

Group III: Internal focus of attention feedback Active Control 1 Intervention

Participants will complete 12 sessions over 3 weeks receiving visual feedback in a mirror of their movement patterns.

Who Is Running the Clinical Trial?

University of North Carolina, Charlotte

Lead Sponsor

Trials

27

Recruited

12,200+

Published Research Related to This Trial

A systematic review of nine studies found that using external focus (EF) instructions during jump landing techniques significantly improved both motor performance and movement technique compared to internal focus (IF) instructions.

The findings suggest that incorporating EF strategies into ACL injury prevention programs could enhance their effectiveness, particularly for healthy adults engaged in sports.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Novel methods of instruction in ACL injury prevention programs, a systematic review. Benjaminse, A., Welling, W., Otten, B., et al.[2022]

Male basketball athletes showed improved performance in sidestep cutting maneuvers when using visual feedback, resulting in greater vertical ground reaction forces and knee flexion moments compared to those using verbal feedback or no feedback.

The study suggests that females may require different types of feedback to effectively learn safe movement patterns, highlighting the importance of sex-specific approaches in ACL injury prevention programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial. Benjaminse, A., Otten, B., Gokeler, A., et al.[2022]

In a study involving 16 patients recovering from ACL reconstruction, using an external focus of attention during rehabilitation significantly improved knee flexion angles and range of motion during single leg hop jumps compared to an internal focus.

The findings suggest that an external focus may promote safer movement patterns, potentially reducing the risk of a second ACL injury during recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Gokeler, A., Benjaminse, A., Welling, W., et al.[2022]

In a study involving 30 patients (mean age 23.26 years) recovering from anterior cruciate ligament reconstruction, using external focus of attention (EF) during jump-landing training significantly improved landing technique compared to internal focus of attention (IF).

The results suggest that incorporating EF techniques in rehabilitation could lead to better treatment outcomes for patients after ACLR, as evidenced by a significantly better score on the Landing Error Scoring System (LESS) with EF instructions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using a target as external focus of attention results in a better jump-landing technique in patients after anterior cruciate ligament reconstruction - A cross-over study. Bæktoft van Weert, M., Skovdal Rathleff, M., Eppinga, P., et al.[2023]

Differential learning strategies and external focus of attention significantly reduced risk factors for anterior cruciate ligament (ACL) injury in athletes, as shown in a study involving 48 male athletes over eight weeks.

The differential learning group exhibited larger effect sizes in improving kinetic and kinematic variables related to ACL injury risk compared to other methods, suggesting that varied movement practices may be more effective in injury prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing the Effects of Differential Learning, Self-Controlled Feedback, and External Focus of Attention Training on Biomechanical Risk Factors of Anterior Cruciate Ligament (ACL) in Athletes: A Randomized Controlled Trial. Ghanati, HA., Letafatkar, A., Shojaedin, S., et al.[2022]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6208302/

The Use of Augmented Information for Reducing Anterior ...

Immediate improvements in ACL injury risk factors at the knee and hip due to augmented feedback were evident. Participants increased their knee-flexion angle (g ...

2.

withpower.com

withpower.com/trial/phase-anterior-cruciate-ligament-injuries-7-2021-0e6c7

Attention Feedback Techniques for ACL Injury Prevention

The findings suggest that an external focus may promote safer movement patterns, potentially reducing the risk of a second ACL injury during recovery.

3.

sciencedirect.com

sciencedirect.com/science/article/pii/S0968016023001035

Using a target as external focus of attention results in ...

This study showed that using a target as EF resulted in a significantly better jump-landing technique than IF in patients after ACLR. Therefore, the use of EF ...

4.

ninercommons.charlotte.edu

ninercommons.charlotte.edu/record/2898/files/Bushel_uncc_0694N_13853.pdf

the association between auditory external focus of attentional ...

14, 15 As a result, external focus of attention is a powerful motor learning tool to incorporate into biomechanical retraining to reduce ACL injury risk.

5.

jospt.org

jospt.org/doi/10.2519/jospt.2015.4986

Optimization of the Anterior Cruciate Ligament Injury ...

To enhance the effectiveness of methods of external focus of attention in ACL injury prevention programs, it is important to consider the ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC12032474/

The Effect of Verbal Combined Focus of Attention and ...

Current anterior cruciate ligament (ACL) injury prevention programs focus on integrating the athlete's cognitive and motor skills.