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McClean ZJ, Pasanen K, Lun V, Charest J, Herzog W, Werthner P, Black A, Vleuten RV, Lacoste E, Jordan MJ. A Biopsychosocial Model for Understanding Training Load, Fatigue, and Musculoskeletal Sport Injury in University Athletes: A Scoping Review. J Strength Cond Res 2024; 38:1177-1188. [PMID: 38781473 DOI: 10.1519/jsc.0000000000004789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT McClean, ZJ, Pasanen, K, Lun, V, Charest, J, Herzog, W, Werthner, P, Black, A, Vleuten, RV, Lacoste, E, and Jordan, MJ. A biopsychosocial model for understanding training load, fatigue, and musculoskeletal sport injury in university athletes: A scoping review. J Strength Cond Res 38(6): 1177-1188, 2024-The impact of musculoskeletal (MSK) injury on athlete health and performance has been studied extensively in youth sport and elite sport. Current research examining the relationship between training load, injury, and fatigue in university athletes is sparse. Furthermore, a range of contextual factors that influence the training load-fatigue-injury relationship exist, necessitating an integrative biopsychosocial model to address primary and secondary injury prevention research. The objectives of this review were (a) to review the scientific literature examining the relationship between training load, fatigue, and MSK injury in university athletes and (b) to use this review in conjunction with a transdisciplinary research team to identify biopsychosocial factors that influence MSK injury and develop an updated, holistic biopsychosocial model to inform injury prevention research and practice in university sport. Ten articles were identified for inclusion in this review. Key findings were an absence of injury surveillance methodology and contextual factors that can influence the training load-fatigue-MSK injury relationship. We highlight the inclusion of academic load, social load, and mental health load as key variables contributing to a multifactorial, gendered environmental, scientific inquiry on sport injury and reinjury in university sport. An integrative biopsychosocial model for MSK injury in university sport is presented that can be used to study the biological, psychological, and social factors that modulate injury and reinjury risk in university athletes. Finally, we provide an example of how causal inference can be used to maximize the utility of longitudinally collected observational data that is characteristic of sport performance research in university sport.
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Affiliation(s)
- Zachary J McClean
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kati Pasanen
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Victor Lun
- Sport Medicine Center, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Charest
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- École de Psychologie, Université Laval, Québec, Quebec, Canada; and
- Center for Sleep & Human Performance, Calgary, Alberta, Canada
| | - Walter Herzog
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Penny Werthner
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Reid Vander Vleuten
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Elise Lacoste
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Jordan
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Center, University of Calgary, Calgary, Alberta, Canada
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Bonell Monsonís O, Spörri J, Warsen M, Bolling C, Gouttebarge V, Verhagen E. We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing. Scand J Med Sci Sports 2024; 34:e14533. [PMID: 37955281 DOI: 10.1111/sms.14533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues. MATERIALS AND METHODS We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix. RESULTS Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season. CONCLUSIONS We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.
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Affiliation(s)
- Oriol Bonell Monsonís
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marit Warsen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Bolling
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
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Hatamzadeh M, Sharifnezhad A, Hassannejad R, Zory R. Discriminative sEMG-based features to assess damping ability and interpret activation patterns in lower-limb muscles of ACLR athletes. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Brassart F, Faupin A, Hays A, Bakatchina S, Alberca I, Watelain E, Weissland T. Upper limb cranking asymmetry during a Wingate anaerobic test in wheelchair basketball players. Scand J Med Sci Sports 2023. [PMID: 37186476 DOI: 10.1111/sms.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Interlimb asymmetry of strength and/or motor coordination could limit the performance of wheelchair athletes or increase their risk of injury. Studies of interlimb asymmetry in the lower limbs have shown high between-subject variability that does not depend on the side of dominance and that does not change with fatigue. Upper limb asymmetry is particularly large in manual wheelchair athletes with a lower degree of impairment. The aim of this study was to evaluate interlimb asymmetry of forces developed during an upper limb Wingate anaerobic test, the effects of fatigue on force, and differences between high- and low-point players. METHOD Twenty-five wheelchair basketball players (13 females and 12 males) of male and female national French teams performed a 30s anaerobic Wingate test on an arm ergometer. Participants were classified into two functional categories, high-point (classed from 3 to 4.5) and low-point (classed from 1 to 2.5), according to the International Wheelchair Basketball Federation classification. Left and right arm forces were measured during the pushing and pulling phases at peak power, 10s, and the end of the 30s test. RESULTS Upper limb asymmetry changed with fatigue during each phase. Force asymmetry differed between peak power, 10s and 30s, with no consistent increase or decrease. Asymmetry did not differ significantly between low- and high-point players but tended to be greater in high-point players. Asymmetry tended to be greater in the females, with significant differences between the males and females in the push phase. CONCLUSION Inter-subject variability was high, but forces were asymmetric for most participants, especially females. The Wingate anaerobic test could highlight problematic asymmetries that might impact daily life or sports performance.
