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Morita ÂK, Tavella Navega M. Women with patellofemoral pain show changes in trunk and lower limb sagittal movements during single-leg squat and step-down tasks. Physiother Theory Pract 2024; 40:1933-1941. [PMID: 37387682 DOI: 10.1080/09593985.2023.2228396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Changes in the trunk and lower limbs' sagittal movements may cause patellofemoral pain (PFP) because they influence the forces acting on this joint. OBJECTIVES To compare trunk and lower limb sagittal kinematics between women with and without PFP during functional tests and to verify whether sagittal trunk kinematics are correlated with those of the knees and ankles. METHODS A total of 30 women with PFP and 30 asymptomatic women performed single-leg squat (SLS) and step-down (SD) tests and were filmed by a camera in the sagittal plane. The trunk inclination angle, forward knee displacement, and ankle angle were calculated. RESULTS The PFP group exhibited less trunk flexion (SLS, p = .006; SD, p = .016) and greater forward knee displacement (SLS, p = .001; SD, p = .004) than the asymptomatic group; there was no significant difference in ankle angle (SLS, p = .074; SD, p = .278). Correlation analysis revealed that decreased trunk flexion was associated with increased forward knee displacement (SLS, r = -0.439, p = .000; SD, r = -0.365, p = .004) and ankle dorsiflexion (SLS, r = -0.339, p = .008; SD, r = -0.356, p = .005). CONCLUSION Women with PFP present kinematic alterations of the trunk and knee in the sagittal plane during unipodal activities. Furthermore, the trunk and lower limb sagittal movements were interdependent.
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Affiliation(s)
- Ângela Kazue Morita
- Center for Education and Health Studies, Faculty of Philosophy and Sciences, São Paulo State University (UNESP). Avenue Hygino Muzzi Filho, Marília, São Paulo, Brazil
- Postgraduate Program in Human Development and Technologies, Institute of Biosciences, São Paulo State University (UNESP). Avenue 24-A, Rio Claro, São Paulo, Brazil
| | - Marcelo Tavella Navega
- Postgraduate Program in Human Development and Technologies, Institute of Biosciences, São Paulo State University (UNESP). Avenue 24-A, Rio Claro, São Paulo, Brazil
- Department of Physical Therapy and Occupational Therapy, Faculty of Philosophy and Sciences, São Paulo State University (UNESP). Avenue Hygino Muzzi Filho, Marília, São Paulo, Brazil
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Hendricks M, van de Water ATM, Verhagen E. Health problems among elite Dutch youth long track speed skaters: a one-season prospective study. Br J Sports Med 2024; 58:785-791. [PMID: 38777387 DOI: 10.1136/bjsports-2023-107433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To describe the frequency, type, and severity of health problems in long-track speed skating to inform injury prevention strategies. METHODS We prospectively collected weekly health and sport exposure data on 84 highly trained Dutch athletes aged 15-21 years during the 2019/2020 season using the Oslo Sports Trauma Research Centre questionnaire on Health Problems and the trainers' documentation. We categorised health problems into acute or repetitive mechanisms of injury or illness and calculated incidences (per 1000 sports exposure hours), weekly prevalence and burden (days of time loss per 1000 sports exposure hours) related to the affected body region. RESULTS We registered 283 health problems (187 injuries, 96 illnesses), yielding an average weekly prevalence of health problems of 30.5% (95% CI 28.7% to 32.2%). Incidence rates were 2.0/1000 hours for acute mechanism injuries (95% CI 1.5 to 2.5) and 3.2/1000 hours for illnesses (95% CI 2.6 to 3.9). For acute mechanism injuries the head, shoulder and lumbosacral region had the highest injury burden of 5.6 (95% CI 4.8 to 6.5), 2.9 (95% CI 2.3 to 3.5) and 2.2 (95% CI 1.7 to 2.8) days of time loss/1000 hours, respectively. For repetitive mechanism injuries, the knee, thoracic spine, lower leg and lumbosacral region had the highest injury burden, with 11.0 (95% CI 9.8 to 12.2), 6.8 (95% CI 5.9 to 7.7), 3.9 (95% CI 3.2 to 4.6) and 2.5 (95% CI 1.9 to 3.1) days of time loss/1000 hours, respectively. CONCLUSION Our study demonstrated a high prevalence of acute and repetitive mechanism injuries in speed skating. These results can guide future research and priorities for injury prevention.
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Affiliation(s)
- Matthias Hendricks
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Alexander T M van de Water
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- AdPhysio: Research, Training & Consultancy, Apeldoorn, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Slovák L, Zahradník D, Land WM, Sarvestan J, Hamill J, Abdollahipour R. Response of Knee Joint Biomechanics to Landing Under Internal and External Focus of Attention in Female Volleyball Players. Motor Control 2024; 28:341-361. [PMID: 38702047 DOI: 10.1123/mc.2023-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study was to examine the effect of attentional focus instructions on the biomechanical variables associated with the risk of anterior cruciate ligament injury of the knee joint during a drop landing task using a time series analysis. Ten female volleyball players (age: 20.4 ± 0.8 years, height: 169.7 ± 7.1 cm, mass: 57.6 ± 3.1 kg, experience: 6.3 ± 0.8 years) performed landings from a 50 cm height under three different attentional focus conditions: (1) external focus (focus on landing as soft as possible), (2) internal focus (focus on bending your knees when you land), and (3) control (no-focus instruction). Statistical parameter mapping in the sagittal plane during the crucial first 30% of landing time showed a significant effect of attentional focus instructions. Despite the similarity in landing performance across foci instructions, adopting an external focus instruction promoted reduced vertical ground reaction force and lower sagittal flexion moment during the first 30% of execution time compared to internal focus, suggesting reduced knee loading. Therefore, adopting an external focus of attention was suggested to reduce most biomechanical risk variables in the sagittal plane associated with anterior cruciate ligament injuries, compared to internal focus and control condition. No significant differences were found in the frontal and horizontal planes between the conditions during this crucial interval.
