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Chen P, Wang L, Dong S, Ding Y, Jia S, Zheng C. Can Symmetry of Single-Leg Vertical Jump Height Represent Normal Lower Limb Biomechanics of Athletes After Anterior Cruciate Ligament Reconstruction? Sports Health 2024; 16:596-605. [PMID: 37554095 PMCID: PMC11195865 DOI: 10.1177/19417381231190119] [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: 08/10/2023] Open
Abstract
BACKGROUND After anterior cruciate ligament reconstruction (ACLR), single-leg horizontal hop distance limb symmetry index (LSI) >90% is recommended as a cutoff point for safe return to sport (RTS). However, athletes after ACLR have abnormal lower limb biomechanics despite an adequate single-leg hop distance LSI, implying that athletes are at high risk of reinjury. Symmetry of single-leg vertical jump height appears to be more difficult to achieve and can be a better representation of knee function than single-leg horizontal hop distance. HYPOTHESIS Athletes after ACLR with single-leg jump height LSI >90% had similar biomechanical characteristics to healthy athletes. STUDY DESIGN Controlled laboratory study. LEVEL OF EVIDENCE Level 3. METHODS A total of 46 athletes after ACLR were divided into low jump height (LJH, jump height LSI <90%, n = 23) and high jump height (HJH, jump height LSI >90%, n = 23) groups according to symmetry of single-leg vertical jump height, while 24 healthy athletes acted as a control (CONT) group. One-way analysis of variance was used to compare the kinematic and kinetic characteristics of the LJH, HJH, and CONT groups during single-leg vertical jump. RESULTS Both the LJH and HJH groups demonstrated greater limb asymmetry (lower LSI) during landing compared with the CONT group in knee extension moment (P < 0.05), peak knee flexion angle (P < 0.05), and knee power (P < 0.05). CONCLUSION Symmetry in single-leg vertical jump height does not represent normal lower limb biomechanics in athletes after ACLR. CLINICAL RELEVANCE Symmetrical jump height may not signify ideal biomechanical or RTS readiness, but single-leg vertical jump test can be used as a supplement to horizontal hop test or other functional tests to reduce the likelihood of false-negative results in the absence of detailed biomechanical evaluation.
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Affiliation(s)
- Peng Chen
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Ling Wang
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Shiyu Dong
- College of Basic Medicine of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yue Ding
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Shaohui Jia
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
- Hubei Provincial Key Laboratory of Sports Training and Monitoring, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, Hubei Province, China
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Cady KP, De Ste Croix M, Deighan M. Effect of Sex and Lateral Ankle Sprain History on Dorsiflexion Range Of Motion Asymmetry During the Weight Bearing Lunge Test. Int J Sports Phys Ther 2024; 19:714-723. [PMID: 38835979 PMCID: PMC11144664 DOI: 10.26603/001c.117775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Reduced dorsiflexion range of motion (DFROM) which is commonly seen following lateral ankle sprain (LAS) has the potential to influence lower extremity biomechanics which have been linked to increased injury risk in the female athlete. Current research on the effect of sex and LAS history on DFROM is limited. Hypothesis/Purpose This study had three aims 1) to determine the effect of sex, leg dominance and LAS history on DFROM, 2) to determine the effect of sex and LAS history on magnitude of DFROM symmetry and 3) to examine the association of sex on direction (whether dominant or non-dominant limb had the higher DFROM) of symmetry. Study Design Cross-Sectional Study. Methods DFROM was measured bilaterally in 105 recreational athletes all participating in multidirectional sports using the tape measurement method during the weight bearing lunge test (WBLT). A mean of three measurements was used for analysis. A 3-way mixed ANOVA was carried out to determine the interaction between sex, LAS history and leg dominance on DFROM and a 2-way ANOVA for the effect of sex and LAS history on asymmetry. A chi-square test was used to determine the association of sex and direction of asymmetry. Results The results indicate no significant effect of sex, LAS history, and leg dominance on DFROM (p=0.65). Main effects were significant for sex and LAS on DFROM. The mean asymmetry for all participants was reported as 12.25±14.76cm. No significant effect of sex and LAS history on magnitude of asymmetry was reported. There was a significant association of sex and direction of asymmetry (χ2(1) = 11.26, p = 0.00). Sixty-five-point two percent of males were shown to have higher DFROM of their non-dominant limb compared to 75% of females who were higher in their dominant limb. Conclusion Findings from this study suggest that DFROM is affected by sex and LAS history. While females have increased DFROM compared to males, those with LAS history are more likely to have a decreased DFROM on the involved side. The results also indicate that interlimb asymmetries in DFROM are present in athletes, therefore practitioners should exercise caution when using bilateral comparisons in injury and return to play assessments. Level of Evidence 2b.
