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Di Paolo S, Musa F, d'Orsi GM, Grassi A, Vulpiani MC, Zaffagnini S, Della Villa F. A comprehensive two-dimensional scoring system to assess the single-leg squat task in football players. Knee 2024; 48:52-62. [PMID: 38513322 DOI: 10.1016/j.knee.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/05/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The single-leg squat (SLS) is a safe and widespread functional test commonly performed in the mid-stages of rehabilitation after severe knee injuries. The use of reliable objective measures has been advocated to improve the quality of SLS assessment. The aim of this study was to describe a qualitative whole-body scoring system based on two-dimensional (2D) video analysis during SLS test and validate it against three-dimensional (3D) kinetics and kinematics. METHODS Thirty-four competitive football (soccer) players performed a series of SLS tasks. 3D kinematics and kinetics were collected through infrared cameras, and 2D video analysis was performed through a scoring system with sub-scores ranging from 0/2 (non-adequate movement) to 2/2 (adequate movement) based on frontal and lateral planes objective measurements. 3D kinematics and kinetics were grouped according to the results of the 2D evaluation and compared through the analysis of variance (P < 0.05). RESULTS Higher hip adduction, hip internalrotation, and knee valgus collapse were found in trials rated 0/2 or 1/2 compared with theone rated 2/2 in the limb stability score. Hip flexion and hip/knee moment ratio were lower in those scoring 0/2 comparedwith those scoring 2/2 in the movement strategy criterion. A low total score was associated with higherknee valgus collapse and lower hip/knee extensor moment ratio. Compensatory strategieswere found in frontal plane scores. CONCLUSIONS The 2D scoring system described was strongly associated with kinematics and kinetics from gold-standard 3D motion capture and might represent a valid tool to describe the movement quality of an SLS task.
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Affiliation(s)
- Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Francesca Musa
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy; Unit of Physical Medicine and Rehabilitation, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Maria d'Orsi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Chiara Vulpiani
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy; Unit of Physical Medicine and Rehabilitation, Sant'Andrea University Hospital, Rome, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Dillon S, Burke A, Whyte EF, O’Connor S, Gore S, Moran KA. Running towards injury? A prospective investigation of factors associated with running injuries. PLoS One 2023; 18:e0288814. [PMID: 37590281 PMCID: PMC10434952 DOI: 10.1371/journal.pone.0288814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/04/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Given the high incidence and heavy burden of running related injuries, large-scale, prospective multifactorial investigations examining potential risk factors are warranted. This study aimed to identify factors associated with running related injuries and to evaluate their potential in injury screening. STUDY DESIGN Prospective cohort study. MATERIALS AND METHODS Two hundred and seventy-four recreational runners were recruited. Clinical measures (strength, range of motion, foot position), injury and training history (via questionnaire), impact loading (via accelerometery) and running technique measures were collected at baseline. Runners were tracked for injury for one year via fortnightly check-ins. A binary logistic regression, (injury versus no injury), was performed for each variable univariably, and then adjusting for age, sex and mileage. A multivariable regression was also performed to evaluate the model's discriminative ability. RESULTS Of the 225 runners included in the final analysis 52% experienced a running related injury. Injury history in the past year, less navicular drop, and measures of running technique (knee, hip, and pelvis kinematics) were associated with increased odds of injury (p < .05). The multivariable logistic regression model was statistically significant, χ2(11) = 56.45, p < .001, correctly classifying 74% of cases with a sensitivity and specificity of 72% and 76%, respectively. The area under the receiver operating characteristic curve was 0.79 (CI95% = 0.73-0.85), demonstrating acceptable discriminative ability. CONCLUSIONS This study found a number of clinical and running technique factors to be associated with prospective running related injuries among recreational runners. With the exception of injury history, the factors identified as being significantly associated with injury may be modifiable and therefore, could form the basis of interventions. Range of motion, spatiotemporal parameters and strength measures were not associated with injury and thus their utilisation in injury prevention practices should be reconsidered.
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Affiliation(s)
- Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Enda F. Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran A. Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
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Effect of external isometric hip rotation force on lower extremity muscles activities during pelvic drop with different hip positions. Sci Rep 2022; 12:21871. [PMID: 36536029 PMCID: PMC9763338 DOI: 10.1038/s41598-022-26472-9] [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: 07/12/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Gluteus medius muscle (Gmed) dysfunction has been confirmed as a functional defect in subjects with Genu Valgum Deformity (GVD). The purpose of this study was to determine whether the change in the positions of hip rotation and applying isometric hip external rotation during pelvic drop (PD) can affect muscles activity in subjects with GVD. A total of thirty recreational female athletes with (n = 15) and without (n = 15) GVD participated in this study. Surface electromyography measured Gmed, tensor fascia latae (TFL), and quadratus lumborum (QL) muscles activity when subjects performed PD in three different positions of hip rotations with and without applied isometric hip external rotation force. There were differences in muscle activity between GVD and healthy subjects. The Gmed/TFL and Gmed/QL muscles activity ratio altered while placing the hip in different rotation positions and applying isometric load. The lower extremity muscles' activity is affected by GVD, and changing the positions of the hip rotation in the PD task can be associated with altered muscle activity in both GVD and healthy Groups. However, applying isometric hip external rotation during PD can be suggested as an effective intervention to increase Gmed activity.