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Affiliation(s)
- Lukáš Slovák
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - David Zahradník
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - William M Land
- Department of Kinesiology, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Javad Sarvestan
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Biomechanics and Functional Morphology Laboratory, CIPER, Faculdade de Motricidade Humana, University of Lisbon, Lisboa, Portugal
| | - Joseph Hamill
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
| | - Reza Abdollahipour
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
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Tian TF, Mo FH, Su HY, Huang C, Zhao H, Liu J, Shang B, Li K, Qiu JL. Investigation on vehicle occupant dummy applicability for under-foot impact loading conditions. Chin J Traumatol 2024; 27:235-241. [PMID: 38637177 PMCID: PMC11357746 DOI: 10.1016/j.cjtee.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Under-foot impact loadings can cause serious lower limb injuries in many activities, such as automobile collisions and underbody explosions to military vehicles. The present study aims to compare the biomechanical responses of the mainstream vehicle occupant dummies with the human body lower limb model and analyze their robustness and applicability for assessing lower limb injury risk in under-foot impact loading environments. METHODS The Hybrid III model, the test device for human occupant restraint (THOR) model, and a hybrid human body model with the human active lower limb model were adopted for under-foot impact analysis regarding different impact velocities and initial lower limb postures. RESULTS The results show that the 2 dummy models have larger peak tibial axial force and higher sensitivity to the impact velocities and initial postures than the human lower limb model. In particular, the Hybrid III dummy model presented extremely larger peak tibial axial forces than the human lower limb model. In the case of minimal difference in tibial axial force, Hybrid III's tibial axial force (7.5 KN) is still 312.5% that of human active lower limb's (2.4 KN). Even with closer peak tibial axial force values, the biomechanical response curve shapes of the THOR model show significant differences from the human lower limb model. CONCLUSION Based on the present results, the Hybrid III dummy cannot be used to evaluate the lower limb injury risk in under-foot loading environments. In contrast, potential improvement in ankle biofidelity and related soft tissues of the THOR dummy can be implemented in the future for better applicability.
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Affiliation(s)
- Teng-Fei Tian
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Fu-Hao Mo
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Hao-Yang Su
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Can Huang
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jun Liu
- Chongqing Zhongzheng Judicial Expert Center, Chongqing, 400020, China
| | - Bo Shang
- NIO Limited Liability Company, Shanghai, 200050, China
| | - Kui Li
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China; Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics, Chongqing, 400042, China.
| | - Jin-Long Qiu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics, Chongqing, 400042, China.
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Kraszewski A, Argentieri E, Harris K, Toresdahl B, Drakos M, Hillstrom H, Allen A, Nwawka OK. Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason. Orthop J Sports Med 2024; 12:23259671241242008. [PMID: 38686323 PMCID: PMC11057346 DOI: 10.1177/23259671241242008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 05/02/2024] Open
Abstract
Background Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. Purpose To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. Results There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Conclusion Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.
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Affiliation(s)
| | - Erin Argentieri
- University of California–Berkeley, Berkeley, California, USA
| | - Kindred Harris
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Mark Drakos
- Hospital for Special Surgery, New York, New York, USA
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Scattone Silva R, Song K, Hullfish TJ, Sprague A, Silbernagel KG, Baxter JR. Patellar Tendon Load Progression during Rehabilitation Exercises: Implications for the Treatment of Patellar Tendon Injuries. Med Sci Sports Exerc 2024; 56:545-552. [PMID: 37847102 PMCID: PMC10925836 DOI: 10.1249/mss.0000000000003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE This study aimed to evaluate patellar tendon loading profiles (loading index, based on loading peak, loading impulse, and loading rate) of rehabilitation exercises to develop clinical guidelines to incrementally increase the rate and magnitude of patellar tendon loading during rehabilitation. METHODS Twenty healthy adults (10 females/10 males, 25.9 ± 5.7 yr) performed 35 rehabilitation exercises, including different variations of squats, lunge, jumps, hops, landings, running, and sports specific tasks. Kinematic and kinetic data were collected, and a patellar tendon loading index was determined for each exercise using a weighted sum of loading peak, loading rate, and cumulative loading impulse. Then the exercises were ranked, according to the loading index, into tier 1 (loading index ≤0.33), tier 2 (0.33 < loading index <0.66), and tier 3 (loading index ≥0.66). RESULTS The single-leg decline squat showed the highest loading index (0.747). Other tier 3 exercises included single-leg forward hop (0.666), single-leg countermovement jump (0.711), and running cut (0.725). The Spanish squat was categorized as a tier 2 exercise (0.563), as was running (0.612), double-leg countermovement jump (0.610), single-leg drop vertical jump (0.599), single-leg full squat (0.580), double-leg drop vertical jump (0.563), lunge (0.471), double-leg full squat (0.428), single-leg 60° squat (0.411), and Bulgarian squat (0.406). Tier 1 exercises included 20 cm step up (0.187), 20 cm step down (0.288), 30 cm step up (0.321), and double-leg 60° squat (0.224). CONCLUSIONS Three patellar tendon loading tiers were established based on a combination of loading peak, loading impulse, and loading rate. Clinicians may use these loading tiers as a guide to progressively increase patellar tendon loading during the rehabilitation of patients with patellar tendon disorders and after anterior cruciate ligament reconstruction using the bone-patellar tendon-bone graft.
