PREVENTION OF ACL TRAUMATIC PATHOLOGIES - 4TH PART -

Training that reduces the risk of ACL injuries in women's basketball.

During the daily life of competitive sports, a greater selective co-activation must be sought to reduce the incidence of ACL injuries in basketball as in other sports:

both of the medial compartment of the knee flexors and quadriceps, to oppose the stress movement in valgus;

and through a selective co-activation of the lateral compartment flexors and the quadriceps, to oppose varus loads.

It is evident that the maximum of the preventive aspects is in the optimal levels of strength, proprioception and flexibility, the latter to be sought - in our opinion - through the constant use of the Esnoult method. A perfect and optimal balance of these components represents the most effective protective and preventive aspect for the musculoskeletal and support system.
Hewett et al., Showed that a decrease in knee capsule ligament injuries is possible only after neuromuscular training associated with plyometric exercise protocols.
Proprioceptive training stimulates the joint and muscle mechanoreceptors in the activation of generalized and selective models of co-contraction not only of the flexor and extensor group of the knee, but - through the concept of muscle chain - all the muscle areas of the lower limb are involved. which in any case are involved in the cutting maneuver.
Clearly, if the activation time is very slow and it is not possible to provide any neuromuscular support or protection, the possibility of incurring a specific trauma event increases considerably.
An examination of the effects of different types of neuromuscular training on joint stability performed in the literature suggests, as previously mentioned, that resistance training in basketball has a negative transference, as it unfavorably stimulates muscle stretch reflexes, elevating the time and decreasing the contractile capacity of the co-contraction, facilitating among other things the increase of the voluntary activation times and the time to reach the peak of the moment of force.
Plyometric training if compared to programs aimed constantly at improving the "resistance to force" or resistant force, contribute to a reduction in the time of co-contraction, a more rapid activation of the voluntary response and a reduction in the time to reach the peak of strength.
A rational neuromuscular training program, therefore, contributes to the decrease of the risk of "ACL injuries"
This neuromotor reprogramming must be codified through some guidelines which include:

increased intra and intermuscular coordination and co-contraction of the flexors and quadriceps

increase in general and local performance to improve joint stabilization.

Through exercises aimed at:

to stimulate and stimulate the mechanoreceptors of the knee joint as well as to reinforce the activation patterns involved in the stability of the joint;

improve the response time of voluntary activation, aimed at lowering the time to reach peak torque, improving the expressive levels of strength, especially those relating to the hamstring.

Primary prevention passes through coordinative training integrated into the "technical-tactical training" with the specific objective of optimizing the perceptive, processing speed, correlated to a "harmonious execution of the basketball movement.
Mechanical stability and neuromuscular control remain the primary focus of prevention.
Agility training are designed to allow the athlete to adapt to specific basketball gestures: rapid changes of direction, acceleration, deceleration.
Training is always offered before training or customized compensatory sessions.
A training program based on exercises is proposed:

of balance

dynamic stability of the knee joint;

plyometric;

of agility;

exercises related to gestural patterns typical of the sport practiced

The ACL injury prevention program can be divided into phases throughout the season, (for example: 5 phases of 3 or 5 weeks each), by inserting in the various phases of the aforementioned training, gestural patterns typical of basketball combined with the ball.
Referring to phase 3 of the protocol, Hewett et al., In a recent work demonstrated the "importance of" plyometric training "in preventing knee injuries. Following a protocol for 6 weeks female athletes, they reduced injuries by 0.43 percent. at 0.12 per 1000 exposures (p = 0.05) ..
Another interesting protocol present in the literature is described as "the Star". 8 vectors separated by 45 degrees are drawn on the parquet. These constitute the "star". The athlete is in monopodalic support, in the center of the star and he directs himself on the reference vectors with the foot not in support, thus tracing a typical basketball gesture. The increase in difficulty has as its progression the projection of the upper limb, the support of the "pivot foot" on a proprioceptive table on sulf 2 and 1 used in sequential order.

The subsequent return indicates the end of each exercise

The exercises are performed on three planes: frontal, sagittal and diagonal.
The teaching proposals must be modified, in succession, by varying the planes of motion, the range of motion of the ankle, knee or hip, the load (using barbells, mono and bi-podalic squats), speed and the type of feedback.
Proprioceptive training must be performed throughout the range of motion of the joint. This is very important, because mechanoreceptors appear to be selectively activated at specific joint angles.
In association with these methodological suggestions, technical and agility coordination training can be included, designed to allow the athlete to adapt to rapid changes in direction, acceleration and deceleration, and to all the cutting activities typical of sports such as basketball. to reduce the high incidence of anterior cruciate ligament injuries in women's basketball