The Effect of Verbal Combined Focus of Attention and Video Instruction Training on Landing Technique and Proprioception in Semi-Professional Female Athletes

Approximately 70% of lower extremity injuries occur during non-contact, single-leg landings, and jumping to the ground is a common injury mechanism in both genders. Additionally, female athletes have higher injury rates compared to men, potentially due to anatomical differences of the lower kinematic chain. Events in which athletes experience non-contact ACL injuries generally show many common biomechanical features such as increased ground reaction forces during single-leg landing, decreased joint flexion in the sagittal plane of the ankle, knee, hip and trunk, as well as increased knee internal rotation angles. Another critical ACL injury risk factor is performing a secondary task during sharp deceleration movements. Current rehabilitation programs focus on neuromuscular training programs to prevent adverse movement patterns and increase proper movement control. However, there is still a need to increase the effectiveness of these neuromuscular training programs to have a more significant impact on ACL injury rates. Therefore, the use of motor learning strategies and neuromuscular training programs with adequate and correct techniques in the rehabilitation of athletes should still be investigated.

There are various approaches to motor learning. One of the best-known approaches is the cognitive approach, where the athlete reaches the automation stage by receiving feedback and repeating the model technique as often as possible. The common denominator of motor learning strategies is the use of explicit instructions and feedback regarding desired landing positions. Instructions for the implementation of movements in rehabilitation programs aim to improve performance and motor learning. These instructions may address the action outcome or the course of action. There are many studies showing that feedback training changes jump landing biomechanics. In line with the results of these studies, using feedback techniques, especially to reduce the vertical ground reaction force and increase the knee flexion angle during landing from a jump, can reduce the stress and risk of injury in the lower extremity.

Motor skills can be learned with an internal focus of attention or with an external focus of attention. Although the difference in these instructions may seem insignificant, externally focused education; has been shown to result in better performance, retention, transfer, and greater movement automaticity. The main purpose of this study is to investigate the effects of training on vertical jump landing technique by comparing a verbal training group that receives instructions with an external focus of attention and an internal focus of attention combined, a visual training group with video instructions, and a control group in female athletes with knee valgus. It is also to examine whether possible beneficial results are still present in the retention test performed one week after the test session. The secondary aim of our study is to examine the effect of the training provided on knee joint position sense.