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Affiliation(s)
- Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, BRAZIL
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ke Song
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Todd J. Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Andrew Sprague
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | | | - Josh R. Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
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Llombart R, Mariscal G, Barrios C, Llombart-Ais R. The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses. Sports (Basel) 2024; 12:46. [PMID: 38393266 PMCID: PMC10893258 DOI: 10.3390/sports12020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Patellar tendinopathy is a frequent overuse injury in sports that can cause significant pain and disability. It requires evidence-based guidelines on effective prevention and management. However, optimal treatments remain uncertain. We aimed to analyze available meta-analyses to summarize treatment recommendations, compare therapeutic modalities, examine included trials, and offer methodological suggestions to improve future systematic reviews. Meta-analyses were systematically searched for in PubMed (PROSPERO: CRD42023457963). A total of 21 meta-analyses were included. The AMSTAR-2 scale assessed study quality, which was low, with only 23.8% of the meta-analyses being of moderate quality, and none were considered to be of high quality. Heterogeneous outcomes are reported. Multiple platelet-rich plasma (PRP) injections appear superior to eccentric exercises and provide lasting improvements compared to eccentric exercises when conservative treatments fail. Extracorporeal shockwave therapy (ESWT) also seems superior to non-operative options and similar to surgery for patellar tendinopathy in the long term. However, evidence for eccentric exercise efficacy remains unclear due to inconclusive findings. Preliminary findings also emerged for genetic risk factors and diagnostic methods but require further confirmation. This review reveals a lack of high-quality evidence on optimal patellar tendinopathy treatments. While PRP and ESWT show promise, limitations persist. Further rigorous meta-analyses and trials are needed to strengthen the evidence base and guide clinical practice. Methodological enhancements are proposed to improve future meta-analyses.
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Affiliation(s)
- Rafael Llombart
- Orthopedic Surgery Department, University Clinic of Navarra, 31008 Pamplona, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Rafael Llombart-Ais
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
- Traumacenter, Casa de Salud Hospital, 46021 Valencia, Spain
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Vermeulen S, De Bleecker C, Spanhove V, Segers V, Willems T, Roosen P, Vanrenterghem J, De Ridder R. The effect of fatigue on spike jump biomechanics in view of patellar tendon loading in volleyball. Scand J Med Sci Sports 2023; 33:2208-2218. [PMID: 37522308 DOI: 10.1111/sms.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Patellar tendinopathy (PT) is a highly prevalent overuse injury in volleyball and is often linked with overloading of the patellar tendon. Little is known, however, about whether and how patellar tendon loading is affected by fatigue during the most challenging jump activity in volleyball. Therefore, this study investigates the effect of a high-intensity, intermittent fatigue protocol on movement alterations in terms of patellar tendon loading during a volleyball spike jump. METHODS Forty-three male volleyball players participated in this study. Three-dimensional full-body kinematics and kinetics were collected when performing a spike jump before and after the fatigue protocol. Sagittal plane joint angles, joint work and patellar tendon loading were calculated and analyzed with curve analyses using paired sample t-tests to investigate fatigue effects (p < 0.05). RESULTS Fatigue induced a stiffer lower extremity landing strategy together with prolonged pelvis-trunk flexion compared to baseline (p = 0.001-0.005). Decreased patellar tendon forces (p = 0.001-0.010) and less eccentric knee joint work (-5%, p < 0.001) were observed after the fatigue protocol compared to baseline. CONCLUSION Protective strategies seem to be utilized in a fatigued state to avoid additional tensile forces acting on the patellar tendon, including proximal compensations and stiff lower extremity landings. We hypothesize that players might be more prone for developing PT if eccentric patellar tendon loads are high in the non-fatigued state and/or these loads are somehow not decreased after fatigue.
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Affiliation(s)
- Stefan Vermeulen
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Camilla De Bleecker
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Veerle Segers
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Philip Roosen
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Roel De Ridder
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Morita ÂK, Navega MT. Activation, strength, and resistance: Which variables predict the kinematics of women with and without patellofemoral pain? J Bodyw Mov Ther 2023; 36:327-334. [PMID: 37949580 DOI: 10.1016/j.jbmt.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Investigating the possible relationship between neuromuscular changes and movement alterations could help to describe the mechanisms underlying patellofemoral pain (PFP). OBJECTIVE To investigate whether activation and muscle strength of the trunk and lower limb and muscle resistance of the trunk predict the knee frontal and trunk sagittal kinematics in women with and without PFP. METHOD Sixty women (PFP, n = 30; asymptomatic, n = 30) underwent the single-leg squat test to collect electromyographic and kinematic data. Activation of transversus abdominis/internal oblique, gluteus medius (GMed), and vastus medialis oblique (VMO); knee frontal and trunk sagittal angles were analyzed. Participants also underwent maximal isometric tests to determine lateral trunk, hip abductor, and knee extensor torques and performed a lateral trunk resistance test. Multiple regression was used to determine predictive models. RESULTS In the PFP group, knee frontal angle (R2 = 0.39, p = 0.001) was predicted by GMed activation (β = 0.23, p = 0.000) and hip abductor torque (β = 0.08, p = 0.022). No variable was able to predict trunk sagittal kinematics in this group. In the asymptomatics, knee frontal angle (R2 = 0.16, p = 0.029) was predicted by hip abductor torque (β = 0.07, p = 0.029), while trunk sagittal angle (R2 = 0.24, p = 0.024) was predicted by VMO activation (β = 0.12, p = 0.016). CONCLUSION Kinematics is predicted by the muscles acting in the respective planes, such that hip abductors capacities are related to the knee frontal alignment in both groups, and that of the VMO is related to the trunk sagittal alignment only in asymptomatic women.
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Affiliation(s)
- Ângela Kazue Morita
- Postgraduate Program in Human Development and Technologies, Institute of Biosciences, São Paulo State University (UNESP), Avenue 24-A, 1515, CEP 13506-900, Rio Claro, São Paulo, Brazil; Center for Education and Health Studies, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil.
