Hamstring-to-Quadriceps Torque Ratios of Professional Male Soccer Players: A Systematic Review

Prediction of specific structural damage to the knee joint using qualitative isokinetic analysis

BACKGROUND

An isokinetic moment curve (IMC) pattern-damaged structure prediction model may be of considerable value in assisting the diagnosis of knee injuries in clinical scenarios. This study aimed to explore the association between irregular IMC patterns and specific structural damages in the knee, including anterior cruciate ligament (ACL) rupture, meniscus (MS) injury, and patellofemoral joint (PFJ) lesions, and to develop an IMC pattern-damaged structure prediction model.

METHODS

A total of 94 subjects were enrolled in this study and underwent isokinetic testing of the knee joint (5 consecutive flexion-extension movements within the range of motion of 90°-10°, 60°/s). Qualitative analysis of the IMCs for all subjects was completed by two blinded examiners. A multinomial logistic regression analysis was used to investigate whether a specific abnormal curve pattern was associated with specific knee structural injuries and to test the predictive effectiveness of IMC patterns for specific structural damage in the knee.

RESULTS

The results of the multinomial logistic regression revealed a significant association between the irregular IMC patterns of the knee extensors and specific structural damages ("Valley" - ACL, PFJ, and ACL + MS, "Drop" - ACL, and ACL + MS, "Shaking" - ACL, MS, PFJ, and ACL + MS). The accuracy and Macro-averaged F1 score of the predicting model were 56.1% and 0.426, respectively.

CONCLUSION

The associations between irregular IMC patterns and specific knee structural injuries were identified. However, the accuracy and Macro-averaged F1 score of the established predictive model indicated its relatively low predictive efficacy. For the development of a more accurate predictive model, it may be essential to incorporate angle-specific and/or speed-specific analyses of qualitative and quantitative data in isokinetic testing. Furthermore, the utilization of artificial intelligence image recognition technology may prove beneficial for analyzing large datasets in the future.

Testing the Posterior Chain: Diagnostic Accuracy of the Bunkie Test versus the Isokinetic Hamstrings/Quadriceps Measurement in Patients with Self-Reported Knee Pain and Healthy Controls

(1) Background: The isokinetic measurement (IM) of the leg muscles is well established but costly, whereas the Bunkie Test (BT) is a rarely investigated but easy-to-conduct functional test to evaluate the total posterior chain. Although the tests differ in aim and test structures, both have their justification in the assessment process. Therefore, this study evaluated the diagnostic accuracy of the BT and the IM. (2) Methods: 21 participants (9 female, 12 male; age, 26.2 ± 5.26 years; weight 73.8 ± 14.6 kg; height 176.0 ± 9.91 cm) and 21 patients (9 female, 12 male; age, 26.5 ± 5.56 years; weight, 72.6 ± 16.9 kg; height 177.0 ± 10.1 cm) with self-reported pain in the knee performed the IM and the BT. For IM, we calculated the ratio of the knee mean flexor/extensor peak torque (H/Q ratio) for 60°/s and 120°/s, and BT performance was measured in seconds. We classified the IM (<0.6 H/Q ratio) and the BT (leg difference ≥4 s) as binary results according to the literature. We calculated the sensitivity and specificity, which we compared with the Chi-Square test, and the 95% confidence intervals (CI). A p-value of ≤0.05 is considered significant. (3) Results: The sensitivity for the BT was 0.89, 95% CI [0.67, 0.99], and the specificity was 0.52 [0.30, 0.74]. For the IM, the sensitivity was 0.14 [0.03, 0.36] for 60°/s and 0.05 [0.00, 0.24] for 120°/s, and the specificity was 0.70 [0.46, 0.88] for 60°/s and 0.90 [0.68, 0.99] for 120°/s. The results of the Chi-Square tests were significant for the BT (χ2 (1) = 6.17, p = 0.01) but not for the IM (60°/s: χ2 (1) = 0.70, p = 0.40; 120°/s: χ2 (1) = 0.00, p = 0.97). (4) Conclusions: Patients were more likely to obtain a positive test result for the BT but not for the IM.

Explainable Machine Learning Techniques to Predict Muscle Injuries in Professional Soccer Players through Biomechanical Analysis

There is a significant risk of injury in sports and intense competition due to the demanding physical and psychological requirements. Hamstring strain injuries (HSIs) are the most prevalent type of injury among professional soccer players and are the leading cause of missed days in the sport. These injuries stem from a combination of factors, making it challenging to pinpoint the most crucial risk factors and their interactions, let alone find effective prevention strategies. Recently, there has been growing recognition of the potential of tools provided by artificial intelligence (AI). However, current studies primarily concentrate on enhancing the performance of complex machine learning models, often overlooking their explanatory capabilities. Consequently, medical teams have difficulty interpreting these models and are hesitant to trust them fully. In light of this, there is an increasing need for advanced injury detection and prediction models that can aid doctors in diagnosing or detecting injuries earlier and with greater accuracy. Accordingly, this study aims to identify the biomarkers of muscle injuries in professional soccer players through biomechanical analysis, employing several ML algorithms such as decision tree (DT) methods, discriminant methods, logistic regression, naive Bayes, support vector machine (SVM), K-nearest neighbor (KNN), ensemble methods, boosted and bagged trees, artificial neural networks (ANNs), and XGBoost. In particular, XGBoost is also used to obtain the most important features. The findings highlight that the variables that most effectively differentiate the groups and could serve as reliable predictors for injury prevention are the maximum muscle strength of the hamstrings and the stiffness of the same muscle. With regard to the 35 techniques employed, a precision of up to 78% was achieved with XGBoost, indicating that by considering scientific evidence, suggestions based on various data sources, and expert opinions, it is possible to attain good precision, thus enhancing the reliability of the results for doctors and trainers. Furthermore, the obtained results strongly align with the existing literature, although further specific studies about this sport are necessary to draw a definitive conclusion.

Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players

ABSTRACT

Lunn, DE, Nicholson, G, Cooke, M, Crespo, R, Robinson, T, Price, RJ, and Walker, J. Discrete hamstring: quadriceps strength ratios do not represent angle-specific ratios in Premier League soccer players. J Strength Cond Res 37(12): 2417-2422, 2023-This study compared angle-specific hamstring:quadriceps (H:Q) ratios with their discrete counterparts during strength testing in professional male soccer players. Twenty-seven professional English Premier League soccer players were recruited for this study (age: 22 ± 4 years; stature: 1.81 ± 0.08 m; body mass: 74.7 ± 6.5 kg). Isokinetic testing of the knee flexors and extensors was conducted concentrically at two angular velocities (60° and 240°·s -1 ) and eccentrically (for the knee flexors only) at 30°·s -1 . Conventional H:Q ratio was calculated as the ratio between peak joint moment in the flexors and extensors at 60°·s -1 . Functional H:Q ratio was calculated as the peak joint moment in the flexors during the eccentric condition and the extensors at 240°·s -1 . Discrete conventional and functional H:Q ratios were 0.56 ± 0.06 and 1.28 ± 0.22, respectively. The residual differences between discrete values and angle-specific residual values were 13.60 ± 6.56% when normalized to the magnitude of the discrete value. For the functional ratios, the normalized residual was 21.72 ± 5.61%. Therefore, neither discrete ratio was representative of angle-specific ratios, although the conventional ratio had lower error overall. Therefore, practitioners should consider H:Q ratio throughout the full isokinetic range of motion, not just the discrete ratio calculated from peak joint moments, when designing and implementing training programs or monitoring injury risk, recovery from injury, and readiness to return to play.

Soccer's AI transformation: deep learning's analysis of soccer's pandemic research evolution

Introduction

This paper aims to identify and compare changes in trends and research interests in soccer articles from before and during the COVID-19 pandemic.

Methods

We compared research interests and trends in soccer-related journal articles published before COVID-19 (2018-2020) and during the COVID-19 pandemic (2021-2022) using Bidirectional Encoder Representations from Transformers (BERT) topic modeling.

Results

In both periods, we categorized the social sciences into psychology, sociology, business, and technology, with some interdisciplinary research topics identified, and we identified changes during the COVID-19 pandemic period, including a new approach to home advantage. Furthermore, Sports science and sports medicine had a vast array of subject areas and topics, but some similar themes emerged in both periods and found changes before and during COVID-19. These changes can be broadly categorized into (a) Social Sciences and Technology; (b) Performance training approaches; (c) injury part of body. With training topics being more prominent than match performance during the pandemic; and changes within injuries, with the lower limbs becoming more prominent than the head during the pandemic.

Conclusion

Now that the pandemic has ended, soccer environments and routines have returned to pre-pandemic levels, but the environment that have changed during the pandemic provide an opportunity for researchers and practitioners in the field of soccer to detect post-pandemic changes and identify trends and future directions for research.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of eccentric-emphasized leg curl intervention on muscle strength imbalance markers in professional soccer players during pre-season

BACKGROUND

The effects of strength training on muscle strength imbalance are unclear in professional soccer players. As a result, this study examined the effects of an 8-week strength training program comprising eccentric-emphasized prone leg curl adjusted according to the individual strength imbalance status.

METHODS

Ten professional soccer players (26.0 ± 3.6 yrs) participated in the study. Players who had a ≥ 10% contralateral imbalance in knee flexors eccentric peak torque (n = 6) performed two additional repetitions per set in the low-strength limb (high-volume, HV) compared to the high-strength limb (low-volume, LV). Isokinetic concentric knee extension and concentric and eccentric knee flexion peak torque (PT) and derived contralateral imbalances and conventional and functional hamstring-to-quadriceps ratios (H:Q) were assessed at baseline and after 8 weeks. Differences at baseline were assessed using paired-sample T-tests, and a two-way (limb x time) repeated measures analysis of covariance (ANCOVA) for changes over time.

RESULTS

A significant improvement in the eccentric knee flexion PT was observed in both limbs after 8 weeks (P < 0.05), with greater effects observed in the HV limb (25.0 N m, 95% CI: 15.1-34.9 N m). Significant decreases were also observed in the contralateral imbalances from concentric knee extension and flexion and eccentric knee flexion PT (P < 0.05). Differences were not observed in concentric knee extension and flexion PT (P > 0.05).

CONCLUSIONS

A short-term eccentric-emphasized leg curl intervention adjusted by the initial knee flexors eccentric strength was an efficient method to improve knee flexors strength imbalance in professional soccer players.

Sport-Related Effect on Knee Strength Profile during Puberty: Basketball vs. Soccer

The present study examined and compared the isokinetic peak torque and the reciprocal ratios of the knee joint between young basketball and soccer players. An amount of 100 soccer and 100 basketball players took part in this study and were separated into five equal groups (n = 20), according to their chronological age (12, 13, 14, 15, and 16 years old). The absolute concentric (CON) and eccentric (ECC) peak torque of the knee flexor and extensor muscles (at 60°/s, 180°/s) were assessed using a Cybex Norm dynamometer, and the relative peak torque (per unit of body mass), as well as the conventional (CON/CON; ECC/ECC) and functional (CON/ECC; ECC/CON) ratios, were calculated. Data analysis indicated that the basketball players had higher absolute peak torque values than the soccer players throughout their developmental ages (p < 0.05). When the isokinetic peak torque values were normalized relative to body mass, no differences were observed between basketball and soccer players in any age group (p > 0.05). Additionally, no differences were observed in conventional and functional ratios between soccer and basketball players (p > 0.05). In conclusion, it appears that, during developmental ages (12-16 years old), the isokinetic strength profile (independent of body mass affecting absolute values) of knee extensor and flexor muscles develops similarly in basketball and soccer players.

Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review

BACKGROUND

For the past 30 years, the hamstring (H)-to-quadriceps (Q) (H:Q) torque ratio has been considered an important index of muscle strength imbalance around the knee joint. The purpose of this systematic review was to examine the value of H:Q torque ratio as an independent risk factor for hamstring and anterior cruciate ligament (ACL) injuries.

METHODS

Database searches were performed to identify all relevant articles in PubMed, MEDLINE, Cochrane Library, and Scopus. Prospective studies evaluating the conventional (concentric H:Q), functional (eccentric H: concentric Q), and mixed (eccentric H at 30°/s: concentric Q at 240°/s) H:Q ratios as risk factors for occurrence of hamstring muscle strain or ACL injury were considered. Risk of bias was assessed using the Quality In Prognosis Studies tool.

RESULTS

Eighteen included studies reported 585 hamstrings injuries in 2945 participants, and 5 studies documented 128 ACL injuries in 2772 participants. Best evidence synthesis analysis indicated that there is very limited evidence that H:Q strength ratio is an independent risk factor for hamstring and ACL injury, and this was not different between various ratio types. Methodological limitations and limited evidence for ACL injuries and some ratio types might have influenced these results.

CONCLUSION

The H:Q ratio has limited value for the prediction of ACL and hamstring injuries. Monitoring strength imbalances along with other modifiable factors during the entire competitive season may provide a better understanding of the association between H:Q ratio and injury.

Low Pre-Season Hamstring-to-Quadriceps Strength Ratio Identified in Players Who Further Sustained In-Season Hamstring Strain Injuries: A Retrospective Study from a Brazilian Serie A Team

A common pre-season injury prevention assessment conducted by professional football clubs is the hamstring-to-quadriceps (H:Q) strength ratio calculated by peak torque (PT). However, it is debatable whether players that present low pre-season H:Q ratios are more susceptible to further sustaining in-season hamstring strain injuries (HSI). Based upon retrospective data from a Brazilian Serie A football squad, a particular season came to our attention as ten out of seventeen (~59%) professional male football players sustained HSI. Therefore, we examined the pre-season H:Q ratios of these players. H:Q conventional (CR) and functional (FR) ratios, and the respective knee extensor/flexor PT from the limbs of players further sustaining in-season HSI (injured players, IP) were compared to the proportional number of dominant/non-dominant limbs from uninjured players (UP) in the squad. FR and CR were ~18-22% lower (p < 0.01), whereas quadriceps concentric PT was ~25% greater for IP than UP (p = 0.002). Low scores of FR and CR were correlated (p < 0.01) with high levels of quadriceps concentric PT (r = -0.66 to -0.77). In conclusion, players who sustained in-season HSI had lower pre-season FR and CR compared to UP, which appears to be associated with higher levels of quadriceps concentric torque than hamstring concentric or eccentric torque.

Isokinetic Muscle Strength in Elite Soccer Players 3 and 6 months After Anterior Cruciate Ligament Reconstruction

ABSTRACT

Milutinović, A, Jakovljević, V, Dabović, M, Faude, O, Radovanović, D, and Stojanović, E. Isokinetic muscle strength in elite soccer players 3 months and 6 months after anterior cruciate ligament reconstruction. J Strength Cond Res 37(4): e297-e304, 2023-The aim of this study was to evaluate interlimb symmetry in quadriceps and hamstring peak torque of elite soccer players at 3 months (stage 1) and 6 months (stage 2) after anterior cruciate ligament (ACL) reconstruction. Eight male professional soccer players competing at the highest level across different European countries, who had undergone ACL reconstruction, participated in this study. All patients underwent a supervised physiotherapy program after surgery. Data analyses included the use of separate two-way repeated-measures analyses of variance and effect sizes. Although knee extensor and flexor strength of the non-injured limb was found to be relatively unaltered ( g = -0.10 to 0.00) between stage 1 and stage 2, comparisons across time points revealed moderate improvements in quadriceps peak torque ( p = 0.01, g = 0.52), hamstring peak torque ( p = 0.07, g = 0.51), and hamstring:quadriceps (H/Q) ratio ( p = 0.03, g = -0.68) of the injured leg, as well as small-large improvements in the quadriceps ( p = 0.004, g = 1.24) and hamstring limb symmetry index (LSI) ( p = 0.056, g = 0.41). A time-dependent moderate-large asymmetry observed at stage 1 between the injured and noninjured leg in quadriceps peak torque ( p < 0.001, g = -1.83), hamstring peak torque ( p = 0.157, g = -0.67), and the H:Q ratio ( p = 0.06, g = 1.01), as well as between the hamstring and quadriceps LSI ( p = 0.03, g = -0.74) was eliminated at stage 2 ( g = -0.31 to 0.42). Our findings indicate the importance of supervised and comprehensive therapy, as well as strength screening to assist in recovery aimed at optimizing identified strength deficits following ACL reconstruction.

