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A Thesis Entitled the Effect of Feedback Training on the Landing A Thesis entitled The Effect of Feedback Training on the Landing Error Scoring System by Sara C. Doebel, ATC Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Science Degree in Exercise Science _________________________________________ Dr. Phillip Gribble, Committee Chair _________________________________________ Dr. Brian Pietrosimone, Committee Member _________________________________________ Dr. Kate Pfile, Committee Member _________________________________________ Dr. Patricia R. Komuniecki, Dean College of Graduate Studies The University of Toledo May 2012 Copyright 2012, Sara C. Doebel, ATC This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of The Effect of Feedback Training on the Landing Error Scoring System by Sara C. Doebel, ATC Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Science Degree in Exercise Science The University of Toledo May 2012 Context: Suboptimal lower extremity biomechanics during jump-landing may lead to various lower extremity joint injuries. Verbal feedback has been used previously to positively alter landing biomechanics, yet the use of technology in an effort to allow for the participant to make real-time biomechanical adjustments during landing has not been evaluated. Objective: Determine the immediate effects of real-time feedback (RTF) and traditional feedback (TF) on Landing Error Scoring System (LESS) scores compared to a control condition, that performed jump-landing without any feedback. Design: Single blinded, randomized controlled trial. Setting: Research laboratory. Participants: Twenty- eight physically active female participants with no history of lower extremity injury volunteered and were randomized into 3 groups (RTF: n=9, age=20.0±1.4yrs, height=163.98±5.7cm, mass=65.4±9.5kg; TF: n=10, age=20.5±1.3yrs, height=166.12±6.4cm, mass=62.6±7.2kg; Control: n=9, age=21.0±2.1yrs, height=163.16±6.6cm, weight=64.8±17.8kg). Interventions: All participants completed three sets of six jump-landing trials (18 total) off a 30cm box. Participants in the RTF and TF groups were additionally provided standardized verbal feedback instructions from a single clinician after each set. In addition to verbal feedback, participants in the RTF iii group were equipped with retroreflective markers positioned on the lower extremity. Using Cortex software and 3-dimentional Motion Analysis, markers on the middle of the patella and the dorsum of the great toe of the right limb were highlighted in color, and connected with a segment line. RTF participants were able to visualize their 3- dimensional model on a 107cm monitor, and were instructed to align the highlighted knee-foot segment with a stationary vertical reference line in the frontal plane during landing. Control participants received no feedback while performing the 18 box jumps. Main Outcome Measures: All participants performed the LESS testing protocol at baseline and immediately following the intervention consisting of a forward jump off a 30cm box transitioning into a maximal vertical jump. Trials were recorded in the frontal and sagittal planes using two-dimensional video and evaluated with the LESS scoring criteria by two blinded independent assessors. Delta scores from baseline were calculated for all three groups. Independent t-tests and effect sizes (Cohen’s d) were performed to assess change scores in the LESS for specific comparisons (TF v. control; RTF v. control). Alpha was set at p<0.05 a priori. Results: While not statistically significant, LESS scores decreased following RTF (-1.33±1.5) and TF(-1.10±2.4), while the control group remained unchanged. (0.00±1.2; F2,25=1.39, P=0.27). However , a strong effect size indicated the RTF was more effective than the Control group (d = -0.97; -1.90, 0.05); while a moderate effect size supported the differences between the TF and Control groups (d = -0.56; -1.46, 0.38). Conclusion: RTF decreased LESS score and had a strong effect for immediately improving LESS score compared to the control.TF showed significantly decreased LESS scores compared to the control. Further study is warranted iv to determine the clinical impact of the addition of RTF in making biomechanical corrections during landing. v Acknowledgements I would first like to thank my advisor Dr. Phillip Gribble for providing direction and offering his assistance throughout the entire development of this research project. I also need to thank Hayley Ericksen, my doctoral advisor. Her guidance and involvement in the writing process, data collection and statistical analysis, helped make this process less intimidating and much more fun. Thank you for all of the time and effort you put into to helping me complete this project. I’d like to thank my committee members, Dr. Brian Pietrosimone and Dr. Kate Pfile, for their assistance in the writing process. Another big thank you goes to my fellow data collection partners, Adam Lepley and Allison Strouse. I appreciate the many hours spent collecting LESS footage. Finally, I need to thank my family for encouraging me and supporting me in all my endeavors. Go Rockets! Blast off! vi Table of Contents Abstract ........................................................................................................................... iii-v Acknowledgements ............................................................................................................ vi Table of Contents ........................................................................................................ vii-viii List of Tables ................................................................................................................... ix List of Figures ......................................................................................................................x List of Abbreviations ......................................................................................................... xi 1 Introduction…………. .............................................................................................1 1.1 Background ........................................................................................................1 1.2 Problem Statement .............................................................................................4 1.3 Purpose Statement ..............................................................................................4 1.4 Significance of Study .........................................................................................5 1.5 Hypothesis..........................................................................................................5 1.6 Limitations .........................................................................................................5 2 Literature Review.....................................................................................................7 2.1 ACL Injury .........................................................................................................7 2.2 Poor Jump-Landing Technique ..........................................................................8 2.3 Landing Error Scoring System...........................................................................9 2.4 Proper Jump-Landing Technique .....................................................................12 vii 2.5 Feedback…………. .........................................................................................15 2.6 Summary ........................................................................................................21 3 Methodology…….. ................................................................................................23 3.1 Participants .......................................................................................................23 3.2 Instrumentation ................................................................................................24 3.3 Independent Variables .....................................................................................24 3.4 Dependent Variables ........................................................................................24 3.5 Procedures ........................................................................................................25 3.6 Landing Error Scoring System (LESS) ...........................................................25 3.7 Interventions ....................................................................................................27 3.7.1 Real-Time Feedback Intervention ....................................................27 3.7.2 Traditional Feedback Intervention ...................................................28 3.7.3 Control Group ...................................................................................29 3.7 Statistical Analysis ...........................................................................................29 4 Results………. .......................................................................................................30 5 Discussion………… ..............................................................................................32 5.1 Limitations .......................................................................................................34 5.2 Future Research ...............................................................................................35 5.3 Conclusion .......................................................................................................36
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