Effect of unplanned athletic movement on knee mechanics: a systematic review with multilevel meta-analysis

Neuromechanical proficiency in elite performance decision-making: An event-related potential (ERP) analysis

This research focuses intensively on the neural mechanisms of action selection responses in elite athletes during high-stakes decision-making. It emphasizes the neuromechanical dimensions of these processes, contrasting the responses of expert and novice players within a theoretical framework of neural information processing in high-performance contexts. Utilizing advanced EEG technologies, including event-related potential (ERP) analysis, the study captures a comprehensive view of both behavioral and neurophysiological data. The central aim is to unravel the intricate neural underpinnings that distinguish elite athletes in their decision-making strategies. Key findings highlight: (1) Enhanced accuracy and swifter reaction times in elite athletes during the action selection phase; (2) Significant neurophysiological differences, marked by pronounced N1 peak amplitudes with prolonged latencies, reduced P2 peak amplitudes with stable latencies, decreased P3 peak amplitudes with reduced latencies, and increased average PSW amplitudes. These discoveries significantly advance our understanding of the neural foundations of expert decision-making in high-performance sports. This study not only sheds light on the cognitive and neural dynamics of elite sports performance but also provides a foundation for developing training and performance enhancement techniques in various high-stakes domains.

Lack of Proprioceptive Strategy Modulation Leads to At-Risk Biomechanics for Anterior Cruciate Ligament in Healthy Athletes

INTRODUCTION

Anterior cruciate ligament (ACL) injuries are frequent in handball, and altered sensory integration may contribute to increased injury risk. Recent evidence showed that proprioceptive postural control strategies differ among athletes. The aim of this study was to evaluate the relationship between proprioceptive strategy and biomechanics during side-cutting maneuvers.

METHODS

A total of 47 handball players performed anticipated and unanticipated cutting tasks. Their postural proprioceptive strategy was then characterized according to the perturbation of the center of pressure displacement generated by the muscle vibration on a firm and foam surface. Individuals able to reweight proprioception from ankle to lumbar signals according to the stability of the support were defined as flexible. Conversely, athletes maintaining an ankle-steered strategy on foam surface were characterized as rigid. Statistical parametric mapping analysis was used to compare pelvic and lower limb side-cutting kinematics, kinetics, and EMG activity from seven muscles 200 ms before and after initial contact (IC) using a two-way ANOVA (group-condition).

RESULTS

Twenty athletes (11 females and 9 males, 18.5 yr) were characterized as flexible and 20 athletes (12 females and 8 males, 18.9 yr) as rigid. No interaction between condition and proprioceptive profile was observed. More ipsilateral pelvic tilt before IC and lower vastus lateralis (VL) activity immediately after IC was observed during CUT ant . When comparing proprioceptive strategy, rigid individuals exhibited less preactivity of the semitendinosus ( P < 0.001) and higher VL activity ( P = 0.032). Conversely, rigid showed higher gluteus medius preactivity ( P < 0.05) and higher VL activity 100 ms after IC ( P < 0.001). Ankle was also more internally rotated before and during the stance phase ( P < 0.05) among rigid athletes.

CONCLUSIONS

Rigid handball players exhibited at-risk determinants for anterior cruciate ligament injuries during side-cutting maneuvers.

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.

Neurocognitive Errors and Noncontact Anterior Cruciate Ligament Injuries in Professional Male Soccer Players

CONTEXT

Evidence is emerging that core neurocognitive functions such as working memory and inhibitory control (ie, motor-response and attentional inhibition) are linked to the anterior cruciate ligament (ACL) injury risk. Research has been conducted in laboratory settings, but the contribution of neurocognition to actual ACL injuries under real-world conditions is unknown.

OBJECTIVE

To describe the possible neurocognitive errors involved in noncontact ACL injury mechanisms.

DESIGN

Case series.

SETTING

Soccer matches.

PATIENTS OR OTHER PARTICIPANTS

A total of 47 professional male soccer players.

MAIN OUTCOME MEASURE(S)

Three independent reviewers evaluated 47 videos of players sustaining noncontact ACL injuries. Neurocognitive errors in inhibitory control were operationalized as follows: (1) motor-response inhibition was scored when a player demonstrated poor decision-making and approached the opponent with high speed that reduced the ability to stop or change the intended action and (2) an attentional error was scored when a player shifted his selective attention away from the relevant task to irrelevant stimuli.

