Analysis of lower limb asymmetries by isokinetic and vertical jump tests in soccer players

Functional and Lateral Asymmetry of the Knee Joint Muscles Measured Using Tensiomyography (TMG) in Professional Football Players of Different Playing Positions

Background/Objectives: The aim of this study is to determine whether different playing positions in football influence muscle asymmetry, which is a common cause of injuries in football. This study aimed to determine the difference in the functional and lateral asymmetry of the knee joint muscles measured using tensiomyography (TMG) between football players of different playing positions. Methods: This study included 52 professional football players (25.1 ± 4.7 years) divided into three groups according to their playing position: defenders-DF (N = 18), midfielders-MF (N = 15), and forwards-FW (N = 19). Functional and lateral symmetry were investigated by applying TMG on the knee joint muscles Rectus femoris, Vastus medialis, Vastus lateralis, Biceps femoris, and Semitendinosus of the right and left leg, and using the algorithm proposed by the manufacturer and previous studies. Results: The results of one and two-way ANOVA revealed no significant differences in functional (F = 0.596, p = 0.555, on average) and lateral asymmetry (F = 0.888, p = 0.497, on average) from the aspect of muscle contraction velocity and muscle stiffness between football players of different playing positions. Conclusions: The study results show that the specificity of the playing position in football does not influence the functional and lateral asymmetry of the knee joint muscles. However, it has been shown that there is a high percentage of players with lateral (n = 14.5, 39.6%, on average) and specifically functional asymmetry (n = 27, 51.9%, on average).

Muscular robusticity and strength in the lower extremities in elite handball players

The relationship between structural and functional of parameters of skeletal muscles in young athletes needs further observations. The analyses of their age-group differences, sexual dimorphism, asymmetry characteristics in body regions, in sports having different pattern of physical loading could serve important information in this topic. 175 elite Hungarian handball players aged between 14 and 21 years were examined in 2023. Muscle mass component of the body segments was estimated by DEXA method and muscle thickness of the anterior mid-thigh region was measured by a new ultrasonic technique. The strength of knee extensor muscles was assessed by using an isokinetic protocol (Kineosystem dynamometer). A strong association between muscle robusticity and strength in the thigh region was confirmed in males, but not in females. Asymmetry in muscle mass reflected in the asymmetry in the knee extensor strength. A new predictive equation of muscle mass in the jumping leg and the total body from the muscle thickness in the anterior mid-thigh region of jumping leg was introduced. The exploration and understanding of asymmetric structural and functional adaptations can help athletes and trainers in planning the training and training interventions to reduce the risk of injuries.

Assessment of Strength and Power Capacities in Elite Male Soccer: A Systematic Review of Test Protocols Used in Practice and Research

BACKGROUND

Strength and power represent two crucial physical qualities for the attainment of a high level of performance considering the frequency and the importance of explosive actions occurring during elite soccer match-play. Evaluation of strength and power is a multifaceted concept involving a vast array of tests and outcome variables. Nevertheless, a comprehensive and systematic search of strength and power assessment procedures in elite soccer has yet to be undertaken.

OBJECTIVES

The aims of this systematic review were to: (1) identify the tests and outcome variables used to assess strength and power of elite male soccer players; (2) provide normative values for the most common tests of strength and power across different playing levels; and (3) report the reliability values of these strength and power tests.

METHODS

A systematic review of the academic databases MEDLINE, CINAHL, SPORTDiscus, Web of Science and OVID for studies published until August 2023 was conducted, following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were eligible for inclusion if they: (1) were original research studies, published in a peer-reviewed journal, and written in English language; (2) had the primary aim to assess strength and/or power; (3) players were male and older than 17 years of age (i.e., mean age of the group); and (4) their playing level was defined as "professional", "international" or "elite".

RESULTS

Regarding strength testing, 115 studies and 29 different tests were identified. The three most frequent strength tests were the knee extensor isokinetic strength test (58 studies), the knee flexor isokinetic strength test (55 studies) and the Nordic hamstring strength test (13 studies). In terms of power testing, 127 studies with 31 different tests were included. The three most frequent power tests were the countermovement jump with hands fixed on hips (99 studies), the squat jump (48 studies) and the vertical jump with arm swing (29 studies).

CONCLUSIONS

The wide range of different tests and outcome variables identified in this systematic review highlights the large diversity in the employed testing procedures. The establishment of a hybrid testing approach, combining standardised and widely accepted tests for establishing normative standards and enabling comparisons across different contexts, with flexible context-specific testing batteries, has the potential to maximise the impact of testing information for practitioners. In addition, the limited reporting of reliability data across studies highlights the need for practitioners to establish their own reliability measure within their specific contexts, informing the selection of certain tests and outcome variables.

Knee muscle strength, body composition, and balance performance of youth soccer players

BACKGROUND

Muscle strength and balance abilities have been related to game performance injury prevention. This study aimed to (1)  assess knee muscle strength performance based on intra- and inter-limb asymmetries, (2)  investigate the relationships between knee muscle strength, body composition, and balance, and (3) analyze the variance in the overall stability index (OSI) explained by knee muscle strength indicators after controlling for age and body composition.

METHODS

The sample included 104 young male soccer players (16.0 ± 1.6 years). Body composition, knee muscle strength, and balance ability were assessed. A paired samples t-test was used to examine differences between the preferred leg (PL) and the non-preferred leg (NPL). Pearson correlations and hierarchical multiple regression were conducted to explore the relationships between strength, body composition, and balance.

RESULTS

No significant inter-limb asymmetries were detected for the knee flexors (KF) and knee extensors (KE) performance. The hamstrings-to-quadriceps ratio does not suggest the existence of intra-limb asymmetries (p = 0.06). Significant and negative correlations were found between KF (r = -0.38, p ≤ 0.01) and KE (r = -0.58, p ≤ 0.01) for the PL. Concerning the NPL, KE also revealed a significant and negative relationship with balance (r = -0.30, p ≤ 0.01). Significant and positive relationships were found between bodyweight, fat-free mass, and balance. After controlling for age and body composition, knee muscle strength could explain between 13% and 30% of the variance observed in the OSI (NPL and PL, respectively).

CONCLUSIONS

The results underline knee muscle strength as an important predictor of balance. Thus, training programs targeting knee muscle strength development should be considered during the season periodization by coaches and their staff throughout the players' developmental stages.

Seasonal Comparison of Pre-Adolescent Soccer Players' Physical Performance Using an Objective Physical Test Battery

BACKGROUND/OBJECTIVE

Soccer is a multifactorial sport, requiring physical, psychological, technical, and tactical skills to succeed. Monitoring and comparing physical characteristics over time is essential to assess players' development, customize training, and prevent injury. The use of wearable sensors is essential to provide accurate and objective physical data.

METHODS

In this longitudinal study, 128 male adolescent soccer players (from Under 12 to Under 19) were evaluated at two time points (pre- and post-season). Participants completed the Euleria Lab test battery, including stability, countermovement and consecutive jumps, agility, and quick feet tests. A single Inertial Measurement Unit sensor provided quantitative data on fifteen performance metrics. Percentage changes were compared to the Smallest Worthwhile Changes to assess significant changes over time.

RESULTS

The results showed significant improvements in most variables, including a 19.7% increase in quick feet, 10.9% in stability, and 9.6% in countermovement jumps. In principal component analysis, we identified four principal components-strength-power, balance, speed-agility, and stiffness-that explained over 80% of the variance.

CONCLUSIONS

These findings align with previous studies assessing seasonal changes in adolescent soccer players, showing that the proposed test battery seems to be adequate to highlight physical performance changes and provide coaches with meaningful data to customize training and reduce injury rates.

