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Adamson L, Vandamme L, Prior T, Miller SC. Running-Related Injury Incidence: Does It Correlate with Kinematic Sub-groups of Runners? A Scoping Review. Sports Med 2024; 54:1163-1178. [PMID: 38280179 PMCID: PMC11127823 DOI: 10.1007/s40279-023-01984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Historically, kinematic measures have been compared across injured and non-injured groups of runners, failing to take into account variability in kinematic patterns that exist independent of injury, and resulting in false positives. Research led by gait patterns and not pre-defined injury status is called for, to better understand running-related injury (RRI) aetiology and within- and between-group variability. OBJECTIVES Synthesise evidence for the existence of distinct kinematic sub-groups across a population of injured and healthy runners and assess between-group variability in kinematics, demographics and injury incidence. DATA SOURCES Electronic database search: PubMed, Web of Science, Cochrane Central Register of Controlled Trials (Wiley), Embase, OVID, Scopus. ELIGIBILITY CRITERIA Original, peer-reviewed, research articles, published from database start to August 2022 and limited to English language were searched for quantitative and mixed-methods full-text studies that clustered injured runners according to kinematic variables. RESULTS Five studies (n = 690) were included in the review. All studies detected the presence of distinct kinematic sub-groups of runners through cluster analysis. Sub-groups were defined by multiple differences in hip, knee and foot kinematics. Sex, step rate and running speed also varied significantly between groups. Random injury dispersal across sub-groups suggests no strong evidence for an association between kinematic sub-groups and injury type or location. CONCLUSION Sub-groups containing homogeneous gait patterns exist across healthy and injured populations of runners. It is likely that a single injury may be represented by multiple movement patterns, and therefore kinematics may not predict injury risk. Research to better understand the underlying causes of kinematic variability, and their associations with RRI, is warranted.
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Affiliation(s)
- Léa Adamson
- School of Medicine, Sir Alexander Fleming Building, Imperial College London, London, UK
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Liam Vandamme
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Trevor Prior
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Stuart Charles Miller
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK.
- Digital Environment Research Institute (DERI), Queen Mary University of London, London, UK.
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Burke A, Dillon S, O'Connor S, Whyte EF, Gore S, Moran KA. Aetiological Factors of Running-Related Injuries: A 12 Month Prospective "Running Injury Surveillance Centre" (RISC) Study. SPORTS MEDICINE - OPEN 2023; 9:46. [PMID: 37310517 DOI: 10.1186/s40798-023-00589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Running-related injuries (RRIs) are a prevalent issue for runners, with several factors proposed to be causative. The majority of studies to date are limited by retrospective study design, small sample sizes and seem to focus on individual risk factors in isolation. This study aims to investigate the multifactorial contribution of risk factors to prospective RRIs. METHODS Recreational runners (n = 258) participated in the study, where injury history and training practices, impact acceleration, and running kinematics were assessed at a baseline testing session. Prospective injuries were tracked for one year. Univariate and multivariate Cox regression was performed in the analysis. RESULTS A total of 51% of runners sustained a prospective injury, with the calf most commonly affected. Univariate analysis found previous history of injury < 1 year ago, training for a marathon, frequent changing of shoes (every 0-3 months), and running technique (non-rearfoot strike pattern, less knee valgus, greater knee rotation) to be significantly associated with injury. The multivariate analysis revealed previous injury, training for a marathon, less knee valgus, and greater thorax drop to the contralateral side to be risk factors for injury. CONCLUSION This study found several factors to be potentially causative of injury. With the omission of previous injury history, the risk factors (footwear, marathon training and running kinematics) identified in this study may be easily modifiable, and therefore could inform injury prevention strategies. This is the first study to find foot strike pattern and trunk kinematics to relate to prospective injury.
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Affiliation(s)
- Aoife Burke
- School of Health and Human Performance, Dublin City University, XG08, Lonsdale Building, Glasnevin Campus, Dublin, Ireland.