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Affiliation(s)
- kathrine P Cady
- Sports TherapyUniversity of Hertfordshire
- Education and Applied ScienceUniversity of Gloucestershire
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Gomes SKSP, Moreira PF, Veras PM, Catharino LL, Caetano RO, Oliveira TMD, Fonseca DS, Hespanhol L, Felício DC. What is the influence of biomechanical variables on the Y balance test performance in recreational runners? J Bodyw Mov Ther 2024; 38:520-524. [PMID: 38763602 DOI: 10.1016/j.jbmt.2024.03.062] [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: 02/11/2022] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Asymmetries and poor Y balance test (YBT) performance are associated with an increased risk of injuries in athletes. The aim of this study was to investigate the association between YBT performance with biomechanical variables in runners. METHODS The runners underwent the YBT, followed by the assessment of center of pressure, plank position, muscle strength (MS) of hip flexors, extensors, abductors, and external rotators, knee extensors, ankle dorsiflexion range of motion (ROM), Q angle, forefoot alignment, and passive hip internal rotation. Associations between variables were examined using multiple linear regression models with the Bayesian Information Criterion. RESULTS 122 cases were analyzed. The R2 values were 0.38; 0.05; 0.06; and 0.15 for the anterior, posteromedial, posterolateral and composite directions models, respectively. The anterior reach in the YBT was associated with ankle dorsiflexion ROM [Sβ 95%IC: 0.43 (0.32-0.55)], passive hip internal rotation [Sβ 95%IC: 0.35 (0.24-0.47)], MS of the hip extensors [Sβ 95%IC: 0.19 (0.07-0.31)] and forefoot alignment [Sβ 95%IC: 0.14 (-0.25-0.02)]. The posteromedial and posterolateral reach were associated with MS of the hip flexors [Sβ 95%IC: 0.23 (0.09-0.37) and 0.24 (0.11-0.38)], respectively. The composite score was associated with MS of the hip flexors [Sβ 95%IC: 0.31 (0.18-0.45)], ankle dorsiflexion ROM [Sβ 95%IC: 0.24 (0.10-0.37)] and Q angle [Sβ 95%IC: 0.18 (0.04-0.31)]. CONCLUSION YBT performance in different directions demonstrated specific associations with key biomechanical factors.
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Affiliation(s)
- Suellen K S P Gomes
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Poliana F Moreira
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Priscila M Veras
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Leonardo L Catharino
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Raphael O Caetano
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Túlio M D Oliveira
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Diogo S Fonseca
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| | - Luiz Hespanhol
- Programas de Mestrado e Doutorado em Fisioterapia da Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.
