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The effectiveness of the STOP-X coaching program on the knee valgus angle and steadiness in feminine basketball gamers with dynamic knee valgus: a randomized managed trial | BMC Sports activities Science, Drugs and Rehabilitation

Examine design

The current examine was a quasi-experimental design as a result of presence of the management group and in addition an intervention within the experimental group.


The inhabitants included 30 feminine basketball gamers (n = 30, age = 15.50 ± 1.52 years, peak = 1.62 ± 0.06 cm, weight = 55.15 ± 9.65 kg, BMI = 20.69 ± 2.80 kg/m2, leg size = 85.46 ± 3.69 cm, sports activities historical past = 3.73 ± 1.56 years) with DKV defects. The pattern measurement was decided to be 30 by purposive sampling utilizing G*Energy software program with a desired energy of 0.50, an alpha of 0.05, and an impact measurement of 0.75. This impact measurement was akin to earlier analysis reporting adjustments in touchdown mechanics after neuromuscular coaching with twin cognitive duties [20].


Randomization was carried out by an impartial investigator unfamiliar with the testing protocol utilizing a random allocation rule. The letters A and B had been recognized as markers for random teams task and had been positioned in sealed opaque envelopes in a field. One other researcher opened envelopes and proceeded with coaching in accordance with the group task. These letters had been numbered randomly chosen and positioned one after the opposite. Thus, the themes had been divided into two teams A (experimental = 15) and B (management = 15). Group allocation was hid utilizing an opaque envelope till after athletes had been enrolled within the examine to attenuate potential bias.

Moreover, the current examine was a single-blind examine wherein solely the researchers knew which intervention the individuals had been receiving and the themes didn’t know which examine group they had been in till the examine was over. The pre-test lasted for 1 week. To stop damage, the themes had been requested to carry out an preliminary warm-up earlier than doing the pre-test. After the pre-test, the experimental group underwent STOP-X coaching, along with their normal coaching. In that point, the themes of the management group carried out their normal workouts. After 8 weeks, the post-test was carried out, which lasted for 1 week. Afterwards, the collected knowledge had been analyzed.

Eligibility standards.

The inclusion standards consisted of 14- to 19-year-old females with a knee valgus angle higher than 12° throughout single-leg touchdown (SLL) [21, 22], a minimal of three years of coaching expertise, an everyday coaching routine (at the least three coaching periods per week), no historical past of decrease extremity accidents up to now six months resulting in practical or structural limitations or decrease extremity surgical procedure resulting in adjustments in regular alignment, and the absence of spine-related and higher extremity musculoskeletal problems. In any other case, the exclusion standards consisted of noncooperative topics within the pretest or posttest, failure to finish the coaching program for any cause, absence of greater than three train periods or two consecutive periods [23], ache or damage throughout train, and unwillingness to proceed cooperation. This analysis was carried out underneath managed and equivalent situations for topics in a protected setting on the Qazvin Basketball Membership. As soon as chosen, the individuals signed an knowledgeable written consent kind, together with explanations concerning the steps, goals, and analysis participation situations. Moral issues had been adopted on this analysis, and the code of ethics (ID IR.GUILAN.REC.1402.015) was obtained from the Ethics Committee in Biomedical Analysis (ETHICS), Guilan College. This examine adhered to CONSORT pointers for randomized managed trials and had been registered within the Iranian Registry of Scientific Trials (ID: IRCT20231230060574N1, on 04/01/2024). topics’ allocation and dropouts had been remarked on the examine flowchart (Fig. 1).

Fig. 1
figure 1

Consequence measurement

Single-leg touchdown check.

This examine screened and decided the DKV utilizing the SLL check, which demonstrated a reliability of 0.87 [24]. To carry out this check, the themes dropped straight down off a 30-cm-high field onto a mark 30 cm from the field, made landfall on the dominant leg and held the place. The individuals then stood in a balanced place (stance) close to the sting of the field in order that the dominant leg was suspended (heel involved with the sting of the field). A digital video digicam (with exterior reminiscence) was positioned on a tripod on the peak of the topic’s knee at a distance of 230 cm from the field within the frontal view. Three profitable trials had been recorded for every topic. The imply angles of the three trials above had been used within the ultimate evaluation. The knee valgus angle of the dominant leg was then measured utilizing the Kinovea software program bundle (reliability = 0.98) [25]. A frame-by-frame evaluation of the video pictures demonstrated that the whole touchdown picture is the body the place the topic is on the lowest peak (i.e., most knee flexion). The angle subtended between the strains shaped between the markers on the ASIS and center of the tibiofemoral joint and that shaped from the markers on the center of the tibiofemoral joint to the center of the ankle mortise was recorded because the valgus angle of the knees [21, 26]. The recognized markers had been positioned in three areas: the ASIS of the touchdown leg, the middle of the patella, and the middle of the ankle mortise. The conventional knee valgus angle was within the vary of 5–12° for females throughout the SLL check [21, 22]. Females with knee valgus angles higher than 12° throughout SLL had been included on this examine as these with DKV. Harrington et al. instructed that 2D video kinematics have an affordable affiliation with what’s being measured with 3D movement seize [24].

Static steadiness check.

