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Norcross MF, Almog R, Huang YL, Chang E, Hannigan KS, Johnson ST. Greater explosive quadriceps strength is associated with greater knee flexion at initial contact during landing in females. Sports Biomech 2024; 23:1028-1042. [PMID: 33821760 DOI: 10.1080/14763141.2021.1908413] [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: 01/05/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
This study investigated the influences of explosive quadriceps strength and landing task on sagittal plane knee biomechanics. Forty female participants performed isometric knee extensions on a dynamometer and had lower extremity biomechanics assessed during double-leg jump-landings (DLJL) and single-leg jump-cuts (SLJC). Explosive quadriceps strength was quantified by calculating rate of torque development (RTD) between torque onset and 100 ms after onset on a dynamometer. Participants were stratified into high and low RTD groups. Landing biomechanics were compared using 2 (Group) × 2 (Task) mixed-model ANOVAs. The relationships between quadriceps RTD and landing biomechanics were also assessed using simple, bivariate correlations. Across RTD groups, greater knee flexion at initial contact (KFIC), peak vertical ground reaction force, peak anterior tibial shear force, and peak internal knee extension moment, and lesser peak knee flexion was observed during SLJC compared to DLJL. The high RTD group exhibited significantly greater KFIC than the low RTD group across landing tasks. Greater quadriceps RTD was significantly associated with greater KFIC during SLJC, but not during DLJL. As landing with lesser KFIC is a risk factor for ACL injury, greater explosive quadriceps strength capacity might be beneficial for facilitating the use of safer landing mechanics during athletic tasks.
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Affiliation(s)
- Marc F Norcross
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Roy Almog
- School of Medicine, University of California, Irvine, CA, USA
| | - Yu-Lun Huang
- Department of Kinesiology, University of Wisconsin- Eau Claire, Eau Claire, WI, USA
| | - Eunwook Chang
- Department of Kinesiology, Inha University, Incheon, South Korea
| | - Kimberly S Hannigan
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Samuel T Johnson
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Liu Q, Wang L, Dai F, Wang G, Chen P. Effects of ankle Kinesio taping on knee and ankle joint biomechanics during unanticipated jumps in collegiate athletes. PLoS One 2024; 19:e0305480. [PMID: 39088514 DOI: 10.1371/journal.pone.0305480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/31/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE Most biomechanical research on the application of Kinesio taping (KT) to the ankle joint focused on testing anticipated movements. However, ankle sprains frequently occur in real life in unanticipated situations, where individuals are unprepared and face sudden external stimuli. This situation is completely different from the anticipated situation. The aim of the present study was to investigate the effects of ankle KT application on the kinematic and kinetic characteristics of the knee and ankle joints during unanticipated jump tasks in collegiate athletes. METHODS Eighteen healthy collegiate athletes experienced three taping conditions in a randomized order: no taping (NT), placebo taping (PT), and KT, and performed unanticipated jump tasks. A 9-camera infrared high-speed motion capture system was employed to collect knee and ankle kinematic data, and a 3-dimensional force plate was utilized to collect knee and ankle kinetic data during the tasks. RESULTS During the right jumps, KT significantly increased peak knee flexion angle (P = 0.031) compared to NT and significantly decreased peak vertical ground reaction force (P < 0.001, P = 0.001) compared to NT and PT. During the left jumps, KT significantly reduced peak ankle inversion angle (P = 0.022, P < 0.001) and peak ankle inversion moment (P = 0.002, P = 0.001) compared to NT and PT. CONCLUSION During unanticipated jump maneuvers, KT reduced peak ankle inversion angle, peak vertical ground reaction force, and peak ankle inversion moment and increased peak knee flexion angle in collegiate athletes.
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Affiliation(s)
- Quan Liu
- Wuhan Fourth Hospital, Wuhan, Hubei Province, China
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Ling Wang
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei Province, China
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Fan Dai
- Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Guanglan Wang
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei Province, China
| | - Peng Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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McClean ZJ, Pasanen K, Lun V, Charest J, Herzog W, Werthner P, Black A, Vleuten RV, Lacoste E, Jordan MJ. A Biopsychosocial Model for Understanding Training Load, Fatigue, and Musculoskeletal Sport Injury in University Athletes: A Scoping Review. J Strength Cond Res 2024; 38:1177-1188. [PMID: 38781473 DOI: 10.1519/jsc.0000000000004789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT McClean, ZJ, Pasanen, K, Lun, V, Charest, J, Herzog, W, Werthner, P, Black, A, Vleuten, RV, Lacoste, E, and Jordan, MJ. A biopsychosocial model for understanding training load, fatigue, and musculoskeletal sport injury in university athletes: A scoping review. J Strength Cond Res 38(6): 1177-1188, 2024-The impact of musculoskeletal (MSK) injury on athlete health and performance has been studied extensively in youth sport and elite sport. Current research examining the relationship between training load, injury, and fatigue in university athletes is sparse. Furthermore, a range of contextual factors that influence the training load-fatigue-injury relationship exist, necessitating an integrative biopsychosocial model to address primary and secondary injury prevention research. The objectives of this review were (a) to review the scientific literature examining the relationship between training load, fatigue, and MSK injury in university athletes and (b) to use this review in conjunction with a transdisciplinary research team to identify biopsychosocial factors that influence MSK injury and develop an updated, holistic biopsychosocial model to inform injury prevention research and practice in university sport. Ten articles were identified for inclusion in this review. Key findings were an absence of injury surveillance methodology and contextual factors that can influence the training load-fatigue-MSK injury relationship. We highlight the inclusion of academic load, social load, and mental health load as key variables contributing to a multifactorial, gendered environmental, scientific inquiry on sport injury and reinjury in university sport. An integrative biopsychosocial model for MSK injury in university sport is presented that can be used to study the biological, psychological, and social factors that modulate injury and reinjury risk in university athletes. Finally, we provide an example of how causal inference can be used to maximize the utility of longitudinally collected observational data that is characteristic of sport performance research in university sport.
