An 8-week physiotherapist-led return to sport group program after anterior cruciate ligament reconstruction improves measures of physical and psychological function: A case series

BACKGROUND

Low return to competitive sport, high reinjury rates and long-term functional impairment of anterior cruciate ligament reconstruction (ACLR) present significant challenges for patients. A program that facilitates a safe return to sport (RTS) following ACLR could potentially improve outcomes.

STUDY DESIGN

Case Series.

METHODS

Sixty participants (median 20-years-old (13-36), 43 males, 18 females, median 7.5 months (4-25) post-ACLR) completed an eight-week exercise program. A battery of physical tests and patient-reported outcome measures were assessed pre and post-program. The number of participants passing RTS criteria was evaluated, and RTS rates were determined. The correlation between the ACL-RSI and measures of physical function was explored.

RESULTS

Improvements in all isometric strength, hop tests, running T-test, and patient reported outcome measures were seen post-program. Five (8%) participants successfully passed all RTS criteria and eighty-five percent of participants returned to their previous level of sport. The ACL-RSI and the IKDC showed correlation across all time points (pre rs = 0.49; post rs = 0.40; change r = 0.40).

CONCLUSIONS

Our study demonstrated improvements in all RTS criteria tests upon completing the 8-week rehabilitation program; however, few participants (8%) passed all RTS criteria. Psychological readiness is more closely related to patient-reported function than functional tests.

Cutting Technique Modification: A Way to Improve Movement Quality and Develop Agility in Youth?

Thieschäfer, L, Dos’Santos, T, and Büsch, D. Cutting technique modification: a way to improve movement quality and develop agility in youth? J Strength Cond Res 38(9): 1596–1606, 2024—High-quality cutting technique is essential for agility development and safer cuttings in adolescent athletes. Certain sidestep techniques and kinematics are characteristic of high movement quality and are associated with both, faster performance and lower knee joint loading (i.e., reduced anterior cruciate ligament injury risk). The aim of this study was to determine the effects of a 6-week, side step, technique modification training intervention targeting specific kinematics on agility performance and movement quality. Twenty-two adolescent American football players were recruited for a nonrandomized, controlled, intervention study. For 6 weeks, an intervention group (IG) of 11 players participated in 25-minute cutting technique training sessions integrated into team training twice a week, whereas a control group (CG) of 11 players continued their usual training routine. Agility performance was assessed based on percentage-based change of direction deficit (CODDp) obtained during reactive agility tests at 45° and 90° angles. The Cutting Movement Assessment Score (CMAS) qualitative screening tool was used to assess 2D high-speed videos of the cuts for movement quality. The significance level was set at α = 0.01. The intervention effectively altered players' sidestep technique irrespective of cutting angle with large time × group interaction effects observed for CMAS ( = 0.82). Statistical and practical significant improvements in CMAS pre-to-post intervention were evident in the IG (−2.30 ≤ g ≤ −1.75; 313.87 ≤ BF10 ≤ 2,342.00), whereas deteriorations were found in the CG for 90° (g = 1.38; BF10 = 64.21). However, in both groups, no statistically significant differences in CODDp were observed pre-to-post intervention (0.019 ≤ p ≤ 0.586; 0.34 ≤ BF10 ≤ 3.59). The cutting technique modification training meaningfully improved movement quality, without negatively affecting agility performance, and can be used by practitioners to foster a safe technical foundation for subsequent agility development in adolescent athletes.

Kinetics and mechanical work done to move the body centre of mass along a curve

When running on a curve, the lower limbs interact with the ground to redirect the trajectory of the centre of mass of the body (CoM). The goal of this paper is to understand how the trajectory of the CoM and the work done to maintain its movements relative to the surroundings (Wcom) are modified as a function of running speed and radius of curvature. Eleven participants ran at different speeds on a straight line and on circular curves with a 6 m and 18 m curvature. The trajectory of the CoM and Wcom were calculated using force-platforms measuring the ground reaction forces and infrared cameras recording the movements of the pelvis. To follow a circular path, runners overcompensate the rotation of their trajectory during contact phases. The deviation from the circular path increases when the radius of curvature decreases and speed increases. Interestingly, an asymmetry between the inner and outer lower limbs emerges as speed increases. The method to evaluate Wcom on a straight-line was adapted using a referential that rotates at heel strike and remains fixed during the whole step cycle. In an 18 m radius curve and at low speeds on a 6 m radius, Wcom changes little compared to a straight-line run. Whereas at 6 m s-1 on a 6 m radius, Wcom increases by ~25%, due to an augmentation in the work to move the CoM laterally. Understanding these adaptations provides valuable insight for sports sciences, aiding in optimizing training and performance in sports with multidirectional movements.