Agreement between isokinetic eccentric hamstring strength, Nordic hamstring strength and Nordic break-point angle in a sample of trained and healthy individuals

Different eccentric strength assessments are used to identifying the risk of hamstring injury in athletes. However, there is scarce information to determine the association between Nordic-based measurements and the gold standard measurement of eccentric hamstring strength in an isokinetic dynamometer. To investigate the relationship of different measures of eccentric hamstring strength (break-point angle and eccentric strength during Nordic exercise) with eccentric hamstring peak torque measured with an isokinetic dynamometer. Forty-six participants volunteered to participate in this study. Eccentric peak force in the Smart-Nordic System and break-point angle measured as trunk lowering at >20°/s and >150°/s² during the Nordic exercise via high-frequency video-analysis were compared to eccentric hamstring peak torque in an isokinetic dynamometer set to produce knee extension at 30°/s. There was a moderate association between peak eccentric strength with the Smart-Nordic and isokinetic eccentric hamstring peak torque (r = -0.65, p < 0.001, 95%CI = [-0.76-(-0.50)]). The association between Nordic break-point angle measured at 20°/s (r = 0.49, p < 0.001, 95%CI = [0.30-0.64]) and at 150°/s² (r = 0.52, p < 0.001, 95%CI = [0.33-0.66]) presented statistically significant but lower associations with isokinetic eccentric hamstring peak torque. All Nordic-based measurements presented acceptable associations with the gold standard isokinetic eccentric hamstring peak torque. However, peak eccentric force measured on the Smart-Nordic device had a better agreement with eccentric peak torque measured with an isokinetic dynamometer than the video-based measurements.Highlights Peak eccentric force measured on the isometric strain-gauges device had a better agreement with eccentric hamstring peak torque measured with an isokinetic dynamometer than the break-point angle.The Nordic-based measurements are an alternative cost-effective method to assess eccentric muscle strength and weakness when the access to isokinetic dynamometry is not feasible.Caution should be taken with certain variables such as participants body mass, hip position and movement speed when interpreting the results of Nordic-based measurements.

Dynamometric Strength Profile of Hip Muscles in Youth Soccer Players

BACKGROUND

Soccer is the most widely practiced sport in the world, demanding high-speed activities such as jumps, sprints and changes of direction. Therefore, having optimal levels of muscle strength improves performance and reduces the injury rate.

OBJECTIVES

The objectives of our study were (i) to determine the dynamometric profile of hip muscle strength in young soccer players by position, evaluated at different isokinetic speeds, (ii) to describe the conventional and functional unilateral muscle strength ratios, (iii) to analyze the bilateral balance.

METHODS

Thirty-seven male soccer players (age 17.02 ± 0.92 years) participated in the study. Strength assessment was performed with a functional electromechanical dynamometer, and concentric and eccentric strength of abductors, adductors, extensors and hip flexors were measured bilaterally at 0.5 m/s and 1 m/s.

RESULTS

For eccentric right hip abduction at 0.5 m/s, defenders are significantly stronger than midfielders (p = 0.013) and stronger than forwards (p = 0.140). For eccentric right hip adduction at 0.5 m/s, defenders are significantly stronger than midfielders (p = 0.005) and stronger than forwards (p = 0.253), as for eccentric right hip adduction at 1 m/s, defenders are significantly stronger than midfielders (p = 0.014) and stronger than forwards (p = 0.084). There is a significant effect for the conventional strength ratio of left abduction/adduction at 1 m/s. The conventional strength ratio of forwards is significantly higher than that of defenders (p = 0.045) and higher than that of midfielders (p = 0.152).

CONCLUSIONS

Concentric and eccentric hip strength values differ according to playing position.

Inter-limb asymmetries and kicking limb preference in English premier league soccer players

The aims of this study were: (1) to quantify interlimb asymmetries in EPL soccer players in the context of kicking limb preference and (2) to establish the relationship between interlimb asymmetries and measures of physical performance. Twenty-two players (age: 21.8 ± 4.4 years) from an EPL club performed a running gait assessment (20 km/h) and unilateral countermovement jumps, a CoD assessment (modified 505 test), and an isokinetic knee extension/flexion protocol using each leg. Asymmetries were quantified using the percentage difference method and Pearson's correlations were used to quantify the association between variables. Players displayed the greatest level of asymmetry in isokinetic strength measures (5.9–12.7%) and lower levels of asymmetry in gait (1.6–7.7%), jump (0.9–7.0%) and CoD (1.9–3.5%) assessments. The influence of the preferred kicking limb was most evident in the isokinetic assessment with the players showing dominance in the preferred limb for knee flexor strength and in the non-preferred limb for knee extensor strength. These manifested in the asymmetry values calculated for the hamstring:quadricep (H:Q) ratios at 60°/s (8.80 ± 7.82%) and 240°/s (11.22 ± 7.04%) and in the functional H:Q ratio (12.67 ± 8.25%). The asymmetry values for peak extensor moment at 240°/s showed a significant correlation (ρ = −0.55, p = 0.034) with 10 m time in the CoD assessment. These findings provide benchmark asymmetry data for soccer practitioners and reveal that kicking limb preferences may bring about interlimb differences in the H:Q ratio which raises important considerations in the design of testing batteries and injury reduction interventions.

Bilateral asymmetry of hamstring to quadriceps isokinetic torque ratio in different angular velocities in professional basketball players

BACKGROUND

Bilateral symmetry evaluation in lower limb is used for injury prevention, and is an indicator of returning to post-injury activity. The aim of present study was to investigate the effect of different angular velocities on asymmetry of the hamstring-to-quadriceps strength ratio.

METHOD

Isokinetic concentric hamstring to quadriceps (H:Q) peak torque ratio of the 27 male and female professional basketball players was measured at seven angular velocities (60, 90, 120, 150, 180, 180, 240, 300 deg s^-1) on both dominant and non-dominant legs with Biodex Isokinetic Dynamometer. Repeated measure analysis of variance was used to assess the effects of angular velocity and limb side on our outcomes (p≤ 0.05).

RESULTS

The results showed that with increasing angular velocity, the ratio of hamstrings to quadriceps increases (p = 0.001). There was no difference between dominant and non-dominant limbs in the H:Q peak torque ratio (p = 0.254). In addition, velocity of measurement did not affect the bilateral asymmetry of peak torque ratio of the H:Q of both sides (p = 0.852).

