Trunk and hip biomechanics influence anterior cruciate loading mechanisms in physically active participants

BACKGROUND

Excessive trunk motion and deficits in neuromuscular control (NMC) of the lumbopelvic hip complex are risk factors for anterior cruciate ligament (ACL) injury. However, the relationship between trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads during a sidestep cutting task has not been examined.

PURPOSE

To determine if there is an association between multiplanar trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads with ACL injury during a sidestep cutting task.

STUDY DESIGN

Descriptive laboratory study.

METHODS

The hip and knee biomechanics and trunk motion of 30 participants (15 male, 15 female) were analyzed during a sidestep cutting task using an optoelectric camera system interfaced to a force plate. Trunk and lower extremity biomechanics were calculated from the kinematic and ground-reaction force data during the first 50% of the stance time during the cutting task. Pearson product moment correlation coefficients were calculated between trunk and lower extremity biomechanics. Multiple linear regression analyses were carried out to determine the amount of variance in triplanar knee loading explained by trunk motion and hip moments.

RESULTS

A greater internal knee varus moment (mean, 0.11 ± 0.12 N·m/kg*m) was associated with less transverse-plane trunk rotation away from the stance limb (mean, 20.25° ± 4.42°; r = -0.46, P = .011) and a greater internal hip adduction moment (mean, 0.33 ± 0.25 N·m/kg*m; r = 0.83, P < .05). A greater internal knee external rotation moment (mean, 0.11 ± 0.08 N·m/kg*m) was associated with a greater forward trunk flexion (mean, 7.62° ± 5.28°; r = 0.42, P = .020) and a greater hip internal rotation moment (mean, 0.15 ± 0.16 N·m/kg*m; r = 0.59, P = .001). Trunk rotation and hip adduction moment explained 81% (P < .05) of the variance in knee varus moment. Trunk flexion and hip internal rotation moment explained 48% (P < .05) of the variance in knee external rotation moment.

CONCLUSION

Limited trunk rotation displacement toward the new direction of travel and hip adduction moment are associated with an increased internal knee varus moment, while a combined increase in trunk flexion displacement and hip internal rotation moment is associated with a higher internal knee external rotation moment.

CLINICAL RELEVANCE

Prevention interventions for ACL injury should encourage trunk rotation toward the new direction of travel and limit excessive trunk flexion while adjusting frontal- and transverse-plane hip NMC.

Effect of excessive contralateral trunk tilt on pitching biomechanics and performance in high school baseball pitchers

BACKGROUND

There is a growing number of pitching-related upper extremity injuries among young baseball pitchers; however, there is a lack of data on the identification of injury prevention strategies, particularly the prevention of injuries through the instruction/modification of technique. The identification of technical parameters that are associated with increased joint loading is needed.

PURPOSE

To investigate the effects of excessive contralateral trunk tilt, a common technique identifiable by video observation, on pitching biomechanics and performance in high school baseball pitchers. The hypothesis was that this strategy is associated with greater joint loading and poor pitching performance.

STUDY DESIGN

Descriptive laboratory study; Level of evidence, 3.

METHODS

The 3-dimensional pitching biomechanics, ball speed, and frontal view of the pitching technique from 72 high school baseball pitchers were captured on video and analyzed. The videos were reviewed to determine if the pitcher's trunk was excessively contralaterally tilted at the instant of maximal shoulder external rotation by examining whether the side of the pitcher's head ipsilateral to the throwing limb deviated by more than a head width from a vertical line passing through the pitcher's stride foot ankle. Upper extremity kinetics and upper extremity/trunk kinematics between pitchers with and without excessive contralateral trunk tilt were compared using independent t tests.

