Sports Medicine Research: In the Lab & In the Field: Visual Feedback Can Be an Effective Tool for Safer Landing Strategy (Sports Med Res)


Wednesday, November 22, 2017

Visual Feedback Can Be an Effective Tool for Safer Landing Strategy

Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial

Benjaminse A, Otten B, Gokeler A, Diercks RL, Lemmink KAPM. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2365-2376. doi: 10.1007/s00167-015-3727-0 [doi].

Take Home Message: External focus of attention with a visual feedback may be optimal for an effective anterior cruciate ligament (ACL) injury prevention program.

We need to promote motor learning to optimize the effectiveness of injury prevention programs. Athletes can learn motor skills with an internal focus of attention (focus on the movement themselves) or with an external focus of attention (focus on the movement effect; like touching a target). However, the effect of internal and external focus feedbacks on kinetics and kinematics during sport-specific tasks, like sidestep cutting, and their effect on retention of learned motor skills is unclear. Thus, the authors aimed to examine the effects of a visual external focus and a verbal internal focus feedback on peak knee loading during unexpected sidestep cutting over time in female and male athletes. The authors randomized 90 healthy recreational basketball players into 3 groups with both sex equally distributed: visual, verbal and control. As participants completed unexpected sidestep-cutting drills the authors measured numerous kinematic and kinetic outcomes (e.g., vertical ground reaction force, motion and moments of the trunk, hip, knee, ankle). All groups performed 3 sessions of sidestep cutting. During first session, the visual group received visual feedback after each trial, which was a video of their best performance. The verbal group only received verbal instructions: (1) ‘bend your trunk forward’, (2) ‘bend your knee’ and (3) ‘keep your knee straight above your foot’. The control group was only provided with the general instructions. The participants completed two more sessions 1 week and 4 weeks after the first session. During these sessions they received no feedback, which allowed the authors to measure a possible retention effect. Males in the visual group improved and retained better motor skills (e.g., larger vertical ground reaction forces, knee flexion moment, knee range of motion and ankle dorsiflexion angle) when compared with the other two groups and females.

The results from this study support the use of external focus feedback among male athletes. Movement alterations shown in male athletes who received video feedback can be interpreted as safer landing strategies. Visual feedback using video analysis has become popular as an effective tool for injury surveillance and performance assessment. It would be interesting to know if combining self-feedback methods and expert modelling with verbal and visual cues will work better for both sexes. It would also be interesting to see if the learned movement patterns remain during a practice or game. Clinicians need to consider how to use this tool effectively in different settings and if it is feasible with a large team-based training program or better suited for an individual return-to-play rehabilitation program after an injury.

Questions for Discussion: What type of feedbacks can be effective in clinical setting? In providing visual feedback, how can one decide on what the best movement patterns are? How can we examine retention of learned motor skill in clinical setting?

Written by: Mihyang Chang
Reviewed by: Jeffrey Driban

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