A Review of Field-Based Assessments of Neuromuscular Control and Their Utility in Male Youth Soccer Players

Gait asymmetries during perceptually-regulated interval running in hypoxia and normoxia

This study aimed to characterise bilateral asymmetry in running mechanics during perceptually regulated, high-intensity intermittent running in hypoxia and normoxia and examines whether inter-limb differences in running mechanics are modified between and within intervals. Nineteen trained runners completed 4 × 4-min treadmill running bouts (3-min passive recoveries) at a perceived rating exertion of 16 on the 6-20 Borg scale in either hypoxic (FiO2 = 0.15) or normoxic (FiO2 = 0.21) conditions. Ground reaction force recordings at constant velocity (group average: 14.8 ± 1.9 km/h) allowed measurement of running kinetics/kinematics and calculation of spring-mass model characteristics at the beginning and the end of each 4-min interval. Lower limb asymmetry was assessed from the 'symmetry angle' (SA) score. There were no between intervals (P > 0.087), within intervals (P > 0.076) or FiO2 (P > 0.128) differences in SA scores for any of the 16 biomechanical variables. Mean SA scores were lower than 1.5% for spatio-temporal variables, ~1.5-3% for braking and push-off phase durations, peak forces and impulses and ~4-6% for mean loading rate and vertical stiffness. With preserved lower limb asymmetries both between and within intervals and with additional hypoxia, trained runners completing perceptually regulated interval treadmill runs may anticipate a maintained performance without heightened injury risk.

Things to keep in mind when selecting physical assessments in youth soccer: Correlations between test performances, interlimb asymmetries, and effects of maturation

A range of field-based tests have been proposed for inclusion in physical performance assessment batteries. However, there are obvious time and human resources constraints in applied settings. The knowledge of potential relationships between tests on performance, asymmetries, as well as maturation-induced changes, may help select the most informative and least time-consuming testing battery. The purposes of this study were: (1) to determine correlations in performance between different field-based tests, in interlimb asymmetry between those unilateral tests, and between asymmetry scores and test performances, and (2) to determine the influence of players' maturity status on test performances and asymmetries. A total of 309 male youth soccer players completed a nine-test battery including y-balance test, drop vertical jump, countermovement jump, single leg countermovement jump, standing long jump, single leg hop for distance, Illinois agility test, 10 m sprint, and 20 m sprint. The results revealed moderate-to-very large relationships between jump, sprint, and agility performances (r = 0.43-0.94), but weak-to-moderate correlations between these tests and balance scores (r ≤ 0.38). No relevant relationship (r ≤ 0.32) for asymmetries detected through different unilateral tests was found, nor between asymmetries and performance scores (r < 0.29). While maturity status clearly influenced players' performance, a limited impact on asymmetries was evident. Despite the mentioned relationships, the low shared variance between tests indicates that they should not be used interchangeably, and coaches should select those with the greatest specificity for the sport. Asymmetries do not influence performance, but their prevalence and unchanging nature with maturation can be seen as an opportunity for the identification of highly asymmetrical players and the application of interventions to improve the weaker limb, irrespective of the athlete's stage of development. To this end, the single leg countermovement jump might be viewed as an appropriate test in male youth soccer.

Plyometric Training's Effects on Young Male Karatekas' Jump, Change of Direction, and Inter-Limb Asymmetry

This study analysed the effects of performing a plyometric training programme on different types of jumping and specific changes of direction, and their respective asymmetries in karatekas. Twenty male karatekas (age 19 ± 4 years) were distributed in two groups, the control group (CG) and the experimental group (EG). The EG group (n = 10) performed a 6-week intervention of unilateral plyometric training, performing countermovement jumps (CMJ), drop jumps (DJ), and long jumps (SH). The tests performed at the beginning and at the end of the intervention were a unilateral and bilateral countermovement jump test (CMJ), single-leg hop test (SH), single-leg side-hop test (SSH), triple hop test (TH), and change of direction in a karate position test (MKUKS). The EG group obtained improvements in the CMJ with the stronger (p = 0.01; ES = 0.39) and weaker leg (p = 0.01; ES = 0.59), in the SH with the weaker leg (p = 0.01; ES = 0.45), in the SSH with the weaker leg (p = 0.03; ES = 0.33), in the MKUKS (p = 0.00; ES = 0.98), and improved the asymmetries obtained in the TH (p = 0.02; ES = -0.85). The GC group obtained significant differences in the CMJ with the stronger (p = 0.03; ES = 0.46) and weaker leg (p = 0.00; ES = 0.69), in the bilateral CMJ (p = 0.02; ES = 0.24), in the SH with the weaker leg (p = 0.00; ES = 0.34), in the TH with the stronger (p = 0.00; ES = -0.15) and weaker leg (p = 0.01; ES = 0.09), and in the MKUKS test (p = 0.04; ES = -0.94). A between-group analysis showed improvements of the EG over the GC in the TH with the stronger leg (p = 0.02; ES = 1.05). Performing plyometric training provides improvements in jumping, mainly in horizontal jumps, reducing inter-limb asymmetries in repetitive jumps.