| | - Diogo C Felício
- Programa de Pós Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
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Taylor JB, Wright ES, Waxman JP, Schmitz RJ, Groves JD, Shultz SJ. Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing. Sports Health 2021; 14:328-335. [PMID: 34096370 DOI: 10.1177/19417381211019683] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. HYPOTHESIS We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. RESULTS For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion (r2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles (r2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion (r2 = 0.40, P = 0.004), 0.002 N·m·N-1·cm-1 decrease in hip extensor work (r2 = 0.28, P = 0.02), and 0.001 N·m·N-1·cm-1 decrease in knee extensor work (r2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles (r2 = 0.26, P = 0.03) and 0.01 N·m·N-1·cm-1 lesser knee extensor work (r2 = 0.25, P = 0.03). CONCLUSION Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. CLINICAL RELEVANCE While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina
| | - Elena S Wright
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina.,Department of Implementation Science, Division of Public Health Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Justin P Waxman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - James D Groves
- Department of Physical Therapy, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
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Contribution of Lower Extremity Joints on Energy Absorption during Soft Landing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105130. [PMID: 34066090 PMCID: PMC8151821 DOI: 10.3390/ijerph18105130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022]
Abstract
Soft landing after jumping is associated with the prevention of lower extremity injuries during sports activities in terms of the energy absorption mechanisms. In this study, the contribution of lower extremity joints during soft landing was investigated. Subjects comprised 20 healthy females. Kinetics and kinematics data were obtained during drop vertical jumps using a three-dimensional motion analysis system. Negative mechanical work values in the lower extremity joints were calculated during landing. A multiple regression analysis was performed to determine which lower extremity joints contributed more in achieving soft landing. The means of mechanical work of the hip, knee, and ankle in the sagittal plane were −0.30 ± 0.17, −0.62 ± 0.31, and −1.03 ± 0.22 J/kg, respectively. Results showed that negative mechanical work in the hip and knee is effective in achieving soft landing. These findings indicate that energy absorption in the hip and knee joints might be an important factor in achieving soft landing, whereas that in the ankle has a negative effect. Therefore, when improving soft landing techniques, we should consider energy absorption in the hip and knee via eccentric activation of the hip and knee extensors during landing.
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Dai B, Layer JS, Bordelon NM, Critchley ML, LaCroix SE, George AC, Li L, Ross JD, Jensen MA. Longitudinal assessments of balance and jump-landing performance before and after anterior cruciate ligament injuries in collegiate athletes. Res Sports Med 2020; 29:129-140. [PMID: 32009460 DOI: 10.1080/15438627.2020.1721290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose was to quantify the effect of an anterior cruciate ligament (ACL) injury on balance and jump-landing performance and bilateral asymmetries. Among 500 collegiate athletes who performed a reaching test and a double-leg counter-movement jump-landing test at baseline, 8 male and 6 female athletes suffered ACL injuries. In the follow-up, they performed the reaching test 3 and 6 months after ACL reconstruction (ACLR) and the jump-landing test 6 months after ACLR. Less reaching distances for the injured leg and increased reaching distance asymmetries were observed 3 and 6 months after ACLR compared to baseline. Less peak jumping and landing forces for the injured leg and increased jumping and landing force asymmetries were found 6 months after ACLR compared to baseline. The decreased performance of the injured leg and increased asymmetries may contribute to the high ACL re-injury rates. Baseline assessments would be useful for establishing an individual's pre-injury performance.
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Affiliation(s)
- Boyi Dai
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Jacob S Layer
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Nicole M Bordelon
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Meghan L Critchley
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Sydne E LaCroix
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Ana C George
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Jeremy D Ross
- Department of Sports Medicine, University of Wyoming , Laramie, WY, USA
| | - Megan A Jensen
- Department of Sports Medicine, University of Wyoming , Laramie, WY, USA
