Using principles of motor learning to enhance ACL injury prevention programs

Findings from efficacy studies have shown decreased in ACL injury rates in (predominantly female) athletes participating in prevention programs. Given the inherent higher ACL injury risk for females, the majority of intervention studies, have focused on female athletes. Subsequently, the content of exercises in ACL prevention programs is directed to target the modifiable ACL injury risk factors for female athletes. The literature is generally scarce regarding the efficacy of prevention programs to reduce ACL injuries in male athletes. In general, reduction of ACL injury rates seem to be limited to (young) female athletes and male athletes playing at low level of sports. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. A problem is that improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills. In the motor learning domain, these type of instructions are defined as an internal attentional focus. An internal focus, on one's own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes’ behavior.