Evidence for Neuromuscular Retraining to Reduce Noncontact ACL Injuries in Female Athletes Continues to Mount

In the last two years, several meta-analyses and systematic reviews have been published that strongly support the need and rationale for neuromuscular training in young female athletes. These publications reported relative risk reduction rates for noncontact ACL injuries that ranged from 52-100%. Relative risk reduction refers to the estimate of the percentage of risk that is reduced for trained athletes compared with untrained athletes.

In the February 2014 issue of the journal Arthroscopy, we published our systematic review that included eight neuromuscular training programs. Our rigorous analysis found that three programs – Sportsmetrics, PEP, and KIPP – had a statistically significant impact in reducing the risk of ACL injuries in female soccer and basketball players. We believe it is important to understand that not all ACL prevention programs are effective, a concept that is not always made clear in both the scientific literature and in the media. This article is available for download on our website.

In the May 7, 2014 issue of the Journal of Bone and Joint Surgery, a unique article was published on the cost-effectiveness of ACL injury prevention training. The authors (Swart et al, from Columbia University Medical Center, New York) compared three strategies for young athletes who regularly participate in organized sports: 1) no neuromuscular training or ACL injury screening, 2) universal neuromuscular training, and 3) universal screening, with neuromuscular training only done in high-risk athletes. An analysis of the total costs and gains in quality-adjusted life years was conducted of these strategies, assuming that all ACL ruptures would be reconstructed. The neuromuscular training program costs were based on a protocol that included dynamic warm-up, plyometrics, strengthening, sport-specific agility drills, and flexibility and included programs such as Sportsmetrics and PEP. In addition, costs were based on personal and equipment needs for neuromuscular training and injury screening.

The study found that universal neuromuscular training would reduce the incidence of ACL injuries by an average of 63%, whereas screening would reduce the incidence by an average of 40%. The example was given that, in 10,000 athletes, ACL injuries would be sustained by: 1) 300 athletes in the no-screening or training group, 2) 180 in the screen-and-treat high-risk athletes only group, and 3) 110 in the train all group. The average cost of the universal training group was $100 lower than the no train group and $25 lower than screen-and-treat group. The authors concluded that universal neuromuscular training was the most cost-effective strategy for reducing costs and morbidity from ACL injuries. This article is also available for download on our website.


1.         Gagnier JJ, Morgenstern H, Chess L. Interventions Designed to Prevent Anterior Cruciate Ligament Injuries in Adolescents and Adults: A Systematic Review and Meta-analysis. Am J Sports Med. 2013;41(8):1952-1962.

2.         Noyes FR, Barber-Westin SD. Neuromuscular retraining intervention programs: do they reduce noncontact anterior cruciate ligament injury rates in adolescent female athletes? Arthroscopy. 2014;30(2):245-255.

3.         Paszkewicz J, Webb T, Waters B, Welch McCarty C, Van Lunen B. The effectiveness of injury-prevention programs in reducing the incidence of anterior cruciate ligament sprains in adolescent athletes. J Sport Rehabil. 2012;21(4):371-377.

4.         Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769-776.

5.         Stojanovic MD, Ostojic SM. Preventing ACL injuries in team-sport athletes: a systematic review of training interventions. Res Sports Med. 2012;20(3-4):223-238.

6.         Sugimoto D, Myer GD, Bush HM, Klugman MF, Medina McKeon JM, Hewett TE. Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis. J Athl Train. 2012;47(6):714-723.

7.         Swart E, Redler L, Fabricant PD, et al. Prevention and screening programs for anterior cruciate ligament injuries in young athletes. A cost-effectiveness analysis. J Bone Joint Surg Am 2014;96(9):705-71.

8.         Sugimoto D, Myer GD, McKeon JM, Hewett TE. Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. Br J Sports Med. 2012;46(14):979-988.

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Sportsmetrics May Certification Course

On May 23rd, we made our annual trip to Hilton Head Island, SC for the 29th Annual Advances on the Knee and Shoulder and pre-conference Sportsmetrics course.

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Attention Portland and Seattle!

Therapeutic Associates will be hosting a Sportsmetrics Certification Course on May 3-4, 2014.  Course details are below:
Seattle Metro:
Date: May 3-4, 2014
7:30 AM Registration
Class Time: 8AM-5 PM Saturday; 8 AM-12:00 PM Sunday
Registration Deadline: April 5, 2013
Location:  Therapeutic Associates Queen Anne Physical Therapy
7100 Fort Dent Way, Ste 222
Seattle, WA 98188
Instructors: Stephanie Tutalo Smith, MS and Tommy Campbell
Total Hours: 13
Cost:  $690- TAI; $730- Non-TAI
For more information, contact Dorothy Klemetson at dorothyk@taiweb.com, 206-241-8488 (x2200)
or visit : http://www.therapeuticassociates.com/education/continuing-education/

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The Sportsmetrics Certification Course is now approved as an Evidence Based Practice Program!

