Side-to-side differences in the lower leg muscle-bone unit in male soccer players

A cross-sectional study on foot loading patterns in elite soccer players of different ages

BACKGROUND

Alterations in plantar loading patterns are risk factors for stress injuries of the lower limb, particularly of the foot and ankle. Epidemiological studies have revealed a higher incidence of soccer-related stress fractures of the fifth metatarsal (MT V) in younger athletes than in their adult counterparts.

OBJECTIVE

The aim of the present study was to assess the plantar pressure distributions of members of four high-level soccer teams of different age groups to identify age-related differences in loading patterns.

METHODS

A total of 65 elite soccer players were included in the study. Data were computed with sensor-loaded insoles (pedar® X system, novel Inc., Munich, Germany) while the players ran in soccer shoes. Plantar pressures for nine defined regions on the preferred and nonpreferred foot were analyzed.

RESULTS

The participants consisted of 17 elite male soccer professionals from the first national league (mean 23 years, height 184 cm, weight 81 kg), 14 players from the under-21 squad (U21, 20 years, 180 cm, 75 kg), 15 players from the U17 squad (16 years, 176 cm, 69 kg) and 19 players from the U16 squad (15 years, 179 cm, 70 kg). We detected statistically significantly elevated peak pressures on the lateral aspects of the nonpreferred foot compared with the preferred foot in the U16 and U17 players, corresponding to a relative increase by 29% (p= 0.044) in the lateral midfoot, a relative increase by 24% (p= 0.031) in MT heads 4-5 in the U16 players and a difference of 18% (p= 0.049) in the lateral midfoot in the U17 players. In contrast, the U21 and adult professional players displayed symmetric plantar pressure distributions in all foot regions.

CONCLUSIONS

In contrast to adult elite soccer players, adolescents demonstrate asymmetric foot loading patterns with increased peak loads in the lateral aspects of the nonpreferred foot. Our results may provide some explanation for MT V stress fractures that occur in elite adolescents.

Long-Term Patterns of Bone Mineral Density in an Elite Soccer Player

Changes in bone mineral density (BMD) have been associated with association football (soccer) participation. Seasonal changes in BMD of soccer players have been proposed as well. However, previous investigations were based on short-term observations. Actually, longitudinal investigation of BMD in soccer players is lacking, possibly because of frequent inter-club transfer, changes in club policy or continued availability of the relevant facilities. Dual-energy X-ray Absorptiometry (DXA)-measured areal BMD (aBMD) was obtained during the competitive season in an elite soccer player along 10 consecutive years. Findings showed that (1) aBMD tends to increase with age, independently of body mass; (2) The right (preferred, kicking) leg has higher aBMD than the left (non-preferred, support) one; (3) Meaningful (i.e., >least significant change, LSC) changes in aBMD take place along the season; and (4) The off-season (transition) period has no effect on aBMD. Findings prompt for future research aimed at clarifying the long-term and seasonal patterns of bone characteristics in soccer in relation with age and type/dose of training. Season-around, long-term scrutiny of bone status in soccer players would help controlling for possible changes/asymmetries in bone mineralization/strength.

Baseball and Softball Pitchers are Distinct Within-Subject Controlled Models for Exploring Proximal Femur Adaptation to Physical Activity