| | - Marcelo Tavella Navega
- Postgraduate Program in Human Development and Technologies, Institute of Biosciences, São Paulo State University (UNESP), Avenue 24-A, 1515, CEP 13506-900, Rio Claro, São Paulo, Brazil; Physical Therapy and Occupational Therapy Department, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
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Nishiumi D, Nishioka T, Saito H, Kurokawa T, Hirose N. Associations of eccentric force variables during jumping and eccentric lower-limb strength with vertical jump performance: A systematic review. PLoS One 2023; 18:e0289631. [PMID: 37535669 PMCID: PMC10399862 DOI: 10.1371/journal.pone.0289631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
The purpose of this systematic review was to summarize the associations of eccentric force variables during jumping and eccentric lower-limb strength with vertical jump performance. A literature search was conducted in September 2022 using PubMed, Web of Science, and Scopus. Thirteen cross-sectional studies investigating the relationship between eccentric force and strength variables, such as force, rate of force development (RFD), power, time, and velocity, and vertical jump performance, including the jump height, reactive strength index (RSI), and reactive strength index-modified (RSImod), were included in this systematic review. As eccentric strength, variables during the unloading-to-braking phase of countermovement jump (CMJ) (force, RFD, etc.) and the eccentric force of the squat movement and knee joint were included. The CMJ height, RSImod, and drop jump RSI were included to analyze the vertical jump performance. The modified form of the Downs and Black checklist was used to evaluate quality. Associations between the force and RFD during the descending phase of the CMJ and jump height were observed in some studies but not in others, with differences between the studies. Some studies reported associations between the force and/or RFD during the descending phase of the CMJ and RSImod of the CMJ, with no differences among their results. In addition, there are associations of the eccentric forces during squatting and knee extension with the CMJ and the drop jump heights and RSI of the drop jump. The eccentric force variables in the CMJ and RSImod are related; however, their relationship with jump height remains unclear. Furthermore, improved eccentric muscle strength may contribute to vertical jump height because of the associations of the eccentric strength during knee extension and squatting with jump height.
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Affiliation(s)
- Daichi Nishiumi
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Takuya Nishioka
- Institute of Physical Education, Keio University, Hiyoshi, Yokohama, Japan
| | - Hiromi Saito
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Takanori Kurokawa
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Bathe C, Fennen L, Heering T, Greif A, Dubbeldam R. Training interventions to reduce the risk of injury to the lower extremity joints during landing movements in adult athletes: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2023; 9:e001508. [PMID: 37304892 PMCID: PMC10254820 DOI: 10.1136/bmjsem-2022-001508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Objective Aim of this systematic review was to summarise training interventions designed to reduce biomechanical risk factors associated with increased risk of lower extremity landing injuries and to evaluate their practical implications in amateur sports. Design Systematic review and meta-analysis. Data sources MEDLINE, Scopus and SPORTDiscus. Eligibility criteria Training intervention(s) aimed at reducing biomechanical risk factors and/or injury rates included the following: (1) prospective or (non-)randomised controlled study design; (2) risk factors that were measured with valid two-dimensional or three-dimensional motion analysis systems or Landing Error Scoring System during jump landings. In addition, meta-analyses were performed, and the risk of bias was assessed. Results Thirty-one studies met all inclusion criteria, capturing 11 different training interventions (eg, feedback and plyometrics) and 974 participants. A significantly medium effect of technique training (both instruction and feedback) and dynamic strengthening (ie, plyometrics with/without strengthening) on knee flexion angle (g=0.77; 95% CI 0.33 to 1.21) was shown. Only one-third of the studies had training interventions that required minimal training setup and additional coaching educations. Conclusion This systematic review highlights that amateur coaches can decrease relevant biomechanical risk factors by means of minimal training setup, for example, instructing to focus on a soft landing, even within only one training session of simple technique training. The meta-analysis emphasises implementing technique training as stand-alone or combined with dynamic strengthening into amateur sport training routine.
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Affiliation(s)
- Chantal Bathe
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
| | - Lena Fennen
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
| | - Theresa Heering
- Coventry University, Coventry, UK
- Deakin University School of Health and Social Development, Melbourne, Victoria, Australia
| | - Alexander Greif
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
| | - Rosemary Dubbeldam
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
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12
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Nutarelli S, da Lodi CMT, Cook JL, Deabate L, Filardo G. Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231173659. [PMID: 37347023 PMCID: PMC10280536 DOI: 10.1177/23259671231173659] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. Purpose To determine the prevalence and incidence of PT in athletes and the general population. Design Systematic review; Level of evidence, 3. Methods A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population. Results A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004). Conclusion This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.
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Affiliation(s)
- Sebastiano Nutarelli
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Jill L. Cook
- La Trobe University Sport and Exercise
Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury
Drive, Bundoora, Victoria, Australia
| | - Luca Deabate
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences,
Università della Svizzera Italiana, Lugano, Switzerland
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13
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The Effect of Fatigue on Trunk and Pelvic Jump-Landing Biomechanics in View of Lower Extremity Loading: A Systematic Review. J Hum Kinet 2023; 86:73-95. [PMID: 37181257 PMCID: PMC10170549 DOI: 10.5114/jhk/159460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Fatigue has often been considered a risk factor for developing sports injuries, modulating lower extremity jump-landing biomechanics. The impact of fatigue on proximal trunk and pelvic biomechanics has been suggested to play an important role in lower extremity loading and injury risk, yet the available evidence remains ambiguous as the trunk and pelvis were often not the primary focus of research. Therefore, the purpose of this systematic review was to determine how fatigue affects trunk and pelvic three-dimensional jump-landing biomechanics. PubMed (MEDLINE), Web of Science, Embase, CINAHL and SPORTDiscus were consulted up to and including April 2022 for potential studies investigating the effect of fatigue on trunk and pelvic kinematics, kinetics and/or muscular activity during jump-landing tasks in healthy, physically active populations. Methodological quality of the studies was assessed by the modified Downs and Black checklist. Twenty-one studies were included and methodological quality was moderate to high among these studies. The results indicate prevailing evidence for more trunk flexion during standardized jump-landing tasks after lower extremity muscle fatigue. Otherwise, lumbo-pelvic-hip muscle fatigue does not seem to elicit major detrimental changes to these jump-landing biomechanics. Although a wide variability of trunk and pelvic jump-landing strategies was observed, the results provide evidence for increased trunk flexion after lower extremity muscle fatigue. This proximal strategy is suggested to help unload fatigued lower extremity structures and lack of this compensation might increase knee injury risk.