Sportsmetrics is recognized by the Board of Certification, Inc. to offer continuing education for Certified Athletic Trainers.

Receive 3.25 EBP Category CEU’s and 7.25 Category A CEU’s by attending a Sportsmetrics Certification Course.


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Sportsmetrics Certification Course Dates

2014 Dates

May 23-24, 2014:  Hilton Head Island, SC

July 19-20, 2014:  Cincinnati, OH

October 2014:  Cincinnati, OH (Dates TBD)

November 2014:  Cincinnati, OH (Dates TBD)

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Sportsmetrics March Certification Course

On March 8th and 9th, we held our second certification course of 2014.  As far as weather, March is a wild month in Cincinnati.  It could be snowing one day and sunny and 65 degrees the next.  Fortunately, the sun made an appearance and the snow and ice did not.  We welcomed 14 new instructors from Ohio, Tennessee, Nebraska, North Carolina, Wisconsin, Montana and New Mexico.  The class included 9 PT’s, 3 ATC’s, 1 MD and 1 Biomedical Engineer!  We would like to thank our 14 newly certified Sportsmetrics instructors for giving up their weekend and committing to becoming experts in knee injury prevention!

Staci Bornschlegl, PT:  Proformance Physical Therapy, Lincoln, NE

Laura Cleaver, PT:  Charles J. DePaolo, MD, PA, Asheville, NC

Amy Edwards, PT: Specialized Therapy Services, LLC, Lima, OH

Lauren Huser, BS (Biomedical Engineering): Cincinnati SportsMedicine, Cincinnati, OH

Marie Johnsen, DPT: Cincinnati SportsMedicine, Cincinnati, OH

Nicole Kahle, DPT, CSCS: PT Services, Ottawa, OH

Alan Killingsworth, ATC, RN: STAR Physical Therapy, Franklin, TN

Kelly Klika, DPT: Affinity Health System- St. Elizabeth Hospital, Appleton, WI

Savana Melland, DPT: Bridger Orthopedic & Sports Medicine- Freestone Rehab, Belgrade, MT

Tasha Morgan, LAT, PTA: Affinity Health System- St. Elizabeth Hospital, Appleton, WI

Heather Nealey, DPT: Genesis Center for Occupational & Outpatient Rehabilitation

Michal Taylor, MD: Cincinnati SportsMedicine, Cincinnati, OH

Nicole Walkup, ATC: Proformance Physical Therapy, Lincoln, NE

Katie Weems, MPT: Physical Therapy at Dawn, Albuquerque, NM


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Sportsmetrics March Certification Course

On March 8th and 9th, we held our second certification course of 2014.


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Sportsmetrics October Certification Course


On October 12th and 13th, we hosted our second to last Sportsmetrics certification course for the year.


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The actual point is that mankind or a nation I mean the finnish my gathering one now does not react to this

Sportsmetrics October Certification Course

On October 12th and 13th, we hosted our second to last Sportsmetrics certification course for the year. The course roster included 9 PT’s, 3 PTA’s and 1 coach traveling from as far as St. Thomas, VI (do I hear “on-site course”?)  We could not have picked a better weekend as temperatures stayed in the mid 70’s with clear skies.  As usual, on Saturday, after mentally and physically working up an appetite, the majority of the group headed to Montgomery Inn to experience their world famous bbq sauce. Back to work on Sunday, the group discussed ways to implement the program in their own communities before testing and heading home.  We look forward to working with our 13 new instructors and thank you all for dedicating your weekend to ACL injury prevention!  We welcome:


Erin Alverson, PTA:  Coshocton County Memorial Hospital, Coshocton, OH

Kim Bjork, PTA:  NorthStar Health System, Iron River, MI

Quang Bui, DPT: ATC: Inova Physical Therapy Center, Chantilly, VA

Ricky Bussey: DPT: Makovicka/Sylliaasen Physical Therapy, Valley, NE

Jessica Graziano, DPT, CSCS: Hospital for Special Surgery, New York, NY

Patricia Hollowell, Coach: Washington Christian Academy, Olney, MD

Benjamin Igwe, PT: Inova Physical Therapy Center, Vienna, VA

Allison Leisge, MSPT: Kaiser Permanente, Aurora, CO

Jennifer McCurdy, PTA: Coshocton County Memorial Hospital, Coshocton, OH

Beth Milligan, MSPT, CSCS: Therapy and Rehab Solutions, Conway, AR

Ashley Pittman, DPT: Active Physical Therapy, St. Thomas, VI

Turner Sibley, MSPT: Therapy and Rehab Solutions, Conway, AR

Brandon Wehenkel, PT: St. Mary’s Community Hospital, Auburn, NE

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Take the Knee Injury Test!

Learn about some of the testing techniques that we use at Cincinnati SportsMedicine to evaluate if you or your athlete may be at an increased risk for a knee injury.  Although no test can predict an injury, it is important to recognize deficiencies and take the necessary steps to correct these deficiencies in order to reduce your risk of injury.


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