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Straub RK, Powers CM. Does the 2D Frontal Plane Projection Angle Predict Frontal Plane Knee Moments during Stepping, Landing, and Change of Direction Tasks? Int J Sports Phys Ther 2022; 17:1259-1270. [PMID: 36518844 PMCID: PMC9718689 DOI: 10.26603/001c.39612] [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: 03/04/2022] [Accepted: 08/15/2022] [Indexed: 10/08/2023] Open
Abstract
Background Although dynamic knee valgus can be visually identified using the 2D frontal plane projection angle (FPPA), the validity of the FPPA in terms of predicting frontal plane knee kinematics has been questioned. The biomechanical utility of the FPPA may lie in its ability to predict frontal plane knee moments. Hypothesis/Purpose The purpose of the current study was to comprehensively evaluate the ability of the FPPA to predict the frontal plane knee kinetics (peak moment, average moment, and moment at peak knee flexion) across a wide range of tasks (stepping, landing, and change of direction). Design Crossover Study Design. Methods Three-dimensional lower-extremity kinetics and 2D video were obtained from 39 healthy athletes (15 males and 24 females) during execution of six tasks (step down, drop jump, lateral shuffle, deceleration, triple hop, side-step-cut). Linear regression analysis was performed to determine if the 2D FPPA at peak knee flexion predicted frontal plane knee moment variables during the deceleration phase of each task (peak moment, average moment, moment at peak knee flexion). Results The FPPA was found to significantly predict the peak frontal plane knee moment for two tasks (deceleration and side-step-cut, R2 = 12% to 25%), average frontal plane knee moment for five tasks (drop jump, shuffle, deceleration, triple hop, side-step-cut, R2 = 15% to 40%), and frontal plane knee moment at peak knee flexion for five tasks (drop jump, shuffle, deceleration, triple hop, side-step-cut, R2 = 16% to 45%). Conclusion An increased FPPA (medial knee collapse) predicted increased knee valgus moments (or decreased knee varus moments) during landing and change of direction tasks (but not stepping). However, the predictive ability of the FPPA was weak to moderate.
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Unuvar E, Guney-Deniz H, Akinoglu B, Kocahan T, Nyland J. Frontal plane lower extremity alignment in adolescent athletes with chronic hip adductor-related groin injury symptoms: A case-control study. Phys Ther Sport 2022; 57:53-60. [PMID: 35921782 DOI: 10.1016/j.ptsp.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare trunk and lower extremity frontal plane projection angles (FPPA) during single leg squat (SLS) performance, perceived hip and groin function and symptoms, and isometric hip strength of adolescent athletes with chronic hip adductor-related groin injury (HARGI) symptoms and age, gender, and sport-matched healthy subjects. DESIGN Case-control study. SETTING Junior Olympic Development Training Centre. PARTICIPANTS Twenty-six athletes at 59.1 ± 60 weeks (range = 12-208 weeks) post-index grade II HARGI injury who had continued sport training (injury group) and 26 control group subjects. MAIN OUTCOME MEASURES SLS trunk, hip, and knee FPPA, isometric hip strength standardized to bodyweight, and Copenhagen Hip and Groin Outcome Scores (HAGOS). RESULTS The injury group had greater bilateral knee FPPA, and greater injury side hip FPPA during maximum SLS. Injury group HAGOS subscale scores were lower than control group scores. Hip abductor, adductor, external rotator, and internal rotator strength was lower at the injury side of the injury group compared to the matched control group limb. Forward stepwise multiple regression analysis of the injury group found that 50% of injury side knee FPPA was predicted by hip internal rotator strength and time post-index HARGI; and 47% of injury side hip FPPA was predicted by other side hip flexor strength and the HAGOS function, sport and recreation subscale score (p = 0.002). CONCLUSIONS Greater injury side hip and bilateral knee FPPA during maximum SLS, lower self-reported hip symptom and function scores, and less injury side hip abductor, adductor, external rotator and internal rotator strength suggests that adolescent athletes with chronic HARGI symptoms are at an increased risk for sustaining a non-contact knee injury. Impaired hip internal rotator strength at the side of the chronic HARGI was related to increased knee FPPA, and impaired hip flexor strength at the other side of the HARGI was related to increased hip FPPA. Findings support using SLS performance testing in this athlete group to help determine safe return to sport training readiness.
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Affiliation(s)
- Ezgi Unuvar
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, 06100, Ankara, Turkey
| | - Hande Guney-Deniz
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, 06100, Ankara, Turkey
| | - Bihter Akinoglu
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Etlik, Ankara, Turkey
| | - Tugba Kocahan
- University of Health Sciences, Gulhane Faculty of Medicine, Sports Medicine Department, Ankara, Turkey
| | - John Nyland
- Spalding University, Kosair Charities College of Health and Natural Sciences, Louisville, KY, USA.
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Preliminary brain-behavioral neural correlates of anterior cruciate ligament injury risk landing biomechanics using a novel bilateral leg press neuroimaging paradigm. PLoS One 2022; 17:e0272578. [PMID: 35951584 PMCID: PMC9371272 DOI: 10.1371/journal.pone.0272578] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/21/2022] [Indexed: 01/02/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury risk reduction strategies primarily focus on biomechanical factors related to frontal plane knee motion and loading. Although central nervous system processing has emerged as a contributor to injury risk, brain activity associated with the resultant ACL injury-risk biomechanics is limited. Thus, the purposes of this preliminary study were to determine the relationship between bilateral motor control brain activity and injury risk biomechanics and isolate differences in brain activity for those who demonstrate high versus low ACL injury risk. Thirty-one high school female athletes completed a novel, multi-joint leg press during brain functional magnetic resonance imaging (fMRI) to characterize bilateral motor control brain activity. Athletes also completed an established biomechanical assessment of ACL injury risk biomechanics within a 3D motion analysis laboratory. Knee abduction moments during landing were modelled as a covariate of interest within the fMRI analyses to identify directional relationships with brain activity and an injury-risk group classification analysis, based on established knee abduction moment cut-points. Greater landing knee abduction moments were associated with greater lingual gyrus, intracalcarine cortex, posterior cingulate cortex and precuneus activity when performing the bilateral leg press (all z > 3.1, p < .05; multiple comparison corrected). In the follow-up injury-risk classification analysis, those classified as high ACL injury-risk had greater activity in the lingual gyrus, parietal cortex and bilateral primary and secondary motor cortices relative to those classified as low ACL injury-risk (all z > 3.1, p < .05; multiple comparison corrected). In young female athletes, elevated brain activity for bilateral leg motor control in regions that integrate sensory, spatial, and attentional information were related to ACL injury-risk landing biomechanics. These data implicate crossmodal visual and proprioceptive integration brain activity and knee spatial awareness as potential neurotherapeutic targets to optimize ACL injury-risk reduction strategies.