Evaluation of multi-directional speed qualities throughout adolescence in youth soccer: The non-linear nature of transfer

Training and assessment of agility is often prioritised by soccer coaches and practitioners aiming to develop multi-directional speed. Although the importance of agility is advocated throughout childhood and adolescence, limited data evidence agility performance at different stages of adolescence. The purpose of this study was to examine differences in multi-directional speed performance in youth soccer players spanning an entire soccer academy. A total of 86 male junior-elite soccer players volunteered to participate. Anthropometric data were collected, alongside performance data from a battery of physical tests including sprinting, jumping, change of direction, reaction time, and agility. Bayesian models using log-likelihoods from posterior simulations of parameter values displayed linear or curvilinear relationships between both chronological and biological age and performance in all tests other than agility and reaction time. For agility and reaction time tests, performance improved until ~14 years of age or the estimated age of peak height velocity whereby arrested development in performance was observed. Our results demonstrate that while most performance skills improve as chronological or biological age increases, measures of agility and reaction time may not. These findings support the notion that agility performance is complex and multifaceted, eliciting unique, challenging physical demands and non-linear development.

Assessing Limb Dominance and Interlimb Asymmetries Over Multiple Angles During Change of Direction Speed Tests in Basketball Players

ABSTRACT

Gonzalo-Skok, O, Dos' Santos, T, and Bishop, C. Assessing limb dominance and interlimb asymmetries over multiple angles during change of direction speed tests in basketball players. J Strength Cond Res 37(12): 2423-2430, 2023-The aims of this study were to establish whether directional dominance is displayed during change of direction (COD) tasks across various angles, to determine the angle-variation data for the asymmetry magnitude and direction, and to analyze the relationships in COD performance (completion time and COD deficit) across tasks. Twenty-four young (U-16 to U-20), highly trained male basketball players performed a 10-m linear sprint test and four 10-m COD tests (45°, 90°, 135°, and 180°) in left and right directions. Change of direction performance was determined via total times and COD deficit, and asymmetry comparisons were made between faster and slower directions and dominant leg (DL) (i.e., first step leg in lay-up) and nondominant leg (NDL). No significant differences (p > 0.05) were found between DL and NDL for any task excluding 45° COD (p < 0.05, effect size [ES] = 0.44-0.78), but significant differences were established between faster and slower sides for all angles (p < 0.05, ES = 0.70-1.28). Levels of the agreement in directional dominance during COD tasks were generally poor to slight (k = -0.14 to 0.14), excluding a fair agreement between COD45 and COD90 (k = 0.34). Correlations between COD total times and COD deficits between angles were moderate to very large (r = 0.32 to 0.81) and moderate to large (r = -0.30 to 0.55), respectively. Players displayed superior COD performance in a particular direction across various angles. This directional dominance is not necessarily consistent between angles, thus highlighting the angle-dependent nature of COD performance. Consequently, practitioners should investigate multiple angles and directions to create a COD angle profile for their athletes.

Effects of shoe collar types on ankle and knee biomechanics characteristics when performing the side-step cutting task

This study aimed to examine the effect of football shoes with different collar types on ankle and knee kinematic and kinetics features during 45° and 135° side-step cutting tasks. Fifteen healthy college football players volunteered for the study. Each participant was instructed to perform side-step cutting tasks with high, low, and no collar football shoes. The kinematic and ground reaction force data were measured using a Vicon motion capture system and a Kistler force plate, respectively. Two-way MANOVAs with repeated measures were used to examine the effect of shoe collar type and task conditions. There were no interaction effects. The high collar football shoe showed decreased ankle range of motion in the sagittal plane (p = 0.010) and peak ankle external rotation moment (p = 0.009) compared to the no collar football shoe. The high (p = 0.025) and low (p = 0.029) collar football shoes presented greater peak ankle external rotation angles than the no collar football shoe. These results imply that football shoes with high collars made of high intensity knitted fabric could be used to restrict ankle joint movement, with potential implications for decreasing the risk of ankle sprain injuries in football players.

