Lower limb stability with ACL impairment

Time series of ground reaction forces following a single leg drop jump landing in elite youth soccer players consist of four distinct phases

The single leg drop jump landing test may assess dynamic and static balance abilities in different phases of the landing. However objective definitions of different phases following landing and associated reliability are lacking. Therefore, we determined the existence of possible distinct phases of single leg drop jump landing on a force plate in 82 elite youth soccer players. Three outcome measures were calculated over moving windows of five sizes: center of pressure (COP) speed, COP sway and horizontal ground reaction force (GRF). Per outcome measure, a Factor Analysis was employed with all windows as input variables. It showed that four factors (patterns of variance) largely (>75%) explained the variance across subjects/trials along the 12s time series. Each factor was highly associated with a distinct phase of the time series signal: dynamic (0.4-2.7s), late dynamic (2.5-5.0s), static 1 (5.0-8.3s) and static 2 (8.1-11.7s). Intra-class correlations (ICC) between trials were lower for the dynamic phases (0.45-0.68) than for the static phases (0.60-0.86). The COP speed showed higher ICC's (0.63-0.86) than COP sway (0.45-0.61) and GRF (0.57-0.71) for all four phases. In conclusion, following a drop jump landing unique information is available in four distinct phases. The COP speed is most reliable, with higher reliability in the static phases compared to the dynamic phases. Future studies should assess the sensitivity of information from dynamic, late dynamic and static phases.

Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk

Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016;46(8):650-657. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6278.

Bilateral and unilateral vertical ground reaction forces and leg asymmetries in soccer players

The purposes of this study were to assess unilateral and bilateral vertical jump performance characteristics, and to compare the vertical ground reaction force characteristics of the impulse and landing phase of a vertical jump between the dominant and non-dominant leg in soccer players. The sample consisted of 20 male soccer players (22.80 ± 2.71 years, 1.88 ± 0.06 m, 76.47 ± 8.80 kg) who competed in the third division of the Spanish football league. Vertical jump performance was determined by testing the impulse and landing phase of a bilateral vertical jump, dominant leg vertical jump and non-dominant leg vertical jump. Significant differences (p < 0.05) between dominant and non-dominant legs were found in counter movement jump (CMJ) flight time (LA = -2.38%, d = 0.33), CMJ flight height (LA = -4.55%, d = 0.33) and CMJ speed take-off (LA = -2.91%, d = 0.42). No significant differences were found between the dominant and non-dominant leg in the F1 and F2 magnitudes during the landing phase, the time from the first contact of the foot with the ground to the production of F1, the time from the second contact of the foot with the ground to the production of F2, and the time to stabilization of the landing phase. Although differences were found between the dominant and non-dominant leg in the impulse phase of the jump, no significant differences were found between dominant and non-dominant legs in the landing phase of vertical jump variables.

The ground reaction force thresholds for detecting postural stability in participants with and without flat foot

Foot mobility commonly contributes to injury via altered motion of the lower extremities. However, there is a lack of understanding of sensitive kinetic changes with flat foot. The purpose of this study was to investigate the threshold that best distinguishes between participants with and without flat foot. The kinetic stability index was developed based on the three-dimensional data from the ground reaction force (GRF) during one leg standing. In total, 34 control participants and 30 participants with flat foot were asked to maintain one leg standing for 25s with the contra lateral hip and knee flexed approximately 90°. The various thresholds (3, 7, 15, 30, 50, and 200N) were analyzed by the kinetic stability index. The standing time was not significantly different between groups (t=1.07, p=0.28); however, there were significant differences on threshold level (F=369.23, p=0.001) as well as group interactions with threshold (F=6.72, p=0.01). The post hoc test indicated that less than 15N was the best to detect the kinetic stability index between the groups. Clinicians need to understand sensitive threshold settings to differentiate the participants with and without flat foot. The threshold changes might be altered to detect postural deficits by the kinetic stability index.

Identification of preferred landing leg in athletes previously injured and uninjured: A brief report

BACKGROUND

The preferred or dominant limb is often subjectively defined by self-report. The purpose was to objectively classify preferred landing leg during landing in athletes previously injured and uninjured.

METHODS

Subjects with a history of anterior cruciate ligament reconstruction (n=101) and uninjured controls (n=57) participated. Three trials of a drop vertical jump were collected. Leg dominance was defined as the leg used to kick a ball while landing leg preference was calculated as the leg which landed first during landing trials. Limb symmetry index was also calculated during a single leg hop battery. The distribution of subjects that landed first on their uninvolved or dominant leg, respectively, was statistically compared. Limb symmetry from the single leg hop tests were compared within each subgroup.

FINDINGS

The distribution of preferred landing leg to uninvolved limb for injured (71%) and dominant limb for controls (63%) was not statistically different between groups (P=0.29). Limb symmetry was decreased in injured subjects that preferred to land on their uninvolved limb compared to their involved limb during single leg (P<0.001), triple (P<0.001), cross-over (P<0.001), and timed hops (P=0.007). Differences in limb symmetry were not statistically different in controls (P>0.05).

INTERPRETATION

The leg that first contacts the ground during landing may be a useful strategy to classify preferred landing leg. Among the injured subjects, 29% preferred to land on their involved leg, which may relate to improved confidence and readiness to return to sport, as improved limb symmetry was present during hop tests.

The effect of time-of-day on static and dynamic balance in recreational athletes

The purpose of this study was to investigate the effect of time-of-day (morning vs. afternoon) on static and dynamic balance in recreational athletes. A total of 34 recreational athletes completed the single-leg stance test with or without eyes open, lower quarter Y-balance test, upper quarter Y-balance test, and single-leg landing balance test in a random order in the morning (7:00-10:00 am) and afternoon (3:00-6:00 pm) for two consecutive days. Compared with the morning, participants demonstrated decreased centre of pressure (COP) sway areas (p = 0.002; Cohen's d (d) = 0.28) and sway speeds (p = 0.002; d = 0.17) during the eyes-open single-leg stance test, increased stance time (p = 0.031; d = 0.16) and decreased COP sway areas (p = 0.029; d = 0.22) during the eyes-closed single-leg stance test, and increased reaching distances (p = 0.024; d = 0.10) during the upper quarter Y-balance test in the afternoon. The between-day effect (day 1 vs. day 2) was observed for several parameters. Time-of-day had a minimal effect on dynamic balance and a noticeable effect on static balance. Time-of-day may be considered as a factor in designing balance training programmes and intervention studies for recreational athletes.