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Affiliation(s)
- Florian Brassart
- Université de Toulon, La Garde, France
- Laboratoire IMS, Pessac, France
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Georgoulis JD, Melissaridou D, Patras K, Megaloikonomos PD, Trikoupis I, Savvidou OD, Papagelopoulos PJ. Neuromuscular activity of the lower-extremities during running, landing and changing-of-direction movements in individuals with anterior cruciate ligament reconstruction: a review of electromyographic studies. J Exp Orthop 2023; 10:43. [PMID: 37058177 PMCID: PMC10105000 DOI: 10.1186/s40634-023-00603-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Running, jumping/landing and cutting/change of direction (CoD) are critical components of return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR), however the electromyographic (EMG) activity patterns of the operated leg during the execution of these tasks are not clear. METHODS A systematic review was conducted to retrieve EMG studies during running, jumping/landing and cutting/(CoD) in ACLR patients. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to May, 2022 using a combination of keywords and their variations: "anterior cruciate ligament reconstruction" OR "ACLR", "electromyography" OR "EMG", "running", "jumping" OR "landing", "cutting" OR "change-of-direction" OR "CoD". The search identified studies comparing EMG data during running, landing and cutting/(CoD) between the involved limb and contralateral or control limbs. Risk of bias was assessed and quantitative analyses using effect sizes were performed. RESULTS Thirty two studies met the inclusion criteria. Seventy five percent (24/32) of the studies reported altered EMG activity pattern of the ACLR leg during running, jumping/landing and cutting/(CoD) when compared with either the healthy control leg or the contra-lateral leg. Twelve studies showed decreased, delayed or earlier onset and delayed peak in quadriceps EMG activity with small to large effect sizes and 9 studies showed increased, delayed or earlier onset and delayed peak in hamstrings EMG activity with small to large effect sizes. Four studies showed a "hamstrings-dominant" strategy i.e. decreased quadriceps coupled with increased hamstrings EMG activity in both running and jumping/landing irrespective of graft type. One study reported that on the grounds of decreased quadriceps activity, lower hamstrings EMG activity was predictive of ipsilateral re-injury in ACLR patients. CONCLUSION This systematic review of Level III evidence showed that the ACLR leg displays decreased quadriceps or increased hamstrings EMG activity or both despite RTS. Simultaneous decreased quadriceps and increased hamstrings EMG activity was shown for both running and jumping/landing. From a clinical perspective this "hamstrings dominant" strategy can serve as a protective mechanism against graft re-injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jim D Georgoulis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece.
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Patras
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Trikoupis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
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The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries. J Clin Med 2023; 12:jcm12031144. [PMID: 36769792 PMCID: PMC9917777 DOI: 10.3390/jcm12031144] [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: 01/09/2023] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.
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Kositsky A, Barrett RS, du Moulin W, Diamond LE, Saxby DJ. Semitendinosus muscle morphology in relation to surface electrode placement in anterior cruciate ligament reconstructed and contralateral legs. Front Sports Act Living 2022; 4:959966. [PMID: 36425302 PMCID: PMC9680646 DOI: 10.3389/fspor.2022.959966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/03/2022] [Indexed: 09/08/2024] Open
Abstract
The semitendinosus tendon is commonly harvested as graft tissue for anterior cruciate ligament reconstruction (ACLR). Although the semitendinosus tendon can regenerate following harvesting, ACLR results in substantial reductions in semitendinosus muscle size and length, potentially complicating electrode placement for electromyography. The purpose of this study was to assess whether the most commonly used electrode placement [recommended by the "Surface Electromyography for Non-Invasive Assessment of Muscles" (SENIAM) project] is appropriate for measuring semitendinosus electromyograms after ACLR. In nine participants (unilateral ACLR with a semitendinosus graft), B-mode ultrasonography was used to bilaterally determine (i) the semitendinosus muscle-tendon junction position and the state of tendon regeneration (latter for the ACLR leg only) and (ii) the anatomical cross-sectional area (ACSA) of the semitendinosus muscle at the SENIAM-recommended electrode placement site at rest and during isometric maximal voluntary contraction (MVC) at two knee joint angles. Depending on the contraction state and joint angle, the semitendinosus muscle had retracted past the recommended placement site in 33-78% of ACLR legs, but not in any contralateral legs. The ACSA of semitendinosus was smaller both at rest and MVC in the ACLR compared to contralateral leg. The ACSA for both legs decreased at MVC compared to rest and at deep compared to shallow knee flexion angles, likely due to sliding of the muscle under the skin. These results suggest SENIAM guidelines are likely unsuitable for recording surface electromyograms from the semitendinosus muscle after tendon harvesting for ACLR as the muscle of interest may not be within the electrode detection volume.