Development of a Cutting Technique Modification Training Program and Evaluation of its Effects on Movement Quality and Cutting Performance in Male Adolescent American Football Players

This study developed a cutting technique modification training program and investigated its effects on cutting performance and movement quality in adolescent American football players. For six weeks, an intervention group (IG) of 11 players participated in 25 min cutting technique modification training sessions integrated into team training twice a week, while a control group (CG) of 11 players continued their usual team training. Movement quality was assessed by evaluating 2D high-speed videos, obtained during preplanned 45° and 90° cutting tests, using the Cutting Movement Assessment Score (CMAS) qualitative screening tool. Cutting performance was assessed based on change of direction deficit (CODD). Significant interaction effects of time × group were found for CMAS in 45° and 90° cuttings (p < 0.001, ηp2 = 0.76, p < 0.001, ηp2 = 0.64, respectively), with large improvements in the IG (p < 0.001, g = -2.16, p < 0.001, g = -1.78, respectively) and deteriorations in the CG for 45° cuttings (p = 0.002, g = 1.15). However, no statistically significant differences in CODD were observed pre-to-post intervention. The cutting technique modification training was effective at improving movement quality without impairing cutting performance, and it can be used by practitioners working with adolescent athletes.

In-field assessment of change-of-direction ability with a single wearable sensor

The Agility T-test is a standardized method to measure the change-of-direction (COD) ability of athletes in the field. It is traditionally scored based on the total completion time, which does not provide information on the different CODs. Augmenting the T-test with wearable sensors provides the opportunity to explore new metrics. Towards this, data of 23 professional soccer players were recorded with a trunk-worn GNSS-IMU (Global Navigation Satellite System-Inertial Measurement Unit) device. A method for detecting the four CODs based on the wavelet-denoised antero-posterior acceleration signal was developed and validated using video data (60 Hz). Following this, completion time was estimated using GNSS ground speed and validated with the photocell data. The proposed method yields an error (mean ± standard deviation) of 0 ± 66 ms for the COD detection, - 0.16 ± 0.22 s for completion time, and a relative error for each COD duration and each sequential movement durations of less than 3.5 ± 16% and 7 ± 7%, respectively. The presented algorithm can highlight the asymmetric performance between the phases and CODs in the right and left direction. By providing a more comprehensive analysis in the field, this work can enable coaches to develop more personalized training and rehabilitation programs.

Effects of the menstrual cycle phase on anterior cruciate ligament neuromuscular and biomechanical injury risk surrogates in eumenorrheic and naturally menstruating women: A systematic review

BACKGROUND

Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee laxity, and neuromuscular function. This systematic review aimed to examine the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates during dynamic tasks, to establish whether a particular MC phase predisposes women to greater ACL injury risk.

METHODS

PubMed, Medline, SPORTDiscus, and Web of Science were searched (May-July 2021) for studies that investigated the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates. Inclusion criteria were: 1) injury-free women (18-40 years); 2) verified MC phases via biochemical analysis and/or ovulation kits; 3) examined neuromuscular and/or biomechanical injury risk surrogates during dynamic tasks; 4) compared ≥1 outcome measure across ≥2 defined MC phases.

RESULTS

Seven of 418 articles were included. Four studies reported no significant differences in ACL injury risk surrogates between MC phases. Two studies showed evidence the mid-luteal phase may predispose women to greater risk of non-contact ACL injury. Three studies reported knee laxity fluctuated across the MC; two of which demonstrated MC attributed changes in knee laxity were associated with changes in knee joint loading (KJL). Study quality (Modified Downs and Black Checklist score: 7-9) and quality of evidence were low to very low (Grading of Recommendations Assessment Development and Evaluation: very low).

CONCLUSION

It is inconclusive whether a particular MC phase predisposes women to greater non-contact ACL injury risk based on neuromuscular and biomechanical surrogates. Practitioners should be cautious manipulating their physical preparation, injury mitigation, and screening practises based on current evidence. Although variable (i.e., magnitude and direction), MC attributed changes in knee laxity were associated with changes in potentially hazardous KJLs. Monitoring knee laxity could therefore be a viable strategy to infer possible ACL injury risk.

The three-dimensional reconstruction of an Achilles tendon rupture in a professional football player reveals a multiplanar injury mechanism

Achilles tendon rupture (ATR) is a rare although very serious injury for football players; currently, studies on ATR in football are scant. This case report intends to firstly describe the situational pattern and three-dimensional mechanism of the ATR injury occurred to a professional football player during the last UEFA 2020 Championship. To reconstruct the full 3D joint kinematics throughout the injury action, the model-based image-matching technique was used. The key findings were: (i) ATR injury combined a sudden ankle dorsiflexion action with an internal plantarflexion moment while performing a crossover cut at high speed; (ii) a multi-planar loading occurred during the push-off phase.Level of evidence V.

