Technique determinants of knee joint loads during cutting in female soccer players

Increased Visual Attentional Demands Alter Lower Extremity Sidestep Cutting Kinematics in Male Basketball Players

Background

In basketball, changing direction is one of the primary mechanisms of anterior cruciate ligament (ACL) injury, often occurring within complex game situations with high cognitive demands. It is unknown how visual attention affects sidestep cutting kinematics during the entire energy absorption phase of the cut in an ecologically valid environment.

Purpose

The purpose of this research was to study the effect of added cognitive load, in the form of increased visual attentional demands, on sidestep cutting kinematics during the energy absorption phase of the cut in an ecologically valid environment.

Study Design

Crossover Study.

Methods

Fifteen male basketball players (aged 22.1 ± 2.3) performed ten sidestep cutting movements without (BASE) and with (VIS) a visual attention dual task. 3D kinematics of the hip, knee and ankle were recorded utilizing Xsens IMU motion capture. Temporal kinematics were analyzed using Statistical Parametric Mapping. Discrete time point kinematics were additionally analyzed at initial contact (IC) and at peak knee flexion utilizing paired t-tests. Effect sizes were calculated.

Results

Hip flexion was significantly reduced in the VIS condition compared to the BASE condition (p<0.01), including at IC (VIS 35.0° ± 7.2°, BASE 40.7° ± 4.9°, p=0.02, d=0.92) and peak (VIS 37.8° ± 9.7°, BASE 45.5° ± 6.9°, p=0.001, d=0.90). Knee flexion was significantly reduced in the VIS condition, in comparison to the BASE condition (p<0.01), at peak (VIS 59.9° ± 7.5°, BASE 64.1° ± 7.4°, p=0.001, d=0.55).

Conclusion

The addition of visual attention during sidestep cutting altered lower limb kinematics, which may increase ACL injury risk. It is suggested that ACL injury risk screening and prevention should include sidestep cutting with visual attentional demands, in order to mimic the cognitive demands of the sports environment.

Level of Evidence

3.

Effects of stiffness-altered sport compression garments on lower-limb biomechanics in cutting maneuvers

Athletes commonly use compression garments (CGs) for perceived effectiveness in preventing injury occurrence. However, limited evidence is available on whether lower-limb CGs reduce the risk of injury. This study aimed at (1) evaluating the effects of CGs on mitigating the risk factors of cutting-related knee injuries; (2) identifying undesirable side-effects of CGs on other joints and cutting performance; and (3) identifying possible interactions between sex and condition. 62 healthy adults performed pre-planned 90˚ cutting tasks under four conditions: control, knee sleeves, placebo leggings and stiffness-altered leggings. Joint angle at initial contact, range of motion, moments, and ground reaction force were measured. A mixed two-way (sex*condition) ANOVA was performed, followed by post-hoc comparisons and subset analyses for sexes. Results showed that the leggings restricted hip sagittal (45.4 ± 1.3 vs. control 50.0 ± 1.3˚, p = 0.001) and rotational (16.8 ± 0.8 vs. control 22.5 ± 1.1˚, p < 0.001) motion. At initial contact, the stiffness-altered leggings reduced knee valgus (0.4 ± 0.8 vs. control -2.1 ± 0.8˚, p = 0.031). However, the altered alignment of lower-limb joints did not reduce multiplanar knee joint moments (p > 0.05). CGs were not effective protective equipment yet. There was no significant difference between knee sleeves and control, nor between leggings conditions (p > 0.05). Force plate measurements, such as increased rate of force development (stiffness-altered 42.6 ± 1.1 & placebo 42.9 ± 1.1 vs. control 39.9 ± 1.0 BW/s, p < 0.028), implied the possibility of performance enhancement through CGs. While further investigations on the optimal compression and stiffness alterations are warranted, athletes are recommended to be aware of the discrepancies between the claimed and actual biomechanical effects of CGs.

Effect of changes in motor skill induced by educational video program to decrease lower-limb joint load during cutting maneuvers: based on musculoskeletal modeling

BACKGROUND

This study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load.

METHODS

Twenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 [Formula: see text]) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling.

RESULTS

After the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64‒87% of the hip frontal moment (p < 0.001) and 32‒100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32‒100% of the knee frontal moment and 21‒100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44‒95% in the medial-lateral direction and at 17‒43% and 73‒100% in the vertical direction (p < 0.001).

CONCLUSIONS

Injury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.

Small-Sided Soccer Games Promote Greater Adaptations on Vertical Jump and Change-of-Direction Deficit and Similar Adaptations in Aerobic Capacity than High-Intensity Interval Training in Females

The objective of this study was to compare the effectiveness of both small-sided games (SSG) and short interval running-based high-intensity interval training (HIIT) programs over an 8-week period in fostering adaptations in aerobic capacity, change-of-direction abilities, and jumping performances of youth female soccer players. The study involved 48 female youth participants under the age of 19, competing at the regional level, who took part in a randomized controlled trial. Participants were assigned to either the SSG group, the HIIT group, or a control group, which involved regular in-field sessions. Assessments were conducted at baseline and after the 8-week training intervention, measuring aerobic capacity using the 30-15 intermittent fitness test (VIFT), change of direction (COD) using the 5-0-5 test, and jumping performance using the countermovement jump test (CMJ). Time 5 group analysis revealed significant interactions in CMJ (p = 0.005; ηp2= 0.213) and VIFT (p < 0.001; ηp2 = 0.433), although no significant interaction were found in COD deficit (p = 0.246; ηp2 = 0.060). Within-group analysis revealed that SSG significantly improved CMJ (p < 0.001), COD deficit (p < 0.001), and VIFT (p < 0.001). HIIT group also significantly improved CMJ (p = 0.029), COD deficit (p = 0.001), and VIFT (p < 0.001). As conclusion, the study revealed that SSG promoted significantly improvements in VIFT, CMJ and COD deficit, being significantly better than control group, while HIIT was only significantly better than control in VIFT. SSG revealed to be effective approach for favoring key physical attributes of female soccer players, being an interesting and recommended training approach to increase the ecology of the training practice, while favoring physical positive adaptations.

Alternative Models for Pelvic Marker Occlusion in Cycling

Bike fitting aims to optimize riders' positions to improve their performance and reduce the risk of injury. To calculate joint angles, the location of the joint centers of the lower limbs needs to be identified. However, one of the greatest difficulties is the location of the hip joint center due to the frequent occlusion of the anterior superior iliac spine markers. Therefore, the objective of this study was to validate a biomechanical model adapted to cycling (modified pelvic model, MPM), based on the traditional pelvic model (TPM) with an additional lateral technical marker placed on the iliac crests. MPM was also compared with a widely used model in cycling, trochanter model (TM). Thirty-one recreational cyclists pedaled on a roller bike while the movement was captured with a 7-camera VICON system. The position of the hip joint center and knee angle were calculated and compared with the TPM continuously (along 10 pedaling cycles) and discreetly at 90° and 180° crank positions. No significant differences were found in the position of the hip joint center or in the knee flexion/extension angle between the TPM and the MPM. However, there are differences between TPM and TM (variations between 4.1° and 6.9° in favor of the TM at 90° and 180°; P < .001). Bland-Altman graphs comparing the models show an average difference or bias close to 0° (limits of agreement [0.2 to -8.5]) between TPM and MPM in both lower limbs and a mean difference of between -4° and -7° (limits of agreement [-0.6 to -13.2]) when comparing TPM and TM. Given the results, the new cycling pelvic model has proven to be valid compared with the TPM when performing bike fitting studies, with the advantage that the occluded markers are avoided. Despite its simplicity, the TM presents measurement errors that may be relevant when making diagnoses, which makes its usefulness questionable.