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Affiliation(s)
- Zachary J McClean
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kati Pasanen
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Victor Lun
- Sport Medicine Center, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Charest
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- École de Psychologie, Université Laval, Québec, Quebec, Canada; and
- Center for Sleep & Human Performance, Calgary, Alberta, Canada
| | - Walter Herzog
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Penny Werthner
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Reid Vander Vleuten
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Elise Lacoste
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Jordan
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrative Neuromuscular Sport Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Center, University of Calgary, Calgary, Alberta, Canada
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Einarsson E, Barbosa O, Gislason MK, Briem K, Kotsifaki A, Whiteley R. Quadriceps and Hamstrings Activation Peaks Earlier as Athletes Repeatedly Hop, but There are Differences Depending on ACL Reconstruction Technique. Int J Sports Phys Ther 2024; 19:418-428. [PMID: 38576837 PMCID: PMC10987308 DOI: 10.26603/001c.94610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/28/2024] [Indexed: 04/06/2024] Open
Abstract
Background After Anterior Cruciate Ligament Reconstruction (ACLR) athletes face the challenge of regaining their previous competitive level while avoiding re-injury and early knee joint cartilage degeneration. Quadriceps and hamstrings strength reductions and neuromuscular alterations potentially related to risk of re-injury are present after ACLR and relate to deficits in muscle activation. Design Cross-sectional laboratory study. Purpose To examine quadriceps and hamstrings muscle activation during repeated hops in healthy pivoting-sport athletes and those who had undergone ACLR (bone-tendon-bone and semitendinosus graft) who had met functional criteria allowing return to training. Methods Surface electromyography (SEMG) was recorded from vastus medialis and lateralis and medial and lateral hamstrings bilaterally during 30 seconds' repeated hopping in male athletes on average eight months after ACLR surgery (5-12 months). All patients underwent hamstring (HS) (n=24) or bone-tendon-bone (BTB) reconstruction (n=20) and were compared to healthy controls (n=31). The SEMG signals were normalized to those obtained during maximal voluntary isometric contraction. Results A significant time shift in peak muscle activation (earlier) was seen for: vastus medialis and vastus lateralis activation in the control group, in the BTB group's healthy (but not injured) leg and both legs of the HS group. A significant time shift in peak muscle activation was seen for lateral hamstrings (earlier) in all but the BTB group's injured leg and the medial hamstrings in the control group only. Lower peak activation levels of the vastus lateralis (p\<0.001) and vastus medialis (p\<0.001) were observed in the injured compared to healthy legs and lower peak lateral hamstrings activity (p\<0.009) in the injured leg compared to control leg. Decline in medial hamstring peak activation (p\<0.022) was observed between 1st and 3rd phase of the hop cycle in all groups. Conclusion Repeated hop testing revealed quadriceps and hamstring activation differences within ACLR athletes, and compared to healthy controls, that would be missed with single hop tests. Level of evidence 3.
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Affiliation(s)
| | - Olivia Barbosa
- Rehabilitation Qatar Orthopaedic and Sports Medicine Hospital
| | | | - Kristin Briem
- Department of Physical Therapy University of Iceland
| | | | - Rodney Whiteley
- Rehabilitation Qatar Orthopaedic and Sports Medicine Hospital
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Bodkin SG, Bruce AS, Werner BC, Diduch DR, Brockmeier SF, Miller MD, Gwathmey FW, Hart JM. Influence of interim functional assessments on patient outcomes at the time of return to activity following ACL-reconstruction. Phys Ther Sport 2023; 61:179-184. [PMID: 37105085 DOI: 10.1016/j.ptsp.2023.04.006] [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: 01/31/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To compare patient outcomes at the time of the return to activity (RTA) progression between those with a prior interim assessment and those without. DESIGN Retrospective, Cohort Study. SETTING Controlled Laboratory. PARTICIPANTS Patients following Anterior Cruciate Ligament Reconstruction (ACLR) were recruited through an ongoing RTA assessment program. Patients were stratified into two testing groups = "Single RTA test": only assessment between 6 and 9 months post-ACLR and "Repeat RTA test": prior assessment performed >2-months before their RTA assessment. Patients were matched based on time post-surgery, age, activity level, and graft type. MAIN OUTCOME MEASURE Self-reported knee function and isokinetic knee flexor and extensor strength/symmetry were compared between groups. RESULTS 392 patients were identified. Once matched, 138 patients (21.1 ± 7.0 years, 7.3 ±0 .9 mo post-ACLR) were analyzed. Repeat RTA test patients demonstrated higher measures of self-reported knee function (P = .04) and greater knee flexion strength (P = .006) and symmetry (P = .05). CONCLUSION Patients with interim functional assessments reported greater self-reported knee function and higher hamstring strength at the time of RTA compared to patients that completed their only assessment within this time point. Early functional assessments may identify individualized deficits that can be addressed while patients are under supervision of rehabilitation specialists.