Within-subject controlled models in individuals who preferentially load one side of the body enable efficient exploration of the skeletal benefits of physical activity. There is no established model of physical activity-induced side-to-side differences (i.e., asymmetry) at the proximal femur. Proximal femur asymmetry was assessed via dual-energy X-ray absorptiometry in male jumping athletes (JMP, n = 16), male baseball pitchers (BB, n = 21), female fast-pitch softball pitchers (SB, n = 22), and controls (CON, n = 42). The jumping leg was the dominant leg in JMP, whereas in BB, SB and CON the dominant leg was contralateral to the dominant/throwing arm. BB and SB had 5.5% (95% CI 3.9-7.0%) and 6.5% (95% CI 4.8-8.2%) dominant-to-nondominant leg differences for total hip areal bone mineral density (aBMD), with the asymmetry being greater than both CON and JMP (p < 0.05). BB and SB also possessed dominant-to-nondominant leg differences in femoral neck and trochanteric aBMD (p < 0.001). SB had 9.7% (95% CI 6.4-13.0%) dominant-to-nondominant leg differences in femoral neck bone mineral content, which was larger than any other group (p ≤ 0.006). At the narrow neck, SB had large (> 8%) dominant-to-nondominant leg differences in cross-sectional area, cross-sectional moment of inertia and section modulus, which were larger than any other group (p ≤ 0.02). Male baseball and female softball pitchers are distinct within-subject controlled models for exploring adaptation of the proximal femur to physical activity. They exhibit adaptation in their dominant/landing leg (i.e., leg contralateral to the throwing arm), but the pattern differs with softball pitchers exhibiting greater femoral neck adaptation.

Plantar pressures in male adolescent soccer players and its associations with bone geometry and strength

BACKGROUND

Mechanical loads exerted by soccer-specific actions increase bone remodeling activity. Nevertheless, little is known about the relationship between plantar pressure and bone structure. Therefore, the aim of this study was to compare bone geometry and strength between soccer players who exhibited different maximum values of the average pressures (MP) when performing a combination of soccer-specific tasks.

METHODS

Forty male adolescent soccer players (mean age 13.2±0.5 years) and 13 controls (mean age 13.1±0.9 years) participated in this study. Biofoot® system was used to measure MP at the non-dominant foot during a circuit of soccer-specific tasks. Cluster analysis was performed to classify players into groups of similar MP profiles resulting two different groups as follows: 15 players with high MP (SOC-HP; mean MP: 392.7±68.2 kPa) and 25 with low MP (SOC-LP; mean MP: 261.0±49.6 kPa). Total and cortical volumetric bone mineral content (Tt.BMC/Ct.BMC), cross-sectional area (Tt.Ar/Ct.Ar), cortical thickness (Ct.Th), fracture load in X-axis, and polar strength index (SSIp) were measured at 38% of the non-dominant tibia by peripheral quantitative computed tomography. Bone geometry and strength comparisons between SOC-HP and SOC-LP were performed using analyses of covariance controlling by weight and tibia length.

RESULTS

Greater Tt.BMC, Ct.BMC and Tt.Ar. were found in SOC-HP compared to CG (Tt.BMC: 3.22vs2.95 g, Ct.BMC: 2.95vs2.68 g, Ct.Ar: 280vs253 mm2; P<0.05). Nevertheless, no significant bone geometry and strength differences were found between soccer groups and between SOC-LP and CG (P>0.05).

CONCLUSIONS

Developing high MP when training and playing soccer might be favorable to bone development.

Functional Basis of Asymmetrical Lower-Body Skeletal Morphology in Professional Australian Rules Footballers

Hart, NH, Newton, RU, Weber, J, Spiteri, T, Rantalainen, T, Dobbin, M, Chivers, P, and Nimphius, S. Functional basis of asymmetrical lower-body skeletal morphology in elite Australian footballers. J Strength Cond Res 34(3): 791-799, 2020-Bone strength is a product of its material and structural properties and is highly responsive to mechanical load. Given the measureable and adaptable features of bone, and thus relevance to medical screening, injury prevention, and injury management in athletes, this study describes the lower-body skeletal morphology of professional Australian rules footballers. Using a cross-sectional and quantitative study design, 54 professional Australian rules football players (n = 54; age: 22.4 ± 3.8 years; height: 189.0 ± 7.5 cm; body mass: 86.0 ± 8.6 kg; tibial length: 436.1 ± 29.2 mm; and body fat: 9.9 ± 1.7%) underwent tibiofibular peripheral quantitative computed tomography scans for the kicking and support limbs, and a whole-body dual-energy X-ray absorptiometry scans. The support leg was significantly stronger than the kicking leg (bone strength: p ≤ 0.001; d = 0.47) with significantly greater bone mass (p < 0.001; d = 0.28), cross-sectional areas (p ≤ 0.002; d = 0.20), and greater cortex thickness (p = 0.017; d = 0.20), owing to significantly greater periosteal apposition (p ≤ 0.001; d = 0.29) and endocortical expansion (p = 0.019; d = 0.13), despite significantly lower cortical density (p = 0.002; d = -0.25). Disparate skeletal morphology between limbs highlights context-specific adaptive responses to mechanical loads experienced during game-based tasks. Practitioners should concomitantly measure material and structural properties of musculoskeletal tissue when examining fragility or resilience to better inform medical screening, monitoring, and injury risk stratification. Support leg axial loading highlights a potential avenue for interventions aiming to remediate or optimize bone cross-sectional area.

