SECTION II - EXERCISE PHYSIOLOGY AND SPORTS MEDICINE / RESEARCH PAPER
Effects of Mixed Training on Biomechanical Risk Proxies for ACL Injury in Trained Youth Basketball Athletes
 
More details
Hide details
1
Athletics & Recreation-Center of Excellence in Food, Tourism & Leisure, DEREE—The American College of Greece, Athens, Greece.
 
2
Faculty of Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain.
 
 
Submission date: 2025-12-08
 
 
Final revision date: 2026-01-18
 
 
Acceptance date: 2026-09-07
 
 
Online publication date: 2026-11-12
 
 
Corresponding author
Loudovikos Dimitrios Liosis   

Athletics, DEREE-The American College of Greece, Greece
 
 
 
KEYWORDS
TOPICS
ABSTRACT
Mixed training may serve as a tool to mitigate injury risk by reducing lower-limb asymmetries, enhancing neuromuscular control, and optimizing landing biomechanics. The purpose of this study was to investigate the effects of mixed training on unilateral lower-limb stiffness (LLS) and the landing error scoring system (LESS) as biomechanical risk proxies associated with anterior cruciate ligament (ACL) injuries. Thirty-two trained youth male basketball athletes were randomly assigned to a French contrast, a contrast, or a complex training protocol in a six-week mesocycle with a training frequency of twice per week. All groups performed pre‐ and post‐training intervention measurements of unilateral drop jump stiffness and the bilateral drop jump LESS. Two-way ANOVAs revealed significant interaction effects between the round and the protocol for non-dominant LLS (p = 0.03) and the LESS (p = 0.003). Athletes experienced significant and pronounced improvements in non-dominant LLS and the LESS following complex (LLS: p = 0.0008, d = 1.30; LESS: p = 0.005, d = 1.41) and contrast (LLS: p = 0.017, d = 1.10; LESS: p = 0.007, d = 1.35), but not French contrast training strategies. Linear regression showed significance (p = 0.009), with changes in non-dominant LLS accounting for 21% of the variance in LESS changes. Our findings demonstrate the effectiveness of both complex and contrast training as an indirect ACL injury risk minimization tool via improvements in non-dominant LLS and the LESS. Such improvements may be attributed to post-intervention neuromuscular adaptations, including greater higher-threshold motor unit recruitment, rate coding, and synchronization.
REFERENCES (46)
1.
Abade, E., Silva, N., Ferreira, R., Baptista, J., Gonçalves, B., Osório, S., & Viana, J. (2021). Effects of adding vertical or horizontal force-vector exercises to in-season general strength training on jumping and sprinting performance of youth football players. Journal of Strength and Conditioning Research, 35(10), 2769–2774. https://doi.org/10.1519/JSC.00....
 
2.
Ambegaonkar, J. P., Shultz, S. J., Perrin, D. H., Schmitz, R. J., Ackerman, T. A., & Schulz, M. R. (2011). Lower body stiffness and muscle activity differences between female dancers and basketball players during drop jumps. Sports Health, 3(1), 89–96. https://doi.org/10.1177/194173....
 
3.
Arboix-Alió, J., Buscà, B., Peralta-Geis, M., Montalvo, A., & Fort-Vanmeerhaeghe, A. (2025). The relationship between change-of-direction performance indicators and inter-limb asymmetries in elite youth female basketball players. Journal of Human Kinetics, 96, 235–246. https://doi.org/10.5114/jhk/20....
 
4.
Ball, N. B., Stock, C. G., & Scurr, J. C. (2010). Bilateral contact ground reaction forces and contact times during plyometric drop jumping. Journal of Strength and Conditioning Research, 24(10), 2762–2769. https://doi.org/10.1519/JSC.0b....
 
5.
Beese, M. E., Joy, E., Switzler, C. L., & Hicks-Little, C. A. (2015). Landing Error Scoring System differences between single-sport and multi-sport female high school-aged athletes. Journal of Athletic Training, 50(8), 806–811. https://doi.org/10.4085/1062-6....
 
6.
Blackburn, J. T., Norcross, M. F., Cannon, L. N., & Zinder, S. M. (2013). Hamstrings stiffness and landing biomechanics linked to anterior cruciate ligament loading. Journal of Athletic Training, 48(6), 764–772. https://doi.org/10.4085/1062-6....
 