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Rabello R, Bertozzi F, Brunetti C, Silva Zandonato L, Bonotti A, Rodrigues R, Sforza C. The influence of task type and movement speed on lower limb kinematics during single-leg tasks. Gait Posture 2022; 96:109-116. [PMID: 35635986 DOI: 10.1016/j.gaitpost.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Single-leg squats and step-downs are commonly used to assess kinematic variables that may be linked to injuries. Task type and movement speed may influence the outcomes of interest because of different balance requirements. RESEARCH QUESTION What is the influence of task type and movement speed on lower limb kinematics? METHODS This is a cross-sectional within-subjects study where 22 physically active females performed three single-leg functional tasks (Squat, Anterior step-down, and Lateral step-down) at three movement speeds (slow [5 s], fast [2 s], and self-selected), while three-dimensional kinematic variables were recorded. Displacement values from the initial position in single-leg support until 60° or peak knee flexion were calculated. Two-way repeated measures ANOVA was used to compare tasks and speeds, and Cohen's d effect size (ES) was calculated for significant pairwise comparisons. RESULTS At 60°, lateral step-down presented the greatest hip adduction (large ES) and internal rotation (small ES). The anterior step-down had the lowest knee abduction displacement while the squat had the greatest (small to medium ES). At peak knee flexion, values increased but differences between tasks followed a similar pattern. Slow speed induced smaller displacement angles at the knee and hip (trivial to small ES). SIGNIFICANCE When knee abduction is the variable of interest, the SLS may be the best test since it elicits the greatest displacement, but when evaluating hip motion, SDLAT might be best. Knee abduction and internal rotation were lowest in the slow condition, suggesting that faster speed may be more appropriate to detect abnormal movement patterns. However, the small difference in absolute values (i.e., degrees of movement) may indicate that the differences are not clinically significant, particularly for speed comparisons. Researchers and clinicians should take this into consideration when choosing the most appropriate task and the instruction to give during its execution.
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Affiliation(s)
- Rodrigo Rabello
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Filippo Bertozzi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy; Dipartimento di Meccanica, Politecnico di Milano, Milano, Italy
| | - Claudia Brunetti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Lucas Silva Zandonato
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Bonotti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Rodrigo Rodrigues
- Exercise Physiology and Physical Assessment Laboratory, Serra Gaúcha University Center, Caxias do Sul, Brazil; Integrated Colleges of Taquara (FACCAT), Taquara, Brazil
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
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Association between Selected Screening Tests and Knee Alignment in Single-Leg Tasks among Young Football Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116719. [PMID: 35682301 PMCID: PMC9179976 DOI: 10.3390/ijerph19116719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/28/2022] [Accepted: 05/28/2022] [Indexed: 01/25/2023]
Abstract
This study aimed to examine the relationship between knee valgus in the frontal plane projection angle (FPPA) during single-leg squat (SLS), single-leg landing (SLL), and other selected clinical tests in young athletes. Forty-three young healthy elite football players (age: 13.2 (1.7) years) that were regularly training in a local sports club participated in the study. The FPPA was assessed using 2D video analysis. The screening tests included the passive single-leg raise (PSLR), hip external and internal rotation (hip ER and IR), sit and reach test, weight-bearing lunge test (WBLT), modified star excursion balance test (mSEBT), countermovement jump (CMJ), single-leg hop for distance (SLHD), and age peak height velocity (APHV). There was a significant positive relationship between the knee valgus angles in the SLS test and the sit and reach test (r = 0.34) and a negative relationship with the hip ER ROM (r = −0.34) (p < 0.05). The knee valgus angles in the SLL were negatively associated with the hip IR (r = −0.32) and ER ROM (r = −0.34) and positive associated with the WBLT (r = 0.35) and sit and reach test (r = 0.33) (p < 0.05). Linear regression analysis showed that the results of the hip ER ROM and sit and reach tests were independent predictors of the FPPA in the SLS test (r2 = 0.11, p = 0.03 and r2 = 0.12, p = 0.02, respectively). The conducted study showed that individuals with more hip range of motion, more spine flexion extensibility, and less ankle dorsiflexion ROM may be more likely to experience high degrees of knee valgus in FPPA.
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Leppänen M, Uotila A, Tokola K, Forsman-Lampinen H, Kujala UM, Parkkari J, Kannus P, Pasanen K, Vasankari T. Players with high physical fitness are at greater risk of injury in youth football. Scand J Med Sci Sports 2022; 32:1625-1638. [PMID: 35621388 DOI: 10.1111/sms.14199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate physical fitness, football-specific skills, and their association with injury risk in youth football. Altogether 447 male and female players aged 9-14 years (median 12 years) participated in performance tests and prospective follow-up. The physical fitness tests included five-jump test for distance, 30-m sprint, football-specific figure of eight agility, countermovement jump, and Yo-Yo intermittent endurance test level 1. The football-specific skill tests included dribbling and passing tests. Injuries and exposure were registered during the 20-week follow-up. Our candidate risk factors were low/high level of physical fitness measured with a composite score of physical fitness tests and low/high level of football-specific skills measured with a composite score of dribbling and passing tests. Secondarily, we investigated performance in individual tests and their association with injury risk. During the follow-up, players reported 565 injuries (264 acute and 301 overuse injuries). High level of physical fitness was associated with increased rate of all injuries (age-, sex-, and mean team exposure-adjusted IRR: 1.28, 95% CI: 1.04-1.58). The level of football-specific skills had no influence on the overall injury rate. Burden of overuse injuries, but not acute injuries was significantly higher in most fit players compared with the players in the reference group (IRR: 2.09, 95% CI: 1.04-4.24). In conclusion, most fit players were at greater risk of sustaining injuries in youth competitive football.
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Affiliation(s)
- Mari Leppänen
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland.,Tampere University Hospital, Tampere, Finland
| | - Aliisa Uotila
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
| | | | | | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pekka Kannus
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
| | - Kati Pasanen
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland.,Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Tommi Vasankari
- UKK Institute, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Comparison of 5 Normalization Methods for Knee Joint Moments in the Single-Leg Squat. J Appl Biomech 2022; 38:29-38. [PMID: 35042188 DOI: 10.1123/jab.2021-0143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/13/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
Abstract
Ratio scaling is the most common magnitude normalization approach for net joint moment (NJM) data. Generally, researchers compute a ratio between NJM and (some combination of) physical body characteristics (eg, mass, height, limb length, etc). However, 3 assumptions must be verified when normalizing NJM data this way. First, the regression line between NJM and the characteristic(s) used passes through the origin. Second, normalizing NJM eliminates its correlation with the characteristic(s). Third, the statistical interpretations following normalization are consistent with adjusted linear models. The study purpose was to assess these assumptions using data collected from 16 males and 16 females who performed a single-leg squat. Standard inverse dynamics analyses were conducted, and ratios were computed between the mediolateral and anteroposterior components of the knee NJM and participant mass, height, leg length, mass × height, and mass × leg length. Normalizing NJM-mediolateral by mass × height and mass × leg length satisfied all 3 assumptions. Normalizing NJM-anteroposterior by height and leg length satisfied all 3 assumptions. Therefore, if normalization of the knee NJM is deemed necessary to address a given research question, it can neither be assumed that using (any combination of) participant mass, height, or leg length as the denominator is appropriate nor consistent across joint axes.