Bone geometry in young male and female football players: a peripheral quantitative computed tomography (pQCT) study

The present study shows that football practice during growth may improve bone geometry in male and female football players. However, only females had better bone strength in comparison with controls.

PURPOSE

The aim of this study was to compare bone geometry in adolescent football players and controls.

METHODS

A total of 107 football players (71 males/36 females; mean age 12.7 ± 0.6/12.7 ± 0.6 years) and 42 controls (20 males/22 females; mean age 13.1 ± 1.4/12.7 ± 1.3 years) participated in this study. Total and trabecular volumetric bone mineral content (Tt.BMC/Tb.BMC), cross-sectional area (Tt.Ar/Tb.Ar), and bone strength index (BSI) were measured at 4% site of the non-dominant tibia by peripheral quantitative computed tomography (pQCT). Moreover, Tt.BMC, cortical BMC (Ct.BMC), Tt.Ar, cortical Ar (Ct.Ar), cortical thickness (Ct.Th), periosteal circumference (PC), endosteal circumference (EC), fracture load in X-axis, and polar strength strain index (SSIp) were measured at 38% site of the tibia. Multivariate analyses of covariance were used to compare bone pQCT variables between football players and controls using the tibia length and maturity offset as covariates.

RESULTS

Female football players demonstrated 13.8-16.4% higher BSI, Ct.Th, fracture load in X-axis, and SSIp than controls (p < .0036). Males showed no significant differences in bone strength when compared to controls (p > .0036). In relation to bone mineral content and area, male football players showed 8.8% higher Tt.Ar and Tb.Ar at the 4% site of the tibia when compared to controls; whereas 13.8-15.8% higher Tt.BMC, Ct.BMC, and Ct.Ar at the 38% site of the tibia were found in female football players than controls (p < .0036).

CONCLUSIONS

In this study, female adolescent football players presented better bone geometry and strength values than controls. In contrast, only bone geometry was higher in male football players than controls.

Soccer helps build strong bones during growth: a systematic review and meta-analysis

The aim of this study was to analyze the effects of soccer practice on bone in male and female children and adolescents. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched for scientific articles published up to and including October 2016. Twenty-seven studies were included in this systematic review (13 in the meta-analysis). The meta-analysis was performed by using OpenMeta[Analyst] software. It is well documented that soccer practice during childhood provides positive effects on bone mineral content (BMC) and density (BMD) compared to sedentary behaviors and other sports, such as tennis, weightlifting, or swimming. Furthermore, soccer players present higher BMC and BMD in most weight-bearing sites such as the whole body, lumbar spine, hip, and legs. Moreover, bone differences were minimized between groups during prepuberty. Therefore, the maturity status should be considered when evaluating bone. According to meta-analysis results, soccer practice was positively associated with whole-body BMD either in males (mean difference 0.061; 95%CI, 0.042-0.079) or in females (mean difference 0.063; 95%CI, 0.026-0.099).

