Trunk Neuromuscular Function and Anterior Cruciate Ligament Injuries: A Narrative Review of Trunk Strength, Endurance, and Dynamic Control

ABSTRACT Trunk strength, endurance, and dynamic control may have an effect on anterior cruciate ligament (ACL) injury rates and biomechanical ACL loading variables during athletic tasks. Individuals responsible for training athletes at risk of ACL injuries should implement training programs that address these components of athletic performance. In ski racers, deficits in trunk flexion/extension strength and decreased trunk flexion/extension strength ratios have been identified as ACL injury risk factors. Trunk strength training alone is not sufficient to decrease biomechanical ACL loading, and there is no clear association between trunk endurance and ACL injury risks. Trunk dynamic control training may improve trunk and knee movements associated with decreased ACL loading during athletic tasks. Dynamic, unanticipated, and perturbed trunk functional assessments and training are recommended to challenge the trunk more during athletic tasks. Injury prevention programs should involve exercises using unstable surfaces, sports-related dual tasks, and perturbations to address trunk dynamic control. More investigation is still needed to further understand the associations between trunk neuromuscular functions and ACL injury risks during athletic tasks.