Real-time feedback during drop landing training improves subsequent frontal and sagittal plane knee kinematics
Nyman E, & Armstrong CW. Clinical Biomechanics. 2015; E pub ahead of print. http://dx.doi.org/10.1016/j.clinbiomech.2015.06.018
Take Home Message: Real-time feedback with Microsoft Kinect-based software helps to improve landing techniques in a female gymnastics.
Poor landing mechanics may predispose individuals to non-contact anterior cruciate ligament (ACL) injuries. Real-time feedback during activities can help to improve neuromuscular control; however, real-time feedback training has not been widely implemented in a clinical setting. New advancements in video games systems (e.g., Microsoft Kinect) may enable clinicians to implement real-time feedback training with minimal expense, time and space. The authors of this randomized trial investigated whether 4 weeks of real-time feedback from software using a Microsoft Kinect would help female gymnasts improve neuromuscular control and landing techniques. Gymnasts (~15 years old) that had no history of surgery nor a recent lower extremity, spine, or concussion injury were randomly assigned to either the Kinect-based feedback group or the control group, resulting in 12 gymnasts per group. Prior to the interventions, all participants performed a drop landing-to-jump task so the authors could assess peak knee flexion angle and minimum knee separation distance. All participants completed the intervention training with 20 drop landings 3 days per week for 4 weeks; however, the Kinect-based feedback group completed this task while watching themselves in real-time on a monitor that used software that gave auditory and colored cues for correct and/or abnormal movement patterns. After 4 weeks the authors re-evaluated the participants’ peak knee flexion angle and minimum knee separation distance during a drop landing-to-jump tasks. The Kinect-based feedback group had a 46% improvement in peak knee flexion angle, which was a greater change than the control group that had very little change in peak knee flexion angle. The Kinect-based feedback group also had a 21% increase in the minimum knee separation distance, which was a greater change than the 8% change by the control group.
The authors of this study found that real-time feedback training using software is effective at altering landing mechanics that are often associated with ACL tears. The Kinect-based software feedback provides objective and tangible goals for athletes to strive for during an intervention program. It would be interesting to see a comparison of real-time training using the Kinect software system compared with real-time feedback by a clinician or coach. This research shows positive outcomes after an intervention program, but it remains unknown as to how long these changes may last after cessation of the intervention program or what the external generalizability of these findings may be to other athletic or physically active populations. Female gymnasts are an especially unique population because they are susceptible to ACL injuries, just like other athletic and physically active females; however, they have a tendency to land more stiff than other female athletes as a result of their sport. It would be interesting to see the findings of these results in other ACL susceptible populations such as female soccer or basketball athletes. While a Kinect-based feedback program may not be realistically feasible for team interventions, it could be a valuable tool to be used within the knee-injury rehabilitation setting or for an athlete identified as high-risk.
Questions for Discussion: Are there any intervention or training programs that you clinically use to improve landing techniques?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Altered Lower Extremity Biomechanics Following an ACL Injury and Surgery May Increase the Risk of ReinjuryNyman, E., & Armstrong, C. (2015). Real-time feedback during drop landing training improves subsequent frontal and sagittal plane knee kinematics Clinical Biomechanics DOI: 10.1016/j.clinbiomech.2015.06.018