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14
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Waiteman MC, Chia L, Ducatti MHM, Bazett-Jones DM, Pappas E, de Azevedo FM, Briani RV. Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:145. [PMID: 36503991 PMCID: PMC9742076 DOI: 10.1186/s40798-022-00536-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. Individuals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between individuals with knee disorders and injury-free controls. METHODS Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between individuals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created. RESULTS A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). Individuals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58-1.18) and stepping tasks (SMD 0.56, 95% CI 0.13-.99); ipsilateral and contralateral trunk lean during walking (SMD 1.36; 95% CI 0.60-2.11) and sit-to-stand (SMD 1.49; 95% CI 0.90-2.08), respectively. Greater trunk flexion during landing tasks in individuals with PFP (SMD 0.56; 95% CI 0.01-1.12) or ACLR (SMD 0.48; 95% CI 0.21-.75) and greater ipsilateral trunk lean during single-leg squat in individuals with PFP (SMD 1.01; 95% CI 0.33-1.70) were also identified. No alterations in trunk kinematics of individuals with TKA were identified. Evidence gap maps outlined the lack of investigations for individuals with PT or ACLD, as well as for trunk kinetics across knee disorders. CONCLUSION Individuals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these individuals in order to identify possible targets for rehabilitation and avoidance strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019129257.
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Affiliation(s)
- Marina C Waiteman
- Department of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo, 19060-900, Brazil.
| | - Lionel Chia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Cleveland Guardians Baseball Company, Cleveland, OH, USA
| | - Matheus H M Ducatti
- Department of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo, 19060-900, Brazil
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW, Australia
| | - Fábio M de Azevedo
- Department of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo, 19060-900, Brazil
| | - Ronaldo V Briani
- Department of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo, 19060-900, Brazil
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15
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Muramoto Y, Kuruma H. The Effectiveness of Trunk and Balance Warm-up Exercises in Prevention, Severity, and Length of Limitation From Overuse and Acute Lower Limb Injuries in Male Volleyball Players. Int J Sports Phys Ther 2022; 17:1026-1032. [PMID: 36237657 PMCID: PMC9528693 DOI: 10.26603/001c.38019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Injuries in volleyball players are most common in the ankles and knees. Many volleyball players suffer from overuse injuries because of the strain placed on the lower extremities from repeated jumping. A characteristic of players who are most at risk for lower extremity injuries is the tendency to display trunk instability during landing, such as lateral flexion and rotation. Research has shown the effectiveness of exercise-based warm-up interventions for acute volleyball injuries. However, comprehensive analyses on the use of lower extremity, trunk, and balance programs to prevent overuse injuries are lacking. Purpose To examine the effects of trunk and balance warm-up exercises on the prevention, severity, and length of limitation of overuse and acute lower limb injuries in male volleyball players. Study Design Prospective, single-cohort study. Methods This study involved the 2019 (control group) and 2021 (intervention group) male volleyball teams. The control and intervention groups were on the same team; however, seven players joined in 2021 through a sports referral program through which different players are recruited. Measurements included injury incidence rate, injury severity, and injury burden. The intervention involved the addition of trunk and balance exercises during the 2021 season. Results There was no significant difference in injury incidence rates between groups. Injury severity decreased by 3.7 days for overuse injuries (p=0.04). Injury burden decreased by 11.8 (days/1000 player hours) overall and by 7.1 (days/1000 player hours) for overuse injuries. Conclusion The results show that an exercise-based warm-up aimed at improving trunk posture during landing did not reduce the incidence rate of injury in men's volleyball. However, the addition of this warm-up did significantly reduce the severity of overuse injury. Level of Evidence Level 3B.
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Affiliation(s)
- Yuki Muramoto
- Insutitute for Integrated Sports Medicine, Keio University
| | - Hironobu Kuruma
- Department of Physical Therapy Science, Tokyo Metropolitan University Graduate School of Human Health Sciences
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16
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Yang T, Huang Y, Zhong G, Kong L, Yan Y, Lai H, Zeng X, Huang W, Zhang Y. 6DOF knee kinematic alterations due to increased load levels. Front Bioeng Biotechnol 2022; 10:927459. [PMID: 36213071 PMCID: PMC9533867 DOI: 10.3389/fbioe.2022.927459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Whether load carriage leads to six-degrees-of-freedom (6DOF) knee kinematic alterations remains unclear. Exploring this mechanism may reveal meaningful knee kinematic information that can be used to improve load carriage conditions, the design of protective devices, and the knowledge of the effects of load carriage on knees. We recruited 44 subjects to explore kinematic alterations from an unloaded state to 60% bodyweight (BW) load carriage. A three-dimensional gait analysis system was used to collect the knee kinematic data. One-way repeated analysis of variance (ANOVA) was used to explore the effects of load levels on knee kinematics. The effects of increasing load levels on knee kinematics were smooth with decreased or increased trends. We found that knees significantly exhibited increased lateral tibial translation (up to 1.2 mm), knee flexion angle (up to 1.4°), internal tibial rotation (up to 1.3°), and tibial proximal translation (up to 1.0 mm) when they went from an unloaded state to 60%BW load carriage during the stance phase (p < 0.05). Significant small knee adduction/abduction angle and posterior tibial translation alterations (<1°/mm) were also identified (p < 0.05). Load carriage can cause significant 6DOF knee kinematic alterations. The results showed that knee kinematic environments are challenging during increased load. Our results contain kinematic information that could be helpful for knee-protection-related activities, such as target muscle training to reduce abnormal knee kinematics and knee brace design.
