Footwear Traction and Lower Extremity Noncontact Injury

Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football

INTRODUCTION

An optimal range of shoe-surface traction (grip) exists to improve performance and minimise injury risk. Little information exists regarding the magnitude of traction forces at shoe-surface interface across a full season of elite football (soccer) using common football shoes.

OBJECTIVE

To assess variation in shoe-surface traction of six different football shoe models throughout a full playing season in Qatar encompassing climatic and grass species variations.

METHODS

Football shoes were loaded onto a portable shoe-surface traction testing machine at five individual testing time points to collect traction data (rotational and translational) on a soccer playing surface across one season. Surface mechanical properties (surface hardness, soil moisture) and climate data (temperature and humidity) were collected at each testing time point.

RESULTS

Peak rotational traction was significantly different across shoe models (F = 218, df = 5, p <0.0001), shoe outsole groups (F = 316.2, df = 2, p < .0001), and grass species (F = 202.8, df = 4, p < 0.0001). No main effect for shoe model was found for translational traction (F = 2.392, p = 0.07).

CONCLUSIONS

The rotational (but not translational) traction varied substantially across different shoe types, outsole groups, and grass species. Highest rotational traction values were seen with soft ground outsole (screw-in metal studs) shoes tested on warm season grass. This objective data allows more informed footwear choices for football played in warm/hot climates on sand-based elite football playing surfaces. Further research is required to confirm if these findings extend across other football shoe brands.

Anterior cruciate ligament injury risk factors in football

INTRODUCTION

Anterior cruciate ligament (ACL) lesion represents one of the most dramatic injuries in a football (soccer) player's career. There are many injury risk factors related to intrinsic (non-modifiable) and/or extrinsic (modifiable) factors of ACL injury.

EVIDENCE ACQUISITION

Research of the studies was conducted until September 2018 without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA.

EVIDENCE SYNTHESIS

To date, evidence from the literature suggests that the risk of ACL injury is multifactorial and involves biomechanical, anatomical, hormonal, and neuromuscular factors. Despite this relative complexity, the mechanisms of injury are well known and rationally classified into two categories: mechanisms of injury based on contact or on non-contact with another player, with the non-contact injury mechanisms clearly prevailing over the mechanisms of contact injury. One of the most frequent biomechanical risk factors, associated with ACL non-contact injury, is represented by the valgus knee in the pivoting and cutting movements and in the landing phase after jumping. Gender-related risk factors show female populations to have a higher predisposition to ACL injury than males However, there are still some theoretical and practical aspects that need further investigation such as; genetic risks together with the role of estrogen and progesterone receptors in female populations, and the in-vivo interaction shoe-playing surface. In particular, the genetic risk factors of ACL lesion seem to be an interesting and promising field of investigation, where considerable progress has still to be made.

CONCLUSIONS

This narrative review provides an insight into the risk factors of ACL injury that could be used by practitioners for preventing injury in football (soccer).

Incidence, Mechanisms, and Severity of Game-Related High School Football Injuries Across Artificial Turf Systems of Various Infill Weights

Background:

Artificial turf surfaces are developed to duplicate playing characteristics of natural grass. With the newer generations of sand and rubber infill systems, the infill is a common component that varies between fields and is a critical factor that could influence the player-surface interaction. Because the influence of infill weight on sport trauma is unknown, this study quantified football trauma in high schools in the United States across artificial turf systems of various infill weights.

Hypothesis:

Athletes would not experience differences in game-related injuries across artificial turf systems of various infill weights.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Artificial turf systems were divided into 4 sand/rubber infill weight groups by pounds per square foot: ≥9.0, 6.0-8.9, 3.0-5.9, and 0.0-2.9. A total of 57 high schools in 4 states participated over the course of 5 seasons. Outcomes of interest included injury severity, as a function of infill weight, across head, knee, and shoulder traumas; injury category; primary type of injury; tissue type; specific body location of injury; cleat design; environmental factors; and turf age. Data were subject to multivariate analyses of variance (MANOVAs) and Wilks λ criteria through use of general linear model procedures.

