The Relationship Between Asymmetry and Athletic Performance: A Critical Review

The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review

BACKGROUND

Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries.

OBJECTIVE

The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review.

METHODS

A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol.

RESULTS

Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters.

CONCLUSIONS

Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.

Effects of core balance training on Cobb angle, isokinetic torque, and balance in unilateral handed athletes

This study aimed to provide fundamental data of core balance training (CBT) on Cobb angle and isokinetic torque and balance in unilateral exercised athletes. Forty-eight subjects were divided by control group (CON; n=16), non-CBT exercised group in unilateral handed athletes (NEG, n=16), and CBT exercised group in unilateral handed athletes (EG, n=16), respectively. Although the group by time interaction in the Cobb angle and in the isokinetic torque were not significantly changed in the EG, the balance of the EG showed significantly improved. As conclusions, these results informed that the 16-week CBT would provide a positive effect on the balance except for the Cobb angle and the isokinetic torque.

A Time-Motion Analysis of the Cross-Over Step Block Technique in Volleyball: Non-Linear and Asymmetric Performances

Blocking performance in volleyball is strongly affected by the time in which the action is executed. This study analyzes the time-motion variables in terms of the player’s role and movement direction (right or left), in different phases of the displacement and jump actions in the cross-over step block technique. A kinematic analysis was conducted with 10 senior male volleyball players. Two series of five repetitions were each recorded and classified in terms of middle-blockers (block in the center and sides of the net) and wing-players (only block in the sides). The results showed that the middle-blockers were significantly slower than the wing-players in the first (0.75 ± 0.24 vs. 0.66 ± 0.19 sec; p = 0.020; ES = −0.37 ± 0.30) and fourth phases (0.33 ± 0.8 vs. 0.29 ± 0.8 sec; p = 0.001; ES = −0.44 ± 0.31), and in the total time for blocking (3.15 ± 0.6 vs. 3 ± 0.58 sec; p = 0.003; ES = −0.23 ± 0.31). Overall, players were significantly faster when moving to the right side, showing performance asymmetries. The fastest phases were also performed just before the jump. These findings provide specific knowledge about the cross-over step block technique in its different phases and displacement direction. This information can be used to improve the movement time in the first defensive action in volleyball.

Habitual and ready positions in female table tennis players and their relation to the prevalence of back pain

Background

The current body of knowledge shows that there is very little research into the occurrence and scale of asymmetry or postural defects in table tennis. It is interesting which regions of the spine are exposed to the greatest changes in the shape of its curvatures and whether the asymmetrical position of the shoulder and pelvic girdles in table tennis players changes when adopting the ready position. Consequently, can overload occur in certain parts of the spine and can the asymmetry deepen as a response of adopting this position? The reply to these questions may be an indication of the need for appropriate compensatory or corrective measures. Therefore, the aim of the study was to evaluate the effect of body position during play on the change in the shape of anterior–posterior spinal curvatures and trunk asymmetry in table tennis players.

Methods

To evaluate body posture the photogrammetric method based on the Moiré phenomenon with equipment by CQ electronic was applied. The study involved 22 female players practicing competitive table tennis (the age of 17 ± 4.5, with the average training experience of 7 ± 4.3 years, body mass of 47.8 ± 15.8, and body height of 161.2 ± 10.4). Each participant completed an author’s own questionnaire on spinal pain. The shape of curvatures in the sagittal and frontal plane was evaluated in the participant in the habitual standing position and in the table tennis ready position. Descriptive statistical analysis was performed and the significance of differences was tested using the Mann–Whitney U test.

Results and Conclusions

This study demonstrated the dominance of kyphotic body posture in table tennis players, which can be caused by many hours of using the ready position during playing. After adopting this position, there are significant differences in the angles of anterior and posterior spinal curvatures compared to the habitual posture. This may be the cause of overloads and pain complaints reported by the study participants. Adopting the ready position is also associated with an increase in asymmetry in the position (rotation) of the pelvis and spinous processes (frontal plane). Therefore, training programs should be extended with exercises that relieve the spine in the vertical line and exercises that improve symmetry of the work of the upper limbs, body trunk muscles and the pelvis.

