REVIEW  PSYCHOLOGY 

The Journal of Sports Medicine and Physical Fitness 2021 July;61(7):1020-6

DOI: 10.23736/S0022-4707.20.11505-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Neuromuscular training programs predominantly include instructions that promote an internal focus

Molly A. STEWART ¹, Lindsey A. WAITE ¹, Jithmie G. JAYAWICKREMA ², Thomas G. ALMONROEDER ¹ ✉

¹ Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA; ² Parkview TherapyOne, Fort Wayne, IN, USA

Neuromuscular training programs that include movement pattern retraining and strengthening, plyometric, and balance exercises are recommended for anterior cruciate ligament injury prevention. Recent evidence suggests that the effectiveness of these programs may be enhanced when athletes train with an external focus; however, clinicians typically rely predominantly on instructions encouraging an internal focus. The aim of this study was to examine the types of instructions provided as part of popular neuromuscular training programs used for anterior cruciate ligament injury prevention. The technique-related instructions provided as part of the FIFA 11+, HarmoKnee, Knakontroll, and Prevent Injury and Enhance Performance programs were categorized as either promoting an internal focus or an external focus. Instructions provided during movement pattern retraining tasks and strengthening, plyometric, and balance training exercises were specifically examined. Next, the percentage of technique-related instructions that promoted an internal focus, versus the percentage that promoted an external focus, were compared for the various program components. Across all programs examined, the vast majority of technique-related instructions for the movement pattern re-training tasks (≥83.3%) and the strengthening, balance, and plyometric exercises (≥75.0%) appeared to promote an internal focus. Despite evidence suggesting that the effectiveness of neuromuscular training programs may be enhanced by encouraging an external focus, most technique-related instructions provided as part of popular neuromuscular training programs appear to promote an internal focus. Modifying neuromuscular training programs to promote a more external focus could help to improve the effectiveness of these programs for anterior cruciate ligament injury prevention.

KEY WORDS: Anterior cruciate ligament injury; Attentional bias; Sports medicine