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Am J Sports Med. 2019 May;47(6):1488-1495. doi: 10.1177/0363546519834544. Epub 2019 Apr 15.

Visual-Spatial Memory Deficits Are Related to Increased Knee Valgus Angle During a Sport-Specific Sidestep Cut.

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Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana, USA.
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, Ohio, USA.
School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA.
Department of Psychology, Montana State University, Bozeman, Montana, USA.
School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.
Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA.



Identifying athletes at an increased risk of injury is a promising approach to improve the effect of injury prevention interventions; however, it requires first identifying the potential athlete-specific risk factors. Cognitive ability was recently shown to correlate with noncontact anterior cruciate ligament injury rates and lower extremity mechanics, marking an underexplored area. A better understanding of how individuals' cognitive ability is associated with neuromuscular control during sport-specific tasks may improve injury prevention.


Athletes with lower cognitive performance on a standardized cognitive assessment would demonstrate greater increases in knee valgus angle and moment when performing a sidestep cut with soccer ball dribbling versus without. Visual-spatial memory was expected to demonstrate stronger relationships than reaction time or processing speed.


Descriptive laboratory study.


Fifteen male collegiate club soccer players participated (mean ± SD: 20.7 ± 2.0 years, 1.78 ± 0.07 m, 76.5 ± 8.9 kg). Participants performed anticipated 45° run-to-cut trials with and without a dual task of dribbling a soccer ball. Peak early-stance knee valgus angle and moment for the plant limb were calculated. Participants also completed a cognitive assessment to evaluate visual memory, verbal memory, reaction time, and processing speed. These composite scores were entered as candidate predictors for a stepwise regression analysis on the dual-task change scores in lower extremity biomechanical parameters (ie, ball handling - non-ball handling).


Visual memory composite score (a measure of visual-spatial memory) was the only cognitive outcome significantly associated with the change in biomechanical parameters. Each unit decrease in the visual memory composite score was associated with an increase of 0.21°± 0.05° in peak knee valgus angle during the ball-handling task as compared with the non-ball handling task ( R2 = 52%, P = .003).


Visual-spatial memory was associated with neuromuscular control during a sidestep cutting task during soccer ball dribbling, with deficits in this cognitive domain being associated with increased peak knee valgus angle.


Assessing visual-spatial memory ability may provide useful information to better understand conditions associated with impaired neuromuscular control and to potentially identify athletes at an elevated risk for musculoskeletal injury.


ACL; cognition; dual task; knee valgus


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