7.
Brazier, J., Maloney, S., Bishop, C., Read, P. J., & Turner, A. N. (2019). Lower extremity stiffness: Considerations for testing, performance enhancement, and injury risk. Journal of Strength and Conditioning Research, 33(4), 1156–1166. https://doi.org/10.1519/JSC.00....
 
8.
Cao, J., Xun, S., Zhang, R., & Zhang, Z. (2024). Effects of unilateral, bilateral and combined plyometric jump training on asymmetry of muscular strength and power, and change-of-direction in youth male basketball players. Journal of Sports Science & Medicine, 23(4), 754–766. https://doi.org/10.52082/jssm.....
 
9.
Chen, Y., Chou, T., Chang, E., & Huang, Y. (2026). Sagittal plane landing mechanics differences between limbs during single- and double-leg jump landings: Implications for ACL injury risk in females. Journal of Human Kinetics, Advance online publication. https://doi.org/10.5114/jhk/20....
 
10.
Cormier, P., Freitas, T. T., Loturco, I., Turner, A., Virgile, A., Haff, G. G., Blazevich, A. J., Agar-Newman, D., Henneberry, M., Baker, D. G., McGuigan, M., Alcaraz, P. E., & Bishop, C. (2022). Within-session exercise sequencing during programming for complex training: Historical perspectives, terminology, and training considerations. Sports Medicine, 52(10), 2371–2389. https://doi.org/10.1007/s40279....
 
11.
Curovic, I., Grecic, D., Rhodes, D., Alexander, J., & Harper, D. J. (2024). Potential importance of maximal upper body strength-generating qualities and upper body strength training for performance of high-intensity running and jumping actions: A scoping review. Sports, 12(12), 357. https://doi.org/10.3390/sports....
 
12.
Cui, H., Cao, Z., Wang, S., Zhang, H., Chen, Z., Wu, X., Zhao, Y., Qie, S., & Li, W. (2023). Surface electromyography characteristics of patients with anterior cruciate ligament injury in different rehabilitation phases. Frontiers in Physiology, 14, 1116452. https://doi.org/10.3389/fphys.....
 
13.
Faigenbaum, A. D., McFarland, J. E., Herman, R. E., Naclerio, F., Ratamess, N. A., Kang, J., & Myer, G. D. (2012). Reliability of the one-repetition-maximum power clean test in adolescent athletes. Journal of Strength and Conditioning Research, 26(2), 432–437. https://doi.org/10.1519/JSC.0b....
 
14.
Fransz, D. P., Huurnink, A., de Boode, V. A., Kingma, I., & van Dieën, J. H. (2016). Time series of ground reaction forces following a single-leg drop jump landing in elite youth soccer players consist of four distinct phases. Gait & Posture, 50, 137–144. https://doi.org/10.1016/j.gait....
 
15.
Galiano, C., Nuñez, F., Floría, P., & Coll, J. (2025). Power up: Comparing PAPE responses in free-weight vs. flywheel resistance training systems. Applied Sciences, 15, 8426. https://doi.org/10.3390/app151....
 
16.
Hanzlíková, I., Válová, K., Lehnert, M., Dvořáček, M., Doleželová, E., & Grinberg, A. (2025). The relationship between attentional control and injury-related biomechanics in young female volleyball players. Frontiers in Physiology, 16, 1622026. https://doi.org/10.3389/fphys.....
 
17.
Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E. (2016). Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. Journal of Orthopaedic Research, 34(11), 1843–1855. https://doi.org/10.1002/jor.23....
 
18.
Hopkins, W. G., Marshall, S. W., Batterham, A. M., & Hanin, J. (2009). Progressive statistics for studies in sports medicine and exercise science. Medicine & Science in Sports & Exercise, 41(1), 3–13. https://doi.org/10.1249/MSS.0b....
 
19.
Humphrys, B., Aspe, R., Clarke, R., & Hughes, J. (2018). The effects of complex training on neuromuscular development of the lower limbs in youth netball players. Journal of Athletic Enhancement, 7, 309. https://doi.org/10.4172/2324-9....
 
