The Influence of Cognitive Loading on Landing Mechanics: A systematic review

Introduction: There is a high prevalence of anterior cruciate ligament (ACL) injuries in the United States, with a majority resulting from sport participation. The external demands and stimuli during competition divert athletes\u27 cognitive-perceptual skills away from the focus of proper landing kinematics. Purpose: The purpose of this evidence synthesis is to evaluate current literature about the effects of cognitive loading on jump landing mechanics. Methodology: Criteria for inclusion of articles included (1) adolescents and young adults, defined as 12-45 years of age; and (2) assessment of jump landing under cognitive-motor dual task conditions. Databases utilized in the search strategy included PubMed, SportDiscuss, and CINAHL (2010-2020). Article screening included a title and abstract, full-text, and quality review and data abstraction which was performed by 4 independent reviewers with consensus majority used for final determination of inclusion of article. Results: Landing tasks included a drop vertical jump onto double or single leg followed by a maximum vertical jump, countermovement jumps, or a variety of jumping, hopping, and cutting tasks. Cognitive loading tasks during landing included the use of backwards counting, virtual reality, an overhead goal, Stroop tasks, and other decision-making tasks provided upon cue. The effects of the cognitive loading tasks on landing mechanics was measured through monitoring systems of the second landing task. During cognitive loading conditions, participants demonstrated less hip and knee flexion, increased knee abduction, and increased peak and posterior ground reaction forces or center of pressure upon landing. Other findings included decreased jump height, longer flight times, increased maximal tibial internal rotation, and increased standing errors. Conclusion: This systematic review demonstrates that landing mechanics are altered with the addition of cognitive loading. Ongoing analysis of dual-task cognitive loading when implementing a return to sport protocol to decrease the risk of ACL injury is warranted