Neuromuscular Exercise Research Articles

Neuromuscular electrical stimulation and exercises effect on functional exercise performance and quality of life in cases of liver cirrhosis

IntroductionPatients with cirrhosis experience severe physical deconditioning, sarcopenia, physical frailty, fatigue, and malnutrition. Exercise capacity is limited owing to inactivity, bed rest, obesity, or cachexia. Limb muscle dysfunction has important consequences for patients with liver cirrhosis because it contributes to exercise limitation and reduces daily activities and social life, leading to a quality of life (QOL) impairment, greater utilization of social and health resources, and a worse prognosis. The study purpose was to compare the effect of neuromuscular electrical stimulation (NMES) and exercises on treatment of patients with liver cirrhosis.MethodsA total of 60 patients (41 males and 19 females) with liver cirrhosis, aged 35–59 years, were randomly assigned to 2 groups: an NMES group (<i>n</i> = 30) and exercises group (<i>n</i> = 30). The intervention was implemented 3 times per week for 3 months. Exercise performance and QOL were measured before and after the intervention.ResultsBefore treatment, there was no significant difference in exercise performance or QOL between the 2 groups; however, after 3 months of intervention, a significant difference in exercise performance was observed between the 2 groups (<i>p</i> = 0.001). Both groups improved their QOL (<i>p</i> = 0.001), but the NMES group improved more than the exercise group.ConclusionsNMES is an important technique to increase exercise performance and QOL in patients with liver cirrhosis.

Neuromuscular exercise with neuromuscular electrical stimulation in knee osteoarthritis: A randomised controlled pilot trial

Neuromuscular exercise with neuromuscular electrical stimulation in knee osteoarthritis: A randomised controlled pilot trial

Immediate effects of neuromuscular joint-facilitation bridging exercises on walking ability and balance function in stroke patients.

[Purpose] This study aimed to examine the immediate effects of a pelvic neuromuscular joint-facilitation intervention on the walking and balance ability of patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] A total of 15 patients with hemiplegia caused by cerebrovascular accidents underwent a neuromuscular joint-facilitation lumbar-pattern intervention (intervention group), a bridge exercise (bridge intervention group), or a neuromuscular joint-facilitation bridge intervention (neuromuscular joint-facilitation bridge group). Each intervention was randomly administered at 7-day intervals. Measurement items included the timed up-and-go test, functional reach test, 10-m maximum walking speed test, and load in the standing position. Measurements were taken before and after the intervention in each group. [Results] The timed up-and-go test result was significantly shorter in the neuromuscular joint-facilitation intervention group. Timed up-and-go test results, functional reach, 10-m walking time, and standing load (non-paralyzed side) significantly improved in the neuromuscular joint-facilitation bridge group. [Conclusion] The neuromuscular joint-facilitation bridge intervention was immediately effective in patients with hemiplegia caused by cerebrovascular accidents and improved their walking and balance ability.

Proprioceptive neuromuscular facilitation exercises versus lumbar stabilization exercises for chronic low back pain patients: A randomized interventional study

Background: Chronic low back pain causes discomfort and disturbance in the mechanoreceptor and proprioception centers. Exercises improve muscle strength, flexibility, endurance, and ability to perform life activities. Proprioceptive neuromuscular facilitation (PNF) involves stretching, resisted movements which improves muscle disharmony, atrophy, and joint movement limitation. Lumbar stabilization exercises (LSE) develop the awareness of muscle contraction and control from simple to complex patterns. Both exercises are effective individually in chronic low back pain patients. This study was conducted to find out which technique is better. Objectives: The objective of the study is to determine the efficacy of PNF versus LSE program in chronic low back pain patients. Study Design: A Randomized study was conducted. Methods: A prospective, interventional study was conducted on patients with mechanical low back pain of more than 3 months, in both males and females, of age 20–45 years. Patients having systemic illness, central or peripheral neurologic signs, and specific causes of low back pain were excluded. Individuals having systemic illness and psychiatric illness were also excluded from the study. Twenty-two patients were selected and divided into two groups. Patients were assessed on the Visual Analog Scale (VAS), modified Schober's test, Modified Oswestry Low Back Pain Disability Questionnaire (ODI), Roland and Morris Low Back Pain and Disability Questionnaire (RMDQ). Patients in the PNF Group received concentric and eccentric contractions of agonist and antagonist muscles, patterns such as chopping, lifting, bilateral leg, and trunk lateral flexion. LSE Group received core strengthening exercises. Both group received 3 treatment sessions per week for 4 weeks, each session lasting for 45 min. Results: PNF group showed significant improvement in pain on VAS (P = 0.003; 95% confidence interval [CI[, 2.15–3.01), in disability on ODI (P = 0.001, 95% CI, 12.09–20.1), and in lumbar flexibility Modified Schober's test (P = 0.000, 95% CI, 5.15–5.93) On RMDQ, there was no statistically significant difference between PNF and LSE groups (P = 0.061, 95% CI, 6.87–8.97). Conclusion: There was a significant improvement seen in the pain and disability which was assessed on VAS and ODI in the PNF group over LSE. Hence, PNF exercises can be incorporated with LSE in the treatment of LBP.