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Affiliation(s)
- Stephan G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, 290 S 1850 E HPER-W Rm113. Salt Lake City, UT, 84112, USA.
| | - Amelia S Bruce
- Department of Kinesiology, University of Virginia, Charlottesville, VA Memorial Gymnasium Rm 206 210 Emmet St So, Charlottesville, VA, 22903, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, USA
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, USA
| | - Joe M Hart
- Department of Orthopaedic Surgery, University of North Carolina Chapel Hill, NC 102 Mason Farm Rd Second Floor, Chapel Hill, NC, 27514, USA
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Martínez-Serrano A, Freitas TT, Franquesa X, Enrich E, Mallol M, Alcaraz PE. Does External Load Reflect Acute Neuromuscular Fatigue and Rating of Perceived Exertion in Elite Young Soccer Players? J Strength Cond Res 2023; 37:e1-e7. [PMID: 35836311 DOI: 10.1519/jsc.0000000000004296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Martínez-Serrano, A, Freitas, TT, Franquesa, X, Enrich, E, Mallol, M, and Alcaraz, PE. Does external load reflect acute neuromuscular fatigue and rating of perceived exertion in elite young soccer players? J Strength Cond Res 37(3): e1-e7, 2023-This study aimed to analyze the acute and residual effects of increased high-speed running (HSR) demands during an in-season training microcycle in young elite soccer players on localized neuromuscular fatigue (NMF) of the knee extensors (KE), posterior chain muscles, and rating of perceived exertion (RPE). Thirty-four elite young soccer players (age = 17.1 ± 0.8 years) were assessed in 2 consecutive days at different time points (baseline, POST-activation gym-based session, POST-small-sided game [SSG], POST-training 1 [TR1], POST-6H, POST-24H, POST-preventive gym-based session, and POST-training 2 [TR2]). Neuromuscular fatigue of the KE and posterior chain muscles was measured with a maximum voluntary isometric contraction (MVIC). External (total distance, number of accelerations or decelerations, and HSR distance) and internal (RPE) load was assessed during the SSG, TR1, and TR2 sessions. Players were divided through a median split, into "HIGH" or "LOW" group according to the training demands. The alpha level was set at p ≤ 0.05. A 2-way mixed effects model ANOVA showed a significant decreased in 90:20 MVIC after TR1 in the "HIGH" HSR group ( p = 0.037; effect size [ES] = 0.45). No significant differences in RPE were found after TR1 ( p = 0.637; ES = 0.58) and TR2 ( p = 0.109; ES = 0.62) when comparing the "HIGH" HSR group with the "LOW" HSR group. Assessing player's force production capabilities can be an effective strategy to detect NMF when HSR demands are acutely increased. Special caution should be taken when prescribing the training load of the training session based solely on RPE, as NMF might be present.
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Affiliation(s)
- Antonio Martínez-Serrano
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Strength and Conditioning Society, Rome, Italy
| | - Tomás T Freitas
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Strength and Conditioning Society, Rome, Italy
- NAR-Nucleus of High Performance in Sport, São Paulo, Brazil
- Faculty of Sport Sciences, Catholic University of Murcia, Murcia, Spain
| | - Xavi Franquesa
- Strength and Conditioning Department, Futbol Club Barcelona, Barcelona, Spain; and
- Barça Innovation Hub, Futbol Club Barcelona, Barcelona, Spain
| | - Edgar Enrich
- Strength and Conditioning Department, Futbol Club Barcelona, Barcelona, Spain; and
- Barça Innovation Hub, Futbol Club Barcelona, Barcelona, Spain
| | - Milos Mallol
- Strength and Conditioning Department, Futbol Club Barcelona, Barcelona, Spain; and
- Barça Innovation Hub, Futbol Club Barcelona, Barcelona, Spain
| | - Pedro E Alcaraz
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Strength and Conditioning Society, Rome, Italy
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Plyometrics Did Not Improve Jump-Landing Biomechanics in Individuals With a History of Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2022. [DOI: 10.1123/ijatt.2020-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Second anterior cruciate ligament (ACL) injury has similar biomechanical risk factors as primary injury. Standard of care rehabilitation does not adequately mitigate these biomechanical risks. This study examined the effectiveness of a 4-week plyometric intervention on biomechanical risk factors of second ACL injury versus no intervention in patients with a history of ACL reconstruction. Thirty adults post-ACL reconstruction received 12 sessions of plyometric (age: 19.9 ± 1.62 years; body mass index: 23.9 ± 2.6 kg/m2; months postoperative: 35.7 ± 24.2) or no (age: 21.3 ± 3.5 years; body mass index: 27.7 ± 4.8 kg/m2; months postoperative: 45.3 ± 25.4) exercise intervention. Hip and knee biomechanics were quantified during a jump-landing task before and after the intervention. Individual response to the intervention was evaluated via minimal detectable change. Hip flexion angle had the greatest response to plyometric training. Overall, focused plyometric intervention did not adequately mitigate biomechanical risk factors of second ACL injury; thus, development of interventions capable of modifying biomechanics known to contribute to ACL injury risk remains necessary.