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland.
| | - Sarah Dillon
- School of Health and Human Performance, Dublin City University, XG08, Lonsdale Building, Glasnevin Campus, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Siobhán O'Connor
- School of Health and Human Performance, Dublin City University, XG08, Lonsdale Building, Glasnevin Campus, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Enda F Whyte
- School of Health and Human Performance, Dublin City University, XG08, Lonsdale Building, Glasnevin Campus, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance, Dublin City University, XG08, Lonsdale Building, Glasnevin Campus, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran A Moran
- School of Health and Human Performance, Dublin City University, XG08, Lonsdale Building, Glasnevin Campus, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
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Arieh H, Abdoli B, Farsi A, Haghparast A. Pain-induced Impact on Movement: Motor Coordination Variability and Accuracy-based Skill. Basic Clin Neurosci 2022; 13:421-431. [PMID: 36457887 PMCID: PMC9706296 DOI: 10.32598/bcn.2021.2930.1] [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: 09/29/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Studies on pain are generally conducted for two purposes: first, to study patients with pain who have physical changes due to nerve and muscle lesions, and second, to regain the appropriate kinematic post-pain pattern. The present study aimed to investigate the effect of pain on the coordination variability pattern and throwing accuracy. METHODS The study participants included 30 people aged 18-25 years who volunteered to participate in the study. Participants practiced and acquired skills in 10 blocks of 15 trials. In the test phase associated with pain, Individuals were randomly divided into three groups: local pain, remote pain, and control. In their respective groups, participants were tested in a 15-block trial, 24 hours, and 1 week after acquisition. RESULTS The results revealed that pain did not affect the throwing accuracy (P=0.456). Besides, in the phase of acceleration in throwing, movement variability in the pain-related groups in the shoulder and elbow joints (P=0.518), elbow and wrist (P=0.399), and the deceleration and dart drop phase movement variability in the pain-related groups in the shoulder and elbow joints (P=0.622), elbow and wrist (P=0.534). CONCLUSION Based on the results, the accuracy and coordination variability in pain-related groups were similar. However, to confirm these results, more research is needed on performing motor functions in the presence of pain. HIGHLIGHTS Pain are generally conducted for two purposes.pain which has physical changes due to nerve and muscle lesions and pain to regain the appropriate kinematic post-pain pattern.People who experience pain show poor motor results.Pain restriction is ordinary in joints and the body compensates by increasing movement. PLAIN LANGUAGE SUMMARY One of the constant concerns of sports science experts is to find ways to improve performance or to know the factors that strengthen or weaken motor learning. After injury, pain has been described as one of the passive symptoms, and the mechanism of how overexertion of joints and muscles increases injury and pain is unknown. Following any injury, pain is one of the most important causes of disability and one of the most important problems in people's general health. Many treated individuals present with pain and impaired movement, and typically changes in movement control are a result of the pain. Research evidence suggests that pain induces changes in cortical excitability and the neuroplasticity model that accompanies practice of a new motor task interferes with the performance improvement that must occur simultaneously. According to the new approaches of motor and biomechanical learning and control, movement variability, especially in movement coordination, is considered as an important and influential factor of a person with different conditions. Novice athletes show high non-functional variability in order to reduce the degrees of freedom and then simplify their motor task, in contrast to skilled people, they display functional variability that allows them to perform a motor task better. in variable conditions. Scientists and researchers have concluded that in the presence of pain, there are changes in the pattern requirements and muscle coordination. Clearly, variability is a main feature of most neurological and musculoskeletal pains, and it is necessary for therapists to diagnose and classify incomplete movements and to effectively manage symptoms by controlling incomplete movements, so conducting such research in this field in order to show muscle and movement changes It is necessary under the influence of pain.
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Affiliation(s)
- Hasan Arieh
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Alireza Farsi
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abbas Haghparast
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chang R, van Emmerik R, Hamill J. Chronic plantar fasciitis reduces rearfoot to medial-forefoot anti-phase coordination. Clin Biomech (Bristol, Avon) 2021; 88:105439. [PMID: 34340098 DOI: 10.1016/j.clinbiomech.2021.105439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is commonly assumed that abnormal foot biomechanics cause plantar fasciitis; however, this assumption is not well supported. In this study, we investigated rearfoot to medial-forefoot coordination of healthy and plantar fasciitis individuals. We hypothesized that chronic plantar fasciitis individuals would exhibit greater intersegmental rearfoot to medial-forefoot anti-phase coordination and greater coordinative variability than a healthy cohort. METHODS Twenty-two individuals with chronic plantar fasciitis (symptomatic mean 4.5 years) and 22 healthy individuals participated. Three-dimensional kinematics of the rearfoot and medial forefoot segments were captured using reflective markers for walking trials. After resolving rearfoot and medial-forefoot segment angle data, a modified vector coding method was used to compute coupling angles, anti-phase movements, and coordinative variability. FINDINGS Compared to healthy individuals, individuals with plantar fasciitis exhibited fewer anti-phase movements (frontal plane: P = 0.003, effect size = 0.38). No group differences were detected in coordinative variability magnitude (sagittal, frontal, transverse, respectively: P = 0.99, 0.72, 0.86; effect sizes = 0.00, 0.12, 0.04). There were significant main effect differences in coupling variability between stance periods (P < 0.0001). INTERPRETATION Contrary to our hypothesis, these data suggest that a relative reduction of rearfoot to medial-forefoot anti-phase movements with a chronic plantar fasciitis injury indicates a coordinative deficit, and that a greater frequency of anti-phase movements is associated with healthy foot function. Pain, guarding, and/or the state of chronic injury may be impairing fluid inter-segmental motion. Although no group differences were found in coordinative variability, this variability increased around transitions between loading, weight acceptance, and propulsive phases of gait.