Static steadiness was evaluated utilizing the Bass–Stick check, which information how lengthy an individual can stand for 60 s on a 2.5-cm wood block with out touching the bottom. This check was carried out 3 times on the dominant leg, and the perfect end result was thought-about the static steadiness check rating [27]. Check-retest reliability was reported to be 0.91 [28].

Dynamic steadiness check.

To carry out the dynamic steadiness check, the true leg size (from the ASIS to the distal portion of the medial malleolus) was measured to normalize the info and examine the themes. Moreover, the dominant leg was evaluated utilizing the ball-kicking check. This analysis employed the Y-balance check (YBT) to judge dynamic steadiness. Y-Steadiness Check Package was additionally used to judge this check. Earlier than the check, every topic carried out the check 3 times as a follow to attenuate the training impact. After that, the topic rested and carried out the check 3 times with dominant leg. The individuals had been requested to face within the heart of their instructions, place themselves on the dominant leg, attain the opposite leg, return to the traditional place on each legs, and keep their place for 10–15 s earlier than the subsequent trial. All trials in a single route needed to be accomplished sequentially clockwise or counterclockwise earlier than continuing within the subsequent route. The topics had been requested to the touch the farthest potential level in any given route with their toe. The attain distance was outlined as the gap from the contact level to the middle in centimeters. The distinction between the typical steadiness scores (YBT) in every route was measured individually utilizing Eq. (1). The validity of the YBT was reported to be 0.85–0.93 [29]. Additionally, there was reasonable to top quality proof demonstrating that the YBT is a dependable dynamic neuromuscular management check with Intra-rater reliability ranged from 0.85 to 0.91 [30]. The normalized common of three repetitions was recorded because the rating. The hassle was repeated within the occasion of the next conditions: palms being separated from the hip, utilizing the reaching leg to bear weight, transferring the supporting leg and shedding steadiness. To calculate the overall rating of the dynamic steadiness check, the measurements of all three instructions had been added collectively and divided by 3 times the size of the dominant leg.

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Knee damage prevention coaching program (STOP-X program)

Primarily based on the outcomes of medical analysis, STOP-X has been developed as a prevention idea that may cut back the danger of significant knee joint accidents, which incorporates applications that may be built-in into regular coaching. The prevention technique consisted of a number of parts, together with educating damage mechanisms, correcting harmful motion patterns, steadiness workouts, neuromuscular coaching for muscular coordination, and hip stabilization workouts [31]. The STOP-X program consisted of working, steadiness coaching, a jump-landing sample, and power coaching for 25–40 min for eight weeks (3 times per week). Though this system can be utilized integrally for warm-up, athletes with DKV can run it to appropriate their defects and cut back the incidence of knee accidents by as much as 27% and ACL accidents by as much as 51% [11]. This system began with easy workouts, and the problem degree of particular person workouts elevated over time. The STOP-X program includes quite a lot of confirmed damage restoration applications, together with the Henning program, the Vermont Alpine Knee damage program, the FIFA 11 + program, the Monica Santa Damage program, the Oslo Handball damage program, and the aerial program from German handball damage [31, 32]. The aforementioned coaching program is introduced in Desk 1. After the variables had been decided throughout the pretest, the themes within the experimental group carried out the STOP-X program for eight weeks as warm-ups firstly of the basketball workouts. In distinction, the management group merely carried out routine warm-up, together with working, stretching, warm-up with a ball firstly of the basketball workouts with the identical time schedule. One other level is that the routine warm-up program within the management group lacked power, steadiness, stability and efficiency workouts to have the power to affect the touchdown mechanics of the athletes, whereas the STOP-X coaching embrace these things.

Desk 1 The STOP-X coaching program

Statistical evaluation

To evaluate the normality of knowledge distribution and homogeneity of variances, Shapiro-Wilk and Levene’s assessments had been used, respectively. Descriptive statistics had been calculated for all variables, and imply, and customary deviation (SD) had been reported. Unbiased samples t-test was utilized to check the demographic traits of the 2 teams. Then, in accordance with the analysis design, Two-factor ANOVA check 2 (group: experimental, management) × 2 (time: pre-test, post-test) with a gaggle x situation interplay was used to investigate the inside and between group analysis over the eight-week STOP-X coaching. If a major interplay impact was discovered between elements, publish hoc analyses (paired t-test) with Bonferroni adjustment for pairwise comparisons had been utilized. Inside-group issue (pre-test to post-test) as the principle impact of time and between-group as the principle impact of the group had been thought-about. Share adjustments from the pre-test to the post-test had been calculated. Impact sizes (ES) utilizing partial eta squared had been calculated to extend the evaluation energy. Impact sizes had been labeled as small (0.01), reasonable (0.06), and enormous (0.14) [33]. A modified intention to deal with evaluation primarily based on the whole case methodology was used. On this methodology, since one individual was randomly faraway from every management and experimental group, they had been excluded from the examine. The evaluation was carried out solely on those that accomplished the pre-test and post-test. Findings had been analyzed at a significance degree of 95%, with a statistical significance of (p < 0.05), and carried out utilizing IBM SPSS software program (SPSS, model 26, Chicago; IL).

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