Neuromuscular training improves muscle co‐activation and knee kinematics in female athletes with high risk of anterior cruciate ligament injury

Abstract Neuromuscular deficits at the proximal or distal to the knee may contribute to knee valgus and anterior cruciate ligament (ACL) injury. A valgus or abducted position of the knee greater than 12° for females is suggested to be an indicator of the risk of lower extremity injuries. However, there is a lack of examination regarding neuromuscular patterns in both proximal and distal kinetic chains. The purpose of this study was to investigate the effect of 8 weeks of neuromuscular training on knee valgus and co‐activation of the hip and ankle muscles during a countermovement jump in female athletes with a high risk of ACL injury. Twenty‐eight female athletes, with knee valgus greater than 12°, were randomly assigned into two groups: training ( n = 14) and control ( n = 14). The following measurements were taken before and after the intervention: co‐activation of Gluteus Maximus‐Tensor Fasciae Latae (GMax‐TFL), Gluteus Medius‐Adductor Longus (GMed‐AL), Tibialis Anterior‐Medial Gastrocnemius (TA‐MG), Tibialis Anterior‐Lateral Gastrocnemius (TA‐LG), Medial Gastrocnemius‐Lateral Gastrocnemius (MG‐LG) muscles, and DKV angle during single‐leg countermovement jump task. Following the intervention, the training group demonstrated increased co‐activation of muscles (except TA‐LG) ( P < 0.05). The knee valgus angle in the training group decreased by 5.9° ( P = 0.001). Our results demonstrated that neuromuscular training alters muscle activity patterns and the neuromuscular group demonstrated a clinically meaningful and statistical reduction in knee valgus.