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Werner DM, Mostaed MF, Price SK, Barrios JA. Modified Biering-Sorenson Protocol Changes Joint Contributions to Total Support in Individuals with a History of Anterior Cruciate Ligament Reconstruction During Drop Vertical Jump Landings. Int J Sports Phys Ther 2022; 17:201-209. [PMID: 35136689 PMCID: PMC8805103 DOI: 10.26603/001c.31881] [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: 05/26/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are persistent deficits of the proximal musculature in individuals with anterior cruciate ligament reconstruction. Previous research has shown that proximal musculature fatigue alters drop vertical jump performance in healthy individuals. It is unknown how proximal musculature fatigue will alter drop vertical jump performance in individuals who have undergone anterior cruciate ligament reconstruction. HYPOTHESIS/PURPOSE The purpose of this study was to examine the effects of a proximal extensor musculature fatigue protocol on drop vertical jump landing biomechanics of individuals with a history of anterior cruciate ligament reconstruction using both single-joint parameters and total support moment analysis. STUDY DESIGN Quasi-experimental pre-post laboratory experiment. METHODS Nineteen participants with a history of unilateral anterior cruciate ligament reconstruction were recruited. Three-dimensional motion analysis was performed bilaterally during a drop vertical jump. Participants then completed a proximal extensor musculature fatigue protocol and immediately repeated the drop vertical jump task. Sagittal plane kinetics and kinematics were collected. Joint contributions to peak total support moment were calculated. A condition-by-limb repeated measures analysis of variance was performed to explore the effects of the fatigue protocol, using an alpha level of 0.05. RESULTS There were no interactions observed for any parameters. However, the injured limb demonstrated less vertical ground reaction force (13%, p=0.013) and reduced peak dorsiflexion angle (2°, p=0.028) both before and after the protocol. After the fatigue protocol both limbs demonstrated reduced hip extensor contribution to peak total support moment (4%, p=0.035). CONCLUSIONS Individuals with a history of anterior cruciate ligament reconstruction performed the drop vertical jump with an altered anti-gravity support strategy after the proximal extensor musculature fatigue protocol. The significant reduction in bilateral hip extensor contribution to peak total support moment suggests evidence of targeted fatigue. LEVEL OF EVIDENCE III.
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Affiliation(s)
- David M Werner
- Division of Physical Therapy Education, University of Nebraska Medical Center; Medical Sciences Interdepartmental Area Program, University of Nebraska Medical Center
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O’Loughlin E, Reid D, Sims S. Is there a role for menstrual cycle phased resistance training programmes for women post anterior cruciate ligament reconstruction? A scoping review protocol. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2017613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma O’Loughlin
- The Sports Performance Research Institute New Zealand (SPRINZ), Level 2, AUT Millennium, Auckland University of Technology, Rosedale, Auckland, New Zealand
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Duncan Reid
- The Sports Performance Research Institute New Zealand (SPRINZ), Level 2, AUT Millennium, Auckland University of Technology, Rosedale, Auckland, New Zealand
| | - Stacy Sims
- The Sports Performance Research Institute New Zealand (SPRINZ), Level 2, AUT Millennium, Auckland University of Technology, Rosedale, Auckland, New Zealand
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand
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Hedayatpour N, Mohammed Sediq Rashid D, Izanloo Z, Seylaneh H, Falla D. Men and women show different adaptations of quadriceps activity following fatiguing contractions: An explanation for the increased incidence of sports-related knee injuries in women? J Electromyogr Kinesiol 2021; 58:102552. [PMID: 33930804 DOI: 10.1016/j.jelekin.2021.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
We investigated whether adaptations of quadriceps muscle activity to fatiguing exercise differs between sexes. Fifteen healthy men (age, mean ± SD; 22. ± 2.4 yr, body mass 70.5 ± 11.4 kg, height 1.72 ± 0.06 m) and 15 healthy women (age, mean ± SD; 21 ± 1.8 yr, body mass 60 ± 7.5 kg, height 1.62 ± 0.07 m), all right leg dominant, participated in the study. Participants performed a submaximal isometric knee extension contraction at 50% of the maximum voluntary contraction (MVC) sustained until task failure before and after a fatiguing exercise. Surface electromyography (EMG) was simultaneously recorded from nine regions distributed over the medial, middle and lateral locations of the quadriceps muscles in a longitudinal direction corresponding to the vastus medialis, rectus femoris (RF) and vastus lateralis muscle, respectively. A significant reduction in maximal force and time to task failure were observed after fatiguing exercise for both sexes (P < 0.001). However, women displayed greater myoelectric manifestations of fatigue specifically for the RF during the post-fatigue sustained contraction (P < 0.05). The RF is more susceptible to fatiguing exercise in women compared to men which may partly explain the higher risk of knee injuries among female athletes during competitive sports.
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Affiliation(s)
- Nosratollah Hedayatpour
- Center for Biomechanics and Motor Control (BMC), Department of Physical Education and Sport Science, University of Bojnord, Bojnord, Iran
| | | | - Zahra Izanloo
- Center for Biomechanics and Motor Control (BMC), Department of Physical Education and Sport Science, University of Bojnord, Bojnord, Iran
| | | | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, United Kingdom.
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
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Park S, Yoon S. Quantifying Coordination and Variability in the Lower Extremities after Anterior Cruciate Ligament Reconstruction. SENSORS 2021; 21:s21020652. [PMID: 33477847 PMCID: PMC7832890 DOI: 10.3390/s21020652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 01/13/2023]
Abstract
Patients experience various biomechanical changes following reconstruction for anterior cruciate ligament (ACL) injury. However, previous studies have focused on lower extremity joints as a single joint rather than simultaneous lower extremity movements. Therefore, this study aimed to determine the movement changes in the lower limb coordination patterns according to movement type following ACL reconstruction. Twenty-one post ACL reconstruction patients (AG) and an equal number of healthy adults (CG) participated in this study. They were asked to perform walking, running, and cutting maneuvers. The continuous relative phase and variability were calculated to examine the coordination pattern. During running and cutting at 30 and 60°, the AG demonstrated a lower in-phase hip–knee coordination pattern in the sagittal plane. The AG demonstrated low hip–knee variability in the sagittal plane during cutting at 60°. The low in-phase coordination pattern can burden the knee by generating unnatural movements following muscle contraction in the opposite direction. Based on the results, it would be useful to identify the problem and provide the fundamental evidence for the optimal timing of return-to-sport after ACL reconstruction (ACLR) rehabilitation, if the coordination variable is measured with various sensors promptly in the sports field to evaluate the coordination of human movement.