Role of proprioceptive neuromuscular facilitation exercises in post-COVID individuals: A randomized-control trial

Role of proprioceptive neuromuscular facilitation exercises in post-COVID individuals: A randomized-control trial

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.

Lower Limb Exercise-Based Injury Prevention Programs Are Effective in Improving Sprint Speed, Jumping, Agility and Balance: an Umbrella Review.

BackgroundExercise-based injury prevention programs for athletes have demonstrated consistent results in reducing the risk of lower limb injuries. Compliance is essential for program effectiveness and may be facilitated when these programs demonstrate positive effects on athletic performance.Hypothesis/PurposeTo summarize the findings of current systematic reviews on the effectiveness of lower limb injury prevention programs with multiple neuromuscular components on sports performance and quantify these effects. The authors hypothesized that injury prevention programs can improve certain sports performance criteria.Study DesignUmbrella systematic reviewMethodsSystematic reviews published in French, German, or English between January 1990 and January 2020 were identified in five databases. Only articles that investigated multicomponent lower limb injury prevention programs and their effects on the performance criteria of strength, balance, agility, jumping or speed by both amateur and professional athletes of all ages and sex were included. The methodological quality of the included systematic reviews was assessed by two reviewers independently using the Assessing the Methodological Quality of Systematic Reviews measurement tool.ResultsFive systematic reviews met the inclusion criteria. Overall, beneficial effects of multicomponent exercise-based injury prevention programs were observed for balance, agility, jumping and speed. While the effects on strength were more variable, there was a positive trend in favor of injury prevention programs.ConclusionInjury prevention programs with multiple neuromuscular exercise components demonstrate overall beneficial effects on the performance criteria of balance, agility, jumping or speed. These beneficial effects may be used to promote the implementation of such programs.Level of Evidence2a

11+ Dance: A Neuromuscular Injury Prevention Exercise Program for Dancers

ABSTRACT Epidemiological studies over the past decade indicate high injury prevalence in preprofessional ballet (76%) and professional contemporary and ballet dancers (60–69%). Injuries can have detrimental effects both for the dancers and the dance company. Most injuries are in the lower limb and reported as the gradual onset of overuse. Professional dance companies have reduced injury incidence and severity through the implementation of comprehensive injury audit programs and proactive exercise prescription. Injury prevention research in dance is scarce, and there has been no intervention targeting dance injuries. This article describes the development of 11+ Dance, an injury prevention training program designed for dancers, based on current evidence and best practice on injury prevention in sports. It is a 25–30-minute neuromuscular-based training program focused on strength, balance, and jumping/landing technique, with special attention to ankle, knee, and hip alignment. The high prevalence of injuries reported in the different styles of dance suggests that implementation of an injury prevention program is both the plausible and ethical action to take for all levels of performance.

Commentary: "You're Only as Strong as Your Weakest Link": A Current Opinion About the Concepts and Characteristics of Functional Training.

Exercise adaptations are highly dependent on the specific training stimulus (Nader, 2006; Egan and Zierath, 2013; Hughes et al., 2018). Therefore, an apt description of physical training programs is essential for adequate planning of neuromuscular, cardiovascular, metabolic, and functional exercise performance and recovery enhancements. Although muscle strength, power, flexibility, and endurance training are well-defined concepts within exercise prescription and muscle performance, functional training (FT) does not have a universal definition. Examining the manuscript of La Scala Teixeira et al. (2017), reviled inconsistent concepts regarding the definition of FT. Specifically, they did not differentiate FT from strength, power, flexibility, or endurance training programs. In the PubMed database, their manuscript (La Scala Teixeira et al., 2017) was cited by six articles (Crawford et al., 2018; Da Silva-Grigoletto et al., 2019, 2020; Drum et al., 2019; La Scala Teixeira et al., 2019; Muyor et al., 2020), three of which were self-citations. Despite not yet (as of May 2021) being extensively cited in the literature, their manuscript (La Scala Teixeira et al., 2017) has a total of 9,535 views (https://www.frontiersin.org/articles/10.3389/fphys.2017.00643/full) and 1,282 downloads (http://loop-impact.frontiersin.org/impact/article/285700#totalviews/downloads), and may create a relevant social and health impact. Considering that functional fitness training was regarded as one of the Top 20 Worldwide Fitness Trends for 2021 (Thompson, 2021), the dissemination of inconsistent concepts regarding the definition of FT may create substantial confusion among students, coaches, athletes, and sports scientists. In this context, this commentary builds upon the concepts and characteristics of FT presented by La Scala Teixeira et al. (2017). Therefore, we aimed to present a critical commentary to enrich the debate of such a topic and alleviate the potential confusion.