Relationships among countermovement vertical jump performance metrics, strategy variables, and inter-limb asymmetry in females

Dependent variables commonly studied during countermovement vertical jump (CMVJ) tests largely stem from male-only studies despite females'distinct energy storage and reutilisation strategies. This could limit progress among females seeking increased CMVJ performance through targeted changes in certain variables. We explored relationships between CMVJ performance metrics (jump height, modified reactive strength index, jump power, and takeoff momentum) and (a) temporal and force application variables and (b) inter-limb force and yank (i.e., rate of force development) asymmetry in 31 recreationally active females. Participants performed eight CMVJs while ground reaction force (GRF) data were obtained. Pearson product-moment correlation coefficients assessed the strength and direction of the associations. Twenty-six significant relationships (r ≥ ±0.357; p < 0.05) were detected across the CMVJ performance variables. The significantly correlated variables were generally isolated to only one of the four performance metrics. Only the percentage of concentric phase inter-limb force asymmetry was significantly associated with CMVJ performance, specifically jump power and takeoff momentum. Coaches and physical performance professionals should be aware of popular strategy variables' association or lack of association with commonly studied performance metrics when seeking to understand or improve specific CMVJ jumping abilities in females.

The association between unilateral and bilateral performance-related measures in elite female soccer players: a multifaceted investigation

Purpose

The present study aimed to investigate a) the associations between bilateral performance utilizing countermovement jump (CMJ), squat jump (SJ), speed and unilateral CMJ, isokinetic peak torque in knee extension and flexion with angular velocities of 60°/s and 180°/s and tensiomyography (TMG) parameters; b) whether the asymmetries derived from unilateral tests are associated with bilateral CMJ, SJ and speed in elite female soccer players.

Methods

Thirty-five elite female soccer players (average age: 20 ± 5 years) completed CMJ, SJ, speed, isokinetic muscle strength and TMG tests.

Results

Compared to the non-dominant leg, the dominant leg demonstrated greater peak torque output in both knee flexion (7.4%) and knee extension (5.6%) isokinetic tasks, as well as m. vastus medialis contraction time (7.6%), and soccer-specific agility test (4.1%). Conversely, the hamstring to quadriceps peak torque ratio at 180°/s (8.5%) was significantly greater in the non-dominant leg. The associations between CMJ, SJ and speed performance were positive and ranged from weak (r = 0.350) to high (r = 0.710). For speed and TMG-derived variables, correlations were negative and ranged from weak (r = -0.345, p = 0.042, for vastus medialis contraction time) to moderate (r = -0.530, p = 0.001, for biceps femoris contraction time). Furthermore, both bilateral CMJ and SJ negatively correlated with TMG-derived variables, ranging from weak (r = -0.350, p = 0.039, for vastus lateralis contraction time) to moderate (r = -0.537, p = 0.003, for rectus femoris contraction time).

Conclusion

The overall significant, albeit inconsistent, correlations between the diverse performance scores obtained highlight the necessity for a multifaceted and thorough diagnostic strategy in female soccer players.

A new approach to quantify asymmetry in human movement

In this perspective paper, we propose a new approach to quantify the asymmetries in human movement. Before describing this approach, we delve into the asymmetry in human movement, often defined as the opposite of symmetry, and its implications for studying human movement. We critically examine the various methods available to quantify and describe bilateral differences, from arbitrary thresholds (such as the commonly employed 10-15% difference) to the measure of the smallest meaningful changes, and we stress the need for consideration of interindividual variability in the analysis. Our proposal centers on a straightforward metric, the probability of agreement, and a corresponding plot summarizing the agreement between measures from two limbs. Critically, the agreement between two limbs depends on the value of the clinically acceptable difference. The agreement will increase with larger values of clinically acceptable difference and decrease with smaller values of clinically acceptable difference. Data from various movements and conditions in athletes' sports training and rehabilitation are used to illustrate this approach. Our perspective provides valuable insights into the nature of asymmetry in human movement, considering that a rational understanding of asymmetry in human movement requires a thoughtful approach encompassing both statistical and clinical significance. The data and codes employed in our research are openly accessible in the supplementary materials, enabling others in the field to replicate and build upon our findings.

Validity and reliability of the My Jump 2 app for detecting interlimb asymmetry in young female basketball players

Introduction

The aim of this study was to examine the validity and reliability of the My Jump 2 app for the assessment of interlimb jump asymmetry in young female basketball players.

Methods

Nine athletes (age 15 ± 0.9 years; weight 62.9 ± 5.8 kg; height 173.6 ± 6.1 cm) performed single-leg drop jumps (DJs) and both-leg drop jumps on a force plate (Kistler Quattro jump) and were simultaneously recorded on two smartphones using the My Jump 2 app. Jump height from flight time and contact time data were statistically analyzed to evaluate the validity of two different camera settings, drop jump performance, and interlimb jump asymmetry in basketball players. The testing was repeated after 1 week for test retest reliability.

Results

High test-retest reliability [intraclass correlation coefficient (ICC) > 0.88] was observed in DJ height. High correlation between the force plate and the My Jump 2 app was observed in DJ height (r = 0.99) and DJ contact time (r = 0.98). For the interlimb jump height asymmetries, mean differences were 0.6 percentages for the My Jump 2 app and the force plate, respectively (p = 0.77). Inter-device reliability revealed almost perfect correlation for the DJ height (ICC = 0.99, r = 0.98).

Conclusion

The My Jump 2 app is a valid and reliable tool to assess drop jump performance and interlimb asymmetry in young female basketball players.

Evaluation of muscular and functional inter-limb asymmetries during mid-season in young male soccer athletes

BACKGROUND

To identify inter-limb asymmetries through the knee's muscular and lower limb functional performance in young male soccer athletes.

METHODS

Twenty male soccer athletes aged 17 to 19 from an under-20 team performed isokinetic tests at 60°/s., 120°/s., 180°/s., and 240°/s. To assess the knee extensors and flexors muscles and functional tests (hop tests and Y-balance test).

RESULTS

There were no significant differences between the dominant limb (DL) and non-dominant limb (NDL) in the knee extensors and flexors peak torque and hamstrings (H)/quadriceps(Q) conventional ratio. Moreover, no angular velocities observed inter-limb asymmetries seen by values higher than 10% in the isokinetic parameters. However, the H/Q conventional ratio shows borderline values in low angular velocities (60°/s. and 120°/s.). No significant changes were observed in the functional test performance between the DL and NDL. Furthermore, we did not see inter-limb asymmetries in both hop and Y-balance tests. On the contrary, the anterior distance reached was lower than found in the literature, and the composite score of the Y-balance test demonstrated values below the normative (>94%).

CONCLUSION

The data demonstrated that soccer athletes have muscular and functional inter-limb symmetry. However, they tend to have knee muscle imbalance in low velocities and dynamic balance deficits that might increase the risk of musculoskeletal injury.

Bilateral differences of isokinetic knee extensor strength are velocity- and task-dependent

The purpose of this study was to investigate the concordance of isokinetic bilateral strength differences of the knee extensors in single- and multi-joint movement tasks. One hundred and nineteen male athletes performed isokinetic legpresses at 0.1 m/s and 0.7 m/s as well as isokinetic knee extensions at 60°/s and 180°/s. Bilateral differences and directed bilateral differences (sign indicating the direction of the difference) were calculated for all measurements. Bland-Altman-Plots were plotted to investigate if the different conditions detect bilateral differences of the same magnitude. Additionally, concordance correlations for the directed bilateral differences of the different tests were calculated to investigate magnitude and direction. The results indicate poor to fair concordance between the bilateral differences in the legpress conditions as well as between single- and multi-joint tasks. The single-joint knee extensions displayed a moderate level of agreement. Bilateral strength differences in isokinetic movement tasks are dependent on movement velocity and the nature of the task (single- or multi-joint movement) in the lower extremities. Both the value and the direction of the strength differences show no clear pattern across the investigated measurements and cannot be used interchangeably. Therefore, to assess interlimb strength balance, multiple different tests should be performed.