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Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis. Phys Ther Sport 2021; 47:91-104. [DOI: 10.1016/j.ptsp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022]
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Burland JP, Lepley AS, Frechette L, Lepley LK. Protracted alterations in muscle activation strategies and knee mechanics in patients after Anterior Cruciate Ligament Reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3766-3772. [PMID: 31897547 DOI: 10.1007/s00167-019-05833-4] [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] [Received: 08/19/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Altered quadriceps muscle activity can contribute to reduced ability of the muscle to quickly generate force and appropriately attenuate landing forces, exacerbating poor landing and movement strategies commonly seen after anterior cruciate ligament reconstruction (ACLR). The purpose was to evaluate if electromyographic (EMG) activity and knee biomechanics during a single-limb forward hop task are influenced by a history of ACLR. METHODS Twenty-six individuals with a history of unilateral ACLR (age 20.2 ± 2.7 years, height 1.7 ± 0.1 m; weight 69.6 ± 12.4 kg; time from surgery, 2.9 ± 2.7 years; graft type, 21 bone-patellar-tendon bone, 5 hamstring) and 8 healthy controls (age 23.3 ± 1.8 years, height 1.7 ± 0.1 m; mass 66.3 ± 13.9 kg) volunteered. Sagittal plane knee kinetics and EMG of the vastus lateralis were synchronized and measured using a three-dimensional motion analysis system during a single-limb forward hop task. Mixed-effect models were used to assess the effect of group on kinetic and EMG variables. RESULTS Kinetic outcomes (peak and rate of knee extension moment) and temporal muscle activity and activation patterns differed between the ACLR limb and healthy-control limb. Inter-limb asymmetries in the ACLR group were observed for all variables except EMG onset time; no limb differences were observed in the healthy cohort. CONCLUSION Years after ACLR, persistent quadriceps functional deficits are present, contributing to altered neuromuscular control strategies during functional tasks that may increase the risk of reinjury. To counteract these effects, emerging evidence indicates that clinicians could consider the use of motor learning strategies to improve neuromuscular control after ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Adam S Lepley
- University of Michigan, 2126 Observatory Lodge, 1402 Washington Heights, Ann Arbor, MI, 48109, USA
| | | | - Lindsey K Lepley
- University of Michigan, 3745B CCRB, 401 Washtenaw Avenue, Ann Arbor, MI, 48109, USA.
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15
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Smeets A, Vanrenterghem J, Staes F, Vandenneucker H, Claes S, Verschueren S. Are Anterior Cruciate Ligament-reconstructed Athletes More Vulnerable to Fatigue than Uninjured Athletes? Med Sci Sports Exerc 2020; 52:345-353. [PMID: 31479009 DOI: 10.1249/mss.0000000000002143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fatigue has a negative impact on lower extremity neuromuscular and biomechanical control. Because anterior cruciate ligament reconstruction (ACLR) athletes show already neuromuscular/biomechanical deficits in an unfatigued state, the negative impact of fatigue may magnify these deficits or help expose other deficits. So far, this has only scarcely been assessed warranting further research. METHODS Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks before and after a match simulation protocol, whereas muscle activation (vastus medialis, vastus lateralis, hamstrings medialis, hamstrings lateralis, gastrocnemius medialis, gastrocnemius lateralis, gluteus medius) and landing kinematics and kinetics of the hip, knee, and ankle joint were recorded. A two-way ANOVA with a mixed-model design (main effects for group and fatigue) was used to compare landing kinematics, kinetics, and muscle activation between groups, and prefatigue and postfatigue. To avoid unjustified reduction of the data to discrete values, we used one-dimensional Statistical Parametric Mapping. RESULTS Only two interaction effects were found: an increased postfatigue knee abduction moment and an increased postfatigue thorax flexion angle was found in the ACL injured legs but not in the uninjured legs of the ACL group or in the control group, during the lateral hop and the vertical hop with 90° medial rotation, respectively. CONCLUSIONS This study showed that overall ACLR athletes and uninjured athletes have similar biomechanical and neuromuscular responses to fatigue. For two biomechanical parameters, however, we did find an interaction effect, suggesting that landing deficits in ACLR athletes may become clearer in certain tasks when fatigued.
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Affiliation(s)
- Annemie Smeets
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, BELGIUM
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, BELGIUM
| | - Filip Staes
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, BELGIUM
| | | | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, BELGIUM
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, BELGIUM
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16
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Abstract
Neuromuscular fatigue is a commonly accepted risk factor for anterior cruciate ligament (ACL) injury. It has been proposed that fatigue leads to transient reductions in muscle strength, and deleterious changes in lower limb kinematics and kinetics, during potentially hazardous tasks such as cutting or landing. The purpose of this clinical commentary is to (1) highlight the complexity of fatigue; (2) discuss the theoretical basis by which it is thought to contribute to ACL injury; and (3) critically discuss the evidence underpinning this hypothesis. Despite a significant amount of research, none of the published fatigue protocols appear to have any consistent effect on any lower limb kinematic or kinetic variables known to increase ACL injury risk. On the contrary, fatigued athletes appear to land with greater peak knee and hip flexion angles, and lower landing forces than unfatigued athletes-all of which are considered favourable movement strategies for reducing ACL loading. These data support recent analyses demonstrating no relationship between player workload in training and competition and the occurrence of ACL injury in sport.