CONCLUSIONS

Based on the results of this study, it can be concluded that measurement velocity does not affect the bilateral asymmetry of the H:Q peak torque ratio of the dominant and non-dominant limbs. In clinical assessments of H:Q bilateral asymmetry, we suggest that physical trainer can assess bilateral asymmetry of H:Q with arbitrary angular velocities.

The Validity of the 2-Point Method for Assessing the Force-Velocity Relationship of the Knee Flexors and Knee Extensors: The Relevance of Distant Force-Velocity Testing

Over the past decade, force-velocity (F-v) profiling has emerged as a promising tool for assessing neuromuscular capacity to design individually tailored interventions in diverse populations. To date, a limited number of studies have addressed the optimization of the linear method for measuring F-v profiles of single-joint isokinetic movements. We aimed to simplify the measurement of knee extension (KE) and knee flexion (KF) isokinetic tasks by evaluating the most appropriate combination of two velocities (i.e., the 2-point method). Twenty-two healthy participants (11 males and 11 females) were included in the study. Isokinetic peak torque was measured at nine angular velocities (30-60-90-120-150-180-210-240-300°/s) and under isometric conditions (at 150° and 120° of KF for KE, and KF, respectively). Maximal theoretical force (F₀), maximal theoretical velocity (v₀), slope of the relationship (S_fv) and maximal theoretical power (P_max) were derived from the linear F-v profiles of KE and KF and compared between the 9-point method and all possible combinations (36 in total) of the 2-point methods. The F-v profiles obtained from nine points were linear for KE (R2 = 0.95; 95% CI = 0.94–0.96) and KF (R2 = 0.93; 95% CI = 0.90–0.95), with F₀ underestimating isometric force. Further analyses revealed great to excellent validity (range: ICCs = 0.89–0.99; CV = 2.54%–4.34%) and trivial systematic error (range: ES = −0.11–0.24) of the KE 2-point method when force from distant velocities (30°/s, 60°/s or 90°/s combined with 210°/s, 240°/s or 300°/s) was used. Similarly, great to excellent validity and trivial systematic error of the KF 2-point method for F0 and Pmax (range: ICC = 0.90–0.96; CV = 2.94%–6.38%; ES = −0.07–0.14) were observed when using the previously described combinations of velocities. These results suggest that practitioners should consider using more distant velocities when performing simplified isokinetic 2-point single-joint F-v profiling. Furthermore, the F-v profile has the potential to differentiate between the mechanical properties of knee extensors and flexors and could therefore serve as a potential descriptor of performance.

The Relationship between the Hamstring-to-Quadriceps Ratio and Jumping and Sprinting Abilities of Young Male Soccer Players

The correct torque ratio between the knee joint extensor and flexor muscle groups can effectively prevent injuries to the anterior cruciate ligament and hamstring strain. However, it is unclear whether a high torque ratio of the knee joint flexor muscles to the extensor muscles is beneficial for sport performance. Therefore, the aim of the study was to investigate the relationship between the hamstring-to-quadriceps (H/Q) ratio and sprint times (10- and 30-m) and jump heights (CMJ—countermovement jump and SJ—squat jump) in soccer players. The study examined 26 young elite soccer players (age: 18.1 ± 0.7 years; body height: 1.77 ± 0.05 m; body mass: 72.7 ± 5.7 kg). Knee joint flexor and extensor peak torques were assessed using the Cybex dynamometer (at 60°/s, 120°/s and 180°/s). Additionally, each participant performed the CMJ, SJ, and 30 m sprint. A significant relationship was obtained between the H/Q ratio (60°/s) and 30 m sprint time (r = 0.47). The positive direction of this relationship may indicate an important role of knee joint extensors in sprinting performance. Moreover, the H/Q ratio was not significantly associated with the CMJ, SJ or 10 m sprint performance. The H/Q ratio should be considered together with the peak torque values in terms of the assessment of sprinting and jumping performance.

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

CONTEXT

Soccer players often have a dominant (D) leg, which could influence the relative strength between the quadriceps and hamstrings. The hamstring-to-quadriceps (H:Q) ratio can be assessed on a dynamometer at various velocities to provide information on injury risk.

OBJECTIVE

To assess the concentric hamstrings and concentric quadriceps strength ratio (conventional H:Q ratio) assessed in D and nondominant (ND) legs at various speeds in male soccer players.

DATA SOURCES

A systematic literature search was completed from inception to 2020 in PubMed, Academic Search Ultimate, CINAHL, and SPORTDiscus.

STUDY SELECTION

Keywords associated with the H:Q ratio were connected with terms for soccer players. Titles and abstracts were screened by 2 reviewers based on inclusion and exclusion criteria related to sex, playing level, language, and measurement. A total of 81 studies were reviewed and 17 studies (21%) were used.

STUDY DESIGN

A meta-analysis with random effects modeling generated standardized mean differences with 95% CIs between legs and speeds.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

A total of 38 cohorts were identified, with 14, 13, and 11 cohorts assessed at low, intermediate, and high velocities, respectively. The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies from the National Institutes of Health was used.

RESULTS

The mean H:Q ratio at low velocities was 59.8 ± 9.5% in D leg and 58.6 ± 9.9% in ND leg, 64.2 ± 10.7% (D) and 63.6 ± 11.3% (ND) at the intermediate velocity, and 71.9 ± 12.7% (D) and 72.8 ± 12.7% (ND) at the high velocity. Low, intermediate, and high velocities had small effects of 0.13, 0.10, and -0.06, respectively.

CONCLUSION

Conventional H:Q ratios vary across velocities but did not differ between D and ND limbs in male soccer players. This study may provide the foundation to establish norms and clinically meaningful differences.

Reliability of a Clinical Test for Measuring Eccentric Knee Flexor Strength Using a Handheld Dynamometer

CONTEXT

Eccentric knee flexor strength assessments have a key role in both prevention and rehabilitation of hamstring strain injuries.