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Norouzi S, Esfandiarpour F, Mehdizadeh S, Yousefzadeh NK, Parnianpour M. Lower extremity kinematic analysis in male athletes with unilateral anterior cruciate reconstruction in a jump-landing task and its association with return to sport criteria. BMC Musculoskelet Disord 2019; 20:492. [PMID: 31656192 PMCID: PMC6815439 DOI: 10.1186/s12891-019-2893-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Return to sport (RTS) criteria are widely being used to identify anterior cruciate ligament reconstructed (ACLR) athletes ready to return to sportive activity and reduce risk of ACL re-injury. However, studies show a high rate of ACL re-injury in athletes who passed RTS criteria. This indicates that the current RTS criteria might not be sufficient to determine return to sport time in ACLR athletes. Previous studies have reported a close association between altered lower limb kinematics and ACL re-injury. However, it is not clear how lower extremity kinematics differs between ACLR athletes who passed the RTS-criteria and who failed. This study compared lower extremity kinematics in a jump-landing task between ACLR athletes who passed the RTS criteria (Limb symmetry in hop tests, quadriceps strength and questionnaires) to those who failed and to the healthy individuals. Methods Participants were 27 male football players with unilateral ACLR including 14 who passed -RTS criteria and 13 failed, and 15 healthy football players. A 3D motion capture system recorded participants’ lower extremity motion while performing 10 trials of a bilateral jump-landing task. Hip, knee and ankle angular motion were examined at initial contact. Two-way mixed analysis of variances (2 limbs × 3 groups) and Bonferroni post-hoc tests were performed to compare the joint angles between the limbs and groups. Results lower hip abduction angle was found in the failed (involved limb 4.1 ° ± 4.2) and passed RTS (involved limb 6.8° ± 3.3) groups compared to the healthy group (non-dominant limb 10.7° ± 3.7). Ankle inversion in the failed RTS (0.4° ± 4.9) group was significantly lower than both passed RTS (4.8° ± 4.8, p = 0.05) and healthy (8.2° ± 8.1, p < 0.001) groups. There were no significant differences between the groups in knee kinematics. Conclusions Our findings indicate reduced hip abduction during initial contact phase of landing in athletes returned to sport. Reduced hip abduction during the complex multiplanar movement of jump-landing is a risk factor for ACL re-injury. Current RTS criteria may not be sufficient to identify ACLR athletes at high risk of re-injury. The kinematic analysis in conjunction with current RTS criteria can provide additional insight into the return to sport decision making.
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Affiliation(s)
- Sadegh Norouzi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fateme Esfandiarpour
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Department of Family Medicine, University of Alberta, Edmonton, Canada.
| | - Sina Mehdizadeh
- Toronto Rehabilitation Institute, University of Health Network, Toronto, Canada
| | - Nasim Kiani Yousefzadeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Dashti Rostami K, Alizadeh M, Minoonejad H, Thomas A, Yazdi H. Relationship between electromyographic activity of knee joint muscles with vertical and posterior ground reaction forces in anterior cruciate ligament reconstructed patients during a single leg vertical drop landing task. Res Sports Med 2019; 28:1-14. [PMID: 31352787 DOI: 10.1080/15438627.2019.1647204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of the present study is to examine the relation between activity patterns of knee joint muscles with vertical and posterior ground reaction forces (VGRF and PGRF, respectively) in patients after anterior cruciate ligament reconstruction (ACLR). Twenty males post-ACLR participated in this cross-sectional study. The association between muscle activity with VGRF and PGRF was assessed during a single leg vertical drop-landing task. There were strong negative associations between preparatory VL, VM and MG activity and PGRF (P< 0.05). Strong positive associations were found between reactive VM and LH activity with PGRF (P< 0.05). Preparatory co-activation of VM: MH had significant negative associations with VGRF (P< 0.05) and reactive co-activation of VL:LH had a significant positive relation with PGRF(P< 0.05). Greater preparatory activity and co-activation of knee muscles were associated with lower peak PGRF and VGRF, whereas greater reactive activity and co-activation of knee muscles was associated with greater peak PGRF and VGRF. According to our findings, both activity and co-activation of knee muscles during the preparatory phase were associated with reduced PGRF and VGRF, respectively in ACLR patients; thus, incorporating exercises in order to increase preparatory activity and co-activation of knee joint muscles into rehabilitation programs in ACLR patients seems necessary.
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Affiliation(s)
- Komeil Dashti Rostami
- Faculty of Physical education and sports sciences, Department of Sport Medicine and Health, University of Tehran, Tehran, Iran
| | - Mohammadhossein Alizadeh
- Faculty of Physical education and sports sciences, Department of Sport Medicine and Health, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Faculty of Physical education and sports sciences, Department of Sport Medicine and Health, University of Tehran, Tehran, Iran
| | - Abbey Thomas
- Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, USA
| | - Hamidreza Yazdi
- Neuromusculoskeletal research center, Iran University of Medical Sciences, Tehran, Iran
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