Graded Exercise Therapy and Cognitive Behavioral Therapy for Fatigue in Patients With Breast Cancer: Protocol for a Randomized Controlled Pilot Study.

Anterior cruciate ligament (ACL) injuries represent a significant concern in team sports due to high incidence rates and long-term consequences for athletes [, ]. Understanding the underlying injury mechanisms is crucial for developing effective prevention strategies [, ]. A variety of methodological approaches have been employed to investigate these mechanisms, including interviews with injured athletes, biomechanical modeling and simulation, biomechanical laboratory studies imitating injury-related movements, and the analysis of injury occurrences through video recordings []. Research on ACL injury mechanisms in football revealed that ACL injuries mainly occur during horizontal movements like change-of-direction (COD) maneuvers, particularly in defensive pressing situations, often without direct opponent contact [–]. In addition, video analyses across various sports identified key biomechanical ACL risk factors such as an increased knee abduction angle, excessive hip adduction, and lateral trunk flexion [–]. Besides mere biomechanical ACL risk factors, the role of cognition during the injury incidence has received more attention in research over the past years. Non-contact football ACL injuries frequently occur during defensive maneuvers in high-pressure and time-restricted scenarios which require quick cognitive processing, decision making and finally reactive motor responses [–]. Moreover, injuries that occur during pressing actions frequently involve deceiving opponent actions such as feints happening roughly 250 ms before the initial ground contact [, , ]. The increased cognitive demands in these scenarios, which are caused by unpredictable and complex environmental conditions, may contribute to what Gokeler et al. called a ‘neurocognitive error’, resulting in altered neuromuscular control, ultimately increasing the ACL injury risk []. Cognitive factors associated with such injury-incidence situations include impaired decision-making, divided attention, reduced attentional inhibition, and diminished inhibitory control [, ]. For example, when responding to an opponent’s feint, adequate motor-response inhibition is needed to suppress an initial response in favor of an appropriate movement decision. A failure in these inhibitory processes (neurocognitive error) may influence neuromuscular control, potentially leading to impaired and injury-prone movement patterns []. These insights are limited, as they do not provide direct empirical evidence of the biomechanical and neurocognitive mechanisms underlying ACL injuries, leaving important aspects of the injury mechanism open to debate.