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Affiliation(s)
- Tao Yang
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Hospital of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yaxiang Huang
- Department of Orthopaedics, The First People’s Hospital of Jiujiang, Affiliated Jiujiang Hospital of Nanchang University, Jiujiang, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lingchuang Kong
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Hospital of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yuan Yan
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huahao Lai
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaolong Zeng
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Hospital of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Xiaolong Zeng, ; Wenhan Huang, ; Yu Zhang,
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Hospital of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- *Correspondence: Xiaolong Zeng, ; Wenhan Huang, ; Yu Zhang,
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Hospital of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Xiaolong Zeng, ; Wenhan Huang, ; Yu Zhang,
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17
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The development of a clinical screening tool to evaluate unilateral landing performance in a healthy population. Phys Ther Sport 2022; 55:309-315. [DOI: 10.1016/j.ptsp.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
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18
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Li Z, Xu G, Wang C, Wang Q, Liu C, Guo T, Wu L, Cao D. Variation characteristics of stress distribution in the subchondral bone of the knee joint of judo athletes with long-term stress changes. Front Endocrinol (Lausanne) 2022; 13:1082799. [PMID: 36778597 PMCID: PMC9909959 DOI: 10.3389/fendo.2022.1082799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To investigate the distribution of bone density in the subchondral bone tissue of the knee joint due to the mechanical stress load generated by judo, the bone tissue volume of different densities and the bone remodeling characteristics of the subchondral bone of the knee joint. METHODS CT imaging data of the knee joint were collected from 15 healthy individuals as controls and 15 elite judo athletes. Firstly, they were processed by the CTOAM technique, and secondly, the distribution pattern of high-density areas of the knee joint was localized using nine anatomical regions. In addition, three tomographic images were selected in the sagittal, coronal, and axial 2D image windows to observe the distribution of different densities of bone tissue. Finally, the percentage of bone tissue volume (%BTV) and bone remodeling trend of bone tissues with different densities were determined. RESULTS In this study, high-density areas were found in the 4th, 5th, and 6th regions of the articular surface of the distal femur and the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th and 8th regions of the tibial plateau in judo athletes; the distribution of high-density areas on the articular surface of the distal femur in control subjects was similar with judo athletes, and high-density areas were mainly found in the 4th and 5th regions of the tibial plateau. The %BTV of low (401-500HU in the distal femur; 301-400 HU and 401-500HU in the tibial plateau), moderate, and high bone density was higher in judo athletes than in controls in the subchondral bone of the distal femur and tibial plateau (P< 0.05). CONCLUSION The history of compressive stresses, struck stresses, soft tissue tension and pull, self-gravity and intra-articular stress loading generated by the lower limb exercise technique of judo leads to specific forms of stress distribution and bone tissue remodeling in the subchondral bone tissue within the distal femur and tibia plateau.
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Affiliation(s)
- Zhiqiang Li
- School of Physical Education, North University of China, Taiyuan, China
| | - Guanghua Xu
- School of Physical Education, North University of China, Taiyuan, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chengjun Wang
- School of Physical Education, North University of China, Taiyuan, China
| | - Qiuyuan Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Caiping Liu
- School of Physical Education, North University of China, Taiyuan, China
| | - Tingting Guo
- Ergonomics and Functional Clothing Laboratory, School of Textiles and Fashion, Shanghai University of Engineering Science, Shanghai, China
| | - Lijun Wu
- School of Physical Education, Shanxi University, Taiyuan, China
- *Correspondence: Diankang Cao, ; Lijun Wu,
| | - Diankang Cao
- School of Physical Education, North University of China, Taiyuan, China
- *Correspondence: Diankang Cao, ; Lijun Wu,
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Tayfur A, Haque A, Salles JI, Malliaras P, Screen H, Morrissey D. Are Landing Patterns in Jumping Athletes Associated with Patellar Tendinopathy? A Systematic Review with Evidence Gap Map and Meta-analysis. Sports Med 2021; 52:123-137. [PMID: 34554424 PMCID: PMC8761156 DOI: 10.1007/s40279-021-01550-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/25/2022]
Abstract
Background Patellar tendinopathy (PT) is common and debilitating for jumping athletes. Intriguingly, despite its high prevalence and many research studies, a causal explanation for PT presence remains elusive. Objective Our objective was to investigate whether landing biomechanics among jumping athletes are associated with PT and can predict onset. Methods We conducted a systematic review with evidence gap map and meta-analysis. We searched three databases from inception to May 2021 for observational studies or trials evaluating landing biomechanics in jumping athletes with PT (JPTs). We assessed quality with a modified Downs and Black checklist, risk of bias with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and evidence levels with van Tulder’s criteria and provided an evidence gap map. Results One prospective cohort (moderate quality), one cross-sectional cohort (moderate quality), and 14 case–control (four high-, seven moderate-, and three low-quality) studies, including 104 JPTs, 14 with previous PT, 45 with asymptomatic patellar tendon abnormality (PTA), and 190 controls were retained. All studies had a high risk of bias. Meta-analysis showed an association between lower ankle dorsiflexion and the presence of tendinopathy during drop and spike landings, and JPTs had reduced knee joint power and work during volleyball approach or drop landings (moderate evidence). Limited evidence suggested that JPTs had lower patellar tendon loads during drop landings. Strong or moderate evidence showed no relation between PT and sagittal plane peak knee and hip angles or range of motion; hip, knee, or ankle angles at initial contact (IC); knee angular velocities, peak trunk kinematics, or trunk angles at IC; sagittal plane hip, knee, or ankle moments; and peak vertical ground reaction force (vGRF) and vGRF impulse. Identified gaps were that no study simultaneously investigated athletes with previous PT, current PT, and PTA, and studies of joint angular velocities at IC, ankle and hip angular velocities after touchdown, leg stiffness, loading rate of forces, and muscle activation are lacking. Conclusion Despite the voluminous literature, large number of participants, multitude of investigated parameters, and consistent research focus on landing biomechanics, only a few associations can be identified, such as reduced ankle dorsiflexion–plantarflexion range. Further, the quality of the existing literature is inadequate to draw strong conclusions, with only four high-quality papers being found. We were unable to determine biomechanical factors that predicted PT onset, as longitudinal/prospective studies enabling causal inference are absent. The identified gaps indicate useful areas in which to explore causal relationships to inform intervention development. Therefore, high-quality prospective studies are essential to definitively determine whether landing biomechanics play a part in the development, recurrence, or management of PT and represent a potential therapeutic or preventive target alongside non-biomechanical factors. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01550-6.
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Affiliation(s)
- Abdulhamit Tayfur
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK.,Barts Health NHS Trust, London, UK
| | - Arman Haque
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK
| | - Jose Inacio Salles
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK
| | - Peter Malliaras
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Hazel Screen
- School of Engineering Material Sciences, QMUL, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK. .,Barts Health NHS Trust, London, UK.
