Is there evidence that proprioception or balance training can prevent anterior cruciate ligament (ACL) injuries in athletes without previous ACL injury?

Abstract

The purpose of “Evidence in Practice” is to illustrate how evidence is gathered and used to guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A collegiate-level soccer player was instructed by her coach to incorporate a proprioceptive component into her training program. He suggested that she purchase a balance board and immediately begin a program that he designed. She approached her physical therapist (SJF) for more information. I immediately recognized that, because of her sex and sport of choice, she would be at high risk for an anterior cruciate ligament (ACL) injury. Hewett et al1 estimated that as many as 2,200 ACL ruptures per year occur in female collegiate athletes in both the recreational and competitive ranks. Treatment and rehabilitation costs are estimated at $17,000 per ACL injury, which do not take into account the potential loss of long-term participation, loss of scholarship funding, and future disability from arthritic changes in a reconstructed knee.1 For these reasons, a shift toward injury prevention is warranted. Injury prevention for the ACL can take many forms, including a variety of training protocols, athlete education, and bracing. Current studies focus on neuromuscular training as a preventive measure, with programs that include strength, flexibility, plyometrics, sport-specific agility drills, speed enhancement, balance, and athlete education.1–7 A clinician who understands the individual components of these programs could optimize injury prevention and aid athletes in appropriate program design and equipment purchases. In the case of this athlete, my colleagues and I focused on the use of proprioception or balance training and its effect on incidence of ACL injury. We searched the literature to answer our clinical question “Is there evidence that proprioception or balance training can prevent ACL injuries in athletes …