RESULTS

Compared with pitchers who did not demonstrate excessive contralateral trunk tilt, those with excessive contralateral trunk tilt pitched at a higher ball speed (mean, 32.6 ± 2.2 vs 31.1 ± 2.9 m/s, respectively; P = .019) and experienced a greater elbow proximal force (mean, 103.9 ± 12.7 vs 93.2 ± 13.9 %weight, respectively; P = .001), shoulder proximal force (mean, 104.8 ± 14.1 vs 94.3 ± 15.5 %weight, respectively; P = .004), elbow varus moment (mean, 4.29 ± 0.73 vs 3.84 ± 0.8 %height*weight, respectively; P = .017), and shoulder internal rotation moment (mean, 4.21 ± 0.71 vs 3.75 ± 0.78 %height*weight, respectively; P = .011). Pitchers with excessive contralateral trunk tilt demonstrated less upper torso flexion at stride foot contact, less upper torso rotation, and greater upper torso contralateral flexion at maximal shoulder external rotation and ball release (P < .05).

CONCLUSION

Excessive contralateral trunk tilt is a strategy that is associated with higher ball speeds and increased joint loading.

CLINICAL RELEVANCE

Pitching with excessive contralateral trunk tilt, which can be identified through screening of the pitching technique, is associated with a benefit in performance and increased joint loading. Future study is warranted to determine if this strategy should be encouraged or discouraged by baseball coaches.

Lower extremity energy absorption and biomechanics during landing, part II: frontal-plane energy analyses and interplanar relationships

CONTEXT

Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence frontal-plane biomechanics. We do not know whether frontal-plane INI EA is related to high-risk frontal-plane biomechanics.

OBJECTIVE

To compare biomechanics among INI EA groups, determine if women are represented more in the high group, and evaluate interplanar INI EA relationships.

DESIGN

Descriptive laboratory study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Participants included 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active volunteers.

INTERVENTION(S)

We assessed landing biomechanics with an electromagnetic motion-capture system and force plate.

MAIN OUTCOME MEASURE(S)

We calculated frontal- and sagittal-plane total, hip, knee, and ankle INI EA. Total frontal-plane INI EA was used to create high, moderate, and low tertiles. Frontal-plane knee and hip kinematics, peak vertical and posterior ground reaction forces, and peak internal knee-varus moment (pKVM) were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to evaluate male and female allocation to INI EA groups. We used simple, bivariate Pearson product moment correlations to assess interplanar INI EA relationships.

RESULTS

The high-INI EA group exhibited greater knee valgus at ground contact, hip adduction at pKVM, and peak hip adduction than the low-INI EA group (P < .05) and greater peak knee valgus, pKVM, and knee valgus at pKVM than the moderate- (P < .05) and low- (P < .05) INI EA groups. Women were more likely than men to be in the high-INI EA group (χ(2) = 4.909, P = .03). Sagittal-plane knee and frontal-plane hip INI EA (r = 0.301, P = .006) and sagittal-plane and frontal-plane ankle INI EA were associated (r = 0.224, P = .04). No other interplanar INI EA relationships were found (P > .05).

CONCLUSIONS

Greater frontal-plane INI EA was associated with less favorable frontal-plane biomechanics that likely result in greater ACL loading. Women were more likely than men to use greater frontal-plane INI EA. The magnitudes of sagittal- and frontal-plane INI EA were largely independent.

Lower extremity energy absorption and biomechanics during landing, part I: sagittal-plane energy absorption analyses

CONTEXT

Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential.

OBJECTIVE

To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk.

DESIGN

Descriptive laboratory study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered.

INTERVENTION(S)

We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task.

MAIN OUTCOME MEASURE(S)

Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to compare male and female representation in the high and low groups.

RESULTS

The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P < .05) and low (P < .05) groups and greater anterior tibial shear force than the low group (P < .05). No other group differences were noted. Women were not represented more than men in the high group (χ(2) = 1.20, P = .27).

CONCLUSIONS

Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential.

Comparison of gluteal and hamstring activation during five commonly used plyometric exercises

BACKGROUND

Anterior cruciate ligament injuries occur frequently in athletics, and anterior cruciate ligament injury prevention programs may decrease injury risk. However, previous prevention programs that include plyometrics use a variety of exercises with little justification of exercise inclusion. Because gluteal and hamstring activation is thought to be important for preventing knee injuries, the purpose of this study was to determine which commonly used plyometric exercises produce the greatest activation of the gluteals and hamstrings.

