Limb-dominance and gender differences in the ground reaction force during single-leg lateral jump-landings

Trunk and Lower Extremity Biomechanics in Female Athletes With and Without a Concussion History

CONTEXT

Athletes with a history of concussion are at a greater risk for lower extremity musculoskeletal injury. Female athletes may be at an even greater risk than male athletes. Previous researchers on postconcussion landing biomechanics have focused on the lower extremities, but the trunk plays a crucial role as an injury risk factor.

OBJECTIVE

To compare lower extremity and trunk biomechanics during jump-landing and cutting maneuvers between female athletes with and those without a concussion history.

DESIGN

Cross-sectional study.

SETTING

Biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 26 athletes (mean ± SD age = 19.0 ± 1.3 years, height = 1.68 ± 0.07 m, mass = 64.02 ± 6.76 kg, body mass index = 22.58 ± 1.97 kg/m2; median [interquartile range] time since most recent concussion = 37.5 months [25.0 months, 65.8 months]) with a concussion history and 38 athletes (age = 19.0 ± 1.1 years, height = 1.71 ± 0.08 m, mass = 64.72 ± 9.45 kg, body mass index = 22.14 ± 1.80 kg/m2) without a concussion history.

MAIN OUTCOME MEASURE(S)

Peak kinetics (vertical ground reaction force, vertical loading rate, external knee-abduction moment, and external knee-flexion moment) and kinematics (trunk-flexion angle, trunk lateral-bending angle, ankle-dorsiflexion angle, knee-flexion angle, knee-abduction angle, and hip-flexion angle) were obtained during the eccentric portion of jump-landing and cutting tasks. Separate 2 (group) × 2 (limb) between- and within-factors analyses of covariance were used to compare outcomes between groups. We covaried for time since the most recent concussion and the limb that had a history of musculoskeletal injury.

RESULTS

Athletes with a concussion history displayed a greater peak knee-abduction angle in their nondominant limb than their dominant limb (P = .01, ηp2 = 0.107) and the nondominant limb of athletes without a concussion history (P = .02, ηp2 = 0.083) during jump landing. They also had less trunk lateral bending during cutting compared with athletes without a concussion history (P = .005, ηp2 = 0.126).

CONCLUSIONS

Our results indicated landing biomechanics are different between female athletes with and those without a concussion history. This finding may be due to impairments in neuromuscular control postconcussion that may ultimately increase the risk of subsequent lower extremity injury, although further research is warranted given the cross-sectional nature of our study.

Differences in lower extremity kinematics during single-leg lateral drop landing of healthy individuals, injured but asymptomatic patients, and patients with chronic ankle instability- a cross-sectional observational study

The lower-extremity kinematics associated with forward jump landing after an ankle injury is known to differ for patients with Chronic Ankle Instability (CAI), copers (injured but asymptomatic patients), and healthy individuals. However, the differences in the lower extremity kinematics of these groups associated with a Single-leg Lateral Drop Landing (SLDL) are unknown. The purpose of this study is to characterize the lower limb and foot kinematics during SLDL in CAI patients and to compare these characteristics with those of the copers and healthy individuals. This was a cross-sectional observational study. Nineteen participants, each, were selected from the CAI, Coper, and control groups. The lower-extremity kinematics during SLDL was measured using three-dimensional motion analysis over an interval progressing from 200 ms before landing to 200 ms after landing. Either one-way ANOVA or the Kruskal-Wallis test was used to compare the attributes of the respective groups, with each parameter measured every 10 ms. The maximum values and excursions of the parameters were established over time intervals progressing from 200 ms before landing to 200 ms after landing. Significant observations were subjected to post hoc analysis. Compared to the Coper group, the CAI group exhibited significantly smaller hip adduction angles at 160 ms, ankle dorsiflexion angles in the 110-150 ms interval, and maximum ankle dorsiflexion angles after landing. Compared to the control group, the CAI group exhibited significantly smaller excursions of MH inversion/eversion after landing. Our findings confirm the necessity of focusing on the kinematics of hip adduction/abduction and plantar/dorsiflexion during SLDL in evaluating patients with ankle injuries.