20.
Jamkrajang, P., Suwanmana, S., Boonkerd, C. & Verheul, J. (2026). Rotational vs. straight landings: Exploring task-specific responses to inform ACL-injury risk screening. Journal of Human Kinetics, 100, 63–73. https://doi.org/10.5114/jhk/20....
 
21.
Joseph, A. M., Collins, C. L., Henke, N. M., Yard, E. E., Fields, S. K., & Comstock, R. D. (2013). A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. Journal of Athletic Training, 48(6), 810–817. https://doi.org/10.4085/1062-6....
 
22.
Kaneko, S., Sasaki, S., Hirose, N., Nagano, Y., Fukano, M., & Fukubayashi, T. (2017). Mechanism of anterior cruciate ligament injury in female soccer players. Asian Journal of Sports Medicine, 8(1), e38205. https://doi.org/10.5812/asjsm.....
 
23.
Kuntz, A., Peters, O., Bello, A., Perkins, R., Monti, R., & Murray, L. (2022). An anterior cruciate ligament (ACL) injury risk screening and reduction program for high school female athletes: A pilot study. International Journal of Sports Physical Therapy, 17(7), 1318–1329. https://doi.org/10.26603/001c.....
 
24.
Li, F., Wang, R., Newton, R. U., Sutton, D., Shi, Y., & Ding, H. (2019). Effects of complex training versus heavy resistance training on neuromuscular adaptation, running economy and 5-km performance in well-trained distance runners. PeerJ, 7, e6787. https://doi.org/10.7717/peerj.....
 
25.
Limroongreungrat, W., Mawhinney, C., Kongthongsung, S., & Pitaksathienkul, C. (2022). Landing error scoring system: Data from youth volleyball players. Data in Brief, 41, 107916. https://doi.org/10.1016/j.dib.....
 
26.
Lipps, D. B., Oh, Y. K., Ashton-Miller, J. A., & Wojtys, E. M. (2014). Effect of increased quadriceps tensile stiffness on peak anterior cruciate ligament strain during a simulated pivot landing. Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society, 32(3), 423–430. https://doi.org/10.1002/jor.22....
 
27.
Lu, X., Liu, W., Zhao, G. & Fan, Y. (2026). Effects of three resistance strength training methods on the biomechanics and kinematics of the lower limbs during the first step of sprinters’ start. Journal of Human Kinetics, Advance online publication. https://doi.org/10.5114/jhk/21....
 
28.
Madruga-Parera, M., Romero-Rodríguez, D., Bishop, C., Beltran-Valls, M. R., Latinjak, A. T., Beato, M., & Fort-Vanmeerhaeghe, A. (2019). Effects of maturation on lower limb neuromuscular asymmetries in elite youth tennis players. Sports, 7(5), 106. https://doi.org/10.3390/sports....
 
29.
Nagai, T., Schilaty, N. D., Strauss, J. D., Crowley, E. M., & Hewett, T. E. (2018). Analysis of lower extremity proprioception for anterior cruciate ligament injury prevention: Current opinion. Sports Medicine, 48(6), 1303–1309. https://doi.org/10.1007/s40279....
 
30.
Nessler, T., Denney, L., & Sampley, J. (2017). ACL injury prevention: What does research tell us? Current Reviews in Musculoskeletal Medicine, 10(3), 281–288. https://doi.org/10.1007/s12178....
 
31.
Padua, D. A., Marshall, S. W., Boling, M. C., Thigpen, C. A., Garrett Jr, W. E., & Beutler, A. I. (2009). The landing error scoring system (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: The JUMP-ACL study. The American Journal of Sports Medicine, 37(10), 1996–2002. https://doi.org/10.1177/036354....
 
32.
Padua, D. A., DiStefano, L. J., Beutler, A. I., de la Motte, S. J., DiStefano, M. J., & Marshall, S. W. (2015). The landing error scoring system as a screening tool for an anterior cruciate ligament injury-prevention program in elite-youth soccer athletes. Journal of Athletic Training, 50(6), 589–595. https://doi.org/10.4085/1062-6....
 