METHODS

EMG (Electromyography) amplitudes of the hamstring and gluteal muscles during preparatory and loading phases of landing were recorded in 41 subjects during 5 commonly used plyometric exercises. Repeated measures ANOVAs (Analysis of Variance) were used on 36 subjects to examine differences in muscle activation.

FINDINGS

Differences in hamstring (P<.01) and gluteal (P<.01) activities were identified across exercises during the preparatory and landing phases. The single-leg sagittal plane hurdle hops produced the greatest gluteal and hamstring activity in both phases. The 180° jumps did not produce significantly greater gluteal or hamstring activity than any other exercise.

INTERPRETATION

Single-leg sagittal plane hurdle hops may be the most effective exercise to activate the gluteals and hamstrings and may be important to include in anterior cruciate ligament injury prevention programs, given the importance of these muscles for limiting valgus loading of the knee. Because 180° jumps do not produce greater gluteal and hamstring activation than other plyometric exercises, their removal from injury prevention programs may be warranted without affecting program efficacy.

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading

CONTEXT

Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks.

OBJECTIVE

To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg).

INTERVENTION(S)

Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests.

MAIN OUTCOME MEASURE(S)

Hamstrings stiffness was normalized to body mass (N/m·kg-1). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height.

RESULTS

Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729-2.224, P < .05).

CONCLUSIONS

Greater hamstrings stiffness was associated with landing biomechanics consistent with less ACL loading and injury risk. Musculotendinous stiffness is a modifiable characteristic; thus exercises that enhance hamstrings stiffness may be important additions to ACL injury-prevention programs.

Lower extremity muscle activation and knee flexion during a jump-landing task

CONTEXT

Decreased sagittal-plane motion at the knee during dynamic tasks has been reported to increase impact forces during landing, potentially leading to knee injuries such as anterior cruciate ligament rupture.

OBJECTIVE

To describe the relationship between lower extremity muscle activity and knee-flexion angle during a jump-landing task.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty recreationally active volunteers (15 men, 15 women: age = 21.63 ± 2.01 years, height = 173.95 ± 11.88 cm, mass = 72.57 ± 14.25 kg).

INTERVENTION(S)

Knee-flexion angle and lower extremity muscle activity were collected during 10 trials of a jump-landing task.

MAIN OUTCOME MEASURE(S)

Simple correlation analyses were performed to determine the relationship between each knee-flexion variable (initial contact, peak, and displacement) and electromyographic amplitude of the gluteus maximus (GMAX), quadriceps (VMO and VL), hamstrings, gastrocnemius, and quadriceps : hamstring (Q : H) ratio. Separate forward stepwise multiple regressions were conducted to determine which combination of muscle activity variables predicted each knee-flexion variable.

RESULTS

During preactivation, VMO and GMAX activity and the Q : H ratio were negatively correlated with knee-flexion angle at initial contact (VMO: r = 0.382, P = .045; GMAX: r = 0.385, P = .043; Q : H ratio: r = 0.442, P = .018). The VMO, VL, and GMAX deceleration values were negatively correlated with peak knee-flexion angle (VMO: r = 0.687, P = .001; VL: r = 0.467, P = .011; GMAX: r = 0.386, P = .043). The VMO and VL deceleration values were negatively correlated with knee-flexion displacement (VMO: r = 0.631, P = .001; VL: r = 0.453, P = .014). The Q : H ratio and GM activity predicted 34.7% of the variance in knee-flexion angle at initial contact (P = .006). The VMO activity predicted 47.1% of the variance in peak knee-flexion angle (P = .001). The VMO and VL activity predicted 49.5% of the variance in knee-flexion displacement (P = .001).

CONCLUSIONS

Greater quadriceps and GMAX activation and less hamstrings and gastrocnemius activation were correlated with smaller knee-flexion angles. This landing strategy may predispose an individual to increased impact forces due to the negative influence on knee-flexion position.