CONCLUSION

Soccer may be considered a sport that positively affects bone mass during growth. Pubertal soccer players presented increased bone mass compared to controls or other athletes; however, these bone differences are minimized during the prepubertal stage. What is known: • It has been described that childhood and adolescence are important periods for bone mass and structure. • Previous studies have demonstrated that soccer participation improves bone mass in male and female children and adolescents. What is new: • The differences between soccer players and controls are more marked during puberty than prepuberty. • Weight-bearing sites such as lumbar spine, hip, femoral neck, trochanter, intertrochanteric region and both legs are particularly sensitive to soccer actions.

Impact of Futsal and Swimming Participation on Bone Health in Young Athletes

Physical activity plays a crucial role in bone mass acquisition during childhood and adolescence, with weightbearing and high-impact sport activities being more beneficial. This study sought to evaluate the impact of different sports activities on bone mineral density and content in male Portuguese athletes. Seventy adolescent boys (aged 12-15 years) including 28 futsal players (FG), 20 swimmers (SG) and 22 non-athletic adolescents used as control subjects (CG), participated in the current study. Areal bone mineral density (aBMD) and areal bone mineral content (aBMC) were measured by dual energy x-ray absorptiometry (DEXA). Futsal players had significantly higher aBMD (lumbar spine - FG: 0.95 ± 0.18, SG: 0.80 ± 0.13, CG: 0.79 ± 0.13 g/cm2, p = 0.001; pelvis - FG: 1.17 ± 0.21, SG: 0.91 ± 0.12, CG: 0.98 ± 0.10 g/cm2, p < 0.001; lower limbs - FG: 1.21 ± 0.19, SG: 0.97 ± 0.10, CG: 0.99 ± 0.09 g/cm2, p < 0.001) and aBMC (lumbar spine - FG: 51.07 ± 16.53, SG: 40.19 ± 12.47, CG: 40.50 ± 10.53 g, p = 0.013; pelvis - FG: 299.5 ± 110.61, SG: 170.02 ± 55.82, CG: 183.11 ± 46.78 g, p < 0.001; lower limbs - FG: 427.21 ± 117.11, SG: 300.13 ± 76.42, CG: 312.26 ± 61.86 g/cm2, p < 0.001) than swimmers and control subjects. Data suggest that futsal, as a weightbearing and high or odd-impact sport, may improve bone mass during childhood and adolescence.

The effect of body composition and serum inflammatory markers on the functional muscle-bone unit in premenopausal women

BACKGROUND/OBJECTIVES

A number of recent studies dealing with the relationship between the effects of high body mass (BM) and fat mass (FM) on bone mass and strength exhibit a range of contrasting variations in their findings. These diverse findings have led to an ongoing controversy as to whether high BM and FM positively or negatively affect bone mass and strength. Excessive FM and the associated low-grade inflammation might overturn the higher mechanical stimulus arising from a higher BM. Therefore, we aimed at quantifying the functional muscle-bone unit in premenopausal women with markedly diverging body composition.

SUBJECTS/METHODS

Sixty-four young women with BMs ranging from 50 to 113 kg and body fat percentages between 20.7% and 51.8% underwent jumping mechanography and peripheral quantitative computed tomography measurements. Maximum voluntary ground reaction force during multiple one-legged hopping (F_m1LH), as well as bone characteristics at 4, 14 and 38% of tibia length, were determined. Body composition was assessed by dual-energy X-ray absorptiometry, and serum inflammatory markers were analyzed from blood samples.

RESULTS

F_m1LH predicted volumetric bone mineral content at the 14% site by 48.7%. Women with high body fat percentage had significantly higher F_m1LH, significantly lower relative bone mass, relative bone strength and relative bone area, as well as higher serum inflammatory markers in comparison to women with lower body fat percentage.

CONCLUSIONS

In conclusion, high body fat percentage was associated with lower relative bone mass and strength despite normal habitual muscle force in premenopausal women, indicating that high body fat percentage compromised the functional muscle-bone unit in these individuals.