Relationships of lower extremity and trunk asymmetries in elite soccer players

In light of previous research highlighting the prevalence of asymmetries in soccer players and possible links to injury risks, there is a crucial gap in the biomechanical understanding of complex relationships between lower extremity and trunk asymmetries in elite soccer players. The purpose of this study was to investigate the level, relationships, and differences among twelve different parameters of strength, morphological, and neuromuscular asymmetries in elite soccer players. Methods: Elite male soccer players (n = 25, age 21.7 ± 3.9 years) were tested in the following tests: bilateral fluid distribution, hip flexor range of motion, postural stability, isokinetic strength of knee extensors and flexors, isometric lateral trunk rotation strength, eccentric strength of knee flexors, isometric bilateral strength of hip adductors, and vertical ground reaction force in counter-movement jump-free arms, counter-movement jump, squat jump, and drop jump tests. One-way ANOVA, Pearson's coefficient (r), and partial eta squared (η p 2) were used for data analysis. Results: Significant differences in asymmetries were found in elite soccer players (F11,299 = 11.01, p < .01). The magnitude of asymmetry over 10% was in postural stability and drop jump parameters. The lowest magnitudes of asymmetries were in the fluid distribution of the lower limbs and the vertical ground reaction force during the take-off phase in squat jumps. The highest asymmetries between the dominant and non-dominant sides were found in postural stability and drop jump. A total of eleven significant correlations (p < 0.05, r = 0.41-0.63, R2 = 0.17-0.40) were detected between the analyzed asymmetries in elite soccer players. The lateral trunk rotation asymmetries were significantly correlated to vertical ground reaction force asymmetries and knee extensors. Conclusion: Long-term exposure in elite soccer leads to unilateral biomechanical loading that induces abnormal strength and morphological adaptations in favor of the dominant side while linking lower limb and trunk strength asymmetries. By unraveling these complex relationships, we strive to contribute novel methods that could inform targeted training regimens and injury prevention strategies in the elite soccer community. The data should encourage future researchers and coaches to monitor and develop trunk strength linked to lower body kinematics.

Movement Asymmetries: From Their Molecular Origin to the Analysis of Movement Asymmetries in Athletes

Asymmetry plays a major role in biology at all scales. This can be seen in the helix of DNA, the fact that the human heart is on the left side, or that most people use their right hand. A single protein such as Myosin 1D can induce helical motion in another molecule. This causes cells, organs, and even entire bodies to twist in a domino effect, causing left-right behaviour. More generally, athlete movements are often asymmetric and, during the physical rehabilitation after injury, the asymmetry is visually discernible. Herein, we review the molecular basis of the movement asymmetries and report on the available knowledge on the few therapeutics investigated so far such as meloxicam. From a more rehabilitative perspective, it is very important to use effective methods to control the process of resolving the injury-related movement asymmetry through the complex use of specialised exercises, measurements, and gait analysis, which can all provide useful information on the effectiveness of the rehabilitation plans. If for each athlete, the normal range of asymmetry is known, the asymmetry can be individually treated and the evolution can be monitored over time. Appropriate measures should be taken if the movement asymmetry is outside this range. In addition, genetic, physiological, and psychological factors relevant to athlete health should be considered in the process of assessing and improving exercise asymmetry, which we also discuss in this review. The main proposal of this work is that the movement asymmetries in athletes should be individually treated, while taking into account the athlete's genetics, physical condition, and previous injuries.

Analysis on the characteristics and relationships of lower limbs strength and power of sailors in different positions and levels

Hikers and trapeze sailors are two main Olympic groups based on their specific role during sail racing. This study was to analyze the characteristics and relationships of lower limbs strength and power of hikers and trapeze sailors with different levels. Forty-five hikers and trapeze sailors were divided into high-level and low-level groups, respectively. The isokinetic dynamometer was used to measure sailors' lower limbs strength. Concentric and eccentric peak torque (PT) were measured for hamstrings and quadriceps at 60°/s, and isometric knee extensions at 45° knee flexion (0° = full extension). The counter movement jump (CMJ) was performed by Kistler to reflect sailors' lower limbs power. The results showed the hikers had higher quadriceps isometric PT, and male hikers had higher concentric and eccentric PT compared to trapeze sailors (p<0.05). For female sailors, the quadriceps' concentric, eccentric and isometric PT of high-level group were higher than low-level group' (p<0.05). The sailors' conventional and functional H/Q ratio ranged from 0.44 to 0.56 and 0.52 to 0.65, respectively. High-level and low-level groups had no difference in CMJ, which was moderately to strongly correlated with the isokinetic strength (r ranging 0.50-0.81, p<0.01). These findings suggest that long-term training can induce specificity in lower limbs strength of sailors. Hikers have better quadriceps isometric strength compared to trapeze sailors. The quadriceps concentric and eccentric PT can be used as parameters to distinguish between high-level and low-level sailors, but CMJ cannot.

Effects of a neuromuscular training program on physical performance and asymmetries in female soccer

Introduction: Women's football require optimal neuromuscular system development for injury prevention and performance optimization. Standardized neuromuscular training programs have shown promising results in reducing injuries and functional asymmetries, but evidence on their impact on performance is limited. Methods: This research examined the effects of a 10-week neuromuscular training program on physical performance and asymmetries in female football players. Thirty-eight female players from two Spanish Second Division women's football teams participated in the study. The physical performance tests used were: ankle dorsiflexion, bilateral and unilateral horizontal jump, bilateral and unilateral vertical countermovement jump, 40 m sprint including partial times at 10, 20 and 30 m and the 505 test for change of direction evaluation. For 10 weeks, players in the experimental group performed three weekly 24-min neuromuscular training sessions. Participants in the control group completed their normal 24-min strength and conditioning program. Results: The main results were that maximal linear velocity and change of direction skills showed the most notable improvements [effect size (ES), 0.46 to 0.59] after implementation of the training program, ankle dorsiflexion and jumping skills, also improved although, to a lesser extent (ES, <0.35) while asymmetries between limbs were reduced. Maximal running speed improved in the intervention group (p < 0.001) with a mean ES -0.59. Discussion: We conclude that a 10-week neuromuscular training program can be a sufficient stimulus to improve football-specific performance variables in high-level female football players. Therefore, female players and coaches should be aware that weekly inclusion of strength, power and dynamic balance exercises following a neuromuscular paradigm is helpful for football-specific performance improvement.

Difference Asymmetry between Preferred Dominant and Non-Dominant Legs in Muscular Power and Balance among Sub-Elite Soccer Players in Qatar

The objective of this study was to determine and compare leg asymmetry between preferred dominant and non-dominant legs in muscular power and balance among sub-elite soccer (football) players in Qatar. Thirty-two professional local soccer players from the Qatar Stars League (Second Division) participated in the study (23.1 ± 6.1 years). They were classified according to their preferred dominant leg (preferred leg to kick the ball). Twenty-two players had a right dominant leg, and the remaining ten had a left dominant leg. Countermovement jump (CMJ) was used to measure unilateral and bilateral vertical jump performances. The Y-balance test (YBT) was used to assess dynamic balance. No significant differences were found between the dominant and non-dominant leg for CMJ flight height (p > 0.05; asymmetry index (AI) = 1.83 ± 11.46) or the relative and absolute reach distance derived from the YBT (p > 0.05; AI (relative) = −0.45 ± 9.68, AI (absolute) = −0.60 ± 12.3). Bilateral asymmetry in dynamic balance was not significant for any of the anterior, posteromedial, or the posterolateral reaching directions (p > 0.05). The selected football players demonstrated an acceptable level of leg symmetry for power and dynamic balance. These findings may prove helpful for the assessment and evaluation of talents and should help to develop and optimize training regimes.