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Affiliation(s)
- Adam Kositsky
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S. Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - William du Moulin
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Laura E. Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Jordan MJ, Morris N, Nimphius S, Aagaard P, Herzog W. Attenuated Lower Limb Stretch-Shorten-Cycle Capacity in ACL Injured vs. Non-Injured Female Alpine Ski Racers: Not Just a Matter of Between-Limb Asymmetry. Front Sports Act Living 2022; 4:853701. [PMID: 35434617 PMCID: PMC9008592 DOI: 10.3389/fspor.2022.853701] [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: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
A retrospective analysis of routine countermovement jump (CMJ) testing, a coupled eccentric-concentric (stretch-shorten-cycle: SSC) movement, was performed in female elite alpine skiers with anterior cruciate ligament (ACL) reconstruction (ACLR) and without ACLR. A total of 567 tests obtained from the daily training environment were analyzed in 41 elite female athletes (non-injured control: n = 30, ACLR: n = 17), including n = 6 athletes with pre-injury data, between 16 and 32 years of age from alpine ski racing (n = 32) and skier cross (n = 9). Bilateral CMJ testing was conducted on a dual force plate system, and the limb-specific vertical ground reaction force (Fz) was analyzed to obtain the net eccentric deceleration impulse (Ecc), lower limb stiffness (Stiff), maximal vertical jump height (JH), peak external mechanical power (PP) exerted on the body center of mass (BCM), modified-reactive-strength-index (RSImod), and the loss in BCM velocity during the final phase of the takeoff Δ(Vmax-Vtakeoff). Eccentric and concentric phase-specific between-limb asymmetry indexes (AIs) were also calculated. Additive mixed effects models (AMMs) were used to compare the age-dependent and post-injury time course change between groups. The mean values for non-injured controls >25 years of age were used as a comparative benchmark for recovery given the absence of pre-injury data. Net eccentric deceleration impulse increased and Δ(Vmax-Vtakeoff) decreased with age for the non-injured control group (p < 0.001) while between-limb AI (mean ± SD) fell between 1 ± 5% for the concentric phase and 3 ± 7% for the eccentric deceleration phase. Between-limb asymmetry became smaller in ACLR skiers with time-from-surgery to reach non-injured control values by 2 years, but SSC function, such as JH and PP, remained depressed up to 5 years post-surgery (p < 0.01), indicating impairments in SSC function. This highlights the importance of evaluating SSC performance capacity alongside vertical jump force-time asymmetries in female ACLR alpine skiers.
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Affiliation(s)
- Matthew J. Jordan
- Canadian Sport Institute Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada
- School of Medical and Health Science, Centre for Human Performance, Edith Cowan University, Joondalup, WA, Australia
| | | | - Sophia Nimphius
- School of Medical and Health Science, Centre for Human Performance, Edith Cowan University, Joondalup, WA, Australia
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Walter Herzog
- Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada
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Blasimann A, Koenig I, Baert I, Baur H, Vissers D. Which assessments are used to analyze neuromuscular control by electromyography after an anterior cruciate ligament injury to determine readiness to return to sports? A systematic review. BMC Sports Sci Med Rehabil 2021; 13:142. [PMID: 34749813 PMCID: PMC8577028 DOI: 10.1186/s13102-021-00370-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. METHODS This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. RESULTS From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. CONCLUSIONS Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.
