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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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Smith NP, Gallo RA. Return to play and athletic performance in division I female volleyball players following anterior cruciate ligament injury. PHYSICIAN SPORTSMED 2024:1-6. [PMID: 38709544 DOI: 10.1080/00913847.2024.2351790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES The purpose of this study is to examine NCAA Division I volleyball players' return to play rates and performance statistics compared to pre-injury levels following ACL injury. METHODS Female volleyball players that sustained ACL injuries from 2008 to 2020 and competed in one of seven collegiate conferences (n = 99) were identified via an internet search algorithm. Players were categorized by position, academic year, and playing time pre- and post-injury. Post-injury performance statistics were gathered for a subset of outside hitters and middle blockers that played in ≥35 sets in a single season for up to 3 years following injury (mean 1.7 seasons). A control group (n = 512) was generated for demographic and statistical comparison. Mean pre-injury and post-injury statistics were compared for players that did not change positions and played ≥35 sets before and after injury. RESULTS Volleyball attackers were 54.7% of the control population but sustained 78.8% of identified injuries. Following ACL injury, 6.1% of players registered no in-game statistics, 16.2% played in <35 sets, 65.7% played in ≥35 sets, and 12.1% graduated. Mean performance statistics increased linearly the more years players were from ACL injury. CONCLUSIONS Female collegiate volleyball players return to play following ACL injury at high rates (93.1%) and maintain pre-injury performance levels. Volleyball attackers sustain ACL injuries more commonly than setters and libero/defensive specialists.
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Affiliation(s)
- Nathan P Smith
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Robert A Gallo
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Erdman A, Loewen A, Dressing M, Wyatt C, Oliver G, Butler L, Sugimoto D, Black AM, Tulchin-Francis K, Bazett-Jones DM, Janosky J, Ulman S. A 2D video-based assessment is associated with 3D biomechanical contributors to dynamic knee valgus in the coronal plane. Front Sports Act Living 2024; 6:1352286. [PMID: 38558858 PMCID: PMC10978775 DOI: 10.3389/fspor.2024.1352286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Adolescent athletes involved in sports that involve cutting and landing maneuvers have an increased risk of anterior cruciate ligament (ACL) tears, highlighting the importance of identifying risky movement patterns such as dynamic knee valgus (DKV). Qualitative movement screenings have explored two-dimensional (2D) scoring criteria for DKV, however, there remains limited data on the validity of these screening tools. Determining a 2D scoring criterion for DKV that closely aligns with three-dimensional (3D) biomechanical measures will allow for the identification of poor knee position in adolescent athletes on a broad scale. The purpose of this study was to establish a 2D scoring criterion that corresponds to 3D biomechanical measures of DKV. Methods A total of 41 adolescent female club volleyball athletes performed a three-task movement screen consisting of a single-leg squat (SLS), single-leg drop landing (SLDL), and double-leg vertical jump (DLVJ). A single rater scored 2D videos of each task using four criteria for poor knee position. A motion capture system was used to calculate 3D joint angles, including pelvic obliquity, hip adduction, knee abduction, ankle eversion, and foot progression angle. Receiver operating characteristic curves were created for each 2D scoring criterion to determine cut points for the presence of movement faults, and areas under the curve (AUC) were computed to describe the accuracy of each 2D criterion compared to 3D biomechanical data. Results 3D measures indicated knee abduction angles between 2.4°-4.6° (SD 4.1°-4.3°) at the time point when the center of the knee joint was most medial during the three tasks. AUCs were between 0.62 and 0.93 across scoring items. The MEDIAL scoring item, defined as the knee joint positioned inside the medial border of the shoe, demonstrated the greatest association to components of DKV, with AUCs ranging from 0.67 to 0.93. Conclusion The MEDIAL scoring criterion demonstrated the best performance in distinguishing components of DKV, specifically pelvic obliquity, hip adduction, ankle eversion, and foot progression. Along with the previously published scoring definitions for trunk-specific risk factors, the authors suggest that the MEDIAL criterion may be the most indicative of DKV, given an association with 3D biomechanical risk factors.