SIDE TO SIDE DIFFERENCES BETWEEN DOMINANT AND NON-DOMINANT ARM'S BONE DENSITY AND ISOMETRIC HANDGRIP STRENGTH IN MALES AND FEMALES AGED 40-65 YEARS OLD

OBJECTIVE

This observational, cross-sectional study, investigates and compares the differences of BMD, T-score, Z-score and isometric strength between dominant (D) versus non-dominant (ND) arms of 162 subjects aged 40-65 in a developing, low income country (Kosova).

MATERIAL AND METHODS

Bone Mineral Density (BMD), T-score and Z-score at distal forearm regions of both arms (measured by DXA scan), together with the Handgrip Isometric Strength (HIS) (by handgrip) were evaluated in a total subjects (53 Males and 109 Females). Additionally, General Healthcare Status Questionnaire together with self-administrated International Physical Activity Questionnaire (IPAQ) were filled.

RESULTS

Significant differences (p<0.05) between arms were found in BMD, T-score, and Z-score in total subjects and in females, whereas not significant differences (p>0.05) were observed in Males BMD comparing to significantly higher results (p<0.05) in T-score and Z-score. Significant differences (p<0.05) were also found in total subjects and in females handgrip, but not (p>0.05) in males. When comparing the total subject's BMD, T-score, Z-score and Handgrip based on the PA levels (1 to 3 according to IPAQ scoring) no significant differences (p>0.05) were found between PA1, as well as PA3 whereas significantly differences (p<0.05) were found in D arms of PA2 level.

CONCLUSION

The study analyses side-to-side differences in bone density and muscular force between D and ND arms amongst a population which is frequently exposed to diagnostic screenings for age related osteomuscular conditions (aged 40-60), and demonstrates that these differences should be in consideration amongst clinicians, but not in the way it is done right now.

Tibial Bone Strength is Enhanced in the Jump Leg of Collegiate-Level Jumping Athletes: A Within-Subject Controlled Cross-Sectional Study

An efficient method of studying skeletal adaptation to mechanical loading is to assess side-to-side differences (i.e., asymmetry) within individuals who unilaterally exercise one side of the body. Within-subject controlled study designs have been used to explore skeletal mechanoadaptation at upper extremity sites; however, there is no established model in the lower extremities. The current study assessed tibial diaphysis and distal tibia asymmetry in collegiate-level jumping athletes (N = 12). To account for normal crossed asymmetry, data in jumping athletes were compared to asymmetry in a cohort of athletic controls not routinely exposed to elevated unilateral lower extremity loading (N = 11). Jumpers exhibited side-to-side differences between their jump and lead legs at both the tibial diaphysis and distal tibia, with differences at the former site persisting following comparison to dominant-to-nondominant leg differences in controls. In particular, jump-to-lead leg differences for cortical area and thickness at the tibial diaphysis in jumpers were 3.6% (95% CI 0.5-6.8%) and 3.5% (95% CI 0.4-6.6%) greater than dominant-to-nondominant differences in controls, respectively (all p < 0.05). Similarly, jump-to-lead leg differences in jumpers for tibial diaphysis maximum second moment of area and polar moment of inertia were 7.2% (95% CI 1.2-13.2%) and 5.7% (95% CI 1.7-9.8%) greater than dominant-to-nondominant differences in controls, respectively (all p < 0.05). Assessment of region-specific differences of the tibial diaphysis in jumpers indicated that the jump leg had greater pericortical radii on the medial and posterior sides and greater radial cortical thickness posteromedially when compared to the lead leg. These data suggest that athletes who perform repetitive and forceful unilateral jumping may be a useful and efficient within-subject controlled model for studying lower extremity skeletal mechanoadaptation.