Development and Evaluation of a Drop-and-Stick Method to Assess Landing Skills in Various Levels of Competitive Surfers

The purpose of this study was to develop and evaluate a drop-and-stick (DS) test method and to assess dynamic postural control in senior elite (SE), junior elite (JE), and junior development (JD) surfers. Nine SE, 22 JE, and 17 JD competitive surfers participated in a single testing session. The athletes completed 5 drop-and-stick trials barefoot from a predetermined box height (0.5 m). The lowest and highest time-to-stabilization (TTS) trials were discarded, and the average of the remaining trials was used for analysis. The SE group demonstrated excellent single-measures repeatability (ICC = .90) for TTS, whereas the JE and JD demonstrated good single-measures repeatability (ICC .82 and .88, respectively). In regard to relative peak landing force (rPLF), SE demonstrated poor single-measures reliability compared with JE and JD groups. Furthermore, TTS for the SE (0.69 ± 0.13 s) group was significantly (P = .04) lower than the JD (0.85 ± 0.25 s). There were no significant (P = .41) differences in the TTS between SE (0.69 ± 0.13 s) and JE (0.75 ± 0.16 s) groups or between the JE and JD groups (P = .09). rPLF for the SE (2.7 ± 0.4 body mass; BM) group was significantly lower than the JE (3.8 ± 1.3 BM) and JD (4.0 ± 1.1 BM), with no significant (P = .63) difference between the JE and JD groups. A possible benchmark approach for practitioners would be to use TTS and rPLF as a qualitative measure of dynamic postural control using a reference scale to discriminate among groups.

Postural stability deficits during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects

The goal of this study was to evaluate postural stability during the transition from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament reconstructed (ACLR) (n=20) and non-injured control subjects (n=20). All ACLR subjects had fully returned to their pre-injury sport participation. Both groups were similar for age, gender, height, weight, body mass index and activity level. Spatiotemporal center of pressure outcomes of both legs of each subject were measured during the transition from DLS to SLS in eyes open and eyes closed conditions. Movement speed was standardized. The center of pressure displacement after a new stability point was reached during the SLS phase was significantly increased in the ACLR group compared to the control group in the eyes closed condition (P=.001). No significant different postural stability outcomes were found between the operated and non-operated legs. In conclusion, the ACLR group showed postural stability deficits, indicating that these persons may have a decreased ability to stabilize their body after the internal postural perturbation created by the transition from DLS to SLS. The non-operated leg may not be the best reference when evaluating postural stability of the operated leg after ACLR, as no differences were found between legs.

Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects

BACKGROUND

An anterior cruciate ligament injury may lead to deteriorations in postural stability. The goal of this study was to evaluate postural stability during the transition from double-leg stance to single-leg stance of both legs in anterior cruciate ligament injured subjects and non-injured control subjects with a standardized methodology.

METHODS

Fifteen control subjects and 15 anterior cruciate ligament injured subjects (time after injury: mean (SD)=1.4 (0.7) months) participated in the study. Both groups were similar for age, gender, height, weight and body mass index. Spatiotemporal center of pressure outcomes of both legs of each subject were measured during the transition from double-leg stance to single-leg stance in eyes open and eyes closed conditions. Movement speed was standardized.

FINDINGS

The center of pressure displacement after a new stability point was reached during the single-leg stance phase was significantly increased in the anterior cruciate ligament injured group compared to the control group in the eyes closed condition (P<.001). No significant different postural stability outcomes were found between both legs within both groups (P>.05). No significant differences were found during the transition itself (P>.05).

INTERPRETATION

The anterior cruciate ligament injured group showed postural stability deficits during the single-leg stance phase compared to the non-injured control group in the eyes closed condition. Using the non-injured leg as a normal reference when evaluating postural stability of the injured leg may lead to misinterpretations, as no significant differences were found between the injured and non-injured leg of the anterior cruciate ligament injured group.

Time to stabilization in single leg drop jump landings: an examination of calculation methods and assessment of differences in sample rate, filter settings and trial length on outcome values

Time to stabilization (TTS) is the time it takes for an individual to return to a baseline or stable state following a jump or hop landing. A large variety exists in methods to calculate the TTS. These methods can be described based on four aspects: (1) the input signal used (vertical, anteroposterior, or mediolateral ground reaction force) (2) signal processing (smoothed by sequential averaging, a moving root-mean-square window, or fitting an unbounded third order polynomial), (3) the stable state (threshold), and (4) the definition of when the (processed) signal is considered stable. Furthermore, differences exist with regard to the sample rate, filter settings and trial length. Twenty-five healthy volunteers performed ten 'single leg drop jump landing' trials. For each trial, TTS was calculated according to 18 previously reported methods. Additionally, the effects of sample rate (1000, 500, 200 and 100 samples/s), filter settings (no filter, 40, 15 and 10 Hz), and trial length (20, 14, 10, 7, 5 and 3s) were assessed. The TTS values varied considerably across the calculation methods. The maximum effect of alterations in the processing settings, averaged over calculation methods, were 2.8% (SD 3.3%) for sample rate, 8.8% (SD 7.7%) for filter settings, and 100.5% (SD 100.9%) for trial length. Differences in TTS calculation methods are affected differently by sample rate, filter settings and trial length. The effects of differences in sample rate and filter settings are generally small, while trial length has a large effect on TTS values.

Jump landing characteristics in elite soccer players with cerebral palsy

The aim of the present study was to analyse the parameters that characterize the vertical ground reaction force during the landing phase of a jump, and to determine the relationship among these parameters in elite soccer players with cerebral palsy (CP). Thirteen male members of the Spanish national soccer team for people with CP (mean age: 27.1 ± 4.7 years) volunteered for the study. Each participant performed three counter movement jumps. The characteristics of the first peak of the vertical ground reaction force during the landing phase of a jump, which corresponds to the forefoot contact with the ground, were similar to the results obtained in previous studies. However, a higher magnitude of rearfoot contact with the ground (F2) was observed in participants with CP than in participants without CP. Furthermore, a significant correlation between F2 magnitude and the elapsed time until its production (T2) was not observed (r = -0.474 for p = 0.102). This result implies that a landing technique based on a delay in the production of F2 might not be effective to reduce its magnitude, contrary to what has been observed in participants without CP. The absence of a significant correlation between these two parameters in the present study, and the high magnitude of F2, suggest that elite soccer players with CP should use footwear with proper cushioning characteristics.