The Safe Landing warm up technique modification programme: An effective anterior cruciate ligament injury mitigation strategy to improve cutting and jump-movement quality in soccer players

The objective of the study was to evaluate the effectiveness of the Safe Landing (SL), a 6-week technique-modification (TM) programme, on cutting and jump-landing movement quality in football players. In a non-randomized design, 32 male semi-professional football players from two Spanish clubs participated in the study: one served as the control group (CG, n = 11), while the other performed the SL (n = 15). Performance and movement quality of drop vertical jump and 70º change of direction (COD70) were evaluated through 2D video footage pre- and post-intervention. In such tasks, the Landing Error Scoring System for first (LESS1) and second (LESS2) landings, and the Cutting Movement Assessment Score (CMAS) were used for assessing movement quality. Pre-to-post changes and baseline-adjusted ANCOVA were used. Medium-to-large differences between groups at post-test were shown in CMAS, LESS1 and LESS2 (p < 0.082, ղ2 = 0.137-0.272), with small-to-large improvements in SL (p < 0.046, ES=0.546-1.307), and CG remaining unchanged (p > 0.05) pre-to-post. In COD70 performance, large differences were found between groups (p < 0.047, ղ2 = 0.160-0.253), with SL maintaining performance (p > 0.05, ES=0.039-0.420), while CG moderately decreasing performance (p = 0.024, ES=0.753) pre-to-post. The SL is a feasible and effective TM program to improve movement quality and thus potential injury risk in cutting and landing, while not negatively affecting performance.

A classification of specific movement skills and patterns during sprinting in English Premier League soccer

The aim of this study was to quantify and contextualize sprinting actions (≥ 7.0 m/s) of English Premier League (EPL) soccer match-play with respect to the movement skills and patterns employed. Video footage (3.2.6, Premier League DVMS, ChyronHego) and raw video-based locomotor coordinates of 901 sprint efforts from 10 matches of an EPL soccer team (2017-2018), were evaluated using the Football Sprint Movement Classification System pertaining to transition, initiation, and actualisation of sprint movement skills and patterns. The results from a one-way ANOVA or independent t-test revealed that, generally, most sprinting actions begun from a linear initiation position compared to lateral or rear (63%, d = 5.0-5.3, p < 0.01), without a change of direction (COD) (48%, d = 4.9-5.6, p < 0.01) compared to lateral, front-back, back-front, and from forward travelling (linear and diagonal) transition movements (68%, d = 2.1-5.7, p < 0.01) compared to lateral or rear. Additionally, most sprints were initiated with a rolling acceleration (66%, d = 3.2, p < 0.01) compared to explosive acceleration, often performed with a degree of curvature (86%, d = 7.2, p < 0.01) compared to linear, with torso rotation (62%, d = 2.7, p < 0.01) compared to no rotation, and typically end with an action such as duelling with an opponent or involvement with the ball (49%). Additionally, the sprint movement characteristics proportions slightly differed across playing positions. Overall, this study confirms that sprints during EPL soccer matches are initiated from and performed with a variety of different movement skills and patterns in relation to different sport-specific outcomes. This data can be used to assist in the development of more effective physical preparation programmes, inform position-specific contextualized sprinting drills to achieve better specificity and potential transfer of training, while also informing speed testing protocols.

Video analysis of Achilles tendon rupture in male professional football (soccer) players: injury mechanisms, patterns and biomechanics

Background

Achilles tendon rupture (ATR), while rare in football, is a severe career-threatening injury associated with long-layoff times. To date, no study has documented ATR's mechanism in professional football players.

Aim

To describe the mechanisms, situational patterns and gross biomechanics (kinematics) of ATR injuries in professional male football players.

Methods

Eighty-six (n=86) consecutive ATR injuries in professional football players during official matches were identified. Sixty (70%) injury videos were identified for mechanism and situational pattern, with biomechanical analysis feasible in 42 cases. Three independent reviewers evaluated the injury videos. Distribution of ATR during the season, the match play and on the field were also reported.

Results

Fifty (n=50, 83%) injuries were classified as non-contact and 10 (17%) as indirect contact. ATRs are injuries occurring during accelerations; three main situational patterns were identified: (1) forward acceleration from standing (n=25, 42%); (2) cross-over cutting (n=15, 25%) and (3) vertical jumping (n=11, 18%). Biomechanically, ATR injuries were consistent with a multiplanar loading at the injury frame consisting of a slightly flexed trunk (15.5°), extended hip (-19.5°), early flexed knee (22.5°) and end-range dorsiflexed (40°) ankle in the sagittal plane and foot pronation; 27 (45%) ATRs occurred in the first 30 min of effective match time.

Conclusions

All ATRs in professional football were either non-contact (83%) or indirect contact (17%) injuries. The most common situational patterns were forward acceleration from standing, cross-over cutting and vertical jumping. Biomechanics was consistent and probably triggered by a multiplanar, although predominantly sagittal, loading of the injured Achilles tendon.