OBJECTIVE

To verify the reliability of a clinical test for measuring eccentric knee flexor strength during the Nordic hamstring exercise using a commercially available handheld dynamometer.

DESIGN

Reliability study.

SETTING

Physical Therapy Laboratory, Federal University of Health Sciences of Porto Alegre (Brazil).

PARTICIPANTS

Fifty male amateur athletes (soccer or rugby players; 24 [3] y).

MAIN OUTCOME MEASURES

Eccentric knee flexor strength.

RESULTS

When compared with a load cell-based device, the clinical test using a handheld dynamometer provided smaller force values (P < .05) with large effect sizes (.92-1.21), moderate intraclass correlation (.60-.62), typical error of 30 to 31 N, and coefficient of variation of 10% to 11%. Regarding the test-retest reproducibility (2 sessions separated by 1 week), the clinical test provided similar force values (P > .05) with only small effect sizes (.20-.27), moderate to good correlation (.67-.76), typical error of 23 to 24 N, and coefficient of variation of 9% to 10%.

CONCLUSION

The clinical test with handheld dynamometer proposed by this study can be considered an affordable and relatively reliable tool for eccentric knee flexor strength assessment in the clinical setting, but results should not be directly compared with those provided by load cell-based devices.

Hamstring and ACL injuries impacts on hamstring-to-quadriceps ratio of the elite soccer players: A retrospective study

This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s^-1. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.

Do age and body size affect the eccentric knee flexor strength measured during the Nordic hamstring exercise in male soccer players?

The study aimed to verify how age, height, body mass and body mass index affects the eccentric knee flexor strength during the Nordic hamstring exercise (NHE) in male soccer players. Ten professional soccer clubs were included in this cross-sectional trial. Three hundred and eleven soccer players (192 from senior and 119 from under-20 teams) were assessed using a load-cell based device. Pearson's correlation tests were performed between peak force values (measured in Newtons) and age, height, body mass and body mass index. The individual-limb strength (n = 622 limbs) and the between-limb average strength (n = 322 players) presented no correlation with age (r = 0.12 for both) and height (r = 0.13; r = 0,15), and fair correlations with body mass (r = 0.37; r = 0,41) and body mass index (r = 0.40; r = 0,43). In conclusion, the male soccer players' eccentric knee flexor strength measured during the NHE execution is not affected by age or height. Body mass and body mass index play somewhat effect on strength, thus normalising absolute strength measures by body mass or body mass index can provide more accurate analysis in some contexts.

Effect of Cycle-Based High-Intensity Interval Training and Moderate to Moderate-Intensity Continuous Training in Adolescent Soccer Players

Cardiorespiratory fitness, anaerobic power, and lower extremity strength are essential for soccer players at all levels. An effective program should be developed to improve physical strength for adolescent soccer players who need to combine academic and technical training. This study analyzed the impact of short-term high intensity interval training (HIIT) training and traditional moderate intensity continuous training (MICT) on adolescent soccer players. Participants included 56 adolescent soccer players who were divided into HIIT and MICT groups. The training program was conducted 3 times a week for 4 weeks using cycle ergometer. Each session included the same resistance training program, and the characteristics of HIIT and MICT were applied to improve cardiorespiratory fitness and anaerobic power. Body composition analysis, graded exercise test for peak oxygen uptake (VO₂ peak), Wingate anaerobic power test, and isokinetic knee strength test were performed. VO₂ peak was improved in HIIT and MICT, but anaerobic threshold and heart rate recovery significantly improved in the HIIT group. Wingate anaerobic peak power had increased significantly in sets 1, 2, and 3 in the HIIT group, but showed significant improvement only in set 1 in the MICT group. The isokinetic strength improved significantly in the HIIT group at 60°/s and in the MICT group at 240°/s. There was no significant change in body composition in either group. In conclusion, short-term HIIT administered to adolescent soccer players effectively improved cardiorespiratory fitness in HIIT and MICT groups. While HIIT increased anaerobic threshold and power, MICT effectively improved muscle endurance. Short-term intensive training can be considered a time-efficient training strategy.

A Narrative Review of Limb Dominance: Task Specificity and the Importance of Fitness Testing

ABSTRACT

Virgile, A and Bishop, C. A narrative review of limb dominance: Task specificity and the importance of fitness testing. J Strength Cond Res 35(3): 846-858, 2021-Preferential limb function must be sustained through repetitious asymmetrical activities for continuous athletic development and, ultimately, optimal athletic performance. As such, the prevalence of limb dominance and between-limb differences is common in athletes. Severe between-limb differences have been associated with reductions in athletic performance and increased injury risk in athletes. However, in the current literature, the terms limb preference and limb dominance have been used interchangeably. Together, these terms include a limb that is subjectively preferred and one that is objectively dominant in 1 or more performance measures from a variety of athletic tasks. In this review, we (a) discuss reported correspondence between task-specific limb preference and limb dominance outcomes in athletes, (b) provide greater context and distinction between the terms limb preference and limb dominance, and (c) offer pragmatic strategies for practitioners to assess context-specific limb dominance. A limb that is subjectively preferred is not necessarily objectively dominant in 1 or more athletic qualities or sport-specific tasks. Further to this, a limb that is objectively superior in 1 task may not exhibit such superiority in a separate task. Thus, limb preference and limb dominance are both task-specific. As such, we propose that practitioners intentionally select tasks for limb dominance assessment which resemble the most relevant demands of sport. Because limb dominance profiles are inconsistent, we suggest that practitioners increase assessment frequency by integrating limb dominance testing into standard training activities. This will allow practitioners to better understand when changes reflect sport-specific adaptation vs. potential performance or injury ramifications.