Measuring Interlimb Asymmetry for Strength and Power: A Brief Review of Assessment Methods, Data Analysis, Current Evidence, and Practical Recommendations

ABSTRACT

Bishop, C, de Keijzer, KL, Turner, AN, and Beato, M. Measuring interlimb asymmetry for strength and power: A brief review of assessment methods, data analysis, current evidence, and practical recommendations. J Strength Cond Res 37(3): 745-750, 2023-The aim of this brief narrative review is to summarize the present evidence, provide recommendations for data analysis, and provide appropriate training methods to reduce strength and power asymmetries within athlete populations. Present evidence shows that a strong interest in the assessment of asymmetry exists. Despite the perceived associated relationship between asymmetry and injury and performance, a clear link is still missing. Practitioners need to be aware of this when they decide to assess asymmetries and later design training interventions. Several bilateral and unilateral tests could be used to assess asymmetries, such as isokinetic dynamometry, the isometric mid-thigh pull, squat, and Nordic hamstring exercise. Based on the current evidence, future investigations require further standardization of methodology and analysis to optimize interpretation (e.g., within session and between session), adoption, and implementation of interlimb asymmetry testing and appropriate interventions. In this review, 3 training interventions have been proposed to reduce existing lower limb asymmetries in sport populations: traditional resistance training, flywheel resistance training, and combined training interventions, with some evidence suggesting that such interventions can reduce lower limb asymmetries. Nonetheless, the number and quality of articles currently available are too limited to draw firm conclusions; therefore, further research is needed to verify whether training interventions can achieve these aims. To develop an understanding and application of interventions addressing interlimb asymmetries within the sport, greater methodological rigor should be applied toward study design, data analysis, and interpretation of future investigations and when appraising the current literature.

Reliability of wearable sensors-based parameters for the assessment of knee stability

Anterior cruciate ligament (ACL) rupture represents one of the most recurrent knee injuries in soccer players. To allow a safe return to sport after ACL reconstruction, standardised and reliable procedures/criteria are needed. In this context, wearable sensors are gaining momentum as they allow obtaining objective information during sport-specific and in-the-field tasks. This paper aims at proposing a sensor-based protocol for the assessment of knee stability and at quantifying its reliability. Seventeen soccer players performed a single leg squat and a cross over hop test. Each participant was equipped with two magnetic-inertial measurement units located on the tibia and foot. Parameters related to the knee stability were obtained from linear acceleration and angular velocity signals. The intraclass correlation coefficient (ICC) and minimum detectable change (MDC) were calculated to evaluate each parameter reliability. The ICC ranged from 0.29 to 0.84 according to the considered parameter. Specifically, angular velocity-based parameters proved to be more reliable than acceleration-based counterparts, particularly in the cross over hop test (average ICC values of 0.46 and 0.63 for acceleration- and angular velocity-based parameters, respectively). An exception was represented, in the single leg squat, by parameters extracted from the acceleration trajectory on the tibial transverse plane (0.60≤ICC≤0.76), which can be considered as promising candidates for ACL injury risk assessment. Overall, greater ICC values were found for the dominant limb, with respect to the non-dominant one (average ICC: 0.64 and 0.53, respectively). Interestingly, this between-limb difference in variability was not always mirrored by LSI results. MDC values provide useful information in the perspective of applying the proposed protocol on athletes with ACL reconstruction. Thus, The outcome of this study sets the basis for the definition of reliable and objective criteria for return to sport clearance after ACL injury.

Monitorización y periodización del rendimiento desde la fisioterapia deportiva ¿Hacia dónde vamos?

RESUMEN Introducción El concepto de monitorización y periodización es un visión que se ha desarrollado en la última década, donde se busca que se pueda tener un control de la carga interna y externa en los deportistas de distintas disciplinas deportivas producidas por el proceso de interacción con variables de prescripción de ejercicio que causan modificaciones a nivel fisiológico, bioquímico, biomecanico, muscular, neuromuscular  ocasionando la tensión en los subsistemas del movimiento corporal humano generando adaptaciones especificas ante una carga determinada la cual puede ser medida mediante el uso de tecnología especifica o test indirectos Metodología Revisión de la literatura con la combinación de palabras clave como Monitoring, Performance, sports training load, Periodization en bases de datos como Pubmed, Ebsco, Medline, Scopus, Science Direct Resultados se pudo identificar 65 artículos que referencian la existencia  de herramientas tecnológicas para realizar un proceso de monitorización y periodización desde la rehabilitación , prevención, control de carga, recuperación y readaptación deportiva que permiten la generación de datos estadísticos y crear perfiles desde cada área de actuación del fisioterapeuta deportivo. Conclusión la fisioterapia es una profesión encargada de muchos procesos deportivos que deben ser monitorizados y generen datos que permitan estandarizar procesos, crear perfiles de seguimiento específicos para facilitar la toma de decisiones desde el equipo biomédico e investigaciones en el deporte de alto rendimiento fusionando la practica con la evidencia científica.

Neuromuscular characteristics of front and back legs in junior fencers

In elite fencers, muscle strength and muscle mass of the front leg (FL) are greater than those of the back leg (BL) due to characteristic physiological and biomechanical demands placed on each leg during fencing. However, the development of laterality in their neural and muscular components is not well-understood. The present study investigated neuromuscular characteristics of FL and BL in junior fencers. Nineteen junior fencers performed neuromuscular performance tests for FL and BL, separately. There were no significant differences in the isometric knee extension strength (MVC), unilateral vertical jump (UVJ), vastus lateralis muscle thickness (MT), or motor unit firing rate of the vastus lateralis muscle (MUFR) between FL and BL (p > 0.05). In subgroup analyses, a significantly greater MUFR in FL than BL was noted only in fencers with > 3 years of fencing experience, and significantly greater UVJ in FL than BL was observed solely in fencers with < 3 years of fencing experience (p < 0.05). Strong positive correlations between FL and BL were identified in MVC, MT, and MUFR in fencers with > 3 years of fencing experience, but not in those with < 3 years of experience. These findings suggest that in junior fencers, laterality in neuromuscular performance has not manifested, whereas longer fencing experience induces fencing-dependent laterality in neural components, and laterality in dynamic muscle strength is decreased with fencing experience.

Comparison of bilateral isokinetic and isometric strength differences in elite young male and female taekwondo athletes

Definition of strength imbalance between legs and muscles does not only play a decisive role for higher performance but also prevents sport injury. The purpose of this study was to determine bilateral differences on isokinetic and isometric strength of knee extensor and flexor muscles in male and female elite young taekwondo athletes. Ten male (age: 19.40±0.84 years) and female (age: 18.24±1.42 years) taekwondo athletes of the Turkish national team between 17–20-year of age participated in the study. Concentric peak torque of hamstring (H) and quadriceps (Q) of the dominant (D) and nondominant leg (ND) was evaluated using isokinetic machine (Cybex Humac Norm) at 60° and 180°/sec. Isometric peak torque of both legs was determined at 60°. Significant differences were found between genders (P<0.05). Concentric and isometric knee strength was significantly greater in male than that of female (P< 0.05). Although no significant bilateral strength difference was found in both sexes in concentric and isometric strength (P>0.05), and isometric H strength was in favor of the dominant leg 15% for men athletes and 11% for women. H/Q ratio was similar between gender and legs. The study revealed no bilateral knee strength asymmetry in both male and female taekwondo athletes. However, male had 20%–30% higher isometric and concentric knee extensor and flexor strength than female in both legs.

Individualized Analysis of Lateral Asymmetry Using Hip-Knee Angular Measures in Soccer Players: A New Methodological Perspective of Assessment for Lower Limb Asymmetry

This study aimed to: (1) determine the magnitude and direction of lateral asymmetry in well-trained soccer players using hip and knee ROM tests; (2) inquire if asymmetry relies on the ROM test performed and/or gender; and (3) establish asymmetry thresholds for each ROM test to individualize lower-limbs asymmetry. One hundred amateur soccer players were assessed using hip–knee ROM tests: Straight Leg Raise, modified Thomas Test, hip internal rotation and external rotation, hip abduction (ABD) and adduction (ADD), Nachlas Test and Rigde Test. There are significant differences between tests when determining the magnitude of lateral asymmetry (F = 3.451; p = 0.001; η_p² = 0.031) without significant differences between gender (F = 0.204; p = 0.651; η_p² = 0.001). Asymmetry threshold results differ significantly between using a fixed or a specific threshold (F = 65.966; p = 0.001; η_p² = 0.985). All tests indicate that the direction of asymmetry is towards the dominant limb. In conclusion, the ROM test used determines the magnitude and direction of the lateral asymmetry of the amateur soccer players. The ABD and ADD are the ROM tests that showed higher percentages of asymmetry, without differences between female and male soccer players. Using a specific asymmetry threshold formula can classify more players as asymmetrical than with a fixed threshold.

