The Effect of Verbal Combined Focus of Attention and Video Instruction Training on Knee Valgus and Landing Technique in Semiprofessional Female Athletes

Background: Current anterior cruciate ligament (ACL) injury prevention programs focus on integrating the athlete’s cognitive and motor skills. A few studies examine the effectiveness of different types of attentional instructions on motor learning. Purpose: To investigate the acute and first-week effects of combined focus of attention and video instructions given to female athletes with dynamic knee valgus (DKV) and landing technique. Study Design: Controlled laboratory study. Methods: A total of 30 athletes were randomized to (1) a verbal combined focus–instructed group (VFIG) (n = 10), (2) a video-instructed group (VIG) (n = 10), and (3) a control group (CG) (n = 10). DKV was assessed with frontal plane projection angle (FPPA) during the single-leg squat test, and landing technique was assessed with the Landing Error Scoring System (LESS) during drop vertical jump (DVJ) task. After pre-FPPA and pre-LESS values were recorded, 2 training blocks that contained 10 repetitions of the DVJ task in each were completed with group-specific instructions, and posttest measurements were taken immediately afterward and a week after as a retention test. Parametric tests were utilized due to the normal distribution of numerical descriptive features. Independent-sample t tests compared numerical features between groups, chi-square tests assessed categorical features, and mixed-order analysis of variance evaluated variables based on retention times, with Bonferroni correction applied and a significance threshold set at P <.05. Results: Statistical improvement occurred in both VFIG and VIG intragroup FPPA assessment at posttest and retention test (respectively, P <.001; P <.001; P <.01). In the intergroup evaluation, FPPA showed superior improvement in VFIG at the posttest and retention test (P =.001; P <.01). In the intragroup evaluation, there was a statistical improvement in LESS values in both VFIG and VIG, at the posttest and retention test (respectively, P =.04; P <.001; P <.05), and VIG had superior improvement in the intragroup evaluation compared with VFIG. There was no statistically significant difference between LESS values in the intergroup evaluation (for all, P >.05). There was no significant difference in the CG tests (for all, P >.05). Conclusion: Our study demonstrated that while both types of instructions were effective in improving knee valgus and landing technique, verbal combined focus instructions were superior in improving valgus. Future long-term studies will help in the understanding of the prevention of ACL injuries in female athletes. Clinical Relevance: Considering that female athletes have a higher risk of ACL injury due to higher DKV values than men, the authors believe that combined verbal and video instructions are important in reducing the knee valgus value and improving the landing technique, thus possibly reducing the injury rate. Registration: NCT06424886 (ClinicalTrials.gov identifier).