Neuromuscular Training for Rehabilitation of Sports Injuries a Systematic Review

Myer et al. (2011b) defined neuromuscular preparation (NT) equally a grooming plan that incorporates general (east.1000., fundamental movements) and specific (due east.g., sport-specific movements) strength and conditioning activities, such as resistance, dynamic stability, remainder, core strength, plyometric, and agility exercises with the goal to heighten health- and skill-related physical fitness components and to prevent injuries. According to this definition, agility, remainder, plyometric, ability, stability, and strength preparation are subsets of NT.

Over the by decades, the number of scientific publications on NT in non-athletic youth grew exponentially and provided disarming show to overcome long-term held myths on detrimental effects of particularly forcefulness training in youth (e.g., damage to growth plates, high injury adventure) (Figure 1). Today, the positive effects of NT in full general and strength training in detail are well-documented. Findings from original work, systematic reviews and meta-analyses proved the effectiveness of NT on muscular fitness, motor skills, sports performance, resistance to injuries, metabolic and mental wellness in non-athletic youth (Behringer et al., 2011; Myer et al., 2011a; Faigenbaum et al., 2013; Granacher et al., 2016). Less is known on the effectiveness of NT in young athletes. Moreover, findings from NT studies in not-athletic youth cannot directly be translated to young athletes because physiology and proficiency in motor performance differ markedly betwixt non-athletic and able-bodied populations. Despite the limited noesis, several national and international scientific organizations recommended to implement NT in young athletes' regular training routines to (i) stimulate their concrete and athletic development, (ii) tolerate the demands of long-term grooming and competition, and (iii) induce long-term health promoting effects that are robust over fourth dimension and rails into adulthood (Behm et al., 2008; Faigenbaum et al., 2016; Lloyd et al., 2016). Therefore, more research is needed on NT-related effects and physiological adaptations in young athletes.

Figure 1. This effigy illustrates the results of a systematic search in PubMed co-ordinate to the post-obit Boolean search syntax: (("neuromuscular training" OR "forcefulness training" OR "resistance grooming" OR "plyometric training" OR "ability training" OR "stability preparation" OR "balance training" OR "agility grooming") AND (kid*OR adolescent* OR youth*)). The post-obit filters were activated: humans; preschool kid: 2–five years; child: vi–12 years; adolescent: 13–18 years. Overall, the search retrieved N = 1,999 items.

In 2007, the High german Federal Found of Sport Science (BISp) recognized the discrepancy between these practically relevant but not always scientifically substantiated recommendations (Horn et al., 2012) and launched a new inquiry program with funding opportunities on strength grooming in young athletes. Consequently, several researchers beyond Federal republic of germany intensified their efforts and furthered our knowledge in the field (Behringer et al., 2010, 2011, 2013). As part of the BISp research program, the so-called KINGS-study was established in 2014 which is a 4-year interdisciplinary and multi-centered inquiry project that aims at examining functioning-enhancing and health-promoting furnishings of force training in young athletes according to sex, maturational status, and sport discipline (https://world wide web.uni-potsdam.de/kraftprojekt/english language.php).

Of note, KINGS is an acronym and it stands for the German phrase "GRAFTTRAINING IM NorthACHWUCHSLEISTUNThousandDue southDue southPORT" (engl. Strength Training in Young Athletes). A commencement achievement of this research consortium was the evolution and subsequent validation of a conceptual model on the implementation of force training during the different stages of long-term athlete development (LTAD) (Granacher et al., 2016). Many researchers from the KINGS research consortium acted every bit authors and editors of this Frontiers Research Topic. Nosotros purposely selected the title NT and not only strength training to broaden the scope of the articles that are eligible to be included in this Research Topic. Accordingly, the aims of our Enquiry Topic entitled "Neuromuscular Training and Adaptations in Youth Athletes" were to provide in-depth noesis in the course of original work, review articles, and meta-analyses on the effects of NT on muscular fitness, athletic performance, and injury prevention in young athletes during the different stages of LTAD.