Relationship between Lower Extremity Fitness Levels and Injury Risk among Recreational Alpine Skiers: A Prospective Cohort Study

Background: Although the importance of physical fitness for injury prevention is recognized in sports medicine and rehabilitation, few studies have investigated this factor among recreational alpine skiers. Objective: To determine the effect of lower extremity fitness on the risk and severity of injury among recreational alpine skiers. Method: This prospective cohort study involved 117 recreational skiers at two alpine resorts during the 2021−2022 winter season. Anthropometric characteristics, skiing skills, and lower extremity agility (hexagon test), balance (Y-Balance Test), and endurance (60-s squat test) were assessed before the winter season. All of the participants were divided into an injured group and an uninjured group, based on whether an injury was recorded throughout the season. Results: In binary logistic regression, the hexagon test duration and composite Y-Balance Test score were significant injury risk factors (p < 0.05). Ordinal polytomous logistic regression revealed no significant factors for injury severity (p > 0.05). Conclusions: Recreational alpine skiers with inferior lower extremity agility or balance may have a higher injury risk and this must be considered when assessing individual risk. In the context of injury prevention, regular neuromuscular training and testing, including agility and balance aspects should be recommended to skiers.

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.

Biomechanical Effects of a 6-Week Change-of-Direction Technique Modification Intervention on Anterior Cruciate Ligament Injury Risk

ABSTRACT

Dos'Santos, T, Thomas, C, Comfort, P, and Jones, PA. Biomechanical effects of a 6-week change-of-direction technique modification intervention on anterior cruciate ligament injury risk. J Strength Cond Res 35(8): 2133-2144, 2021-The aim of this study was to evaluate the biomechanical effects of a 6-week change-of-direction (COD) technique modification intervention on anterior cruciate ligament (ACL) injury risk (i.e., multiplanar knee joint loads) during 45° (CUT45) and 90° (CUT90) side-step cutting. A nonrandomized, controlled 6-week intervention study was administrated. Fifteen male multidirectional sport athletes formed the intervention group (IG) who participated in two 30-minute COD technique modification sessions per week, whereas 12 male multidirectional sport athletes formed the control group and continued their normal training. Subjects performed 6 trials of the CUT45 and CUT90 task whereby pre-to-post intervention changes in lower-limb and trunk kinetics and kinematics were evaluated using three-dimensional motion and ground reaction force analysis. Two-way mixed analyses of variance revealed no significant interaction effects of group for CUT45 and CUT90 multiplanar knee joint loads (p ≥ 0.116, η2 ≤ 0.096); however, considerable individual variation was observed (positive (n = 5-8) and negative responders (n = 7-8)). Based on IG group means, COD technique modification resulted in no meaningful reductions in multiplanar knee joint loads. However, individually, considerable variation was observed, with "higher-risk" subjects generally responding positively, and subjects initially considered "low-risk" tending to increase their multiplanar knee joint loads, albeit to magnitudes not considered hazardous or "high-risk." Change-of-direction technique modification training is a simple, effective training method, requiring minimal equipment that can reduce knee joint loads and potential ACL injury risk in "higher-risk" subjects without compromising performance.

Change of Direction Speed and Technique Modification Training Improves 180° Turning Performance, Kinetics, and Kinematics

This study aimed to examine the effects of change of direction (COD) speed and technique modification training on 180° turning performance (completion time, ground contact time [GCT], and exit velocity), kinetics, and kinematics. A non-randomised 6 week intervention study was administered. Thirteen male multidirectional sport athletes formed the intervention group (IG), participating in two COD speed and technique modification sessions per week. A total of 12 male multidirectional sport athletes formed the control group (CG). All subjects performed six modified 505 trials, whereby pre-to-post-intervention biomechanical changes were evaluated using three-dimensional motion analysis. Two-way mixed analysis of variances revealed significant interaction effects (group × time) for completion time, mean horizontal propulsive force (HPF), horizontal to vertical mean braking and propulsive force ratios for the penultimate (PFC) and final foot contact (FFC), FFC peak knee flexion and PFC hip flexion angle (p ≤ 0.040, η² = 0.170–0.417). The IG displayed small to large improvements post-intervention in these aforementioned variables (p ≤ 0.058, g = 0.49–1.21). Turning performance improvements were largely to very largely (p ≤ 0.062, r or ρ = 0.527–0.851) associated with increased mean HPF, more horizontally orientated FFC propulsive force and PFC braking force, and greater pelvic rotation, PFC hip flexion, and PFC velocity reductions. COD speed and technique modification is a simple, effective training strategy that enhances turning performance.

