International Journal of

Environmental Research
and Public Health

Article
Effects of Neuromuscular Training on Motor
Competence and Physical Performance in Young
Female Volleyball Players
Nebojša Trajković 1 and Špela Bogataj 2,3, *
1 Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad 21000, Serbia;
trajcevolley83@[Link]
2 Department of Nephrology, University Medical Centre, Ljubljana 1000, Slovenia
3 Faculty of Sport, University of Ljubljana, Ljubljana 1000, Slovenia
* Correspondence: [Link]@[Link]; Tel.: +386-40-415-766




Received: 25 February 2020; Accepted: 6 March 2020; Published: 8 March 2020


Abstract: Although neuromuscular training (NMT) emphasizes injury prevention training, there is
little information about its effects on performance in young athletes. This study aimed to investigate
the effects of eight-weeks NMT on motor competence and physical performance in 10- to 12-year-old
female volleyball players. Sixty-six participants (mean ± SD; 11.05 ± 0.72 years) were randomized into
either the NMT group (NTG; n = 32) or control group (CON; n = 34). Sprint on 10-m, modified T-test,
plank, vertical jump, and medicine ball throw tests were used to assess the physical performance.
The Körperkoordinationstest für Kinder (KTK) was used to assess the subjects’ motor competence.
The NMT was performed twice a week during the first 30 min of each regularly scheduled 90-minute
volleyball training. Participants in the CON group attended only their regular volleyball training.
A significant group x time interaction was found for Motor Quotient KTK (MQKTK) (p < 0.001), KTK
lateral jumps (p < 0.001), and KTK shifting platforms (p < 0.01). There was a significant interaction
for modified T-test results (p < 0.001) and vertical jump (p = 0.04). No change was observed in both
groups for plank performance (p > 0.05). The NMT promoted significant gains in motor competence
and physical performance in youth female volleyball players.

Keywords: movement competence; skills; youth; training

1. Introduction
Motor competence reflects the degree of proficient performance in various motor skills and is
essential for developing an active and healthy lifestyle [1]. If a child has motor problems and is left
untreated, he is likely to transfer them into adulthood [2]. Moreover, low motor competence can
lead to risks for a mixture of behavioral, emotional, and social difficulties [3]. Additionally, it also
significantly impacts the willingness of participation in physical activity and overall performance in
different sports [4].
Volleyball is one of the most intense anaerobic sports that include a combination of explosive
movements with short recovery periods [5,6]. In volleyball, the physical performance plays an essential
role, since the actions in this sport include a variety of changes of direction in sagittal and frontal planes,
frequent sprints, and different types of jumps [7,8]. Explosive strength represents the ability of the
neuromuscular system to manifest strain as quickly as possible and is a crucial fundamental aspect of
successful volleyball performance [9]. Besides the importance of physical performance, volleyball can
also be considered a skill-based and complex game, which requires well-developed motor coordination
levels [10]. The importance of effective motor behavior optimization and decision-making in different

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motor games was established recently [11]. Moreover, Pic et al. [12] found that girls and boys show
differences in the effectiveness of motor behavior and respond differently when they act within a
complex interactive structure. Therefore, well-developed programs and methodologies are essential
and can significantly contribute to motor skill learning and improving movement competence [13].
Therefore, different kinds of training models have been tested to improve the performance
of volleyball players [14–17]. However, there is a high degree of inter-individual variation in the
development of movement competence during early and middle childhood [18]. Accordingly, exercise
and health care professionals agree that we should put the focus on appropriate training models
for the youth [19]. The evidence says that a supervised strength training program is effective
and safe for children and that they can successfully improve their overall health and strength by
participating in such a program [20,21]. The neuromuscular training (NMT) program was identified
as a new innovative approach for school children [22]. It aims to include general and specific
physical activities to enhance health (e.g., endurance and strength) and skill-related (e.g., balance
and agility) physical fitness components with a combination of resistance, balance, dynamic stability,
plyometrics, core strength, and agility exercises [22]. Faigenbaum et al. [23] reported that the NMT
program showed results in the enhancement of children’s fundamental movement skills and fitness.
Faigenbaum et al. [23] demonstrated significant improvements after eight weeks of 15 min NMT
before-school physical education, in curl-ups, push-ups, 0.5-mile run, and single-leg hop performance,
compared to the control group. While the mentioned research adds valuable meaning to NMT, there is
still a lack of NMT research on young volleyball players. In adolescent female volleyball players, the
NMT program resulted in the improvement of their neuromuscular control and decrease of anterior
cruciate ligament (ACL) injury risk by improving dynamic knee stability. Another study showed that
regular participation in NMT enhanced countermovement jumping performance in young volleyball
players [24]. Sugimoto et al. [25] demonstrated on a sample of 21 high school women volleyball
players that the high compliance to NMT significantly elevated the hip abductors isokinetic strength.
However, multiple questions remain regarding the efficacy and utility of NMT as a tool to enhance
motor competence and physical performance in young athletes, especially in volleyball. Besides that,
there is not a sufficient amount of research on this field on the female population. Females may
especially benefit from multicomponent NMT since they usually display decreased baseline levels of
power and strength in comparison with the male population [26].
Therefore, our study aimed to determine the effects of eight-weeks NMT engagement on motor
competence and selected physical performance in 10- to 12-year-old female volleyball players. It
was hypothesized that the NMT group would significantly improve their results in the chosen tests
compared to the control group.