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Affiliation(s)
- Angela Blasimann
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. .,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Irene Koenig
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Heiner Baur
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Ogrin J, Šarabon N, Madsen MK, Kersting U, Holmberg HC, Supej M. Asymmetries in Ground Reaction Forces During Turns by Elite Slalom Alpine Skiers Are Not Related to Asymmetries in Muscular Strength. Front Physiol 2021; 12:577698. [PMID: 33859567 PMCID: PMC8042208 DOI: 10.3389/fphys.2021.577698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
The ground reaction forces (GRF) associated with competitive alpine skiing, which are relatively large, might be asymmetric during left and right turns due to asymmetries in the strength of the legs and torso and the present investigation was designed to evaluate this possibility. While skiing a symmetrical, 20-gate slalom course, the asymmetries of 9 elite alpine skiers were calculated on the basis of measurements provided by inertial motion units (IMU), a Global Navigation Satellite System and pressure insoles. In addition, specialized dynamometers were utilized to assess potential asymmetry in the strength of their legs and torso in the laboratory. In total, seven variables related to GRF were assessed on-snow and eight related to strength of the legs and torso in the laboratory. The asymmetries in these parameters between left and right turns on snow were expressed in terms of the symmetry (SI) and Jaccard indices (JI), while the asymmetries between the left and right sides of the body in the case of the laboratory measurements were expressed as the SIs. The three hypotheses to be tested were examined using multivariable regression models. Our findings resulted in rejection of all three hypotheses: The asymmetries in total GRF (H1), as well as in the GRF acting on the inside and outside legs (H2) and on the rear- and forefeet GRF (H3) during left and right turns were not associated with asymmetries in parameters related to muscular strength. Nevertheless, this group of elite slalom skiers exhibited significant asymmetry between their right and left legs with respect to MVC during ankle flexion (0.53 ± 0.06 versus 0.60 ± 0.07 Nm/kg, respectively) and hip extension (2.68 ± 0.39 versus 2.17 ± 0.26 Nm/kg), as well as with respect to the GRFs on the inside leg while skiing (66.8 ± 7.39 versus 76.0 ± 10.0 %BW). As indicated by the JI values, there were also large asymmetries related to GRF as measured by pressure insoles (range: 42.7–56.0%). In conclusion, inter-limb asymmetries in GRFs during elite alpine skiing are not related to corresponding asymmetries in muscular strength. Although our elite athletes exhibited relatively small inter-limb asymmetries in strength, their asymmetries in GRF on-snow were relatively large.
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Affiliation(s)
- Jan Ogrin
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behavior, Ljubljana, Slovenia
| | - Mads Kjær Madsen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Uwe Kersting
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark.,Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Hans-Christer Holmberg
- Department of Physiology and Pharmacology, Biomedicum C5, Karolinska Institute, Stockholm, Sweden.,China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Matej Supej
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
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Does lower-limb asymmetry increase injury risk in sport? A systematic review. Phys Ther Sport 2021; 49:204-213. [PMID: 33770741 DOI: 10.1016/j.ptsp.2021.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this review was to synthesize the current understanding relating to the risks of lower body functional asymmetry with injury in athletic populations. METHODS An iterative data mining and sampling approach was used to construct a search phrase from key words, which were used to identify studies within SPORTdiscus, Medline and Academic Search Complete databases. Additional references were sourced from the reference lists of these articles. RESULTS After screening, 31 papers were reviewed, from an initial search identifying 302 possible studies. A total of 6228 participants were involved in the studies, of which soccer players were the most observed sporting demographic (n = 2171). Of the 31 studies reviewed eight found no statistical association between lower limb asymmetry and injury risk, 10 studies provided partial statistically significant evidence and a further 10 provided statistically significant statistical links. CONCLUSION Overall moderate to lower quality evidence for functional asymmetry as a risk factor for injury in sport was observed. While the possibility of a relationship between lower limb functional asymmetry and injury risk cannot be ruled out, further higher quality investigations, adopting standardised methodologies, is required.