The Biomechanical Characterization of the Turning Phase during a 180° Change of Direction

The aim of this study was to characterize the turning phase during a modified 505 test. Forty collegiate basketball students, divided into faster and slower performers and high-playing-level and low-playing-level groups, were evaluated for the force-time characteristics (braking and/or propulsive phase) of the penultimate foot contact (PFC), final foot contact (FFC), and first accelerating foot contact (AFC), and for completion time and approach velocity. Based on the composition of the AFC, trials were classified as braking/propulsive or only propulsive. Regression analysis for the prediction of completion time was performed. The AFC contributed to reacceleration through shorter contact times and step length, and lower braking force production (p < 0.05). Faster performers and the high-playing-level group demonstrated (p < 0.05): lower completion times, higher approach velocities, longer steps length in the PFC and FFC, greater braking forces and impulses in the PFC; greater braking and propulsive forces, braking impulses, lower contact times in the FFC; greater braking and propulsive horizontal forces, horizontal impulses, lower contact times and vertical impulses in the AFC. Kinetic variables from only the FFC and AFC and approach velocity predicted 75% (braking/propulsive trials) and 76.2% (only-propulsive trials) of completion times. The characterization of the turning phase demonstrated the specific contribution of each foot contact and the possible implications for training prescription.

Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict?

BACKGROUND

Most cutting biomechanical studies investigate performance and knee joint load determinants independently. This is surprising because cutting is an important action linked to performance and non-contact anterior cruciate ligament (ACL) injuries. The aim of this study was to investigate the relationship between cutting biomechanics and cutting performance (completion time, ground contact time [GCT], exit velocity) and surrogates of non-contact ACL injury risk (knee abduction [KAM] and internal rotation [KIRM] moments) during 90° cutting.

DESIGN

Mixed, cross-sectional study following an associative design. 61 males from multidirectional sports performed six 90° pre-planned cutting trials, whereby lower-limb and trunk kinetics and kinematics were evaluated using three-dimensional (3D) motion and ground reaction force analysis over the penultimate (PFC) and final foot contact (FFC). Pearson's and Spearman's correlations were used to explore the relationships between biomechanical variables and cutting performance and injury risk variables. Stepwise regression analysis was also performed.

RESULTS

Faster cutting performance was associated (p ≤ 0.05) with greater centre of mass (COM) velocities at key instances of the cut (r or ρ = 0.533-0.752), greater peak and mean propulsive forces (r or ρ = 0.449-0.651), shorter FFC GCTs (r or ρ = 0.569-0.581), greater FFC and PFC braking forces (r = 0.430-0.551), smaller hip and knee flexion range of motion (r or ρ = 0.406-0.670), greater knee flexion moments (KFMs) (r = 0.482), and greater internal foot progression angles (r = - 0.411). Stepwise multiple regression analysis revealed that exit velocity, peak resultant propulsive force, PFC mean horizontal braking force, and initial foot progression angle together could explain 64% (r = 0.801, adjusted 61.6%, p = 0.048) of the variation in completion time. Greater peak KAMs were associated with greater COM velocities at key instances of the cut (r or ρ = - 0.491 to - 0.551), greater peak knee abduction angles (KAA) (r = - 0.468), and greater FFC braking forces (r = 0.434-0.497). Incidentally, faster completion times were associated with greater peak KAMs (r = - 0.412) and KIRMs (r = 0.539). Stepwise multiple regression analysis revealed that FFC mean vertical braking force and peak KAA together could explain 43% (r = 0.652, adjusted 40.6%, p < 0.001) of the variation peak KAM.

CONCLUSION

Techniques and mechanics associated with faster cutting (i.e. faster COM velocities, greater FFC braking forces in short GCTs, greater KFMs, smaller hip and knee flexion, and greater internal foot progression angles) are in direct conflict with safer cutting mechanics (i.e. reduced knee joint loading, thus ACL injury risk), and support the "performance-injury conflict" concept during cutting. Practitioners should be conscious of this conflict when instructing cutting techniques to optimise performance while minimising knee joint loading, and should, therefore, ensure that their athletes have the physical capacity (i.e. neuromuscular control, co-contraction, and rapid force production) to tolerate and support the knee joint loading during cutting.

