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Effects of Pivoting Neuromuscular Training on Pivoting Control and Proprioception


Medicine & Science in Sports & Exercise: July 2014 - Volume 46 - Issue 7 - p 1400–1409
doi: 10.1249/MSS.0000000000000249
Applied Sciences

Purpose: Pivoting neuromuscular control and proprioceptive acuity may play an important role in anterior cruciate ligament injuries. The goal of this study was to investigate whether pivoting off-axis intensity adjustable neuromuscular control training (POINT) could improve pivoting neuromuscular control, proprioceptive acuity, and functional performance.

Methods: Among 41 subjects, 21 subjects participated in 18 sessions of POINT (three sessions per week for 6 wk), and 20 subjects served as controls who did their regular workout. Both groups received pre-, mid-, and postintervention evaluations. Propensity score analysis with multivariable regression adjustment was used to investigate the effect of training on pivoting neuromuscular control (pivoting instability, leg pivoting stiffness, maximum internal, and external pivoting angles), proprioceptive acuity, and functional performance in both groups.

Results: Compared with the control group, the training group significantly improved pivoting neuromuscular control as reduced pivoting instability, reduced maximum internal and external pivoting angles, increased leg pivoting stiffness, and decreased entropy of time to peak EMG in the gluteus maximus and lateral gastrocnemius under pivoting perturbations. Furthermore, the training group enhanced weight-bearing proprioceptive acuity and improved the single leg hop distance.

Conclusion: Improvement of pivoting neuromuscular control in functional weight-bearing activities and task performances after POINT may help develop lower limb injury prevention and rehabilitation methods to reduce anterior cruciate ligament and other musculoskeletal injuries associated with pivoting sports.

1Sensory-Motor Performance Program, Rehabilitation Institute of Chicago, Northwestern University, Chicago, IL; 2Department of Biomedical Engineering, Northwestern University, Evanston, IL; 3Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL; 4Department of Orthopaedic Surgery, Northwestern University, Chicago, IL; and 5Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL; and 6Rehabtek LLC, Wilmette, IL

Address for correspondence: Li-Qun Zhang, Ph.D., Rehabilitation Institute of Chicago, Suite 1406, 345 E. Superior Street, Chicago, IL 60611; E-mail:

Submitted for publication August 2013.

Accepted for publication December 2013.

© 2014 American College of Sports Medicine