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Affiliation(s)
- Ashley Erdman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Alex Loewen
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Michael Dressing
- Department of Orthopedics, Joe DiMaggio Children’s Hospital, Hollywood, FL, United States
| | - Charles Wyatt
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gretchen Oliver
- Sports Medicine & Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Lauren Butler
- Department of Rehabilitation, Nicklaus Children’s Hospital, Miami, FL, United States
| | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Sports Medicine Division, The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Amanda M. Black
- Centre for Healthy Youth Development Through Sport, Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Kirsten Tulchin-Francis
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, United States
| | - David M. Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States
| | - Sophia Ulman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Ulman S, Erdman A, Loewen A, Dressing M, Wyatt C, Oliver G, Butler L, Sugimoto D, Black AM, Janosky J. Concurrent Validity of Movement Screening Criteria Designed to Identify Injury Risk Factors in Adolescent Female Volleyball Players. Front Sports Act Living 2022; 4:915230. [PMID: 35813049 PMCID: PMC9263117 DOI: 10.3389/fspor.2022.915230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries in female adolescent athletes occur at disproportionately high levels compared to their male counterparts. However, limited prospective data exist on the validity of low-cost screening tools that can proactively identify ACL injury risk, specifically for female athletes. The purpose of this study was to assess the concurrent validity of a three-task injury risk factor assessment by comparing visually derived outcome scores from two-dimensional (2D) video data with dichotomized three-dimensional (3D) biomechanical variables collected using motion capture technology. A total of 41 female club volleyball athletes (14.7 ± 1.4 years) were tested and asked to perform three tasks: double-leg vertical jump (DLVJ), single-leg squat (SLS), and single-leg drop landing (SLDL). One rater was trained on the scoring criteria for the 2D data and independently scored one forward-facing and one side-facing video for each task. Risk factors identified included poor knee position, lateral trunk lean, and excessive trunk flexion/extension. In addition, 3D joint angles were calculated for the trunk and knee in the sagittal and frontal planes and converted to dichotomous variables based on biomechanical thresholds of injury risk. For comparison of 2D and 3D outcomes, percent agreement and Cohen's kappa were calculated for each risk factor individually. Overall, 2D scores were found to exhibit moderate to excellent percent agreement with 3D outcomes for trunk position (69.1–97.1%). Specifically, ipsilateral trunk lean during single-leg tasks exhibited the highest agreement (85.3–88.2%) with moderate reliability (κ = 0.452–0.465). In addition, moderate to substantial reliability was found for trunk flexion during double-leg tasks (κ = 0.521–0.653); however, an evaluation of single-leg tasks resulted in only fair reliability (κ = 0.354). Furthermore, 2D scores were not successful in identifying poor knee position as percent agreement fell below 50% for both the single-leg tasks and averaged 60% agreement across both the phases of the DLVJ. Kappa coefficients further emphasized these trends indicating no to slight concurrent validity (κ = −0.047–0.167) across tasks. Overall, these findings emphasize the potential for valid, low-cost screening tools that can identify high-risk movement patterns. Further study is needed to develop improved assessment guidelines that may be employed through visual assessment in sports environments.
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Affiliation(s)
- Sophia Ulman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- *Correspondence: Sophia Ulman
| | - Ashley Erdman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Alex Loewen
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Michael Dressing
- Department of Orthopedics, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Charles Wyatt
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gretchen Oliver
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Lauren Butler
- Department of Rehabilitation, Nicklaus Children's Hospital, Miami, FL, United States
| | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Amanda M. Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States
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Song Y, Li L, Hughes G, Dai B. Trunk motion and anterior cruciate ligament injuries: a narrative review of injury videos and controlled jump-landing and cutting tasks. Sports Biomech 2021; 22:46-64. [PMID: 33663318 DOI: 10.1080/14763141.2021.1877337] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Yu Song
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Gerwyn Hughes
- Department of Kinesiology, University of San Francisco, San Francisco, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
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