Mechanical asymmetries remain low-to-moderate during 30 min of self-paced treadmill running

Introduction: We characterized the magnitude and range of gait asymmetry during self-paced treadmill running. Methods: On an instrumented treadmill, twelve trained runners (11 males, 1 female) completed a 30-min self-paced run, during which participants were instructed to cover the most distance possible. Ground reaction force recordings at a constant velocity corresponding to 70% of their maximal aerobic velocity (13.3 ± 0.8 km.h-1) allowed for the measurement of running kinetics and kinematics, as well as the calculation of spring-mass characteristics at the beginning, middle, and end of the run (minutes 1, 14, and 29, respectively). Group mean asymmetry scores were assessed using the "symmetry angle" (SA) formulae, where scores of 0% and 100% represent perfect symmetry and perfect asymmetry, respectively. Results: There was no time effect on SA scores for any of the 13 biomechanical variables (p ≥ 0.128). Mean SA scores were <2.5% for contact time (0.8% ± 0.7%), flight time (1.4% ± 0.6%), step frequency (0.7% ± 0.3%), duty factor (0.7% ± 0.3%), duration of braking (1.3% ± 0.7%) and push-off phases (0.9% ± 0.8%), as well as peak braking (2.3% ± 1.3%) and push-off forces (1.4% ± 0.9%). Mean SA scores were ≥2.5% for peak vertical loading rate (3.1% ± 1.7%), mean vertical loading rate (3.4% ± 2.1%), peak vertical forces (2.9% ± 2.2%), as well as vertical stiffness (5.2% ± 3.5%) and leg stiffness (2.5% ± 1.5%). Conclusion: Throughout a 30-min running time trial, there were consistently low-to-moderate mechanical asymmetries for spatiotemporal variables, kinetics, and spring-mass model characteristics. This suggests that trained runners maintained relatively even strides during the self-paced treadmill run, with lower extremities behaving similarly when controlling for velocity.

The use of sand as an alternative surface for training, injury prevention and rehabilitation in English professional football and barriers to implementation: a cross-sectional survey of medical staff

PURPOSE

The purpose of the present study was to investigate the use of sand as an alternative surface for training, injury prevention and rehabilitation interventions in English professional football. A Secondary aim was to explore the potential barriers to implementation.

MATERIALS AND METHODS

All 92 teams from the male English professional football pyramid during the 2021-22 season were eligible to take part. A cross-sectional survey of the medical personnel (one per club) was conducted between June 2021 and December 2021 based on the RE-AIM framework. A total of 58 respondents (63% of all clubs) completed the survey.

RESULTS AND CONCLUSIONS

Only 18 (31%) of the clubs surveyed used sand-based interventions across the last 3 seasons. Respondents felt sand-based interventions would be effective at improving physiological gains (median 4, interquartile range [IQR] 4-5) and as part of injury prevention and rehabilitation strategies (4, IQR 3-4) but were indifferent in relation to its potential to improve sporting performance (3, IQR 3-4). Barriers to implementation of sand-based interventions within wider football were a lack of facilities, lack of awareness of its potential benefits, lack of high-quality evidence and the surface not being specific to the sport. Medical staff also did not perceive that coaches' positively viewed sand interventions as a training or injury management strategy.

Analysis of grip specificity on force production in grapplers and its effect on bilateral deficit grip specificity and bilateral deficit in force production among grapplers

The use of strength training is important for athletes in combat sports such as judo and jiu-jitsu. Specificity is key when prescribing strength training programs for athletes, considering maximal strength, muscular power and strength-endurance. Grappling combat sports require grip control, which is necessary to execute throwing techniques and groundwork. The aim of this study was to verify the bilateral strength deficit in general and in grappling combat sport-specific action in the control group and grapplers. A sample of 73 subjects, divided into 2 groups, was used: the Student Group (15 females and 16 males) and the Grappler Group (29 males and 13 females). The male and female participants attended four laboratory sessions over a 48-hour interval, the first two to familiarize themselves with the Electromechanical Functional Dynamometer (EMFD), and the last two to collect maximal isometric strength data, using a standard grip and a judo/jiujitsu specific grip. Significant differences in mean and peak forces (p < 0.001) were found, with high performance combat sport athletes having greater maximal isometric strength compared to students both bilaterally and unilaterally (p < 0.001). All comparisons also indicated higher values for males compared to females (p < 0.001). The results suggest that specific training in combat sports as well as sex differences play a significant role in maximal isometric strength performance. The type of grip used affects the application of force in the upper limb isometric strength tests, finding a main effect of grip type (p < 0.001), with the standard grip obtaining higher levels. However, the dominance between hands remains constant. More research is needed on specific judogi/jiu-jitsu-gi grips and their impact on maximal isometric strength with the EMFD.