Factors influencing bilateral deficit and inter-limb asymmetry of maximal and explosive strength: motor task, outcome measure and muscle group

PURPOSE

The purpose of the present study was to investigate the influence of strength outcome [maximal voluntary contraction (MVC) torque vs. rate of torque development (RTD)], motor task (unilateral vs. bilateral) and muscle group (knee extensors vs. flexors) on the magnitude of bilateral deficits and inter-limb asymmetries in a large heterogeneous group of athletes.

METHODS

259 professional/semi-professional athletes from different sports (86 women aged 21 ± 6 years and 173 men aged 20 ± 5 years) performed unilateral and bilateral "fast and hard" isometric maximal voluntary contractions of the knee extensors and flexors on a double-sensor dynamometer. Inter-limb asymmetries and bilateral deficits were compared across strength outcomes (MVC torque and multiple RTD measures), motor tasks and muscle groups.

RESULTS

Most RTD outcomes showed greater bilateral deficits than MVC torque for knee extensors, but not for knee flexors. Most RTD outcomes, not MVC torque, showed higher bilateral deficits for knee extensors compared to knee flexors. For both muscle groups, all RTD measures resulted in higher inter-limb asymmetries than MVC torque, and most RTD measures resulted in greater inter-limb asymmetries during unilateral compared to bilateral motor tasks.

CONCLUSIONS

The results of the present study highlight the importance of outcome measure, motor task and muscle group when assessing bilateral deficits and inter-limb asymmetries of maximal and explosive strength. Compared to MVC torque and bilateral tasks, RTD measures and unilateral tasks could be considered more sensitive for the assessment of bilateral deficits and inter-limb asymmetries in healthy professional/semi-professional athletes.

Bilateral Asymmetries Assessment in Elite and Sub-Elite Male Futsal Players

This study aimed to investigate morphological, functional, and neuromuscular asymmetries on futsal players’ lower limbs at different competitive levels. Sixteen male elite futsal players from the Spanish National Futsal League and thirteen male sub-elite futsal players from the third division participated in this study. Morphological asymmetry was assessed through bioelectrical impedance (fat-mass (g and %) and lean-mass (g)). Functional asymmetry was assessed by means of a 20-s static unipedal balance test. Finally, neuromuscular asymmetry was assessed using tensiomiography tests on both the rectus femoris (RF) and biceps femoris (BF) of each participant. The three tests conducted did not reveal significant bilateral asymmetries in elite players. On the other hand, sub-elite players showed significant bilateral asymmetry in fat-mass percentage between dominant and non-dominant limbs (+6%; CI95%: 1 to 11; ES: 0.88; p = 0.019). They also showed higher bilateral asymmetry in the delay time of the RF (+13%; CI95%: 7 to 21; ES: 1.3; p < 0.05). However, the static unipedal balance test (p > 0.05) did not evidence asymmetries regardless of the level of the participants. Elite futsal players do not develop bilateral asymmetries in lower limbs in the studied parameters. On the contrary, sub-elite players are likely to develop morphological and neuromuscular asymmetries between their dominant leg and non-dominant leg.

Inter-limb asymmetries are associated with decrements in physical performance in youth elite team sports athletes