2. Materials and Methods

2.1. Study Design

Motor competence and physical performance testing were undertaken at the sports facilities of
the Department of Sports at the University of Novi Sad in Serbia. The aim was to test the effects of
10-weeks neuromuscular training on motor competence tests, 10-m sprint, change of direction speed
(modified T-test), medicine ball throw, and jumping ability (countermovement jump). Pretests and
posttests were conducted on two consecutive days, before and after the 10-week intervention period.
The study began in February 2019 and was completed in April 2019. Participants from the NMT group
underwent a one-week familiarization period before starting the training intervention. The study was
conducted during the last two weeks of the precompetition phase.

2.2. Participants
A total of 66 youth female volleyball players (age, 11.05 ± 0.72 years; height 157.81 ± 9.18 cm;
weight 50.68 ± 11.47 kg) who had been competing in volleyball for two or more years and had
Int. J. Environ. Res. Public Health 2020, 17, 1755 3 of 12

no neuromuscular training experience were recruited to participate in the study. Finally, subjects
were randomly divided into either the neuromuscular training group (NTG; n = 32) or control
group (CON; n = 34). Age, height, and weight data across subjects are presented in Table 1, with
no significant differences found between control and experimental groups between the baseline or
post-testing sessions (p > 0.05). Subjects were selected on the following criteria; currently participating
in volleyball training, no prior history of lower limb injuries in the past six months, and no history
of resistance training. Written parental consent and subject assent were provided before initiating
the study in accordance with the Novi Sad University Human Research Ethics Committee guidelines
(ethical approval number: 24/2019).

Table 1. Age, height, and weight data across subjects.

Group Age (years) Height (cm) Mass (kg)

NTG 11.12 ± 0.68 158.28 ± 8.07 47.83 ± 8.97
CON 10.96 ± 0.75 157.37 ± 10.21 48.59 ± 13.46
Note: results are presented as mean ± SD. Abbreviations: NTG, neuromuscular training group; CON, control group.

Analysis of the maturation state [27] revealed that there was no significant difference in
maturational categories between the groups (p > 0.05).

2.3. Testing Procedures

Height was measured to the nearest 0.1 cm with the use of a stadiometer (SECA Instruments
Ltd, Hamburg, Germany), while weight was measured to the nearest 0.1 kg on an electronic scale
TANITA BC 540 (TANITA Corp., Arlington Heights, IL, USA). Both sessions also included a battery of
performance and motor competence tests.
Sprint on 10 m, T-test for agility, plank, vertical jump, and medicine ball throw tests were used to
assess the motor skill performance, and the Körperkoordinationstest für Kinder (KTK) was used to
assess the subjects’ motor competence. The order of testing was constant for both testing sessions with
the movement competency testing occurring first, followed by the motor skill performance measures.
The time of testing for each subject remained consistent for both testing sessions.

2.4. Motor Competence Tests

The assessment of the children’s motor competence consisted of four test items of the KTK battery
test: walking backward, lateral jumps, one leg jumping, and shifting platforms. The standardization of
all test items was demonstrated in previous studies [28,29]. Using normative data tables, based on the
performance of a standardization sample, the raw performance score of each test item was converted
into a standardized Motor Quotient (MQ) adjusted for age and gender. Adding together all four item
MQs resulted in a total MQKTK that was converted into a percentile score and allowed classification in
five gross motor coordination levels.