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Rice RP, Roach K, Kirk-Sanchez N, Waltz B, Ellenbecker TS, Jayanthi N, Raya M. Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players. Sports Health 2022; 14:466-477. [PMID: 35037501 PMCID: PMC9214903 DOI: 10.1177/19417381211062834] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population. HYPOTHESIS Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM. RESULTS A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides. CONCLUSION Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments. CLINICAL RELEVANCE Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.
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Affiliation(s)
- Robyn Porter Rice
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida,Robyn Porter Rice, PT, PhD, Department of Physical Therapy, Miller School of Medicine, University of Miami, 5915 Ponce de Leon Boulevard, Coral Gables FL 33146 () (Twitter: @RiceRobynp)
| | - Kathryn Roach
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Neva Kirk-Sanchez
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Bret Waltz
- DocWaltz LLC, Scottsdale, Arizona,USTA Player Development, Orlando, Florida
| | - Todd S. Ellenbecker
- Vice President Medical Services, ATP Tour, Ponte Vedra Beach, Florida,Rehab Plus Sports Therapy Scottsdale, Scottsdale, Arizona
| | - Neeru Jayanthi
- Emory Sports Medicine Center, Department of Orthopedic Surgery and Family Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michele Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida
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Della Villa F, Di Paolo S, Santagati D, Della Croce E, Lopomo NF, Grassi A, Zaffagnini S. A 2D video-analysis scoring system of 90° change of direction technique identifies football players with high knee abduction moment. Knee Surg Sports Traumatol Arthrosc 2022; 30:3616-3625. [PMID: 33912979 PMCID: PMC9568485 DOI: 10.1007/s00167-021-06571-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Abnormal joint biomechanics and poor neuromuscular control are modifiable risk factors for Anterior Cruciate Ligament (ACL) injury. Although 3D motion capture is the gold standard for the biomechanical evaluation of high-speed multidirectional movements, 2D video analysis is a growing-interest alternative because of its higher cost-effectiveness and interpretability. The aim of the present study was to explore the possible association between a 2D evaluation of a 90° change of direction (COD) and the KAM measured with gold standard 3D motion analysis. METHODS Thirty-four competitive football (soccer) players (age 22.8 ± 4.1, 18 male and 16 females) were enrolled. Each athlete performed a series of pre-planned 90° COD at the maximum speed possible in a laboratory equipped with artificial turf. 3D motion analysis was recorded using 10 stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D evaluation was performed through a scoring system based on the video analysis of frontal and sagittal plane joint kinematics. Five scoring criteria were adopted: limb stability (LS), pelvis stability (PS), trunk stability (TS), shock absorption (SA), and movement strategy (MS). For each criterion, a sub-score of 0/2 (non-adequate), 1/2 (partially adequate), or 2/2 (adequate) was attributed to the movement, based on objective measurements. The intra-rater and inter-rater reliability were calculated for each criterion and the total score. The Knee Abduction Moment (KAM) was extracted from the 3D motion analysis and grouped according to the results of the 2D evaluation. RESULTS Excellent intra-rater reliability (ICC > 0.88) and good-to-excellent inter-rater reliability (ICC 0.68-0.92) were found. Significantly higher KAM was found for athletes obtaining a 0/2 score compared to those obtaining a 2/2 score in all the sub-criteria and the total score (20-47% higher, p < 0.05). The total score and the LS score showed the best discriminative power between the three groups. CONCLUSION The 2D video-analysis scoring system here described was a simple and effective tool to discriminate athletes with high and low KAM in the assessment of a 90° COD and could be a potential method to identify athletes at high risk of non-contact ACL injury. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Stefano Di Paolo
- Department for Life Quality Studies QUVI, Università Di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy.
| | - Dario Santagati
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Edoardo Della Croce
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | | | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy ,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Kuntze G, Nettel-Aguirre A, Lorenzen KN, Küpper J, Ronsky JL, Whittaker JL, Emery CA. Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211058105. [PMID: 34917690 PMCID: PMC8669131 DOI: 10.1177/23259671211058105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background A better understanding of movement biomechanics after anterior cruciate ligament reconstruction (ACLR) could inform injury prevention, knee injury rehabilitation, and osteoarthritis prevention strategies. Purpose To investigate differences in vertical drop jump (VDJ) biomechanics between patients with a 3- to 10-year history of youth sport-related ACLR and uninjured peers of a similar age, sex, and sport. Study Design Cross-sectional study. Level of evidence III. Methods Lower limb kinematics and bilateral ground-reaction forces (GRFs) were recorded for participants performing 10 VDJs. Joint angles and GRF data were analyzed, and statistical analysis was performed using 2 multivariate models. Dependent variables included sagittal (ankle, knee, and hip) and coronal (knee and hip) angles at initial contact and maximum knee flexion, the rate of change of coronal knee angles (35%-90% of the support phase; ie, slopes of linear regression lines), and vertical and mediolateral GRFs (normalized to body weight [BW]). Fixed effects included group, sex, and time since injury. Participant clusters, defined by sex and sport, were considered as random effects. Results Participants included 48 patients with a history of ACLR and 48 uninjured age-, sex-, and sport-matched controls (median age, 22 years [range, 18-26 years]; 67% female). Patients with ACLR demonstrated steeper negative coronal knee angle slopes (β = -0.04 deg/% [95% CI, -0.07 to -0.00 deg/%]; P = .025). A longer time since injury was associated with reduced knee flexion (β = -0.2° [95% CI, -0.3° to -0.0°]; P = .014) and hip flexion (β = -0.1° [95% CI, -0.2° to -0.0°]; P = .018). Regardless of ACLR history, women displayed greater knee valgus at initial contact (β = 2.1° [95% CI, 0.4° to 3.8°]; P = .017), greater coronal knee angle slopes (β = 0.05 deg/% [95% CI, 0.02 to 0.09 deg/%]; P = .004), and larger vertical GRFs (landing: β = -0.34 BW [95% CI, -0.61 to -0.07 BW]; P = .014) (pushoff: β = -0.20 BW [95% CI, -0.32 to -0.08 BW]; P = .001). Conclusion Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges. Clinical Relevance It is important to consider knee motion control during activities such as VDJs when developing injury prevention and rehabilitation interventions aimed at improving joint health after youth sport-related ACLR.