Interday Reliability of a Testing Battery to Assess Lateral Symmetry and Performance in Well-Trained Volleyball Players

ABSTRACT

Iglesias-Caamaño, M, Álvarez-Yates, T, Carballo-López, J, Cuba-Dorado, A, and García-García, O. Interday reliability of a testing battery to assess lateral symmetry and performance in well-trained volleyball players. J Strength Cond Res 36(4): 895-901, 2022-This study aimed to determine the relative and absolute interday reliability of a testing battery for lateral asymmetry detection and performance in well-trained volleyball players and to determine whether retaining for analysis the best or the average value of 3 attempts would modulate the interday reliability and the magnitude of asymmetry. Thirteen Superleague-2 male volleyball players performed on 3 different days a 5-test battery composed of 4 tests for assessing muscle asymmetries: active knee extension, Y-balance test (YBT), modified 20-yard shuttle run (M-20Y), and single-leg countermovement jump; and one for volleyball sports performance: attack jump (AJ). The intraclass correlation index and coefficient of variation (CV) together with the standard error of measurement (SEM, %SEM) and the minimum detectable change (MDC, %MDC) were taken to calculate relative and absolute reliability. Two-way repeated-measures analysis of variance was used to establish the differences between the best value and the average value in each session. The low %MDC (<10%) suggests that all the tests that make up the testing battery would have good sensitivity to detect possible asymmetries. All tests have shown an excellent interday absolute reliability (CV <4.5%; %SEM < 5%), both when retaining the best value and the average value of the 3 attempts. In addition, AJ and YBT (on both legs) obtained a good-excellent relative reliability, whereas the M-20Y test seems to show a lower relative reliability. Retaining the best value or the average value to determine the magnitude and direction of asymmetry seems to be equally reliable with no differences between both values.

Association between Concentric and Eccentric Isokinetic Torque and Unilateral Countermovement Jump Variables in Professional Soccer Players

Isokinetic tests have been highly valuable to athletic analysis, but their cost and technical operation turn them inaccessible. The purpose of this study was to verify the correlation between unilateral countermovement jump variables and isokinetic data. Thirty-two male professional soccer players were subjected to the isokinetic testing of both knee extensors and flexors in concentric and eccentric muscle contractions. They also executed unilateral countermovement vertical jumps (UCMJ) to compare maximum height, ground reaction force, and impulse power with isokinetic peak torque. Data analysis was conducted through Pearson correlation and linear regression. A high correlation was found between dominant unilateral extensor concentric peak torque and the UCMJ maximum height of the dominant leg. The non-dominant leg jump showed a moderate correlation. No other variable showed statistical significance. Linear regression allowed the generation of two formulae to estimate the peak torque from UCMJ for dominant and non-dominant legs. Although few studies were found to compare our results, leading to more studies being needed, a better understanding of the unilateral countermovement jump may be used in the future as a substitute to the expensive and technically demanding isokinetic testing when it is unavailable, allowing the assessment of lower limb physical asymmetries in athletic or rehabilitation environments.

The Calculation, Thresholds and Reporting of Inter-Limb Strength Asymmetry: A Systematic Review

The prevalence of inter-limb strength differences is well documented in the literature however, there are inconsistencies related to measurement and reporting, and the normative values and effects associated with inter-limb asymmetry. Therefore, the aims of this systematic review were to: 1) assess the appropriateness of existing indices for the calculation of asymmetry, 2) interrogate the evidence basis for literature reported thresholds used to define asymmetry and 3) summarise normative levels of inter-limb strength asymmetry and their effects on injury and performance. To conduct this systematic review, scientific databases (PubMed, Scopus, SPORTDiscus and Web of Science) were searched and a total of 3,594 articles were retrieved and assessed for eligibility and article quality. The robustness of each identified asymmetry index was assessed, and the evidence-basis of the identified asymmetry thresholds was appraised retrospectively using the references provided. Fifty-three articles were included in this review. Only four of the twelve identified indices were unaffected by the limitations associated with selecting a reference limb. Eighteen articles applied a threshold to original research to identify "abnormal" asymmetry, fifteen of which utilised a threshold between 10-15%, yet this threshold was not always supported by appropriate evidence. Asymmetry scores ranged between and within populations from approximate symmetry to asymmetries larger than 15%. When reporting the effects of strength asymmetries, increased injury risk and detriments to performance were often associated with larger asymmetry, however the evidence was inconsistent. Limitations of asymmetry indices should be recognised, particularly those that require selection of a reference limb. Failure to reference the origin of the evidence for an asymmetry threshold reinforces doubt over the use of arbitrary thresholds, such as 10-15%. Therefore, an individual approach to defining asymmetry may be necessary to refine robust calculation methods and to establish appropriate thresholds across various samples and methodologies that enable appropriate conclusions to be drawn.

Levels of Agreement for the Direction of Inter-Limb Asymmetry during Four Simple Change-of-Direction Tests in Young Male Handball Players: A Pilot Study

The purpose of this pilot study was to investigate the effects of change-of-direction (CoD) angle (90° vs. 180°) and the inclusion of acceleration approach on total task time, CoD deficit, and agreement regarding inter-limb asymmetry direction across CoD tasks. The sample included 13 young male handball players (age: 22.4 ± 3.2 years). The CoD tasks were performed over a 10 m distance with 90° and 180° turns. Both CoD tasks were performed under two conditions: (1) from the standing start and, (2) with a 10 m prior acceleration approach. Linear sprint times over a 10 m distance were also recorded for the purpose of determining the CoD deficit. The differences between the outcomes of different test variants were assessed with pairwise t-tests and associated Cohen’s d effect size. The agreement in terms of inter-limb asymmetry direction was assessed descriptively, using percentage of agreement. Results showed that the inclusion of the 10 m approach reduced the total task time (mean differences ranging between 0.26 and 0.35 s; d = 2.27–4.02; p < 0.002). The differences between 90° and 180° turn times were statistically significant under both conditions: (a) without approach (0.44–0.48 s; d = 4.72–4.84; all p < 0.001), and (b) with approach (0.50–0.54 s; d = 4.41–5.03; p < 0.001). The agreement regarding inter-limb asymmetry direction among the tasks was 30.7–61.5%. The differences between the tasks could be explained by the angle–velocity trade-off. The results of this study imply that the CoD tasks should not be used interchangeably when assessing inter-limb asymmetries.

Vertical jump impulse deficits persist from six to nine months after ACL reconstruction

Later-stage rehabilitation following anterior cruciate ligament (ACL) reconstruction (ACLR) provides a valuable opportunity to target performance deficits before return to sport. This study aimed to: (1) evaluate bilateral counter-movement jump (CMJ) phase-specific impulse and isokinetic strength inter-limb asymmetry progression from 6 to 9 months post-ACLR; and (2) examine the extent to which individual changes in strength asymmetry could explain changes in impulse asymmetry. Male athletes (n = 44) with a hamstring tendon or bone-patellar tendon-bone autograft were tested 6 and 9 months post-ACLR. Two-way mixed-model ANOVAs were used to identify inter-session and inter-graft differences in CMJ phase-specific impulse asymmetries and knee isokinetic flexor and extensor strength asymmetries, as well as in absolute impulse and strength values of independent (ACLR/uninvolved) limbs. Linear regression models were used to assess the relationship between changes in impulse asymmetry and strength asymmetry. Reductions in strength asymmetry arose from improved ACLR-limb performance, whereas concentric impulse asymmetry reduced consequent to decreased uninvolved-limb performance and eccentric deceleration impulses decreased bilaterally. Graft type did not modulate findings. Changes in strength asymmetry had little or no ability to explain changes in impulse asymmetry. Consideration of approaches that may influence persisting deficits observed bi-laterally throughout vertical jumping performance post-ACLR may enhance rehabilitation practice.