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Affiliation(s)
- Ryan Chang
- Biomechanics Laboratory, Department of Kinesiology, University of Massachusetts Amherst, Amherst 01003, USA; Human Factors Center of Excellence, Microsoft Corporation, Redmond 98052, USA.
| | - Richard van Emmerik
- Motor Control Laboratory, Department of Kinesiology, University of Massachusetts Amherst, Amherst 01003, USA
| | - Joseph Hamill
- Biomechanics Laboratory, Department of Kinesiology, University of Massachusetts Amherst, Amherst 01003, USA
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Sex and Limb Differences in Lower Extremity Alignment and Kinematics during Drop Vertical Jumps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073748. [PMID: 33916746 PMCID: PMC8038346 DOI: 10.3390/ijerph18073748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/14/2023]
Abstract
Sex and limb differences in lower extremity alignments (LEAs) and dynamic lower extremity kinematics (LEKs) during a drop vertical jump were investigated in participants of Korean ethnicity. One hundred healthy males and females participated in a drop vertical jump, and LEAs and LEKs were determined in dominant and non-dominant limbs. A 2-by-2 mixed model MANOVA was performed to compare LEAs and joint kinematics between sexes and limbs (dominant vs. non-dominant). Compared with males, females possessed a significantly greater pelvic tilt, femoral anteversion, Q-angle, and reduced tibial torsion. Females landed on the ground with significantly increased knee extension and ankle plantarflexion with reduced hip abduction and knee adduction, relatively decreased peak hip adduction, knee internal rotation, and increased knee abduction and ankle eversion. The non-dominant limb showed significantly increased hip flexion, abduction, and external rotation; knee flexion and internal rotation; and ankle inversion at initial contact. Further, the non-dominant limb showed increased peak hip and knee flexion, relatively reduced peak hip adduction, and increased knee abduction and internal rotation. It could be suggested that LEAs and LEKs observed in females and non-dominant limbs might contribute to a greater risk of anterior cruciate ligament injuries.
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Arieh H, Abdoli B, Farsi A, Haghparast A. Assessment of motor skill accuracy and coordination variability after application of local and remote experimental pain. Res Sports Med 2021; 30:325-341. [PMID: 33573421 DOI: 10.1080/15438627.2021.1888104] [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: 10/22/2022]
Abstract
Motor learning is a relatively permanent change in motor performance. Also, one of the factors that can affect movement acquisition and movement patterns is pain and injury. The present study aims to investigate the effect of the induced local and remote pain during dart-throwing skill acquisition by examining motor skill accuracy and coordination variability. Three groups of 30 participants with a mean age of 18-25 were randomly assigned to local and remote pain or control groups. Capsaicin gel was applied to the pain groups for measuring the severity of pain using the Visual Analogue Scale (VAS). The results revealed that pain had no impact on dart-throwing skill acquisition, and there was no significant difference (p = 0.732) among the three groups at three stages of retention test. The results also showed that there was a significant difference among the three groups in terms of variability in shoulder-elbow (p = 0.025) and elbow-wrist joints (p = 0.000) in the deceleration and dart-throwing phases. The Central Nervous System seems to make adjustments when the task is associated with pain during the acquisition phase. Also, the groups with or without pain have notably various strategies, so differently, to perceive motor skills.