Comparison of postural sway in individuals with and without dynamic knee valgus

BACKGROUND

Dynamic knee valgus (DKV) is a multi-planar faulty movement pattern that can cause faulty postural control. The primary objective of this study is to investigate the differences in postural sway (PS) between individuals aged 18-30 years old diagnosed with and without DKV.

METHODS

In this cross-sectional study, 62 students (39 males and 23 females) with and without DKV (age: 24.58 ± 2.63 years) were selected and assigned to two groups by conducting the single-leg squat test in the screening stage. The Biodex balance system was then employed to compare the two groups in PS. Mann-Whitney U test was conducted to compare the groups in PS (p ≤ 0.05).

RESULTS

The study's findings indicate that individuals with DKV did not exhibit any significant differences, compared to those without, about the anterior-posterior stability index (with p values for both static and dynamic situations at 0.309 and 0.198, respectively), medial-lateral stability index (with p values for both static and dynamic situations at 0.883 and 0.500, respectively), and overall stability index (with p values for both static and dynamic situations at 0.277 and 0.086, respectively).

CONCLUSION

Though several possible factors could contribute to the lack of significant differences in postural sway between individuals with and without DKV, such as measurement tool differences, variable sensitivity in postural stability tests, and differences in movement variability and test stance, we recommend analyzing postural sway in more functional tasks and with different methodological patterns in future studies. Such research could help develop targeted interventions for individuals with DKV and offer a better understanding of the relationship between postural control and DKV.

Curves and kinematics: Relationship between the force-time curve and landing ability

Anterior cruciate ligament (ACL) injuries have a significant impact on athletic performance and long-term quality of life. Force plates and qualitative screening tools are feasible and effective screening methods to identify abnormal movement quality associated with increased injury risk. Comparing qualitative assessments of landing ability with force-time curves, may detect unique differences between safe and high-risk athletic movement patterns. The aim of this study was to determine low- and high-risk landing ability from qualitive landing assessments and to examine the resulting force-time curves using functional principal component analysis (fPCA). Thirty-one healthy academy athletes (10 males and 21 females) completed double- and single-leg dominant and non-dominant jump-landing-rebound tasks. All movements were filmed in multiple-planes, and vertical ground reaction forces (vGRF) were simultaneously collected. The Landing Error Scoring System (LESS) and Single-Leg Landing Error Scoring System (SL-LESS) were used to score landing footage. From these scores, athletes were categorized into low-risk and high-risk groups for further analysis. fPCA was used to examine differences between landing quality groups force-time curves. Compared to high-risk landers, low-risk landers demonstrated significantly longer contact times across all movements. Scores from fPC1 revealed safe and high-risk landing techniques expose athletes to significantly different loading patterns during double- and single-leg dominant movements. A significant positive relationship was observed between fPC1 and LESS scores, however this relationship was not observed in both single-leg landing scores. Where possible incorporating curve analysis methods like fPCA into multi-faceted screening approaches may help practitioners uncover unique insights into athletic loading strategies.

Assessment of Physical Tests in 6-11 Years Old Children: Findings from the Play Lifestyle and Activity in Youth (PLAY) Study

The purpose was to evaluate selected physical tests in children and to compare the outcomes by sex. A cross-sectional study design was used to evaluate children 6-11 years who completed five physical tests: hand grip, vertical jump, sit and reach, Y-balance, and obstacle course (time and score). The outcome measures including test results were descriptively examined and compared by sex. The study participants consisted of 133 children (62 males and 71 females, with a median age of 7.8 years). Girls showed superior sit and reach performance (p = 0.002) compared with boys. Boys demonstrated better Y-balance scores (p = 0.007) and faster obstacle time (p = 0.042) than girls. Sex comparison within three age groups (6-<8 years, 8-<10 years, and 10-<12 years) showed that girls performed better on the sit and reach compared with boys in the in 6-<8 years (p = 0.009). Boys demonstrated higher Y-balance scores (p = 0.017) and faster obstacle time (p = 0.007) compared with girls in the 8-<10-year age group. These data will serve to guide future efforts to evaluate normative measures of physical literacy and guide targeted training interventions to promote sustained physical activity in children with deficits relative to their age and sex norms.

Differences in the Contractile Properties of the Biceps Femoris and Semitendinosus Muscles Throughout a Season in Professional Soccer Players

The aim of this study was to monitor seasonal changes in the mechanical and neuromuscular characteristics of the knee flexor muscles with tensiomyography, the biceps femoris (BF) and semitendinosus (ST) muscles, of 27 soccer players. All male professional soccer players (age 25 ± 4 years) were measured at the beginning of the preseason (second week) and in the competitive season (10 weeks later). The variables contraction time (Tc) and muscle displacement (Dm) showed significant differences in some muscles, and in others they indicated a tendency to change. In general, the BF improved (more explosive and better muscle tone) and the ST worsened (slower and worse muscle tone) its values during the season. The findings of this study suggest that usual daily soccer training and weekly competition might produce antagonistic changes between the knee flexor muscles.