RESULTS

Of 47 noncontact ACL injuries, 26 (55%) were related to a pressing-type injury, 19 (73%) of which involved a deceiving action made by the opponent, suggesting poor inhibitory control of the defender. Of the remaining 21 noncontact ACL injuries (45%), 16 (76%) could be attributed to attentional errors. Agreement among the 3 raters was very good for all items except poor decision-making, which showed fair to good agreement (Fleiss κ = 0.71). Interrater reliability was excellent (intraclass correlation coefficient = 0.99-1.00).

CONCLUSIONS

Errors in motor-response inhibitory control and attentional inhibition were common during noncontact ACL injury events in professional male soccer players. The interrater agreement in detecting neurocognitive errors in general was very good.

Knee Biomechanics During Neurocognitively Challenged Drop Landings in Male Elite Soccer Players with Anterior Cruciate Ligament Reconstruction

BACKGROUND

Reactive decision-making during athletic movement has been demonstrated to evoke unfavorable biomechanics associated with anterior cruciate ligament (ACL) rupture. However, the current evidence is based on assessments of healthy individuals. We aimed to investigate unplanned jump landing kinetics and knee kinematics in ACL-reconstructed (ACLR) and non-injured athletes.

METHODS

A total of 30 male professional soccer players (n = 15 ACLR after return to play, n = 15 matched controls) performed six drop landings onto a force plate. As a neurocognitive challenge requiring decision-making, a diode flashing in randomly selected colors indicated the requested landing location. Knee joint kinematics (flexion, valgus and tibial rotation angles) assessed with a 10-camera motion capture system, vertical ground reaction force (vGRF), time to stabilization (TTS) and length of the center of pressure (COP) trace (all analyzed from force plate data) were calculated. Cognitive function was assessed using the CNS Vital Signs battery.

RESULTS

The ACLR group produced lower knee flexion angles than the control group (median [interquartile range] 50.00° [6.60] vs. 55.20° [4.45], p = .02). In addition, path length of the center of pressure (379 mm [56.20] vs. 344 mm [37.00], p = .04) and ground reaction force (3.21 N/kg [0.66] vs. 2.87 N/kg [0.48], p = .01) were higher for the ACLR group. No differences were found for knee valgus (p = .96), tibial rotation (p = .83) and TTS (p = .82). ACLR participants scored lower for reaction time (p = .02) and processing speed (p = .01). Unfavorable knee biomechanics were more often related to cognitive function in the ACLR group than in the control group (p < .05).

CONCLUSIONS

Impaired reactive decision-making during athletic movement may contribute to the high re-injury risk in individuals with ACLR. Prospective studies confirming potential cause-effect relationships are warranted.

Anticipation of landing leg masks ankle inversion orientation deficits and peroneal insufficiency during jump landing in people with chronic ankle instability

Ankle inversion orientation and peroneal activation insufficiency may contribute to lateral ankle sprains during landing in chronic ankle instability (CAI); however, how anticipation alters these factors is neglected. This study aimed to assess the impact of anticipation on joint orientation and muscle activity during landing in individuals with CAI. Fifteen participants with CAI and 15 healthy participants (control) were recruited to perform single-leg landings after bilateral countermovement jumps when the landing limb was specified before (planned) or after (unplanned) take-off. Joint angle (hip, knee, and ankle) and electromyography (gluteus medius, rectus femoris, biceps femoris, gastrocnemius lateral head, tibialis anterior, and peroneal longus) were collected and analyzed with 2 (groups) × 2 (conditions) statistical parametric mapping ANOVA. In the unplanned condition, the CAI group demonstrated a less plantarflexed (maximum difference [MD] = 9.5°, p = 0.047) and more inverted ankle joint (MD = 4.1°, p < 0.001) before ground contact, along with lower peroneal activity at ground contact compared to the control group (MD = 28.9% of peak activation, p < 0.001). No significant differences between groups were observed in the planned condition. In conclusion, anticipation may mask jump landing deficits in people with CAI, including inverted ankle orientation and reduced peroneus longus activity pre- and post-landing, which were observed exclusively in unplanned landings. Clinicians and researchers need to recognize the impact of anticipation on apparent landing deficits and consider the implications for injury prevention and rehabilitation strategies.

Are change of direction speed and agility different abilities from time and coordinative perspectives?