Estrogen and muscle stiffness have a negative relationship in females

PURPOSE

Hormonal fluctuations are one potential reason why females might have a greater rate of noncontact ACL injury. The hamstrings are capable of limiting anterior cruciate ligament (ACL) loading. This study examined whether relationships existed between reproductive hormones (estradiol-β-17, free testosterone, and progesterone) and hamstring neuromechanical variables (hamstring musculotendinous stiffness (MTS), rate of force production (RFP), time to 50% peak torque (T50%), and electromechanical delay (EMD)) in genders combined and independently.

METHODS

Muscle properties of the hamstrings and reproductive hormones were evaluated in 30 subjects (15 males and 15 females) that were free from lower extremity injury and had no history of ACL injury. Females were tested 3-5 days after the onset of menses and were not using oral contraceptive. Pearson correlation coefficients were calculated for each hormone and muscle property.

RESULTS

For genders combined, estrogen (mean = 46.0 ± 28.2 pg/mL) was negatively correlated with RFP (mean = 758.8 ± 507.6 N/kg s(-1), r = -0.43, P = 0.02) and MTS (mean = 12.8 ± 2.6 N/cm, r = -0.43, P = 0.02). Free testosterone (mean = 13.2 ± 13.0 pg/mL) was positively correlated with RFP (r = 0.56, P < 0.01) and MTS (r = 0.46, P = 0.01) but negatively correlated with T50% (mean = 114.7 ± 38.9 ms, r = -0.43, P = 0.02). When gender was considered separately, females demonstrated negative correlation between estrogen (mean = 68.0 ± 23.2 pg/mL) and MTS (mean = 11.7 ± 1.5 N/cm, r = -0.53, P = 0.05) and free testosterone (mean = 1.5 ± 0.6 pg/mL) and MTS (r = -0.52, P = 0.05). Males alone displayed no significant correlations between the selected hormones and muscle properties.

CONCLUSIONS

Correlations exist between muscle properties and reproductive hormones. Females, however, may be more sensitive to reproductive hormones and their fluctuations.

The impact of stochastic resonance electrical stimulation and knee sleeve on impulsive loading and muscle co-contraction during gait in knee osteoarthritis

BACKGROUND

Increased impulsive loading and muscle co-contraction during gait have been observed in individuals with knee osteoarthritis. Proprioceptive deficits in this population may contribute to these effects. Proprioception has been shown to improve with the combination of stochastic resonance electrical stimulation and a knee sleeve in knee osteoarthritis. Our goal was to determine whether stochastic resonance stimulation combined with a knee sleeve would decrease impulsive loading rates and muscle co-contraction during gait in knee osteoarthritis.

METHODS

Gait kinetics, kinematics and muscle activity were assessed during walking in subjects with knee osteoarthritis during three different conditions: no stochastic resonance/no sleeve (control), stochastic resonance at 75% threshold/sleeve, and no stochastic resonance/sleeve. Loading rates were calculated from the ground reaction force. Muscle co-contraction was calculated from the ratio of vastus lateralis to lateral hamstring activity. Differences between conditions were assessed using a repeated measures analysis of variance (P<0.05).

FINDINGS

The 75% threshold/sleeve and sleeve only conditions resulted in increased knee flexion at contact and reduced loading rates compared to the control condition (P<0.05). However, these measures did not significantly differ between the 75% threshold/sleeve and sleeve only conditions. Muscle co-contraction was found to decrease with the 75% threshold/sleeve condition compared to the other conditions.

INTERPRETATION

Increased knee flexion and decreased loading rates may be a result of proprioceptive improvements resulting from the sleeve or sleeve/stimulation combination. The stochastic resonance stimulation did not demonstrate an ability to enhance the effects of the sleeve with the exception of reductions in muscle co-contraction.

