Comparison of the H:Q Ratio Between the Dominant and Nondominant Legs of Soccer Players: A Meta-Analysis

Isokinetic assessment of the female's soccer player's knee. A systematic review of outcomes measures

BACKGROUND

Isokinetic normative data in females' soccer players is scarce in comparison to males. Furthermore, evaluation protocols employed to obtain those data in female's studies, strongly differ from each other, using different ranges of speeds and movement patterns, thus producing different output data. Thus, it is difficult for the researcher and the clinician to choose a correct protocol for knee isokinetic test in female soccer players. Aim of this paper is to review the literature to provide updated information on how to interpret a knee isokinetic testing in healthy females.

METHODS

Google Scholar, PubMed, Sport Discus, and Psych info databases were queried, and 17 papers were selected. Following PRISMA methodology and PEDro scale, we classified the retrieved papers and assessed the quality.

RESULTS

In this review some common features of isokinetic testing in female soccer players of various levels of qualification are highlighted. The isokinetic performance indexes widely accepted are the hamstring/quadriceps (H/Q) ratio and dominant/non-dominant (D/ND) ratio. It also emerges that, 3 reps at the speed of 60°/sec in knee flexion/extension are preferable due to the higher reliability and that the optimal H/Q ratio in healthy female soccer players of different level of qualification and age is 50%, while the interlimb differences (D/ND) should be below 10%.

CONCLUSIONS

Normative data and methodologies reviewed can be useful for the isokinetic test of female soccer players. It emerges that simplifying test procedures limiting at few testing speed and considering selected H/Q and D/ND gives all the necessary relevant informations.

Relationships of lower extremity and trunk asymmetries in elite soccer players

In light of previous research highlighting the prevalence of asymmetries in soccer players and possible links to injury risks, there is a crucial gap in the biomechanical understanding of complex relationships between lower extremity and trunk asymmetries in elite soccer players. The purpose of this study was to investigate the level, relationships, and differences among twelve different parameters of strength, morphological, and neuromuscular asymmetries in elite soccer players. Methods: Elite male soccer players (n = 25, age 21.7 ± 3.9 years) were tested in the following tests: bilateral fluid distribution, hip flexor range of motion, postural stability, isokinetic strength of knee extensors and flexors, isometric lateral trunk rotation strength, eccentric strength of knee flexors, isometric bilateral strength of hip adductors, and vertical ground reaction force in counter-movement jump-free arms, counter-movement jump, squat jump, and drop jump tests. One-way ANOVA, Pearson's coefficient (r), and partial eta squared (η p 2) were used for data analysis. Results: Significant differences in asymmetries were found in elite soccer players (F11,299 = 11.01, p < .01). The magnitude of asymmetry over 10% was in postural stability and drop jump parameters. The lowest magnitudes of asymmetries were in the fluid distribution of the lower limbs and the vertical ground reaction force during the take-off phase in squat jumps. The highest asymmetries between the dominant and non-dominant sides were found in postural stability and drop jump. A total of eleven significant correlations (p < 0.05, r = 0.41-0.63, R2 = 0.17-0.40) were detected between the analyzed asymmetries in elite soccer players. The lateral trunk rotation asymmetries were significantly correlated to vertical ground reaction force asymmetries and knee extensors. Conclusion: Long-term exposure in elite soccer leads to unilateral biomechanical loading that induces abnormal strength and morphological adaptations in favor of the dominant side while linking lower limb and trunk strength asymmetries. By unraveling these complex relationships, we strive to contribute novel methods that could inform targeted training regimens and injury prevention strategies in the elite soccer community. The data should encourage future researchers and coaches to monitor and develop trunk strength linked to lower body kinematics.

No Association Between Hamstrings-to-Quadriceps Strength Ratio and Second ACL Injuries After Accounting for Prognostic Factors: A Cohort Study of 574 Patients After ACL-Reconstruction

BACKGROUND

The stress on the anterior cruciate ligament (ACL) induced by the quadriceps can be attenuated by activation of the hamstrings by exerting an opposing torque to the anterior translation of tibia. Consequently, considering the ratio between strength of the hamstrings-to-quadriceps (HQ-ratio) may be of value to reduce the odds of second ACL injuries. The objective was therefore to evaluate (1) the association between HQ-ratio and the occurrence of a second ACL injury in patients after ACL-reconstruction within 2 years of return to preinjury sport level and (2) to compare the HQ-ratio between males and females after ACL reconstruction.