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20
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Hu G, Wang W, Chen B, Zhi H, Yudi Li, Shen Y, Wang K. Concurrent validity of evaluating knee kinematics using Kinect system during rehabilitation exercise. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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21
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Egerton T, Donkin D, Kazantzis S, Ware H, Moore S. Conceptualisation of a region-based group of musculoskeletal pain conditions as 'tibial loading pain' and systematic review of effects of load-modifying interventions. J Sci Med Sport 2021; 25:46-52. [PMID: 34366244 DOI: 10.1016/j.jsams.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Conceptualisation of a clinically-relevant group of conditions as a region-based, load-related musculoskeletal pain condition ('tibial loading pain') to enable identification of evidence of treatment effect from load-modifying interventions. DESIGN Systematic review and evidence synthesis based on a developed and justified theoretical position. METHODS Musculoskeletal pain localised to the tibial (shin) region and consistent with clinical presentations of an exercise/activity-related onset mechanism, was conceptualised as a group of conditions ('tibial loading pain') that could be reasoned to respond to load modifying interventions. Five databases were searched for randomized controlled studies investigating any load-modifying intervention for pain in the anterior-anteromedial lower leg (shin). Study quality was evaluated (Risk of Bias Tool Version 2) and level of certainty for the findings assessed. RESULTS Six studies reporting seven comparisons were included. Interventions included braces, anti-pronation taping, compression stocking and a stretch + strengthening programme. All included studies were assessed as having unclear or high risk of bias. The review found no evidence of beneficial effect from any of the load-modifying interventions on symptoms, physical performance or biomechanical measures, apart from a possible benefit of anti-pronation 'kinesio' taping. There was very low certainty evidence that kinesio taping improves pain and pain-free hopping distance after one week. The braces were associated with minor adverse effects and problems with acceptability. CONCLUSIONS None of the treatments investigated by the included studies can be recommended. Conceptualisation of the problem as regional, primarily loading-related pain rather than as multiple distinct pathoanatomically-based conditions, and clearer load-modifying hypotheses for interventions are recommended.
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Affiliation(s)
- Thorlene Egerton
- Physiotherapy Department, The University of Melbourne, Australia; Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Australia
| | - David Donkin
- Physiotherapy Department, The University of Melbourne, Australia; Department of Health Professions, Macquarie University, Australia
| | - Sia Kazantzis
- Physiotherapy Department, The University of Melbourne, Australia
| | - Hannah Ware
- Physiotherapy Department, The University of Melbourne, Australia; The Melbourne Sports Medicine Centre, Australia
| | - Sonya Moore
- Physiotherapy Department, The University of Melbourne, Australia.
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Eitzen I, Renberg J, Færevik H. The Use of Wearable Sensor Technology to Detect Shock Impacts in Sports and Occupational Settings: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:4962. [PMID: 34372198 PMCID: PMC8348544 DOI: 10.3390/s21154962] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 12/03/2022]
Abstract
Shock impacts during activity may cause damage to the joints, muscles, bones, or inner organs. To define thresholds for tolerable impacts, there is a need for methods that can accurately monitor shock impacts in real-life settings. Therefore, the main aim of this scoping review was to present an overview of existing methods for assessments of shock impacts using wearable sensor technology within two domains: sports and occupational settings. Online databases were used to identify papers published in 2010-2020, from which we selected 34 papers that used wearable sensor technology to measure shock impacts. No studies were found on occupational settings. For the sports domain, accelerometry was the dominant type of wearable sensor technology utilized, interpreting peak acceleration as a proxy for impact. Of the included studies, 28 assessed foot strike in running, head impacts in invasion and team sports, or different forms of jump landings or plyometric movements. The included studies revealed a lack of consensus regarding sensor placement and interpretation of the results. Furthermore, the identified high proportion of validation studies support previous concerns that wearable sensors at present are inadequate as a stand-alone method for valid and accurate data on shock impacts in the field.
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Affiliation(s)
- Ingrid Eitzen
- Department of Smart Sensor Systems, SINTEF Digital, 0373 Oslo, Norway
| | - Julie Renberg
- Department of Health Research, SINTEF Digital, 7034 Trondheim, Norway
| | - Hilde Færevik
- Department of Health Research, SINTEF Digital, 7034 Trondheim, Norway
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Ellenberger L, Casutt S, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Thigh muscle activation patterns and dynamic knee valgus at peak ground reaction force during drop jump landings: Reliability, youth competitive alpine skiing-specific reference values and relation to knee overuse complaints. J Sci Med Sport 2021; 24:1230-1234. [PMID: 34238661 DOI: 10.1016/j.jsams.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES (1) To evaluate the reliability of quantifying thigh muscle activation patterns and dynamic knee valgus during drop jump landings, (2) to provide reference values for female and male youth alpine skiers, and (3) to study their associations with age, anthropometrics, biological maturation and knee overuse complaints. DESIGN Cross-sectional biomechanical experiment including questionnaires. METHODS One hundred fourteen skiers of the under 16 category (main experiment) and twelve healthy participants (reliability experiment) volunteered. Quadriceps-to-hamstring-activation ratio and medial knee displacementat peak ground reaction force during drop jump landings were measured using marker-based motion analysis, force plates and electromyography. Additionally, age, anthropometrics, biological maturation and knee overuse complaints were assessed. RESULTS There were good test-retest reliabilities and moderate standardized typical errors for both quadriceps-to-hamstring-activation ratio (intraclass correlation coefficient(3,1) = 0.84 [95% confidence interval: 0.69, 0.94]; standardized typical errors = 0.43 [0.35, 0.56]) and medial knee displacement (intraclass correlation coefficient(3,1) = 0.87 [0.74, 0.95]; standardized typical errors = 0.39 [0.32, 0.50]). Male skiers had a significantly higher quadriceps-to-hamstring-activation ratio (3.9 ± 2.0 vs. 2.9 ± 1.4, p = 0.011), whilst medial knee displacement was comparable to females (12 mm ± 11 mm vs. 13 mm ± 9 mm; p = 0.419). In male skiers, medial knee displacement correlated with anthropometrics and maturity offset; in female skiers, quadriceps-to-hamstring-activation ratio and medial knee displacement were associated with knee overuse complaints (p < 0.05). CONCLUSIONS Female and male youth skiers use different thigh muscle activation strategies, but show comparable dynamic knee valgus motions during drop jump landings. In females, a combination of increased relative quadriceps activity and medial knee displacement may favour knee overuse complaints.