Effects of an age-specific anterior cruciate ligament injury prevention program on lower extremity biomechanics in children

BACKGROUND

Implementing an anterior cruciate ligament injury prevention program to athletes before the age at which the greatest injury risk occurs (15-17 years) is important from a prevention standpoint. However, it is unknown whether standard programs can modify lower extremity biomechanics in pediatric populations or if specialized training is required.

HYPOTHESIS/PURPOSE

To compare the effects of traditional and age-specific pediatric anterior cruciate ligament injury prevention programs on lower extremity biomechanics during a cutting task in youth athletes. The authors hypothesized that the age-specific pediatric program would result in greater sagittal plane motion (ie, hip and knee flexion) and less motion in the transverse and frontal plane (ie, knee valgus, knee and hip rotation) as compared with the traditional program.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

Sixty-five youth soccer athletes (38 boys, 27 girls) volunteered to participate. The mean age of participants was 10 ± 1 years. Teams (n, 7) were cluster randomized to a pediatric injury prevention program, a traditional injury prevention program, or a control group. The pediatric program was modified from the traditional program to include more feedback, progressions, and variety. Teams performed their programs as part of their normal warm-up routine. Three-dimensional lower extremity biomechanics were assessed during a sidestep cutting task before and after completion of the 9-week intervention period.

RESULTS

The pediatric program reduced the amount of knee external rotation at initial ground contact during the cutting task, F ((2,62)) = 3.79, P = .03 (change: pediatric, 7.73° ± 10.71°; control, -0.35° ± 7.76°), as compared with the control group after the intervention period. No other changes were observed.

CONCLUSION

The injury prevention program designed for a pediatric population modified only knee rotation during the cutting task, whereas the traditional program did not result in any changes in cutting biomechanics. These findings suggest limited effectiveness of both programs for athletes younger than 12 years of age in terms of biomechanics during a cutting task.

Ankle-dorsiflexion range of motion and landing biomechanics

CONTEXT

A smaller amount of ankle-dorsiflexion displacement during landing is associated with less knee-flexion displacement and greater ground reaction forces, and greater ground reaction forces are associated with greater knee-valgus displacement. Additionally, restricted dorsiflexion range of motion (ROM) is associated with greater knee-valgus displacement during landing and squatting tasks. Because large ground reaction forces and valgus displacement and limited knee-flexion displacement during landing are anterior cruciate ligament (ACL) injury risk factors, dorsiflexion ROM restrictions may be associated with a greater risk of ACL injury. However, it is unclear whether clinical measures of dorsiflexion ROM are associated with landing biomechanics.

OBJECTIVE

To evaluate relationships between dorsiflexion ROM and landing biomechanics.

DESIGN

Descriptive laboratory study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-five healthy, physically active volunteers.

INTERVENTION(S)

Passive dorsiflexion ROM was assessed under extended-knee and flexed-knee conditions. Landing biomechanics were assessed via an optical motion-capture system interfaced with a force plate.

MAIN OUTCOME MEASURE(S)

Dorsiflexion ROM was measured in degrees using goniometry. Knee-flexion and knee-valgus displacements and vertical and posterior ground reaction forces were calculated during the landing task. Simple correlations were used to evaluate relationships between dorsiflexion ROM and each biomechanical variable.

RESULTS

Significant correlations were noted between extended-knee dorsiflexion ROM and knee-flexion displacement (r  =  0.464, P  =  .029) and vertical (r  =  -0.411, P  =  .014) and posterior (r  =  -0.412, P  =  .014) ground reaction forces. All correlations for flexed-knee dorsiflexion ROM and knee-valgus displacement were nonsignificant.

CONCLUSIONS

Greater dorsiflexion ROM was associated with greater knee-flexion displacement and smaller ground reaction forces during landing, thus inducing a landing posture consistent with reduced ACL injury risk and limiting the forces the lower extremity must absorb. These findings suggest that clinical techniques to increase plantar-flexor extensibility and dorsiflexion ROM may be important additions to ACL injury-prevention programs.