Comparison of the effectiveness of proprioceptive neuromuscular facilitation exercises and shoulder mobilization patients with Subacromial Impingement Syndrome: A randomized clinical trial

IntroductionThe aim of this study was to compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) exercises and shoulder mobilization (SM) in addition to conventional physiotherapy on pain, range of motion (ROM), functionality, and muscle strength in patients with Subacromial Impingement Syndrome (SIS). MethodsForty-four patients were randomly allocated into three groups as conventional physiotherapy (control group; n = 14), conventional physiotherapy + PNF exercises (PNF group; n = 15), and conventional physiotherapy + SM techniques (SM group; n = 15). Pain, ROM, muscle strength, and functionality were evaluated by using VAS (Visual Analog Scale), goniometer, push-pull dynamometer, Constant-Murley score and DASH (Disabilities of the Arm, Shoulder and Hand) score. Patients were received 20 sessions (4 weeks) of treatment. Assessments were performed at baseline, and weeks two, four, and sixteen. ResultsAfter treatment, significant improvements in outcome measurements were observed in all groups (all p < 0.05). PNF or SM groups were not superior to each other in terms of improving pain and functionality. SM group was superior to PNF group for improving shoulder flexion ROM at week 4 (p = 0.009). The improvements in shoulder extension muscle strength were greater in PNF group at weeks 2 and 16 compared with other groups (p = 0.030, 0.035). ConclusionPNF or SM, in addition to conventional physiotherapy, might help to improve pain and functionality more in patients with SIS. It is recommended to add SM or PNF to conventional treatment to maintain the ROM increase gained with SIS treatment after treatment, and to apply this treatment for 4 weeks for muscle strength increase.

The effect of a neuromuscular neck exercise program on head impact magnitude during heading: A pilot randomised controlled trial

Introduction: Football is the only sport where the head is deliberately used to strike a ball. While heading has always been an integral part of football, there is growing research and public concern that retired footballers have an increased risk for neurodegenerative disease due to changes to brain tissue from repeated ball-head impacts. Any impact to the head has the potential to cause a transmission of force to the brain. Whether this results in detrimental stress and strain to brain tissue is likely related to head impact magnitude.

The effects of progressive neuromuscular exercise program and taping on muscle strength and pain in patellofemoral pain. A randomized controlled blind study

Purpose To investigate the effects of corrective kinesio taping applied on patellofemoral and foot joint in addition to a progressive neuromuscular exercise program in women with Patellofemoral Pain (PFP) on knee pain and muscle strength. Methods Thirty females (20–45 years), diagnosed with unilateral PFP were randomly divided into two groups: the exercise (n = 15) and the exercise and taping (n = 15). Both groups performed three-stage progressive neuromuscular exercises for 12 weeks as home exercises. Plantar and knee corrective taping was additionally applied to the exercise and taping group. The knee pain was measured using the Visual Analogue Scale (VAS) during stair ascending and descending. Isokinetic dynamometer was used to evaluate the isokinetic muscle strength of the hamstring and quadriceps femoris muscles. All assessments were conducted before the treatment, at the end of the 6th-week treatment, and at the end of the 12th week of the treatment. Results After intervention, pain, and muscles peak torque were improved in all groups (p ˂ 0.05). The decrease in pain and the increase in quadriceps and hamstring muscle peak tork were found to be significant for both groups (p < 0.05). In the taping group, the decrease in pain during stair descending and the increase in hamstring muscle tork were higher than that of the exercise group (p < 0.05). Conclusion In order to reduce pain in a short time and control it in the long term, it will be beneficial to tape the knee and foot in addition to neuromuscular exercises.