The effects of ankle Kinesio taping on ankle stiffness and dynamic balance

The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.

A diagonal landing task to assess dynamic postural stability in ACL reconstructed females

BACKGROUND

Previous research has used time to stabilization (TTS) from forward landing tasks to assess dynamic postural stability in ACL reconstructed (ACLR) athletes in order to identify impaired sensorimotor control and mechanical stability. This may not be an appropriate test due to the fact that research has suggested that ACL injury has a multi-planar mechanism of injury. The purpose of the present study was to compare TTS values from a forward land and a diagonal land to determine if diagonal landing TTS values are more sensitive to dynamic postural stability deficits in female ACLR athletes.

METHODS

A group of ACL reconstructed female athletes and a group of female control athletes performed three forward lands and three diagonal lands onto a force-plate and remained still on one foot for 15s. TTS was calculated for the anterior-posterior and medial-lateral ground reaction forces as well as the resultant vector of both forces.

RESULTS

All three TTS values were significantly increased in the ACLR group from the control group for the diagonal landing task. There was no difference in TTS values between the groups for the forward landing task.

CONCLUSION

TTS values from a diagonal landing are more sensitive at detecting impaired dynamic postural stability in a group of female ACLR athletes compared to TTS values from a forward land.

LEVEL OF EVIDENCE

III - Casecontrolled study.

The Effect of Jump-Landing Directions on Dynamic Stability

Dynamic stability is often measured by time to stabilization (TTS), which is calculated from the dwindling fluctuations of ground reaction force (GRF) components over time. Common protocols of dynamic stability research have involved forward or vertical jumps, neglecting different jump-landing directions. Therefore, the purpose of the present investigation was to examine the influence of different jump-landing directions on TTS. Twenty healthy participants (9 male, 11 female; age = 28 ± 4 y; body mass = 73.3 ± 21.5 kg; body height = 173.4 ± 10.5 cm) completed the Multi-Directional Dynamic Stability Protocol hopping tasks from four different directions—forward, lateral, medial, and backward—landing single-legged onto the force plate. TTS was calculated for each component of the GRF (ap = anterior-posterior; ml = medial-lateral; v = vertical) and was based on a sequential averaging technique. All TTS measures showed a statistically significant main effect for jump-landing direction. TTSml showed significantly longer times for landings from the medial and lateral directions (medial: 4.10 ± 0.21 s, lateral: 4.24 ± 0.15 s, forward: 1.48 ± 0.59 s, backward: 1.42 ± 0.37 s), whereas TTSap showed significantly longer times for landings from the forward and backward directions (forward: 4.53 ± 0.17 s, backward: 4.34 0.35 s, medial: 1.18 ± 0.49 s, lateral: 1.11 ± 0.43 s). TTSv showed a significantly shorter time for the forward direction compared with all other landing directions (forward: 2.62 ± 0.31 s, backward: 2.82 ± 0.29 s, medial: 2.91 ± 0.31 s, lateral: 2.86 ± 0.32 s). Based on these results, multiple jump-landing directions should be considered when assessing dynamic stability.

Examining the diagnostic accuracy of dynamic postural stability measures in differentiating among ankle instability status

BACKGROUND

Dynamic postural stability is defined as the ability to transition from a dynamic movement to a stable condition over one's base of support. Measures of dynamic stability have been used extensively to classify ankle instability status and assist clinicians with ankle injury interventions. Therefore, the purpose of this study was to determine if current methods of quantifying dynamic stability are accurate in differentiating among healthy, coper, and unstable ankles.

METHODS

One hundred ninety four Division-I collegiate athletes (football, volleyball, field hockey, men's/women's soccer, men's/women's lacrosse, men's/women's basketball) volunteered for this study. Participants were categorized into healthy, coper, and stable groups by a self-reported questionnaire and previous history of ankle injuries. Dynamic postural stability was assessed using the Multi-Directional Dynamic Stability Protocol by jumping and landing single-legged onto a force platform from four different directions. Receiver operator curves were used to analyze the accuracy of current techniques of calculating dynamic stability among groups.

FINDINGS

None of the existing methods were found to be accurate in differentiating ankle instability status in any of the jump landings.

INTERPRETATION

Researchers have commonly used these existing methods to quantify dynamic postural stability. None of the current calculation techniques worked with our jump landing protocol. Researchers need to pay attention to the protocol and calculation technique pairings in that using inaccurate measures of dynamic postural stability makes any findings of that research ineffective. Therefore, this challenges researchers to develop a more accurate calculation to quantify dynamic postural stability, or develop a jump landing protocol that exposes sensorimotor deficits in the more able-bodied population.

Sway activity and muscle recruitment order during transition from double to single-leg stance in subjects with chronic ankle instability

Subjects with CAI (chronic ankle instability) are slower in activating their leg muscles when shifting weight (from double to single leg stance; DLS and SLS). We examined if these delays are associated with longer transition/stabilization times. This was tested by analyzing the center of pressure (COP) trajectory data (1) in the DLS phase before onset of transition, (2) in the quasi-stable phase of the SLS, immediately after the transition phase but before time to stabilization (TTS) and (3) in the SLS phase after TTS. Data were recorded from 20 subjects with CAI and 20 controls. The TTS was longer for the CAIs than for controls (3.25 vs. 2.28 s in EO and 3.41 vs. 2.51 s in EC; p<0.001). Similarly, the time of transition (TTR) was prolonged in CAIs (1.48 vs. 1.14 s in EO and 1.53 vs. 1.20 s in EC; p<0.05). These prolonged periods came in parallel with an increase in the ML sway in the quasi-stable phase (mean displacement 2.20 vs. 1.75 cm in EO; 3.37 vs. 2.62 cm in EC; significant for EC p<0.05). The TTR in CAIs was positively correlated with time onsets of the adductor longus muscle during transitions with EC (R=0.51, p=0.03). The findings support the use of a weight-shifting paradigm for the evaluation of balance control in CAI. Specifically, we underscore the transition phase and quasi-stable phase of the SLS as promising time windows for documenting balance control deficits in CAI.