Ultrasound-guided dry needling versus traditional dry needling for patients with knee osteoarthritis: A double-blind randomized controlled trial

Objective

To compare the effect of ultrasound (US)-guided dry needling (DN) with traditional DN in the treatment of pain and dysfunction for patients with knee osteoarthritis (KOA).

Design

A double-blind, randomized controlled trial.

Methods

Patients (25 male and 65 female), age 50–80 years diagnosed with KOA were recruited and randomly assigned to one of three groups in a 1:1:1 ratio for intervention: real US-guided DN with exercise therapy (G1), placebo US-guided DN with exercise therapy (G2), and exercise therapy solely (G3). G1 and G2 were blinded to the application of real or placebo US guidance by turning the monitor of US imaging out-of-view from participants’ vantage points. The effectiveness of blinding was evaluated by asking the participants whether they had received real-US guided DN. The responses were assessed by Chi-square test. Visual Analogue Scale (VAS), Knee injury, and Osteoarthritis Outcome Score (KOOS) subscales (KOOS-pain, KOOS-symptoms, KOOS-quality-of-life (QoL)) were collected at baseline, 4 weeks, and 8 weeks by a blinded assessor. Data were analyzed by mixed model analysis of variance (ANOVA) with Bonferroni correction.

Results

Eighty-four participants (61.26±5.57 years) completed the study. G1 achieved significant improvement in VAS at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = -15.61, 95% CI [-25.49, -5.51], p = 0.001; G1 vs. G3: MD = -19.90, 95% CI [-29.71, -10.08], p< 0.001). G1 achieved significant improvement in KOOS-pain at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = 9.76, 95% CI [2.38, 17.14], p = 0.006; G1 vs. G3: MD = 9.48, 95% CI [2.31, 16.66], p = 0.010). KOOS-symptoms and KOOS-QoL were not statistically significant between groups. G2 had no significant difference of the perceptions as G1 with p = 0.128. G2 were successfully blinded to placebo US-guided DN.

Conclusion

US-guided DN with exercise therapy may be more effective than traditional DN with exercise therapy or exercise therapy alone in reduce pain of KOA.

Reliability of three-dimensional motion analysis during single-leg side drop landing test after anterior cruciate ligament reconstruction: An in vivo motion analysis study

Background:

Anterior cruciate ligament (ACL) injury is a common sport injury and investigation of landing biomechanics is helpful in injury prevention and rehabilitation. Recent study found a lateral single-leg drop landing test resulted in the highest peak knee valgus angle (PKVA), but its reliability on patients who received ACL reconstruction (ACLR) is unknown.

Objective:

This study aimed to investigate the reliability in both within and between days on the normalized vertical ground reaction force (NVGRF) and kinematics of lower limbs after receiving ACLR. The findings can form the cornerstone for further study related to lateral jumping-and-landing biomechanics in patients with ACLR.

Methods:

This was a test-retest reliability study. Twelve patients (four females and eight males) who received ACLR with mean age of 29.4 (SD ± 1.66) were recruited. The subjects were instructed to jump laterally from 30 cm height and landed with single-leg for five times. The procedure was conducted on both legs for comparison. The NVGRF and local maxima of the hip, knee and ankle angles during the first 100 ms in all three planes were analyzed. The measurement was conducted by the same assessor to evaluate the within-session reliability, and the whole procedure was repeated one week later for the evaluation of the between-session reliability. Intra-class correlation coefficient (ICC) test was used to assess the within- and between-session reliability by ICC (3, 1) and ICC (3, K) respectively.

Results:

The within-session reliability of NVGRF [ICC (3, 1)] was 0.899–0.936, and its between-session reliability [ICC (3, K)] was 0.947–0.923. Overall reliability for kinematics within-session [ICC (3, 1)] was 0.948–0.988, and the between-session reliability [ICC (3, K)] was 0.618–0.982, respectively. Good to excellent reliability for the lateral single-leg drop landing test was observed in most of the outcome measures for within- and between-session. The ICC value of NVGRF of ACLR leg was lower than that of the good leg in the within-session which may associate with lower neuromuscular control in ACLR leg than that of the good leg.

Conclusion:

The results of this study support the use of a lateral single-leg drop landing test to evaluate lower limb biomechanics for ACLR.

Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport after ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (PRIME)

Background

Elite female athletes who successfully return to sport after anterior cruciate ligament reconstruction (ACLR) represent a high-risk group for secondary injury. Little is known about how the functional profile of these athletes compares to their teammates who have not sustained ACL injuries.

Purpose

To compare elite collegiate female athletes who were able to successfully return to sport for at least one season following ACLR to their teammates with no history of ACLR with regard to self-reported knee function, kinetics, and kinematics during a double limb jump-landing task.

Study Design

Cross-Sectional Study.

Level of Evidence

Level 3.

Methods

Eighty-two female collegiate athletes (17 ACLR, 65 control) completed the knee-specific SANE (single assessment numeric evaluation) and three trials of a jump-landing task prior to their competitive season. vGRF data on each limb and the LESS (Landing Error Scoring System) score were collected from the jump-landing task. Knee-SANE, vGRF data, and LESS scores were compared between groups. All athletes were monitored for the duration of their competitive season for ACL injuries.

Results

Athletes after ACLR reported worse knee-specific function. Based on vGRF data, they unloaded their involved limb during the impact phase of the landing, and they were more asymmetrical between limbs during the propulsion phase as compared to the control group. The ACLR group, however, had lower LESS scores, indicative of better movement quality. No athletes in either group sustained ACL injuries during the following season.

Conclusion

Despite reporting worse knee function and demonstrating worse kinetics, the ACLR group demonstrated better movement quality relative to their uninjured teammates. This functional profile may correspond to short-term successful outcomes following ACLR, given that no athletes sustained ACL injuries in the competition season following assessment.

Osteoarthritis induces gender-related changes in the knee range of motion

In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motion (ROM) of joints, we wanted to evaluate how gender impacts gait dynamics in OA patients. For this study, we have compared 106 OA patients (74 females and 32 males) to age matched controls. All participants had their right leg as dominant. Video recording of normal gait was analyzed with a digital goniometry tool phone application, and the knee's ROM was measured in midstance and midswing moment of the gait. During midstance, significant extension and flexion of the knee excursion have been observed in both males and females. During midswing, knee OA presents more differences, whereas subjects with hip and knee OA present changes on the dominant knee. Midstance changes suggest that the knee's joint degenerative changes, such as synovitis, can be linked to hip OA secondary changes. Midswing changes in lower limb OA suggest a connection to the activities of daily life. Gender differences generated by OA must furthermore be studied in both lower limbs so that the best therapeutic approach can be chosen.

Central vs. Peripheral Vision during a Singe-Leg Drop Jump: Implications of Dynamics and Patellofemoral Joint Stress

Landing on a single-leg without receiving direct visual information (e.g., not looking at the ground) may increase the risk of injury. We examined whether visual focus contributed to the changing lower-extremity dynamics and patellofemoral joint stress during a single-leg drop jump task. Twenty healthy volunteers visited the laboratory for three separate sessions. During each session, participants randomly performed either of two types of a single-leg drop jump task from a 30 cm high wooden box. Subsequently, participants looked at the landing spot (central vision condition) or kept their heads up (peripheral vision condition) when performing the task. Sagittal and frontal plane lower-extremity joint angles and joint moments (in the ankle, knee, and hip), including the vertical ground reaction force, and patellofemoral joint stress during the first landing phase (from initial contact to peak knee flexion) were compared. Greater ankle inversion and hip adduction were observed when landing with the peripheral vision condition. However, the magnitudes were negligeable (Cohen’s d effect size <0.35). No statistical difference was observed in other comparisons. Landing on a single-leg from a 30 cm height without receiving full visual attention (peripheral vision condition) does not increase the risk of lower-extremity traumatic and overuse injuries.

Characteristics of ground reaction force and frontal body movement during failed trials of single-leg lateral drop jump-landing task

Background

/objectives: For biomechanical studies using jump-landing tasks, many researchers set the criteria for judging success or failure of the trial. Failed trials are usually removed from the analysis. However, the kinetics and kinematics during tasks included in failed trials might be important for understanding the mechanisms and risk factors of non-contact sports injuries. However, few studies have attempted to analyze failed trials. Therefore, the main objective of this study was to investigate the characteristics associated with ground reaction force (GRF) and two-dimensional frontal body movements during a failed trial of single-leg lateral drop jump-landing.

