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Impact of a Prevent Injury and Enhance Performance (PEP) Training Program on Dynamic Balance and Center of Pressure in Soccer Players With and Without Anterior Cruciate Ligament Reconstruction

Document Type : Original Articles

Authors

1 Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.

2 Department of Sport Biomechanics, Hamedan Branch, Islamic Azad University, Hamedan, Iran.

10.30476/jrsr.2025.106089.1559

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common in soccer and can substantially impair postural stability and athletic performance. The Prevent Injury and Enhance Performance (PEP) program has been developed to reduce the risk of ACL injury. This study aimed to examine the effects of an 8-week PEP training program on time to stability (TTS) and center of pressure (COP) parameters in soccer players with and without ACL reconstruction (ACLR).
Methods: This semi-experimental study employed a pre-test–post-test design. Twenty-one male soccer players (mean age: 25.43 years) at an average of 15.12 months post-ACLR and 21 healthy male soccer players (mean age: 22.79 years) participated. Participants performed a jump-landing task, and COP variables and TTS were measured before and after the 8-week PEP training program. Within-group comparisons were conducted using paired t-tests, while between-group differences were analyzed using one-way ANOVA. Statistical significance was set at p ≤ 0.05.
Results: Within-group analyses demonstrated significant reductions in mediolateral (M-L) COP fluctuations (p = 0.018) and M-L TTS (p = 0.001) in the healthy group. In the ACLR group, significant improvements were observed in M-L COP fluctuations (p = 0.001), M-L COP variability (p = 0.034), total TTS (p = 0.015), and M-L TTS (p = 0.001) following the intervention. Pre-test between-group comparisons revealed significantly greater M-L COP fluctuations (p = 0.001), M-L COP variability (p = 0.044), and total TTS (p = 0.021) in the ACLR group. However, no significant between-group differences were observed post-intervention (p > 0.05), suggesting that the PEP program effectively reduced postural control deficits in the ACLR group to levels comparable with healthy players.
Conclusion: The 8-week PEP training program produced significant improvements in postural control in both healthy and ACLR soccer players. These findings support the potential effectiveness of structured neuromuscular training programs in reducing postural instability and possibly lowering the risk of ACL injury or re-injury.