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Affiliation(s)
- Lynn Ellenberger
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Selina Casutt
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Jess G Snedeker
- Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Switzerland.
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Motion Analysis Zurich, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
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24
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Forsyth JR, Richards CJ, Tsai MC, Whitting JW, Riddiford-Harland DL, Sheppard JM, Steele JR. Rate of loading, but not lower limb kinematics or muscle activity, is moderated by limb and aerial variation when surfers land aerials. J Sports Sci 2021; 39:1780-1788. [PMID: 33775223 DOI: 10.1080/02640414.2021.1898167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We aimed to determine whether there were any differences in how surfers used their lead and trail limbs when landing two variations of a simulated aerial manoeuvre, and whether technique affected the forces generated at landing. Fifteen competitive surfers (age 20.3 ± 5.6 years, height 178.2 ± 9.16 cm, mass 71.0 ± 10.5 kg) performed a Frontside Air (FA) and Frontside Air Reverse (FAR), while we collected the impact forces, ankle and knee muscle activity, and kinematic data. A principal component analysis (PCA) was used to reduce 41 dependent variables into 10 components. A two-way MANOVA revealed that although there were no limb x aerial variation interactions, surfers generated significantly higher relative loading rates at landing for the trail limb compared to the lead limb (+28.8 BW/s; F(1,303) = 20.660, p < 0.0001, η2 = 0.064). This was likely due to the surfers "slapping" the trail limb down when landing, rather than controlling placement of the limb. Similarly, higher relative loading rates were generated when landing the FA compared to the FAR (+23.6 BW/s; F(1,303) = 31.655, p < 0.0001, η2 = 0.095), due to less time over which the forces could be dissipated. No relationships between aerial variation or limb were found for any of the kinematic or muscle activity data. Practitioners should consider the higher relative loading rates generated by a surfer's trail limb and when surfers perform a FA when designing dry-land training to improve the aerial performance of surfing athletes.
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Affiliation(s)
- James R Forsyth
- Biomechanics Research Laboratory, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong NSW, Australia
| | - Christopher J Richards
- Biomechanics Research Laboratory, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong NSW, Australia.,ARC Centre of Excellence for Electromaterial Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Ming-Chang Tsai
- Department of Biomechanics & Performance Analysis, Canadian Sports Institute, Victoria BC, Canada
| | - John W Whitting
- School of Health & Human Sciences, Southern Cross University, Lismore NSW Australia
| | - Diane L Riddiford-Harland
- Biomechanics Research Laboratory, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong NSW, Australia
| | - Jeremy M Sheppard
- School of Medical & Health Sciences, Edith Cowan University, Joondalup WA, Australia.,Department of Health & Performance Services,Canadian Sports Institute Pacific, Whistler BC, Canada
| | - Julie R Steele
- Biomechanics Research Laboratory, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong NSW, Australia
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25
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Biomechanics Differ for Individuals With Similar Self-Reported Characteristics of Patellofemoral Pain During a High-Demand Multiplanar Movement Task. J Sport Rehabil 2021; 30:860-869. [PMID: 33596543 DOI: 10.1123/jsr.2020-0220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/05/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Patellofemoral pain (PFP) is often categorized by researchers and clinicians using subjective self-reported PFP characteristics; however, this practice might mask important differences in movement biomechanics between PFP patients. OBJECTIVE To determine whether biomechanical differences exist during a high-demand multiplanar movement task for PFP patients with similar self-reported PFP characteristics but different quadriceps activation levels. DESIGN Cross-sectional design. SETTING Biomechanics laboratory. PARTICIPANTS A total of 15 quadriceps deficient and 15 quadriceps functional (QF) PFP patients with similar self-reported PFP characteristics. INTERVENTION In total, 5 trials of a high-demand multiplanar land, cut, and jump movement task were performed. MAIN OUTCOME MEASURES Biomechanics were compared at each percentile of the ground contact phase of the movement task (α = .05) between the quadriceps deficient and QF groups. Biomechanical variables included (1) whole-body center of mass, trunk, hip, knee, and ankle kinematics; (2) hip, knee, and ankle kinetics; and (3) ground reaction forces. RESULTS The QF patients exhibited increased ground reaction force, joint torque, and movement, relative to the quadriceps deficient patients. The QF patients exhibited: (1) up to 90, 60, and 35 N more vertical, posterior, and medial ground reaction force at various times of the ground contact phase; (2) up to 4° more knee flexion during ground contact and up to 4° more plantarflexion and hip extension during the latter parts of ground contact; and (3) up to 26, 21, and 48 N·m more plantarflexion, knee extension, and hip extension torque, respectively, at various times of ground contact. CONCLUSIONS PFP patients with similar self-reported PFP characteristics exhibit different movement biomechanics, and these differences depend upon quadriceps activation levels. These differences are important because movement biomechanics affect injury risk and athletic performance. In addition, these biomechanical differences indicate that different therapeutic interventions may be needed for PFP patients with similar self-reported PFP characteristics.
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McClinton SM, Cobian DG, Heiderscheit BC. Physical Therapist Management of Anterior Knee Pain. Curr Rev Musculoskelet Med 2020; 13:776-787. [PMID: 33128200 PMCID: PMC7661565 DOI: 10.1007/s12178-020-09678-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. RECENT FINDINGS The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.
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Affiliation(s)
- Shane M. McClinton
- Doctor of Physical Therapy Program, Des Moines University, Des Moines, IA USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI USA
| | - Bryan C. Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA
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