Tibia and radius bone geometry and volumetric density in obese compared to non-obese adolescents

Childhood obesity is associated with biologic and behavioral characteristics that may impact bone mineral density (BMD) and structure. The objective was to determine the association between obesity and bone outcomes, independent of sexual and skeletal maturity, muscle area and strength, physical activity, calcium intake, biomarkers of inflammation, and vitamin D status. Tibia and radius peripheral quantitative CT scans were obtained in 91 obese (BMI>97th percentile) and 51 non-obese adolescents (BMI>5th and <85th percentiles). Results were converted to sex- and race-specific Z-scores relative to age. Cortical structure, muscle area and muscle strength (by dynamometry) Z-scores were further adjusted for bone length. Obese participants had greater height Z-scores (p<0.001), and advanced skeletal maturity (p<0.0001), compared with non-obese participants. Tibia cortical section modulus and calf muscle area Z-scores were greater in obese participants (1.07 and 1.63, respectively, both p<0.0001). Tibia and radius trabecular and cortical volumetric BMD did not differ significantly between groups. Calf muscle area and strength Z-scores, advanced skeletal maturity, and physical activity (by accelerometry) were positively associated with tibia cortical section modulus Z-scores (all p<0.01). Adjustment for muscle area Z-score attenuated differences in tibia section modulus Z-scores between obese and non-obese participants from 1.07 to 0.28. After multivariate adjustment for greater calf muscle area and strength Z-scores, advanced maturity, and less moderate to vigorous physical activity, tibia section modulus Z-scores were 0.32 (95% CI -0.18, 0.43, p=0.06) greater in obese, vs. non-obese participants. Radius cortical section modulus Z-scores were 0.45 greater (p=0.08) in obese vs. non-obese participants; this difference was attenuated to 0.14 with adjustment for advanced maturity. These findings suggest that greater tibia cortical section modulus in obese adolescents is attributable to advanced skeletal maturation and greater muscle area and strength, while less moderate to vigorous physical activities offset the positive effects of these covariates. The impact of obesity on cortical structure was greater at weight bearing sites.

Muscle torque relative to cross-sectional area and the functional muscle-bone unit in children and adolescents with chronic disease

Measures of muscle mass or size are often used as surrogates of forces acting on bone. However, chronic diseases may be associated with abnormal muscle force relative to muscle size. The muscle-bone unit was examined in 64 children and adolescents with new-onset Crohn's disease (CD), 54 with chronic kidney disease (CKD), 51 treated with glucocorticoids for nephrotic syndrome (NS), and 264 healthy controls. Muscle torque was assessed by isometric ankle dynamometry. Calf muscle cross-sectional area (CSA) and tibia cortical section modulus (Zp) were assessed by quantitative CT. Log-linear regression was used to determine the relations among muscle CSA, muscle torque, and Zp, adjusted for tibia length, age, Tanner stage, sex, and race. Muscle CSA and muscle torque-relative-to-muscle CSA were significantly lower than controls in advanced CKD (CSA -8.7%, p = 0.01; torque -22.9%, p < 0.001) and moderate-to-severe CD (CSA -14.1%, p < 0.001; torque -7.6%, p = 0.05), but not in NS. Zp was 11.5% lower in advanced CKD (p = 0.005) compared to controls, and this deficit was attenuated to 6.7% (p = 0.05) with adjustment for muscle CSA. With additional adjustment for muscle torque and body weight, Zp was 5.9% lower and the difference with controls was no longer significant (p = 0.09). In participants with moderate-to-severe CD, Zp was 6.8% greater than predicted (p = 0.01) given muscle CSA and torque deficits (R(2)  = 0.92), likely due to acute muscle loss in newly-diagnosed patients. Zp did not differ in NS, compared with controls. In conclusion, muscle torque relative to muscle CSA was significantly lower in CKD and CD, compared with controls, and was independently associated with Zp. Future studies are needed to determine if abnormal muscle strength contributes to progressive bone deficits in chronic disease, independent of muscle area. © 2014 American Society for Bone and Mineral Research.