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Affiliation(s)
- Hasan Arieh
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Alireza Farsi
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abbas Haghparast
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Denızoglu Kulli H, Yeldan I, Yildirim NU. Influence of quadriceps angle on static and dynamic balance in young adults. J Back Musculoskelet Rehabil 2020; 32:857-862. [PMID: 30932878 DOI: 10.3233/bmr-181332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Changes in postural stability may be a reason for injuries in individuals who have altered musculoskeletal alignment. Q angle (QA) has shown to be a predictor for lower extremity injuries. However, the relationship between balance and QA has not been investigated in young adults. OBJECTIVE The aim of the study was to investigate the relationship between QA and balance in young adults. METHODS Ninety participants performed the single leg stance test (SLST) and Star Excursion Balance Test (SEBT) to assess static and dynamic balance, respectively. QA was measured using a manual goniometer. Participants were divided into low, normal and high QA groups. RESULTS The relationship between SLST and QA was not statistically significant in both eyes opened and closed condition (r=-0.030, p= 0.782; r= 0.031, p= 0.774; respectively). SLST scores did not differ among the three groups in both eyes opened and closed condition (p= 0.781, p= 0.790; respectively). QA significantly correlated with lateral, posterolateral directions and sum score of SEBT (r= 0.240, p= 0.023; r= 0.269, p= 0.010; r= 0.210, p= 0.047). The comparisons among the low, normal and high Q angle groups' SEBT scores showed that balance performance in lateral direction was poorer in low QA group (p= 0.027). CONCLUSIONS The results of the study showed that QA and dynamic balance have a significant relationship. To reduce musculoskeletal injury risk, the dynamic balance should be assessed in young adults who have lower QA.
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Affiliation(s)
- Hilal Denızoglu Kulli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Ipek Yeldan
- Department of Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necmiye Un Yildirim
- Department of Physiotherapy and Rehabilitation, Gulhane Faculty of Health Sciences, Health Science University, Ankara, Turkey
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Abalo-Núñez R, Gutiérrez-Sánchez A, Iglesias Pérez M, Vernetta-Santana M. Injury prediction in aerobic gymnastics based on anthropometric variables. Sci Sports 2018. [DOI: 10.1016/j.scispo.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lopezosa-Reca E, Gijon-Nogueron G, Garcia-Paya I, Ortega-Avila AB. Does the type of sport practised influence foot posture and knee angle? Differences between footballers and swimmers. Res Sports Med 2018; 26:345-353. [DOI: 10.1080/15438627.2018.1447470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Eva Lopezosa-Reca
- Department of Nursing and Podiatry, University of Malaga, Malaga, Spain
| | | | - Irene Garcia-Paya
- Department of Nursing and Podiatry, University of Malaga, Malaga, Spain
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van Oeveren BT, de Ruiter CJ, Beek PJ, van Dieën JH. Optimal stride frequencies in running at different speeds. PLoS One 2017; 12:e0184273. [PMID: 29059198 PMCID: PMC5653196 DOI: 10.1371/journal.pone.0184273] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/21/2017] [Indexed: 12/12/2022] Open
Abstract
During running at a constant speed, the optimal stride frequency (SF) can be derived from the u-shaped relationship between SF and heart rate (HR). Changing SF towards the optimum of this relationship is beneficial for energy expenditure and may positively change biomechanics of running. In the current study, the effects of speed on the optimal SF and the nature of the u-shaped relation were empirically tested using Generalized Estimating Equations. To this end, HR was recorded from twelve healthy (4 males, 8 females) inexperienced runners, who completed runs at three speeds. The three speeds were 90%, 100% and 110% of self-selected speed. A self-selected SF (SFself) was determined for each of the speeds prior to the speed series. The speed series started with a free-chosen SF condition, followed by five imposed SF conditions (SFself, 70, 80, 90, 100 strides·min-1) assigned in random order. The conditions lasted 3 minutes with 2.5 minutes of walking in between. SFself increased significantly (p<0.05) with speed with averages of 77, 79, 80 strides·min-1 at 2.4, 2.6, 2.9 m·s-1, respectively). As expected, the relation between SF and HR could be described by a parabolic curve for all speeds. Speed did not significantly affect the curvature, nor did it affect optimal SF. We conclude that over the speed range tested, inexperienced runners may not need to adapt their SF to running speed. However, since SFself were lower than the SFopt of 83 strides·min-1, the runners could reduce HR by increasing their SFself.