Distance reached in the Anteromedial Reach Test as a function of learning and leg length

The anteromedial reach test (ART) is a new outcome measure for assessing dynamic knee stability in anterior cruciate ligament-injured patients. The effect of learning and leg length on distance reached in the ART was examined. Thirty-two healthy volunteers performed 15 trials of the ART on each leg. There was a moderate correlation (r = .44-.50) between reach distance and leg length, therefore reach distances were normalized for leg length. Normalized reach distance increased significantly over the 15 trials (p < .01), reaching a plateau after 8 trials, identified by a moving average graph. It is recommended that participants be afforded eight practice trials and that reach distances be normalized by expressing them as a percentage of leg length.

Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction

BACKGROUND

More than 2 years after undergoing anterior cruciate ligament (ACL) reconstruction, women still present bilateral asymmetries during multijoint movement tasks. Given the well-known ACL-injury gender bias, the goal of this study was to investigate whether males also present such asymmetries more than 2 years after undergoing ACL reconstruction.

METHODS

This study involved 12 participants submitted to ACL reconstruction in the ACL group and 17 healthy participants in the control group. The mean postoperative period was 37 months. The participants executed bilateral countermovement jumps and load squat tasks. The kinematics and ground reaction forces on each lower limb and pelvis were recorded, and used to compute bilateral peak vertical ground reaction forces, peak knee and hip joint powers in the sagittal plane, and the ratio between these powers.

RESULTS

For the jump task, the groups had the same performance in the jump height, but for the ACL group the peak knee joint power on the operated side was 13% lower than on the non-operated side (p = 0.02). For the squat task, the hip-knee joint power ratio on the operated side of the ACL group was 31% greater than on the non-operated side (p = 0.02).

CONCLUSIONS

The ACL group presented a deficit in the operated knee that had its energy generation over time (joint power) partially substituted by the hip joint power of the same side. The fact that, even after more than 2 years following the ACL reconstruction and returning to regular activity, the ACL group still had neuromuscular asymmetries suggests a need for improvement in the ACL reconstruction surgery procedures and/or rehabilitation protocols.

Time to stability differences between male and female dancers after landing from a jump on flat and inclined floors

OBJECTIVE

To determine the effect of gender and inclined floor on time to stability (TTS) after landing from a vertical jump.

DESIGN

This study used a repeated measures design with male and female professional dancers landing on a flat and 4 inclined floors. A repeated measures univariate analysis of variance (gender × floor) was performed on TTS in the anterior-posterior and medial-lateral directions.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Twenty-three female and 13 male professional dancers.

INDEPENDENT VARIABLES

Gender and floor inclination (flat, posterior, anterior, lateral, and medial).

MAIN OUTCOME MEASURES

Time to stability in the anterior-posterior and medial-lateral directions after landing from a vertical jump.

RESULTS

Female dancers exhibited longer TTS in both directions (P ≤ 0.05). Floor inclination or the interaction of gender × floor did not have an effect on TTS (P > 0.3).

CONCLUSIONS

Female dancers exhibited longer TTS after landing from a vertical jump compared with their male counterparts. This balance difference may be a factor related to the higher rate of ankle sprain among female dancers. Additionally, professional dancers exhibited similar TTS when landing on flat and inclined floors.

Time to stabilization of anterior cruciate ligament-reconstructed versus healthy knees in National Collegiate Athletic Association Division I female athletes

CONTEXT

Jump landing is a common activity in collegiate activities, such as women's basketball, volleyball, and soccer, and is a common mechanism for anterior cruciate ligament (ACL) injury. It is important to better understand how athletes returning to competition after ACL reconstruction are able to maintain dynamic postural control during a jump landing.

OBJECTIVE

To use time to stabilization (TTS) to measure differences in dynamic postural control during jump landing in ACL-reconstructed (ACLR) knees compared with healthy knees among National Collegiate Athletic Association Division I female athletes.

DESIGN

Case-control study.

SETTING

University athletic training research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-four Division I female basketball, volleyball, and soccer players volunteered and were assigned to the healthy control group (n  =  12) or the ACLR knee group (n  =  12). Participants with ACLR knees were matched to participants with healthy knees by sport and by similar age, height, and mass.

INTERVENTION(S)

At 1 session, participants performed a single-leg landing task for both limbs. They were instructed to stabilize as quickly as possible in a single-limb stance and remain as motionless as possible for 10 seconds.

MAIN OUTCOME MEASURE(S)

The anterior-posterior TTS and medial-lateral TTS ground reaction force data were used to calculate resultant vector of the TTS (RVTTS) during a jump landing. A 1-way analysis of variance was used to determine group differences on RVTTS. The means and SDs from the participants' 10 trials in each leg were used for the analyses.

RESULTS

The ACLR group (2.01 ± 0.15 seconds, 95% confidence interval [CI]  =  1.91, 2.10) took longer to stabilize than the control group (1.90 ± 0.07 seconds, 95% CI  =  1.86, 1.95) (F(1,22)  =  4.28, P  =  .05). This result was associated with a large effect size and a 95% CI that did not cross zero (Cohen d  =  1.0, 95% CI  =  0.91, 1.09).

CONCLUSIONS

Although they were Division I female athletes at an average of 2.5 years after ACL reconstruction, participants with ACLR knees demonstrated dynamic postural-control deficits as evidenced by their difficulty in controlling ground reaction forces. This increased TTS measurement might contribute to the established literature reflecting differences in single-limb dynamic control. Clinicians might need to focus rehabilitation efforts on stabilization after jump landing. Further research is needed to determine if TTS is a contributing factor in future injury.

The assessment of function: How is it measured? A clinical perspective

Testing for outcome or performance can take many forms; including multiple iterations of self-reported measures of function (an assessment of the individual's perceived dysfunction) and/or clinical special tests (which are primarily assessments of impairments). Typically absent within these testing mechanisms is whether or not one can perform a specific task associated with function. The paper will operationally define function, discuss the construct of function within the disablement model, will overview the multi-dimensional nature of 'function' as a concept, will examine the current evidence for functional testing methods, and will propose a functional testing continuum. Limitations of functional performance testing will be discussed including recommendations for future research.

Whole body, long-axis rotational training improves lower extremity neuromuscular control during single leg lateral drop landing and stabilization

BACKGROUND

Poor neuromuscular control during sports activities is associated with non-contact lower extremity injuries. This study evaluated the efficacy of progressive resistance, whole body, long-axis rotational training to improve lower extremity neuromuscular control during a single leg lateral drop landing and stabilization.