Biomechanical Analysis of the Tuck Jump Assessment

ABSTRACT

Nascimento, N, Sideris, V, and Read, PJ. Biomechanical analysis of the tuck jump assessment. J Strength Cond Res 36(10): 2946-2949, 2022-The tuck jump assessment (TJA) examines plyometric technique flaws associated with the increased risk of anterior cruciate ligament injury. Biomechanical data to investigate the mechanics used during the TJA are limited and assessing each jump individually across the entire test period is time inefficient. This study examined performance characteristics and movement mechanics in 16 professional soccer players during a standardized TJA protocol (10 jumps) to determine if sensitive periods exist within the test period (first 5 vs. last 5). Jump height, average power (PW) reactive strength index (RSI), frontal plane projection angle (FPPA), knee angular velocity (AV), and peak knee flexion angle (PKA) were analyzed using an optoelectrical and inertial measurement unit device. Jump height and PW increased in the past 5 jumps displaying a medium effect size (d = > 0.5). A trend was observed of increased AV, FPPA, and PKA during the past 5 jumps; however, no meaningful differences were observed between respective jump phases, and effect sizes were small (d ≤ 0.2). This study indicates that performance metrics increase during the past 5 jumps of a standardized TJA 10-jump protocol; thus, analyzing the entire test period may not be required, providing a time-efficient approach. Caution should be applied if using this protocol as an injury risk screening tool or to identify fatigue related alterations in male professional soccer players as no obvious movement abnormalities were apparent and minimal differences were present between jump phases in a range of kinematic variables across the recorded test duration.

A Simple Field Tapping Test for Evaluating Frequency Qualities of the Lower Limb Neuromuscular System in Soccer Players: A Validity and Reliability Study

Over the years, the foot tapping test protocol has been proposed by scientists to identify the capabilities of the lower limb neuromuscular system in the medical context; however, to our knowledge, no studies have established its usefulness and relationship to athletic performance. The aim of the present study was to test the reliability, criterion validity and sensitivity of a new foot tapping (TAP) test, and to examine its relationship with proxies of athletic performance in soccer players. Forty voluntary soccer players of two different levels participated in this study (20 players from the national level: age: 22.6 ± 2.5 years and 20 players from regional level: 25.1 ± 3.6 years). They performed the TAP test on two separate occasions to test its relative and absolute reliability. To examine the criterion validity of the TAP test, all participants performed four types of jumps, sprint tests, agility tests, the Wingate test and the finger tapping test considered a gold standard tapping test. The sensitivity was assessed with national and regional player levels. The TAP test presented a high relative and absolute reliability with intra-class correlation coefficient ICC > 0.90, standard errors of measurement SEM < 5% and mean difference ±95% limits of agreement equal to 0.2 ± 0.8 tap·s−1. National level players showed a higher TAP score (p < 0.001; dz = 1.96, large) compared to regional players (9.68 ± 1.41 tap·s−1 vs. 7.28 ± 1.01 tap·s−1, respectively) and the value of area under curve measured by the receiver operating characteristic curve technique was 0.95 (95% CI: 0.827−0.990). The TAP test showed a significant association with the finger tapping test (r = 0.84, p < 0.001), whereas no correlation was seen between the TAP test and all the other physical tests measured. The TAP test could be considered a valid and reliable test to assess lower limb neuromuscular ability in soccer players.

Reliability, Validity, and Performance Characteristics of Elite Adolescent Athletes at Different Stages of Maturity in the 10 to 5 Repeated Jump Test

PURPOSE

To examine the reliability, validity, and performance characteristics of the 10 to 5 repeated jump test (10-5 RJT) in adolescent male athletes. The 10-5 RJT has been shown to be a valid and reliable test of reactive strength index (RSI) in older adolescents (age 17-19 y), but less is known in younger adolescent athletes at different stages of maturity.

METHODS

Athletes (age 11-17 y) completed the 10-5 RJT on 2 days, 1 week apart, to examine the reliability (n = 41), validity (n = 18) of the test. Athletes were classified as pre, circa, or post peak height velocity (PHV) height velocity using maturity offset to examine the effect of maturation status on RSI, flight time (FT), ground contact time (GCT), and jump height (JH) (n = 68) using a cross-sectional design.

RESULTS

Paired samples t tests showed no significant differences (P ≥ .05), and Bland-Altman analysis showed no bias and close limits of agreement for RSI, JH, FT, and GCT between the contact mat and force plate. Interday reliability was rated excellent for RSI (intraclass correlation coefficient = .91) and good for GCT, FT, and JH (intraclass correlation coefficient = .81-.85). All variables had a coefficient of variation ≤ 10%. RSI increased across maturation groups, with significant differences between pre-PHV and post-PHV groups (P = .014, d = 1.00).

CONCLUSION

The 10-5 RJT is a valid and reliable test for adolescent male athletes. Greater RSI with advancing maturity was primarily due to increased FT and JH, with GCT remaining similar.