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12
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Sherman DA, Glaviano NR, Norte GE. Hamstrings Neuromuscular Function After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2021; 51:1751-1769. [PMID: 33609272 DOI: 10.1007/s40279-021-01433-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hamstrings neuromuscular function is a crucial component of functional movement, and changes after anterior cruciate ligament (ACL) injury contribute to risk factors for secondary injury and long-term sequelae. To effectively treat muscular impairments, an accurate understanding of hamstrings neuromuscular function in patients with ACL reconstruction (ACLR) is needed. OBJECTIVE A systematic review and meta-analysis were undertaken to describe and quantify hamstrings neuromuscular function in individuals with ACLR compared to controls. METHODS We searched PubMed, Web of Science, SPORTDiscus, CINAHL, and EBSCOhost databases in October of 2020 for studies evaluating the difference between hamstrings electromyography (EMG) between individuals with ACLR and controls. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow random-effect size (ES) meta-analysis calculations for comparison of results. RESULTS Thirty-four studies were included for final review. From these, 5 categories of neuromuscular outcomes were identified, and studies were grouped accordingly: (1) muscle activation levels (EMG amplitude), (2) co-activation, (3) onset timing, (4) electromechanical delay, and (5) time-to-peak activity. Moderate to strong evidence indicates that individuals with ACLR demonstrate higher hamstrings EMG amplitude (normalized to % maximum voluntary isometric contraction) and hamstrings-to-quadriceps co-activation during gait and stair ambulation compared to controls. In addition, there was moderate evidence of longer electromechanical delay during knee flexion and greater hamstrings-to-quadriceps co-activation during knee extension compared to controls. CONCLUSIONS Greater hamstrings EMG amplitude and co-activation during gait and ambulation tasks and longer electromechanical delay of the hamstrings in individuals with ACLR align with clinical impairments following ACLR and have implications for re-injury risk and long-term joint health, thus warranting attention in rehabilitation.
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Affiliation(s)
- David A Sherman
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, 2801 W. Bancroft St., HH 2505E, Mail Stop 119, Toledo, OH, 43606, USA.
| | - Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT, USA
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, 2801 W. Bancroft St., HH 2505E, Mail Stop 119, Toledo, OH, 43606, USA
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13
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Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis. Phys Ther Sport 2021; 47:91-104. [DOI: 10.1016/j.ptsp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022]
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14
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Jordan MJ, Morris N, Lane M, Barnert J, MacGregor K, Heard M, Robinson S, Herzog W. Monitoring the Return to Sport Transition After ACL Injury: An Alpine Ski Racing Case Study. Front Sports Act Living 2020; 2:12. [PMID: 33345007 PMCID: PMC7739580 DOI: 10.3389/fspor.2020.00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/28/2020] [Indexed: 11/29/2022] Open
Abstract
Alpine ski racing is an extreme sport and ski racers are at high risk for ACL injury. ACL injury impairs neuromuscular function and psychological readiness putting alpine skiers with ACL injury at high risk for ACL reinjury. Consequently, return to sport training and testing protocols are recommended to safeguard ACL injured athletes against reinjury. The aim of this paper was to present a real-world example of a return to sport training plan for a female elite alpine ski racer who sustained an ACL injury that was supported by an interdisciplinary performance team (IPT) alongside neuromuscular testing and athlete monitoring. A multi-faceted return to sport training plan was developed by the IPT shortly after the injury event that accounted for the logistics, healing, psychological readiness, functional milestones, work capacity and progression to support the return to sport/return to performance transition. Neuromuscular testing was conducted at several timepoints post-injury. Importantly, numerous pre-injury tests provided a baseline for comparison throughout the recovery process. Movement competencies and neuromuscular function were assessed, including an evaluation of muscle properties (e.g., the force-velocity and force-length relationships) to assist the IPT in pinpointing trainable deficits and managing the complexities of the return to sport transition. While the athlete returned to snow 7 months post-injury, presenting with interlimb asymmetries below 10%, functional and strength deficits persisted up to 18 months post-injury. More research is required to establish a valid return to sport protocol for alpine ski racers with ACL injury to safeguard against the high risk for ACL reinjury.
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Affiliation(s)
- Matthew J Jordan
- Canadian Sport Institute Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada
| | - Nathaniel Morris
- Canadian Sport Institute Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada
| | - Mike Lane
- Canadian Sport Institute Calgary, Calgary, AB, Canada
| | | | | | - Mark Heard
- Banff Sports Medicine Centre, Banff, AB, Canada
| | | | - Walter Herzog
- Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada
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15
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Altered Neuromuscular Activity of the Lower-Extremities During Landing Tasks in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review of Electromyographic Studies. J Sport Rehabil 2020; 29:1194-1203. [PMID: 32357316 DOI: 10.1123/jsr.2019-0393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/27/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered lower-limb biomechanics have been observed during landing task in patients with anterior cruciate ligament reconstruction (ACLR), which increases the risk of secondary anterior cruciate ligament injury. However, the alteration in neuromuscular activity of the lower-extremity during landing task is not clear. OBJECTIVE To compare the muscle activity pattern assessed by electromyography between the involved limb of patients with ACLR and the contralateral limb or control limb of matched healthy subjects during landing task. EVIDENCE ACQUISITION Database of PubMed, Ovid, Scopus, and Web of Science from the inception of the databases until July 2019, using a combination of keywords and their variations: (anterior cruciate ligament OR ACL) AND (electromyography OR EMG) AND (landing OR land). Studies that assessed lower-extremity muscle activity patterns during landing task in patients with ACLR and compared them either with the contralateral side or healthy controls were included. EVIDENCE SYNTHESIS Of the 21 studies, 16 studies reported altered muscle activity pattern during landing tasks when compared with either the healthy controls or the contralateral side. For the specific muscle activity patterns, the majority of the studies showed no significant difference in reactive muscle activity, and comparisons across studies revealed a possible trend toward the early onset of quadriceps and hamstring activity and increased cocontraction of the involved limb. There are inconsistent findings regarding the alteration in muscle timing and preparatory muscle activity. CONCLUSIONS Patients with ACLR displayed an altered muscle activity pattern during landing tasks, even though they were considered to be capable for sport return. Nevertheless, a firm conclusion could not be drawn due to great heterogeneity in the subject selection and study methods.