2.4.1. Walking Backward

The task for a child was to walk backward on three balance beams. The dimensions of the beams
were 3 m in length, 5 cm in height, but with decreasing widths of 6, 4.5, and 3 cm. The child had three
attempts at each beam, and the number of successful steps was recorded; a maximum of 24 steps
(eight per trial) was counted for each balance beam, which comprised a maximum of 72 steps.

2.4.2. Lateral Jumps

The goal of this test for a child was to make consecutive jumps from side to side over a beam
(60 × 4 × 2 cm) as quickly as possible in a time window of 15 s. The child was given the instructions to
keep his/her feet together. The number of correct jumps in two trials was summed.
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2.4.3. One Leg Jumping

The child was instructed to hop on one foot at the time, preceding the jump over a stack of foam
blocks after a short run-up. After a successful hop with each foot (meaning that the child cleared the
block without touching it and successfully continued hopping on the same foot at least two times), the
hight was increased by adding new blocks (50 cm, 20 cm, 5 cm). The subject had three attempts at each
height and on each foot; three, two, or one point(s) was/were awarded for successful completion on the
first, second, or third trial; a maximum of 39 points (12 stacks of blocks) could be awarded for each leg
(maximum score of 78).

2.4.4. Shifting Platforms

The child began the trial by standing with both feet on one platform (25 × 25 × 2 cm; 0.5 kg)
supported on four legs, 3.7 cm in height. The subject held the second identical platform in his/her
hands; the child was then instructed to place the second platform alongside the first one and then to
step onto it; the first platform was then lifted and placed alongside the second, and the child stepped
onto it. The sequence lasted for 20 s. Two points were awarded for each successful transfer from one
platform to another (one point for shifting the platform, the other for transferring the body onto the
second one). The number of points in the 20-s interval was recorded and summed for two trials. If the
child fell off the platform in the process, he/she stepped back onto the platform and continued the test.

2.5. Physical Performance Tests

2.5.1. 10-m Sprint

The photocells were settled at the starting and finishing points of the distance of 10 meters [30].
All subjects started approximately 0.5 m behind the starting photocell. The best score out of three trials
was recorded for further analysis.

2.5.2. Modified T-test

Change of direction speed was evaluated using the modified agility T-test and following the
guidelines proposed by Sassi et al. [31]. The subject started behind the photocell (cone A). On the
command, the subject sprinted towards the cone B set at the distance of 5 m and touched the base of the
cone with the right hand. Then, they turned left and shuffled sideways to cone C (2.5 m), touching the
base as well, but this time with the left hand. Then, shuffling sideways to the cone D (5 m), touching
its base with the right hand, followed up by shuffle to the left to the cone B (5 m), touching its base
with the left hand and running back to the cone A (5 m), finishing photocell. The time was stopped
when the finishing photocell was passed by. Trials were deemed unsuccessful if participants failed to
touch a designated cone, crossed their legs while shuffling, or were unable to face forward at all times.
Subjects performed three trials, and the best score in seconds was taken for further analysis.

2.5.3. Plank
Plank test was modified according to Padulo et al. [32]. This test aimed at holding an elevated
position for as long as possible. Starting position was with the upper body supported off the ground by
elbows and forearms and the legs straight with the weight taken by the toes. The hip was lifted off the
floor, creating a straight line from head to toe. The timing was started as soon as the subject got into
the appropriate position. The head faced the ground instead of forward. The test was concluded when
the subject was not capable of holding the right position any further. The measured time in seconds to
exhaustion was used for further analysis.
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2.5.4. Vertical Jump (Countermovement Jump with Arm Swing)

The vertical jump test was measured using the "OptoJump" system of analysis and
measurement [33]. Each jump began in a standing position, motionless. Arm swing was performed
with the arms first moving in an extension direction at the shoulder joint, followed by movement in
the direction of flexion. The subjects performed three jumps with arm swing and were instructed to
jump naturally and as high as they could, performing all jumps with maximal effort. A minimum of
30 s of sufficient rest was allowed between consecutive jumps to prevent the harmful effects of fatigue.

2.5.5. Medicine Ball Throw (Overhead)

The goal of this test was to measure upper body strength and explosive power. Subjects were set
to stand on the line with feet side by side but slightly apart and facing the direction to which the ball
was thrown [34]. The ball (3 kg) was held with the hands on the side of the ball and slightly behind the
center. The ball is brought back behind the head, then thrown vigorously forward as far as possible.
The distance in cm from the starting position to where the ball landed during three trials was recorded,
and the best one was taken for further analysis.