Influence of lower limb dominance on mechanical asymmetries during high-speed treadmill running

We determine whether mechanical asymmetries differ between dominant and non-dominant legs at fast treadmill speed. Stride temporal variables, derived from high-speed camera recordings, allowed to estimate leg and vertical stiffness through the sine-wave method in 31 uninjured males during treadmill running at 6.67 m.s-1. Lower limb dominance was determined by the triple-jump test. The asymmetry was expressed as dominant-non-dominant and indexed by the absolute asymmetry index (ASI). The lowest and highest mean ASI values were detected for contact time (1.69%) and flight time (5.66%), respectively; ASI values for spring-mass characteristics (2.6% ≤ leg and vertical stiffness, peak vertical force, change in vertical leg length and centre of mass vertical displacement ≤ 4.7%) were within this range. Inter-subject variability in ASI varied substantially among the seven analysed variables with larger and smaller range of variability in ASI found for flight time (0-16.56%) and contact time (0-3.47%), respectively. Because the magnitude of group mean ASI appears inconsistent among stride temporal and spring-mass characteristics, different biomechanical variables should not be used interchangeably to assess laterality effects at fast treadmill speed. The widespread ASI range also indicates that using a 'fixed cut-off' threshold is an arbitrary approach.

An Assessment of the Hopping Strategy and Inter-Limb Asymmetry during the Triple Hop Test: A Test–Retest Pilot Study

The aims of the present study are to: (1) determine within- and between-session reliability of multiple metrics obtained during the triple hop test; and (2) determine any systematic bias in both the test and inter-limb asymmetry scores for these metrics. Thirteen male young American football athletes performed three trials of a triple hop test on each leg on two separate occasions. In addition to the total distance hopped, manual detection of touch down and toe-off were calculated via video analysis, enabling flight time (for each hop), ground contact time (GCT), reactive strength index (RSI), and leg stiffness (between hops) to be calculated. Results showed all coefficient of variation (CV) values were ≤ 10.67% and intraclass correlation coefficients (ICC) ranged from moderate to excellent (0.53–0.95) in both test sessions. Intrarater reliability showed excellent reliability for all metrics (CV ≤ 3.60%, ICC ≥ 0.97). No systematic bias was evident between test sessions for raw test scores (g = −0.34 to 0.32) or the magnitude of asymmetry (g = −0.19 to 0.43). However, ‘real’ changes in asymmetry (i.e., greater than the CV in session 1) were evident on an individual level for all metrics. For the direction of asymmetry, kappa coefficients revealed poor-to-fair levels of agreement between test sessions for all metrics (K = −0.10 to 0.39), with the exception of the first hop (K = 0.69). These data show that, given the inherent limitations of distance jumped in the triple hop test, practitioners can confidently gather a range of reliable data when computed manually, provided sufficient test familiarization is conducted. In addition, although the magnitude of asymmetry appears to show only small changes between test sessions, limb dominance does appear to fluctuate between test sessions, highlighting the value of also monitoring the direction of the imbalance.

Clinical Implications of Landing Distance on Landing Error Scoring System Scores

CONTEXT

The Landing Error Scoring System (LESS) screens for risk of noncontact anterior cruciate ligament injury. The LESS requires individuals to jump forward from a 30-cm box to a distance of 50% of their body height. However, different landing distances have been cited in the scientific literature.

OBJECTIVE

To examine whether landing distance influences LESS outcomes.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PARTICIPANTS OR OTHER PARTICIPANTS

Seventy young active individuals (34 males, 36 females).

INTERVENTION(S)

Participants performed 3 × 30-cm jump-landing tasks under 2 landing conditions in randomized order: (1) 50% of body height (d50%), (2) self-selected distance (dss).

MAIN OUTCOME MEASURE(S)

Mean LESS scores, proportions of individuals categorized at high (LESS: ≥ 5 errors) and low (LESS: < 5 errors) injury risk, and landing distances were compared between conditions using generalized estimating equations. Consistency of risk categorization was examined using odds ratios (ORs) and McNemar tests. McNemar and Wilcoxon signed rank tests were used to compare the occurrence of specific LESS errors.

RESULTS

Participants landed closer to the box under the dss condition (difference = -23.28 [95% CI = -20.73, -25.81]%, P < .001). Group mean LESS scores (difference = -0.01 [95% CI = -0.59, 0.57] error, P = .969) and risk categorization (OR = 0.94 [95% CI = 0.47, 1.88], P = .859) were similar between conditions. However, individual-level risk categorization was inconsistent in 33% of participants, as was the occurrence of specific errors.

CONCLUSIONS

Using dss during the LESS might lead to different LESS errors and risk categorizations at an individual level than using d50%. Given that individual LESS scores are of primary interest in clinical and sport settings and the injury-risk threshold has not been validated for dss, we recommend use of the original LESS protocol. When only group mean LESS scores or proportions of at-risk individuals are of interest, using dss is feasible to facilitate the testing of large cohorts.