METHODS

Thirty-six healthy subjects were randomly assigned to either Training or Control groups. Electromyographic, ground reaction force, and kinematic data were collected from three pre-test, post-test trials. Independent sample t-tests with Bonferroni corrections for multiple comparisons were used to compare group mean change differences (P≤0.05/21≤0.0023).

FINDINGS

Training group gluteus maximus and gluteus medius neuromuscular efficiency improved 35.7% and 31.7%, respectively. Training group composite vertical-anteroposterior-mediolateral ground reaction force stabilization timing occurred 1.35s earlier. Training group knee flexion angle at landing increased by 3.5°. Training group time period between the initial two peak frontal plane knee displacements following landing increased by 0.17s. Training group peak hip and knee flexion velocity were 21.2°/s and 20.1°/s slower, respectively. Time period between the initial two peak frontal plane knee displacements following landing and peak hip flexion velocity mean change differences displayed a strong relationship in the Training group (r(2)=0.77, P=0.0001) suggesting improved dynamic frontal plane knee control as peak hip flexion velocity decreased.

INTERPRETATION

This study identified electromyographic, kinematic, and ground reaction force evidence that device training improved lower extremity neuromuscular control during single leg lateral drop landing and stabilization. Further studies with other populations are indicated.

Single leg jumping neuromuscular control is improved following whole body, long-axis rotational training

Improved lower extremity neuromuscular control during sports may decrease injury risk. This prospective study evaluated progressive resistance, whole body, long-axis rotational training on the Ground Force 360 device. Our hypothesis was that device training would improve lower extremity neuromuscular control based on previous reports of kinematic, ground reaction force (GRF) or electromyographic (EMG) evidence of safer or more efficient dynamic knee stability during jumping. Thirty-six healthy subjects were randomly assigned to either training (Group 1) or control (Group 2) groups. Using a pre-test, post-test study design data were collected from three SLVJ trials. Unpaired t-tests with adjustments for multiple comparisons were used to evaluate group mean change differences (P≤0.05/25≤0.002). During propulsion Group 1 standardized EMG amplitude mean change differences for gluteus maximus (-21.8% vs. +17.4%), gluteus medius (-28.6% vs. +15.0%), rectus femoris (-27.1% vs. +11.2%), vastus medialis (-20.2% vs. +9.1%), and medial hamstrings (-38.3% vs. +30.3%) differed from Group 2. During landing Group 1 standardized EMG amplitude mean change differences for gluteus maximus (-32.9% vs. +11.1%) and rectus femoris (-33.3% vs. +29.0%) also differed from Group 2. Group 1 peak propulsion vertical GRF (+0.24N/kg vs. -0.46N/kg) and landing GRF stabilization timing (-0.68 vs. +0.05s) mean change differences differed from Group 2. Group 1 mean hip (-16.3 vs. +7.8°/s) and knee (-21.4 vs. +18.5°/s) flexion velocity mean change differences also differed from Group 2. Improved lower extremity neuromuscular efficiency, increased peak propulsive vertical GRF, decreased mean hip and knee flexion velocities during landing, and earlier landing stabilization timing in the training group suggests improved lower extremity neuromuscular control.

Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport

BACKGROUND

Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes.

HYPOTHESES

Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury.

STUDY DESIGN

Cohort study (prognosis); Level of evidence, 2.

METHODS

Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury.

RESULTS

Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81).

CONCLUSION

Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.

Alterations in knee kinematics and dynamic stability associated with chronic ankle instability

CONTEXT

Chronic ankle instability (CAI) has been previously and separately associated with deficits in dynamic stability and proximal joint neuromuscular alterations, but how the 2 factors relate is unclear.

OBJECTIVE

To examine the contributions of lower extremity kinematics during an assessment of dynamic stability in participants with CAI.

DESIGN

Repeated-measures case-control design.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-eight volunteers were categorized into groups of those with unilateral CAI (10 men, 9 women; age = 20.3 +/- 2.9 years, height = 1.77 +/- 0.1 m, mass = 76.19 +/- 13.19 kg) and those without (10 men, 9 women; age = 23.1 +/- 3.9 years, height = 1.72 +/- 0.1 m, mass = 72.67 +/- 16.0 kg).

INTERVENTION(S)

Participants performed 10 jump landings on each limb with a rest period between test limbs.

MAIN OUTCOME MEASURE(S)

Ankle plantar flexion, knee flexion, and hip flexion were captured with an electromagnetic tracking device at the point of ground impact. Ground reaction force data were used to calculate time to stabilization in the anteroposterior and mediolateral planes.

RESULTS

For the anteroposterior plane, we found a group-by-side interaction (P = .003), with the injured side of the CAI group demonstrating reduced dynamic stability. For knee flexion, a group main effect (P = .008) showed that the CAI group landed with less knee flexion than the control group.

CONCLUSIONS

Diminished dynamic stability and decreased knee flexion angle at initial contact were apparent in the CAI group and may play a role in contributing to CAI. This altered kinematic pattern may influence preventive and therapeutic interventions for those with CAI.

Lower extremity compensatory neuromuscular and biomechanical adaptations 2 to 11 years after anterior cruciate ligament reconstruction

PURPOSE

To determine whether compensatory neuromuscular and biomechanical adaptations exist after successful anterior cruciate ligament reconstruction and rehabilitation.

METHODS

Seventy subjects, 5.3 +/- 3 years after surgery, participated in this study. Sagittal-plane lower extremity kinematic, gluteus maximus, vastus medialis, medial hamstring, and gastrocnemius electromyography (EMG) and vertical ground reaction force data were collected during single-leg countermovement jump (CMJ) performance.

RESULTS

Women had lower propulsive and landing forces, lower CMJ heights, less hip and knee flexion, and greater angular hip, knee, and ankle velocities than men (P < or = .014). The involved lower extremity of men and women had decreased landing forces (P = .008). During propulsion, men and women had increased involved-lower extremity gluteus maximus (P < .0001) and decreased vastus medialis (P = .013) EMG amplitudes, whereas women had bilaterally increased gastrocnemius EMG amplitudes compared with men (P = .003). During propulsion, men had longer gluteus maximus and vastus medialis EMG durations than women (P < .0001). During landing, both men and women had increased gluteus maximus EMG amplitudes at the involved lower extremity (P < .0001). Women had increased vastus medialis (P = .01) and gastrocnemius (P < .0001) EMG amplitudes compared with men. During landing, men had longer gluteus maximus (P = .004), vastus medialis (P = .012), and gastrocnemius (P = .007) EMG durations than women and the involved-lower extremity vastus medialis EMG durations of both men and women were shorter than at the noninvolved lower extremity (P = .011).