2.6. Neuromuscular Training Program

The NMT program used in this study was designed specifically for volleyball and primary school
children, taken and modified from the previous studies [24,35,36].
The intervention was performed twice per week (Tuesday and Thursday) during the first 30 min
of each regularly scheduled 90-minute volleyball training. The NMT was performed before volleyball
practice (after warm-up) to secure total neuromuscular activation. The NTG group had one additional
volleyball training for improving volleyball skills and techniques.
Participants in the CON group did not perform specific NTG but attended only their regular
volleyball training three times per week during the study period.
All subjects went through a comprehensive one-week familiarization period in order to ensure
familiarity with the types of exercises that were used in the NMT (Table 2). All familiarization
and training sessions were initiated with the use of a standardized 10-minute dynamic warm-up
(light running, and stretching) followed by plyometric exercises, coordination ladder, strength training,
and finishing with the plank. The training was supervised, and players received instructions on how
to perform each exercise. Exercises followed a progression, and emphasis was given to the use of a
proper technique.

Table 2. Neuromuscular training program structure.

Tuesday Duration Thursday Duration

Deep squat 2 sets of 10–12 rep Wall sits 2 sets, 35–50 s
Forward lunges with Med Ball 2 sets of 7–10 rep Backward lunges with Med Ball 2 sets of 7–10 rep
Push-ups 3 sets of 7–12 rep Volleyball push-ups 3 sets of 7–12 rep
Med ball throw Med ball throw (overhead,
2 sets of 5–15 rep 2 sets of 5–15 rep
(from the chest, side throw) backward)
Plank 60-90 s Crunches, Side plank 60–90 s
Hurdle jumps 2 sets of 8–12 rep Knee tucks 2 sets of 8–12 rep
Squat jump 2 sets of 6–10 rep Box jumps 2 sets of 6–10 rep
Four-way jumps
60 s Single leg four-way jumps 60 s
(forward, backward, side to side)
Lunge jumps 8–12 rep Block jumps 2 sets of 8–12 rep
Agility ladder: Various patterns 2 rep Agility ladder: various patterns 2 rep
Abbreviations: rep—repetitions; med—medicine; s—seconds.
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2.7. Statistical Analysis

Descriptive statistics were calculated for age, height, and body mass. The distribution of raw
data sets was checked using the Kolmogorov–Smirnov test and demonstrated that all data had a
normal distribution (p > 0.05). Test-retest reliability was assessed for physical performance tests
using a one-way intra-class correlation coefficient (ICC) based on average measurements (ICC 1,k).
A repeated measure ANOVA (2 × 2) was computed to test for interactions and main effects for time
(pretest vs. posttest) and group (NTG vs. CON) on the selected physical test variables. All tests were
carried out using SPSS, version 22 (SPSS Inc., Chicago, IL, USA), and assessed at the p ≤ 0.05 level of
significance. The effect size (ES) of each variable was tested using Cohen’s d within each group and
was classified as follows: <0.2 was defined as trivial; 0.2–0.6 was defined as small; 0.6–1.2 was defined
as moderate; 1.2–2.0 was defined as large; >2.0 was defined as very large; and >4.0 was defined as
extremely large [37], and partial eta (η) squared between groups (0.01 = small effect, 0.06 = medium
effect, and 0.14 = large effect) [38].

3. Results
All participants completed the study. There were no reports of injury during the study. The ICC
for physical performance tests ranged from 0.85 to 0.96.

3.1. Motor Competence

Results from repeated measures ANOVA indicated a significant group (NTG vs. CON) × time (Pre
to Post) interaction for Motor Quotient Körperkoordinationstest für Kinder (MQKTK) (F 1, 90 = 22.65,
p = 0.001, Partial η2 = 0.38, See Table 3). Following the NMT, a significant interaction of group and time
was found for KTK raw scores, KTK lateral jumps (F = 23.18, p < 0.001), and in KTK shifting platforms
(F = 9.76, p = 0.003). A borderline significant interaction was also found for KTK single-lever jumps
(F = 4.1, p = 0.05). Large effects favoring the NMT group were observed in KTK lateral jumps (ES = 1.2,
% change = 22.2%) and KTK shifting platforms (ES = 1.3, % change = 17.2%), compared to CON group
(ES = 0.2, % change = 4.7% and ES = 0.2, % change = 3.1%), respectively.
When examining the impact of the NMT program on KTK walking backward performance, there
was a significant main effect for time (p < 0.001) with both groups improving their result after the
eight-weeks intervention (NTG-ES = 0.6, % change = 15.5% vs. CON-ES = 0.3, % change = 7.4%).
There were no significant group x time effects (p = 0.065).