Keywords

References
  1. Kazman JB, Galecki JM, Lisman P, Deuster PA, O'Connor FG. Factor structure of the functional movement screen in marine officer candidates. The Journal of Strength & Conditioning Research. 2014;28(3):672–8.
  2. Forsythe B, Knapik DM, Crawford MD, Diaz CC, Hardin D, Gallucci J, et al. Incidence of injury for professional soccer players in the United States: A 6-year prospective study of Major League Soccer. Orthopaedic journal of sports medicine. 2022;10(3):23259671211055136.
  3. Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Medicine and science in sports and exercise. 2002;34(5):838–44.
  4. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee surgery, sports traumatology, arthroscopy. 2009;17:705–29.
  5. Tagliero AJ, Miller MD. Anterior Cruciate Ligament Tears in Soccer Players. Sports Medicine and Arthroscopy Review. 2024;32(3):138–45.
  6. Farinelli L, Abermann E, Meena A, Ueblacker P, Hahne J, Fink C. Return to play and pattern of injury after ACL rupture in a consecutive series of elite UEFA soccer players. Orthopaedic Journal of Sports Medicine. 2023;11(3):23259671231153629.
  7. Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, et al. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. The American journal of sports medicine. 2012;40(11):2517–22.
  8. Chaput M, Onate JA, Simon JE, Criss CR, Jamison S, McNally M, et al. Visual cognition associated with knee proprioception, time to stability, and sensory integration neural activity after ACL reconstruction. Journal of Orthopaedic Research®. 2022;40(1):95–104.
  9. Calisti M, Mohr M, Federolf P. Bilateral Deficits in Dynamic Postural Stability in Females Persist Years after Unilateral ACL Injury and Are Modulated by the Match between Injury Side and Leg Dominance. Brain Sciences. 2023;13(12):1721.
  10. Culvenor AG, Alexander BC, Clark RA, Collins NJ, Ageberg E, Morris HG, et al. Dynamic single-leg postural control is impaired bilaterally following anterior cruciate ligament reconstruction: implications for reinjury risk. journal of orthopaedic & sports physical therapy. 2016;46(5):357–64.
  11. Rodriguez C, Echegoyen S, Aoyama T. The effects of “Prevent Injury and Enhance Performance Program” in a female soccer team. J Sports Med Phys Fitness. 2018;58(5):659–63.
  12. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. The American journal of sports medicine. 2005;33(7):1003–10.
  13. Lim B-O, Lee YS, Kim JG, An KO, Yoo J, Kwon YH. Effects of sports injury prevention training on the biomechanical risk factors of anterior cruciate ligament injury in high school female basketball players. The American journal of sports medicine. 2009;37(9):1728–34.
  14. Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. The American journal of sports medicine. 2008;36(8):1476–83.
  15. Maeda N, Urabe Y, Tsutsumi S, Fujishita H, Numano S, Takeuchi T, et al. Symmetry tensiomyographic neuromuscular response after chronic anterior cruciate ligament (ACL) reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2018;26:411–7.
  16. Butler R, Russell M, Queen R. Effect of soccer footwear on landing mechanics. Scandinavian journal of medicine & science in sports. 2014;24(1):129–35.
  17. Durall CJ, Kernozek TW, Kersten M, Nitz M, Setz J, Beck S. Associations between single-leg postural control and drop-landing mechanics in healthy women. Journal of sport rehabilitation. 2011;20(4):406–18.
  18. Ogasawara I, Revankar GS, Konda S, Matsuo T, Aoyama C, Nakata K. Individual variation in adaptive ability of the anticipated postural stability during a dual-task single-leg landing in female athletes. Orthopaedic Journal of Sports Medicine. 2023;11(7):23259671231177312.
  19. Khuu A. Not all single leg squats are equal: a biomechanical comparison of three non-stance leg positions: Boston University; 2017.
  20. Lin D, Seol H, Nussbaum MA, Madigan ML. Reliability of COP-based postural sway measures and age-related differences. Gait & posture. 2008;28(2):337–42.
  21. Fransz DP, Huurnink A, de Boode VA, Kingma I, van Dieën JH. Time to stabilization in single leg drop jump landings: an examination of calculation methods and assessment of differences in sample rate, filter settings and trial length on outcome values. Gait & posture. 2015;41(1):63–9.
  22. Liu K, Heise GD. The effect of jump-landing directions on dynamic stability. Journal of applied biomechanics. 2013;29(5):634–8.
  23. Babu Kaiyaperumal A, Babu S, Paulraj M, Sudhan P. Prevention Enhance Program (Pep) with proprioceptive training on the recurrence of ACL injury for post-ACL reconstruction among football players. Neuroquantology. 2022;20(19):143.
  24. Lysholm M, Ledin T, Ödkvist L, Good L. Postural control—a comparison between patients with chronic anterior cruciate ligament insufficiency and healthy individuals. Scandinavian journal of medicine & science in sports. 1998;8(6):432–8.