Overall, 22 articles from 110 authors from Australia, Europe, N and South America were published in this Research Topic. Tabular array 1 outlines a summary of the included articles according to commodity blazon, contents, and authors.

Table 1. This table contains a summary of the 22 articles published in this research topic entitled "Neuromuscular Training and Adaptations in Youth Athletes" co-ordinate to article blazon, contents, and authors.

With regards to number of full views (August, 2018), the summit 3 papers of this Inquiry Topic were Behm et al., Steib et al., and Granacher and Borde.

In the grade of a systematic review and meta-assay, Behm et al. examined the effectiveness of traditional force vs. power training on musculus strength, power and speed with youth. Based on the statistically aggregated findings of 107 studies, moderate effects of power (effect size [ES] = 0.69) and force training (ES = 0.53) on jump measures. In terms of sprint performances, both power (ES = 0.38) and forcefulness training (ES = 0.48) produced small effects. Finally, power training showed niggling effects on lower body strength (ES = 0.16), while force training caused large furnishings (ES = 1.xiv). More specifically, children and untrained individuals accomplished larger ES compared with adolescents and trained individuals. Based on their findings, Behm et al. concluded that strength grooming should be applied before power grooming to induce an adequate foundation of strength for subsequent power training activities.

Using a systematic review and meta-analysis, Steib et al. studied the dose-response relationship of NT for injury prevention in youth young athletes. The authors identified 16 trials that examined the effects of NT on lower extremity injuries, including whatsoever form of muscular, ligamentous or bony injuries (traumatic or overuse). The authors reported an overall take chances reduction of 42% with NT. Training frequencies of 2–3 sessions per week revealed the largest risk reduction, and a weekly training duration of more than than 30 min tended to exist more than effective compared to lower training duration. Finally, interventions lasting more than than half-dozen months were not superior compared with shorter programs.

In an original research article, Granacher and Borde examined the effects of a 1-year sport-specific training and/or concrete education on physical fitness, trunk limerick, cognitive and academic performances in young athletes and their non-athletic peers. For this purpose, 45 prepubertal fourth graders from an aristocracy sport class or age-matched peers from a regular class. Young athletes participated in sports that afforded an early on offset into LTAD (eastward.g., swimming, gymnastics). Over the 1-year intervention period, the authors observed an boilerplate weekly training volume of 620 min for the athletes and 155 min for their not-able-bodied peers. Sport-specific training did non take a negative impact on growth rates. Meliorate performances were found in physical fitness and physical education grades in favor of the participants from the elite sports class. Similar performances were observed after the intervention for measures of noesis and academics. The authors concluded that sport-specific grooming in combination with concrete education promotes immature athletes' physical fettle development during LTAD and does not impede their cognitive and academic performances (Granacher and Borde).

In addition to the above mentioned about frequently viewed papers, some other 3 manufactures from this Frontiers Research topic had a similar scope and focused on musculus and tendon adaptations in young athletes. Mersmann et al. provided a narrative review of current evidence and concepts on the prevention of tendinopathies in young athletes. According to these authors, adolescent athletes are especially vulnerable to imbalanced development of muscle force and tendon mechanical backdrop. This was confirmed in another cantankerous-sectional study of the same research group (Mersmann et al.) in which they provided prove of imbalanced musculotendinous adaptations in adolescent volleyball athletes compared with age-matched non-athletic peers. These imbalances appear to be a precursor of tendinopathies. There is testify that these non-uniform musculotendinous adaptations are related to high prevalence rates of tendon overload injuries during maturation (Simpson et al., 2016). Increased levels of circulating sex steroid hormones with growth and maturation could be a critical factor that even augment imbalanced development of muscle strength and tendon mechanical properties (Murray and Clayton, 2013). For example Cassel et al. showed greater thickness in Achilles and Patellar tendons in boyish boys compared with girls. As well growth and sex activity-related circulating hormones, mechanical loading represents another critical factor that influences the evolution of muscle and tendon adaptations. In fact, muscle and tendon differ with regards to the time course of adaptation to mechanical loading likewise every bit the responsiveness to certain types of mechanical stimulation. Therefore, it seems that there are tissue-specific (musculus vs. tendon) dose-response relationships that either promote or prevent non-uniform musculotendinous development. For instance plyometric training is characterized by short and intensive bouts of eccentric followed by concentric musculus actions. This stimulus primarily induces neuromuscular but not tendinous adaptations. Consequently, the application of high plyometric training volumes during adolescence may promote the development of musculotendinous imbalances past increasing the risk of sustaining tendon injuries. In their narrative review article, Mersmann et al. provided an testify-based concept for a specific loading program with the goal to prevent tendon injuries through increased tendon stiffness. This program includes five sets of four repetitions with an intensity of 85–90% of the maximal isometric voluntary wrinkle and a 3 south movement/contraction duration that provides high magnitude tendon strain (Mersmann et al.).