Methods

Ten healthy women and 16 healthy men participated in this study. Spearman's rank correlation coefficients were calculated using the total number of failed trials and GRF data of successful trials. The association between frontal body movement and kinetics data was identified using correlation analyses. Wilcoxon signed-rank tests were performed to compare the GRF data of successful trials and failed trials of the same subject. Additionally, a two-way repeated measure analysis of variance was used to determine significant interactions of each trial and time after initial contact in the frontal body movement.

Results

A total of 137 trials including successful and failed trials were recorded. There were 59 failed jump trials. There was a significant negative correlation between the number of failed jump trials and the elapsed time from initial contact to peak vertical GRF (peak vGRF time) during successful trials (r = -0.427). The majority of failed trials were judged to be due to rearfoot movement patterns (rearfoot medial slip or rearfoot lateral slip). During rearfoot medial slip, we observed shorter peak vGRF time, larger trunk medial motions, and larger hip adduction movements after landing than that during successful trials. During rearfoot lateral slip, we observed larger trunk lateral motions and hip abduction movements after landing than that during successful trials.

Conclusions

Athletes who frequently failed during single-leg lateral drop jump-landing had poor skills absorbing jump-landing impact, which is related to various sports injuries. It is possible to identify the risk factors for sports injuries by analyzing failure patterns.

Correlations between isokinetic knee torques and single-leg hop distances in three directions in patients after ACL reconstruction

Background

When planning rehabilitation and conditioning for performance enhancement and a return to sports after anterior cruciate ligament reconstruction, identifying the elements of physical function associated with single-leg hop is important. The purpose of this study was to clarify the relationship between single-leg hop distances in three directions and knee extensor and flexor strengths at 6 months after reconstruction.

Methods

Participants were 47 patients taking part in training sessions for sports involving cutting, pivoting, and jump-landing 6 months after reconstruction using a hamstring tendon. Single-leg hop distances in 3 directions (anterior, lateral, and medial) and isokinetic concentric strengths of knee extension and flexion were assessed at an angular velocity of 60°/s and 180°/s. Simple regression analyses using Spearman’s rank correlation coefficient were performed to assess relationships between single-leg hop distances and knee strengths.

Results

In the involved limb, correlations between single-leg hop distances in 3 directions and knee strengths were significant (P < 0.01) and correlation coefficients ranged from 0.48 to 0.65. Correlation coefficients between all single-leg hop parameters and knee extension/flexion strengths at an angular velocity of 180°/s were greater than those of 60°/s.

Conclusions

In this cross-sectional study of patients who participated in sports training sessions that required jump-landings and cutting approximately 6 months after reconstruction using hamstring grafts, isokinetic knee flexor, and extensor torques were moderately to strongly associated with single-leg hop distances in lateral, medial, and anterior directions. Given these relationships, assessments and exercises for knee strength and single-leg hop distances should be planned.

[Handball injuries and their prevention]

BACKGROUND

Handball is one of the most popular team sports in Germany, as well as one of the most dangerous ones. Injury rates in Germany are higher amongst handball professionals than in soccer, with the knee being the most commonly injured joint. To prevent injuries, a functional inert stability is necessary, but definitions and objective measures are lacking.

OBJECTIVES

Establishing valid reference data of functional knee stability in amateur handball players with use of an established test battery giving objective measures METHODS: 261 athletes (f:130; m:131), mean age 25.1 ± 5.8 y were screened during the preseason. The test battery consisted of double and single-leg counter movement jumps, balance tests, agility, parkour, quick feet test and plyometric jumps.

RESULTS

Significant differences between males and females were noted in regard to balance scores (favour for females p ≤ 0.001), as well as jump height, agility and speed tests (favour for males [p ≤ 0.002-0.001]).

CONCLUSION

The noted differences once again bring focus to the interindividual presence of risk factors, because female and male handball athletes have gender-specific ground levels. These attributes have to be considered in further screening and prevention programs, as well as in the context of the return-to-sports decision after injury. The given data may serve as objective reference measures.