Differences in Biomechanical Determinants of ACL Injury Risk in Change of Direction Tasks Between Males and Females: A Systematic Review and Meta-Analysis

BACKGROUND

Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading.

OBJECTIVE

The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks.

METHODS

Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021-June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18-40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis.

RESULTS

This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098-0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299-1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134-0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: -0.454, 95% CI 0.151-0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status.

CONCLUSION

No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females.

Relationship of Knee Abduction Moment to Trunk and Lower Extremity Segment Acceleration during Sport-Specific Movements

The knee abduction moment (KAM) has been identified as a significant predictor of anterior cruciate ligament (ACL) injury risk; however, the cost and time demands associated with collecting three-dimensional (3D) kinetic data have prompted the need for alternative solutions. Wearable inertial measurement units (IMUs) have been explored as a potential solution for quantitative on-field assessment of injury risk. Most previous work has focused on angular velocity data, which are highly susceptible to bias and noise relative to acceleration data. The purpose of this pilot study was to assess the relationship between KAM and body segment acceleration during sport-specific movements. Three functional tasks were selected to analyze peak KAM using optical motion capture and force plates as well as peak triaxial segment accelerations using IMUs. Moderate correlations with peak KAM were observed for peak shank acceleration during single-leg hop; peak trunk, thigh, and shank accelerations during a deceleration task; and peak trunk, pelvis, and shank accelerations during a 45° cut. These findings provide preliminary support for the use of wearable IMUs to identify peak KAM during athletic tasks.

Predictive simulation of single-leg landing scenarios for ACL injury risk factors evaluation

The Anterior Cruciate Ligament (ACL) rupture is a very common knee injury during sport activities. Landing after jump is one of the most prominent human body movements that can lead to such an injury. The landing-related ACL injury risk factors have been in the spotlight of research interest. Over the years, researchers and clinicians acquire knowledge about human movement during daily-life activities by organizing complex in vivo studies that feature high complexity, costs and technical and most importantly physical challenges. In an attempt to overcome these limitations, this paper introduces a computational modeling and simulation pipeline that aims to predict and identify key parameters of interest that are related to ACL injury during single-leg landings. We examined the following conditions: a) landing height, b) hip internal and external rotation, c) lumbar forward and backward leaning, d) lumbar medial and lateral bending, e) muscle forces permutations and f) effort goal weight. Identified on related research studies, we evaluated the following risk factors: vertical Ground Reaction Force (vGRF), knee joint Anterior force (AF), Medial force (MF), Compressive force (CF), Abduction moment (AbdM), Internal rotation moment (IRM), quadricep and hamstring muscle forces and Quadriceps/Hamstrings force ratio (Q/H force ratio). Our study clearly demonstrated that ACL injury is a rather complicated mechanism with many associated risk factors which are evidently correlated. Nevertheless, the results were mostly in agreement with other research studies regarding the ACL risk factors. The presented pipeline showcased promising potential of predictive simulations to evaluate different aspects of complicated phenomena, such as the ACL injury.

The reliability of lower limb 3D gait analysis variables during a change of direction to 90- and 135-degree manoeuvres in recreational soccer players

BACKGROUND

Several biomechanical outcomes are being used to monitor the risk of injuries; therefore, their reliability and measurement errors need to be known.

OBJECTIVE

To measure the reliability and measurement error in lower limb 3D gait analysis outcomes during a 90∘ and 135∘ change of direction (COD) manoeuvre.

METHODS

A test re-test reliability study for ten healthy recreational players was conducted at seven-day intervals. Kinematics (Hip flexion, adduction, internal rotation angles and knee flexion abduction angles) and kinetics (Knee abduction moment and vertical ground reaction force) data during cutting 90∘ and 135∘ were collected using 3D gait analysis and force platform. Five trials for each task and leg were collected. Standard error of measurement (SEM) and the intraclass correlation coefficient (ICC) were calculated from the randomised leg.

RESULT

The ICC values of the kinematics, kinetics, and vertical ground reaction force (VGRF) outcomes (90∘ and 135∘) ranged from 0.85 to 0.95, showing good to excellent reliability. The SEM for joint angles was less than 1.69∘. The VGRV showed a higher ICC value than the other outcomes.

CONCLUSION

The current study results support the use of kinematics, kinetics, and VGRF outcomes for the assessment of knee ACL risk in clinic or research. However, the hip internal rotation angle should be treated with caution since the standard measurement error exceeded 10% compared to the mean value. The measurement errors provided in the current study are valuable for future studies.

Biomechanical and Neuromuscular Performance Requirements of Horizontal Deceleration: A Review with Implications for Random Intermittent Multi-Directional Sports

Rapid horizontal accelerations and decelerations are crucial events enabling the changes of velocity and direction integral to sports involving random intermittent multi-directional movements. However, relative to horizontal acceleration, there have been considerably fewer scientific investigations into the biomechanical and neuromuscular demands of horizontal deceleration and the qualities underpinning horizontal deceleration performance. Accordingly, the aims of this review article are to: (1) conduct an evidence-based review of the biomechanical demands of horizontal deceleration and (2) identify biomechanical and neuromuscular performance determinants of horizontal deceleration, with the aim of outlining relevant performance implications for random intermittent multi-directional sports. We highlight that horizontal decelerations have a unique ground reaction force profile, characterised by high-impact peak forces and loading rates. The highest magnitude of these forces occurs during the early stance phase (< 50 ms) and is shown to be up to 2.7 times greater than those seen during the first steps of a maximal horizontal acceleration. As such, inability for either limb to tolerate these forces may result in a diminished ability to brake, subsequently reducing deceleration capacity, and increasing vulnerability to excessive forces that could heighten injury risk and severity of muscle damage. Two factors are highlighted as especially important for enhancing horizontal deceleration ability: (1) braking force control and (2) braking force attenuation. Whilst various eccentric strength qualities have been reported to be important for achieving these purposes, the potential importance of concentric, isometric and reactive strength, in addition to an enhanced technical ability to apply braking force is also highlighted. Last, the review provides recommended research directions to enhance future understanding of horizontal deceleration ability.