Actually, there is scarce literature looking for the relationship between inter-limb asymmetries and performance in youth elite team sports. The main purpose of this cross-sectional study was to examine the relationships between inter-limb asymmetries and physical performance in youth elite team-sports players. A secondary objective was to evaluate the presence of between-sexes differences in inter-limb asymmetries in elite youth team sports players. Eighty-one young elite team-sports athletes (age: u-14 to u-18) performed the star excursion balance test in the anterior direction (SEBT ANT), a single leg vertical countermovement jump test (SLCMJ), the one leg hop test for distance (OLHT), a 30 m sprint test, and the V-cut test. Inter-limb asymmetries were calculated for SEBT ANT, SLCMJ and OLHT. Pearson r was used to analyse the relationships between inter-limb asymmetries and physical performance. Results showed significant (p < 0.05) but small (r = 0.26) relationships between SLCMJ asymmetries and 30 m sprint time for the total group. Significant negative correlations with small to moderate magnitude of correlation were also found between SLCMJ asymmetries and SLCMJ performance on the lowest performing limb for the total group (p < 0.05; r = -0.26), males (p < 0.01; r = -0.48) and females (p < 0.05; r = -0.30). Moreover, significant negative correlations with moderate and large magnitude were also present between OLHT asymmetries and OLHT performance on the lowest performing limb for the total group (p < 0.01; r = -0.44), males (p < 0.01; r = -0.56) and females (p < 0.01; r = -0.64). No correlations were observed between asymmetries and either the V-cut test or SEBT ANT performance. No correlation were observed between SEBT ANT asymmetries and physical performance. In addition, when comparing asymmetry values between sexes there were no significant differences in vertical (p = 0.06) and horizontal (p = 0.61) jumping tests. However, there were significant differences in asymmetry between sexes in the ANT SEBT (p = 0.04). In conclusion, the current study indicated that jumping asymmetries were associated with decrements in sprint speed and jumping performance. Therefore, assessing inter-limb asymmetries would be recommended to improve training interventions for youth elite team-sports athletes.

Jumping-based Asymmetries are Negatively Associated with Jump, Change of Direction, and Repeated Sprint Performance, but not Linear Speed, in Adolescent Handball Athletes

The aim of the present study was to determine the association of multi-directional jumping asymmetries with measures of physical performance. Forty-two youth handball athletes (age: 16.0 ± 1.3 years; body height: 174.11 ± 7.3 cm; body mass: 70.49 ± 13.3 kg) performed a mid-season fitness test battery consisting of single leg countermovement, lateral and broad jump tests, two change of direction speed (CODS) tests, an 8 x 10 m repeated sprint test, and a 20 m sprint. The Kappa coefficient showed only 'slight' levels of agreement (K range = -0.05 to 0.15), indicating that asymmetries rarely favoured the same side during each of the jump tests. The single leg countermovement jump showed significantly (p = 0.006) larger asymmetries (11.2 ± 8.4) than the broad jump (6.4 ± 4.6) and significant correlations were present between jumping asymmetries and jump (r = -0.32 to -0.52), CODS (r = 0.31 to 0.32) and repeated sprint (r = 0.35 to 0.40) performance. The findings of the present study highlight the independent nature of jumping asymmetries and associations with measures of physical performance. Practitioners are encouraged to use multiple tests to detect existing side differences and consider appropriate training interventions for the reduction of inter-limb asymmetries.

Comparing the magnitude and direction of asymmetry during the squat, countermovement and drop jump tests in elite youth female soccer players

The aims of the present study were to provide an in-depth comparison of inter-limb asymmetry and determine how consistently asymmetry favours the same limb during different vertical jump tests. Eighteen elite female under-17 soccer players conducted unilateral squat jumps (SJ), countermovement jumps (CMJ) and drop jumps (DJ) on a portable force platform, with jump height, peak force, concentric impulse and peak power as common metrics across tests. For the magnitude of asymmetry, concentric impulse was significantly greater during the SJ test compared to CMJ (p = 0.019) and DJ (p = 0.003). No other significant differences in magnitude were present. For the direction of asymmetry, Kappa coefficients revealed fair to substantial levels of agreement between the SJ and CMJ (Kappa = 0.35 to 0.61) tests, but only slight to fair levels of agreement between the SJ and DJ (Kappa = -0.26 to 0.18) and CMJ and DJ (Kappa = -0.13 to 0.26) tests. These results highlight that the mean asymmetry value may be a poor indicator of true variability of between-limb differences in healthy athletes. The direction of asymmetry may provide a useful monitoring tool for practitioners in healthy athletes, when no obvious between-limb deficit exists.