CONCLUSIONS

Decreased involved-lower extremity landing forces, decreased vastus medialis activation, and increased gluteus maximus and gastrocnemius activation suggest a protective mechanism to minimize knee loads that increase anterior translatory knee forces during single-leg jumping. Women showed more balanced gluteus maximus, vastus medialis, and gastrocnemius contributions to dynamic knee stability than men during CMJ landings but used shorter activation durations.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

The effect of fatigue on landing biomechanics in single-leg drop landings

OBJECTIVE

To examine the effects of fatigue on landing biomechanics in single-leg drop landings.

DESIGN

Quasi-experimental.

SETTING

Controlled research laboratory.

PARTICIPANTS

Twenty-four healthy individuals (12 women and 12 men).

INTERVENTIONS

Participants performed 3 single-leg drop landings from a height of 0.36 m before and after a fatiguing protocol.

MAIN OUTCOME MEASURES

Sagittal ankle flexion, sagittal knee flexion, and frontal knee valgus angles (degrees) at initial ground contact; vertical ground reaction forces (N); and time to stabilization (TTS) were compared between sexes and before (pre) and after (post) the fatiguing protocol.

RESULTS

After fatigue, participants landed with greater knee flexion [P = 0.001; pre 142.58 (14.35) degrees; post 136.12 (14.48) degrees] and ankle plantar flexion [P = 0.012; pre 79.04 (6.96) degrees; post 80.78 (6.13) degrees], and higher peak vertical ground reaction forces (P = 0.002; pre 2202.5 (536.29) N to post 2537.86 (469.66) N] but did not show changes in frontal knee angles [P = 0.815; pre, 7.94 (3.74) degrees; post, 8.08 (4.33) degrees]. Participants had higher anterior-posterior TTS [P = 0.021; pre 1.73 (0.53) seconds to post 1.93 (0.53) seconds] and vertical TTS [P = 0.002; pre 0.65 (0.24) seconds to post 0.93 (0.37) seconds] with a significant interaction noted in medial-lateral TTS [P = 0.043; pre 1.49 (0.64) seconds to post 1.61 (0.67) seconds]. No significant sex differences existed across any of the examined variables.

CONCLUSIONS

When landing after fatigue, participants had greater knee and ankle flexion angles at initial contact, had greater peak ground reaction forces, and required longer times to stabilize the body after landing, regardless of sex. Overall, fatigue clearly affects lower body biomechanics during single-leg landings. Whether these changes actually increase injury risk during activity warrants further investigation.

Altered force ratio in unanticipated side jumps after treadmill run

OBJECTIVE

The aim was to investigate the influence of a run at the individual anaerobic threshold (IAT) on postural control in jumps with an unanticipated change of direction.

HYPOTHESIS

Dynamic postural control is less affected by the run in trained athletes than in recreational ones.

DESIGN

: Controlled prospective cohort study with an intervention.

SETTING

Biomechanics laboratory.

PARTICIPANTS

A total of 18 female high-level handball and volleyball players, 16 female and 8 male recreational athletes, with a mean age of 21.7 +/-4.1 years.

INTERVENTIONS

In the jump test, the ball switch, hit above the force plate during a forward jump, triggers indicator lamps on either side. After landing on the dominant leg, a second jump 90 degrees sideways following a light signal or a stabilization in one-leg stance was required. Nine jumps (randomized order) were performed before and at 1, 5, 10, 15 and 20 min after a 30-min treadmill run at the IAT.

MAIN OUTCOME MEASUREMENTS

For the second jump, the ratio of the absolute values of the maximum forces in anteroposterior and mediolateral direction was calculated as a parameter of dynamic postural control in the change of direction.

RESULTS

In both groups, the force ratio increased significantly at 1 and 5 min after the treadmill run. The relative increase did not differ between groups. Dynamic postural control in transfer from a forward to a sideward jump was reduced after the run. Recovery occurred within 10 min.

CONCLUSIONS

This study shows that dynamic postural control in jumps with an unanticipated change of direction is influenced by fatigue. These findings could be used to develop training programs aimed at reducing lower limb injuries in high-level ball sport athletes. The preventive effects have to be evaluated in further studies.

Influences of hip external rotation strength on knee mechanics during single-leg drop landings in females

BACKGROUND

To determine the influence of hip external rotation strength on kinematic and kinetic variables during single-leg drop landings.

METHODS

Females were divided into strong and weak groups based on isometric hip external rotation strength and lower extremity flexion-extension and varus-valgus kinematics and kinetics were evaluated during single-legged 40 cm drop landings.

FINDINGS

Hip external rotation strength had no effect on sagittal or frontal plane angular motion throughout the landing cycle at the hip and knee. The strong group generated a statistically significant decrease in the peak vertical ground reaction force and external knee flexor moment. The weak group produced a greater external knee adduction moment, net knee anterior shear joint reaction force, and a greater hip external adduction moment.

INTERPRETATION

Subjects with greater hip and quadriceps/hamstring strength exhibited a significant decrease in the vertical ground reaction force and external knee adduction and flexor moments. Hip and knee strength appear to relate to differences in high risk landing strategies.

Ankle bracing, fatigue, and time to stabilization in collegiate volleyball athletes

CONTEXT

Fatigue has been shown to disrupt dynamic stability in healthy volunteers. It is not known if wearing prophylactic ankle supports can improve dynamic stability in fatigued athletes.

OBJECTIVE

To determine the type of ankle brace that may be more effective at providing dynamic stability after a jump-landing task during normal and fatigued conditions.

DESIGN

Two separate repeated-measures analyses of variance with 2 within-subjects factors (condition and time) were performed for each dependent variable.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Ten healthy female collegiate volleyball athletes participated (age = 19.5 +/- 1.27 years, height = 179.07 +/- 7.6 cm, mass = 69.86 +/- 5.42 kg).