Influence of Fatigue on the Rapid Hamstring/Quadriceps Force Capacity in Soccer Players

The objective of this study was to examine the effect of fatigue on maximal and rapid force capacities and muscular activation of the knee extensors and flexors. Seventeen professional soccer players volunteered to participate in this study. Peak torque (T_peak) and rate of torque development (RTD) of knee flexor (90°. s^-1, -30°. s^-1) and extensor (90°. s^-1) muscles were measured before and after fatigue (i.e., 30 maximal knee extension and flexion repetitions at 180°s^-1) performed on an isokinetic dynamometer. Hamstring to quadriceps peak strength and RTD ratios were calculated. Besides, using surface EMG, the mean level of activation (RMS_mean), Rate of EMG Rise (RER), and EMG Frequency-Time maps were measured on quadriceps and hamstring muscles. Following fatigue, T_peak, RTD, RER declined significantly in the two muscle groups (all p < 0.05) without modification of RMS_mean. No decrease in conventional and functional H/Q ratios was observed after fatigue except for a significant increase in the H _ecc30/Q _con180 ratios (1.03 ± 0.19 vs. 1.36 ± 0.33, p < 0.001). Besides, the RTD H/Q ratios decreased significantly after fatigue, and the statistical parametric mapping analysis (SPM) performed on the EMG/angle curves, and EMG Frequency-Time maps showed that fatigue strongly influenced the muscle activation during the first 100 ms of the movement, following the higher EMG frequency component shift toward the lower frequency component. Our results show that the reduction of RTD and RER during the first 100 ms of the contraction after fatigue exercise makes more sense than any H/Q ratio modification in understanding injury risk in soccer players.

Lower-Limb Muscle Strength, Anterior-Posterior and Inter-Limb Asymmetry in Professional, Elite Academy and Amateur Soccer Players

Given the importance of the lower-limb strength and strength balance in soccer players and its relationship with injury prevention and performance, the present study compared quadriceps and hamstrings strength, the conventional (H_conc:Q_conc), functional (H_ecc:Q_conc) hamstrings-to-quadriceps ratio and inter-limb strength asymmetry in professional, elite academy and amateur male soccer players. In this cross-sectional study, two hundred-six soccer players (professional = 75, elite academy = 68, amateurs = 63) volunteered to participate. Quadriceps and hamstrings isokinetic peak torque was investigated at 60^° _.s^-1 in both the concentric and eccentric modality and at 300^°.s^-1 in the concentric modality. The conventional H_conc:Q_conc, functional H_ecc:Q_conc ratio and quadriceps and hamstrings inter-limb strength asymmetry were then calculated. Professional players presented greater quadriceps and hamstrings strength than elite academy (effect size from small to moderate) and amateur players (moderate to very large). Both the conventional H_conc:Q_conc and functional H_ecc:Q_conc ratio were greater in professional than elite academy and amateur players (small to moderate). Overall, quadriceps and hamstrings inter-limb strength asymmetry was greater in amateurs than professional (small to very large) and elite academy (trivial to large) players. The present findings provide coaches and medical staffs with normative lower-limb muscle strength data on professional, academy and amateur soccer players. Overall lower-limb muscle strength and inter-limb strength asymmetry could be used to evaluate possible inference on injury prevention and performance. The hamstrings-to-quadriceps ratio poorly differentiates between the soccer players background and offers limited prediction for injury prevention and performance.

Unilateral and Bilateral Strength Asymmetry among Young Elite Athletes of Various Sports

Background and objective: Type of physical activity may influence morphological and muscular asymmetries in the young population. However, less is known about the size of this effect when comparing various sports. The aim of this study was to identify the degree of bilateral asymmetry (BA) and the level of unilateral ratio (UR) between isokinetic strength of knee extensors (KE) and flexors (KF) among athletes of three different types of predominant locomotion in various sports (symmetric, asymmetric and hybrid). Material and methods: The analyzed group consisted of young elite athletes (n = 50). The maximum peak muscle torque of the KE and KF in both the dominant (DL) and non-dominant (NL) lower limb during concentric muscle contraction at an angular velocity of 60°·s⁻¹ was measured with an isokinetic dynamometer. Results: Data analysis showed a significant effect of the main factor (the type of sport) on the level of monitored variables (p = 0.004). The type of sport revealed a significant difference in the bilateral ratio (p = 0.01). The group of symmetric and hybrid sports achieved lower values (p = 0.01) of BA in their lower limb muscles than those who played asymmetric sports. The hybrid sports group achieved higher UR values (p = 0.01) in both lower limbs. Conclusions: The results indicate that sports with predominantly symmetrical, asymmetrical, and hybrid types of locomotion affected the size of the BA, as well as the UR between KE and KF in both legs in young athletes. We recommend paying attention to regular KE and KF strength diagnostics in young athletes and optimizing individual compensatory exercises if a higher ratio of strength asymmetry is discovered.

Effect of a Simulated Match on Lower Limb Neuromuscular Performance in Youth Footballers-A Two Year Longitudinal Study

The aim of this study was to explore the effects of simulated soccer match play on neuromuscular performance in adolescent players longitudinally over a two-year period. Eleven players completed all measurements in both years of the study (1st year: age 16.0 ± 0.4 y; stature 178.8 ± 6.4 cm; mass 67.5 ± 7.8 kg; maturity-offset 2.24 ± 0.71 y). There was a significant reduction in hamstring strength after simulated match by the soccer-specific aerobic field test (SAFT⁹⁰), with four out of eight parameters compromised in U16s (4.7–7.8% decrease) and six in the U17s (3.1–15.4%). In the U17s all of the concentric quadriceps strength parameters were decreased (3.7–8.6%) as well as the vastus lateralis and semitendinosus firing frequency (26.9–35.4%). In both ages leg stiffness decreased (9.2–10.2%) and reactive strength increased pre to post simulated match (U16 8.0%; U17 2.5%). A comparison of changes between age groups did not show any differences. This study demonstrates a decrease in neuromuscular performance post simulated match play in both ages but observed changes were not age dependent.