Relationship between vertical stiffness and soft-tissue injuries in professional Australian football

Soft-tissue injuries are common in Australian football. Recently, literature has identified non-modifiable and modifiable risk factors, including vertical stiffness (K_vert). However, limitations regarding measurement frequency and duration exist; thus, further information is required about the role of K_vert as a modifiable risk factor for injury. This study examined the seasonal variation in K_vert and its relationship to soft-tissue injuries in professional Australian football. The mean K_vert and bilateral asymmetry were assessed and compared between injured and non-injured players. For the seasonal analysis, 56 players were tested across two seasons with no variation in bilateral asymmetry evident (p= 0.33). While there were generally no changes in K_vert, the value from the end of the second pre-season revealed 5% lower values than the mean of two seasons (p= 0.02). Considering the injury analysis, 21 lower-body soft-tissue injuries were recorded from 18 participants. No differences were recorded for mean K_vert between the injured and non-injured groups (p= 0.16-0.76). When assessing K_vert asymmetry, the injured group displayed a 4.5% higher value than the non-injured group at the end of the pre-season test (p= 0.03) but not at other time-points (p= 0.16-0.99). Higher K_vert bilateral asymmetry measures after the pre-season appear to be related to lower-body soft-tissue injury in professional Australian footballers. Medical and conditioning staff should consider this measure when trying to mitigate the onset of injury or identify at-risk players.

Using Unilateral Strength, Power and Reactive Strength Tests to Detect the Magnitude and Direction of Asymmetry: A Test-Retest Design

The aims of the present study were to determine test-retest reliability for unilateral strength and power tests used to quantify asymmetry and determine the consistency of both the magnitude and direction of asymmetry between test sessions. Twenty-eight recreational trained sport athletes performed unilateral isometric squat, countermovement jump (CMJ) and drop jump (DJ) tests over two test sessions. Inter-limb asymmetry was calculated from both the best trial and as an average of three trials for each test. Test reliability was computed using the intraclass correlation coefficient (ICC), coefficient of variation (CV) and standard error of measurement (SEM). In addition, paired samples t-tests were used to determine systematic bias between test sessions and Kappa coefficients to report how consistently asymmetry favoured the same side. Within and between-session reliability ranged from moderate to excellent (ICC range = 0.70⁻0.96) and CV values ranged from 3.7⁻13.7% across tests. Significant differences in asymmetry between test sessions were seen for impulse during the isometric squat (p = 0.04; effect size = ⁻0.60) but only when calculating from the best trial. When computing the direction of asymmetry across test sessions, levels of agreement were fair to substantial for the isometric squat (Kappa = 0.29⁻0.64), substantial for the CMJ (Kappa = 0.64⁻0.66) and fair to moderate for the DJ (Kappa = 0.36⁻0.56). These results show that when asymmetry is computed between test sessions, the group mean is generally devoid of systematic bias; however, the direction of asymmetry shows greater variability and is often inter-changeable. Thus, practitioners should consider both the direction and magnitude of asymmetry when monitoring inter-limb differences in healthy athlete populations.

Drop Jump Asymmetry is Associated with Reduced Sprint and Change-of-Direction Speed Performance in Adult Female Soccer Players

Studies that examine the effects of inter-limb asymmetry on measures of physical performance are scarce, especially in adult female populations. The aim of the present study was to establish the relationship between inter-limb asymmetry and speed and change-of-direction speed (CODS) in adult female soccer players. Sixteen adult players performed a preseason test battery consisting of unilateral countermovement jump (CMJ), unilateral drop jump (DJ), 10 m, 30 m, and 505 CODS tests. Inter-limb asymmetry was calculated using a standard percentage difference equation for jump and CODS tests, and Pearson's r correlations were used to establish a relationship between asymmetry and physical performance as well as asymmetry scores themselves across tests. Jump-height asymmetry from the CMJ (8.65%) and DJ (9.16%) tests were significantly greater (p < 0.05) than asymmetry during the 505 test (2.39%). CMJ-height asymmetry showed no association with speed or CODS. However, DJ asymmetries were significantly associated with slower 10 m (r = 0.52; p < 0.05), 30 m (r = 0.58; p < 0.05), and 505 (r = 0.52⁻0.66; p < 0.05) performance. No significant relationships were present between asymmetry scores across tests. These findings suggest that the DJ is a useful test for detecting existent between-limb asymmetry that might in turn be detrimental to speed and CODS performance. Furthermore, the lack of relationships present between different asymmetry scores indicates the individual nature of asymmetry and precludes the use of a single test for the assessment of inter-limb differences.