Constant low-to-moderate mechanical asymmetries during a treadmill graded exercise test

This study describes asymmetry in key mechanical variables during a treadmill-based, running graded exercise test (GXT). Twenty-one recreationally trained male runners completed a continuous, maximal GXT on an instrumented treadmill, starting at 9 km.h^-1 with speed increases of +0.5 km.h^-1 every 30 s, for the determination of ventilatory threshold (VT), respiratory compensation point (RCP), and maximal oxygen uptake (MAX). Ground reaction forces were recorded continuously and subsequently averaged from 10 consecutive steps corresponding to VT, RCP and MAX intensity stages (13.4 ± 1.2 km.h^-1, 16.0 ± 1.6 km.h^-1 and 18.2 ± 1.5 km.h^-1, respectively). Asymmetry scores were assessed from the "symmetry angle" (SA) formulae, where a score of 0%/100% indicates perfect symmetry/asymmetry; these were then compared between the three intensity stages. There was no influence of exercise intensity on SA scores for any of the sixteen biomechanical variables (P > 0.222). The group mean SA scores did not exceed 1.5% for spatio-temporal variables (contact time, aerial time, frequency and step length). There were larger mean SA scores for mean loading rate (3.7 ± 2.7%) and most spring-mass model variables (vertical stiffness: 2.2 ± 1.6% and leg stiffness: 1.7 ± 1.4%). The SA scores were ∼1.0-3.5% for braking and propulsive phase durations, peak forces, and resulting impulses. Lower extremities behave similarly at submaximal and maximal intensities during GXT, indicating that runners maintained relatively even strides as intensity increased. However, practitioners must be careful not to infer the presence of asymmetry during GXT based on a single variable, given the lower SA scores for spatio-temporal parameters.

Reliability of Hand-Held Dynamometer for assessing Isometric Lumbar Muscles Strength in Asymptomatic Healthy Population

Objective:

To determine intra-rater and inter-rater reliability of hand-held dynamometer for assessing isometric lumbar muscle strength in asymptomatic healthy population.

Methods:

It was a cross-sectional study conducted at the department of physiotherapy, University of Lahore Teaching Hospital, Lahore, Pakistan, from July 2020 to August 2020 through non probability-purposive sampling technique. Thirty healthy subjects were tested at thirty-degree lumbar flexion and zero-degree lumbar extension positions. Two raters assessed isometric strength of lumbar flexor and extensor muscles, by a hand-held dynamometer. Strength was measured and recorded by each of the two raters and re-assessed after a week. Correlation and pairwise comparison were done between readings. ICC values were calculated for the assessment of isometric lumbar muscle strength using handheld dynamometer.

Results:

A total of 30 healthy subjects had participated with mean age of 22.84±1.21 years, height 174.33±6.83 cm, weight 68.58±5.08 kg and BMI 22.52±0.35. Findings showed an excellent intra-rater (ICC 2, k = 0.95 to 0.97) and inter-rater (ICC 2, k = 0.94 to 0.95) reliability.

Conclusions:

Hand held dynamometer demonstrated an excellent intra- and inter-rater reliability for assessment of isometric lumbar muscles strength of healthy subject at clinical setting as it is simple to use, portable and cost-effective for the precise measurement of lumbar muscles strength.

Analyzing the Magnitude of Interlimb Asymmetries in Young Female Soccer Players: A Preliminary Study

Although asymmetries in lower limbs have been linked with players' performance in male soccer players, literature that has been published addressing female soccer is scarce. Thus, the aim of this study was twofold: (i) describe the asymmetries of women soccer players during jumping, change-of-direction and range-of-motion tests; and (ii) test possible relationships between asymmetries and injury risk in female soccer players. Sixteen female players (15.5 ± 1.5 years) performed a battery of fitness tests (i.e., jump ability, change-of-direction ability and passive range-of-motion) and muscle mass analysis via dual-energy X-ray absorptiometry, through which the specific asymmetry index and the related injury risk were calculated. Significant (p < 0.05) lower asymmetries in the change-of-direction test were observed in comparison to those observed in jumping and range-of-motion tests; significant (p < 0.05) lower asymmetries in muscle mass were also reported compared to those found in the change-of-direction and countermovement jump tests. Additionally, increased injury risk for countermovement jump and hip flexion with extended knee range-of-motion (relating to asymmetry values) and for ankle flexion with flexed knee range-of-motion in both legs (relating to reference range-of-motion values), as well as increased individual injury risk values, were observed across all tests. These findings suggest the necessity to implement individual approaches for asymmetry and injury risk analyses.

Performance on sprint, agility and jump tests have moderate to strong correlations in youth football players but performance tests are weakly correlated to neuromuscular control tests

PURPOSE

This study aimed at evaluating the correlation between seven different performance tests and two neuromuscular control tests in youth football players and to evaluate the influence of sex and age groups on test results.

METHODS

One-hundred and fifteen football players (66 boys, 49 girls) mean age 14 ± 0.7 (range 13-16) years from youth teams were tested at the start of the second half of the competitive season. A test battery including agility t-test, 505 agility test, single-leg hop for distance test, side-hop test, countermovement jump test, 10-m sprint test, 20-m sprint test, tuck jump assessment (TJA) and drop vertical jump (DVJ) was completed.