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Affiliation(s)
- Matthew N Bourne
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Timothy E Hewett
- Mayo Clinic Biomechanics Laboratories and Sports Medicine Research Center, Departments of Orthopedic Surgery, and of Physical Medicine and of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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17
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Smeets A, Vanrenterghem J, Staes F, Verschueren S. Match Play-induced Changes in Landing Biomechanics with Special Focus on Fatigability. Med Sci Sports Exerc 2020; 51:1884-1894. [PMID: 30933003 DOI: 10.1249/mss.0000000000001998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Growing evidence exists that match-related fatigue induces biomechanical alterations that might increase lower extremity injury risk. Fatigue studies often use match simulation protocols that expose all subjects to a standardized demand (e.g., a fixed distance/time). In those studies, the induced level of fatigue depends then on subjects' fatigability. If between-subject variability in fatigability is high, this might confound overall fatigue effects. Therefore, the first aim was to investigate whether a fatigue protocol with fixed demand causes alterations in landing patterns. Second, we assessed the relationship between fatigability and landing patterns as we hypothesized that athletes with high fatigability would show movement patterns that involve greater injury risk. METHODS Eighteen athletes performed three different unilateral landing tasks before and after a match simulation protocol while muscle activation (vastus medialis, vastus lateralis, hamstrings medialis, hamstrings lateralis, gastrocnemius medialis, gastrocnemius lateralis, and gluteus medius) and landing kinematics and kinetics of the hip, knee, and ankle joint were recorded. Furthermore, RPE was administered to measure fatigability. ANOVA analyses were conducted to investigate fatigue effects on landing patterns. Correlation analyses assessed the relationship between fatigability (postfatigue RPE) and landing patterns. RESULTS The ANOVA analyses did not show any overall postfatigue alterations in landing patterns. However, correlation analyses showed an association between fatigability and landing patterns. Athletes who had higher RPE scores showed smaller postfatigue knee flexion angles and smaller pre- and postfatigue knee abduction angles across different landing tasks. CONCLUSION The fixed demand protocol did not cause overall alterations in landing patterns. When fatigability was taken into account, high fatigability was related with less optimal landing patterns.
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Affiliation(s)
- Annemie Smeets
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
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18
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Fidai MS, Okoroha KR, Meldau J, Meta F, Lizzio VA, Borowsky P, Redler LH, Moutzouros V, Makhni EC. Fatigue Increases Dynamic Knee Valgus in Youth Athletes: Results From a Field-Based Drop-Jump Test. Arthroscopy 2020; 36:214-222.e2. [PMID: 31864579 DOI: 10.1016/j.arthro.2019.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether fatigue increases dynamic knee valgus in adolescent athletes, as measured after a standardized exercise protocol and video-based drop-jump test. A secondary aim was to determine whether individual risk factors place certain athletes at increased risk for dynamic knee valgus. METHODS Athletes aged 14 to 18 years were recruited for this video analysis study. Athletes were recorded performing a standard drop-jump to assess dynamic valgus. Participants then completed a standardized exercise protocol. Fatigue was quantified using a maximum vertical jump, which was compared with pre-exercise values. The drop-jump was repeated postexercise. All drop-jump recordings were randomized and scored for dynamic valgus by 11 blinded reviewers. Univariate analysis was performed to identify characteristics that predisposed athletes to increased dynamic valgus. RESULTS Eighty-five (47 female, 38 male) athletes with an average age of 15.4 years were included in this study. Forty-nine percent of athletes demonstrated an increase in dynamic valgus determined by drop-jump assessment after exercise. A significantly greater percentage of athletes were graded "medium or high risk" in jumps recorded after the exercise protocol (68%) as compared with before the exercise protocol (44%; P < .01). Female athletes (P < .01) and those older than 15 years of age (P < .01) were the most affected by fatigue. CONCLUSIONS In conclusion, our study found that exercise increases dynamic knee valgus in youth athletes. Female athletes and those older than 15 years of age were most significantly affected by exercise. Greater fatigue levels were found to correlate with an increase in dynamic knee valgus, which may place athletes at greater anterior cruciate ligament injury risk. The field-based exercise drop-jump test is a low-cost and reproducible screening tool to identify at-risk athletes who could possibly benefit from anterior cruciate ligament injury-prevention strategies. LEVEL OF EVIDENCE III, Comparative trial.
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19
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Connell R, Paton B, Milne R. Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running. BMJ Open Sport Exerc Med 2019; 5:e000375. [PMID: 30899542 PMCID: PMC6407560 DOI: 10.1136/bmjsem-2018-000375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background The risk of reinjury and other sequelae following anterior cruciate ligament reconstruction (ACLR) remains high. Lack of knowledge regarding factors contributing to these risks limits our ability to develop sensitive return to play (RTP) tests. Using a running task, we evaluate whether fatigue induces alterations in foot progression angle (FPA), a proposed biomechanical risk factor and could be used to enhance RTP test sensitivity. Method Transverse plane foot kinematics (FPA) were assessed for 18 post-ACLR subjects during a treadmill running task, before and after a generalised lower limb fatigue protocol. Subject’s contralateral limbs were used as a control group. Results A small but significant difference between FPA for ACLR and contralateral limbs was observed before but not after fatigue. When confounding variables were considered, there was a significant difference in FPA change between ACLR and contralateral limbs from the prefatigue to postfatigue state. Conclusions Following ACLR athletes may develop a knee-protective movement strategy that delays the progression of osteoarthritis in the ACL-injured knee. This may, however, increase the risk of ACL reinjury. Following the onset of fatigue this proposed movement strategy, and thus osteoarthritis protection, is lost.