INTERVENTION(S)

Athletes participated in 3 separate testing sessions, applying a different bracing condition at each session: no brace (NB), Swede-O Universal lace-up ankle brace (AB), and Active Ankle brace (AA). Three trials of a jump-landing task were performed under each condition before and after induced functional fatigue. The jump-landing task consisted of a single-leg landing onto a force plate from a height equivalent to 50% of each participant's maximal jump height and from a starting position 70 cm from the center of the force plate.

MAIN OUTCOME MEASURE(S)

Time to stabilization in the anterior-posterior (APTTS) and medial-lateral (MLTTS) directions.

RESULTS

For APTTS, a condition-by-time interaction existed (F(2,18) = 5.55, P = .013). For the AA condition, Tukey post hoc testing revealed faster pretest (2.734 +/- 0.331 seconds) APTTS than posttest (3.817 +/- 0.263 seconds). Post hoc testing also revealed that the AB condition provided faster APTTS (2.492 +/- 0.271 seconds) than AA (3.817 +/- 0.263 seconds) and NB (3.341 +/- 0.339 seconds) conditions during posttesting. No statistically significant findings were associated with MLTTS.

CONCLUSIONS

Fatigue increased APTTS for the AA condition. Because the AB condition was more effective than the other 2 conditions during the posttesting, the AB appears to be the best option for providing dynamic stability in the anterior-posterior direction during a landing task.

Jump-landing direction influences dynamic postural stability scores

The purpose of this investigation was to determine dynamic postural stability differences among forward, diagonal, and lateral single leg-hop-stabilization protocols in healthy subjects. A one-within repeated measures design was used to determine the effects of jump direction on dynamic postural stability during landing. Subjects were required to perform a two-legged forward, diagonal, and lateral jump to a height equivalent to 50% of their maximum vertical leap, land on a single leg and balance for three seconds. Twenty-six subjects [10 males (22+/-3.9 years of age, 70.9+/-7.6kg, and 176.8+/-6.5cm) and 16 females (20.6+/-.5 years of age, 65.6+/-9.1kg, and 166.4+/-5.9cm)] volunteered to participate in this investigation. Dynamic postural stability indices for the anterior/posterior, medial/lateral, and vertical planes were collected during jump-landing trials of each direction. The results of the investigation show that medial/lateral and vertical dynamic postural stability were significantly affected by the direction of the jump. More specifically, lateral and diagonal jump-landings produce increased medial/lateral stability index (MLSI) scores and forward jump-landings produce increased vertical stability index (VSI) scores. The results suggest that in a healthy population, jump protocol direction will statistically affect dynamic postural stability in the frontal and vertical planes. These alterations could be exacerbated in individuals with lower extremity impairments and further research is warranted.

Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction

The hamstrings musculature is a vital component of an intricate dynamic knee joint restraint mechanism. However, there is evidence based on research studies suggesting potential deficits to this complex mechanism due to donor site morbidity resulting from harvest of the ipsilateral semitendinosus and gracilis autograft (ISGA) for anterior cruciate ligament reconstruction (ACLR). The purpose of this retrospective research study was to investigate the effects of ISGA ACLR on neuromuscular and biomechanical performance during a single-leg vertical drop landing (VDL), a functional task and associated mechanism of anterior cruciate ligament disruption during physical activity. Fourteen physically active participants 22.5 +/- 4.1 years of age and 21.4 +/- 10.7 months post ISGA ACLR underwent bilateral neuromuscular, biomechanical and isokinetic strength and endurance evaluations matched to 14 control participants by sex, age, height and mass. Kinetic and kinematic data was obtained with 3-D motion analyses utilizing inverse dynamics while performing single-leg VDLs from a height of 30 cm. Integrated surface electromyography (SEMG) assessments of the quadriceps, hamstrings and gastrocnemius musculature were also conducted. Additionally, knee joint flexion strength (60 degrees s(-1)) and endurance (240 degrees s(-1)) measurements were tested via isokinetic dynamometry. No significant differences existed in hip and net summated extensor moments within or between groups. The ISGA ACLR participants recorded significantly decreased peak vertical ground reaction force (VGRF) landing upon the involved lower extremity compared to uninvolved (P = 0.028) and matched (P < 0.0001) controls. Participants having undergone ISGA ACLR also displayed greater peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.020) and matched (P = 0.026) controls at initial ground contact. The ISGA ACLR group furthermore exhibited increased peak hip joint flexion angles landing upon the involved lower extremity compared to uninvolved (P = 0.019) and matched (P = 0.007) controls at peak VGRF. Moreover, ISGA ALCR participants demonstrated greater peak knee (P = 0.005) and ankle (P = 0.017) joint flexion angles when landing upon the involved lower extremity compared to the matched control at peak VGRF. The ISGA ACLR group produced significantly greater reactive muscle activation of the vastus medialis (P = 0.013), vastus lateralis (P = 0.008) and medial hamstrings (P = 0.024) in the involved lower extremity compared to the matched control. The ISGA ACLR participants also exhibited greater preparatory (P = 0.033) and reactive (P = 0.022) co-contraction muscle activity of the quadriceps and hamstrings landing upon the involved lower extremity compared to the matched control. In addition, the ISGA ACLR group produced significantly less preparatory (P = 0.005) and reactive (P = 0.010) muscle activation of the gastrocnemius in the involved lower extremity compared to the uninvolved control. No significant differences were present in hamstrings muscular strength and endurance. Harvest of the ISGA for purposes of ACLR does not appear to result in significant neuromuscular, biomechanical or strength and endurance deficiencies due to donor site morbidity. However, it is evident that this specific population exhibits unique neuromuscular and biomechanical adaptations aimed to stabilize the knee previously subjected to ACL trauma and safeguard the ISGA ACLR joint. Co-contraction of quadriceps and hamstrings as well as inhibition of gastrocnemius muscle activation may serve to moderate excessive loads exposed to the intra-articular ISGA during single-leg VDLs. Furthermore, greater muscle activation of the hamstrings in conjunction with increased peak hip, knee and ankle joint flexion angles may assist in enhancing acceptance of VGRF transferred through the kinetic chain following single-leg VDLs.

Movement discrimination after intra-articular local anaesthetic of the ankle joint

BACKGROUND

The effect on clinical safety of dampening articular mechanoreceptor feedback at the ankle is unknown. Injection of the ankle joint for pain control may result in such dampening. Athletes receiving intra-articular local anaesthetic may therefore be at increased risk of sustaining ankle injuries, which are a common reason for missed sporting participation.