Biomechanical Effects of a 6-Week Change of Direction Speed and Technique Modification Intervention: Implications for Change of Direction Side step Performance

ABSTRACT

Dos'Santos, T, Thomas, C, Comfort, P, and Jones, PA. Biomechanical effects of a 6-week change of direction speed and technique modification intervention: implications for change of direction side step performance. J Strength Cond Res XX(X): 000-000, 2020-The aim of this study was to evaluate the biomechanical effects of change of direction (COD) speed and technique modification training on COD performance (completion time, ground contact time [GCT], and exit velocity) during 45° (CUT45) and 90° (CUT90) side step cutting. A nonrandomized, controlled 6-week intervention study was administrated. Fifteen male, multidirectional, sport athletes (age, 23.5 ± 5.2 years; height, 1.80 ± 0.05 m; mass, 81.6 ± 11.4 kg) formed the intervention group (IG) who participated in two 30-minute COD speed and technique modification sessions per week, whereas 12 male, multidirectional, sport athletes (age, 22.2 ± 5.0 years; height, 1.76 ± 0.08 m; mass, 72.7 ± 12.4 kg) formed the control group (CG) and continued their normal training. All subjects performed 6 trials of the CUT45 and CUT90 task whereby pre-to-post intervention changes in lower-limb and trunk kinetics and kinematics were evaluated using 3-dimensional motion and ground reaction force analyses. Two-way mixed analysis of variances revealed significant main effects for time (pre-to-post changes) for CUT45 completion time, exit velocity, and CUT90 completion time (p ≤ 0.045; η2 = 0.152-0.539), and significant interaction effects of time and group were observed for CUT45 completion time, GCT, exit velocity, and CUT90 completion time (p ≤ 0.010; η2 = 0.239-0.483), with the IG displaying superior performance postintervention compared with the CG (p ≤ 0.109; g = 0.83-1.35). Improvements in cutting performance were moderately to very largely associated (p ≤ 0.078; r or ρ = 0.469-0.846) with increased velocity profiles, increased propulsive forces over shorter GCTs, and decreased knee flexion. Change of direction speed and technique modification is a simple, effective training method requiring minimal equipment that can enhance COD performance, which practitioners should consider incorporating into their pitch- or court-based training programs.

Tracking Quantitative Characteristics of Cutting Maneuvers with Wearable Movement Sensors during Competitive Women's Ultimate Frisbee Games

(1) Ultimate frisbee involves frequent cutting motions, which have a high risk of anterior cruciate ligament (ACL) injury, especially for female players. This study investigated the in-game cutting maneuvers performed by female ultimate frisbee athletes to understand the movements that could put them at risk of ACL injury. (2) Lower-body kinematics and movement around the field were reconstructed from wearable lower-body inertial sensors worn by 12 female players during 16 league-sanctioned ultimate frisbee games. (3) 422 cuts were identified from speed and direction change criteria. The mean cut had approach speed of 3.4 m/s, approach acceleration of 3.1 m/s², cut angle of 94 degrees, and ground-contact knee flexion of 34 degrees. Shallow cuts from 30 to 90 degrees were most common. Speed and acceleration did not change based on cut angle. Players on more competitive teams had higher speed and acceleration and reduced knee flexion during cutting. (4) This study demonstrates that a lower-body set of wearable inertial sensors can successfully track an athlete’s motion during real games, producing detailed biomechanical metrics of behavior and performance. These in-game measurements can be used to specify controlled cutting movements in future laboratory studies. These studies should prioritize higher-level players since they may exhibit higher-risk cutting behavior.

Effects of Strength vs. Plyometric Training on Change of Direction Performance in Experienced Soccer Players

The purpose of this study was to compare how 6 weeks of strength- vs. plyometric training, which were matched upon direction of motion and workload, influences change of direction (COD) performance. Twenty-one experienced male soccer players (age: 22.2 ± 2.7) were pair-matched into a strength- (n = 10) and a plyometric (n = 11) training group. CODs of 45°, 90°, 135° and 180° performed from either a 4 m or 20 m approach distance were compared before and after intervention. Results showed no significant difference between groups. Significant effects were only found within the plyometric training group (−3.2% to −4.6%) in 90°, 135° and 180° CODs from 4 m and a 180° COD from a 20 m approach distance. Individual changes in COD performances showed that with the 4 m approach at least 55% and 81% of the strength and plyometric training group, respectively, improved COD performance, while with the 20 m approach at least 66% of both groups improved performance. This study showed that the plyometric training program can improve most CODs, with angles over 90°, although this is dependent on the distance approaching the COD. Considering the limited time of implementing physical conditioning, in addition to regular soccer practice in most soccer environments, the current plyometric training program can be advantageous in improving CODs at maximal intensity.

Train the Engine or the Brakes? Influence of Momentum on the Change of Direction Deficit

PURPOSE

Currently, it is unclear which physical characteristics may underpin the change of direction deficit (COD-D). This investigation sought to determine if momentum, speed-, and jump-based measures may explain variance in COD-D.