Correlation between strength and skin temperature asymmetries in the lower limbs of Brazilian elite soccer players before and after a competitive season

This study aimed to investigate the correlation between strength and skin temperature (T_sk) asymmetries in the lower limbs of elite soccer players before and after a competitive season. The sample (n = 20) was composed of elite male soccer players. Strength asymmetry and T_sk asymmetry was measured through the countermovement jump (CMJ) test and infrared thermography, respectively. Asymmetries were quantified using the symmetry angle (SA) equation. A strong correlation was found between the SA of rate of force development (RFD) and the SA of T_sk before (baseline) (r = 0.7; r² = 0.43; p = 0.03) and after (r = 0.6; r² = 0.42; p = 0.04) the competitive season. Moreover, after the competitive season there were significant decreases in Peak force (p < 0.018), Impulse (p < 0.04), RFD (p = 0.0001) and CMJ height (p = 0.05), and significant increases in T_sk (p < 0.03), C-reactive protein (p = 0.03), Creatine kinase (p = 0.0001) and Cortisol (p = 0.04), even after a 3-day rest interval (no training). These results suggest that the CMJ test can be combined with infrared thermography for monitoring strength asymmetry and contribute to the prevention of muscle injuries.

Relationship between Asymmetries Measured on Different Levels in Elite Basketball Players

In this study, we investigated the association of magnitude and agreement in direction between asymmetries measured on single-joint (hip and trunk), complex movement (jumping), and skill (change of direction (CoD)) levels. The study sample comprised 43 junior- and senior-level (age = 20.5 ± 6.0 years; height = 194.5 ± 7.2 cm; body mass = 86.8 ± 10.1 kg) elite male basketball players. Both limbs/sides were tested in hip and trunk isometric strength; passive range of motion (RoM); unilateral, horizontal, and vertical jumping; and CoD tests, from which asymmetry indexes were calculated. The associations between asymmetry magnitudes were calculated with Spearman’s ρ correlation coefficient. The agreement between the direction of asymmetries on different levels was calculated with Cohen’’s Kappa (κ) coefficient. The average magnitude of asymmetry varied substantially (2.9–40.3%). Most associations between asymmetry magnitudes measured on different levels were small and statistically non-significant, with a few exceptions of moderate and large associations. Asymmetry in single-leg countermovement jump parameters was strongly associated with hip abduction maximal strength (ρ = 0.58 and 0.50, p < 0.01). Agreement between asymmetry directions was slight to fair, with a few moderate exceptions. Results indicate that multiple tests are needed to obtain a comprehensive picture of athletes’ asymmetries and that universal thresholds and golden standard tests for return to play should be reconsidered and reinvestigated.

Effects of a Competitive Soccer Match on Jump Performance and Interlimb Asymmetries in Elite Academy Soccer Players

ABSTRACT

Bromley, T, Turner, A, Read, P, Lake, J, Maloney, S, Chavda, S, and Bishop, C. Effects of a competitive soccer match on jump performance and interlimb asymmetries in elite academy soccer players. J Strength Cond Res 35(6): 1707-1714, 2021-The purpose of this study was to investigate the effects of a competitive soccer match on jump performance and interlimb asymmetries over incremental time points during a 72-hour period. Fourteen elite adolescent players from a professional English category 3 academy performed single-leg countermovement jumps pre, post, 24-, 48-, and 72-hour post-match on a single force platform. Eccentric impulse, concentric impulse, peak propulsive force, jump height, peak landing force, and landing impulse were monitored throughout. Interlimb asymmetries were also calculated for each metric as the percentage difference between limbs. Significant negative changes (p < 0.05) in jump performance were noted for all metrics at all time points, with the exception of jump height. Interlimb asymmetries were metric-dependent and showed very large increases, specifically post-match, with a trend to reduce back toward baseline values at the 48-hour time point for propulsive-based metrics. Asymmetries for landing metrics did not peak until the 24-hour time point and again reduced toward baseline at 48-hour time point. This study highlights the importance of monitoring distinct jump metrics, as jump height alone was not sensitive enough to show significant changes in jump performance. However, interlimb asymmetries were sensitive to fatigue with very large increases post-match. More frequent monitoring of asymmetries could enable practitioners to determine whether existing imbalances are also associated with reductions in physical performance or increased injury risk.

Associations between Inter-Limb Asymmetries in Jump and Change of Direction Speed Tests and Physical Performance in Adolescent Female Soccer Players

The association between asymmetries in jump and change of direction (COD) with physical performance in several sports show inconclusive results. The purposes of this study were to: (1) measure inter-limb asymmetries in three distinct groups in adolescent female soccer players and, (2) to determine the association between inter-limb asymmetries and physical performance in different age groups. Fifty-four players were distributed in three age groups: U-18, U-16 and U-14. All of them performed a series of jumps, sprints and change of direction speed tests. Asymmetries were assessed as the percentage difference between limbs, with the equation: 100/Max value (right and left) * in value (right and left) * -1 + 100. Mean inter-limb asymmetries were 2.91%, 4.82% and 11.6% for 180° COD, single leg hop and single leg countermovement jump tests respectively, but higher percentages of asymmetries were observed in many players individually. U-18 and U-16 showed significant differences on 180° left COD compared to U-14. Effect size (ES): 0.80 and 0.74, respectively; U-18 presented differences on single left leg hop test compared to U-14, ES: -0.72; U-16 also showed differences on 40 m speed compared to U-14, ES 0.87 (All p < 0.05). Jumping and COD physical tests show asymmetries in adolescent female soccer players, but these asymmetries do not interfere with physical performance. The largest asymmetry was observed in the single leg countermovement jump, and no asymmetries between groups were found. Due to the high variability in the direction of asymmetries, it is recommended to consider players' individual asymmetries for designing specific training programs.

Isokinetic Strength, Vertical Jump Performance, and Strength Differences in First Line Professional Firefighters Competing in Fire Sport

The purpose of our study was to investigate peak torque (PT) of knee extensors (KE) and knee flexors (KF), bilateral and unilateral strength asymmetries in isokinetic testing and vertical jump height (JH), vertical ground reaction force (VGRF), and force differences (_ΔVGRF) between legs during different jump tests in professional first-line firefighters (n = 15) competing in fire sports disciplines. There was a significant effect of jump type on JH (F_2,44 = 7.23, p < 0.05), VGRF (F_2,44 = 16.03, p < 0.05), and _ΔVGRF (F_2,44 = 3.45, p < 0.05). Professional firefighters achieved a mean JH of 50.17 cm in the countermovement jump free arms and high PT of KEs (3.15 Nm/kg). No significant differences (p > 0.05) and small effect sizes (d < 0.3) were found between the legs when PTs were assessed. We found a slightly higher (d = 0.53) unilateral strength ratio in non-dominant legs (58.12 ± 10.26%) compared to dominant legs (55.31 ± 7.51%). No effect of laterality was found among limb comparisons, but a higher unilateral isokinetic strength ratio was found in non-dominant legs of firefighters. A high level of strength (PT of KEs > 3 times body weight) and vertical jump performance is comparable to the performance of elite athletic populations.

Influence of Load and Phase of Contraction on Lateral Symmetries in Flywheel Squats

Assessment of lateral symmetries (LS) of lower limbs has been widely investigated. However, there are no studies about LS during exposure to high eccentric and concentric loads during flywheel (FW) squats. A total of 422 young, physically active participants performed squats on an FW device with different equidistant loads (0.05, 0.125 and 0.2 kg∙m2). The mean and peak force of the left and right leg were assessed for the concentric and eccentric contaction phase. LS values were calculated for each load and phase of squat. Our results showed that the absolute mean and peak force of the concentric and eccentric phase of contraction had excellent reliability, while LS values were more reliable when eccentric force was used for their calculation. Mean and peak forces were increased with the higher FW load. In general, we found a decrease in LS values in the concentric phase of contraction with the higher load. Moreover, values of LS are similar to a wide range of other functional movements. Nevertheless, symmetrical force application during squatting on a FW device should be satisfied regardless of the FW load. Due to the large sample size, our results are valuable as a reference point when athletes are evaluated during training.

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.