OBJECTIVE

To determine the effect of intra-articular local anaesthetic on movement discrimination at the ankle joint.

DESIGN

Prospective, randomised, double-blinded, placebo-controlled, cross-over trial.

SETTING

Australian Institute of Sport Medical Centre, Canberra, Australia.

PATIENTS

Twenty two healthy subjects (44 ankles) aged 18-26 were recruited for the three visits of the study.

INTERVENTIONS

Subjects were tested for their initial movement discrimination scores using the active movement extent discrimination apparatus (AMEDA). They then received ultrasound-guided intra-articular injections of local anaesthetic (2% lignocaine hydrochloride) or normal saline, on two separate later occasions, before further AMEDA assessment.

MAIN OUTCOME MEASURES

Change in movement discrimination scores after intra-articular injection of local anaesthetic or saline.

RESULTS

Movement discrimination scores were not significantly different from control ankles after injection of either local anaesthetic or saline into the ankle joint.

CONCLUSIONS

The intra-articular injection of neither 2 ml lignocaine nor an equivalent amount of normal saline resulted in significant effects on movement discrimination at the ankle joint. These results suggest that injections of local anaesthetic into the ankle joint are unlikely to significantly affect proprioception and thereby increase injury risk.

Test-Retest Reliability of Three Dynamic Tests Obtained from Active Females Using the Neurocom Balance Master

Context:

There is a growing need for objective measures of proprioception and balance in athletic females.

Objective:

To determine the intertester and intratester reliability of the Neurocom Balance Master (NBM) forward lunge (FL), step up and over (SUO), and step quick turn (SQT) tests on a young, healthy, female population.

Design:

Repeated measures design.

Setting:

University medical laboratory.

Participants:

15 young healthy female volunteers (height 155.1 cm ± 18.5 cm, mass 61.1 kg ± 7.3 kg, age 24.2 years ± 2.9 years).

Measurements:

The average of three trials on the FL, SUO, and SQT taken during each of three testing sessions on the NBM long force plate.

Results:

Inter and intratester reliability for the FL (ICC r = 0.71 to r = 0.93) and SQT (ICC r = 0.70 to r = 0.88) ranged from good to excellent while reliability for the SUO ranged from fair to excellent (ICC r = 0.59 to r = 0.92).

Conclusions:

The three NBM tests are reliable in healthy, young, physically active females.

Gender and limb differences in dynamic postural stability during landing

OBJECTIVE

To determine if gender and limb dominance affect dynamic postural stability and vertical ground reaction force data during jump landings. Secondary objective was to assess the reliability of the dynamic postural stability index (DPSI).

DESIGN

A mixed model (2 genderx2 limb) repeated measures design was used to determine the effects of gender and limb dominance on dynamic postural stability. Subjects were required to perform a two-legged jump to a height equivalent of 50% of their maximum vertical leap, land on a single-leg and balance for three seconds.

SETTING

Sports Medicine Research Laboratory.

PARTICIPANTS

Forty healthy subjects (20 men, 20 women) participated in this investigation.

MAIN OUTCOME MEASURES

The DPSI and its directional components quantified dynamic postural stability during a single-leg jump landing. Normalized vertical ground reaction force data quantified energy absorption.

RESULTS

DPSI values revealed that females had significantly different dynamic postural stability as compared to males in the vertical plane [T (78)=-4.2, P<0.01], and in the composite score (dynamic postural stability index) [T (78)=-6.3, P<0.01]. In addition, females had significantly higher peak vertical ground reaction forces [T (78)=-13, P=0.01] than males. The DPSI also showed excellent reliability (ICC=0.96), with a 95% confidence interval ranging from 0.94 to 0.97.

CONCLUSIONS

The results indicate that females have higher dynamic postural stability scores in the vertical direction as well as the composite score. This suggests that females used different dynamic postural stability strategies than males. There were no side-to-side dynamic postural stability differences between healthy contralateral limbs.

Gender differences in hip adduction motion and torque during a single-leg agility maneuver

The purpose of this study was to identify gender differences in hip motion and kinetics during a single leg bidirectional deceleration maneuver. The rationale for the development of this maneuver was to test dynamic hip control during the deceleration of three different types of single-leg landings. The hypothesis was that female athletes would display increased hip adduction angles and moments during the maneuver compared to male athletes. Thirty-six collegiate soccer players (19 female, 17 male) volunteered to participate. Subjects were instructed to start the maneuver balancing on one foot, to hop through an agility-speed ladder on the same leg "up two boxes, back one, and then up one and hold it." Hip kinematics and kinetics during all three landings were examined. Females demonstrated significantly greater hip adduction angles at initial contact during all three landings and greater maximal hip adduction during landings 1 and 2 compared to male athletes. Females also exhibited significantly increased external hip adduction moments during landing 1, however, no differences were found between genders during landings 2 and 3.

Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors

The mechanism underlying gender disparity in anterior cruciate ligament injury risk is likely multifactorial in nature. Several theories have been proposed to explain the mechanisms underlying the gender difference in anterior cruciate ligament injury rates. These theories include the intrinsic variables of anatomical, hormonal, neuromuscular, and biomechanical differences between genders and extrinsic variables. Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals.

Measurement and Evaluation of Dynamic Joint Stability of the Knee and Ankle After Injury

Injuries to the lower extremity, specifically the knee and ankle joints of the human body can occur in any athletic event and are most prevalent in sports requiring cutting and jumping manoeuvres. These joints are forced to rely on the dynamic restraints to maintain joint stability, due to the lack of bony congruence and the inability of the static restraints to handle the forces generated during functional tasks. Numerous variables (proprioception, postural control, electromyography, kinetics/kinematics, dynamic stability protocols) have been measured to better understand how the body maintains joint stability during a wide range of activities from static standing to dynamic cutting or landing from a jump. While the importance of dynamic restraints is not questioned, a recent impetus to conduct more functional or sport-specific testing has emerged and placed a great deal of emphasis on dynamic joint stability and how it is affected by lower extremity injuries. Evidence suggests that surgery and aggressive rehabilitation will not necessarily restore the deficits in dynamic joint stability caused by injury to the anterior cruciate ligament or lateral ankle ligaments. In today's athletic society, there is a major push to return athletes to play as quickly as possible. However, the ramifications of those decisions have not been fully grasped. If an athlete is not fully recovered, a quick return to play could start a vicious cycle of chronic injuries or permanent disability.