Changes in infraspinatus cross-sectional area and shoulder range of motion with repetitive eccentric external rotator contraction

BACKGROUND

Repetitive eccentric loading results in muscle damage and subsequent changes in muscle stiffness and edema accumulation, which manifest as reduced joint range of motion and increased muscle cross-sectional area. The purpose of the study was to evaluate changes in shoulder range of motion and the infraspinatus cross-sectional area with repetitive eccentric contraction.

METHODS

Twenty physically active participants performed 9 sets of 25 repetitions of eccentric external rotator contractions. The ultrasonographic measurement of the infraspinatus cross-sectional area, and shoulder internal/external rotation and horizontal adduction range of motion were measured before, immediately after, and 24h after the intervention.

FINDINGS

Infraspinatus cross-sectional area significantly increased from baseline immediately after exercise (P<0.001), and remained elevated from baseline at the 24-hour follow up (P<0.001). Internal rotation and horizontal adduction range of motion did not change significantly between baseline and post-exercise (P>0.05), but were significantly decreased at the 24-hour follow up from the baseline (internal rotation: P<0.001, horizontal adduction: P<0.001) and the immediate post-exercise (internal rotation: P=1.012, horizontal adduction: P=0.016).

INTERPRETATION

These changes observed after the eccentric contractions may have implications for injury development in pitchers, because 1) the infraspinatus endures repetitive eccentric loading with pitching and 2) decreased internal rotation and horizontal adduction range of motion have been linked to upper extremity injuries. However, since the muscle response after eccentric loading varies by the task and previous exposure to similar stress, future study needs to investigate the time course of recovery of the muscle cross-sectional area and range of motion after pitching in competitive pitchers.

Collision type and player anticipation affect head impact severity among youth ice hockey players

OBJECTIVE

The objective was to determine how body collision type and player anticipation affected the severity of head impacts sustained by young athletes. For anticipated collisions, we sought to evaluate different body position descriptors during delivery and receipt of body collisions and their effects on head impact severity. We hypothesized that head impact biomechanical features would be more severe in unanticipated collisions and open-ice collisions, compared with anticipated collisions and collisions along the playing boards, respectively.

METHODS

Sixteen ice hockey players (age: 14.0 + or - 0.5 years) wore instrumented helmets from which biomechanical measures (ie, linear acceleration, rotational acceleration, and severity profile) associated with head impacts were computed. Body collisions observed in video footage captured over a 54-game season were evaluated for collision type (open ice versus along the playing boards), level of anticipation (anticipated versus unanticipated), and relative body positioning by using a new tool developed for this purpose.

RESULTS

Open-ice collisions resulted in greater head linear (P = .036) and rotational (P = .003) accelerations, compared with collisions along the playing boards. Anticipated collisions tended to result in less-severe head impacts than unanticipated collisions, especially for medium-intensity impacts (50th to 75th percentiles of severity scores).

CONCLUSION

Our data underscore the need to provide players with the necessary technical skills to heighten their awareness of imminent collisions and to mitigate the severity of head impacts in this sport.

Integrated injury prevention program improves balance and vertical jump height in children

Implementing an injury prevention program to athletes under age 12 years may reduce injury rates. There is limited knowledge regarding whether these young athletes will be able to modify balance and performance measures after completing a traditional program that has been effective with older athletes or whether they require a specialized program for their age. The purpose of this study was to compare the effects of a pediatric program, which was designed specifically for young athletes, and a traditional program with no program in the ability to change balance and performance measures in youth athletes. We used a cluster-randomized controlled trial to evaluate the effects of the programs before and after a 9-week intervention period. Sixty-five youth soccer athletes (males: n = 37 mass = 34.16 +/- 5.36 kg, height = 143.07 +/- 6.27 cm, age = 10 +/- 1 yr; females: n = 28 mass = 33.82 +/- 5.37 kg, height = 141.02 +/- 6.59 cm) volunteered to participate and attended 2 testing sessions in a research laboratory. Teams were cluster-randomized to either a pediatric or traditional injury prevention program or a control group. Change scores for anterior-posterior and medial-lateral time-to-stabilization measures and maximum vertical jump height and power were calculated from pretest and post-test sessions. Contrary with our original hypotheses, the traditional program resulted in positive changes, whereas the pediatric program did not result in any improvements. Anterior-posterior time-to-stabilization decreased after the traditional program (mean change +/- SD = -0.92 +/- 0.49 s) compared with the control group (-0.49 +/- 0.59 s) (p = 0.003). The traditional program also increased vertical jump height (1.70 +/- 2.80 cm) compared with the control group (0.20 +/- 0.20 cm) (p = 0.04). There were no significant differences between control and pediatric programs. Youth athletes can improve balance ability and vertical jump height after completing an injury prevention program. Training specificity appears to affect improvements and should be considered with future program design.