Results:

Of 1837 games documented, 528 games were played on infill weights of ≥9.0 lb/ft², 521 on 6.0-8.9 lb/ft², 525 on 3.0-5.9 lb/ft², and 263 on 0.0-2.9 lb/ft², with 4655 total injuries reported. MANOVAs indicated significant infill weight effects across injury severity (F_2,4648 = 5.087; P = .0001), with significant main effects also observed by injury category, tissue injured, lower extremity joint and muscle, cleat design, environmental factors, and turf age. Post hoc analyses indicated significantly lower (P < .05 to .0001) total and substantial traumas, concussions, shoe-surface interaction during contact trauma, surface impacts, muscle-tendon overload, cleat design influence, adverse weather trauma, lower extremity injuries, and turf age effect while athletes were competing on the 6.0 to ≥9.0 lb/ft² infill weight systems compared with the lighter infill weight systems.

Conclusion:

As infill surface weight decreased, football trauma significantly increased across numerous playing conditions. Based on findings, high school football fields should minimally contain 6.0 pounds of infill per square foot.

Development of a Footwear Sizing System in the National Football League

Context:

Footwear performance and injury mitigation may be compromised if the footwear is not properly sized for an athlete. Additionally, poor fit may result in discomfort and foot injury such as fifth metatarsal stress fracture, foot deformities, turf toe, and blisters. Current footwear fitting methods consist of foot length and width measurements, which may not properly describe the shape of the individual foot, correlated with shoe size descriptors that are not standardized. Footwear manufacturers employ a range of sizing rubrics, which introduces shoe size and shape variability between and even within footwear companies. This article describes the synthesis of literature to inform the development and deployment of an objective footwear fitting system in the National Football League (NFL). The process may inform athletic footwear fitting at other levels of play and in other sports.

Evidence Acquisition:

Literature related to footwear fitting, sizing, and foot scanning from 1980 through 2017 was compiled using electronic databases. Reference lists of articles were examined for additional relevant studies. Sixty-five sources are included in this descriptive review.

Study Type:

Descriptive review.

Level of Evidence:

Level 5.

Results:

Current methods of footwear fitting and variability in the size and shape of athletic footwear complicate proper fitting of footwear to athletes. An objective measurement and recommendation system that can match the 3-dimensional shape of an athlete’s foot to the internal shape of available shoe models can provide important guidance for footwear selection. One such system has been deployed in the NFL.

Conclusion:

An objective footwear fitting system based on 3-dimensional shape matching of feet and shoes can facilitate the selection of footwear that properly fits an athlete’s foot.

Neuromechanical adaptations to slippery sport shoes

Although shoe friction has been widely studied in occupational ergonomics, information was lacking about friction in sport shoes. The purpose of the study was to examine the neuromechanical adaptations to different shoe-surface interface in an aerobic-gym specific movement. Sixteen females performed 10 change of direction movements in two shoe conditions differing by their outsoles (ethyl-vinyl-acetate: EVA and rubber: RB) to ensure significant differences in mechanical coefficients of friction (EVA = 0.73 ± 0.07 and RB = 1.46 ± 0.15). The kinematics, kinetics and muscle activities of the right lower-limb were analysed. Statistical parametric mapping was used to investigate the kinematics and kinetics adaptation to the different shoe-surface coefficients of friction. The participants had a longer stance duration in the EVA compared to the RB condition (526 ± 160 ms vs. 430 ± 151 ms, p < .001). The ankle and knee joints powers and works were lower during both the braking and the push-off phases in the EVA as compared to the RB condition. Preactivation of the agonist muscles (soleus, gastrocnemius medialis and vastus medialis) decreased in the EVA compared to the RB condition (-28.5%, -26.5% and -49.0%, respectively). Performing a change of direction movement with slippery shoes reduced the ankle and knee joints loadings, but impaired the stretch-shortening cycle performance. Participants demonstrated thus a different neuromechanical strategy to control their movement which was associated with a reduced performance.