Muscle excitation, force response, and efficiency during explosive force production after diacutaneous fibrolysis on lateral gastrocnemius of recreational athletes

OBJECTIVE

Fibrous adhesions impair normal muscle mechanics. The present study aimed to assess lateral gastrocnemius muscle excitation, isometric force response, and neuromuscular efficiency during explosive force in plantarflexion before and after diacutaneous fibrolysis.

METHODS

Thirty-five recreational athletes were allocated in the intervention group (n = 20) treated with diacutaneous fibrolysis, while the sham group (n = 15) was treated with placebo diacutaneous fibrolysis. Force response synchronized with surface electromyography during a plantarflexion task was collected.

RESULTS

Differences between Pre- and Post-diacutaneous fibrolysis were observed for all variables, except for the placebo group.

CONCLUSIONS

Diacutaneous fibrolysis was effective to increase force, muscle excitation, and neuromuscular efficiency on lateral gastrocnemius.

Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance

Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed.

Poor hamstrings-to-quadriceps torque ratios in male soccer players: weak hamstrings, strong quadriceps, or both?

This study aimed to evaluate the influence of hamstrings and quadriceps strength on the hamstrings-to-quadriceps conventional (H:Q_con) and functional (H:Q_fun) ratios in male soccer players. Quadriceps concentric peak torque (PT) and hamstrings concentric and eccentric PT were assessed with isokinetic dynamometry at 60°/s in 101 players (202 legs). The cut-points of 0.50, 0.55 and 0.60 were used to assess muscle imbalance through the H:Q_con ratio, while 0.80, 0.85 and 0.90 were used for H:Q_fun ratio. Legs with lower H:Q_con ratio had decreased hamstrings concentric PT (p < 0.01; moderate and large effect sizes) and increased quadriceps concentric PT (p < 0.01; moderate effect sizes) in all cut-points. Legs with lower H:Q_fun ratio had decreased hamstrings eccentric PT (p < 0.01; large effect sizes) for all cut-points, and controversial results for quadriceps concentric PT (p < 0.01 only for 0.80 cut-point; small effect sizes). H:Q_con ratio presented only weak correlations with quadriceps (r = -0.37) and hamstrings (r = 0.45) concentric PT, while H:Q_fun ratio had a negligible correlation with quadriceps concentric PT (r = -0.30) and a moderate correlation with hamstrings eccentric PT (r = 0.66). In conclusion, our findings support that hamstrings strength deficit is the key factor for low H:Q ratios in male soccer players, especially those with poor H:Q_fun ratio.

Alternative Methods of Determining Hamstrings-to-Quadriceps Ratios: a Comprehensive Review

The hamstrings-to-quadriceps muscle strength ratio calculated by peak torque has been used as an important tool to detect muscle imbalance, monitor knee joint stability, describe muscle strength properties and functionality, and for lower extremity injury prevention and rehabilitation. However, this ratio does not consider other neuromuscular variables that can also influence the antagonist to agonist muscle relationship, such as torque produced at multiple angles of range of motion, explosive strength, muscle size, muscle fatigue, or muscle activation. The aim of this study was to comprehensively review alternative methods of determining the hamstrings-to-quadriceps ratio. These include ratios calculated by angle-specific torque, rate of torque development, muscle size, fatigue index, and muscle activation (measured by electromyography). Collectively, the literature demonstrates that utilizing alternative methods of determining the hamstrings-to-quadriceps ratio can be functionally relevant for a better understanding of the neuromuscular mechanisms underpinning the interaction of strength between hamstrings and quadriceps. However, there is insufficient evidence to recommend any of the alternative methods as sensitive clinical tools for predicting injury risk and monitoring knee joint integrity. Future longitudinal studies, along with injury incidence, are needed to further investigate all alternative methods of determining the hamstrings-to-quadriceps ratio. These have potential to offer insight into how athletes and the general population should be trained for performance enhancement and injury reduction, and may be used along with traditional methods for a thorough assessment of an individual’s H:Q muscle balance.

Photobiomodulation therapy as a tool to prevent hamstring strain injuries by reducing soccer-induced fatigue on hamstring muscles

Muscle fatigue is a potential risk factor for hamstring strain injuries in soccer players. The aim of this study was to verify the effect of photobiomodulation therapy (PBMT) on the hamstrings' muscle fatigue of soccer players during a simulated match. Twelve male amateur soccer players (~ 25 years) participated in this randomized, crossover, double-blinded, placebo-controlled trial. The volunteers were evaluated in two sessions, with a minimum 7-day interval. At each session, volunteers received either PBMT (300 J per thigh) or placebo treatment on the hamstrings prior to the simulated soccer match. Muscle strength and functional capacity were evaluated through isokinetic dynamometry and countermovement jump (CMJ) tests, respectively, before and immediately after the simulated soccer match. Players had lower reductions on hamstring eccentric peak torque [4.85% (ES = 0.31) vs. 8.72% (ES = 0.50)], hamstring-to-quadriceps torque ratio [3.60% (ES = 0.24) vs. 7.75% (ES = 0.50)], and CMJ height [1.77% (ES = 0.09) vs. 5.47% (ES = 0.32)] when treated with PBMT compared to placebo. Magnitude-based inference supports that PBMT promoted 75%, 69%, and 53% chances for beneficial effects on hamstring eccentric peak torque, hamstring-to-quadriceps torque ratio, and CMJ height, respectively, compared to placebo treatment. In conclusion, PBMT applied before a simulated soccer match proved to be effective in attenuating the hamstrings' muscle fatigue. These findings support PBMT as a promising tool to prevent hamstring strain injury in soccer players.