RESULTS

Correlations between the seven different performance tests of agility, jump and sprint ability were generally moderate to strong (r = 0.534-0.971). DVJ did not correlate with the performance tests (rho = 0.004 to  -  0.101) or with TJA total score (rho = 0.127). There were weak to moderate correlations between TJA total score and the performance tests (r =  - 0.323-0.523). Boys performed better than girls in all performance tests (p < 0.001) and in TJA total score (p = 0.002). In boys, older players performed better than younger players in the majority of the tests, while there was no clear age influence among girls.

CONCLUSION

Sprint performance was moderately to strongly correlated with agility and jump performance, and performance tests were weakly to moderately correlated to TJA, while DVJ did not correlate with the other tests. Boys performed better than girls on performance tests and TJA. An age effect on performance was evident in boys but not in girls.

LEVEL OF EVIDENCE

Level IV TRIAL REGISTRATION: Clinical Trials gov identifier: NCT03251404.

Discriminative validity of the lower and upper quarter Y balance test performance: a comparison between healthy trained and untrained youth

Background

The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test have been widely used for the assessment of dynamic balance and shoulder mobility/stability, respectively. However, investigations on the validity of the two tests in youth are lacking. Therefore, we performed two studies to determine discriminative validity of the YBT-LQ (study 1) and the YBT-UQ (study 2) in healthy youth.

Methods

Sixty-nine male soccer players (age: 14.4 ± 1.9 yrs) and 69 age-matched untrained male subjects (14.3 ± 1.6 yrs) participated in study 1 and 37 young swimmers (age: 12.3 ± 2.1 yrs) as well as 37 age−/sex-matched individuals (age: 12.5 ± 2.0 yrs) took part in study 2. Absolute (cm) and relative (% leg/arm length) maximal reach distances per reach direction and the composite score of the YBT-LQ/UQ were used as outcome measures. One-way analysis of variance and the receiver operator characteristic curve analysis (i.e., calculating the area under the curve [AUC]) were conducted to assess discriminative validity.

Results

Concerning the relative values, youth athletes showed significantly better YBT-LQ (study 1: p < 0.001, d = 0.86–1.21) and YBT-UQ (study 2: p < 0.001, d = 0.88–1.48) test performances compared to age- and sex-matched untrained subjects. Further, AUC-values indicated a chance of ≥74% (YBT-LQ) and ≥ 71% (YBT-UQ) to discriminate between youth athletes and controls. These findings were confirmed when using the absolute data for analysis.

Conclusions

According to our results, the YBT-LQ and the YBT-UQ seem to be useful test instruments to discriminate trained and untrained healthy youth performance for dynamic balance and shoulder mobility/stability, respectively.

Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention

Soccer is the most popular sport in the world. Expectedly, the incidence of soccer-related injuries is high and these injuries exert a significant burden on individuals and families, including health and financial burdens, and on the socioeconomic and healthcare systems. Using established injury prevention frameworks, we present a concise synthesis of the most recent scientific evidence regarding injury rates, characteristics, mechanisms, risk and protective factors, interventions for prevention, and implementation of interventions in soccer. In this umbrella review, we elucidate the most recent available evidence gleaned primarily from systematic reviews and meta-analyses. Further, we express the exigent need to move current soccer injury prevention research evidence into action for improved player outcomes and widespread impact through increased attention to dissemination and implementation research. Additionally, we highlight the importance of an enabling context and effective implementation strategies for the successful integration of evidence-based injury prevention programs into real-world soccer settings. This narrative umbrella review provides guidance to inform future research, practice, and policy towards reducing injuries among soccer players.

Utility of the anterior reach Y-BALANCE test as an injury risk screening tool in elite male youth soccer players

OBJECTIVES

Examine growth and maturation trends in dynamic balance using the anterior reach Y-Balance test, and its utility as an injury risk screening tool.

DESIGN

Cross sectional and prospective cohort.

SETTING

Elite male youth soccer players.

PARTICIPANTS

346 players grouped as pre, circa or post peak height velocity (PHV).

MAIN OUTCOME MEASURES

Pre-season anterior reach absolute and relative Y-Balance test scores and seasonal prospective lower extremity injury monitoring.

RESULTS

Absolute reach distances were greatest post-PHV (p < 0.05). Relative to leg length, pre-PHV achieved the highest scores and increased between-limb differences. Significant associations between injury and anterior reach scores were present in pre (OR: 0.94, CI: 0.91-0.98, p < 0.05) and circa-PHV (OR: 1.05, 95% CI: 1.05-1.10, p < 0.05). Increased age (OR: 1.49, 95% CI: 1.04-2.13, p < 0.05) and height (OR: 1.06, 95% CI: 0.99-1.13, p = 0.82) were risk factors post-PHV. No differences in injury occurrence were shown between players with absolute reach difference >4 cm in any group.

CONCLUSIONS

Anterior reach scores increased injury risk, but associations were small and inconsistent. The Y-Balance should be used with caution as a screening tool in this cohort.