The effect of planning time on penultimate and ultimate step kinematics and subsequent knee moments during sidestepping

Frontal plane postures during the ultimate step of sidestepping are linked to increased anterior cruciate ligament injury risk. However, there is a lack of research detailing the kinematic strategies present in the penultimate step. This study, therefore, investigated penultimate and ultimate step kinematics of planned sidestepping (pSS) and unplanned sidestepping (upSS) to further understand the effect of planning time on known ultimate step kinematic and kinetic differences. Sixty male amateur Australian Rules football players performed three trials of straight-line running (RUN), pSS, and upSS in a randomized order. Mediolateral foot placement and three-dimensional joint kinematics for the knee, pelvis, and trunk were measured at final foot contact of the penultimate step and initial foot contact of the ultimate step. Peak knee moments were measured during the weight acceptance phase of the ultimate step. In pSS, at the penultimate step final foot contact, the support foot was placed across the midline of the center of mass, in the frontal plane, contralateral to the sidestep direction. Greater trunk lateral flexion toward the sidestep direction and greater negative pelvic lateral tilt were observed in pSS compared with upSS and RUN. Differences between pSS and upSS frontal plane kinematics at penultimate step final foot contact suggest preparatory reorientation strategies are likely constrained by the amount of planning time available. As there are clear differences in preparatory kinematics, we recommend that planning time be considered when training and assessing sidestepping maneuvers and planned and unplanned maneuvers not be treated as interchangeable skills.

Video Analysis of Anterior Cruciate Ligament Injury Situations in the Women's Australian Football League

Anterior cruciate ligament (ACL) injury rates in the Women's Australian Football League (AFLW) are alarmingly high. Understanding injuries within their sporting context is important to develop effective injury prevention strategies, yet there is currently little knowledge of how ACL injuries occur to AFLW players. This study addressed the common scenarios and characteristics of ACL injuries in the AFLW.

Online match and AFLW club injury reports identified 38 ACL injury cases. After excluding injuries where footage was unavailable (i.e. training, pre-season games), a video analysis of 21 match ACL injuries from the 2017-2020 AFLW seasons was performed. We examined match characteristics, and the player's movements and body postures preceding and at the estimated time of injury. Descriptive frequencies and relative proportions were determined across the assessed categories.

Non-contact ACL injuries were frequently observed (n=13, 61.9%), while contact preceding the injury event (i.e. indirect contact) was also common (n=10, 47.6%). The most common game situation was direct defence (i.e. defending an opponent in possession) (n=14, 66.7%). Sidestep cutting was the most prevalent movement (n=11, 52.4%), with this commonly performed while applying defensive pressure (n=6 of 11, 54.6%).

Sidestep cutting when applying defensive pressure is the most common non-contact ACL injury scenario in the AFLW. Preceding contact potentially contributing to a player's loss of balance was another prominent AFLW scenario. AFLW players may benefit from injury prevention programs emphasising appropriate sidestep cutting technique during reactive defensive scenarios, and maintenance of lower limb postures known to withstand knee loading relative to the sporting task.

Reliability of a Qualitative Instrument to Assess High-Risk Mechanisms during a 90° Change of Direction in Female Football Players

Sidestep cuts between 60° and 180° and one-leg landings have been identified as the main mechanisms of ACL injuries in several sports. This study sought to determine intra- and inter-rater reliability of a qualitative tool to assess high-risk movements in a 90° change of direction when the test is applied in a real framework of sport practice. Female footballers from two teams (n = 38) participated in this study and were asked to perform 90° cutting trials to each side, which were simultaneously filmed from a frontal and a sagittal view. A total of 61 cases were selected for 2D qualitative observational analysis by three raters. Poor reliability was found among each pair of raters as well as moderate reliability when the Cutting Movement Assessment Score (CMAS) was given by the same rater at different moments, but with too high a minimum detectable change. On the other hand, raters presented a significant, as well as moderate-to-good intra-rater reliability for most items of the CMAS tool. There was, however, non-significant reliability between observers in rating most check-points of the tool. For these reasons, more objective guidelines and clearer definitions for each criterion within the CMAS, as well as a longer, standardised training period for novel observers, would be highly recommended to improve the reliability of this tool in an applied context with female footballers.

Effects of foot progression angle on kinematics and kinetics of a cutting movement

Purpose

Foot progression angle is a key factor for biomechanical knee load, which is associated with noncontact anterior cruciate ligament (ACL) injury during sports-specific tasks. The purpose of the present study was to assess the biomechanics of trunk, pelvis, and lower extremities during a cutting maneuver under different foot progression angles.

Methods

Nineteen male collegiate athletes (ages 18–24) participated in the present study. Cutting motion was analyzed using eight infrared cameras (250 Hz), two force plates (1250 Hz), and 44 reflective markers. Subjects performed 45-degree side cutting maneuvers under three foot progression angles, including 20 degrees (toe-out: TO), 0 degrees (neutral: TN), and − 20 degrees (toe-in: TI). Peak values of each biomechanical parameters in trunk, pelvis, hip, and knee within a first 40% stance phase and each parameter at the timing of the peak vertical ground reaction force were assessed. A statistical analysis was performed to compare data among the three-foot progression angles using the Friedman test.

Results

Peak angles of knee abduction, tibial internal rotation, hip internal rotation, and hip adduction were significantly greater for TI position than for TO position (p < 0.01). Peak moments of knee abduction and tibial internal rotation under TI position were also significantly larger than TO position (p < 0.01). Moreover, greater peak pelvis-trunk rotation was found for TI position than for TN and TO positions (p < 0.01).

Conclusion

From the present study, TI position could lead to an increased risk of ACL injury during a pre-planned cut maneuver, compared to TO position.

Influence of Physical and Technical Aspects on Change of Direction Performance of Rugby Players: An Exploratory Study

We examined the relationships between change of direction (COD) speed and deficit, and a series of speed- and power-related measurements in national team rugby union players and analyzed the influence of movement patterns on COD ability. Eleven male athletes completed the following physical assessments on different days: day 1—anthropometric measurements, and lower-body kinematic parameters (assessed with eight inertial sensors) and completion time in COD tests (pro-agility, 45° cutting maneuver (CUT), and “L” (L-Drill)); day 2—bilateral and unilateral squat and countermovement jumps, 40 m linear sprint, and bar-power output in the jump squat and half-squat exercises. Pearson’s product–moment correlations were performed to determine the relationships between COD velocities, COD deficits, and the speed–power variables. Differences between players with higher and lower COD deficits were examined using magnitude-based inferences. Results showed that (1) greater sprint momentum was associated with higher COD deficits, particularly in drills with sharper angles and multiple directional changes (L-drill and pro-agility); (2) higher unilateral jump heights were associated with greater COD deficits in the pro-agility and L-drill but not in the CUT; (3) faster athletes were less efficient at changing direction and presented greater trunk and knee flexion angles during COD maneuvers, probably as a consequence of higher inertia.

When puberty strikes: Longitudinal changes in cutting kinematics in 172 high-school female athletes

OBJECTIVES

Young female athletes involved in high-speed cutting and change-of-direction sports are particularly susceptible to anterior cruciate ligament (ACL) injuries. Little is known if maturational changes in cutting technique contribute to the increased injury risk. Our objective was to examine longitudinal changes in cutting kinematics in female athletes as they matured through puberty.

DESIGN

Longitudinal cohort study METHODS: High school female athletes (n=172) performed an unanticipated 45° cutting task in the biomechanics laboratory across two or more pubertal stages. Pubertal stages were classified using a modified Pubertal Maturational Observational Scale (pre-, mid-, or post-pubertal stages). Generalized linear mixed models were used to compare kinematics across pubertal stages.

RESULTS

As girls matured through puberty, they displayed a decrease in sagittal-plane hip (1.8-2.6°, p<0.03) and knee range-of-motion (ROM) (2.7-2.9°, p≤0.01), and decreased peak hip (2.9-3.2°, p≤0.02) and knee flexion angles (2.7-2.9°, p≤0.01), which is indicative of greater quadriceps dominance. Peak knee abduction angles also increased as girls progressed through puberty (0.9-1.4°, p≤0.02), suggesting greater ligament dominance. In terms of trunk dominance, there were mixed findings with a decrease in trunk frontal- (2.5-5.7°, p≤0.03) and sagittal-plane ROM (2.0°, p≤0.01), but an increase in trunk transverse-plane ROM (2.8-3.6°, p≤0.02) observed as girls mature. Other significant changes in cutting technique were decreased peak trunk flexion (3.8-7.8°, p≤0.01), and decreased hip flexion (2.9-3.3°, p≤0.02) and knee flexion angles (2.0-3.0°, p≤0.03) at initial contact, suggesting a more upright and stiffer cutting posture.

CONCLUSIONS

As girls mature through puberty, there is a change in cutting strategy characterized by greater quadriceps and ligament dominance.

Deceleration Training in Team Sports: Another Potential 'Vaccine' for Sports-Related Injury?

High-intensity horizontal decelerations occur frequently in team sports and are typically performed to facilitate a reduction in momentum preceding a change of direction manoeuvre or following a sprinting action. The mechanical underpinnings of horizontal deceleration are unique compared to other high-intensity locomotive patterns (e.g., acceleration, maximal sprinting speed), and are characterised by a ground reaction force profile of high impact peaks and loading rates. The high mechanical loading conditions observed when performing rapid horizontal decelerations can lead to tissue damage and neuromuscular fatigue, which may diminish co-ordinative proficiency and an individual’s ability to skilfully dissipate braking loads. Furthermore, repetitive long-term deceleration loading cycles if not managed appropriately may propagate damage accumulation and offer an explanation for chronic aetiological consequences of the ‘mechanical fatigue failure’ phenomenon. Training strategies should look to enhance an athlete’s ability to skilfully dissipate braking loads, develop mechanically robust musculoskeletal structures, and ensure frequent high-intensity horizontal deceleration exposure in order to accustom individuals to the potentially damaging effects of intense decelerations that athletes will frequently perform in competition. Given the apparent importance of horizontal decelerations, in this Current Opinion article we provide considerations for sport science and medicine practitioners around the assessment, training and monitoring of horizontal deceleration. We feel these considerations could lead to new developments in injury-mitigation and physical development strategies in team sports.

Characteristics of ground reaction force and frontal body movement during failed trials of single-leg lateral drop jump-landing task

Background

/objectives: For biomechanical studies using jump-landing tasks, many researchers set the criteria for judging success or failure of the trial. Failed trials are usually removed from the analysis. However, the kinetics and kinematics during tasks included in failed trials might be important for understanding the mechanisms and risk factors of non-contact sports injuries. However, few studies have attempted to analyze failed trials. Therefore, the main objective of this study was to investigate the characteristics associated with ground reaction force (GRF) and two-dimensional frontal body movements during a failed trial of single-leg lateral drop jump-landing.

Methods

Ten healthy women and 16 healthy men participated in this study. Spearman's rank correlation coefficients were calculated using the total number of failed trials and GRF data of successful trials. The association between frontal body movement and kinetics data was identified using correlation analyses. Wilcoxon signed-rank tests were performed to compare the GRF data of successful trials and failed trials of the same subject. Additionally, a two-way repeated measure analysis of variance was used to determine significant interactions of each trial and time after initial contact in the frontal body movement.

Results

A total of 137 trials including successful and failed trials were recorded. There were 59 failed jump trials. There was a significant negative correlation between the number of failed jump trials and the elapsed time from initial contact to peak vertical GRF (peak vGRF time) during successful trials (r = -0.427). The majority of failed trials were judged to be due to rearfoot movement patterns (rearfoot medial slip or rearfoot lateral slip). During rearfoot medial slip, we observed shorter peak vGRF time, larger trunk medial motions, and larger hip adduction movements after landing than that during successful trials. During rearfoot lateral slip, we observed larger trunk lateral motions and hip abduction movements after landing than that during successful trials.

Conclusions

Athletes who frequently failed during single-leg lateral drop jump-landing had poor skills absorbing jump-landing impact, which is related to various sports injuries. It is possible to identify the risk factors for sports injuries by analyzing failure patterns.

The effect of angle on change of direction biomechanics: Comparison and inter-task relationships

The aim of this was study to examine the inter-task relationships and compare change of direction (COD) biomechanics between different angles (45°, 90°, and 180°). Twenty-seven men performed three COD tasks, whereby lower-limb and trunk kinematics and kinetics were assessed via 3D motion and ground reaction force (GRF) analysis. Key mechanical differences (p ≤ 0.025, η² = 0.024-0.940) in velocity profiles, GRF, sagittal joint angles and moments, multiplanar knee joint moments, and technical parameters existed between CODs. The primary findings were that as COD angle increased, velocity profiles decreased (p < 0.001, d = 1.56-8.96), ground contact times increased (p < 0.001, d = 3.00-5.04), vertical GRF decreased (p < 0.001, d = 0.87-3.48), and sagittal peak knee joint moments decreased (p ≤ 0.040, d = 0.62-2.73). Notably, the greatest peak knee internal rotation (KIRMs) and abduction moments (KAMs) and angles were observed during the 90° COD (p < 0.001, d = 0.88-1.81), indicating that this may be the riskiest COD angle. Small to very large (r = 0.260-0.702) associations in KAMs and KIRMs were observed between tasks, indicating that evaluations at different angles are needed to develop an athlete's biomechanical injury risk profile. The results support the concept that COD biomechanics and potential surrogates of non-contact anterior cruciate ligament injury risk are "angle-dependent"; which have important implications for COD coaching, screening, and physical preparation.

Motor learning methods that induce high practice variability reduce kinematic and kinetic risk factors of non-contact ACL injury

The prevention of non-contact anterior cruciate ligament (ACL) injuries often involves movement training, but the effectiveness of different motor learning methods has not been fully investigated. The purpose of this study was therefore to examine the effects of linear pedagogy (LP), nonlinear pedagogy (NLP) and differential learning (DL) motor learning methods on changing kinetic and kinematic factors during expected sidestep cutting related to non-contact ACL injuries. These methods primarily differ in the amount and type of movement variability they induce during practice. Sixty-six beginner male soccer players (27.5 ± 2.7 years, 180.6 ± 4.9 cm, 78.2 ± 4.6 kg) were randomly allocated to a group that trained for 12 weeks with either a LP, NLP or DL type of motor learning methods. All participants completed a biomechanical evaluation of side-step cutting before and after the training period. Analysis of covariance was used to compare post-testing outcomes among the groups while accounting for group differences in baseline performance. Changes in all kinematic and kinetic variables in NLP and DL groups were significantly higher compared to the LP group. Most comparisons were also different between NLP and DL group with the exception of vertical ground reaction force, the knee extension/flexion, knee valgus, and ankle dorsiflexion moments. Our findings indicate that beginner male soccer players may benefit from training programs incorporating NLP or DL versus LP to lower biomechanical factors associated with non-contact ACL injury, most likely because of the associated increased execution variability during training. We discuss that practitioners should consider using the NLP or DL methods, and particular the NLP, during which variability is induced to guide search, when implementing training programs to prevent ACL injuries in soccer.

Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict?

BACKGROUND

Most cutting biomechanical studies investigate performance and knee joint load determinants independently. This is surprising because cutting is an important action linked to performance and non-contact anterior cruciate ligament (ACL) injuries. The aim of this study was to investigate the relationship between cutting biomechanics and cutting performance (completion time, ground contact time [GCT], exit velocity) and surrogates of non-contact ACL injury risk (knee abduction [KAM] and internal rotation [KIRM] moments) during 90° cutting.

DESIGN

Mixed, cross-sectional study following an associative design. 61 males from multidirectional sports performed six 90° pre-planned cutting trials, whereby lower-limb and trunk kinetics and kinematics were evaluated using three-dimensional (3D) motion and ground reaction force analysis over the penultimate (PFC) and final foot contact (FFC). Pearson's and Spearman's correlations were used to explore the relationships between biomechanical variables and cutting performance and injury risk variables. Stepwise regression analysis was also performed.

RESULTS

Faster cutting performance was associated (p ≤ 0.05) with greater centre of mass (COM) velocities at key instances of the cut (r or ρ = 0.533-0.752), greater peak and mean propulsive forces (r or ρ = 0.449-0.651), shorter FFC GCTs (r or ρ = 0.569-0.581), greater FFC and PFC braking forces (r = 0.430-0.551), smaller hip and knee flexion range of motion (r or ρ = 0.406-0.670), greater knee flexion moments (KFMs) (r = 0.482), and greater internal foot progression angles (r = - 0.411). Stepwise multiple regression analysis revealed that exit velocity, peak resultant propulsive force, PFC mean horizontal braking force, and initial foot progression angle together could explain 64% (r = 0.801, adjusted 61.6%, p = 0.048) of the variation in completion time. Greater peak KAMs were associated with greater COM velocities at key instances of the cut (r or ρ = - 0.491 to - 0.551), greater peak knee abduction angles (KAA) (r = - 0.468), and greater FFC braking forces (r = 0.434-0.497). Incidentally, faster completion times were associated with greater peak KAMs (r = - 0.412) and KIRMs (r = 0.539). Stepwise multiple regression analysis revealed that FFC mean vertical braking force and peak KAA together could explain 43% (r = 0.652, adjusted 40.6%, p < 0.001) of the variation peak KAM.

CONCLUSION

Techniques and mechanics associated with faster cutting (i.e. faster COM velocities, greater FFC braking forces in short GCTs, greater KFMs, smaller hip and knee flexion, and greater internal foot progression angles) are in direct conflict with safer cutting mechanics (i.e. reduced knee joint loading, thus ACL injury risk), and support the "performance-injury conflict" concept during cutting. Practitioners should be conscious of this conflict when instructing cutting techniques to optimise performance while minimising knee joint loading, and should, therefore, ensure that their athletes have the physical capacity (i.e. neuromuscular control, co-contraction, and rapid force production) to tolerate and support the knee joint loading during cutting.

Trunk motion and anterior cruciate ligament injuries: a narrative review of injury videos and controlled jump-landing and cutting tasks

The aims of this narrative review were to summarise trunk motion and external trunk perturbation observed in anterior cruciate ligament (ACL) injury videos and to review the association between trunk motion and ACL loading variables in controlled jump-landing and cutting tasks in non-injured populations. Video analyses have shown limited trunk flexion and increased trunk lateral bending towards the injured leg are associated with increased risk of ACL injuries, while trunk axial rotation away from the injured leg is more frequent than rotation towards the injured leg. Contact with the trunk before and at the time of the injury is common and might increase the risk of ACL injury. Controlled jump-landing and cutting studies have shown that limited trunk flexion and increased trunk lateral bending are associated with increased ACL loading. However, the findings of trunk axial rotation are not consistent with most video analyses. Mid-flight external trunk perturbation could increase ACL loading variables for one leg and is consistent with the videos of trunk-contact ACL injuries. These findings may help understand the role of trunk motion on primary ACL injury mechanisms and improve ACL injury screening tasks and ACL injury prevention strategies with the consideration of trunk motion.

The Risk of Knee Osteoarthritis in Professional Soccer Players—a Systematic Review With Meta-Analyses

BACKGROUND

We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis.

METHODS

A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria.

RESULTS

The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%).

CONCLUSION

A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.

The effect of simulated marker misplacement on the interpretation of inter-limb differences during a change of direction task

The objective assessment of biomechanical asymmetries during movement tasks is used to monitor rehabilitation following anterior cruciate ligament reconstruction (ACLR). Marker placement is an important source of methodological variability within human motion analysis. It is currently unclear how marker placement error effects the interpretation of biomechanical asymmetries throughout post ACLR rehabilitation. The aim of this investigation was to determine the effect of random marker placement variation on the interpretation of inter-limb differences during a change of direction (CoD) task. Forty-seven participants 9 months post-ACLR and fifty uninjured controls completed a 90° CoD task on both limbs. Inter-limb differences in kinematic and kinetic metrics during the CoD stance phase were calculated for both groups using the Vicon Plug-in Gait model, and ACLR subjects were classified as having 'normal' or 'abnormal' inter-limb differences relative to the control group. Simulated random marker displacements based on published marker placement error ranges were then repeatedly applied to the lateral thigh, femoral epicondyle and tibia markers. ACLR inter-limb differences were recalculated each time, allowing the estimation of 95% confidence intervals and minimal identifiable between-session changes. ACLR subjects were also reclassified relative to the control group after each simulation and the percentage of participants to change classification was calculated. Marker displacements caused large deviations in inter-limb difference measures in several variables including hip rotation angle, knee abduction angle and knee abduction moment, thus limiting the ability to identify participants with large inter-limb differences relative to a control group. These findings highlight the challenges in using marker-based biomechanical models to conduct objective assessments of inter-limb differences during CoD tasks.

Biomechanical Determinants of Knee Joint Loads Associated with Increased Anterior Cruciate Ligament Loading During Cutting: A Systematic Review and Technical Framework

Background

Cutting actions are associated with non-contact ACL injuries in multidirectional sports due to the propensity to generate large multiplanar knee joint loads (KJLs) that have the capacity to increase ACL loading and strain. Numerous studies have investigated the biomechanical determinants of KJLs in cutting tasks. The aim of this systematic review was to comprehensively review the literature regarding biomechanical determinants of KJLs during cutting, in order to develop a cutting technical framework alongside training recommendations for practitioners regarding KJL mitigation.

Methods

Databases (SPORTDiscus, Web of Science and PubMed) were systematically searched using a combination of the following terms: “Biomechanical determinants”, or “Knee abduction moment”, or “Technical determinants”, or “Knee loading”, or “Knee loads”, or “Mechanical determinants”, or “ACL strain”, or “Knee adduction moment”, or “Anterior tibial shear”, or “Knee internal rotation moment”, or “Knee valgus moment” AND “Change of direction”, or “Cutting manoeuvre”, or “Run and cut”, or “Run-and-cut”, or “Sidestepping”, or “Side-stepping”, or “Shuttle run”. Inclusion criteria were as follows: studies examining a cutting task < 110° with a preceding approach run that examined biomechanical determinants of KJLs using three-dimensional motion analysis.

Results

The search returned 6404 possibly eligible articles, and 6 identified through other sources. Following duplicate removal, 4421 titles and abstracts were screened, leaving 246 full texts to be screened for inclusion. Twenty-three full texts were deemed eligible for inclusion and identified numerous determinants of KJLs; 11 trunk, 11 hip, 7 knee, 3 multiplanar KJLs, 5 foot/ankle and 7 identifying ground reaction forces (GRFs) as determinants of KJLs.

Conclusion

Using the framework developed from the results, cutting KJLs can be mitigated through the following: reducing lateral foot-plant distances, thus lowering hip abduction and orientating the foot closer to neutral with a mid-foot or forefoot placement strategy; minimising knee valgus and hip internal rotation angles and motion at initial contact (IC) and weight acceptance (WA); avoiding and limiting lateral trunk flexion and attempt to maintain an upright trunk position or trunk lean into the intended direction; and finally, reducing GRF magnitude during WA, potentially by attenuation through increased knee flexion and emphasising a greater proportion of braking during the penultimate foot contact (PFC).

Changes in the kinetics and kinematics of a reactive cut maneuver after successful athletic groin pain rehabilitation

Athletic groin pain (AGP) is a chronic, painful condition which is prevalent in players of field sports that require rapid changes of direction. Following successful rehabilitation, systematic changes have been observed in the kinetics and kinematics of pre-planned change of direction maneuvers, providing insight into potential foci for rehabilitation monitoring and for the assessment of interventions. However, changing direction in field sports is often reactive rather than pre-planned, and it is not known whether such post-rehabilitation changes are seen in reactive maneuvers. We analyzed the stance phase kinetics and kinematics of a 90° reactive cutting maneuver in 35 AGP patients before and after a successful exercise intervention program. Following the intervention, transverse plane rotation of the pelvis toward the intended direction of travel increased, and the body center of mass was positioned more anteriorly relative to the center of pressure. Ankle dorsiflexion also increased, and participants demonstrated greater ankle plantar flexor internal moment and power during the second half of stance. These findings provide insight into mechanical variables of potential importance in AGP, as identified during a maneuver based on a common sporting task.

Biomechanical Determinants of the Modified and Traditional 505 Change of Direction Speed Test

Dos'Santos, T, McBurnie, A, Thomas, C, Comfort, P, and Jones, PA. Biomechanical determinants of the modified and traditional 505 change of direction speed test. J Strength Cond Res 34(5): 1285-1296, 2020-The aim of this study was to investigate the whole-body biomechanical determinants of 180° change of direction (COD) performance. Sixty-one male athletes (age: 20.7 ± 3.8 years, height: 1.77 ± 0.06 m, mass: 74.7 ± 10.0 kg) from multiple sports (soccer, rugby, and cricket) completed 6 trials of the modified and traditional 505 on their right leg, whereby 3D motion and ground reaction force data were collected during the COD. Pearson's and Spearman's correlations were used to explore the relationships between biomechanical variables and COD completion time. Independent t-tests and Hedges' g effect sizes were conducted between faster (top 20) and slower (bottom 20) performers to explore differences in biomechanical variables. Key kinetic and kinematic differences were demonstrated between faster and slower performers with statistically significant (p ≤ 0.05) and meaningful differences (g = 0.56-2.70) observed. Faster COD performers displayed greater peak and mean horizontal propulsive forces (PF) in shorter ground contact times, more horizontally orientated peak resultant braking and PFs, greater horizontal to vertical mean and peak braking and PF ratios, greater approach velocities, and displayed greater reductions in velocity over key instances of the COD. In addition, faster performers displayed greater penultimate foot contact (PFC) hip, knee, and ankle dorsi-flexion angles, greater medial trunk lean, and greater internal pelvic and foot rotation. These aforementioned variables were also moderately to very largely (r or ρ = 0.317-0.795, p ≤ 0.013) associated with faster COD performance. Consequently, practitioners should focus not only on developing their athletes' ability to express force rapidly, but also develop their technical ability to apply force horizontally. In addition, practitioners should consider coaching a 180° turning strategy that emphasizes high PFC triple flexion for center of mass lowering while also encouraging whole-body rotation to effectively align the body toward the exit for faster performance.

The Effect of Training Interventions on Change of Direction Biomechanics Associated with Increased Anterior Cruciate Ligament Loading: A Scoping Review

Change of direction (COD) manoeuvres are associated with anterior cruciate ligament (ACL) injury risk due to the propensity to generate large multiplanar knee joint loads. Given the short- and long-term consequences of ACL injury, practitioners are interested in methods that reduce knee joint loads and subsequent ACL loading. An effective strategy to reduce ACL loading is modifying an athlete’s movement mechanics to reduce knee joint loading. The purpose of this scoping review was to critically appraise and comprehensively synthesise the existing literature related to the effects of training interventions on COD biomechanics associated with increased knee joint loads and subsequent ACL loading, and identify gaps and recommend areas for future research. A review of the literature was conducted using Medline and Sport DISCUS databases. Inclusion criteria consisted of pre-post analysis of a COD task, a minimum 4-week training intervention, and assessments of biomechanical characteristics associated with increased ACL loading. Of the 1,027 articles identified, 22 were included in the scoping review. Based on current literature, balance training and COD technique modification are the most effective training modalities for reducing knee joint loading (small to moderate effect sizes). One study reported dynamic core stability training was effective in reducing knee joint loads, but further research is needed to definitively confirm the efficacy of this method. Perturbation-enhanced plyometric training, the F-MARC 11 + soccer specific warm-up, Oslo Neuromuscular warm-up, and resistance training are ineffective training modalities to reduce COD knee joint loads. Conflicting findings have been observed for the Core-Pac and mixed training programme. Consequently, practitioners should consider incorporating balance and COD technique modification drills into their athletes’ training programmes to reduce potentially hazardous knee joint loads when changing direction. However, training intervention studies can be improved by investigating larger sample sizes (> 20), including a control group, acknowledging measurement error when interpreting their findings, and considering performance implications, to confirm the effectiveness of training interventions and improve adherence.

