Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Carl G. Mattacola

Second Advisor

Dr. Timothy E. Hewett


The anterior cruciate ligament (ACL) originates from posterior part of the medial side of the lateral condyle of femur to anterior intercondylar notch between a transverse meniscal ligament and medial side of medial meniscus of tibia. Once ACL is disrupted, pain, effusion and atrophy are commonly observable and cause functional disability. Because of the functional limitations, athletic participation is severely restricted. ACL injury is more prevalent in physically active females compared to their male counterparts in the sports of basketball and soccer in high school and collegiate levels.

Several attributes of females are considered risk factors for the higher ACL injury incidences and include: anatomy, physiology and neuromuscular/biomechanics. Among them, neuromuscular/biomechanics is the only modifiable risk factor. Performing neuromuscular training may change muscular strength profiles, which may lead to reduction in ACL injury incidence in female athletes. However, this principle was not fully examined. Also, neuromuscular compliance may play a role in muscular strength development and ACL injury incidences.

Thus, the purpose of this dissertation was to investigate the effects of neuromuscular training compliance on muscular strength development and ACL injury incidence. The influence of hip abductor, hamstrings and quadriceps strength was examined in this project.

The results of these studies indicate neuromuscular training is an effective intervention to reduce ACL injury incidence in female athletes, and there is an inverse dose-response relationship between compliance of the neuromuscular training and number of ACL incidences in female athletes. The effect of compliance on muscular strength development was inconsistent. The results of these studies support that compliance of neuromuscular training is a key to reduce ACL injury incidences; however, more studies are need to conclude neuromuscular training compliance effects on muscular strength development in female athletes.