METHODS

Seventeen males from a professional soccer academy (age, 16.76 [0.75] y; height, 1.80 [0.06] m; body mass, 72.38 [9.57] kg) performed 505 tests on both legs, a 40-m sprint, and single-leg countermovement and drop jumps.

RESULTS

The regression analyses did not reveal any significant predictors for COD-D on either leg. "Large" relationships were reported between the COD-D and 505 time on both limbs (r = .65 to .69; P < .01), but COD-D was not associated with linear momentum, speed-, or jump-based performances. When the cohort was median split by COD-D, the effect sizes suggested that the subgroup with the smaller COD-D was 5% faster in the 505 test (d = -1.24; P < .001) but 4% slower over 0-10 m (d = 0.79; P = .33) and carried 11% less momentum (d = -0.81; P = .17).

CONCLUSION

Individual variance in COD-D may not be explained by speed- and jump-based performance measures within academy soccer players. However, when grouping athletes by COD-D, faster athletes with greater momentum are likely to display a larger COD-D. It may, therefore, be prudent to recommend more eccentric-biased or technically focused COD training in such athletes and for coaches to view the COD action as a specific skill that may not be represented by performance time in a COD test.

Change of Direction Assessment Following Anterior Cruciate Ligament Reconstruction: A Review of Current Practice and Considerations to Enhance Practical Application

Change of direction (CoD) has been indicated as a key mechanism in the occurrence of anterior cruciate ligament (ACL) injury during invasion sports. Despite these associations, assessments of knee function in athletic populations at the time of return to sport following ACL reconstruction (ACLr) have often focused on strength and single-leg hop tests, with a paucity of evidence to describe the CoD characteristics. Therefore, the aim of this narrative review was to describe the movement strategies exhibited following ACLr during CoD tasks and to critically analyze the range of tests that have been used. Specifically, we examined their ability to identify between-limb deficits and individuals who display a heightened risk of secondary injury and/or reductions in their level of pre-injury performance. MEDLINE, PubMed and SPORT Discuss databases were used and 13 articles were identified that met the inclusion criteria. Examination of the available literature indicates that current field-based practices are not representative of relevant sport demands and are unable to effectively assess knee function following ACLr. Laboratory-based studies have identified residual deficits and altered movement strategies at the time of return to sport, and this in part may be related to risk of re-injury. However, these assessments exhibit inherent limitations and are not practically viable for monitoring progress during rehabilitation. Consequently, alternative solutions that are more-aligned with the multitude of factors occurring during CoD maneuvers in chaotic sports environments are warranted to allow practitioners to 'bridge the gap' between the laboratory and the sports field/court. This approach may facilitate a more informed decision-making process with the end goal being, a heightened 'return to performance' and a lower risk of re-injury.

The Effects of Six-Weeks Change of Direction Speed and Technique Modification Training on Cutting Performance and Movement Quality in Male Youth Soccer Players

Cutting manoeuvres are important actions associated with soccer performance and a key action associated with non-contact anterior cruciate ligament injury; thus, training interventions that can improve cutting performance and movement quality are of great interest. The aim of this study, therefore, was to determine the effects of a six-week change of dire[ction (COD) speed and technique modification training intervention on cutting performance and movement quality in male youth soccer players (U17s, n = 8) in comparison to a control group (CG) (U18s, n = 11) who continued ‘normal’ training. Cutting performance was assessed based on completion time and COD deficit, and the field-based cutting movement assessment score (CMAS) qualitative screening tool was used to assess cutting movement quality. Significant main effects for time (pre-to-post changes) (p ≤ 0.041, η² = 0.224–0.839) and significant interaction effects of time and group were observed for cutting completion times, COD deficits, and CMASs. Improvements in completion time (p < 0.001, g = 1.63–1.90, −9% to −11% vs. −5% to 6%) and COD deficit (p ≤ 0.012, g = −1.63 to −2.43, −40–52% vs. −22% to −28%) for the COD intervention group (IG) were approximately two-times greater than the CG. Furthermore, lower CMASs (i.e., improved cutting movement quality) were only observed in the IG (p ≤ 0.025, g = −0.85 to −1.46, −23% to −34% vs. 6–19%) compared to the CG. The positive changes in CMASs were attributed to improved cutting technique and reduced incidences of high-risk deficits such as lateral trunk flexion, extended knee postures, knee valgus, hip internal rotation, and improved braking strategies. The results of this study indicate that COD speed and technique modification training, in addition to normal skills and strength training, improves cutting performance and movement quality in male youth soccer players. Practitioners working with male youth soccer players should implement COD speed and technique modification training to improve cutting performance and movement quality, which may decrease potential injury-risk.