The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study

ABSTRACT Objective To investigate whether a combination of dry-needling treatments and upper extremity neuromuscular reeducation exercises can significantly improve neck pain and/or headache-related disability, joint position error, cervical range of motion, and pain pressure threshold in individuals suffering from cervicogenic headache (CGH). Methods This study is a quasi-experimental design. Seven participants met the inclusion criteria and received dry needling to three muscles that reproduced the participant’s headache symptoms and completed the Neck Disability Index (NDI), Headache Disability Inventory (HDI), Visual Analog Scale (VAS), and Numeric Pain Rating Scale (NPRS). Participants performed an exercise regimen designed to address strength and mobility of cervical and scapulothoracic musculature. Results There were significant improvements seen in cervical range of motion and neck pain-related disability (NDI) during the 4-week treatment period. Conclusion Dry needling and neuromuscular re-education (NMR) exercises could be effective components of treatment for individuals suffering from CGH to reduce disability and pain.

Neuromuscular exercises: A new perspective in knee osteoarthritis

Background. Knee osteoarthritis (OA) is the most prevalent arthropathy across the world. It presents with swelling, pain, decreased range of motion (ROM) and instability. Patients also complain of thigh muscle weakness and lower limb weakness resulting in poor joint shielding and joint overload. Owing to these presenting features patients are prone to increased risk of morbidity and are forced to live with functional impairment. Exercises are one of the vital intervention programme used in knee OA. Exercises lead to improvement in physical function, strengthening of the muscles and reduction in pain. Neuromuscular exercises have effects on functional performance, biomechanics and activation pattern of surrounding musculatures of the patient. Therefore, neuromuscular exercises may prove to be beneficial in enhancing the efficacy of exercise training programmes in such patients due to functional instability and disturbed neuromuscular function. Purpose. This article intends to review the effect and role of neuromuscular exercises in the management of knee osteoarthritis. Method. Comprehensive computerized search was performed on Google Scholar, Pubmed and Cochrane. Conclusion. By evaluating various articles on neuromuscular exercises in knee osteoarthritis the present review suggest that neuromuscular exercises are helpful in the treatment of knee osteoarthritis.

Effect of Neuromuscular Stabilization Exercise Program Using Whole Body Vibration on Patients with Low Back Pain

Effect of Neuromuscular Stabilization Exercise Program Using Whole Body Vibration on Patients with Low Back Pain

The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study.

BackgroundHigher neck strength has been postulated to reduce head impact magnitude during purposeful heading in football.ObjectivesThis pilot trial explored the effect of a neck exercise programme on (1) neck strength and (2) head impact magnitude during heading in male and female adolescent football players.MethodsBoys and girls (aged 12–17 years) were randomised by team to the intervention (5 weeks of supervised neuromuscular neck exercises integrated into part 2 of the FIFA 11 + , completed three times per week) or the control group (usual part 2 of the FIFA 11 + , no neck exercises). Outcomes included isometric neck strength and head impact magnitude (peak linear acceleration and peak angular velocity) during standardised heading from a throw-in (at baseline and 6 weeks) plus completion of an evaluation survey by intervention players and coaches.ResultsIn total, 52 players (n = 31 intervention; n = 21 control) completed the study. Mixed-model analysis of variance (ANOVA) revealed significant differences in neck strength variables (p < 0.001), peak linear acceleration (p = 0.04) and peak angular velocity (p = 0.04) between the intervention and control groups over time. Intervention players demonstrated increases in mean composite neck strength (53.8% intervention vs 15.6% control) as well as decreases in mean peak linear head acceleration during heading (− 11.8% vs − 5.0%) from baseline to follow-up. Reduction in peak angular velocity was more pronounced in girls (− 27.7%) than boys (− 11.5%) in the intervention group. The addition of neck exercises into part 2 of the FIFA 11 + was feasible and accepted by players and coaches.ConclusionOn average, players who completed neck exercises demonstrated an increase in isometric neck strength and a decrease in head impact magnitude during heading. These exercises were easily incorporated into usual training.Australian New Zealand Clinical Trials Registry (no: ACTRN12619001375145).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40279-021-01564-0.

Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists

BackgroundPhysical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy. ObjectivesDescribe Australian physical therapists’ awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence. MethodsAn online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework. Results1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23–24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so. ConclusionAustralian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.