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16
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Heil J, Loffing F, Büsch D. The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review. SPORTS MEDICINE - OPEN 2020; 6:39. [PMID: 32844254 PMCID: PMC7447715 DOI: 10.1186/s40798-020-00270-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/12/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries. OBJECTIVE The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review. METHODS A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol. RESULTS Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters. CONCLUSIONS Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.
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Affiliation(s)
- Jessica Heil
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.
| | - Florian Loffing
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Dirk Büsch
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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17
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Schumacher AN, Houck DA, Vidal AF, Wolcott ML, McCarty EC, Bravman JT, Frank RM. Do Older Skiers Have Worse Outcomes After Anterior Cruciate Ligament Reconstruction Compared With Non-Skiers or Younger Skiers? Orthop J Sports Med 2020; 8:2325967120923868. [PMID: 32596405 PMCID: PMC7298430 DOI: 10.1177/2325967120923868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: There remains a paucity of literature comparing clinical outcomes after
anterior cruciate ligament reconstruction (ACLR) between skiers and
non-skiers, particularly in older patient populations. Purpose: To compare clinical outcomes after ACLR between skiers and non-skiers, with a
subanalysis based on age. Study Design: Cohort study; Level of evidence, 3. Methods: A nested cohort of 128 patients from the Multicenter Orthopaedic Outcomes
Network cohort who underwent primary ACLR completed a series of
patient-reported outcomes pre- and postoperatively at 2 and 6 years
including the Knee injury and Osteoarthritis Outcome Score (KOOS), Marx
Activity Rating Scale, and subjective International Knee Documentation
Committee (IKDC) score. Data including patient sex, age at surgery, graft
type, and sport participation were analyzed. Patients were stratified by
participation in skiing (skiers vs non-skiers) and by age subgroup (≤29,
30-39, and ≥40 years). Student t tests and analysis of
variance were used to compare mean improvement between pre- and
postoperative outcomes. Results: A total of 44 skiers (female, 59.1%; age, 35.3 ± 11.6 years) and 84
non-skiers (female, 34.5%; age, 27.7 ± 11.3 years) were included. ACLR was
performed using allograft in 36.7% (22 skiers, 25 non-skiers), autograft in
58.6% (19 skiers, 56 non-skiers), or hybrid autograft-allograft in 4.7% (3
skiers, 3 non-skiers). Although both non-skiers and skiers demonstrated
improvements in outcomes from baseline to 2 and 6 years, non-skiers
demonstrated significantly less overall improvement from 2 to 6 years
postoperatively in KOOS Symptoms (P = .01), KOOS Pain
(P = .002), and KOOS Activities of Daily Living
(P = .03) subscales compared with skiers. There were 15
skiers who were 29 years or younger (34.1%), 14 skiers between 30 and 39
years (31.8%), and 15 skiers 40 years or older (34.1%). Skiers 40 years and
older demonstrated significantly greater mean improvement in KOOS Symptoms
(P = .02) and KOOS Quality of Life (QoL)
(P = .01) subscales at 2 years and KOOS QoL
(P = .01) at 6 years postoperatively compared with
skiers 29 years or younger. Conclusion: Compared with non-skiers, skiers demonstrated significantly greater mean
improvements in KOOS scores between 2 and 6 years after ACLR. In addition,
skiers 40 years or older showed greater improvement in KOOS QoL compared
with younger skiers. This information can be used to counsel skiers,
especially those older than 40 years, as to their expected outcomes after
ACLR.