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Affiliation(s)
- Gregor Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kristin N Lorenzen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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14
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Leppänen M, Parkkari J, Vasankari T, Äyrämö S, Kulmala JP, Krosshaug T, Kannus P, Pasanen K. Change of Direction Biomechanics in a 180-Degree Pivot Turn and the Risk for Noncontact Knee Injuries in Youth Basketball and Floorball Players. Am J Sports Med 2021; 49:2651-2658. [PMID: 34283648 PMCID: PMC8355634 DOI: 10.1177/03635465211026944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies investigating biomechanical risk factors for knee injuries in sport-specific tasks are needed. PURPOSE To investigate the association between change of direction (COD) biomechanics in a 180-degree pivot turn and knee injury risk among youth team sport players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 258 female and male basketball and floorball players (age range, 12-21 years) participated in the baseline COD test and follow-up. Complete data were obtained from 489 player-legs. Injuries, practice, and game exposure were registered for 12 months. The COD test consisted of a quick ball pass before and after a high-speed 180-degree pivot turn on the force plates. The following variables were analyzed: peak vertical ground-reaction force (N/kg); peak trunk lateral flexion angle (degree); peak knee flexion angle (degree); peak knee valgus angle (degree); peak knee flexion moment (N·m/kg); peak knee abduction moment (N·m/kg); and peak knee internal and external rotation moments (N·m/kg). Legs were analyzed separately and the mean of 3 trials was used in the analysis. Main outcome measure was a new acute noncontact knee injury. RESULTS A total of 18 new noncontact knee injuries were registered (0.3 injuries/1000 hours of exposure). Female players sustained 14 knee injuries and male players 4. A higher rate of knee injuries was observed in female players compared with male players (incidence rate ratio, 6.2; 95% CI, 2.1-21.7). Of all knee injuries, 8 were anterior cruciate ligament (ACL) injuries, all in female players. Female players displayed significantly larger peak knee valgus angles compared with male players (mean for female and male players, respectively: 13.9°± 9.4° and 2.0°± 8.5°). No significant associations between biomechanical variables and knee injury risk were found. CONCLUSION Female players were at increased risk of knee and ACL injury compared with male players. Female players performed the 180-degree pivot turn with significantly larger knee valgus compared with male players. However, none of the investigated variables was associated with knee injury risk in youth basketball and floorball players.
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Affiliation(s)
- Mari Leppänen
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Tampere University Hospital, Tampere,
Finland,Mari Leppänen, PhD, Tampere
Research Center of Sport Medicine, UKK Institute, Kaupinpuistonkatu 1, Tampere,
33501, Finland () (Twitter:
@mari_leppanen)
| | - Jari Parkkari
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Tampere University Hospital, Tampere,
Finland
| | - Tommi Vasankari
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Faculty of Medicine and Health
Technology, Tampere University, Tampere, Finland
| | - Sami Äyrämö
- Faculty of Information Technology,
University of Jyväskylä, Jyväskylä, Finland
| | - Juha-Pekka Kulmala
- Motion Analysis Laboratory, Children’s
Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,
Finland
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center,
Department of Sports Medicine, Norwegian School of Sport Science, Oslo, Norway
| | - Pekka Kannus
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Tampere University Hospital, Tampere,
Finland
| | - Kati Pasanen
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Faculty of Kinesiology, Sport Injury
Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research
Institute, University of Calgary, Calgary, Alberta, Canada,McCaig Institute for Bone and Joint
Health, University of Calgary, Calgary, Alberta, Canada
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Drop Jump? Single-Leg Squat? Not if You Aim to Predict Anterior Cruciate Ligament Injury From Real-Time Clinical Assessment: A Prospective Cohort Study Involving 880 Elite Female Athletes. J Orthop Sports Phys Ther 2021; 51:372-378. [PMID: 34192883 DOI: 10.2519/jospt.2021.10170] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether visually assessed performances of the single-leg squat (SLS) and vertical drop jump (VDJ) were associated with future noncontact anterior cruciate ligament (ACL) injury. DESIGN Prognostic accuracy cohort study. METHODS Elite female handball and football (soccer) athletes (n = 880) were tested from 2007 to 2014 and tracked through 2015. Trained physical therapists visually rated each leg during a SLS and overall control during a VDJ. Receiver operating characteristic curve, Pearson chi-square, and logistic regression analyses were used to determine the prognostic accuracy of the 2 screening tests. RESULTS Sixty-five noncontact ACL injuries occurred during the follow-up period. Fourteen percent of athletes who sustained an ACL injury had poor SLS performance, compared to 17% of the noninjured athletes (P = .52 and .67 for hip and knee ratings, respectively). Side-to-side asymmetry in the SLS was not different between injured and noninjured athletes (P = .10 and .99 for hip and knee asymmetry, respectively). Twenty-one percent of athletes who sustained an ACL injury had a poor VDJ rating, compared to 27% of the noninjured athletes (P = .09). Furthermore, area under the curve values ranged from 0.43 to 0.54 for the SLS and VDJ, demonstrating no to poor prognostic accuracy. CONCLUSION Neither SLS nor VDJ test performance distinguished between athletes who sustained a subsequent noncontact ACL injury and those who did not. J Orthop Sports Phys Ther 2021;51(7):372-378. doi:10.2519/jospt.2021.10170.