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Affiliation(s)
- Ben T. van Oeveren
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands, Amsterdam, The Netherlands
| | - Cornelis J. de Ruiter
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands, Amsterdam, The Netherlands
| | - Peter J. Beek
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands, Amsterdam, The Netherlands
| | - Jaap H. van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands, Amsterdam, The Netherlands
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Almeida GPL, França FJR, Magalhães MO, Burke TN, Marques AP. Ângulo‐q na dor patelofemoral: relação com valgo dinâmico de joelho, torque abdutor do quadril, dor e função. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Rev Bras Ortop 2016; 51:181-6. [PMID: 27069887 PMCID: PMC4812005 DOI: 10.1016/j.rboe.2016.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/28/2015] [Indexed: 01/29/2023] Open
Abstract
Objective To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). Methods This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. Results The q-angle did not present any significant correlation with severity of knee pain (r = −0.29; p = 0.19), functional capacity (r = −0.08; p = 0.72), FPPA (r = −0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = −0.21; p = 0.35). Conclusion The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.
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Hoerzer S, von Tscharner V, Jacob C, Nigg BM. Defining functional groups based on running kinematics using Self-Organizing Maps and Support Vector Machines. J Biomech 2015; 48:2072-9. [DOI: 10.1016/j.jbiomech.2015.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 02/08/2015] [Accepted: 03/12/2015] [Indexed: 11/26/2022]
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Sakaguchi M, Ogawa H, Shimizu N, Kanehisa H, Yanai T, Kawakami Y. Gender differences in hip and ankle joint kinematics on knee abduction during running. Eur J Sport Sci 2012; 14 Suppl 1:S302-9. [DOI: 10.1080/17461391.2012.693953] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chung SCY, Chan WL, Wong SH. Lower limb alignment in anterior cruciate ligament-deficient versus -intact knees. J Orthop Surg (Hong Kong) 2011; 19:303-8. [PMID: 22184159 DOI: 10.1177/230949901101900308] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To compare anatomic lower limb features of anterior cruciate ligament (ACL)-deficient versus -intact knees in Chinese subjects. METHODS Anatomic lower limb features (mechanical axis, tibiofemoral angle, posterior tibial slope, notch width index, and hip neck-shaft angle) of 25 men and 3 women aged 18 to 39 (mean, 26) years with ACL-deficient knees, and 16 men and 4 women aged 24 to 31 (mean, 28) years with ACL-intact knees were compared using radiography. RESULTS The notch width index (0.26 vs. 0.29, p=0.02) was significantly smaller in ACL-deficient than ACL-intact knees. CONCLUSION Small notch width was associated with a thin ACL and can be regarded as an anatomic intrinsic risk factor for ACL injuries.
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Park SK, Stefanyshyn DJ. Greater Q angle may not be a risk factor of patellofemoral pain syndrome. Clin Biomech (Bristol, Avon) 2011; 26:392-6. [PMID: 21177007 DOI: 10.1016/j.clinbiomech.2010.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 11/03/2010] [Accepted: 11/23/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND A greater Q-angle has been suggested as a risk factor for Patellofemoral Pain Syndrome. Greater frontal plane knee moment and impulse have been found to play a functional role in the onset of Patellofemoral Pain Syndrome in a running population. Therefore, the purpose of this investigation was to determine the relationship between Q-angle and the magnitude of knee abduction moment and impulse during running. METHODS Q-angle was statically measured, using a goniometer from three markers on the anterior superior iliac spine, the midpoint of the patella and the tibial tuberosity. Thirty-one recreational runners (21 males and 10 females) performed 8-10 trials running at 4m/s (SD 0.2) on a 30m-runway. Absolute and normalized knee moment and impulse were calculated and correlated with Q-angle. FINDINGS Negative correlations between Q-angle and the magnitude of peak knee abduction moment (R²=0.2444, R=-0.4944, P=0.005) and impulse (R²=0.2563, R=-0.5063, P=0.004) were found. Additionally, negative correlations between Q-angle and the magnitude of weight normalized knee abduction moment (R²=0.1842, R=-0.4292, P=0.016) and impulse (R²=0.2304, R=-0.4801, P=0.006) were found. INTERPRETATION The findings indicate that greater Q-angle, which is actually associated with decreased frontal plane knee abduction moment and impulse during running, may not be a risk factor of Patellofemoral Pain Syndrome.
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Affiliation(s)
- Sang-Kyoon Park
- Biomechanics Laboratory, Sport Science Institute, Korea National Sport University, 88-15 Oryun-dong, Songpa-gu, Seoul, Republic of Korea.
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Rishiraj N, Taunton JE, Lloyd-Smith R, Woollard R, Regan W, Clement D. The Potential Role of Prophylactic/Functional Knee Bracing in Preventing Knee Ligament Injury. Sports Med 2009; 39:937-60. [DOI: 10.2165/11317790-000000000-00000] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Decker L, Houser JJ, Noble JM, Karst GM, Stergiou N. The effects of shoe traction and obstacle height on lower extremity coordination dynamics during walking. APPLIED ERGONOMICS 2009; 40:895-903. [PMID: 19187929 PMCID: PMC2811528 DOI: 10.1016/j.apergo.2008.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/10/2008] [Accepted: 12/29/2008] [Indexed: 05/21/2023]
Abstract
This study aims to investigate the effects of shoe traction and obstacle height on lower extremity relative phase dynamics (analysis of intralimb coordination) during walking to better understand the mechanisms employed to avoid slippage following obstacle clearance. Ten participants walked at a self-selected pace during eight conditions: four obstacle heights (0%, 10%, 20%, and 40% of limb length) while wearing two pairs of shoes (low and high traction). A coordination analysis was used and phasing relationships between lower extremity segments were examined. The results demonstrated that significant behavioral changes were elicited under varied obstacle heights and frictional conditions. Both decreasing shoe traction and increasing obstacle height resulted in a more in-phase relationship between the interacting lower limb segments. The higher the obstacle and the lower the shoe traction, the more unstable the system became. These changes in phasing relationship and variability are indicators of alterations in coordinative behavior, which if pushed further may have lead to falling.
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Affiliation(s)
- Leslie Decker
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0216, USA
| | - Jeremy J. Houser
- Department of Health and Exercise Sciences, School of Health Sciences and Education, Truman State University, 212 Pershing Building, 100 E. Normal St., Kirksville, MO 63501, USA
| | - John M. Noble
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0216, USA
| | - Gregory M. Karst
- Division of Physical Therapy Education, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Nicholas Stergiou
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0216, USA
- Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, 987850 Nebraska Medical Center, Omaha, NE 68198-7850, USA
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Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 2009; 17:705-29. [PMID: 19452139 DOI: 10.1007/s00167-009-0813-1] [Citation(s) in RCA: 495] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 04/18/2009] [Indexed: 01/12/2023]
Abstract
Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.
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Park S, Park SK, Lee J, Lee K, Kim D, Lee KK. Flexible walking shoes with separated outsole design for middle-aged females. FOOTWEAR SCIENCE 2009. [DOI: 10.1080/19424280902977368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Park SK, Stefanyshyn DJ, Loitz-Ramage B, Hart DA, Ronsky JL. Changing hormone levels during the menstrual cycle affect knee laxity and stiffness in healthy female subjects. Am J Sports Med 2009; 37:588-98. [PMID: 19174550 DOI: 10.1177/0363546508326713] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whether knee laxity varies throughout the menstrual cycle remains controversial. As increased laxity may be a risk factor for anterior cruciate ligament (ACL) injury, further research is warranted. HYPOTHESIS Variation in estradiol and progesterone levels during the menstrual cycle influences knee laxity and stiffness. STUDY DESIGN Case control study; Level of evidence, 3. METHODS The serum estradiol and progesterone levels of 26 healthy female subjects were recorded in the follicular phase, ovulation, and the luteal phase. Knee joint laxity was assessed using a standard knee arthrometer at the same intervals. Stiffness changes in the load-displacement curve were determined. Hormone levels across the cycle were compared between responders and nonresponders, defined by whether changes in knee laxity at 89 N occurred. RESULTS Greater laxity at 89 N during ovulation was observed (ovulation: 5.13 +/- 1.70 mm vs luteal: 4.55 +/- 1.54 mm, P = .012). In knee laxity testing at manual maximum load, greater laxity was noticed during ovulation (14.43 +/- 2.60 mm, P = .018), as compared with the follicular phase (13.35 +/- 2.53 mm). A reduction in knee stiffness of approximately 17% (ovulation: 12.48 +/- 5.46 N/mm vs luteal: 15.02 +/- 7.71 N/mm, P = .042) during ovulation was observed. However, there were no differences in hormone levels between responders and nonresponders at 89 N. CONCLUSION Female hormone levels are related to increased knee joint laxity and decreased stiffness at ovulation. To understand subject variations in knee joint laxity during the menstrual cycle in female athletes, further investigation is warranted.
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Affiliation(s)
- Sang-Kyoon Park
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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22
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Chumanov ES, Wall-Scheffler C, Heiderscheit BC. Gender differences in walking and running on level and inclined surfaces. Clin Biomech (Bristol, Avon) 2008; 23:1260-8. [PMID: 18774631 DOI: 10.1016/j.clinbiomech.2008.07.011] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 07/03/2008] [Accepted: 07/08/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gender differences in kinematics during running have been speculated to be a contributing factor to the lower extremity injury rate disparity between men and women. Specifically, increased non-sagittal motion of the pelvis and hip has been implicated; however it is not known if this difference exists under a variety of locomotion conditions. The purpose of this study was to characterize gender differences in gait kinematics and muscle activities as a function of speed and surface incline and to determine if lower extremity anthropometrics contribute to these differences. METHODS Whole body kinematics of 34 healthy volunteers were recorded along with electromyography of muscles on the right lower limb while each subject walked at 1.2, 1.5, and 1.8m/s and ran at 1.8, 2.7, and 3.6m/s with surface inclinations of 0%, 10%, and 15% grade. Joint angles and muscle activities were compared between genders across each speed-incline condition. Pelvis and lower extremity segment lengths were also measured and compared. FINDINGS Females displayed greater peak hip internal rotation and adduction, as well as gluteus maximus activity for all conditions. Significant interactions (speed-gender, incline-gender) were present for the gluteus medius and vastus lateralis. Hip adduction during walking was moderately correlated to the ratio of bi-trochanteric width to leg length. INTERPRETATION Our findings indicate females display greater non-sagittal motion. Future studies are needed to better define the relationship of these differences to injury risk.
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Affiliation(s)
- Elizabeth S Chumanov
- Department of Orthopedics and Rehabilitation, Physical Therapy Program, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706-1532, USA
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Transverse-plane mechanics at the knee and tibia in runners with and without a history of achilles tendonopathy. J Orthop Sports Phys Ther 2008; 38:761-7. [PMID: 19047768 DOI: 10.2519/jospt.2008.2911] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To determine if runners with a history of Achilles tendonopathy (AT) demonstrate a difference in transverse-plane motion and moments at the distal tibia and knee compared to runners without a history of AT. BACKGROUND One of the more prevalent overuse running injuries is AT. It has been hypothesized that prolonged pronation causes contradictory rotational forces acting on the AT. Conflicting joint motions may also accentuate the rotation of the tendon. This may further affect the opposing transverse-plane moments at the knee and distal tibia. METHODS AND MEASURES Eight runners with a history of AT and a noninjured control group consisting of 8 runners ran along a 20-m runway at a fixed speed. Biomechanical measurements were taken using a 6-camera motion analysis system and a force plate. Student t tests were employed to determine statistically significant differences (P </= .05) in transverse-plane motion and moment variables at the distal tibia and knee between groups. RESULTS The AT group showed less tibial external rotation moment (P = .01) and peak knee internal rotation (P = .05) compared to the control group. There was no difference in external rotation moment at the knee (P = .34) or peak tibial internal rotation (P = .44). CONCLUSION Runners with a previous history of AT exhibited less tibial external rotation moments during running. The lack of control in the transverse-plane at the distal tibia may be due to decreased function of the muscles primarily responsible for transverse-plane motion, resulting in greater strain on the AT in the transverse-plane. Designing an exercise program to strengthen lower leg muscles and improve distal tibial control in the transverse-plane may reduce the risk for developing AT or augment the rehabilitation of AT.
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The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players. Clin J Sport Med 2008; 18:329-37. [PMID: 18614884 DOI: 10.1097/jsm.0b013e31817f3e35] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The project aimed to implement neuromuscular training during a full soccer and handball league season and to experimentally analyze the neuromuscular adaptation mechanisms elicited by this training during a standardized sidecutting maneuver known to be associated with non-contact anterior cruciate ligament (ACL) injury. DESIGN The players were tested before and after 1 season without implementation of the prophylactic training and subsequently before and after a full season with the implementation of prophylactic training. PARTICIPANTS A total of 12 female elite soccer players and 8 female elite team handball players aged 26 +/- 3 years at the start of the study. INTERVENTION The subjects participated in a specific neuromuscular training program previously shown to reduce non-contact ACL injury. METHODS Neuromuscular activity at the knee joint, joint angles at the hip and knee, and ground reaction forces were recorded during a sidecutting maneuver. Neuromuscular activity in the prelanding phase was obtained 10 and 50 ms before foot strike on a force plate and at 10 and 50 ms after foot strike on a force plate. RESULTS Neuromuscular training markedly increased before activity and landing activity electromyography (EMG) of the semitendinosus (P < 0.05), while quadriceps EMG activity remained unchanged. CONCLUSIONS Neuromuscular training increased EMG activity for the medial hamstring muscles, thereby decreasing the risk of dynamic valgus. This observed neuromuscular adaptation during sidecutting could potentially reduce the risk for non-contact ACL injury.
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Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, Demaio M, Dick RW, Engebretsen L, Garrett WE, Hannafin JA, Hewett TE, Huston LJ, Ireland ML, Johnson RJ, Lephart S, Mandelbaum BR, Mann BJ, Marks PH, Marshall SW, Myklebust G, Noyes FR, Powers C, Shields C, Shultz SJ, Silvers H, Slauterbeck J, Taylor DC, Teitz CC, Wojtys EM, Yu B. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med 2006; 34:1512-32. [PMID: 16905673 DOI: 10.1177/0363546506286866] [Citation(s) in RCA: 599] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.
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Nyland J, Lachman N, Kocabey Y, Brosky J, Altun R, Caborn D. Anatomy, function, and rehabilitation of the popliteus musculotendinous complex. J Orthop Sports Phys Ther 2005; 35:165-79. [PMID: 15839310 DOI: 10.2519/jospt.2005.35.3.165] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We present a clinical commentary of existing evidence regarding popliteus musculotendinous complex anatomy, biomechanics, muscle activation, and kinesthesia as they relate to functional knee joint rehabilitation. The popliteus appears to act as a dynamic guidance system for monitoring and controlling subtle transverse- and frontal-plane knee joint movements, controlling anterior-posterior lateral meniscus movement, unlocking and internally rotating the knee joint (tibia) during flexion initiation, assisting with 3-dimensional dynamic lower extremity postural stability during single-leg stance, preventing forward femoral dislocation on the tibia during flexed-knee stance, and providing for postural equilibrium adjustments during standing. These functions may be most important during mid-range knee flexion when capsuloligamentous struCtures are unable to function optimally. Because the popliteus musculotendinous complex has attachments that approximate the borders of both collateral ligaments, it has the potential for providing instantaneous 3-dimensional kinesthetic feedback of both medial and lateral tibiofemoral joint compartment function. Enhanced popliteus function as a kinesthetic knee joint monitor acting in synergy with dynamic hip muscular control of femoral internal rotation and adduction, and ankle subtalar muscular control of tibial abduction-external rotation or adduction-internal rotation, may help to prevent athletic knee joint injuries and facilitate recovery during rehabilitation by assisting the primary sagittal plane dynamic knee joint stabilization provided by the quadriceps femoris, hamstrings, and gastrocnemius.
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Affiliation(s)
- John Nyland
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY 40202, USA.
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Mizuno Y, Kumagai M, Mattessich SM, Elias JJ, Ramrattan N, Cosgarea AJ, Chao EY. Q-angle influences tibiofemoral and patellofemoral kinematics. J Orthop Res 2001; 19:834-40. [PMID: 11562129 DOI: 10.1016/s0736-0266(01)00008-0] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Numerous surgical procedures have been developed to correct patellar tracking and improve patellofemoral symptoms by altering the Q-angle (the angle between the quadriceps load vector and the patellar tendon load vector). The influence of the Q-angle on knee kinematics has yet to be specifically quantified, however. In vitro knee simulation was performed to relate the Q-angle to tibiofemoral and patellofemoral kinematics. Six cadaver knees were tested by applying simulated hamstrings, quadriceps and hip loads to induce knee flexion. The knees were tested with a normal alignment, after increasing the Q-angle and after decreasing the Q-angle. Increasing the Q-angle significantly shifted the patella laterally from 20 degrees to 60 degrees of knee flexion, tilted the patella medially from 20 degrees to 80 degrees of flexion, and rotated the patella medially from 20 degrees to 50 degrees of flexion. Decreasing the Q-angle significantly tilted the patella laterally at 20 degrees and from 50 degrees to 80 degrees of flexion, rotated the tibia externally from 30 degrees to 60 degrees of flexion, and increased the tibiofemoral varus orientation from 40 degrees to 90 degrees of flexion. The results show that an increase in the Q-angle could lead to lateral patellar dislocation or increased lateral patellofemoral contact pressures. A Q-angle decrease may not shift the patella medially, but could increase the medial tibiofemoral contact pressure by increasing the varus orientation.
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Affiliation(s)
- Y Mizuno
- Johns Hopkins Orthopaedic Biomechanics Laboratory, Baltimore, MD 21205, USA
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