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Affiliation(s)
- Alexandra N Schumacher
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | | | - Michelle L Wolcott
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, Aurora, Colorado, USA
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18
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Grazioli R, Lopez P, Andersen LL, Machado CLF, Pinto MD, Cadore EL, Pinto RS. Hamstring rate of torque development is more affected than maximal voluntary contraction after a professional soccer match. Eur J Sport Sci 2019; 19:1336-1341. [PMID: 31099729 DOI: 10.1080/17461391.2019.1620863] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Match-induced fatigue of knee muscle strength and agonist-antagonist strength-ratios may affect both performance and risk of injury in soccer players. Once explosive tasks are imperative in soccer as well as hamstring strain injuries occur during high-velocity moments, rapid force capacity of this muscle group is especially important. This study evaluated the effect of match-induced fatigue on knee muscle strength and strength-ratio parameters after a single professional soccer match. Male professional soccer players (n = 16; 24.2 ± 3.9 years) were tested before and after a soccer match (56.2 ± 22.6 min of playing) for knee flexors (hamstring) and extensors (quadriceps) isometric peak torque (MVC) and rate of torque development (RTD) - as well as the hamstring-to-quadriceps ratio (H:Q) - at 30° of knee flexion. Knee injuries often occur at this joint angle, which is common in sprinting, pivoting, sidecutting, and jumping. Match-induced fatigue caused a left shift in the knee extensors torque-time curve with no significant change in both early (i.e. 0-50 ms) and late (i.e. 0-200 ms) RTD, and a right shift in the knee flexors torque-time curve with a decrease in early RTD (∼16%, p = .029) and late RTD (∼11%, p = .011). Knee extensors and knee flexors peak torque remained unchanged (p > .05). Early RTD H:Q decreased by∼24% (p = .027), while late RTD H:Q and MVC H:Q remained unchanged (p > .05). In conclusion, match-induced fatigue impaired the ability to rapidly produce force at an angle where injuries are most susceptible to occur. Important information is missed if only the traditional H:Q is considered.
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Affiliation(s)
- Rafael Grazioli
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
| | - Pedro Lopez
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
| | - Lars L Andersen
- National Research Center for the Working Environment , Copenhagen , Denmark.,Physical Activity and Human Performance, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University , Aalborg , Denmark
| | - Carlos Leonardo Figueiredo Machado
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
| | - Matheus Daros Pinto
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University , Joondalup , Australia
| | - Eduardo Lusa Cadore
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
| | - Ronei Silveira Pinto
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
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19
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Jordan MJ, Aagaard P, Herzog W. A comparison of lower limb stiffness and mechanical muscle function in ACL-reconstructed, elite, and adolescent alpine ski racers/ski cross athletes. JOURNAL OF SPORT AND HEALTH SCIENCE 2018; 7:416-424. [PMID: 30450249 PMCID: PMC6226549 DOI: 10.1016/j.jshs.2018.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of this study was to compare mechanical muscle function in the eccentric/concentric phases of vertical bilateral jumping in anterior cruciate ligament-reconstructed (ACLR), elite (ELITE), and adolescent (ADOL) alpine ski racers and ski cross athletes. METHODS Alpine ski racers/ski crossers (ACLR: n = 12, age = 26.7 ± 3.8 years; ELITE: n = 12, age = 23.9 ± 3.0 years; ADOL: n = 12, age = 17.8 ± 0.7 years; females: n = 6 per group, males: n = 6 per group) performed 5 maximal countermovement jumps (CMJs) and 5 squat jumps. The ground reaction forces for each limb were analyzed using dual force plate recording to obtain body center of mass (BCM) velocity, displacement, and power. The eccentric deceleration (ECC) and concentric phases were determined from BCM velocity. CMJ net concentric and ECC impulses were calculated (body mass normalized) along with the peak and mean BCM power and maximal vertical jump height. CMJ lower limb stiffness (LLS) was determined by the slope of the ground reaction forces vs. the BCM displacement curve over the ECC phase. Concentric and ECC asymmetry indices were calculated for each leg, and the left vs. right LLS was compared. Outcome measures (reported as mean ± SD) calculated as a 5-jump mean were normalized to body mass and compared using an analysis of variance. RESULTS No between-group differences were found for peak and mean power or jump heights. There were no group differences for LLS or net concentric phase impulse, but the net ECC impulse was lower in the ADOL group compared with ELITE skiers (ADOL: 1.33 ± 0.32 Ns/kg; ELITE: 1.59 ± 0.16 Ns/kg; p < 0.05). Although no group differences were found for ECC asymmetry indices, a group × limb interaction was found for LLS (p < 0.01), which was systematically higher in the right vs. the left limb of ADOL skiers (right: 54.1 ± 17.9 N/m/kg; left: 48.7 ± 15.7 N/m/kg; p < 0.01). CONCLUSION ADOL skiers demonstrated decreased ECC impulse and systematic right limb dominance in LLS compared with ACLR and ELITE skiers. The implication of these findings for injury and performance are unknown, but further investigation into these potential relationships is warranted.