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Poor Motor Coordination Elicits Altered Lower Limb Biomechanics in Young Football (Soccer) Players: Implications for Injury Prevention through Wearable Sensors. SENSORS 2021; 21:s21134371. [PMID: 34202369 PMCID: PMC8271557 DOI: 10.3390/s21134371] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/29/2023]
Abstract
Motor coordination and lower limb biomechanics are crucial aspects of anterior cruciate ligament (ACL) injury prevention strategies in football. These two aspects have never been assessed together in real scenarios in the young population. The present study aimed to investigate the influence of motor coordination on lower limb biomechanics in young footballers during an on-the-pitch training. Eighteen juvenile football players (10 y ± 2 m) were enrolled. Each player performed a training drill with sport-specific movements (vertical jump, agility ladders, change of direction) and the Harre circuit test (HCT) to evaluate players' motor coordination. Wearable inertial sensors (MTw Awinda, Xsens) were used to assess lower limb joint angles and accelerations. Based on the results of the HCT, players were divided into poorly coordinated (PC) and well-coordinated (WC) on the basis of the literature benchmark. The PC group showed a stiffer hip biomechanics strategy (up to 40% lower flexion angle, ES = 2.0) and higher internal-external hip rotation and knee valgus (p < 0.05). Significant biomechanical limb asymmetries were found only in the PC group for the knee joint (31-39% difference between dominant and non-dominant limb, ES 1.6-2.3). Poor motor coordination elicited altered hip and knee biomechanics during sport-specific dynamic movements. The monitoring of motor coordination and on-field biomechanics might enhance the targeted trainings for ACL injury prevention.
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Impact of Three Strengthening Exercises on Dynamic Knee Valgus and Balance with Poor Knee Control among Young Football Players: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9050558. [PMID: 34068810 PMCID: PMC8151944 DOI: 10.3390/healthcare9050558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
The observed dynamic knee valgus and the limited dynamic balance described in the literature are modifiable risk factors for injuries in athletes. Therefore, identification and appropriate prevention are crucial in managing the development of young athletes. The aim of the study was to assess the effectiveness of three exercises strengthening the muscles: gluteal medius, popliteal and tibialis posterior to reduce dynamic knee valgus and improve the dynamic balance of the lower limbs in young football players with poor knee control. A total of 134 footballers were assessed for eligibility, and finally 45 participants (age 12–15) met the inclusion criteria. Participants were assessed with 2D video kinematic analysis during single-leg squats to assess the knee valgus angles and the dynamic balance (Y-Balance Test). No significant interactions between groups (Control and Exercise) and time (baseline and after 6 week) were noted for dynamic valgus for the left and right knee (p > 0.05). For the dynamic balance, there were statistically significant results, but not clinically relevant for anterior, posteromedial, and composite direction for the right lower limbs and for the anterior direction for left lower limbs in the exercise group. However, there were no significant differences (p > 0.05) in all of the YBT scores for both lower limbs between groups. This study demonstrated that there were no statistically significant differences in dynamic knee valgus angles and dynamic balance values after 6 weeks of exercise program in young footballers with poor knee control. Future randomized trials should focus on more comprehensive exercises, where possible using biofeedback methods to improve knee kinematics.
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18
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Carroll LA, Kivlan BR, Martin RL, Phelps AL, Carcia CR. The Single Leg Squat Test: A "Top-Down" or "Bottom-Up" Functional Performance Test? Int J Sports Phys Ther 2021; 16:360-370. [PMID: 33842032 PMCID: PMC8016417 DOI: 10.26603/001c.21317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians' interpretation of the SLST. PURPOSE The purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass). HYPOTHESIS There will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD. STUDY DESIGN Cross-sectional study. METHODS Sixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared. RESULTS There were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9o +/- 3.7o, fail group = 7.8o +/- 3.0o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5o +/- 5.6o, fail group = 13.9o +/- 5.3o; weight bearing dorsiflexion: pass group = 42.7o +/- 6.0o, 42.7o +/- 8.3o, p = .611). CONCLUSIONS Failure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - RobRoy L Martin
- Department of Physical Therapy, Duquesne University; UPMC Center for Sports Medicine
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Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors. SENSORS 2021; 21:s21072331. [PMID: 33810610 PMCID: PMC8037754 DOI: 10.3390/s21072331] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.
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CONSISTENCY OF DYNAMIC KNEE VALGUS KINEMATICS AND PAIN ACROSS FUNCTIONAL TASKS IN FEMALES WITH PATELLOFEMORAL PAIN: A CROSS-SECTIONAL STUDY. Int J Sports Phys Ther 2020; 15:985-994. [PMID: 33344015 DOI: 10.26603/ijspt20200985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Dynamic knee valgus has been associated with patellofemoral pain (PFP) during high-level tasks, however, repeated lower-level stresses may be an alternative pain mechanism. The primary purpose of the current study was to examine the consistency of dynamic knee valgus and task-elicited pain demonstrated by females with PFP across four common functional tasks (stair ascent, stair descent, sit-to-stand, and stand-to-sit). A secondary purpose was to assess the correlation between the clinical test of single-limb squat and functional tasks. Hypothesis Females with patellofemoral pain will demonstrate a positive relationship in magnitude of dynamic knee valgus and task-elicited pain across functional tasks. Individuals who demonstrated greater dynamic knee valgus and task-elicited pain during the clinical test of single-limb squat would demonstrate greater dynamic knee valgus and task elicited pain during stair ascent/descent and sit-to-stand/stand-to-sit tasks. Study Design Cross-sectional study; secondary analysis of a feasibility intervention study. Methods Twenty-three women with patellofemoral pain (age: 21.8 SD 3.7 years; BMI: 22.2 SD 2.0 kg/m2) participated. Three-dimensional kinematic data were captured during task completion. Hip and knee frontal and transverse plane angles at 45 ° of knee flexion, and pain using a visual analog scale, were assessed during single-limb squat, stair ascent/descent, and sit-to-stand. Pearson product-moment correlation coefficients were calculated to examine between-task relationships for each variable at the pre-intervention assessment. Results Correlation coefficients between tasks ranged from 0.23-0.76 for hip frontal plane measures (7/10 significant relationships, p<0.02), 0.31-0.90 for hip transverse plane measures (7/10 significant, p<0.01), 0.87-0.95 for knee frontal plane measures (10/10 significant, p<0.01), and 0.54-0.86 for knee transverse plane measures (10/10 significant, p<0.01). Correlations spanned 0.59-0.85 for pain during tasks (10/10 significant, p<0.01). Conclusion Females with patellofemoral pain demonstrated positive correlations in dynamic knee valgus kinematics and task-elicited pain across five tasks. Movement and pain during the clinical test of single-limb squat test also was correlated with movement and pain during the functional tasks of stair ascent/descent and sit-to-stand. Level of Evidence Level 2b.