METHODS

Patients who had undergone primary ACL reconstruction and participated in knee-strenuous activity preinjury were included. Demographics, the occurrence of a second ACL injury, and muscle strength test results before returning to preinjury sport level were extracted from a rehabilitation registry. The endpoint was set at a second ACL injury or 2 years after return to preinjury sport level. A multivariable logistic regression was used to analyze the association between the HQ-ratio and a second ACL injury.

RESULTS

A total of 574 patients (50.0% female) with a mean age of 24.0 ± 9.4 years at primary ACL reconstruction were included. In the univariable logistic regression analysis, the odds of sustaining a second ACL injury decreased by 3% for every 1% increase in the HQ-ratio (OR 0.97 [95% CI 0.95-1.00], p = 0.025). After adjusting for the time from reconstruction to return to preinjury sport level, sex, preinjury sport level, graft choice, age, and body mass index, the results were no longer significant (OR 0.98 [95% CI 0.95-1.01], p = 0.16). Females had a higher HQ-ratio compared with males for both the ACL-reconstructed and uninjured side (3.7% [95% CI 5.7; 1.8%], p = 0.0002 and 3.3% [95% CI 4.6; 2.1], p < 0.001, respectively).

CONCLUSION

The HQ-ratio did not significantly affect the odds for sustaining a second ACL injury upon return to preinjury sports level after primary ACL reconstruction. Females had a significant higher HQ-ratio than males for both the ACL reconstructed and uninjured side.

Short-Term Effects of Lower-Extremity Heavy Resistance versus High-Impact Plyometric Training on Neuromuscular Functional Performance of Professional Soccer Players

BACKGROUND

To compare the effects of short-term 8 week heavy-resistance or plyometric training protocols (HRT or PLY) incorporated into regular soccer practice on measures of neuromuscular functional performance in professional soccer players, a single-blind randomized controlled trial was conducted.

METHODS

Forty-seven participants aged 22.3 ± 3.52 years were assigned to three groups: HRT (n = 15), PLY (n = 15), and control (CON; n = 17). The HRT group performed 3 sets and 10 repetitions twice a week using 80% of their baseline 1-RM (weeks 1-3), followed by 8 repetitions at 85% 1-RM (weeks 4-6), and 6 repetitions at 90% 1-RM (weeks 7-8) of 6 lower-body strength exercises with a 1 min rest period between sets. The PLY protocol involved a preparatory phase (weeks 1-2), followed by two 3-week progressive periods (weeks 3-5 and weeks 6-8). The plyometric sessions consisted of four jump exercises/drills with progressively increasing number of sets and total number of foot contacts. The rest intervals between repetitions and sets were 15 and 90 s, respectively. Outcome measures included tests assessing 10 and 30 m speed (t10m and t30m), one-repetition maximum half-back squat (1-RM squat), isokinetic peak torques for the quadriceps and hamstring muscles (Qcon and Hcon), countermovement jump (CMJ), and squat jump (SJ).

RESULTS

Two-way ANOVA detected main effects of time and group×time interactions for all examined variables, except t30m, 1-RM, and relative 1-RM. Post hoc analyses revealed significant increases in the HRT group (t10m: 6.3%, t30m: 7.1%; absolute 1-RM: 29.6%; relative 1-RM: 30.3%, Qcon: 24.5%; Hcon: 14.4%; CMJ: 5.9%; SJ: 7.2%, all p < 0.001) and the PLY group (t10m: 3.1%; t30m: 4.1%; absolute 1-RM:19.1%; relative 1-RM: 20.3%; Qcon: 12.6%; Hcon: 8.7%; CMJ: 3.3%; SJ: 3.5%, all p < 0.001). HRT was superior compared to PLY in relative 1-RM, Qcon and Hcon (all p < 0.001). In addition, we found knee muscular strength imbalance in 70.5% of participants from the total sample (H/Q ratio < 60%). The HRT and PLY protocols resulted in improved neuromuscular functional performance compared to the regular soccer regime.

CONCLUSIONS

This study showed that during the pre-competitive season, additional HRT and PLY drills/exercises as a substitute for standard soccer training as part of a regular 90 min practice twice a week for 8 weeks, can produce acute physical performance-enhancing effects in professional soccer players.