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Affiliation(s)
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster, University of Southern Denmark, Odense M5230, Denmark
| | - Walter Herzog
- Human Performance Laboratory, University of Calgary, Calgary AB T2N 1N4, Canada
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20
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Jordan MJ, Doyle-Baker P, Heard M, Aagaard P, Herzog W. A Retrospective Analysis of Concurrent Pathology in ACL-Reconstructed Knees of Elite Alpine Ski Racers. Orthop J Sports Med 2017; 5:2325967117714756. [PMID: 28812037 PMCID: PMC5528939 DOI: 10.1177/2325967117714756] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) tear is the most frequent injury in alpine ski racing, and there is a high prevalence of ACL reinjury. Limited data exist on the concurrent pathology with primary ACL tears in elite alpine ski racers and the magnitude of injury progression after primary ACL reconstruction (ACLR). Purpose: To evaluate (1) the involvement of intra-articular and multiligament pathologies at the time of primary ACLR, (2) the subsequent progression in meniscal/chondral injuries, and (3) the occurrence of ACL reinjury in elite alpine ski racers. Study Design: Case series; Level of evidence, 4. Methods: Primary ACLR operative reports (n = 28) were obtained for 32 elite alpine ski racers along with the reports of 20 operative procedures that occurred subsequent to primary ACLR. Operative reports were evaluated to identify the presence/location of multiligament injury, meniscal tears, and chondral lesions. Results: At the time of primary ACLR, a majority of knees (82%; 23/28) demonstrated concurrent injury compared with isolated ACL tears; 32% of knees sustained multiligament injuries (9/28), and 8 involved the ipsilateral medial collateral ligament (MCL). Of the ACL-injured knees, 54% had chondral lesions, of which 73% were sustained in the lateral knee compartment, and 82% of meniscal tears (14/17) were complex in nature. Bilateral ACL tears were seen in 22% of the participants, and 28% underwent ACL revision. In the case of ACL revision or future meniscal/chondral surgery, 60% of meniscal tears and 80% of chondral lesions had worsened since the time of primary ACLR. Conclusion: Concurrent injury was common in this group of elite ski racers. Primary ACL tears were typically accompanied by lateral compartment chondral lesions and complex meniscal tears that worsened over time. ACL/MCL tears were the most common multiligament injury pattern.
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Affiliation(s)
- Matthew J Jordan
- Human Performance Laboratory, The University of Calgary, Calgary, Alberta, Canada.,Canadian Sport Institute Calgary, Calgary, Alberta, Canada
| | - Patricia Doyle-Baker
- Human Performance Laboratory, The University of Calgary, Calgary, Alberta, Canada
| | - Mark Heard
- Banff Sports Medicine Group, Banff, Alberta, Canada
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense M, Denmark
| | - Walter Herzog
- Human Performance Laboratory, The University of Calgary, Calgary, Alberta, Canada
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21
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Jordan MJ, Aagaard P, Herzog W. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review. Open Access J Sports Med 2017; 8:71-83. [PMID: 28435336 PMCID: PMC5386612 DOI: 10.2147/oajsm.s106699] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ski racing; and 2) provide an overview of what is known pertaining to ACL reinjury and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries, and ACL tears were the most frequent diagnosis. Three primary ACL injury mechanism were identified that involved tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment. While trunk muscle strength imbalance and genetics were found to be predictive of ACL injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness). While skiers seem to make a successful recovery following ACL injury, there may be persistent neuromuscular deficits. Future research efforts should be directed toward prospective studies on ACL injury/reinjury prevention in both male and female skiers and toward the effects of knee injury on long-term health outcomes, such as the early development of osteoarthritis. International collaborations may be necessary to generate sufficient statistical power for ACL injury/reinjury prevention research in alpine ski racing.
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Affiliation(s)
- Matthew J Jordan
- Human Performance Laboratory, The University of Calgary, Calgary, AB, Canada
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense M, Denmark
| | - Walter Herzog
- Human Performance Laboratory, The University of Calgary, Calgary, AB, Canada
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