A rather new and therefore neglected topic in the field of LTAD is how factors like grooming volume and intensity, performance fatigability, stress and pressure due to school (grades) and competition (success) affect immature athletes' mental health. Therefore, Weber et al. studied symptoms of anxiety and depression in immature athletes according to age and sex. Overall, 326 young athletes from different sports were enrolled and classified into the age groups late childhood (12–fourteen years) and belatedly adolescence (15–18 years). Anxiety and depression scores were assessed using the Hospital Anxiety and Depression Calibration (HAD Scale). Overall, 7.1% (subclinical scale) and 3.1% (clinical calibration) of the immature athletes were classified as possible and probable cases suffering from anxiety. In addition, 9.5% (subclinical scale) and 3.7% (clinical scale) of the examined athletes were classified as possible and probable cases for depression. Late childhood athletes showed a slightly lower mean anxiety score compared with late adolescent athletes. No pregnant age effects were observed for the depression score. Moreover, no sex-related effects were found for feet and depression, although female adolescent athletes scored slightly higher in both HAD subscales. The authors concluded that sports medical and sports psychiatric interventional approaches are needed to foreclose feet and depression in immature athletes past educational activity coping strategies (Weber et al.).

The 22 articles in this Inquiry Topic furthered our noesis in the field of NT and adaptations in immature athletes. However, there are still voids in the literature. For example, while Gäbler et al. examined the general effectiveness of concurrent forcefulness and endurance training on physical fitness and athletic functioning in youth in the class of a systematic review and meta-analysis, more original inquiry is needed in regards of sequencing effects of force and endurance preparation in young athletes. Farther, well-nigh studies conducted in immature athletes focussed on operation-related outcomes post-obit a specific intervention plan. The underlying neuromuscular, musculotendinous, and skeletal adaptations are largely unresolved. Yet, data on physiological mechanisms are crucial to understand maturation and sexual practice-specific dose-response relations. Finally, an important issue non only in aristocracy merely too in young athletes is return-to-play (Canty and Nilan, 2015). What are adequate exam batteries that can exist applied in the laboratory but also in the field during the unlike stages of rehabilitation to provide information on immature athletes' state of recovery? This information is needed to individualize rehabilitation programs and to determine readiness for render-to-play.

Author Contributions

All authors listed have fabricated a substantial, direct and intellectual contribution to the work, and approved it for publication.

Funding

This study is part of the research project Strength Training in Youth Athletes (http://www.uni-potsdam.de/kraftprojekt/english.php) that was funded by the German Federal Institute of Sport Scientific discipline (ZMVI1-081901 14-xviii).

Conflict of Interest Statement

The authors declare that the enquiry was conducted in the absence of whatever commercial or financial relationships that could exist construed as a potential conflict of interest.

Acknowledgments

The authors would like to thank Dr. Andrea Horn for her support during the course of the KINGS research project.

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Source: https://www.frontiersin.org/articles/10.3389/fphys.2018.01264/full

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