Improvement in Offaxis Neuromuscular Control Under Slippery Conditions Following Six-Week Pivoting Leg Neuromuscular Training

Knee injuries are usually associated with offaxis loadings in the transverse and frontal planes. Thus, improvement of lower limb offaxis neuromuscular control is important in knee injury prevention and post-injury rehabilitation. The goal of this paper was to investigate the effects of six-week pivoting offaxis intensity adjustable neuromuscular control training (POINT) using a custom-made offaxis elliptical trainer on lower limb offaxis neuromuscular control performance in trained and untrained functional tasks under slippery conditions. Twenty-six subjects participated in 18 sessions of POINT (three sessions per week for six weeks) and 25 subjects served as controls who did a regular workout. Offaxis neuromuscular control performance measures in terms of pivoting instability, sliding instability, and time-to-peak offaxis EMG entropy were evaluated on both groups under slippery conditions including a trained free pivoting task and untrained free sliding task and free pivoting and sliding task. Compared with the control group, the training group significantly decreased pivoting instability and the time-to-peak offaxis EMG entropy in lower limb muscles, indicating improvement in offaxis neuromuscular control performance. Furthermore, the training group showed reduced pivoting instability and sliding instability during the untrained free pivoting and sliding task. This paper may help us develop more focused and effective offaxis training programs to reduce knee injuries associated with offaxis loadings.

EFFECTS OF FOOTWEAR VARIATIONS ON THREE-DIMENSIONAL KINEMATICS AND TIBIAL ACCELERATIONS OF SPECIFIC MOVEMENTS IN AMERICAN FOOTBALL

American football is associated with a high rate of non-contact chronic injuries. Players are able to select from both high and low cut footwear. The aim of the current investigation was to examine the influence of high and low cut American football specific footwear on tibial accelerations and three-dimensional (3D) kinematics during three sport specific movements. Twelve male American football players performed three movements, run, cut and vertical jump whilst wearing both low and high cut footwear. 3D kinematics of the lower extremities were measured using an eight-camera motion analysis system alongside tibial acceleration parameters which were obtained using a shank mounted accelerometer. Tibial acceleration and 3D kinematic differences between the different footwear were examined using either repeated measures or Friedman’s ANOVA. Tibial accelerations were significantly greater in the low cut footwear in comparison to the high cut footwear for the run and cut movements. In addition, peak ankle eversion and tibial internal rotation parameters were shown to be significantly greater in the low cut footwear in the running and cutting movement conditions. The current study indicates that the utilization of low cut American football footwear for training/performance may place American footballers at increased risk from chronic injuries.

The role of shoe design on the prediction of free torque at the shoe-surface interface using pressure insole technology

The goal of the current study was to expand on previous work to validate the use of pressure insole technology in conjunction with linear regression models to predict the free torque at the shoe-surface interface that is generated while wearing different athletic shoes. Three distinctly different shoe designs were utilised. The stiffness of each shoe was determined with a material's testing machine. Six participants wore each shoe that was fitted with an insole pressure measurement device and performed rotation trials on an embedded force plate. A pressure sensor mask was constructed from those sensors having a high linear correlation with free torque values. Linear regression models were developed to predict free torques from these pressure sensor data. The models were able to accurately predict their own free torque well (RMS error 3.72 ± 0.74 Nm), but not that of the other shoes (RMS error 10.43 ± 3.79 Nm). Models performing self-prediction were also able to measure differences in shoe stiffness. The results of the current study showed the need for participant-shoe specific linear regression models to insure high prediction accuracy of free torques from pressure sensor data during isolated internal and external rotations of the body with respect to a planted foot.

The effect of translational and rotational traction on lower extremity joint loading

Previous studies have linked footwear traction to lower extremity non-contact injury; however, these studies mainly focussed on rotational traction exclusively. While studies have shown that increases in traction lead to increases in joint loading, represented by joint moments, these studies failed to determine how the individual components of rotational and translational traction affect joint loading. Therefore, this study investigated how each component of traction independently affects lower extremity joint loading. Traction testing was performed using a robotic testing machine on three shoes that had independent alterations of translational and rotational traction. All testing was conducted on a sample piece of artificial turf. Kinematic and kinetic data were then collected on 10 athletes performing two cutting movements in each shoe condition. As rotational and translational traction were independently altered, decreased rotational traction led to significant decreases in transverse and frontal plane joint loading at the ankle and knee joints, while increases in translational traction led to increases in frontal plane joint loading at the ankle and knee joints. Increases in joint loading in the transverse and frontal planes are one of the possible mechanisms of lower extremity non-contact injury. Both translational and rotational traction can independently alter the joint loading.

Comparison of injury incidences between football teams playing in different climatic regions

Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999–2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01–1.10) with quadriceps strains (RR 1.32, 95% CI 1.10–1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16–1.74), and ankle sprains (RR 1.17, 95% CI 1.00–1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47–1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes.