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Hernandez PA, Bradford JC, Brahmachary P, Ulman S, Robinson JL, June RK, Cucchiarini M. Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life? Osteoarthritis Cartilage 2024:S1063-4584(24)01172-5. [PMID: 38703811 DOI: 10.1016/j.joca.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females. DESIGN We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives. RESULTS The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures. CONCLUSIONS We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.
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Affiliation(s)
- Paula A Hernandez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | | | - Priyanka Brahmachary
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Sophia Ulman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Movement Science Laboratory, Scottish Rite for Children, Frisco, TX 75034, USA.
| | - Jennifer L Robinson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA.
| | - Ronald K June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar D-66421, Germany.
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Belozo FL, Belozo RSMN, Ricardo Lopes C, Yamada AK, Silva VRR. Anterior cruciate ligament: A brief narrative review of main risk factors for injury and re-injury. J Bodyw Mov Ther 2024; 38:92-99. [PMID: 38763622 DOI: 10.1016/j.jbmt.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/26/2023] [Accepted: 01/13/2024] [Indexed: 05/21/2024]
Abstract
Anterior cruciate ligament (ACL) injury is one of the main injuries in professional and amateur athletes of different sports. Hundreds of thousands of ACL ruptures occurs annually, and only 55% of the athletes return to competitive level, with a 15 times higher chance of suffering a second injury. 60% of these injuries occur without physical contact and since they occur in the acute process, they can cause joint effusion, muscle weakness and functional incapacity. In the long term, they can contribute to a premature process of osteoarthritis. This narrative review is of particular interest for clinicians, practitioners, coaches and athletes to understand the main factors that contribute to an injury and/or re-injury and thus, to optimize their training to reduce and/or prevent the risk of injury and/or reinjury of ACL. Therefore, we aimed reports a narrative overview of the literature surrounding communication and explore through a theoretical review, the main risk factors for an ACL injury and/or re-injury, as well as bringing practical and correct methods of training applications. The lack of theoretical/practical knowledge on the part of rehabilitation and/or training professionals may impair the treatment of an athlete and/or student. High-quality research that can testing different training methods approaches in randomized controlled trials is needed.
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Affiliation(s)
- Felipe L Belozo
- College of Physical Education - Network Faculty, Nova Odessa, Sao Paulo, Brazil
| | - Rebeca S M N Belozo
- College of Physical Education - Network Faculty, Nova Odessa, Sao Paulo, Brazil
| | - Charles Ricardo Lopes
- Methodist University of Piracicaba, Piracicaba, SP, Brazil; Faculty Adventist of Hortolândia, Hortoslândia, SP, Brazil
| | - André K Yamada
- Methodist University of Piracicaba, Piracicaba, SP, Brazil
| | - Vagner R R Silva
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Sánchez-Morales S, Gutiérrez-Martín B, Ibáñez-Vera AJ, Rodríguez-Almagro D, Pecos-Martín D, Achalandabaso-Ochoa A. Effectiveness of a specific strength program of the gluteus maximus muscle to improve dynamic postural control in female basketball players. A randomized controlled trial. Gait Posture 2024; 108:90-96. [PMID: 38016398 DOI: 10.1016/j.gaitpost.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Basketball is a team sport in which players perform multidirectional movements, jumps and landings, experiencing abrupt accelerations and decelerations and numerous changes of rhythm. In this sport, speed and intensity are two key factors that are associated with an increased risk of injury. The aim of this randomized controlled trial was to determine the effectiveness of a specific gluteus maximus strength programme as preventive work for young female basketball players, to improve dynamic postural stability and to observe its impact in the rate of lower limb injuries, vertical jump, dynamic knee valgus and pain. RESEARCH QUESTION Is effective a strength programme to improve dynamic postural stability, vertical jump and dynamic valgus in female basketball players? METHODS A hundred and thirteen female basketball players that play in professional clubs were recruited, reaching the final stage 92 (46 per group). One group (CG) received conventional injury prevention training while the experimental group (EG) added to the conventional team prevention program, a gluteus maximus strength programme of 5 months composed of 4 exercises/2 days per week/2 sets of 10 repetitions per leg. RESULTS The total injury incidence decreased from 0.33 to 0.16 cases (control group pre=0.43 to post=0.14 cases, EG pre=022 to post=0.19). The EG improved overall (p = 0.000), posterior (p = 0.001), posteromedial (p = 0.001) and posterolateral (p = 0.000) dynamic stability of the right leg; anterior (p = 0.024), medial (p = 0.07) and posteromedial (p = 0.01) of the left leg. Both groups improved vertical jump (GC: p = 0.045 and GE: p = 0.000). There was no significant improvement in pain or valgus. SIGNIFICANCE This strength programme is effective in improving dynamic stability especially of the dominant leg and jump height.
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Affiliation(s)
- Sandra Sánchez-Morales
- Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, Madrid, Spain
| | - Belén Gutiérrez-Martín
- Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, Madrid, Spain
| | | | | | - Daniel Pecos-Martín
- Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, Madrid, Spain
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Butler L, Martinez A, Erdman A, Sugimoto D, Loewen A, Milian E, Wyatt C, Hayden K, DeVerna A, Tulchin-Francis K, Ulman S. Concurrent Validity of The Expanded Cutting Alignment Scoring Tool (E-CAST). Int J Sports Phys Ther 2023; 18:1147-1155. [PMID: 37795331 PMCID: PMC10547067 DOI: 10.26603/001c.87633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
Background The Expanded Cutting Alignment Scoring Tool (E-CAST) has been previously shown to be reliable when assessing lower extremity alignment during a 45-degree sidestep cut, however, the validity of this tool remains unknown. The purpose of this study was to assess the concurrent validity of the E-CAST by comparing visually identified movement errors from two-dimensional (2D) video with three-dimensional (3D) biomechanical variables collected using motion capture. Study Design Cross Sectional. Methods Sixty female athletes (age 14.1 ± 1.5 years) who regularly participated in cutting/pivoting sports performed a sidestep cut with 2D video and 3D motion capture simultaneously recording. One clinician scored the 2D videos for each limb using the E-CAST criteria. Joint angles and moments captured in 3D were computed for the trunk and knee. Receiver operating characteristic (ROC) curve analyses were performed to determine the accuracy of each E-CAST item and to provide cut-off points for risk factor identification. Results ROC analyses identified a cut-off point for all biomechanical variables with sensitivity and specificity ranging from 70-85% and 55-89%, respectively. Across items, the area under the curve ranged from 0.67 to 0.91. Conclusion The E-CAST performed with acceptable to outstanding area under the curve values for all variables except static knee valgus. Level of evidence 3b.
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Affiliation(s)
- Lauren Butler
- Physical Therapy Florida International University
- Rehabilitation, Nicklaus Children's Hospital
| | | | | | - Dai Sugimoto
- Waseda University
- The Micheli Center for Sports Injury Prevention
| | | | | | - Charles Wyatt
- Scottish Rite for Children
- University of Texas Southwestern Medical Center
| | | | | | | | - Sophia Ulman
- Scottish Rite for Children
- University of Texas Southwestern Medical Center
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Nawasreh ZH, Yabroudi MA, Al-Shdifat A, Daradkeh S, Kassas M, Bashaireh K. Kinetic energy absorption differences during drop jump between athletes with and without radiological signs of knee osteoarthritis: Two years post anterior cruciate ligament reconstruction. Gait Posture 2022; 98:289-296. [PMID: 36252434 DOI: 10.1016/j.gaitpost.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients demonstrate decreased knee loading and energy absorption after anterior cruciate ligament reconstruction (ACLR). This study aimed to determine the differences in the contribution of joints to the absorbed energy between athletes with and without radiological signs of knee OA 2 years after ACLR during drop jump (DJ) landing from 20, 30, and 40 cm. METHODS Forty-one (level I/II) athletes 2 years after ACLR participated in this cross-sectional study and completed motion analysis testing of DJ. Proportional contribution of the joints (foot, ankle, knee, and hip) to the absorbed energy were computed. Posterior-anterior bent-knee radiographs were completed and graded in the medial compartment of the reconstructed knee using the Kellgren-Lawrence (KL) system (OA group: KL ≥2; Non-OA group: KL<2) RESULTS: Thirteen (31.7%) athletes showed radiological signs of knee OA in the medial compartment. There was a significant joint-by-group-by-limb interaction for the contribution of joints to absorbed energy during DJ 40 cm (p ≤ 0.019) and a joint-by-group interaction for the contribution of joints during DJ 20 cm (p = 0.018). The OA group had a lower involved knee (p = 0.043) and higher involved hip contributions (p = 0.014) compared to the Non-OA group, and the non-involved knee (p = 0.007). While the Non-OA group had a lower involved ankle contribution (p = 0.045) compared to their non-involved ankle during DJ 40 cm. The OA group also had higher involved hip contribution than the Non-OA group (p = 0.010), lower involved knee (p = 0.002), and higher involved hip contribution than the non-involved limb during DJ 20 cm. SIGNIFICANCE The OA group may have adopted a compensatory pattern characterized by a decreased involved knee and increased involved hip to attenuate absorbed energy compared to the Non-OA group and their non-involved limb. The contribution of joints to the absorbed energy during DJ landing might be used as an assessment tool to identify patients with radiological signs of knee OA after ACLR.
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Affiliation(s)
- Zakariya H Nawasreh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan.
| | - Mohammad A Yabroudi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Anan Al-Shdifat
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Sharf Daradkeh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Mohamed Kassas
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Khaldoon Bashaireh
- Jordan University of Science and Technology (JUST), Department of Special Surgery, College of Medicine, P.O. Box 3030, Irbid 22110, Jordan
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Mohammadi Nia Samakosh H, Brito JP, Shojaedin SS, Hadadnezhad M, Oliveira R. What Does Provide Better Effects on Balance, Strength, and Lower Extremity Muscle Function in Professional Male Soccer Players with Chronic Ankle Instability? Hopping or a Balance Plus Strength Intervention? A Randomized Control Study. Healthcare (Basel) 2022; 10:healthcare10101822. [PMID: 36292269 PMCID: PMC9602092 DOI: 10.3390/healthcare10101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic ankle instability (CAI) has a higher frequency in soccer due to the rapid changes in body movement. Thus, this study compared the effects of eight weeks of a hopping protocol and a combined protocol of balance plus strength in a within-between group analysis. Thirty-six male professional soccer players participated in this study and were randomly allocated in three groups: control group (CG, n = 12), hopping group (HG, n = 12), and balance plus strength group (BSG, n = 12). Strength, static and dynamic balance, and function were assessed at baseline and eight weeks post intervention. First, Foot and Ankle Ability Measure (FAAM) and FAAM sport scales were applied. Then, a dynamometer was used to measure strength of the muscles around the hip, knee, and ankle joints. The Bass stick measured static balance and the Y balance test measured dynamic balance. Additionally, functional tests were carried out by Triple Hop, the Figure 8 hop, and vertical jump. A repeated measures ANOVA [(3 groups) × 2 moments] was used to compare the within and between group differences. In general, all tests improved after eight weeks of training with both protocols. Specifically, the BSG improved with large ES for all tests, while the HG improved all test with small to large effect sizes (ES). Furthermore, HG showed higher values for vertical jump (p < 0.01, ES = 1.88) and FAAMSPORT (p < 0.05, ES = 0.15) than BSG. BSG showed higher values for hip abduction (p < 0.05, ES = 2.77), hip adduction (p < 0.05, ES = 0.87), and ankle inversion (p < 0.001, ES = 1.50) strength tests, while HG showed higher values for knee flexion [ES = 0.86, (0.02, 1.69)] and ankle plantarflexion [ES = 0.52, (−0.29, 1.33)]. Balance plus strength protocol showed more positive effects than the hopping protocol alone for soccer players with CAI.
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Affiliation(s)
- Hadi Mohammadi Nia Samakosh
- Department of Biomechanics and Corrective Exercises and Sports Injuries, University of Kharazmi, Tehran 15719-14911, Iran
- Correspondence:
| | - João Paulo Brito
- Sports Science School of Rio Maior–Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- Life Quality Research Centre, 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development, 5001-801 Vila Real, Portugal
| | - Seyed Sadredin Shojaedin
- Department of Biomechanics and Corrective Exercises and Sports Injuries, University of Kharazmi, Tehran 15719-14911, Iran
| | - Malihe Hadadnezhad
- Department of Biomechanics and Corrective Exercises and Sports Injuries, University of Kharazmi, Tehran 15719-14911, Iran
| | - Rafael Oliveira
- Sports Science School of Rio Maior–Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- Life Quality Research Centre, 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development, 5001-801 Vila Real, Portugal
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Sahabuddin FNA, Jamaludin NI, Hamzah NA, Leang CC, Shaharudin S. The effects of hip- and ankle-focused exercise intervention on lower limb mechanics during single leg squat among physically active females. Phys Ther Sport 2022; 55:70-79. [DOI: 10.1016/j.ptsp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
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Houston A, Fong DTP, Bennett AN, Walters V, Barker-Davies RM. Biomechanical differences between military patients with patellar tendinopathy and asymptomatic controls during single-leg squatting and gait - A statistical parametric mapping study. Clin Biomech (Bristol, Avon) 2021; 90:105514. [PMID: 34757256 DOI: 10.1016/j.clinbiomech.2021.105514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/07/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prior identification of biomechanical differences between patients with patellar tendinopathy and healthy controls has utilised time-discrete analysis which is susceptible to type I error when multiple comparisons are uncorrected. We employ statistical parametric mapping to minimise the risk of such error, enabling more appropriate clinical decision-making. METHODS Lower-limb biomechanics of 21 patients with patellar tendinopathy and 22 controls were captured during walking and three types of squats. A statistical parametric mapping two-sample t-test was used to identify kinematic and kinetic differences between groups for each joint. Paired t-tests were used to compare pain before and after tasks, in patients with patellar tendinopathy. FINDINGS During walking, cases demonstrated reduced knee joint power during initial contact and hip joint power during terminal stance. In squatting, cases demonstrated increased knee abduction angles at various time points of the small knee bend and single-leg squat. Cases demonstrated reduced knee internal rotation moment during the deepest portion of the single-leg squat and single-leg decline squat. INTERPRETATION Gait appears unaffected by patellar tendinopathy, likely due to low task difficulty. Elevated knee abductions angles during squatting were confirmed as a key difference in patients with patellar tendinopathy. Reduced knee internal rotation moments in patients were attributed to a potential reduction in hip external rotator strength and possible pain avoidance strategy; however further evidence is required to substantiate these claims. Findings provide a clear rationale for rehabilitation programs to focus on knee stabilisation and strengthening of the muscles surrounding the hip.
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Affiliation(s)
- Andrew Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK
| | - Vanessa Walters
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, UK
| | - Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK.
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Geisler PR. Current Clinical Concepts: Synthesizing the Available Evidence for Improved Clinical Outcomes in Iliotibial Band Impingement Syndrome. J Athl Train 2021; 56:805-815. [PMID: 34375405 DOI: 10.4085/1062-6050-548-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The current paradigm of insidious lateral knee pain involving the iliotibial band (ITB) in repetitive knee-flexion activities has been termed ITB friction syndrome since 1975. The original model for ITB pain was based on a limited or incorrect understanding of the relevant anatomy, biomechanics, and tissue science, which gradually led to a plethora of frustrating and ineffective interventional strategies. Mounting evidence from arthroscopic, cadaveric, and biomechanical studies, as well as from diagnostic imaging and histologic reports, has helped deconstruct this long-held paradigm for ITB-related pathology and treatment. By outlining the historical paradigm for our understanding of ITB pain and gathering newer evidence through extensive research, I will synthesize the available data in this clinical update to present an updated, more informed model for understanding insidious-onset ITB-related pathology and treating patients. The result is called ITB impingement syndrome.
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Affiliation(s)
- Paul R Geisler
- Exercise Science and Athletic Training, School of Health Sciences and Human Performance, Ithaca College, NY
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10
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Sahabuddin FNA, Jamaludin NI, Amir NH, Shaharudin S. The effects of hip- and ankle-focused exercise intervention on dynamic knee valgus: a systematic review. PeerJ 2021; 9:e11731. [PMID: 34268014 PMCID: PMC8265381 DOI: 10.7717/peerj.11731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background A range of non-contact injuries such as anterior cruciate ligament tear, and patellofemoral pain syndrome are caused by disordered knee joint loading from excessive dynamic knee valgus (DKV). Previous systematic reviews showed that DKV could be modified through the influence of hip strength and ankle range of motion. Therefore, the purpose of this systematic review was to examine the effects of exercise intervention which involved either top-down or bottom-up kinetic chains on minimizing DKV in male and female adults and adolescents, with and without existing knee pain. Methodology Electronic searches were conducted in SAGE, Science Direct, SCOPUS, and Pubmed. The search strategy consisted of medical subject headings and free-text search keywords, synonyms and variations of ‘exercise intervention,’ ‘knee alignment,’ ‘dynamic knee valgus’, ‘knee abduction’ that were merged via the Boolean operator ‘AND’ and ‘OR’. The search was conducted on full-text journals that documented the impact of the exercise intervention program involving either the bottom-up or top-down DKV mechanism on the knee kinematics. Furthermore, exercise intervention in this review should last at least one week which included two or three sessions per week. This review also considered both men and women of all ages with a healthy or symptomatic knee problem. The risk of bias of the included studies was assessed by Cochrane risk assessment tool. The protocol of this review was registered at PROSPERO (registration number: CRD42021219121). Results Ten studies with a total of 423 participants (male = 22.7%, female = 77.3%; adults = 249, adolescents = 123; pre-adolescent = 51) met the inclusion criteria of this review. Seven studies showed the significant effects of the exercise intervention program (range from two weeks to ten weeks) on reducing DKV. The exercise training in these seven studies focused on muscle groups directly attached to the knee joint such as hamstrings and gastrocnemius. The remaining three studies did not show significant improvement in DKV after the exercise intervention (range between eight weeks to twelve weeks) probably because they focused on trunk and back muscles instead of muscles crossing the knee joint. Conclusion Exercises targeting specific knee-joint muscles, either from top-down or bottom-up kinetic chain, are likely to reduce DKV formation. These results may assist athletes and coaches to develop effective exercise program that could minimize DKV and ultimately prevent lower limb injuries.
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Affiliation(s)
| | - Nazatul Izzati Jamaludin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nurul Hidayah Amir
- Department of Translational Health Sciences, Faculty of Health Science, University of Bristol, Bristol, United Kingdom.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Arau, Perlis, Malaysia
| | - Shazlin Shaharudin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Lower limb kinematics differ at the time of foot contact between successful and unsuccessful single limb landings following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 51:17-21. [PMID: 34174529 DOI: 10.1016/j.ptsp.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate differences in lower extremity kinematics at initial ground contact between successful and unsuccessful single limb landings following anterior cruciate ligament (ACL) reconstruction. DESIGN Observational study. SETTING Controlled laboratory environment. PARTICIPANTS 22 male participants (aged 17-40 years) who had undergone unilateral ACL reconstruction attended a single test session. MAIN OUTCOME MEASURES Within-subjects comparisons was performed for pelvis, hip, knee and ankle kinematics using paired t-tests. RESULTS When unsuccessful at landing on the ACL reconstructed limb, participants had significantly increased knee flexion (P = 0.04) and reduced ankle plantarflexion (P = 0.03) compared to their successful landings. In contrast, when unsuccessful at landing on the unaffected limb, participants had significantly increased pelvic contralateral hitch (P < 0.01) and increased hip abduction (P < 0.01) compared to successful landings. CONCLUSION Body position at the time of initial contact was different for landings that were successful compared to landings that were unsuccessful. These differences were limb-specific: altered position in sagittal plane preceded unsuccessful landings on the reconstructed limb whereas altered position in the coronal plane body position that preceded unsuccessful landings on the unaffected limb. These findings suggest that limb specific landing strategies may be required to improve athletes' performance following ACL reconstruction. LEVEL OF EVIDENCE IV.
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12
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Taylor JB, Wright ES, Waxman JP, Schmitz RJ, Groves JD, Shultz SJ. Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing. Sports Health 2021; 14:328-335. [PMID: 34096370 DOI: 10.1177/19417381211019683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. HYPOTHESIS We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. RESULTS For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion (r2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles (r2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion (r2 = 0.40, P = 0.004), 0.002 N·m·N-1·cm-1 decrease in hip extensor work (r2 = 0.28, P = 0.02), and 0.001 N·m·N-1·cm-1 decrease in knee extensor work (r2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles (r2 = 0.26, P = 0.03) and 0.01 N·m·N-1·cm-1 lesser knee extensor work (r2 = 0.25, P = 0.03). CONCLUSION Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. CLINICAL RELEVANCE While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina
| | - Elena S Wright
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina.,Department of Implementation Science, Division of Public Health Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Justin P Waxman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - James D Groves
- Department of Physical Therapy, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
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Dean RS, Beck EC, Waterman BR. Knee Malignment: Is There a Role for Correction in Primary ACLR? OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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14
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Impact of Three Strengthening Exercises on Dynamic Knee Valgus and Balance with Poor Knee Control among Young Football Players: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9050558. [PMID: 34068810 PMCID: PMC8151944 DOI: 10.3390/healthcare9050558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
The observed dynamic knee valgus and the limited dynamic balance described in the literature are modifiable risk factors for injuries in athletes. Therefore, identification and appropriate prevention are crucial in managing the development of young athletes. The aim of the study was to assess the effectiveness of three exercises strengthening the muscles: gluteal medius, popliteal and tibialis posterior to reduce dynamic knee valgus and improve the dynamic balance of the lower limbs in young football players with poor knee control. A total of 134 footballers were assessed for eligibility, and finally 45 participants (age 12–15) met the inclusion criteria. Participants were assessed with 2D video kinematic analysis during single-leg squats to assess the knee valgus angles and the dynamic balance (Y-Balance Test). No significant interactions between groups (Control and Exercise) and time (baseline and after 6 week) were noted for dynamic valgus for the left and right knee (p > 0.05). For the dynamic balance, there were statistically significant results, but not clinically relevant for anterior, posteromedial, and composite direction for the right lower limbs and for the anterior direction for left lower limbs in the exercise group. However, there were no significant differences (p > 0.05) in all of the YBT scores for both lower limbs between groups. This study demonstrated that there were no statistically significant differences in dynamic knee valgus angles and dynamic balance values after 6 weeks of exercise program in young footballers with poor knee control. Future randomized trials should focus on more comprehensive exercises, where possible using biofeedback methods to improve knee kinematics.
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Carroll LA, Kivlan BR, Martin RL, Phelps AL, Carcia CR. The Single Leg Squat Test: A "Top-Down" or "Bottom-Up" Functional Performance Test? Int J Sports Phys Ther 2021; 16:360-370. [PMID: 33842032 PMCID: PMC8016417 DOI: 10.26603/001c.21317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians' interpretation of the SLST. PURPOSE The purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass). HYPOTHESIS There will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD. STUDY DESIGN Cross-sectional study. METHODS Sixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared. RESULTS There were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9o +/- 3.7o, fail group = 7.8o +/- 3.0o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5o +/- 5.6o, fail group = 13.9o +/- 5.3o; weight bearing dorsiflexion: pass group = 42.7o +/- 6.0o, 42.7o +/- 8.3o, p = .611). CONCLUSIONS Failure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - RobRoy L Martin
- Department of Physical Therapy, Duquesne University; UPMC Center for Sports Medicine
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16
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Normative data and correlation between dynamic knee valgus and neuromuscular response among healthy active males: a cross-sectional study. Sci Rep 2020; 10:17206. [PMID: 33268811 PMCID: PMC7710730 DOI: 10.1038/s41598-020-74177-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
The dynamic knee valgus (DKV) during different sport maneuvers has been widely described as risk factor to develop an anterior cruciate ligament injury. Hip and knee muscles seem to have a crucial role to prevent the dynamic knee valgus. This study aimed to give normative and correlational data about DKV and hip and knee neuromuscular response (NMR) among healthy active males. The hypothesis is that DKV could be correlated with hip NMR. A cross-sectional correlational study. Research Anatomy Laboratory. The study was carried out among 50 active, non-injured males. Dynamic Knee-Valgus angle and lower limb posterior chain muscles Neuromuscular Response. DKV was measured using Kinovea software during a Single-Legged Drop Jump test and NMR was measured using tensiomyography and myotonometry for gluteus maximum, biceps femoris, semitendinosus, lateral and medial gastrocnemius. Right and left limbs were both performed and analyzed independently. No significant correlation was observed between DKV and hip and knee muscles NMR. This study shows normative and correlational data about dynamic knee valgus, tensiomyography and myotonometry for healthy and active males. The DKV control seems to be non-correlated with isolated hip and knee muscles NMR so this suggests it is more about Central Nervous System activity than about isolated muscles NMR.
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17
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Jones S, Clair Z, Wrigley R, Mullen R, Andersen TE, Williams M. Strength development and non-contact lower limb injury in academy footballers across age groups. Scand J Med Sci Sports 2020; 31:679-690. [PMID: 33247965 DOI: 10.1111/sms.13889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Non-contact lower limb injuries are common in academy football. Yet, the impact these injuries have on strength development in academy footballers remains unclear. This study aimed to investigate the impact of non-contact lower limb injury on hip, groin, and knee flexor strength development in male academy youth footballers. Furthermore, this study: reports normative strength data of emerging field-based tests that can be easily deployed in football academies; explores the effect of age on injury occurrence; and highlights the number of days lost from injury in male youth footballers. Assessments of hip adductor, abductor, and eccentric knee flexor strength were obtained from 195 academy football players during pre-season and at the end of season. In-season injuries were recorded by medical staff. Those footballers who sustained non-contact lower limb injury were compared with those who did not sustain a non-contact lower limb injury. No between-group differences were observed for any strength assessments when controlled for pre-season measures. Stronger footballers at pre-season experienced strength loses, while those weaker players gained strength across the season. Hip strength development was impaired in older age group footballers. Sustaining a non-contact lower limb injury had minimal impact on strength development. In the absence of in-season lower limb strength monitoring, development in academy youth footballers may not progress as expected, and in particular, stronger and older youth athletes may benefit from individualized strength training.
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Affiliation(s)
- Steven Jones
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University South Wales, Pontypridd, UK.,Round Glass Punjab Football Club, Chandigarh, India
| | - Zoe Clair
- Blackburn Rovers Ladies Football Club, Blackburn, UK
| | - Russ Wrigley
- Blackburn Rovers Football Club Youth Academy, Blackburn, UK
| | - Rich Mullen
- School of Sport, Health and Exercise Sciences, Brunel University, London, UK
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Sports Medicine Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Morgan Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University South Wales, Pontypridd, UK
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Dynamic Knee Valgus in Single-Leg Movement Tasks. Potentially Modifiable Factors and Exercise Training Options. A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218208. [PMID: 33172101 PMCID: PMC7664395 DOI: 10.3390/ijerph17218208] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022]
Abstract
Dynamic knee valgus (DKV) as an incorrect movement pattern is recognized as a risk factor for lower limb injuries. Therefore, it is important to find the reasons behind this movement to select effective preventive procedures. There is a limited number of publications focusing on specific tasks, separating the double-leg from the single-leg tasks. Test patterns commonly used for DKV assessment, such as single-leg squat (SLS) or single leg landings (SLL), may show different results. The current review presents the modifiable factors of knee valgus in squat and landing single-leg tests in healthy people, as well as exercise training options. The authors used the available literature from PubMed, Scopus, PEDro and clinicaltrials.gov databases, and reviewed physiotherapy journals and books. For the purpose of the review, studies were searched for using 2D or 3D motion analysis methods only in the SLL and SLS tasks among healthy active people. Strengthening and activating gluteal muscles, improving trunk lateral flexion strength, increasing ROM dorsiflexion ankle and midfoot mobility should be taken into account when planning training programs aimed at reducing DKV occurring in SLS. In addition, knee valgus during SLL may occur due to decreased hip abductors, extensors, external rotators strength and higher midfoot mobility. Evidence from several studies supports the addition of biofeedback training exercises to reduce the angles of DKV.
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Differences in Gluteal and Quadriceps Muscle Activation Among Adults With and Without Lumbar Hyperlordosis. J Sport Rehabil 2020; 29:1100-1105. [DOI: 10.1123/jsr.2019-0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022]
Abstract
Context:Many factors have been reported contributing to altering the neuromuscular function of hip and knee muscles. The lumbar hyperlordosis, as a poor posture in some athletes, is thought to be associated with the alteration of the hip and knee muscles activity.Objective:To examine the activation of selected hip and knee muscles in athletes with and without lumbar hyperlordosis during functional activities.Design:Case-control study.Setting:University laboratory.Participants:Twenty-six college male athletes (n = 13 with and n = 13 without lumbar hyperlordosis).Interventions:Surface electromyography of gluteus maximus (GMAX), gluteus medius (GMED), vastus medialis oblique (VMO), and vastus lateralis (VL) were recorded during single-leg squat and single-leg jump landing (SLJL) tasks.Main Outcome Measure:Preactivity; reactivity; and onset muscle during SLJL and eccentric activity during single-leg squat (GMAX, GMED, VMO, and VL along with the ratio of VMO:VL) were assessed.Results:Athletes with lumbar hyperlordosis had a higher level of activity in their GMAX (P = .003), VMO (P = .04), and VL (P = .01) muscles at the moment before foot contact during SLJL. These athletes also demonstrated a higher level of GMAX activity (P = .01) immediately after foot contact. Finally, athletes with lumbar hyperlordosis activated their GMAX sooner (P = .02) during the SLJL. Athletes with normal lumbar lordosis had more activity in their GMED muscle (P = .001) in the descending phase of the single-leg squat task and a higher VMO:VL (P = .01) at the moment after the foot contact during the SLJL.Conclusion:The altered activation of GMAX, GMED, VMO, VL, and VMO:VL can reveal the role of lumbar hyperlordosis in the knee and hip muscles’ alteration in athletes. Further study is needed to identify whether these alterations in the hip and knee muscles contribute to injury in athletes.
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20
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Effects of Toe Direction on Biomechanics of Trunk, Pelvis, and Lower-Extremity During Single-Leg Drop Landing. J Sport Rehabil 2020; 29:1069-1074. [PMID: 31754077 DOI: 10.1123/jsr.2019-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/14/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Toe direction is an important factor affecting knee biomechanics during various movements. However, it is still unknown whether toe direction will affect trunk and pelvic movements. OBJECTIVE To examine and clarify the effects of toe directions on biomechanics of trunk and pelvis as well as lower-extremities during single-leg drop landing (SLDL). DESIGN Descriptive laboratory study. SETTING Research laboratory. PARTICIPANTS A total of 27 male recreational-level athletes. INTERVENTION(S) Subjects performed SLDL under 3 different toe directions, including 0° (toe neutral), 20° (toe-in [TI]), and -20° (toe-out). SLDL was captured using a motion analysis system. Nondominant leg (27 left) was chosen for the analysis. MAIN OUTCOME MEASURES Peak values of kinematic and kinetic parameters during landing phase were assessed. In addition, those parameters at the timing of peak vertical ground reaction force were also assessed. The data were statistically compared among 3 different toe directions using 1-way repeated measures of analysis of variance or Friedman χ2 r test. RESULTS Peak knee abduction angle and moment in TI were significantly larger than in toe neutral and toe-out (P < .001). Moreover, peak greater anterior inclination, greater inclination, and rotation of trunk and pelvis toward the nonlanding side were seen in TI (P < .001). At the timing of peak vertical ground reaction force, trunk inclined to the landing side with larger knee abduction angle in TI (P < .001). CONCLUSIONS Several previous studies suggested that larger knee abduction angle and moment on landing side as well as trunk and pelvic inclinations during landing tasks were correlated with knee ligament injury. However, it is still unknown concerning the relationship between toe direction and trunk/pelvis movements during landing tasks. From the present study, TI during SLDL would strongly affect biomechanics of trunk and pelvis as well as knee joint, compared with toe neutral and toe-out.
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21
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Yasuda T, Oyanagi K, Nakagaki M, Itoh H. Differential Effects of Hip Rotation Range on Knee Abduction Biomechanics during Double-Legged Landing between Males and Females. THE ASIAN JOURNAL OF KINESIOLOGY 2020. [DOI: 10.15758/ajk.2020.22.4.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Dynamic knee valgus is composed of hip-knee coupling. While females differ from males in passive hip motion, hip rotation range may alter muscle mechanics and neuromuscular activity. This study aimed to compare knee abduction biomechanics during double-legged drop-landing between males and females with different hip rotation ranges.METHODS This study included five females with the range of hip internal rotation (IR) > the range of hip external rotation (ER), five females with ER>IR, four males with IR>ER, and five males with ER>IR. There was no difference in other hip motions among them or no difference in hip muscle strength between the same sex groups. Three-dimensional motion analyses of the hip and knee joints were performed during double-legged drop-landing.RESULTS Multiple regression analysis of females with IR>ER showed that peak knee abduction moment (KAM) was associated with maximal hip abduction moment before detecting peak KAM whereas peak knee abduction angle (KAA) correlated with no variable. In females with ER>IR, peak KAM was associated with maximal hip ER moment before detecting peak KAM, hip ER muscle strength and hip adduction range while peak KAA correlated with peak hip abduction moment before detecting peak KAM. In males with IR>ER, peak KAM was associated with hip ER range and hip adductor strength whereas peak KAA correlated with maximal hip ER moment and maximal hip IR angle during landing. In males with ER>IR, peak KAM was associated with hip extensor strength, hip abduction range and hip flexion range whereas peak KAA correlated with hip ER moment before detecting peak KAM, hip ER muscle strength, and hip adduction range.CONCLUSIONS Hip rotation range may differentially affect hip-knee coupling strategy for knee abduction control during double-legged drop-landing between males and females.
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22
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Harput G, Ulusoy B, Akmese R, Ergun N. Comparison of muscle activation levels and knee valgus between individuals with medial patellofemoral ligament reconstruction and healthy individuals during fatiguing step down task. Clin Biomech (Bristol, Avon) 2020; 78:105067. [PMID: 32535475 DOI: 10.1016/j.clinbiomech.2020.105067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 03/19/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medial patellofemoral ligament reconstruction becomes first-choice surgical procedure for patients with a history of lateral patellar dislocations but there is limited knowledge about neuromuscular activation patterns of individuals with a history of patellar dislocation who underwent medial patellofemoral ligament reconstruction. OBJECTIVE The aim of this study was to compare muscle activation levels and knee valgus during step down performance test between individuals with a history of medial patellofemoral ligament reconstruction and healthy individuals. METHODS Fifteen individuals with medial patellofemoral ligament reconstruction and 15 healthy individuals were included. Vastus medialis obliquus, vastus lateralis and gluteus medius muscle activation levels and knee valgus were measured during 60-s- step down performance test. Two-way repeated-measures of analysis of covariance was used for statistical analysis. FINDINGS Compared to the healthy individuals, individuals with medial patellofemoral ligament reconstruction showed lower vastus medialis obliquus (p = .04) and gluteus medius (p = .005) activation levels, and higher knee valgus (p = .002) in last period of the step down performance test. INTERPRETATION Since the significant results were only observed in the fatiguing section of the test, endurance tests may provide more information about neuromuscular control of the individuals with history of medial patellofemoral ligament reconstruction. Future studies should investigate whether endurance exercises that target to improve vastus medialis obliquus and gluteus medius activity result in better clinical outcomes than conventional programs for individuals with medial patellofemoral ligament reconstruction.
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Affiliation(s)
- Gulcan Harput
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Burak Ulusoy
- Karatekin University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Cankiri, Turkey
| | - Ramazan Akmese
- Ankara University, Faculty of Medicine, Department of Orthopaedic and Traumatology, Ankara, Turkey
| | - Nevin Ergun
- Sanko University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Gaziantep, Turkey
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Garcia S, Pandya NK. Anterior Cruciate Ligament Re-tear and Revision Reconstruction in the Skeletally Immature Athlete. Curr Rev Musculoskelet Med 2020; 13:369-378. [PMID: 32388725 PMCID: PMC7251003 DOI: 10.1007/s12178-020-09627-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW With an increase in high-demand sporting activity, the rate of pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is increasing. Yet, the failure rates after reconstruction are much higher than the adult population. The purpose of this paper is to understand failure rates, reasons for graft failure, and strategies for successful revision surgery. RECENT FINDINGS A complete understanding of the failure etiology is essential for the clinician treating this population prior to revision. This begins with an assessment of post-operative patient compliance and sporting activity. Surgical technique must then be scrutinized for non-anatomic tunnel placement and poor graft size/type. Concurrent bony deformity must also be addressed including lower extremity valgus alignment and tibial slope abnormalities. Meniscus and chondral injury must be aggressively treated. Furthermore, imaging must be examined to look for missed posterolateral corner injury. Lateral extra-articular tenodesis (in the setting of ligamentous laxity or rotational instability) may be also indicated as well. The surgeon can then choose a graft type and surgical technique that optimizes outcome and respects skeletal growth. Prior to surgical intervention, the clinician must also counsel patients in regard to the guarded prognosis and outcomes in this setting. Prolonged rehabilitation protocols/return-to-play timing as well as sporting activity modification in the post-operative period after revision are critical. There is limited literature on revision ACL reconstruction in the skeletally immature athlete. An understanding of all the risk factors for failure is essential in order to achieve treatment success.
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Affiliation(s)
- Steven Garcia
- Department of Orthopedic Surgery, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
| | - Nirav K. Pandya
- Department of Orthopedic Surgery, Benioff Children’s Hospital, University of California San Francisco, 747 52nd Street, Oakland, CA 94609 USA
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24
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Dischiavi SL, Wright AA, Hegedus EJ, Thornton EP, Bleakley CM. FRAMEWORK FOR OPTIMIZING ACL REHABILITATION UTILIZING A GLOBAL SYSTEMS APPROACH. Int J Sports Phys Ther 2020; 15:478-485. [PMID: 32566384 PMCID: PMC7297005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
UNLABELLED Knee injuries such as ACL tears commonly occur and there is a high re-injury rate after primary ACL reconstruction with figures estimated at 25%-33%. Clinicians often use hip strengthening as a key component of knee rehabilitation. Evidence suggests that adopting a "regional" or "proximal" approach to rehabilitation can increase hip strength, but motor control often remains unchanged, particularly during more complex tasks such as running and jumping. It has been previously suggested that the current approach to "regional/proximal" rehabilitation is too basic and is constrained by a reductionist philosophy. This clinical commentary provides the clinician a framework for optimizing knee rehabilitation, underpinned by a more global approach. Although this approach remains hip-focused, it can be easily adapted to modify exercise complexity and key loading variables (speed, direction, flight), which will help the clinician to better replicate the sport specific demands on the knee. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Alexis A Wright
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, USA, 27268
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, USA, 27268
| | - Erica P Thornton
- Department of Athletic Training, High Point University, High Point, NC, USA
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25
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Taylor JB, Nguyen AD, Shultz SJ, Ford KR. Hip biomechanics differ in responders and non-responders to an ACL injury prevention program. Knee Surg Sports Traumatol Arthrosc 2020; 28:1236-1245. [PMID: 30259145 DOI: 10.1007/s00167-018-5158-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 09/17/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the differences in demographic, anthropometric, biomechanical, and/or performance variables between those that do (responders) and do not (non-responders) exhibit reductions in knee abduction moments after an anterior cruciate ligament injury prevention program (ACL-IPP). METHODS Forty-three adolescent female athletes completed biomechanical (3D motion analysis of a drop vertical jump) and performance testing before and after randomization into a 6-week ACL-IPP. Participants were classified into responders and non-responders based on their level of reduction of knee abduction moment from pre- to post-test. RESULTS Compared to non-responders, responders exhibited increased hip adduction excursion at baseline (p = 0.02) and trended towards attending more training sessions (p = 0.07) and participating in soccer and not basketball (p = 0.07). Responders also showed greater improvements in hip flexion angles (p = 0.02) and moments (p < 0.001), and knee abduction angles (p < 0.001) and excursions (p = 0.001). There were no significant differences in age or experience with prior injury prevention programs (n.s.). CONCLUSIONS After an ACL-IPP, athletes that exhibit the greatest reduction in knee abduction moments exhibit greater hip adduction excursion at baseline and show corresponding improvements in hip flexion and knee abduction kinematics and hip flexion moments. These results can help clinicians prospectively identify individuals that may not respond to an ACL-IPP and target individualized training for those at risk of injury. LEVEL OF EVIDENCE I. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT02530333.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA. .,Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Anh-Dung Nguyen
- Department of Athletic Training, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Sandra J Shultz
- Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA
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Muyor JM, Martín-Fuentes I, Rodríguez-Ridao D, Antequera-Vique JA. Electromyographic activity in the gluteus medius, gluteus maximus, biceps femoris, vastus lateralis, vastus medialis and rectus femoris during the Monopodal Squat, Forward Lunge and Lateral Step-Up exercises. PLoS One 2020; 15:e0230841. [PMID: 32236133 PMCID: PMC7112217 DOI: 10.1371/journal.pone.0230841] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
The Monopodal Squat, Forward Lunge and Lateral Step-Up exercises are commonly performed with one's own body weight for rehabilitation purposes. However, muscle activity evaluated using surface electromyography has never been analyzed among these three exercises. Therefore, the objectives of the present study were to evaluate the amplitude of the EMG activity of the gluteus medius, gluteus maximus, biceps femoris, vastus lateralis, vastus medialis and rectus femoris muscles in participants performing the Lateral Step-Up, Forward Lunge and Monopodal Squat exercises. A total of 20 physically active participants (10 men and 10 women) performed 5 repetitions at 60% (5 repetition maximum) in each of the evaluated exercises. The EMG amplitude was calculated in percentage of the maximum voluntary contraction. The Monopodal Squat exercise showed a higher EMG activity (p ≤ 0.001) in relation to the Lateral Step-Up and Forward Lunge exercises in all of the evaluated muscles (d > 0.6) except for the rectus femoris. The three exercises showed significantly higher EMG activity in all of the muscles that were evaluated in the concentric phase in relation to the eccentric one. In the three evaluated exercises, vastus lateralis and vastus medialis showed the highest EMG activity, followed by gluteus medius and gluteus maximus. The Monopodal Squat, Forward Lunge and Lateral Step-Up exercises not only are recommended for their rehabilitation purposes but also should be recommended for performance objectives and strength improvement in the lower limbs.
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Affiliation(s)
- José M. Muyor
- Laboratory of Kinesiology Biomechanics and Ergonomics (KIBIOMER Lab.), Research Central Services, University of Almería, Almería, Spain
- Health Research Centre University of Almería, Almería, Spain
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Vastus lateralis and medialis muscular activation during frontal and sagittal single-leg jumps in sportswomen. ACTA ACUST UNITED AC 2020; 40:43-54. [PMID: 32220163 PMCID: PMC7357384 DOI: 10.7705/biomedica.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Indexed: 12/03/2022]
Abstract
Introducción. Las diferencias en la activación muscular de las porciones lateral y medial del cuádriceps durante la ejecución del salto, pueden convertirse en un factor de riesgo neuromuscular al aumentar el valgo dinámico de rodilla y, en consecuencia, el riesgo de lesión del ligamento cruzado anterior de la rodilla. Objetivo. Determinar la diferencia en la activación de los vastos lateral y medial del cuádriceps mediante electromiografía de superficie durante el salto con una sola pierna en los planos sagital y frontal en mujeres deportistas. Materiales y métodos. Se hizo un estudio cuantitativo de corte transversal con la participación de 64 mujeres deportistas a quienes se les tomaron las medidas antropométricas. Se hicieron pruebas de salto vertical y lateral con una sola pierna evaluados mediante la activación electromiográfica de los vastos medial y lateral, y la valoración de la flexibilidad de la banda iliotibial. Resultados. Se encontró una relación estadísticamente significativa (p≤0,05) entre el índice de masa corporal, el porcentaje de grasa y la potencia en los saltos verticales con una sola pierna. Se encontró, asimismo, significación estadística (p≤0,05) por una mayor activación del vasto lateral en el salto vertical con la pierna derecha y en el salto lateral con las dos piernas. Conclusión. Las deportistas presentaron diferencias en la activación de los cuádriceps, siendo mayor la activación del vasto lateral en la mayoría de los saltos con una sola pierna tanto en el plano sagital como en el frontal, lo cual puede contribuir a un aumento del riesgo de lesión de rodilla en la práctica deportiva.
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28
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Werner DM, Di Stasi S, Lewis CL, Barrios JA. Test-retest reliability and minimum detectable change for various frontal plane projection angles during dynamic tasks. Phys Ther Sport 2019; 40:169-176. [PMID: 31574410 DOI: 10.1016/j.ptsp.2019.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Establish between-day test-retest reliability metrics for 2-dimensional frontal plane projection angles (FPPAs) during the lateral step-down (LSD), single-limb squat (SLS), single-limb landing (SLL), and drop vertical jump (DVJ). DESIGN Test-retest reliability study. SETTING University laboratory. PARTICIPANTS 20 healthy adults (12 female, age = 23.60 ± 1.93 years old, body mass index = 24.26 ± 2.54 kg/m2) were tested on 2 separate occasions 7-14 days apart. MAIN OUTCOME MEASURES Intraclass correlation coefficients (ICC), standard errors of the measurement (SEM), and minimal detectable change (MDC) values across the LSD, SLS, SLL, and DVJ for the following body region variables: trunk, trunk on pelvis, pelvis, hip, thigh to vertical, knee, and shank to vertical. RESULTS There was moderate-to-substantial between-day test-retest reliability for nearly all body regions across all tasks (ICC = 0.65-0.96). SEM values varied across body regions and tasks (0.9-3.5°). MDCs were variable (2.3-9.8°). Of the body regions, MDCs were largest for the knee and hip. By task, MDCs were lowest for the LSD. CONCLUSIONS This study identified between-day test-retest reliability metrics for 2-dimensional FPPAs across a variety of body regions during commonly assessed clinical tasks. These data allow clinicians and researchers to more confidently assess true change between assessments or over time.
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Affiliation(s)
- D M Werner
- Department of Physical Therapy, University of Dayton, 300 College Park, USA.
| | - S Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Atwell Hall, Columbus, OH, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, USA.
| | - C L Lewis
- Associate Professor of Physical Therapy, Rehabilitation Sciences and Medicine, Boston University, 635 Commonwealth Avenue, Boston, MA, USA.
| | - J A Barrios
- Department of Physical Therapy, University of Dayton, 300 College Park, USA.
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29
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Bennett H, Arnold J, Martin M, Norton K, Davison K. A randomised controlled trial of movement quality-focused exercise versus traditional resistance exercise for improving movement quality and physical performance in trained adults. J Sports Sci 2019; 37:2806-2817. [PMID: 31500505 DOI: 10.1080/02640414.2019.1665234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this trial was to compare an eight-week individual movement quality versus traditional resistance training intervention on movement quality and physical performance. Forty-six trained adults were randomised to a movement quality-focused training (MQ) or a traditional resistance training (TRAD) group, and performed two individualised training sessions per week, for 8 weeks. Session-RPE (sRPE) was obtained from each session. Measures of movement quality (MovementSCREEN and Functional Movement Screen (FMS)) and physical performance were performed pre- and post-intervention. All measures improved significantly in both groups (3-14.5%, p = <0.005). The between-group difference in MovementSCREEN composite score was not statistically significant (0.3, 95% CI -3.4, 4.1, p = 0.852). However, change in FMS composite was significantly greater in MQ (1.3, 95% CI 0.8, 1.8, p < 0.001). There were no significant between-group differences in physical performance (p = 0.060-0.960). The mean sRPE was significantly lower in MQ (5.25, SD 1.2) compared to TRAD (6.6 SD 1.0, p = <0.001). Thus, although movement quality scores were not distinctly greater in the MQ group, a movement quality specific intervention caused comparable improvements in physical performance compared to traditional resistance training but at lower perceived training intensity.
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Affiliation(s)
- Hunter Bennett
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia , Adelaide , Australia
| | - John Arnold
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia , Adelaide , Australia
| | - Max Martin
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia , Adelaide , Australia
| | - Kevin Norton
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia , Adelaide , Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia , Adelaide , Australia
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Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Multiplanar Loading of the Knee and Its Influence on Anterior Cruciate Ligament and Medial Collateral Ligament Strain During Simulated Landings and Noncontact Tears. Am J Sports Med 2019; 47:1844-1853. [PMID: 31150273 PMCID: PMC6988507 DOI: 10.1177/0363546519850165] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears and concomitant medial collateral ligament (MCL) injuries are known to occur during dynamic athletic tasks that place combinatorial frontal and transverse plane loads on the knee. A mechanical impact simulator that produces clinical presentation of ACL injury allows for the quantification of individual loading contributors leading to ACL failure. PURPOSE/HYPOTHESIS The objective was to delineate the relationship between knee abduction moment, anterior tibial shear, and internal tibial rotation applied at the knee and ACL strain during physiologically defined simulations of impact at a knee flexion angle representative of initial contact landing from a jump. The hypothesis tested was that before ACL failure, abduction moment would induce greater change in ACL strain during landing than either anterior shear or internal rotation. STUDY DESIGN Controlled laboratory study. METHODS Nineteen cadaveric specimens were subjected to simulated landings in the mechanical impact simulator. During simulations, external knee abduction moment, internal tibial rotation moment, and anterior tibial shear loads were derived from a previously analyzed in vivo cohort and applied to the knee in varying magnitudes with respect to injury risk classification. Implanted strain gauges were used to track knee ligament displacement throughout simulation. Kruskal-Wallis tests were used to assess strain differences among loading factors, with Wilcoxon each pair post hoc tests used to assess differences of magnitude within each loading. RESULTS Each loading factor significantly increased ACL strain (P < .005). Within factors, the high-risk magnitude of each factor significantly increased ACL strain relative to the baseline condition (P≤ .002). However, relative to knee abduction moment specifically, ACL strain increased with each increased risk magnitude (P≤ .015). CONCLUSION Increased risk levels of each load factor contributed to increased levels of ACL strain during a simulated jump landing. The behavior of increased strain between levels of increased risk loading was most prevalent for changes in knee abduction moment. This behavior was observed in the ACL and MCL. CLINICAL RELEVANCE Knee abduction moment may be the predominant precursor to ACL injury and concomitant MCL injury. As knee abduction occurs within the frontal plane, primary preventative focus should incorporate reduction of frontal plane knee loading in landing and cutting tasks, but secondary reduction of transverse plane loading could further increase intervention efficacy. Constraint of motion in these planes should restrict peak ACL strain magnitudes during athletic performance.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Address correspondence to Nathaniel A. Bates, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55902, USA ()
| | - Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V. Nagelli
- Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report. J Funct Morphol Kinesiol 2019; 4:jfmk4020024. [PMID: 33467339 PMCID: PMC7739354 DOI: 10.3390/jfmk4020024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/21/2022] Open
Abstract
Athletes with femoroacetabular impingement syndrome (FAIS) managed arthroscopically do not always return to sport. Inability to control back/pelvis, hip and lower limb movements may contribute to the onset and recurrence of symptoms. Our hypothesis is that results from a battery of cognitive movement control tests can inform a cognitive movement control (neuromuscular) retraining programme for improving the clinical presentation and quality of life in an athlete with FAIS. This case report presents a female elite rower with persistent left-sided anterior hip pain, four years post-arthroscopic surgery for FAIS, whose symptoms failed to respond to conventional physical therapy. Hip and groin outcome score (HAGOS), passive and active hip flexion range of motion (ROM) workload (time training on water), hip and pelvic kinematics (3-D motion analysis) and electromyography during a seated hip flexion movement control test, and a movement control test battery to identify movement control impairments (The Foundation Matrix), were assessed pre-intervention (week 0) and immediately post-intervention (week 16). Impaired movement control was targeted in a tailored 16-week cognitive movement control retraining exercise program. All measures improved: HAGOS (all 6 sub-scales); symptoms (61/100 pre-training to 96/100 post-training); physical activities participation (13/100 to 75/100); and active hip flexion ROM increased (78 to 116 and 98 to 118 degrees, respectively); workload increased from 4 to 18 h/week; and movement control impairment reduced (25/50 to 9/50). Pelvic motion on kinematic analysis were altered, and delayed activation onset of tensor fascia latae and rectus femoris muscles reduced. This proof-of-concept case report supports the hypothesis that cognitive movement control tests can inform a targeted cognitive movement control retraining program to improve symptoms, function and quality of life, in an elite rower with persistent hip pain. This training offers an alternative approach to conventional physical therapy, which has failed to restore function in FAIS, and the present study illustrates how specific cognitive movement control assessment can direct individual training programmes.
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Frontal plane movement of the pelvis and thorax during dynamic activities in individuals with and without anterior cruciate ligament injury. Knee 2018; 25:997-1008. [PMID: 30172444 PMCID: PMC6291429 DOI: 10.1016/j.knee.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND For elite athletes with anterior cruciate ligament (ACL) reconstruction, reducing pelvis and trunk obliquities is a common goal of rehabilitation. It is not known if this is also a suitable goal for the general population. This study aimed to quantify pelvis and thorax obliquities during dynamic activities in individuals from the general population with and without history of ACL injury. METHODS Retrospective analysis of cross-sectional data from 30 participants with ACL reconstruction, 28 participants with ACL deficiency (ACLD), and 32 controls who performed overground walking and jogging, single-leg squat, and single-leg hop for distance. Pelvis and thorax obliquities were quantified in each activity and compared across groups using one-way ANOVA. Coordination was quantified using cross covariance. RESULTS In the stance phase of walking and jogging, pelvis and thorax obliquities were within ±10° of neutral and there was a negative correlation between the two segments at close to zero phase lag. In single-leg squat and hop, range of obliquities varied across individuals and there was no consistent pattern of coordination. Eight ACLD participants felt unable to perform the single-leg hop. In the remaining participants, range of pelvis (p = 0.04) and thorax (p = 0.02) obliquities was smaller in ACLD than controls. CONCLUSIONS In challenging single-leg activities, minimal frontal plane motion was not the typical movement pattern observed in the general population. Coordination between the pelvis and thorax was inconsistent within and across individuals. Care should be taken when considering minimising pelvis and thorax obliquities in patients with ACL injury.
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Taylor JB, Wright AA, Dischiavi SL, Townsend MA, Marmon AR. Activity Demands During Multi-Directional Team Sports: A Systematic Review. Sports Med 2018; 47:2533-2551. [PMID: 28801751 DOI: 10.1007/s40279-017-0772-5] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Late-stage rehabilitation programs often incorporate 'sport-specific' demands, but may not optimally simulate the in-game volume or intensity of such activities as sprinting, cutting, jumping, and lateral movement. OBJECTIVE The aim of this review was to characterize, quantify, and compare straight-line running and multi-directional demands during sport competition. DATA SOURCES A systematic review of PubMed, CINAHL, SPORTDiscus, and Cochrane Central Register of Controlled Trials databases was conducted. STUDY ELIGIBILITY CRITERIA Studies that reported time-motion analysis data on straight-line running, accelerations/decelerations, activity changes, jumping, cutting, or lateral movement over the course of an entire competition in a multi-directional sport (soccer, basketball, lacrosse, handball, field hockey, futsal, volleyball) were included. STUDY APPRAISAL AND SYNTHESIS METHODS Data was organized based on sport, age level, and sex and descriptive statistics of the frequency, intensity, time, and volume of the characteristics of running and multi-directional demands were extracted from each study. RESULTS Eighty-one studies were included in the review (n = 47 soccer, n = 11 basketball, n = 9 handball, n = 7 field hockey, n = 3 futsal, n = 4 volleyball). Variability of sport demand data was found across sports, sexes, and age levels. Specifically, soccer and field hockey demanded the most volume of running, while basketball required the highest ratio of high-intensity running to sprinting. Athletes change activity between 500 and 3000 times over the course of a competition, or once every 2-4 s. Studies of soccer reported the most frequent cutting (up to 800 per game), while studies of basketball reported the highest frequency of lateral movement (up to 450 per game). Basketball (42-56 per game), handball (up to 90 per game), and volleyball (up to 35 per game) were found to require the most jumping. LIMITATIONS These data may provide an incomplete view of an athlete's straight-line running load, considering that only competition and not practice data was provided. CONCLUSIONS Considerable variability exists in the demands of straight-line running and multi-directional demands across sports, competition levels, and sexes, indicating the need for sports medicine clinicians to design future rehabilitation programs with improved specificity (including the type of activity and dosage) to these demands.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA.
| | - Alexis A Wright
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - M Allison Townsend
- Department of Exercise Science, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Adam R Marmon
- Department of Kinesiology and Applied Physiology, University of Delaware, 540 South College Avenue, Newark, DE, 19711, USA
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Taylor JB, Ford KR, Schmitz RJ, Ross SE, Ackerman TA, Shultz SJ. A 6-week warm-up injury prevention programme results in minimal biomechanical changes during jump landings: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26:2942-2951. [PMID: 29340745 DOI: 10.1007/s00167-018-4835-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the extent to which an ACL injury prevention programme modifies lower extremity biomechanics during single- and double-leg landing tasks in both the sagittal and frontal plane. It was hypothesized that the training programme would elicit improvements in lower extremity biomechanics, but that these improvements would be greater during a double-leg sagittal plane landing task than tasks performed on a single leg or in the frontal plane. METHODS Ninety-seven competitive multi-directional sport athletes that competed at the middle- or high-school level were cluster randomized into intervention (n = 48, age = 15.4 ± 1.0 years, height = 1.7 ± 0.07 m, mass = 59.9 ± 11.0 kg) and control (n = 49, age = 15.7 ± 1.6 years, height = 1.7 ± 0.06 m, mass = 60.4 ± 7.7 kg) groups. The intervention group participated in an established 6-week warm-up-based ACL injury prevention programme. Three-dimensional biomechanical analyses of a double- (SAG-DL) and single-leg (SAG-SL) sagittal, and double- (FRONT-DL) and single-leg (FRONT-SL) frontal plane jump landing tasks were tested before and after the intervention. Peak angles, excursions, and external joint moments were analysed for group differences using 2 (group) × 4 (task) repeated measures MANOVA models of delta scores (post-pre-test value) (α < 0.05). RESULTS Relative to the control group, no significant biomechanical changes were identified in the intervention group for any of the tasks (n.s.). However, a group by task interaction was identified for knee abduction (λ = 0.80, p = 0.02), such that participants in the intervention group showed relative decreases in knee abduction moments during the SAG-DL compared to the SAG-SL (p = 0.005; d = 0.45, CI = 0.04-0.85) task. CONCLUSION A 6-week warm-up-based ACL injury prevention programme resulted in no significant biomechanical changes during a variety of multi-directional jump landings. Clinically, future prevention programmes should provide a greater training stimulus (intensity, volume), more specificity to tasks associated with the mechanism of ACL injury (single-leg, non-sagittal plane jump landings), and longer programme duration (> 6 weeks) to elicit meaningful biomechanical changes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA. .,Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Kevin R Ford
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Scott E Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
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Brindle RA, Milner CE. The hip control test is a valid and reliable measure of hip neuromuscular control. Sports Biomech 2018; 19:235-244. [PMID: 29895207 DOI: 10.1080/14763141.2018.1466907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Insufficient hip neuromuscular control may contribute to non-contact sport injuries. However, the current evaluative test of hip neuromuscular control, the single-leg squat, requires hip abductor muscle strength to complete. The purpose of this study was to develop the hip control test (HCT) and determine the test's reliability and construct validity. Nineteen healthy adults visited the laboratory twice. The HCT is a 10-s test of reciprocal toe-tapping accuracy. Both automated and manual HCT ratings were recorded simultaneously during each visit. Additionally, eccentric hip abductor torque was measured. HCT reliability was assessed with intra-class correlation coefficients (ICC). Agreement between automated and manual ratings was determined with Bland-Altman plots. Construct validity was established if HCT performance significantly decreased with a secondary cognitive task (p < 0.05). Bivariate regression determined the relationship between HCT performance and eccentric hip abductor torque. Automated and manual HCT ratings both had moderate reliability (ICC = 0.72) and yielded similar results (limits of agreement = -1 to 2 taps). The HCT had construct validity (p = 0.001), and no correlation with hip abductor muscle strength (r = 0.213). Thus, the HCT is a reliable and valid test. The HCT is simple to administer and measures hip neuromuscular control separately from strength.
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Affiliation(s)
- Richard A Brindle
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Clare E Milner
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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36
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Omi Y, Sugimoto D, Kuriyama S, Kurihara T, Miyamoto K, Yun S, Kawashima T, Hirose N. Effect of Hip-Focused Injury Prevention Training for Anterior Cruciate Ligament Injury Reduction in Female Basketball Players: A 12-Year Prospective Intervention Study. Am J Sports Med 2018; 46:852-861. [PMID: 29360406 DOI: 10.1177/0363546517749474] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Programs to prevent anterior cruciate ligament (ACL) injuries in female basketball players are scarce. Also, ACL injury prevention training that focuses on hip joint function has not been reported. PURPOSE To determine the effectiveness of a hip-focused ACL injury prevention program in female basketball players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective intervention study was conducted for 12 years. Incidence rates of ACL injuries were collected in the first 4 years (observation period) from college female basketball players. After the observation period, a hip-focused ACL injury prevention program was implemented for 8 years (intervention period). A total of 309 players (mean ± SD age, 19.6 ± 1.2 years; height, 163.7 ± 5.6 cm; weight, 59.1 ± 5.1 kg; body mass index, 22.0 ± 1.4) were tracked in the observation period and compared with 448 players (age, 19.6 ± 1.1 years; height, 162.6 ± 5.8 cm; weight, 58.0 ± 5.7 kg; body mass index, 21.9 ± 1.5) who participated in the intervention period. Athlete-exposures (AEs), ACL numbers and mechanisms of injury (MOIs), relative risk (RR), absolute risk reduction (ARR), numbers needed to treat (NNT), and compliance were analyzed. RESULTS There were 16 ACL injuries (13 noncontact MOIs) in the 4-year observation period, whereas 9 ACL injuries (8 noncontact MOIs) were recorded in the 8-year intervention period. The overall ACL injury incidence was 0.25/1000 AEs in the 4-year observation period compared with 0.10/1000 AEs in the 8-year intervention period, respectively. Compared with the 4-year observation period, significant RR reduction was observed (0.38; 95% CI, 0.17-0.87; P = .017) with ARR and NNT of 0.032 (95% CI, 0.027-0.037) and 31.6 (95% CI, 27.1-37.7), respectively, in the 8-year intervention period. The noncontact ACL injury incidence was 0.21 per 1000 AEs during the 4-year observation period compared with 0.08/1000 AEs in the 8-year intervention period, which also showed significant RR reduction (0.37; 95% CI, 0.15-0.92; P = .026), with ARR and NNT of 0.024 (95% CI, 0.020-0.029) and 41.3 (95% CI, 34.6-51.3), respectively. The mean compliance rate during the intervention periods (8 years) was 89%. CONCLUSION A hip-focused injury prevention program demonstrated significant reduction in the incidence of ACL injury in female collegiate basketball players.
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Affiliation(s)
- Yorikatsu Omi
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan.,Department of Rehabilitation, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Waltham, Massachusetts, USA.,Department of Orthopaedics, Harvard Medical School, Boston, Massachusetts, USA
| | - Setsurou Kuriyama
- Department of Orthopedic Surgery, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomohisa Kurihara
- Department of Rehabilitation, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Kenji Miyamoto
- Department of Rehabilitation, Aobasawai Hospital, Yokohama, Kanagawa, Japan
| | - Songjo Yun
- Department of Rehabilitation, Ito shimin Hospital, Ito, Shizuoka, Japan
| | | | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Are two-dimensional measured frontal plane angles related to three-dimensional measured kinematic profiles during running? Phys Ther Sport 2018. [DOI: 10.1016/j.ptsp.2017.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hewett TE, Bates NA. Preventive Biomechanics: A Paradigm Shift With a Translational Approach to Injury Prevention. Am J Sports Med 2017; 45:2654-2664. [PMID: 28199800 PMCID: PMC6405413 DOI: 10.1177/0363546516686080] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preventive medicine techniques have alleviated billions of dollars' worth of the economic burden in the medical care system through the implementation of vaccinations and screenings before the onset of disease symptoms. Knowledge of biomechanical tendencies has progressed rapidly over the past 20 years such that clinicians can identify, in healthy athletes, the underlying mechanisms that lead to catastrophic injuries such as anterior cruciate ligament (ACL) ruptures. As such, preventive medicine concepts can be applied to noncontact musculoskeletal injuries to reduce the economic burden of sports medicine treatments and enhance the long-term health of athletes. PURPOSE To illustrate the practical medical benefits that could be gained from preventive biomechanics applied to the ACL as well as the need and feasibility for the broad implementation of these principles. STUDY DESIGN Literature review. METHODS The recent literature pertinent to the screening and prevention of musculoskeletal injuries was reviewed and compiled into a clinical commentary on the current state and applicability of preventive biomechanics. RESULTS Investigators have identified neuromuscular training protocols that screen for and correct the underlying biomechanical deficits that lead to ACL injuries. The literature shows that when athletes comply with these prescribed training protocols, the incidence of injuries is significantly reduced within that population. Such preventive biomechanics practices employ basic training methods that would be familiar to athletic coaches and have the potential to save billions of dollars in cost in sports medicine. CONCLUSION The widespread implementation of preventive biomechanics concepts could profoundly affect the field of sports medicine with a minimum of initial investment.
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Affiliation(s)
- Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,Department of Sports Medicine, Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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Tate J, Suckut T, Wages J, Lyles H, Perrin B. THE ASSOCIATIONS BETWEEN HIP STRENGTH AND HIP KINEMATICS DURING A SINGLE LEG HOP IN RECREATIONAL ATHLETES POST ACL RECONSTRUCTION COMPARED TO HEALTHY CONTROLS. Int J Sports Phys Ther 2017; 12:341-351. [PMID: 28593088 PMCID: PMC5455184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Only a small amount of evidence exists linking hip abductor weakness to dynamic knee valgus during static and dynamic activities. The associations of hip extensor strength and hip kinematics during the landing of a single leg hop are not known. Purpose: To determine if relationships exist between hip extensor and abductor strength and hip kinematics in both involved and uninvolved limb during the landing phase of a single leg hop in recreational athletes post anterior cruciate ligament (ACL) reconstruction. The presence of similar associations was also evaluated in healthy recreational athletes. STUDY DESIGN Controlled Laboratory Study; Cross-sectional. METHODS Twenty-four recreational college-aged athletes participated in the study (12 post ACL reconstruction; 12 healthy controls). Sagittal and frontal plane hip kinematic data were collected for five trials during the landing of a single leg hop. Hip extensor and abductor isometric force production was measured using a hand-held dynamometer and normalized to participants' height and weight. Dependent and independent t-tests were used to analyze for any potential differences in hip strength or kinematics within and between groups, respectively. Pearson's r was used to demonstrate potential associations between hip strength and hip kinematics for both limbs in the ACL group and the right limb in the healthy control group. RESULTS Independent t-tests revealed that participants post ACL reconstruction exhibited less hip extensor strength (0.18 N/Ht*BW vs. 0.25 N/Ht*BW, p=<.01) and landed with greater hip adduction (9.0 º vs. 0.8 º, p=<.01) compared with their healthy counterparts. In the ACL group, Pearson's r demonstrated a moderate and indirect relationship (r=-.62, p=.03) between hip extensor strength and maximum hip abduction/adduction angle in the involved limb. A moderate and direct relationship between hip abductor strength and maximum hip flexion angle was demonstrated in the both the involved (r=.62) and uninvolved limb (r=.65, p=.02). No significant associations were demonstrated between hip extensor or abductor strength and hip flexion and/or abduction/adduction angles in the healthy group. CONCLUSION The results suggest that hip extensors may play a role in minimizing hip adduction in the involved limb while the hip abductors seem to play a role in facilitating hip flexion during the landing phase of a single leg hop for both limbs following ACL reconstruction. Researchers and clinicians alike should consider the importance of the hip extensors in playing a more prominent role in contributing to frontal plane motion. LEVELS OF EVIDENCE Level 2a.
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Affiliation(s)
- Jeremiah Tate
- Physical Therapy Department, University of Tennessee at Chattanooga, Chattanooga, TN
| | - Tell Suckut
- Physical Therapy Department, University of Tennessee at Chattanooga, Chattanooga, TN
| | - Jensen Wages
- Physical Therapy Department, University of Tennessee at Chattanooga, Chattanooga, TN
| | - Heather Lyles
- Physical Therapy Department, University of Tennessee at Chattanooga, Chattanooga, TN
| | - Benjamin Perrin
- Physical Therapy Department, University of Tennessee at Chattanooga, Chattanooga, TN
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Taylor JB, Nguyen AD, Paterno MV, Huang B, Ford KR. Real-time optimized biofeedback utilizing sport techniques (ROBUST): a study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:71. [PMID: 28173788 PMCID: PMC5297146 DOI: 10.1186/s12891-017-1436-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long-term physical, financial, and psychosocial ramifications. While dedicated injury prevention training programs have shown promise, ACL injury rates remain high as implementation has not become widespread. Conventional prevention programs use a combination of resistance, plyometric, balance and agility training to improve high-risk biomechanics and reduce the risk of injury. While many of these programs focus on reducing knee abduction load and posture during dynamic activity, targeting hip extensor strength and utilization may be more efficacious, as it is theorized to be an underlying mechanism of injury in adolescent female athletes. Biofeedback training may complement traditional preventive training, but has not been widely studied in connection with ACL injuries. We hypothesize that biofeedback may be needed to maximize the effectiveness of neuromuscular prophylactic interventions, and that hip-focused biofeedback will improve lower extremity biomechanics to a larger extent than knee-focused biofeedback during dynamic sport-specific tasks and long-term movement strategies. Methods This is an assessor-blind, randomized control trial of 150 adolescent competitive female (9–19 years) soccer players. Each participant receives 3x/week neuromuscular preventive training and 1x/week biofeedback, the mode depending on their randomization to one of 3 biofeedback groups (hip-focused, knee-focused, sham). The primary aim is to assess the impact of biofeedback training on knee abduction moments (the primary biomechanical predictor of future ACL injury) during double-leg landings, single-leg landings, and unplanned cutting. Testing will occur immediately before the training intervention, immediately after the training intervention, and 6 months after the training intervention to assess the long-term retention of modified biomechanics. Secondary aims will assess performance changes, including hip and core strength, power, and agility, and the extent to which maturation effects biofeedback efficacy. Discussion The results of the Real-time Optimized Biofeedback Utilizing Sport Techniques (ROBUST) trial will help complement current preventive training and may lead to clinician-friendly methods of biofeedback to incorporate into widespread training practices. Trial registration Date of publication in ClinicalTrials.gov: 20/04/2016. ClinicalTrials.gov Identifier: NCT02754700.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, 27268, USA.
| | - Anh-Dung Nguyen
- Department of Athletic Training, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, 27268, USA
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Dingenen B, Janssens L, Luyckx T, Claes S, Bellemans J, Staes FF. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Hum Mov Sci 2015; 44:234-45. [PMID: 26409102 DOI: 10.1016/j.humov.2015.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022]
Abstract
The goal of this study was to evaluate muscle activation onset times (MAOT) of both legs during a transition task from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament injured (ACLI) (n=15) and non-injured control subjects (n=15) with eyes open and eyes closed. Significantly delayed MAOT were found in the ACLI group compared to the control group for vastus lateralis, vastus medialis obliquus, hamstrings medial, hamstrings lateral, tibialis anterior, peroneus longus and gastrocnemius in both vision conditions, for gluteus maximus and gluteus medius with eyes open and for tensor fascia latae with eyes closed. Within the ACLI group, delayed MAOT of tibialis anterior with eyes open and gastrocnemius with eyes closed were found in the injured leg compared to the non-injured leg. All other muscles were not significantly different between legs. In conclusion, the ACLI group showed delayed MAOT not only around the knee, but also at the hip and ankle muscles compared to the non-injured control group. No differences between both legs of the ACLI group were found, except for tibialis anterior and gastrocnemius. These findings indirectly support including central nervous system re-education training to target the underlying mechanisms of these altered MAOT after ACL injury.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Thomas Luyckx
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Steven Claes
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium; Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
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