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Affiliation(s)
| | - Bruce Paton
- The Institute of Sport, Exercise & Health, London, UK
| | - Ross Milne
- The Institute of Sport, Exercise & Health, London, UK
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20
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Lisee C, Lepley AS, Birchmeier T, O'Hagan K, Kuenze C. Quadriceps Strength and Volitional Activation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Sports Health 2019; 11:163-179. [PMID: 30638441 PMCID: PMC6391557 DOI: 10.1177/1941738118822739] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Context: Quadriceps function is a significant contributor to knee joint health that is influenced by central and peripheral factors, especially after anterior cruciate ligament reconstruction (ACLR). Objective: To assess differences of unilateral quadriceps isometric strength and activation between the involved limb and contralateral limb of individuals with ACLR and healthy controls. Data Sources: Web of Science, SportDISCUS, PubMed, CINAHL, and the Cochrane Database were all used during the search. Study Selection: A total of 2024 studies were reviewed. Twenty-eight studies including individuals with a unilateral history of ACLR, isometric knee extension strength normalized to body mass, and quadriceps activation measured by central activation ratios (CARs) through a superimposed burst technique were identified for meta-analysis. The methodological quality of relevant articles was assessed using a modified Downs and Black scale. Results of methodological quality assessment ranged from low to high quality (low, n = 10; moderate, n = 8; high, n = 10). Study Design: Meta-analysis. Level of Evidence: Level 2. Data Extraction: Means, standard deviations, and sample sizes were extracted from articles, and magnitude of between-limb and between-group differences were evaluated using a random-effects model meta-analysis approach to calculate combined pooled effect sizes (ESs) and 95% CIs. ESs were classified as weak (d < 0.19), small (d = 0.20-0.49), moderate (d = 0.50-0.79), or large (d > 0.80). Results: The involved limb of individuals with ACLR displayed lower knee extension strength compared with the contralateral limb (ES, –0.78; lower bound [LB], –0.99; upper bound [UB], –0.58) and healthy controls (ES, –0.76; LB, –0.98; UB, –0.53). The involved limb displayed a lower CAR compared with healthy controls (ES, –0.84; LB, –1.18; UB, –0.50) but not compared with the contralateral limb (ES, –0.15; LB, –0.37; UB, 0.07). The ACLR contralateral limb displayed a lower CAR (ES, –0.73; LB, –1.39; UB, –0.07) compared with healthy control limbs but similar knee extension strength (ES, –0.24; LB, –0.68; UB, –0.19). Conclusion: Individuals with ACLR have bilateral CAR deficits and involved limb strength deficits that persist years after surgery. Deficits in quadriceps function may have meaningful implications for patient-reported and objective outcomes, risk of reinjury, and long-term joint health after ACLR.
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Affiliation(s)
- Caroline Lisee
- Department of Kinesiology, College of Education, Michigan State University, East Lansing, Michigan
| | - Adam S Lepley
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut.,School of Medicine, Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Thomas Birchmeier
- Department of Kinesiology, College of Education, Michigan State University, East Lansing, Michigan
| | - Kaitlin O'Hagan
- Division of Sports Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Christopher Kuenze
- Department of Kinesiology, College of Education, Michigan State University, East Lansing, Michigan.,Division of Sports Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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21
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van Melick N, van Rijn L, Nijhuis-van der Sanden MWG, Hoogeboom TJ, van Cingel REH. Fatigue affects quality of movement more in ACL-reconstructed soccer players than in healthy soccer players. Knee Surg Sports Traumatol Arthrosc 2019; 27:549-555. [PMID: 30259146 PMCID: PMC6394549 DOI: 10.1007/s00167-018-5149-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/19/2018] [Indexed: 11/08/2022]
Abstract
PURPOSE Athletes who meet return to play (RTP) criteria after anterior cruciate ligament reconstruction (ACLR) rehabilitation still have a substantially increased risk of second ACL injury. One of the contributing factors to this increased risk could be that the RTP criteria are often not tested in an ecologically valid environment and in a fatigued state. The purpose of this cross-sectional case-control study was to investigate the influence of neuromuscular fatigue on both movement quantity and quality in fully-rehabilitated soccer players after ACLR and to compare them with healthy soccer players. METHODS ACL-reconstructed soccer players (n = 14) and healthy soccer players (n = 19) participated in the study and were matched by playing level and training hours. RTP measurements were performed on the soccer field, in both a non-fatigued and fatigued state. The RTP measurements focussed on both movement quantity (hop tests) and quality [countermovement jump with a Landing Error Scoring System (LESS) score]. RESULTS Movement quantity did not differ between ACL-reconstructed and healthy soccer players, both expressed in absolute values and the LSI-D/ND (calculated as dominant/non-dominant*100%). However, movement quality decreased more in the ACL-reconstructed soccer players in the fatigued state compared to the non-fatigued state. CONCLUSIONS Ideally, RTP measurements should focus on movement quality and should be conducted on the soccer field in a fatigued state, creating an ecologically valid environment. The LSI-D/ND can be used as an outcome parameter for RTP measurements of movement quantity and should be at least 95%. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- N. van Melick
- Knee Expert Center, Vijfkamplaan 8, 5624 EB Eindhoven, The Netherlands ,0000 0004 0444 9382grid.10417.33Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - L. van Rijn
- Praktijk voor Fysiotherapie Vossen, Echt, The Netherlands
| | - M. W. G. Nijhuis-van der Sanden
- 0000 0004 0444 9382grid.10417.33Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - T. J. Hoogeboom