Seasonal variation in neuromuscular control in young male soccer players

OBJECTIVE

Determine how lower limb neuromuscular control changes over the course of a competitive soccer season.

DESIGN

Repeated measures.

SETTING

Academy soccer club.

PARTICIPANTS

43 male youth soccer players (age 13.1 ± 2.2 yr; height 160.1 ± 15.7 cm; body mass 49.4 ± 14.3 kg; maturity offset 0.2 ± 1.9 yr).

MAIN OUTCOME MEASURES

Pre-, mid- and end of season assessments of peak landing forces during single leg 75% horizontal hop and stick (75%HOP) and a single leg countermovement jump (SLCMJ), single leg hop for distance (SLHD), knee valgus during the tuck jump assessment (TJA) and inter-limb symmetries.

RESULTS

Hop distance increased significantly. Absolute peak landing forces in the left leg during the SLCMJ and 75%HOP increased significantly, with significant increases also present in the same leg for SLCMJ relative peak landing force. TJA knee valgus score was reduced in the right leg, but remained at a 'moderate' level in the left knee.

CONCLUSION

Neuromuscular control, as evidenced by increased absolute and relative peak landing forces, appears to reduce over the course of a competitive season. Young soccer players should engage in neuromuscular training throughout the season to offset any decrements in neuromuscular control and to facilitate appropriate landing strategies.

Is the Landing Error Scoring System Reliable and Valid? A Systematic Review

CONTEXT

The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task.

OBJECTIVE

To systematically review the literature addressing the psychometric properties of the LESS.

DATA SOURCES

Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term "Landing Error Scoring System."

STUDY SELECTION

All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded.

STUDY DESIGN

Systematic literature review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template.

RESULTS

Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence.

CONCLUSION

The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.

Drop Jump Asymmetry is Associated with Reduced Sprint and Change-of-Direction Speed Performance in Adult Female Soccer Players

Studies that examine the effects of inter-limb asymmetry on measures of physical performance are scarce, especially in adult female populations. The aim of the present study was to establish the relationship between inter-limb asymmetry and speed and change-of-direction speed (CODS) in adult female soccer players. Sixteen adult players performed a preseason test battery consisting of unilateral countermovement jump (CMJ), unilateral drop jump (DJ), 10 m, 30 m, and 505 CODS tests. Inter-limb asymmetry was calculated using a standard percentage difference equation for jump and CODS tests, and Pearson's r correlations were used to establish a relationship between asymmetry and physical performance as well as asymmetry scores themselves across tests. Jump-height asymmetry from the CMJ (8.65%) and DJ (9.16%) tests were significantly greater (p < 0.05) than asymmetry during the 505 test (2.39%). CMJ-height asymmetry showed no association with speed or CODS. However, DJ asymmetries were significantly associated with slower 10 m (r = 0.52; p < 0.05), 30 m (r = 0.58; p < 0.05), and 505 (r = 0.52⁻0.66; p < 0.05) performance. No significant relationships were present between asymmetry scores across tests. These findings suggest that the DJ is a useful test for detecting existent between-limb asymmetry that might in turn be detrimental to speed and CODS performance. Furthermore, the lack of relationships present between different asymmetry scores indicates the individual nature of asymmetry and precludes the use of a single test for the assessment of inter-limb differences.

Performance and reliability of the Lower Quarter Y Balance Test in healthy adolescents from grade 6 to 11

BACKGROUND

The Lower Quarter Y Balance Test (YBT-LQ) has been widely used in the field to assess dynamic balance performance in various populations. However, no study has demonstrated test-retest reliability of the YBT-LQ in adolescents including several age cohorts, even though reliability is necessary to provide repeatable performance data.

OBJECTIVE

Thus, we examined test-retest reliability of the YBT-LQ in healthy adolescents.

METHODS

In a school setting, 178 secondary school students (93 female, 85 male) in sixth to eleventh grades (11-19 years) performed the YBT-LQ twice, 7 days apart. Normalized maximal reach distances (% leg length) for all three directions (i.e., anterior, posterolateral, posteromedial) and both legs and the composite score were used as outcome measures. Intraclass correlation coefficient (ICC_3,1) and standard error of measurement (SEM) were calculated to assess relative and absolute test-retest reliability, respectively. Practical relevance of the YBT-LQ was determined by calculating the minimal detectable change (MDC_95%).

RESULTS

Irrespective of grade, test-retest reliability for all distances reached was predominately "excellent" (i.e., ICC_3,1 > 0.75) and the rather small SEM values ranged from 1.77 to 5.81%. Depending on grade and reach direction, MDC values of 4.90 to 16.10% represent the minimum amount of change needed to identify clinically relevant effects in repeated measurements of the YBT-LQ performance.

CONCLUSIONS

The observed values suggest that the YBT-LQ is a reliable test and suitable to detect changes of dynamic balance performance in healthy adolescents from grade six to eleven (i.e., aged 11-19 years).