3.2. Physical Performance

Both NTG and CON demonstrated improvements in sprint10 (4.8% and 4.3%, p < 0.001), but no
group or interaction effects were observed (p > 0.05).
There was a significant group x time interaction when examining the impact of the NTG and CON
on the modified T-test results (F 1, 90 = 12.78, p = 0.001, Partial η2 = 0.17). The NTG demonstrated
a significant decrease in time for the modified T-test (p = 0.001, moderate ES), whereas the CON
displayed only a small decrease (ES = 0.3, 0.9 % change).
There was no effect of time, group, or interaction on plank performance (p > 0.05, Table 4).
There was an interaction (F 1, 90 = 4.42, p = 0.04, Partial η2 = 0.07), time and group effect (p < 0.05)
for vertical jump, with the NTG improving performance by 12.2% (moderate ES) between pre- and
post-tests, while a 6.6% (small ES) improvement was observed in the CON group.
When examining the impact of the NMT program on medicine ball throw, there was a significant
main effect for the time after the eight-week intervention (p = 0.002). There were no significant group x
time effects (p = 0.4). However, the NTG demonstrated a significant increase on medicine ball throw
(p = 0.003, ES = 0.5), whereas the CON only displayed a 0.14-m increase (ES = 0.3).
Int. J. Environ. Res. Public Health 2020, 17, 1755 7 of 12

Table 3. Pretest and posttest results for motor competence.

Group Pretest Posttest ES % change p-value, η2 p

MQKTK
NTG 98.58 ± 8.82 112.33 ± 12.36 1.3 13.9% Group: p = 0.014, η2 p : 0.15
CON 95.89 ± 8.60 99.72 ± 8.39 0.5 4.0%
Time: p ≤ 0.001, η2 p : 0.66

Interaction: p < 0.001, η2 p : 0.38

KTK walking backward
NTG 38.81 ± 10.21 44.81 ± 10.77 0.6 15.5% Group: p = 0.037, η2 p : 0.11
CON 33.89 ± 9.66 36.39 ± 9.13 0.3 7.4%
Time: p < 0.001, η2 p : 0.36

Interaction: p = 0.065, η2 p : 0.09

KTK one leg jumping
NTG 37.52 ± 8.87 43.38 ± 11.49 0.6 15.6% Group: p = 0.031, η2 p : 0.12
CON 32.61 ± 8.81 35.06 ± 8.56 0.3 7.5%
Time: p < 0.001, η2 p : 0.4

Interaction: p = 0.05, η2 p : 0.1

KTK lateral jumps
NTG 45.57 ± 6.56 55.67 ± 9.53 1.2 22.2% Group: p = 0.52, η2 p : 0.011
CON 47.67 ± 9.64 49.89 ± 10.98 0.2 4.7%
Time: p < 0.001, η2 p : 0.61

Interaction: p < 0.001, η2 p : 0.39

KTK shifting platforms
NTG 33.71 ± 4.71 39.52 ± 3.96 1.3 17.2% Group: p = 0.101, η2 p : 0.07
CON 33.94 ± 5.07 35.00 ± 4.79 0.2 3.1%
Time: p < 0.001, η2 p : 0.36

Interaction: p = 0.003, η2 p : 0.21

Note: pretest and posttest results are presented as mean ± SD. Abbreviations: NTG, neuromuscular training group;
CON, control group; MQKTK, Motor Quotient Körperkoordinationstest für Kinder; KTK, Körperkoordinationstest
für Kinder.

Table 4. Pretest and posttest results for physical performance.