Individual hop analysis and reactive strength ratios provide better discrimination of ACL reconstructed limb deficits than triple hop for distance scores in athletes returning to sport

BACKGROUND

The triple hop for distance test commonly uses a limb symmetry index (LSI) 'pass' threshold of >90% for total hop distance following anterior cruciate ligament reconstruction (ACLR). However, understanding the manner in which athletes generate and dissipate forces during consecutive hops within the test may provide greater insight into residual limb deficits. The aim of the study was to examine reactive strength ratios (RSR) of individual hops during a triple hop test in a cohort of ACLR patients at discharge prior to return-to-sport.

METHODS

Twenty male athletes (24.6 ± 4.2 years; height 175.3 ± 10.2 cm; mass 73.6 ± 14.5 kg) completed the test on both non-operated and operated limbs. Total distance hopped, contact times, flight times and RSR were collected for each hop using a floor-level optical measurement system.

RESULTS

Significant, small to moderate between-limb differences (p < 0.05; d = 0.45-0.72) were shown for triple hop distance, flight time and RSR for each hop, with lower performance consistently displayed in the operated limb. Large, significant differences in RSR were evident between hops one and two on the operated limb (p < 0.05; d = 0.97). Despite 80% of participants achieving >90% LSI for total hop distance, less than 50% of participants reached the >90% LSI threshold for RSR.

CONCLUSIONS

Standardised LSI 'pass' thresholds (>90% LSI) for triple hop distance may mask residual deficits in reactive strength performance of operated limbs; therefore, more detailed analyses of individual hop performance may be warranted to enhance return to sport criteria following ACLR.

Preliminary Feasibility Study to Measure the Immediate Changes of Bilateral Asymmetry After Lumbar Spinal Manipulative Therapy in Asymptomatic Athletes

Objective

The purpose of this preliminary study was to assess the feasibility of a study to measure the immediate changes in bilateral asymmetry on physical performance tests before and after lumbar spinal manipulative therapy (SMT).

Methods

Thirteen asymptomatic athletes participated in this study. Each participant underwent a clinical and physical evaluation for inclusion according to eligibility criteria. Assessments were performed in all participants and included a physical test symmetry sequence (static standing position, squat, and countermovement jump) before and after lumbar SMT intervention. The immediate changes were quantitatively measured from before to after intervention by statistical calculations.

Results

All recruited participants completed the study, and none of them reported complaints during participation. Statistically significant differences between before and after lumbar SMT were found only for static symmetry (respectively, mean = 14.4% and 3.7%), not for squatting or the countermovement jump.

Conclusion

According our sample characteristics, asymptomatic athlete participants, presented initially bilateral asymmetry values, such as described in the literature, and after lumbar SMT, these values decreased significantly in static posture. This preliminary study demonstrates the feasibility to measure the pre-to-post changes in symmetry after lumbar SMT intervention. The results showed a great decrease in bilateral symmetry on static symmetry percentage, but none in dynamic tests, which deserves further investigation. Nevertheless, this preliminary study demonstrated the feasibility of measuring the immediate changes in symmetry produced by lumbar SMT, and of a larger study to measure whether lumbar SMT changes symmetry.

Isokinetic ankle eversion and inversion strength profiling of female ballet dancers

Ankle injuries are highly prevalent in ballet, with strength highlighted as a primary risk factor. To profile ankle strength, fourteen female ballet dancers (age: 19.29 ± 1.59 years) completed an isokinetic testing protocol comprising concentric eversion (CON_EV) and inversion (CON_INV), and, eccentric inversion (ECC_INV) trials at four angular velocities (30° · s^-1, 60° · s^-1, 90° · s^-1, 120° · s^-1) for both the dominant and non-dominant limb. In addition to Peak Torque (PT) and the corresponding Dynamic Control Ratios (DCRs), angle-specific derivatives of strength (AST) and Functional Range (FR) were calculated. There was no evidence of any significant bilateral strength asymmetry (p = 0.90) across all metrics, and no significant interactions with limb and contraction mode or velocity. A significant main effect for contraction mode (p = 0.001) highlighted greater ECC_INV strength - which was maintained with increasing isokinetic velocity - in contrast to reductions in CON_EV and CON_INV strength. Specifically, dancers are ECC_INV dominant at angular velocities greater than 60° · s^-1, which is likely to be characteristic of most functional tasks. The lack of bilateral asymmetry may be attributed to dance training interventions that facilitate bilateral development, but ipsilateral mode and velocity-specific asymmetries have implications for injury risk and the training needs of female ballet dancers.

Preseason assessment of anaerobic performance in elite soccer players: comparison of isokinetic and functional tests

Isokinetic and functional jump tests are frequently performed for assessing the physical qualities of soccer players during preseason. The purpose of this investigation was to explore, in an elite soccer players population, the relationships between isokinetic strength and functional jump performances. Thirty-eight professional soccer players were evaluated as follows: isokinetic knee assessment in concentric (CON) mode (60, 240°/s) for quadriceps and hamstrings, and in eccentric (ECC) mode for the hamstrings only (30°/s); one-leg hop tests for distance (single hop (SH), triple hop (TH) and triple crossover hop (TCH)); one-leg vertical jump tests (countermovement jump, drop jump). Players with a low bodyweight normalised (BWN) quadriceps (Q) strength (<2.71 Nm/kg) performed, for a majority of the measured variables, significantly reduced jump performances compared to the players with high BWN Q strength (>3.14 Nm/kg; p < 0.05). Greater bilateral differences between uninjured and past injured lower limbs were found with isokinetics (Q CON 60°/s (mean bilateral difference (MBD): 10.3%; p < 0.01), Q CON 240°/s (MBD: 9.9%; p < 0.05), H ECC 30°/s (MBD: 16.1%; p < 0.001) than with functional tests (MBD: 2 to 9%; p > 0.05. In conclusion, due to their complementary role and implications for performance, functional and isokinetic tests should be associated in a preseason soccer players assessment.

Inter-limb asymmetries are associated with decrements in physical performance in youth elite team sports athletes

Actually, there is scarce literature looking for the relationship between inter-limb asymmetries and performance in youth elite team sports. The main purpose of this cross-sectional study was to examine the relationships between inter-limb asymmetries and physical performance in youth elite team-sports players. A secondary objective was to evaluate the presence of between-sexes differences in inter-limb asymmetries in elite youth team sports players. Eighty-one young elite team-sports athletes (age: u-14 to u-18) performed the star excursion balance test in the anterior direction (SEBT ANT), a single leg vertical countermovement jump test (SLCMJ), the one leg hop test for distance (OLHT), a 30 m sprint test, and the V-cut test. Inter-limb asymmetries were calculated for SEBT ANT, SLCMJ and OLHT. Pearson r was used to analyse the relationships between inter-limb asymmetries and physical performance. Results showed significant (p < 0.05) but small (r = 0.26) relationships between SLCMJ asymmetries and 30 m sprint time for the total group. Significant negative correlations with small to moderate magnitude of correlation were also found between SLCMJ asymmetries and SLCMJ performance on the lowest performing limb for the total group (p < 0.05; r = -0.26), males (p < 0.01; r = -0.48) and females (p < 0.05; r = -0.30). Moreover, significant negative correlations with moderate and large magnitude were also present between OLHT asymmetries and OLHT performance on the lowest performing limb for the total group (p < 0.01; r = -0.44), males (p < 0.01; r = -0.56) and females (p < 0.01; r = -0.64). No correlations were observed between asymmetries and either the V-cut test or SEBT ANT performance. No correlation were observed between SEBT ANT asymmetries and physical performance. In addition, when comparing asymmetry values between sexes there were no significant differences in vertical (p = 0.06) and horizontal (p = 0.61) jumping tests. However, there were significant differences in asymmetry between sexes in the ANT SEBT (p = 0.04). In conclusion, the current study indicated that jumping asymmetries were associated with decrements in sprint speed and jumping performance. Therefore, assessing inter-limb asymmetries would be recommended to improve training interventions for youth elite team-sports athletes.