Evaluation of the Effectiveness of Dynamic Neuromuscular Stability Exercises on Balance and Walking Function in the Elderly

Objectives: Walking and balance control are determining factors in the independence of the elderly because they are the main components of daily physical activity. This study evaluated the effectiveness of Dynamic Neuromuscular Stability (DNS) training on balance and gait function in the elderly. Methods: This study had a pre-test/post-test design. It was a quasi-experimental study performed on 30 older men aged 60-70 years in Qom Province, Iran, in 2021. The elderly was randomly divided into experimental (n=15) and control (n=15) groups. The Experimental Group (EG) participated in three 45-min sessions of dynamic neuromuscular stability training every week for 6 weeks, and the Control Group (CG) continued their normal daily routine. Berg balance scale (dynamic balance), modified stork stand (static balance), and temporal and spatial gait parameters were used to collect information before and after applying the training protocol. The obtained data were analyzed using ANCOVA statistical method and the paired t test. Results: There were significant differences between pre-test and post-test in EG regarding the variables of dynamic balance, static balance (P=0.001), and gait function, but in the CG, no significant difference was observed for these variables (P&gt;0.05). Also, there was a significant difference between the mean scores obtained in the balance and gait tests between the two groups (P&lt;0.05), and EG performed better in the post-test. Discussion: DNS training due to the great variety of movement in different parts of the body and the effect on improving strength, flexibility, range of motion, and physical fitness can also improve balance and gait function in the elderly. According to the present study results, one of the best ways to reduce the costs and physical, psychological, and social problems caused by aging is to use DNS training for the elderly.

Hip-Focused Neuromuscular Exercise Provides Immediate Benefits in Foot Pronation and Dynamic Balance: A Sham-Controlled Cross-Over Study.

Knowledge on how to utilize a kinetic chain approach in foot and ankle rehabilitation is important. The aim of this study was to investigate the immediate effects of hip-focused neuromuscular exercise on foot pronation and single-leg neuromuscular control. Cross-over study. University laboratory. This cross-over study included 44 asymptomatic volunteers with foot pronation. All participants performed (1)a hip-focused neuromuscular exercise and (2)a sham exercise in randomized order. Foot pronation was assessed by the navicular drop test, and lower-extremity neuromuscular control was assessed by the Modified Star Excursion Balance Test and frontal plane projection angle during single-leg squat before and after the experiments. Navicular drop test scores were significantly lower after the hip-focused neuromuscular exercise than after the sham exercise (mean difference [95% CI] = 2.84 [-1.08 to 6.77], P = .003). Modified Star Excursion Balance Test scores in the anterior (P = .008), posteromedial (P = .04), and posterolateral (P < .001) directions were significantly increased after hip-focused neuromuscular exercise. No statistically significant condition × time interaction was found for the frontal plane projection angle (P > .05). However, a main effect of time (P = .003) indicated that less dynamic knee valgus occurred during single-leg squat after both experiments. Hip-focused neuromuscular exercise produced immediate alterations in foot pronation and dynamic balance. Thus, the hip-focused neuromuscular exercise may be used to control foot posture in foot rehabilitation integrated with a kinetic chain approach and could be an effective prevention and treatment strategy.

Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial.

BackgroundAdolescent females are at much greater risk for ACL injury than their male counterparts when participating in the same sports. Preventative and pre-operative rehabilitation neuromuscular (NM) exercise programs are often recommended to improve knee function and reduce injury rates. The effectiveness of perturbation-based NM training program has been established in an adult population but has yet to be investigated in the at-risk adolescent female population.PurposeTo determine the effectiveness of a perturbation-based NM exercise program in a group of physically active adolescent females.Study DesignProspective randomized trial.MethodsTwenty-four healthy and an exploratory group of 10 ACL-injured females (ages 12-18) were equally randomized into a perturbation-based NM training or control group and evaluated before and after a five-week intervention period. The primary outcome of dynamic balance was measured using the Y-Balance test (YBT); secondary outcome measures included lower limb strength, proprioception, and flexibility.ResultsThe perturbation-based NM training intervention was safely completed by all participants but had no significant effect on YBT scoring, lower limb strength, proprioception or flexibility in either the healthy or ACL-injured groups.ConclusionsPerturbation-based NM training is safe, but may offer little preventative benefit for healthy or pre-operative rehabilitation benefit for ACL-injured adolescent females. Future research should examine whether the effectiveness of perturbation-based NM training is influenced by the length of the training intervention, training intensity, or when it is combined with other forms of prophylactic or pre-surgical rehabilitation frequently used with at-risk adolescent females who regularly participate in sport.Level of EvidenceLevel 3.