Whole-body dynamic stability in side cutting: Implications for markers of lower limb injury risk and change of direction performance

Control of the centre of mass (CoM) whilst minimising the use of unnecessary movements is imperative for successful performance of dynamic sports tasks, and may indicate the condition of whole-body dynamic stability. The aims of this study were to express movement strategies that represent whole-body dynamic stability, and to explore their association with potentially injurious joint mechanics and side cutting performance. Twenty recreational soccer players completed 45° unanticipated side cutting. Five distinct whole-body dynamic stability movement strategies were identified, based on factors that influence the medial ground reaction force (GRF) vector during ground contact in the side cutting manoeuvre. Using Statistical Parametric Mapping, the movement strategies were linearly regressed against selected performance outcomes and peak knee abduction moment (peak KAM). Significant relationships were found between each movement strategy and at least one selected performance outcome or peak KAM. Our results suggest excessive medial GRFs were generated through sagittal plane movement strategies, and despite being beneficial for performance aspects, poor sagittal plane efficiency may destabilise control of the CoM. Frontal plane hip acceleration is the key non-sagittal plane movement strategy used in a corrective capacity to moderate excessive medial forces. However, whilst this movement strategy offered a way to retrieve control of the CoM, mitigating reduced whole-body dynamic stability, it also coincided with increased peak KAM. Overall, whole-body dynamic stability movement strategies helped explain the delicate interplay between the mechanics of changing direction and undesirable joint moments, providing insights that might support development of future intervention strategies.

Change of Direction Assessment Following Anterior Cruciate Ligament Reconstruction: A Review of Current Practice and Considerations to Enhance Practical Application

Change of direction (CoD) has been indicated as a key mechanism in the occurrence of anterior cruciate ligament (ACL) injury during invasion sports. Despite these associations, assessments of knee function in athletic populations at the time of return to sport following ACL reconstruction (ACLr) have often focused on strength and single-leg hop tests, with a paucity of evidence to describe the CoD characteristics. Therefore, the aim of this narrative review was to describe the movement strategies exhibited following ACLr during CoD tasks and to critically analyze the range of tests that have been used. Specifically, we examined their ability to identify between-limb deficits and individuals who display a heightened risk of secondary injury and/or reductions in their level of pre-injury performance. MEDLINE, PubMed and SPORT Discuss databases were used and 13 articles were identified that met the inclusion criteria. Examination of the available literature indicates that current field-based practices are not representative of relevant sport demands and are unable to effectively assess knee function following ACLr. Laboratory-based studies have identified residual deficits and altered movement strategies at the time of return to sport, and this in part may be related to risk of re-injury. However, these assessments exhibit inherent limitations and are not practically viable for monitoring progress during rehabilitation. Consequently, alternative solutions that are more-aligned with the multitude of factors occurring during CoD maneuvers in chaotic sports environments are warranted to allow practitioners to 'bridge the gap' between the laboratory and the sports field/court. This approach may facilitate a more informed decision-making process with the end goal being, a heightened 'return to performance' and a lower risk of re-injury.

High-Intensity Acceleration and Deceleration Demands in Elite Team Sports Competitive Match Play: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

The external movement loads imposed on players during competitive team sports are commonly measured using global positioning system devices. Information gleaned from analyses is employed to calibrate physical conditioning and injury prevention strategies with the external loads imposed during match play. Intense accelerations and decelerations are considered particularly important indicators of external load. However, to date, no prior meta-analysis has compared high and very high intensity acceleration and deceleration demands in elite team sports during competitive match play.

OBJECTIVE

The objective of this systematic review and meta-analysis was to quantify and compare high and very high intensity acceleration vs. deceleration demands occurring during competitive match play in elite team sport contexts.

METHODS

A systematic review of four electronic databases (CINAHL, MEDLINE, SPORTDiscus, Web of Science) was conducted to identify peer-reviewed articles published between January 2010 and April 2018 that had reported higher intensity (> 2.5 m·s-2) accelerations and decelerations concurrently in elite team sports competitive match play. A Boolean search phrase was developed using key words synonymous to team sports (population), acceleration and deceleration (comparators) and match play (outcome). Articles only eligible for meta-analysis were those that reported either or both high (> 2.5 m·s-2) and very high (> 3.5 m·s-2) intensity accelerations and decelerations concurrently using global positioning system devices (sampling rate: ≥ 5 Hz) during elite able-bodied (mean age: ≥ 18 years) team sports competitive match play (match time: ≥ 75%). Separate inverse random-effects meta-analyses were conducted to compare: (1) standardised mean differences (SMDs) in the frequency of high and very high intensity accelerations and decelerations occurring during match play, and (2) SMDs of temporal changes in high and very high intensity accelerations and decelerations across first and second half periods of match play. Using recent guidelines recommended for the collection, processing and reporting of global positioning system data, a checklist was produced to help inform a judgement about the methodological limitations (risk of detection bias) aligned to 'data collection', 'data processing' and 'normative profile' for each eligible study. For each study, each outcome was rated as either 'low', 'unclear' or 'high' risk of bias.

RESULTS

A total of 19 studies met the eligibility criteria, comprising seven team sports including American Football (n = 1), Australian Football (n = 2), hockey (n = 1), rugby league (n = 4), rugby sevens (n = 3), rugby union (n = 2) and soccer (n = 6) with a total of 469 male participants (mean age: 18-29 years). Analysis showed only American Football reported a greater frequency of high (SMD = 1.26; 95% confidence interval [CI] 1.06-1.43) and very high (SMD = 0.19; 95% CI - 0.42 to 0.80) intensity accelerations compared to decelerations. All other sports had a greater frequency of high and very high intensity decelerations compared to accelerations, with soccer demonstrating the greatest difference for both the high (SMD = - 1.74; 95% CI - 1.28 to - 2.21) and very high (SMD = - 3.19; 95% CI - 2.05 to - 4.33) intensity categories. When examining the temporal changes from the first to the second half periods of match play, there was a small decrease in both the frequency of high and very high intensity accelerations (SMD = 0.50 and 0.49, respectively) and decelerations (SMD = 0.42 and 0.46, respectively). The greatest risk of bias (40% 'high' risk of bias) observed across studies was in the 'data collection' procedures. The lowest risk of bias (35% 'low' risk of bias) was found in the development of a 'normative profile'.

CONCLUSIONS

To ensure that elite players are optimally prepared for the high-intensity accelerations and decelerations imposed during competitive match play, it is imperative that players are exposed to comparable demands under controlled training conditions. The results of this meta-analysis, accordingly, can inform practical training designs. Finally, guidelines and recommendations for conducting future research, using global positioning system devices, are suggested.