33.
Pontillo, M., Hines, S. M., & Sennett, B. J. (2021). Prediction of ACL injuries from vertical jump kinetics in Division I collegiate athletes. International Journal of Sports Physical Therapy, 16(1), 156–161. https://doi.org/10.26603/001c.....
 
34.
Pueo, B., Penichet-Tomás, A., & Jiménez-Olmedo, J. M. (2020). Reliability and validity of the Chronojump open-source jump mat system. Biology of Sport, 37(3), 255–259. https://doi.org/10.5114/biolsp....
 
35.
Scott, D. J., Ditroilo, M., Orange, S. T., & Marshall, P. (2023). The Effect of complex training on physical performance in Rugby League players. International Journal of Sports Physiology and Performance, 18(3), 240–247. https://doi.org/10.1123/ijspp.....
 
36.
Shen, X., Li, H., Yan, K., Zhang, S., & Li, L. (2025). Effects of 8-week complex and resistance training on strength and power in adolescent long jumpers. Scientific Reports, 15(1), 21329. https://doi.org/10.1038/s41598....
 
37.
Struzik, A., Zawadzki, J., Rokita, A., & Pietraszewski, B. (2020). Application of an accelerometric system for determination of stiffness during a hopping task. Applied Bionics and Biomechanics, 3826503. https://doi.org/10.1155/2020/3....
 
38.
Tai, W. H., Peng, H. T., Lin, J. Z., & Li, P. A. (2025). Adaptive neuromuscular co-contraction strategies under varying approach speeds and distances during single-leg jumping: An exploratory study. Life, 15(12), 1859. https://doi.org/10.3390/life15....
 
39.
Toumi, H., Best, T. M., Martin, A., & Poumarat, G. (2004). Muscle plasticity after weight and combined (weight + jump) training. Medicine & Science in Sports & Exercise, 36(9), 1580–1588. https://doi.org/10.1249/01.mss....
 
40.
Trajković, N., Milić, V., Đurković, T., Rešetar, T., & Korobeynikov, G. (2024). Diurnal variations in upper and lower body power in adolescent volleyball players: Exploring time-of-day effects on performance. Sports, 12(12), 320. https://doi.org/10.3390/sports....
 
41.
Warathanagasame, P., Subedi, M., Sinsurin, K., & Suttiwong, J. (2026). Higher risk of non-contact anterior cruciate ligament injury in the non-dominant limb during single-leg lateral jump landing in active individuals. Journal of Human Kinetics, 103, 97–106. https://doi.org/10.5114/jhk/20....
 
42.
Watson, S. L., Gohal, C., Owen, M. M., Bajaj, P. M., Plantz, M. A., & Tjong, V. K. (2026). A systematic review and meta-analysis of anterior cruciate ligament injury prevention programs: Training to stay in the game. The American Journal of Sports Medicine, 54(3), 733–740. https://doi.org/10.1177/036354....
 
43.
Zhang, W., Chen, X., Xu, K., Xie, H., Li, D., Ding, S., & Sun, J. (2023a). Effect of unilateral training and bilateral training on physical performance: A meta-analysis. Frontiers in Physiology, 14, 1128250. https://doi.org/10.3389/fphys.....
 
44.
Zhang, Y., Hu, Z., Li, B., Qiu, X., Li, M., Meng, X., Kim, S., & Kim, Y. (2023b). Gender differences in lower extremity stiffness during a single-leg landing motion in badminton. Bioengineering, 10(6), 631. https://doi.org/10.3390/bioeng....
 
45.
Zhang, W., Chen, X., Xu, K., Xie, H., Chen, J., Zhu, Z., Ji, H., Li, D., & Sun, J. (2024). The potential of a targeted unilateral compound training program to reduce lower limb strength asymmetry and increase performance: a proof-of-concept in basketball. Frontiers in Physiology, 15, 1361719. https://doi.org/10.3389/fphys.....
 
46.
Zhao, J., Łosińska, K., Chen, L., & Aschenbrenner, P. (2026). Neuromuscular adaptation to varying drop jump heights: A muscle synergy approach in elite handball players. Journal of Human Kinetics, 101, 147–164. https://doi.org/10.5114/jhk/21....
 
eISSN:1899-7562
ISSN:1640-5544
Journals System - logo
Scroll to top