Sagittal-plane trunk position, landing forces, and quadriceps electromyographic activity

CONTEXT

Researchers have suggested that large landing forces, excessive quadriceps activity, and an erect posture during landing are risk factors for anterior cruciate ligament (ACL) injury. The influence of knee kinematics on these risk factors has been investigated extensively, but trunk positioning has received little attention.

OBJECTIVE

To determine the effect of trunk flexion on landing forces and quadriceps activation during landing.

DESIGN

Two (sex) x 2 (task) repeated-measures design.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty healthy, physically active volunteers (20 men, 20 women).

INTERVENTION(S)

Participants performed 2 drop-landing tasks. The first task represented the natural, or preferred, landing strategy. The second task was identical to the first except that participants flexed the trunk during landing.

MAIN OUTCOME MEASURE(S)

We measured peak vertical and posterior ground reaction forces and mean quadriceps electromyographic amplitude during the loading phase of landing (ie, the interval from initial ground contact to peak knee flexion).

RESULTS

Trunk flexion decreased the vertical ground reaction force (P < .001) and quadriceps electromyographic amplitude (P < .001). The effect of trunk flexion did not differ across sex for landing forces or quadriceps electromyographic activity.

CONCLUSIONS

We found that trunk flexion during landing reduced landing forces and quadriceps activity, thus potentially reducing the force imparted to the ACL. Research has indicated that trunk flexion during landing also increases knee and hip flexion, resulting in a less erect landing posture. In combination, these findings support emphasis on trunk flexion during landing as part of ACL injury-prevention programs.

Return of postural control to baseline after anaerobic and aerobic exercise protocols

CONTEXT

With regard to sideline concussion testing, the effect of fatigue associated with different types of exercise on postural control is unknown.

OBJECTIVE

To evaluate the effects of fatigue on postural control in healthy college-aged athletes performing anaerobic and aerobic exercise protocols and to establish an immediate recovery time course from each exercise protocol for postural control measures to return to baseline status.

DESIGN

Counterbalanced, repeated measures.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-six collegiate athletes (18 males, 18 females; age = 19.00 +/- 1.01 years, height = 172.44 +/- 10.47 cm, mass = 69.72 +/- 12.84 kg).

INTERVENTION(S)

Participants completed 2 counterbalanced sessions within 7 days. Each session consisted of 1 exercise protocol followed by postexercise measures of postural control taken at 3-, 8-, 13-, and 18-minute time intervals. Baseline measures were established during the first session, before the specified exertion protocol was performed.

MAIN OUTCOME MEASURE(S)

Balance Error Scoring System (BESS) results, sway velocity, and elliptical sway area.

RESULTS

We found a decrease in postural control after each exercise protocol for all dependent measures. An interaction was noted between exercise protocol and time for total BESS score (P = .002). For both exercise protocols, all measures of postural control returned to baseline within 13 minutes.

CONCLUSIONS

Postural control was negatively affected after anaerobic and aerobic exercise protocols as measured by total BESS score, elliptical sway area, and sway velocity. The effect of exertion lasted up to 13 minutes after each exercise was completed. Certified athletic trainers and clinicians should be aware of these effects and their recovery time course when determining an appropriate time to administer sideline assessments of postural control after a suspected mild traumatic brain injury.