Comparison of Change of Direction Speed Performance and Asymmetries between Team-Sport Athletes: Application of Change of Direction Deficit

The purpose of this study was twofold: (1) to examine differences in change of direction (COD) performance and asymmetries between team-sports while considering the effects of sex and sport; (2) to evaluate the relationship between linear speed, COD completion time, and COD deficit. A total of 115 (56 males, 59 females) athletes active in cricket, soccer, netball, and basketball performed the 505 for both left and right limbs and a 10-m sprint test. All team-sports displayed directional dominance (i.e., faster turning performance/shorter COD deficits towards a direction) (p ≤ 0.001, g = −0.62 to −0.96, −11.0% to −28.4%) with, male cricketers tending to demonstrate the greatest COD deficit asymmetries between directions compared to other team-sports (28.4 ± 26.5%, g = 0.19–0.85), while female netballers displayed the lowest asymmetries (11.0 ± 10.1%, g = 0.14–0.86). Differences in sprint and COD performance were observed between sexes and sports, with males demonstrating faster 10-m sprint times, and 505 times compared to females of the same sport. Male soccer and male cricketers displayed shorter COD deficits compared to females of the same sport; however, female court athletes demonstrated shorter COD deficits compared to male court athletes. Large significant associations (ρ = 0.631–0.643, p < 0.001) between 505 time and COD deficit were revealed, while trivial, non-significant associations (ρ ≤ −0.094, p ≥ 0.320) between COD deficit and 10-m sprint times were observed. In conclusion, male and female team-sport athletes display significant asymmetries and directional dominance during a high approach velocity 180° turning task. Coaches and practitioners are advised to apply the COD deficit for a more isolated measure of COD ability (i.e., not biased towards athletes with superior acceleration and linear speed) and perform COD speed assessments from both directions to establish directional dominance and create a COD symmetry profile.

Interlimb Asymmetries Identified Using the Rate of Torque Development in Ballistic Contraction Targeting Submaximal Torques

Evaluating the rate of torque development (RTD) in isometric ballistic contraction targeting submaximal torques is usually overlooked in the literature. In a series of isometric ballistic contractions targeting a range of submaximal torque values, there is a linear relationship between the peak torque and the peak RTD obtained in each contraction. RTD scaling factor (RTD-SF) represents the slope of this relationship. In this study, we investigated the prevalence of interlimb asymmetry in the RTD-SF and in the RTD calculated across submaximal torques. Furthermore, we compared these asymmetry indices with those calculated adopting more classical approaches, such as ballistic contraction targeting maximal torque and isokinetic concentric conditions. Quadriceps and hamstrings strength was evaluated in both limbs of elite under 17 and under 19 soccer players (20 males, 17 ± 1 years). Participants performed three concentric isokinetic contractions at 240°/s and a series of isometric ballistic contractions targeting from 20 to 100% of maximal isometric torque. The interlimb difference was calculated for each parameter and players presenting an interlimb difference >15% were identified. A total of 40% (for quadriceps) and 60% (for hamstring) of players showed an interlimb asymmetry in isometric RTD for at least 50% of submaximal torque range. The RTD-SF was able to identify more players with asymmetry than the classical isokinetic tests. However, isokinetic and isometric indices of asymmetry were in general poorly or not correlated with each other. Most players presented an interlimb asymmetry in RTD for a wide part of the torque range and the adopted protocol was able to highlight important interindividual differences. Furthermore, players showed a large prevalence of RTD-SF asymmetry in both quadriceps and hamstrings. It is still to be determined if these asymmetries are functionally relevant. Nevertheless, the adopted protocol provided meaningful information for identifying interlimb asymmetries that could not be gathered when adopting the classical method of ballistic contractions targeting only maximal torques.