  25. Sugimoto D, Howell DR, Micheli LJ, Meehan III WP. Single-leg postural stability deficits following anterior cruciate ligament reconstruction in pediatric and adolescent athletes. Journal of Pediatric Orthopaedics B. 2016;25(4):338–42.
  26. Edis Ç, Vural F, Vurgun H. The importance of postural control in relation to technical abilities in small-sided soccer games. Journal of human kinetics. 2016;53:51.
  27. Shiravi Z, Shadmehr A, Moghadam ST, Moghadam BA. Comparison of dynamic postural stability scores between athletes with and without chronic ankle instability during lateral jump landing. Muscles, ligaments and tendons journal. 2017;7(1):119.
  28. Hart HF, Culvenor AG, Collins NJ, Ackland DC, Cowan SM, Machotka Z, et al. Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. British journal of sports medicine. 2016;50(10):597–612.
  29. Chouliaras V, Ristanis S, Moraiti C, Stergiou N, Georgoulis AD. Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts: an in vivo study comparing tibial internal-external rotation. The American journal of sports medicine. 2007;35(2):189–96.
  30. Nagelli CV, Wordeman SC, Di Stasi S, Hoffman J, Marulli T, Hewett TE. Neuromuscular training improves biomechanical deficits at the knee in anterior cruciate ligament–reconstructed athletes. Clinical Journal of Sport Medicine. 2021;31(2):113–9.
  31. Jouira G, Borji R, Waer FB, Srihi S, Rebai H, Sahli S. Impact of neuromuscular training including balance, strength and plyometric exercises on static and dynamic balance in high‐level male runners with mild intellectual disability. Journal of Applied Research in Intellectual Disabilities. 2024;37(3):e13211.
  32. Kowalczyk M, Tomaszewski P, Bartoszek N, Popieluch M. Three-week intensive neuromuscular training improves postural control in professional male soccer players. Polish Journal of Sport and Tourism. 2019;26(2):14–20.
  33. Bieć E, Kuczyński M. Postural control in 13-year-old soccer players. European journal of applied physiology. 2010;110:703–8.
  34. Lee K-J, Seon S-Y, An K-O. Arrangement order effects of neuromuscular training on the physical fitness of youth soccer players. Applied Sciences. 2024;14(11):4748.
  35. Borghuis AJ, Lemmink K, Hof AL, Visscher C. The effect of a soccer-specific neuromuscular training program on stability, agility and injury in elite youth soccer. Core Stab Soccer it's a Matter Control. 2013:83–100.
  36. McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Medicine & science in sports & exercise. 2008;40(10):1810–9.
  37. Verhagen E, Bobbert M, Inklaar M, van Kalken M, van der Beek A, Bouter L, et al. The effect of a balance training programme on centre of pressure excursion in one-leg stance. Clinical Biomechanics. 2005;20(10):1094–100.
  38. Kazemi AS, Daneshmandi H, Sedaghati P, Hoseini Y. Comparison of the Effect of Sportsmetrics Soccer Training on Movement Performance in Soccer Players with and without Anterior Cruciate Ligament Reconstruction. Muscles, Ligaments & Tendons Journal (MLTJ). 2024;14(2).
  39. Paterno MV, Myer GD, Ford KR, Hewett TE. Neuromuscular training improves single-limb stability in young female athletes. Journal of orthopaedic & sports physical therapy. 2004;34(6):305–16.
  40. Myer GD, Ford KR, Brent JL, Hewett TE. The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes. The Journal of Strength & Conditioning Research. 2006;20(2):345–53.
  41. Mikkola J, Rusko H, Izquierdo M, Gorostiaga E, Häkkinen K. Neuromuscular and cardiovascular adaptations during concurrent strength and endurance training in untrained men. International journal of sports medicine. 2012;33(09):702–10.
  42. Kamath-Rayne B, Josyula S, Rule A, Vasquez J. Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training. Journal of Perinatology. 2017;37(10):1153–60.
  43. Lee S-J, Kim J-Y, Sim Y-J. Effects of accelerated rehabilitation exercise on quadriceps femoris and postural stability after anterior versus posterior cruciate ligament reconstruction. Journal of exercise rehabilitation. 2023;19(5):293.
  44. Choi H, Shin Y. Changes of muscular strength and balance ability after rehabilitation programme related with graft choice in ACL rehabilitation. Korean J Phys Educ Sci. 2012;51(51):429–40.
  45. Tanpowpong T, Jaiharn O. Does a six-weeks of Hip-focused exercises has the effects on Time to Stabilization after Anterior Cruciate Ligament Reconstruction? 2020.
  46. Arumugam A, Björklund M, Mikko S, Häger CK. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ open. 2021;11(5):e049226.

 

 

Journal of Rehabilitation Sciences & Research
Volume 13, Issue 2
June 2026
Pages 145-152
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