Group Pretest Posttest ES % change p-value, η2 p
Sprint10 (s)
NTG 2.29 ± 0.19 2.18 ± 0.15 −0.6 −4.8% Group: p = 0.44, η2 p : 0.01
CON 2.31 ± 0.19 2.21 ± 0.15 −0.7 −4.3%
Time: p = 0.001, η2 p : 0.16

Interaction: p = 0.8, η2 p : 0.001

Modified T-test (s)
NTG 7.61 ± 0.55 7.38 ± 0.55 −0.6 −3.0% Group: p = 0.33, η2 p : 0.02
CON 7.39 ± 0.57 7.32 ± 0.64 −0.2 −0.9%
Time: p < 0.001, η2 p : 0.37

Interaction: p < 0.001, η2 p : 0.17

Plank (s)
NTG 86.60 ± 32.54 86.91 ± 31.22 0.0 0.4% Group: p = 0.34, η2 p : 0.01
CON 97.85 ± 55.90 96.73 ± 52.75 −0.0 −1.1%
Time: p = 0.56, η2 p : 0.01

Interaction: p = 0.30, η2 p : 0.02

Vertical jump (cm)
NTG 21.92 ± 4.51 24.60 ± 4.80 0.6 12.2% Group: p = 0.01, η2 p : 0.11
CON 19.79 ± 4.12 21.10 ± 3.80 0.3 6.6%
Time: p < 0.001, η2 p : 0.38

Interaction: p = 0.04, η2 p : 0.07

Medicine ball throw (m)
NTG 4.28 ± 0.71 4.52 ± 0.72 0.5 5.6% Group: p = 0.03, η2 p : 0.07
CON 3.96 ± 0.75 4.10 ± 0.68 0.3 3.5%
Time: p = 0.002, η2 p : 0.14

Interaction: p = 0.4, η2 p : 0.01

Note: pretest and posttest results are presented as mean ± SD. Abbreviations: NTG, neuromuscular training group;
CON, control group.
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4. Discussion
The present study aimed to implement the NMT program into young female volleyball practice
and examine its impact on motor competence and physical performance. The main findings of the
study were that the eight-week NMT intervention significantly improved MQKTK, KTK single-lever
jumps, KTK lateral jumps, and KTK transfer on platforms compared to the control group. Additionally,
the NTG improved agility (modified T-test) and vertical jump in young female volleyball players.
The largest effect sizes were found for MQKTK (ES = 1.3), KTK lateral jumps (ES = 1.2), and for KTK
shifting platforms (ES = 1.3).
Good motor competence is a significant predictor for high-level sports performance [39], and also
for the engagement in sports activities [40]. Additionally, the stability of motor competence levels in
childhood may have implications for talent identification purposes as well as potential health-related
benefits throughout the lifespan [41]. Deprez et al. [42] showed that results in the KTK test were a good
predictor of future dropout and adherence to an elite talent development program in 8- to 16-year-old
soccer players. Moreover, Pion et al. [10] showed that motor coordination is an essential factor in
determining inclusion into the elite level in female volleyball. Therefore, improving motor competence
in young volleyball players could be of great importance. In the present study, we demonstrated
that neuromuscular training improved KTK results, and to the best of our knowledge, until now, no
published articles have examined the effects of this type of training on motor competence of youth
female volleyball players. For NTG, there was seen an improvement in MQ, such as reaching a typical
score of 112.3 for age and gender (normal MQ = score 86–115) with a large effect size (ES = 1.3).
Similar large improvements were seen in seven–nine-year-old overweight/obese boys following the
plyometric training only (large ES, d = 1.02) [28]. Despite the expected positive effects that NMT
may offer in terms of children’s development, there are only two published studies regarding motor
competence in children [43,44]. Although the studies mentioned above examined the effect of NMT on
process-oriented movement skills in slightly younger participants than that investigated in the present
study, their data identified positive improvements in their studied variables compared to a control
group. Participation in the NMT program resulted in the most significant gains in the KTK lateral
jumps (large ES, 22.2%) and KTK transfer on platforms (large ES, 17.2%). These improvements were
expected as the NMT program mostly included jumps and hops. Moreover, short shuffling moves
in volleyball training, which involve leg coordination [45], could significantly contribute to better
results in KTK transfer on platforms. NMT represents an integrative model that includes multiple
components (e.g., strength, balance, power, skill development) [46]. However, our program (Table 2)
did not include balance exercises, which could be the reason for nonsignificant effects in KTK walking
backward test.
Participants in the NMT group made significantly greater gains in selected physical performance
measures following the training period than the CON group. Plyometric training was recognized as
the superior training method in improving sprint performance in pre- and mid-pubertal males, where
a combined training method was most effective in post-pubertal males [47]. Following puberty, males
experience natural increases in strength, muscular power, and coordination that are not generally
seen in females [35]. Moreover, Pic et al. [48] revealed motor asymmetry in relation to gender in
this age group, which was the expression of behaviors lacking in playful neutrality. Additionally,
a general change in girls posture with maturation causes greater knee valgus and lower neuromuscular
control compared to boys [49], which may suggest the need for integration of neuromuscular training
programs, including plyometrics and strength training, to improve performance.
Following the intervention, both the NTG (+2.68 cm) and the CON group (+1.31 cm) improved their
vertical jump performance; however, the NTG made a larger and significantly greater improvement.
This improvement is in agreement with the study conducted by Hopper et al. [36], who reported that
11–13-year-old female netball athletes were able to improve their vertical jump by 4 cm in response to a
6-week NMT program. Also, Chappell et al. [50] found a 4-cm improvement in vertical jump following
an NMT program in college female athletes. Both programs were compounded with a combination of
Int. J. Environ. Res. Public Health 2020, 17, 1755 9 of 12