Biomechanical Associates of Performance and Knee Joint Loads During A 70-90° Cutting Maneuver in Subelite Soccer Players

McBurnie, AJ, Dos'Santos, T, Jones, PA. Biomechanical associates of performance and knee joint loads during a 70-90° cutting maneuver in subelite soccer players. J Strength Cond Res XX(X): 000-000, 2019-The aim of this study was to explore the "performance-injury risk" conflict during cutting, by examining whole-body joint kinematics and kinetics that are responsible for faster change-of-direction (COD) performance of a cutting task in soccer players, and to determine whether these factors relate to peak external multiplanar knee moments. 34 male soccer players (age: 20 ± 3.2 years; body mass: 73.5 ± 9.2 kg; height: 1.77 ± 0.06 m) were recruited to investigate the relationships between COD kinetics and kinematics with performance and multiplanar knee joint moments during cutting. Three-dimensional motion data using 10 Qualisys Oqus 7 infrared cameras (240 Hz) and ground reaction force data from 2 AMTI force platforms (1,200 Hz) were collected to analyze the penultimate foot contact and final foot contact (FFC). Pearson's or Spearman's correlations coefficients revealed performance time (PT), peak external knee abduction moment (KAM), and peak external knee rotation moment (KRM) were all significantly related (p < 0.05) to horizontal approach velocity (PT: ρ = -0.579; peak KAM: ρ = 0.414; peak KRM: R = -0.568) and FFC peak hip flexor moment (PT: ρ = 0.418; peak KAM: ρ = -0.624; peak KRM: ρ = 0.517). Performance time was also significantly (p < 0.01) associated with horizontal exit velocity (ρ = -0.451) and, notably, multiplanar knee joint loading (peak KAM: ρ = -0.590; peak KRM: ρ = 0.525; peak KFM: ρ = -0.509). Cohen's d effect sizes (d) revealed that faster performers demonstrated significantly greater (p < 0.05; d = 1.1-1.7) multiplanar knee joint loading, as well as significantly greater (p < 0.05; d = 0.9-1.2) FFC peak hip flexor moments, PFC average horizontal GRFs, and peak knee adduction angles. To conclude, mechanics associated with faster cutting performance seem to be "at odds" with lower multiplanar knee joint loads. This highlights the potential performance-injury conflict present during cutting.

The Effect of Angle and Velocity on Change of Direction Biomechanics: An Angle-Velocity Trade-Off

Changes of direction (CODs) are key manoeuvres linked to decisive moments in sport and are also key actions associated with lower limb injuries. During sport athletes perform a diverse range of CODs, from various approach velocities and angles, thus the ability to change direction safely and quickly is of great interest. To our knowledge, a comprehensive review examining the influence of angle and velocity on change of direction (COD) biomechanics does not exist. Findings of previous research indicate the biomechanical demands of CODs are 'angle' and 'velocity' dependent and are both critical factors that affect the technical execution of directional changes, deceleration and reacceleration requirements, knee joint loading, and lower limb muscle activity. Thus, these two factors regulate the progression and regression in COD intensity. Specifically, faster and sharper CODs elevate the relative risk of injury due to the greater associative knee joint loading; however, faster and sharper directional changes are key manoeuvres for successful performance in multidirectional sport, which subsequently creates a 'performance-injury conflict' for practitioners and athletes. This conflict, however, may be mediated by an athlete's physical capacity (i.e. ability to rapidly produce force and neuromuscular control). Furthermore, an 'angle-velocity trade-off' exists during CODs, whereby faster approaches compromise the execution of the intended COD; this is influenced by an athlete's physical capacity. Therefore, practitioners and researchers should acknowledge and understand the implications of angle and velocity on COD biomechanics when: (1) interpreting biomechanical research; (2) coaching COD technique; (3) designing and prescribing COD training and injury reduction programs; (4) conditioning athletes to tolerate the physical demands of directional changes; (5) screening COD technique; and (6) progressing and regressing COD intensity, specifically when working with novice or previously injured athletes rehabilitating from an injury.

Exploring individual adaptations to an anterior cruciate ligament injury prevention programme

BACKGROUND

Individual responses to anterior cruciate ligament injury prevention programmes (ACL IPPs) have received little attention. This study examined the effects of an ACL IPP on neuromuscular control and lower limb biomechanics during landing at the group and individual levels.

METHODS

Sixteen female athletes were randomly allocated to training (n=8) or control (n=8) groups. Electromyography, and three-dimensional kinematic and kinetic data were collected during landing at two testing sessions. Repeated measures ANOVA and effect sizes (Cohen's d) examined the effect of the IPP at the group and individual levels. A sub-group analysis comparing the effect of the IPP on 'high-' (i.e. large peak knee abduction moment at baseline) versus 'low-risk' individuals was also conducted.

RESULTS

At the group level; the IPP increased activation of the medial hamstrings prior to landing (p<0.001; d=0.264) and the medial gastrocnemius at landing (p<0.001; d=0.426), and increased hip external rotation early after initial contact (p<0.001; d=0.476). Variable adaptations were seen across individuals within the training group for all variables (p<0.001). The IPP had a large effect in reducing frontal plane knee moments for 'high-risk' individuals (d>0.91), however these results did not reach statistical significance (p>0.05).

CONCLUSIONS

The IPP induced adaptations during landing, however, individual data revealed dissimilar responses to the programme. Individuals displaying a pre-existing high-risk strategy may incur greater benefits from IPPs, yet only if the programme targets the relevant high-risk strategy.

The analysis of knee joint loading during drop landing from different heights and under different instruction sets in healthy males

Background

Mechanical loading during exercise has been shown to promote tissue remodeling. Safe and accessible exercise may be beneficial to populations at risk of diminished bone and joint health. We examined the effect of drop height and instruction on knee loading during a drop-landing task and proposed a task that makes use of drop heights that may be appropriate for rehabilitation purposes and functional in daily life to examine transient knee joint loads.

Methods

Twenty males (22.0 ± 2.8 years) performed drop landings from 22 cm (low) and 44 cm (high) heights, each under three instructions: “land naturally” (natural), “softly” (soft), and “stiffly” (stiff). Knee compression force and external flexion moment were estimated using three-dimensional inverse dynamics and normalized to body mass.

Results

Peak knee compression force was larger (p < 0.001) for high (17.8 ± 0.63 N/kg) than low (14.8 ± 0.61 N/kg) heights. There was an increase (p < 0.001) in the knee compression force across soft (11.8 ± 0.40 N/kg), natural (17.0 ± 0.62 N/kg), and stiff (20.2 ± 0.67 N/kg) instructions. Peak knee flexion moment in high-natural (2.12 ± 0.08 Nm/kg) was larger (p < 0.001) than in high-soft (1.88 ± 0.08 Nm/kg), but lower than in high-stiff (2.23 ± 0.08 Nm/kg). No differences in peak knee flexion moment were observed across instructions for the low height.

Conclusions

We propose a drop-landing task that creates a scalable increase in knee compression loading. The absence of increased knee flexion moment with drop from the low height, compared to high, suggests that individuals could perform the task without incremental risk of knee injury. This task could be used in future studies to examine the effect of acute bouts of mechanical loading on bone and cartilage metabolism.