- 0000 0004 0444 9382grid.10417.33Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - R. E. H. van Cingel
- 0000 0004 0444 9382grid.10417.33Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands ,grid.491452.fSport Medisch Centrum Papendal, Arnhem, The Netherlands
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22
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Chang EW, Johnson S, Pollard C, Hoffman M, Norcross M. Landing biomechanics in anterior cruciate ligament reconstructed females who pass or fail a functional test battery. Knee 2018; 25:1074-1082. [PMID: 30482641 DOI: 10.1016/j.knee.2018.09.006] [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: 02/21/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A functional test battery (FTB) has been proposed to determine return to full activity following anterior cruciate ligament reconstruction (ACLR). However, there is little biomechanical evidence of FTB usefulness. The purpose of this study was to compare knee joint landing and cutting biomechanics between ACLR patients who passed (ACLR-Pass), failed (ACLR-Fail), and healthy females (Healthy) before and after exercise. METHODS Thirty females were included: 10 ACLR-Pass, eight ACLR-Fail and 12 Healthy. Participants performed a FTB consisting of The 2000 International Knee Documentation Committee Subjective Knee Evaluation Form, the Knee Outcome Survey Activities of Daily Living Scale, and quadricep strength and single-leg hop tests. Double-leg jump landing (DLJL) and single-leg jump cutting (SLJC) biomechanics were assessed before and after exercise. RESULTS Significant main effects of exercise were found during DLJL: lesser knee flexion angle at initial contact after exercise (before exercise: 15.8 ± 5.0, after exercise: 14.2 ± 5.4, P = 0.01, ηp 2 = 0.25); and during SLJC: smaller peak knee extension moment (before exercise: -0.33 ± 0.1, after exercise: -0.31 ± 0.1, P = 0.02, ηp 2 = 0.18). While there was a significant group by time interaction effect with lesser peak knee flexion angle after exercise, this interaction effect was likely driven by a reduction in peak knee flexion in only the Healthy group. CONCLUSIONS Healthy females exhibited a reduction in peak knee flexion during SLJC after exercise. However, there were no differences in ACLR knee biomechanics during DLJL and SLJC performed before and after exercise.
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Affiliation(s)
- Eun Wook Chang
- School of Art and Sport, Department of Kinesiology, Inha University, Nam-gu, Incheon, South Korea.
| | - Samuel Johnson
- College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Kinesiology Program Oregon State University, Corvallis, OR, USA
| | - Christine Pollard
- College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Kinesiology Program, Oregon State University - Cascades, Bend, OR, USA
| | - Mark Hoffman
- College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Kinesiology Program Oregon State University, Corvallis, OR, USA
| | - Marc Norcross
- College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Kinesiology Program Oregon State University, Corvallis, OR, USA
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23
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Barber-Westin SD, Noyes FR. Effect of Fatigue Protocols on Lower Limb Neuromuscular Function and Implications for Anterior Cruciate Ligament Injury Prevention Training: A Systematic Review. Am J Sports Med 2017; 45:3388-3396. [PMID: 28298066 DOI: 10.1177/0363546517693846] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Approximately two-thirds of anterior cruciate ligament (ACL) tears are sustained during noncontact situations when an athlete is cutting, pivoting, decelerating, or landing from a jump. Some investigators have postulated that fatigue may result in deleterious alterations in lower limb biomechanics during these activities that could increase the risk of noncontact ACL injuries. However, prior studies have noted a wide variation in fatigue protocols, athletic tasks studied, and effects of fatigue on lower limb kinetics and kinematics. PURPOSE First, to determine if fatigue uniformly alters lower limb biomechanics during athletic tasks that are associated with noncontact ACL injuries. Second, to determine if changes should be made in ACL injury prevention training programs to alter the deleterious effects of fatigue on lower limb kinetics and kinematics. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature using MEDLINE was performed. Key terms were fatigue, neuromuscular, exercise, hop test, and single-legged function tests. Inclusion criteria were original research studies involving healthy participants, use of a fatigue protocol, study of at least 1 lower limb task that involved landing from a hop or jump or cutting, and analysis of at least 1 biomechanical variable. RESULTS Thirty-seven studies involving 806 athletes (485 female, 321 male; mean age, 22.7 years) met the inclusion criteria. General fatigue protocols were used in 20 investigations, peripheral protocols were used in 17 studies, and 21 different athletic tasks were studied (13 single-legged, 8 double-legged). There was no consistency among investigations regarding the effects of fatigue on hip, knee, or ankle joint angles and moments or surface electromyography muscle activation patterns. The fatigue protocols typically did not produce statistically significant changes in ground-reaction forces. CONCLUSION Published fatigue protocols did not uniformly produce alterations in lower limb neuromuscular factors that heighten the risk of noncontact ACL injuries. Therefore, justification does not currently exist for major changes in ACL injury prevention training programs to account for potential fatigue effects. However, the effect of fatigue related to ACL injuries is worthy of further investigation, including the refinement of protocols and methods of analysis.
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Affiliation(s)
- Sue D Barber-Westin
- Cincinnati Sportsmedicine and Orthopaedic Center/Mercy Health, Cincinnati, Ohio, USA.,Noyes Knee Institute, Cincinnati, Ohio, USA
| | - Frank R Noyes
- Cincinnati Sportsmedicine and Orthopaedic Center/Mercy Health, Cincinnati, Ohio, USA.,Noyes Knee Institute, Cincinnati, Ohio, USA
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