balance, plyometrics, and resistance exercises. The possible explanation for the improvement in the
CON group is that they were participating in regular volleyball training throughout the study, which
requires jumping performance, and this may have contributed to the vertical jump improvement in the
CON group.
The 8-week intervention improved NTG agility measured by the modified T-test by 3%. We
demonstrated a significant group x time interaction (p < 0.001). Similarly, Hopper et al. [36] examined
the impact of a 6-week NMT program on agility determined by 505 Agility Test and found a significant
group x time interaction (p < 0.001).
In 10-m sprint, plank, and medicine ball throw, we did not show any significant differences
compared to the CON group following an 8-week NMT intervention. This may be explained by the fact
that our program was more focused on jumps. However, on the contrary, a 12-week plyometric training
study [51] with or without a weighted vest in 14–16-year-old female volleyball players investigating
the effects on sprint performance showed significant improvements in 50-m sprint test in both groups
(with a vest: 1.05 s, no vest: 0.53 s). Another study investigated the effect of six-weeks NMT on
20-m sprint in court-sport athletes and found a significant improvement (2.4% decrease) [36]. On
the other hand, a considerable improvement of initial acceleration (10-m sprint) was reported for
early-pubertal soccer players after the implementation of NMT in the form of plyometric training [52].
In this study, NMT induced a 4.8% improvement in 10-m sprint. These improvements in speed may be
related to increased neuromuscular activation, improved ground contact time, and muscle-tendon unit
stiffness [53].
Performance gains in the abdominal plank test following NMT were trivial since the training
intervention included only one exercise specifically designed to enhance core strength. Similarly,
Faigenbaum et al. [23] found only particularly notable gains in the abdominal curl-up test following
NMT in eight-year-old children.
One of the limitations was that we did not incorporate any specific balance training as part of the
NMT program. Moreover, we did not know the participants’ previous involvement in other sports
activities. Additionally, because of the short program duration, we do not know what long-term
training adaptations would be. Therefore, future studies should be conducted in order to see the
long-term adaptations but also whether the program is effective in injury prevention. A vital strength
of the present study was the fact that this was the first study that reported improvement in motor
competence in young female volleyball players. This improvement in motor competence is of great
importance because once these fundamental skills are developed, young female players can begin to
participate in strength and conditioning programs. Neuromuscular training seems to be the best way
since it sensibly progressed and design to players’ individual needs, goals, and abilities [22].

5. Conclusions
The findings of this study indicate that neuromuscular training promotes significant gains in
motor competence and physical performance in female youth volleyball players. Our results support
the fact that youth in sport should first build an important foundation by developing movement
competence, and then build and enrich sport-specific skill sets. This study offers an empirically tested
training program that coaches can directly use in practice with female youth volleyball players, and that
requires limited equipment and can be appropriate for youth with adequate guidance and instruction
from qualified professionals. The results of this study highlight the potential of using neuromuscular
training along with volleyball training as a useful, time-efficient, and practical mode of exercise to
improve movement competence along with physical performance. Moreover, this study supports the
findings that talent identification programs in female volleyball should include motor competence
testing to assure a broader performance screening.

Author Contributions: Conceptualization, N.T. and Š.B.; methodology, N.T.; formal analysis, Š.B.; investigation,
N.T.; resources, N.T.; data curation, N.T.; writing—original draft preparation, Š.B.; writing—review and editing,
N.T.; visualization, N.T. All authors have read and agreed to the published version of the manuscript.
Int. J. Environ. Res. Public Health 2020, 17, 1755 10 of 12

Funding: This research received no external funding.

Conflicts of Interest: The authors declare no conflict of interest.

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