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21
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Cronström A, Creaby MW, Ageberg E. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. BMC Musculoskelet Disord 2020; 21:563. [PMID: 32819327 PMCID: PMC7441716 DOI: 10.1186/s12891-020-03552-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/31/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. METHODS Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. RESULTS Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: - 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: - 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: - 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: - 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. CONCLUSION Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Y-Balance Test Asymmetry and Frontal Plane Knee Projection Angle During Single-leg squat as Predictors of Patellofemoral Pain in Male Military Recruits. Phys Ther Sport 2020; 44:121-127. [DOI: 10.1016/j.ptsp.2020.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
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Kuntze G, Nettel-Aguirre A, Brooks J, Esau S, Nesbitt C, Mosher D, Twilt M, Benseler S, Ronsky JL, Emery CA. Consequences of Juvenile Idiopathic Arthritis on Single Leg Squat Performance in Youth. Arthritis Care Res (Hoboken) 2020; 73:1187-1193. [PMID: 32407563 DOI: 10.1002/acr.24254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/05/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) affects body structure and function outcomes that may increase the risk of acute joint injury. The purpose of this study was to examine single leg squat (SLS) biomechanics for youth with JIA and their healthy peers. The study design was a matched pair cohort study. METHODS Sixty-five youth (JIA n = 30; control n = 35) participated in this ethics-approved study. Participants performed 3 sets of 5 consecutive SLS tasks. Disease activity and functional status were assessed using the Juvenile Arthritis Disease Activity Score and Child Health Assessment Questionnaire. Indexed (most-affected leg [JIA]; dominant leg [control]) and contralateral extremity biomechanics were obtained using a 12-camera system. Outcomes included hip flexion/extension (FE), adduction/abduction (AA), and internal/external (IE) rotation range of motion (ROM). Data were analyzed using a multivariate random coefficient model in R (α⍺ = 0.05). RESULTS A total of 29 matched pairs were analyzed. Youth with JIA had low disease activity and performed the SLS with a more internally rotated hip (indexed leg P = 0.023, β = -1.9°). Female participants displayed greater hip FE (indexed leg P = 0.015, β = -4.3°; contralateral leg P = 0.005, β = -4.8°) and IE ROM (indexed leg P = 0.021, β = -2.1°) than male participants. Associations were observed for body mass index and hip IE ROM (contralateral leg P = 0.001, β = -0.4°), knee flexion angle, and hip FE ROM (indexed leg P = 0.001, β = 0.4°; contralateral leg P = 0.001, β = 0.5°) and AA (indexed leg P = 0.010, β = 0.1°; contralateral leg P = 0.002, β = 0.2°). CONCLUSION This study identified functional alterations for an SLS in youth with JIA. These findings support the use of physical therapy as part of a multidisciplinary management approach, to restore normal hip posture and movement.
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Affiliation(s)
| | | | - Julia Brooks
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Shane Esau
- University of Calgary, Calgary, Alberta, Canada
| | | | - Dianne Mosher
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Susanne Benseler
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Carolyn A Emery
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leppänen M, Rossi MT, Parkkari J, Heinonen A, Äyrämö S, Krosshaug T, Vasankari T, Kannus P, Pasanen K. Altered hip control during a standing knee‐lift test is associated with increased risk of knee injuries. Scand J Med Sci Sports 2020; 30:922-931. [DOI: 10.1111/sms.13626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Mari Leppänen
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
| | - Marko T. Rossi
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
| | - Jari Parkkari
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Sami Äyrämö
- Faculty of Information Technology University of Jyväskylä Jyväskylä Finland
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center Norwegian School of Sport Science Oslo Norway
| | - Tommi Vasankari
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
| | - Pekka Kannus
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
- Tampere University Hospital Tampere Finland
| | - Kati Pasanen
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
- Faculty of Kinesiology Sport Injury Prevention Research Centre University of Calgary Calgary Alberta Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary Alberta Canada
- McCaig Institute for Bone and Joint Health University of Calgary Calgary Alberta Canada
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25
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Ellenberger L, Oberle F, Lorenzetti S, Frey WO, Snedeker JG, Spörri J. Dynamic knee valgus in competitive alpine skiers: Observation from youth to elite and influence of biological maturation. Scand J Med Sci Sports 2020; 30:1212-1220. [DOI: 10.1111/sms.13657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/15/2020] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Lynn Ellenberger
- Sports Medical Research Group Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
| | - Felix Oberle
- Sports Medical Research Group Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
| | - Silvio Lorenzetti
- Swiss Federal Institute of Sport Magglingen (SFISM) Magglingen Switzerland
| | - Walter O. Frey
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
| | - Jess G. Snedeker
- Biomechanics Laboratory Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- Institute for Biomechanics ETH Zurich Zurich Switzerland
| | - Jörg Spörri
- Sports Medical Research Group Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
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26
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Bishop EL, Kuntze G, Ronsky JL. Characterizing healthy knee symmetry using the finite helical axis and muscle power during open and closed chain tasks. J Biomech 2020; 99:109580. [PMID: 31898978 DOI: 10.1016/j.jbiomech.2019.109580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/16/2022]
Abstract
Understanding healthy joint movement and muscle control, and injurious alterations, is important to determine musculoskeletal contributions to post-injury joint instabilities or altered dynamic joint function. The contralateral limb is often used as a point of reference to determine the effects of knee joint injury. However, it is currently difficult to interpret within subject variability between limbs as this is not well established in the healthy population. There is a continuing need to characterize healthy knee joint mechanics and neuromuscular control to determine the degree of symmetry within healthy individuals. The current study quantified limb symmetry in healthy individuals using the finite helical axis with a unique reference position (rFHA) and electromyography (EMG) approaches, for a closed-chain single leg squat (SLS) and an open-chain seated leg swing. Muscle power and FHA translation, orientation and dispersion were similar between limbs. However, the FHA was located significantly more anterior in the dominant limb relative to the contralateral during both tasks. These between-limb differences in FHA location could be attributed to differences in joint geometry and strength between limbs. This finding provides evidence that healthy knees have asymmetries which have implications for selection of control limbs in studies comparing conditions within and between individuals. Differences identified in dynamic joint function between tasks suggest that the SLS is useful for revealing joint asymmetries due to altered muscular control strategies, while the swing task is expected to highlight asymmetries in joint motion due to altered knee structures following injury.
