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1- Department of Sport Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
Abstract: (9 Views)
Objective: Anterior cruciate ligament (ACL) injury is one of the most common sports injuries and is associated with persistent alterations in running biomechanics, including decreased knee flexion during the stance phase, reduced knee extension moment, increased ground contact time, and inter-limb asymmetry. The aim of this systematic review was to evaluate the effect of these exercises on running performance in individuals with ACL injury or reconstruction.
Methods: A comprehensive search was performed across PubMed, Scopus, Web of Science, Google Scholar, and Persian databases (Noormags, Magiran, and the Scientific Information Database [SID]) for studies published between January 2000 and January 2026, using terms related to "ACL injury", "neuromuscular training", "running", and "biomechanics. Original studies (randomized controlled trials, quasi-experimental, and cohort studies) that reported the effect of neuromuscular interventions on kinematic, kinetic, or electromyographic variables during running were included. Methodological quality was assessed using the PEDro scale. Due to considerable heterogeneity in training protocols, assessment timelines, and outcome measures, a meta-analysis was not performed, and the findings were narratively synthesized based on training type, running phase, and outcome category.
Findings: Synthesis of the 5 included studies indicated that targeted neuromuscular interventions (incorporating balance, proprioception, perturbation, and external attentional focus) lead to statistically significant improvements in selected biomechanical parameters, including moderate gains in knee flexion angles at initial contact, reductions in dynamic knee valgus, and partial restoration of inter-limb symmetry. However, across the majority of studies, abnormal kinetics (such as altered vertical ground reaction force attenuation) and atypical electromyographic activation patterns (quadriceps under-activation and compensatory hamstring co-contraction) persisted during running when compared with uninjured controls.
Conclusion: Neuromuscular training effectively ameliorates specific biomechanical impairments and functional symmetry during running following ACL injury or reconstruction. However, current evidence does not demonstrate that neuromuscular training alone is sufficient to achieve complete normalization of running mechanics. Given the substantial heterogeneity in protocols, populations, and outcome metrics, clinical recommendations should emphasize targeted multi-modal programs while maintaining realistic expectations regarding the persistence of subtle gait deficits.
Methods: A comprehensive search was performed across PubMed, Scopus, Web of Science, Google Scholar, and Persian databases (Noormags, Magiran, and the Scientific Information Database [SID]) for studies published between January 2000 and January 2026, using terms related to "ACL injury", "neuromuscular training", "running", and "biomechanics. Original studies (randomized controlled trials, quasi-experimental, and cohort studies) that reported the effect of neuromuscular interventions on kinematic, kinetic, or electromyographic variables during running were included. Methodological quality was assessed using the PEDro scale. Due to considerable heterogeneity in training protocols, assessment timelines, and outcome measures, a meta-analysis was not performed, and the findings were narratively synthesized based on training type, running phase, and outcome category.
Findings: Synthesis of the 5 included studies indicated that targeted neuromuscular interventions (incorporating balance, proprioception, perturbation, and external attentional focus) lead to statistically significant improvements in selected biomechanical parameters, including moderate gains in knee flexion angles at initial contact, reductions in dynamic knee valgus, and partial restoration of inter-limb symmetry. However, across the majority of studies, abnormal kinetics (such as altered vertical ground reaction force attenuation) and atypical electromyographic activation patterns (quadriceps under-activation and compensatory hamstring co-contraction) persisted during running when compared with uninjured controls.
Conclusion: Neuromuscular training effectively ameliorates specific biomechanical impairments and functional symmetry during running following ACL injury or reconstruction. However, current evidence does not demonstrate that neuromuscular training alone is sufficient to achieve complete normalization of running mechanics. Given the substantial heterogeneity in protocols, populations, and outcome metrics, clinical recommendations should emphasize targeted multi-modal programs while maintaining realistic expectations regarding the persistence of subtle gait deficits.
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