Anthropometric, Body Composition, and Morphological Lower Limb Asymmetries in Elite Soccer Players: A Prospective Cohort Study

The aim of this study was to identify and compare parameters related to anthropometry, body composition (BC), and morphological asymmetry in elite soccer players in nine age categories at the same soccer club (n = 355). We used a bio-impedance analyzer to measure the following indicators of BC: body height (BH); body mass (BM); relative fat-free mass (FFMr); percentage of fat mass (FM); and bilateral muscle mass differences in the lower extremities (BLD∆). Age showed a significant influence on all parameters observed (F_64,1962 = 9.99, p = 0.00, λ = 14.75, η²_p = 0.25). Adolescent players (from U16 through adults) had lower FM values (<10%) compared to players in the U12-U15 categories (>10%). The highest FFMr was observed in the U18 category. Players in the U12 and U13 categories showed more homogenous values compared to older players. With increasing age, significantly higher FFMr was observed in the lower extremities. An inter-limb comparison of the lower extremities showed significant differences in the U17 category (t₂₇ = 2.77, p = 0.01) and in adult players (t₆₈ = 5.02, p = 0.00). Our results suggest that the end of height growth occurs around the age of 16 years, while weight continues to increase until 20 years. This increase is not linked to decreasing FM, nor to the FFMr, which remains stable. We found morphological asymmetries between limbs in players of the U17 category and in adult players.

Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer)

Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.

Do asymmetry scores influence speed and power performance in elite female soccer players?

This study examined the relationships between vertical jump asymmetries and speed and power performance in elite female soccer athletes. Sixteen professional female soccer players (age: 23.0 ± 3.8 years; body mass: 60.2 ± 7.3 kg; height: 165.1 ± 5.5 cm) from the same professional club participated in this study. Athletes performed unilateral and bilateral squat jumps (SJ) and countermovement jumps (CMJ) on a portable force plate; 30-m sprinting test; Zigzag change-of-direction (COD) test; and muscle power testing using the jump squat (JS) exercise. Asymmetry scores were obtained from the results of the unilateral SJ and CMJ by the percentage difference between the dominant and non-dominant legs. The Pearson product-moment coefficient of correlation was used to analyse the correlations between the bilateral and unilateral vertical jump variables and the physical tests. The bilateral vertical jump performance (in both SJ and CMJ) was closely related to sprinting and JS power performances (r values ranging from 0.50 to 0.73; P< 0.05). In contrast, no significant associations were found between jump asymmetries and performance measures. Our data suggest that asymmetry scores derived from unilateral vertical jumps are not capable of influencing the speed-power performance of professional female soccer players.

Bilateral Strength Asymmetries and Unilateral Strength Imbalance: Predicting Ankle Injury When Considered With Higher Body Mass in US Special Forcesa

CONTEXT

Ankle injury is one of the most common conditions in athletics and military activities. Strength asymmetry (SA) and imbalance may represent a risk factor for injury, but past investigations have produced ambiguous conclusions. Perhaps one explanation for this ambiguity is the fact that these authors used univariate models to predict injury.

OBJECTIVE

To evaluate the predictive utility of SA and imbalance calculations for ankle injury in univariate and multivariate prediction models.

DESIGN

Prospective cohort study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 140 male US Air Force Special Forces.

MAIN OUTCOME MEASURE(S)

Baseline testing consisted of body composition, isometric strength, and aerobic and anaerobic capacity. A clinician conducted medical chart reviews 365 days posttesting to document the incidence of ankle injury. Strength asymmetries were calculated based on the equations most prevalent in the literature along with known physiological predictors of injury in the military: age, height, weight, body composition, and aerobic capacity. Simple logistic regression was conducted using each predictor, and backward stepwise logistic regression was conducted with each equation method and the physiological predictors entered initially into the model.

RESULTS

Strength asymmetry or imbalance or both, as a univariate predictor, was not able to predict ankle injury 365 days posttesting. Body mass (P = .01) and body mass index (P = .01) significantly predicted ankle injury. Strength asymmetry or imbalance or both significantly predicted ankle injury when considered with body mass (P = .002-.008).

CONCLUSIONS

As a univariate predictor, SA did not predict ankle injury. However, SA contributed significantly to predicting ankle injury in a multivariate model using body mass. Interpreting SA and imbalance in the presence of other physiological variables can help elucidate the risk of ankle injury.

Countermovement Jump Inter-Limb Asymmetries in Collegiate Basketball Players

The purpose of the present study was to establish the intrasession and intersession reliability of variables obtained from a force plate that was used to quantitate lower extremity inter-limb asymmetry during the bilateral countermovement jump (CMJ). Secondarily, a comparison was performed to determine the influence of the jump protocol CMJ with or without an arm swing (CMJ AS and CMJ NAS, respectively) on inter-limb asymmetries. Twenty-two collegiate basketball players performed three CMJ AS and three CMJ NAS on dual force platforms during two separate testing sessions. A majority of variables met the acceptable criterion of intersession and intrasession relative reliability (ICC > 0.700), while fewer than half met standards established for absolute reliability (CV < 10%). CMJ protocol appeared to influence asymmetries; Concentric Impulse-100 ms, Eccentric Braking Rate of Force Development, Eccentric Deceleration, and Force at Zero velocity were significantly different between jumping conditions (CMJAS versus CMJ NAS; p < 0.05). The present data establish the reliability and smallest worthwhile change of inter-limb asymmetries during the CMJ, while also identifying the influence of CMJ protocol on inter-limb asymmetries, which can be useful to practitioners and clinicians in order to effectively monitor changes associated with performance, injury risk, and return-to-play strategies.

Ground Reaction Forces and Kinematics of Ski Jump Landing Using Wearable Sensors

In the past, technological issues limited research focused on ski jump landing. Today, thanks to the development of wearable sensors, it is possible to analyze the biomechanics of athletes without interfering with their movements. The aims of this study were twofold. Firstly, the quantification of the kinetic magnitude during landing is performed using wireless force insoles while 22 athletes jumped during summer training on the hill. In the second part, the insoles were combined with inertial motion units (IMUs) to determine the possible correlation between kinematics and kinetics during landing. The maximal normal ground reaction force (GRFmax) ranged between 1.1 and 5.3 body weight per foot independently when landing using the telemark or parallel leg technique. The GRFmax and impulse were correlated with flying time (p < 0.001). The hip flexions/extensions and the knee and hip rotations of the telemark front leg correlated with GRFmax (r = 0.689, p = 0.040; r = -0.670, p = 0.048; r = 0.820, p = 0.007; respectively). The force insoles and their combination with IMUs resulted in promising setups to analyze landing biomechanics and to provide in-field feedback to the athletes, being quick to place and light, without limiting movement.

Validity of inertial sensor based 3D joint kinematics of static and dynamic sport and physiotherapy specific movements

3D joint kinematics can provide important information about the quality of movements. Optical motion capture systems (OMC) are considered the gold standard in motion analysis. However, in recent years, inertial measurement units (IMU) have become a promising alternative. The aim of this study was to validate IMU-based 3D joint kinematics of the lower extremities during different movements. Twenty-eight healthy subjects participated in this study. They performed bilateral squats (SQ), single-leg squats (SLS) and countermovement jumps (CMJ). The IMU kinematics was calculated using a recently-described sensor-fusion algorithm. A marker based OMC system served as a reference. Only the technical error based on algorithm performance was considered, incorporating OMC data for the calibration, initialization, and a biomechanical model. To evaluate the validity of IMU-based 3D joint kinematics, root mean squared error (RMSE), range of motion error (ROME), Bland-Altman (BA) analysis as well as the coefficient of multiple correlation (CMC) were calculated. The evaluation was twofold. First, the IMU data was compared to OMC data based on marker clusters; and, second based on skin markers attached to anatomical landmarks. The first evaluation revealed means for RMSE and ROME for all joints and tasks below 3°. The more dynamic task, CMJ, revealed error measures approximately 1° higher than the remaining tasks. Mean CMC values ranged from 0.77 to 1 over all joint angles and all tasks. The second evaluation showed an increase in the RMSE of 2.28°– 2.58° on average for all joints and tasks. Hip flexion revealed the highest average RMSE in all tasks (4.87°– 8.27°). The present study revealed a valid IMU-based approach for the measurement of 3D joint kinematics in functional movements of varying demands. The high validity of the results encourages further development and the extension of the present approach into clinical settings.