This study aimed to test whether agility and change of direction speed (COD) are independent capacities using the same movement pattern (1) in terms of the completion time and (2) the entropy. Seventeen semi-professional female football players participated in the study. The agility task consisted of a Y-shaped (45° COD) task with three possible exit options (center, right and left) performed pre-planned or in reaction to the movement of two testers (i.e., blocking exit gates). Players' acceleration was measured using an inertial measurement unit. Entropy was calculated from the acceleration signal and completion time was extracted using a magnet-based timing system. Significantly greater times and lower entropy (p<0.001) were found during agility runs to pre-planned COD runs. Furthermore, weak to moderate correlations were found between COD and agility for both completion time (r = 0.29, p<0.001) and entropy (r = 0.53, p<0.001, r2 = 28.1%). These results highlight that COD speed and agility are independent capacities and skills, and as such, should be tested and trained as distinct, separate qualities. Modifying task constraints including a reactive stimulus (i.e., cognitive factors), is essential for increasing task complexity by altering the biomechanical and coordinative aspects of the action.

Development of a Cutting Technique Modification Training Program and Evaluation of its Effects on Movement Quality and Cutting Performance in Male Adolescent American Football Players

This study developed a cutting technique modification training program and investigated its effects on cutting performance and movement quality in adolescent American football players. For six weeks, an intervention group (IG) of 11 players participated in 25 min cutting technique modification training sessions integrated into team training twice a week, while a control group (CG) of 11 players continued their usual team training. Movement quality was assessed by evaluating 2D high-speed videos, obtained during preplanned 45° and 90° cutting tests, using the Cutting Movement Assessment Score (CMAS) qualitative screening tool. Cutting performance was assessed based on change of direction deficit (CODD). Significant interaction effects of time × group were found for CMAS in 45° and 90° cuttings (p < 0.001, ηp2 = 0.76, p < 0.001, ηp2 = 0.64, respectively), with large improvements in the IG (p < 0.001, g = -2.16, p < 0.001, g = -1.78, respectively) and deteriorations in the CG for 45° cuttings (p = 0.002, g = 1.15). However, no statistically significant differences in CODD were observed pre-to-post intervention. The cutting technique modification training was effective at improving movement quality without impairing cutting performance, and it can be used by practitioners working with adolescent athletes.

Effect of instrument-assisted soft tissue mobilization combined with blood flow restriction training on function, pain and strength of patients with patellofemoral joint pain

BACKGROUND

Patellofemoral pain syndrome is a prevalent sports injury that affects athletes both in their daily lives and during training. This condition causes pain in the area where the kneecap and thigh bone meet, and it can be quite debilitating. Whether an athlete is simply going about their day or pushing themselves to the limit during a workout, patellofemoral pain can be a significant hindrance.

PURPOSE

The purpose of this study is to investigate the impact of combining Instrument-Assisted Soft Tissue Mobilization (IASTM) treatment with blood flow restriction training on individuals with patellofemoral pain. Specifically, the study will assess improvements in pain levels, functional ability, strength, and joint mobility resulting from this treatment approach.

METHODS

Twenty-six patients diagnosed with patellofemoral pain were selected as observation subjects and randomly divided into two groups: the IASTM combined with blood flow restriction training treatment group (n = 13) and the IASTM treatment group alone (n = 13). The treatment period was 4 weeks. In this study, we conducted a comparison and analysis of the knee's visual analogue pain scale (VAS), Lysholm score, and a modified version of the Thomas test (MTT) at three different time points.In this subject paper, we compared and analyzed the VAS score of the knee, Lysholm score of the knee, and MTT at three different time points-before treatment, immediately after the first treatment, and after four weeks of treatment. Additionally, we recorded data using a maximum isometric muscle strength testing system for the lower extremity extensors four weeks before and after treatment.

RESULTS

In comparing the Lysholm scores within the groups, a significant difference was observed between the two groups following the initial treatment and after 4 weeks of treatment (p < 0.05). The scores increased, indicating a significant improvement in function. The VAS scores significantly differed after the first treatment and 4 weeks of treatment compared to before treatment (p < 0.05), indicating a significant improvement in pain. Additionally, after 4 weeks of treatment, the strength of the extensor muscle in the lower extremity significantly improved (p < 0.001). However, there was no significant difference in the strength test between the groups (p > 0.05). The MTT test revealed significant changes in the three joint angles before and after treatment (p > 0.05), suggesting an improvement in joint mobility. Overall, these results demonstrate the effectiveness of the treatment in improving pain and muscle strength in the lower extremity.

CONCLUSION

The combination of IASTM treatment and blood flow restriction has been shown to significantly reduce pain and improve periprosthetic soft tissue flexibility. Additionally, IASTM treatment alone was found to be more effective in improving knee pain and muscle flexibility, ultimately leading to increased knee strength in a pain-free state. In terms of the overall treatment outcome, it was found that the combined treatment was significantly more effective than the adjuvant soft tissue release treatment alone.