After studying the sidestep cutting technique of Norway’s best female handball players, researchers at the Oslo Sports Trauma Research Center identified the safest sidestep cutting technique: land on your toes, use a knee-over-toe position, and perform narrow cuts!
In a new study published in the BJSM, researchers from the Oslo Sports Trauma Research Center studied the sidestep cutting technique of 123 of Norway’s best female handball athletes. They wanted to identify the technique that resulted in the lowest knee abduction moment.
High knee abduction moments, or valgus moments, may increase the risk of ACL injuries, and training of techniques that reduce knee abduction moments is likely beneficial for ACL injury risk. A high proportion of ACL injuries occurs in sidestep cutting, and optimizing sidestep cutting technique is one of the aims of injury prevention programs.
The elite handball players performed sidestep cuts in a biomechanics lab that enabled accurate descriptions of joint movements and loading. The researchers described technique with twelve factors, including knee valgus, hip abduction, toe landing, approach speed, cutting angle and cut width.
Sidestep cutting technique explained 62 percent of the variance in knee abduction moments. Sidestep cuts performed with high knee valgus, heel landing and wide stance had increased knee abduction moments.
This high-loading technique is similar to descriptions of the injury mechanism. In video analysis of sidestep cutting injury situations, analysts have found that the injury commonly occurs with a valgus collapse in wide cuts with a heel landing.
The injury mechanism has recently been described using the highly accurate model-based image-matching technique, and knee valgus and internal rotation are important parts of the mechanism.
Injury prevention programs aim for a sidestep cutting technique that help the athlete avoid situations similar to the injury situation. They focus on toe landings, a knee-over-toe position, and narrow cuts. This study confirms that the technique is related to lower knee abduction moments. Performing such training together with strength training and balance can more than halve your risk of ACL injury!
In a previous blog post, Professor Roald Bahr told how a sustained 50 percent reduction in injury risk was achieved over a ten-year period in Norwegian handball.
To learn more about the principles of injury prevention turn to Chapter 9 in Clinical Sports Medicine. The chapter includes a systemic overview, as well as key information on the warm up, principles and types of stretching, taping, and equipment, among other topics. Videos of ACL injury prevention exercises can be found at the Skadefri webpage of the Oslo Sports Trauma Research center.
Eirik Kristianslund MD is a PhD student at the Oslo Sports Trauma Research Center at the Norwegian School of Sports Sciences.
Selected OSTRC injury mechanism papers:
First OSTRC ACL prevention study:
OSTRC ten year follow-up of prevention:
OSTRC prevention RCT:
RCT with prevention of ACL injuries as primary outcome: