How does it work and how can it be used?

A common approach in athletic training for injury prevention, specifically for lower extremities, is neuromuscular training. This methodology of training aims at training a muscle response to signal dynamic joint stability (1). Neuromuscular control is the capability to produce a controlled movement through systematic muscle activity, which allows a joint to remain stable through the duration of a physical activity (1). Neuromuscular training is focused on the quality of movement, functional performance, and muscle activation and for these reasons can be particularly effective in rehabilitation programs (1), specifically, ACL reconstruction (2). This training methods can be employed via balance exercises, dynamic joint stability exercises, plyometric exercises, agility drills, and sport-specific exercises (2).

Researchers followed a female athlete on her recovery from an ACL tear through the use of proprioception, a type of reactive neuromuscular training. The athlete had a dramatic reduction in muscular imbalance, was able to return to post season competition, and later underwent reconstructive surgery (4). Similarly, neuromuscular training can be used in ACL injury prevention, especially in female athletes, as they are more susceptible to injury due to hormones and anatomical structure (3). Another study echoes that neuromuscular training through plyometric and strengthening exercises are an effective method of injury prevention for female soccer players (3).

Neuromuscular training does have its shortcomings, most importantly, neuromuscular training alone is not sufficient for preventing injuries, therefore it has to be paired with other training or methodologies. Additionally, the most pressing issue is retention and translation from training to game time play. The lack of translation could be due to the artificial conditions of research (6). Playing in a sports game is not the same as preplanned behavior, which is always done in drill setting or artificial research settings, in sports play, the behavior is different and not calculated.

A consequence of all research results, and neuromuscular training is the use of preplanned activities, artificial or drill conditions. In competition, players think on their feet to stay one step ahead of their opponents, thus increasing the risk for injury (8). In a drill setting, athletes take their time to best execute their movements, however, during a game, athletes are constantly adapting to the unanticipated movements of other players (7). The risk for injury is highest in a competitive setting (9) and this shows a flaw in relying on the results of research based preplanned movements.

One potential way to improve the retention rates and increase the translation of training into game play could be the use of biofeedback. Neuromuscular training with the augment of biofeedback can assist athletes in better understanding movement mechanisms (5) and allow newly trained movements to become like second nature in order to most effectively reduce the occurrence of ACL injuries. In addition, with a real-sports device that measures biomechanics without additional infrastructure, the riskier biomechanics are identified and targeted in order to effectively provide feedback for athletes on movement strategies that realistically navigate risk.

How do you think NMT can be improved, or what are your thoughts on the use of preplanned drills in a lab versus real sports?


  1. Contributors, P. (2020). Neuromuscular Exercise Program. Retrieved July 10, 2020, from
  2. Risber, M. (2001). Design and Implementation of a ~eu~omuscular Taining Program Following Anterior Cruciate Ligament ~econstruction. Retrieved 2020, from
  3. Yoo, J.H., Lim, B.O., Ha, M. et al. A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc 18, 824–830 (2010).
  4. Cook, G., Burton, L., & Fields, K. (1999). Reactive neuromuscular training for the anterior cruciate ligament-deficient knee: a case report. Journal of athletic training34(2), 194–201.
  5. Kiefer, A. W., Kushner, A. M., Groene, J., Williams, C., Riley, M. A., & Myer, G. D. (2015). A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes. Journal of sports science & medicine14(1), 1–8.
  6. Nessler, T., Denney, L., & Sampley, J. (2017). ACL Injury Prevention: What Does Research Tell Us?. Current reviews in musculoskeletal medicine10(3), 281–288.
  7. Brown SR, Brughelli M, Hume PA. Knee mechanics during planned and unplanned sidestepping: a systematic review and meta-analysis. Sports Med. 2014;44(11):1573-1588. doi:10.1007/s40279-014-0225-3
  8. Hootman, J. M., Dick, R., & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of athletic training42(2), 311–319.
  9. Dragoo JL, Braun HJ, Durham JL, Chen MR, Harris AH. Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med. 2012;40(5):990-995. doi:10.1177/0363546512442336
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