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Affiliation(s)
- Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada.
| | - Gregor Kuntze
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Harsted S, Holsgaard-Larsen A, Hestbæk L, Boyle E, Lauridsen HH. Concurrent validity of lower extremity kinematics and jump characteristics captured in pre-school children by a markerless 3D motion capture system. Chiropr Man Therap 2019; 27:39. [PMID: 31417672 PMCID: PMC6689331 DOI: 10.1186/s12998-019-0261-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/05/2019] [Indexed: 01/01/2023] Open
Abstract
Background Investigations into the possible associations between early in life motor function and later in life musculoskeletal health, will require easily obtainable, valid, and reliable measures of gross motor function and kinematics. Marker-based motion capture systems provide reasonably valid and reliable measures, but recordings are restricted to expensive lab environments. Markerless motion capture systems can provide measures of gross motor function and kinematics outside of lab environments and with minimal interference to the subjects being investigated. It is, however, unknown if these measures are sufficiently valid and reliable in young children to warrant further use. This study aims to document the concurrent validity of a markerless motion capture system: “The Captury.” Method Measures of gross motor function and lower extremity kinematics from 14 preschool children (age between three and 6 years) performing a series of squats and standing broad jumps were recorded by a marker-based (Vicon) and a markerless (The Captury) motion capture system simultaneously, in December 2015. Measurement differences between the two systems were examined for the following variables: jump length, jump height, hip flexion, knee flexion, ankle dorsi flexion, knee varus, knee to hip separation distance ratio (KHR), ankle to hip separation distance ratio (AHR), frontal plane projection angle, frontal plane knee angle (FPKA), and frontal plane knee deviation (FPKD). Measurement differences between the systems were expressed in terms of root mean square errors, mean differences, limits of agreement (LOA), and intraclass correlations of absolute agreement (ICC (2,1) A) and consistency of agreement. Results Measurement differences between the two systems varied depending on the variables. Agreement and reliability ranged from acceptable for e.g. jump height [LOA: − 3.8 cm to 2.2 cm; ICC (2,1) A: 0.91] to unacceptable for knee varus [LOA: − 33° to 19°; ICC (2,1) A: 0.29]. Conclusions The measurements by the markerless motion capture system “The Captury” cannot be considered interchangeable with the Vicon measures, but our results suggest that this system can produce estimates of jump length, jump height, KHR, AHR, knee flexion, FPKA, and FPKD, with acceptable levels of agreement and reliability. These variables are promising for use in future research but require further investigation of their clinimetric properties.
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Affiliation(s)
- Steen Harsted
- 1Research Unit for Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anders Holsgaard-Larsen
- 2Orthopaedic research unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,3Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lise Hestbæk
- 1Research Unit for Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.,4Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Eleanor Boyle
- 1Research Unit for Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Henrik Hein Lauridsen
- 1Research Unit for Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Lopes JSS, Machado AF, Cavina AP, Michelletti JK, Almeida ACD, Pastre CM. Specific interventions for prevention of muscle injury in lower limbs: systematic review and meta-analysis. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Muscle injuries show an incidence associated with extreme stretching, or even a high-intensity eccentric contraction. Such injuries cause severe damage to athletes, including lower performance, withdrawal, and psychological distress. In this scenario, the study of effective preventive methods is an indispensable factor in the routine of professional athletes, to reduce the incidence of injuries. Objective: To verify the effectiveness of three different interventions (warm-up, neuromuscular training, and eccentric exercise) to prevent muscle injuries in the lower limbs. Method: We searched the Cochrane Library, EMBASE, SPORTDiscus, PEDro, and PubMed databases from the earliest records until January 20, 2018. The search was performed from word combinations such as clinical trial, muscle strain, injury prevention. The data related to the outcome of prevention were grouped in meta-analysis and described in Risk Ratio (RR) with 95% confidence interval. Results: Sixteen studies were included: five assessed eccentric exercise, three investigated neuromuscular training, and eight observed warm-up. The eccentric exercise (RR = 3.49, 95% CI 2.36, 5.16, p < 0.00001) and the neuromuscular training (RR = 2.73, 95% CI 2.03, 2.68, p < 0.00001) showed significant effects on the prevention of muscle injuries in lower limbs. On the other hand, warm-up (RR = 1.57, 95% CI 0.92, 2.7, p = 0.10) was irrelevant in reducing the incidence of injuries in the body segment investigated. Conclusion: The outcomes presented provide clinical relevance inherent in the field practices, with intrinsic potential for practical application in the management of specific preventive techniques.
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Räisänen AM, Arkkila H, Vasankari T, Steffen K, Parkkari J, Kannus P, Forsman H, Pasanen K. Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football. Scand J Med Sci Sports 2018; 28:2084-2092. [DOI: 10.1111/sms.13197] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 01/16/2023]
Affiliation(s)
- A. M. Räisänen
- Tampere Research Center of Sports Medicine; UKK Institute for Health Promotion Research; Tampere Finland
| | - H. Arkkila
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - T. Vasankari
- UKK Institute for Health Promotion Research; Tampere Finland
| | - K. Steffen
- Oslo Sports Trauma Research Center; Norwegian School of Sports Sciences; Oslo Norway
| | - J. Parkkari
- Tampere Research Center of Sports Medicine; UKK Institute for Health Promotion Research; Tampere Finland
| | - P. Kannus
- UKK Institute for Health Promotion Research; Tampere Finland
| | - H. Forsman
- Eerikkilä Sports Institute Training Center; Tammela Finland
| | - K. Pasanen
- Tampere Research Center of Sports Medicine; UKK Institute for Health Promotion Research; Tampere Finland
- Faculty of Kinesiology; Sport Injury Prevention Research Centre; University of Calgary; Calgary AB Canada
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