Effects of Maturation on Lower Limb Neuromuscular Asymmetries in Elite Youth Tennis Players

A Single Bout of On-Ice Training Leads to Increased Interlimb Asymmetry in Competitive Youth Hockey Athletes

Interlimb asymmetry (ILA) refers to an anatomical or physiological imbalance between contralateral limbs, which can influence neuromuscular function. Investigating the influence of neuromuscular fatigue on ILA may be critical for optimizing training programs, injury rehabilitation, and sport-specific performance. The purpose of this study was to determine if a single bout of ice hockey-specific exercise creates or exacerbates lower-limb ILA. Before and after an on-ice training session, 33 youth ice-hockey athletes (14.9 [1.7] y; 11 females) performed 3 repetitions of a maximal vertical countermovement jump (CMJ), an eccentric hamstring contraction, and maximal isometric hip adduction and abduction contractions. Force- and power-related variables were analyzed to determine limb-specific neuromuscular function. The on-ice session reduced maximal isometric hip adduction (left: 7.3% [10.3%]; right: 9.5% [9.6%]) and abduction (left: 4.9% [6.9%]; right: 5.0% [8.1%]) force, but did not impair (P ≥ .10) CMJ performance (jump height, relative peak power, braking duration, and total duration). After the on-ice session, ILA was greater for CMJ propulsive impulse (6.3% [2.9%] vs 5.1% [2.6%]), CMJ braking rate of force development (19.3% [7.6%] vs 15.2% [6.4%]), and peak isometric hip adduction force (6.7% [5.5%] vs 6.1% [4.1%]). In conclusion, hockey-specific exercise leads to increased ILA for multiple force-related metrics, which may be a compensatory mechanism to maintain bilateral task performance when fatigued.

Relationship between Interlimb Asymmetries and Performance Variables in Adolescent Tennis Players

Tennis is an individual sport characterised by high-intensity action, including sprints and changes of direction (COD). However, there is a gap in the knowledge of limb asymmetries in adolescent tennis players and their association with performance. The aim of this study was to investigate the relationship between asymmetry in vertical and horizontal jump tests (CMJ and HJ) and COD with lower limb performance variables in adolescent tennis players. Forty-five adolescent tennis players (age: 13.81 ± 1.08 years; height: 167.64 ± 9.9 cm; body mass: 57.48 ± 10.94 kg; body mass index: 20.27 ± 2.18 kg/m2) performed the CMJ test (unilateral and bilateral), horizontal jumps (unilateral and bilateral), 25 m sprint, and 180° COD test. The single-leg countermovement jump showed the greatest asymmetries among the different tests (6.62 ± 9.35%). Notable negative relationships were found between CMJ asymmetry and COD asymmetry with unilateral horizontal jump variables (r = -0.30 to -0.53). In addition, CMJ asymmetry showed notable relationships with CMJR (r = 0.49) and COD180R (r = 0.29), whereas COD asymmetry showed a notable relationship with COD180L (r = 0.40). On the other hand, HJ asymmetry showed no notable relationships with any variable. The main findings of this study indicate that greater imbalances in the CMJ and COD tests are associated with a reduced capacity to perform unilateral horizontal jumps. These results suggest the incorporation of training protocols to reduce interlimb asymmetries in growing athletes to improve their performance. This practical application is important for coaches and physical trainers who aim to improve the physical performance of adolescent tennis players. Greater asymmetry results in a reduced ability to produce unilateral horizontal force.

Change of Direction Asymmetry in Youth Elite Tennis Players: A Longitudinal Study

Longitudinal investigations into the development of inter-limb asymmetry in sports are scarce. This study examined the development of change of direction (COD) asymmetry magnitude in youth elite tennis players. Dominant (overall best performance) and non-dominant (best performance on the other side) scores and COD asymmetry magnitude were quantified annually (up to six years) in 323 male and 235 female players (ages 6 to13 years). Linear mixed effects regression models examined the development of COD performance and asymmetry magnitude according to players' chronological age and sex. Kappa coefficients examined the consistency for the direction of asymmetry across test occasions. Regardless of sex, COD performance significantly improved (p<0.001) while COD asymmetry magnitude significantly decreased (- 0.17±0.87% / year) with increasing chronological age. Regardless of age, males showed significantly lower COD times (- 0.111±0.091 s) and lower COD asymmetry magnitude (- 0.30±1.00%) compared to females. The slight and poor (k-value=0.02-0.00) kappa coefficients for males and females, respectively, highlight the direction specificity of functional asymmetry. These data show that whereas performance of the COD test improved, the magnitude of COD asymmetry declined across chronological age in youth tennis players.

Effect of Sex and Lateral Ankle Sprain History on Dorsiflexion Range Of Motion Asymmetry During the Weight Bearing Lunge Test

Background

Reduced dorsiflexion range of motion (DFROM) which is commonly seen following lateral ankle sprain (LAS) has the potential to influence lower extremity biomechanics which have been linked to increased injury risk in the female athlete. Current research on the effect of sex and LAS history on DFROM is limited.

Hypothesis/Purpose

This study had three aims 1) to determine the effect of sex, leg dominance and LAS history on DFROM, 2) to determine the effect of sex and LAS history on magnitude of DFROM symmetry and 3) to examine the association of sex on direction (whether dominant or non-dominant limb had the higher DFROM) of symmetry.

Study Design

Cross-Sectional Study.

Methods

DFROM was measured bilaterally in 105 recreational athletes all participating in multidirectional sports using the tape measurement method during the weight bearing lunge test (WBLT). A mean of three measurements was used for analysis. A 3-way mixed ANOVA was carried out to determine the interaction between sex, LAS history and leg dominance on DFROM and a 2-way ANOVA for the effect of sex and LAS history on asymmetry. A chi-square test was used to determine the association of sex and direction of asymmetry.

Results

The results indicate no significant effect of sex, LAS history, and leg dominance on DFROM (p=0.65). Main effects were significant for sex and LAS on DFROM. The mean asymmetry for all participants was reported as 12.25±14.76cm. No significant effect of sex and LAS history on magnitude of asymmetry was reported. There was a significant association of sex and direction of asymmetry (χ2(1) = 11.26, p = 0.00). Sixty-five-point two percent of males were shown to have higher DFROM of their non-dominant limb compared to 75% of females who were higher in their dominant limb.

Conclusion

Findings from this study suggest that DFROM is affected by sex and LAS history. While females have increased DFROM compared to males, those with LAS history are more likely to have a decreased DFROM on the involved side. The results also indicate that interlimb asymmetries in DFROM are present in athletes, therefore practitioners should exercise caution when using bilateral comparisons in injury and return to play assessments.

Level of Evidence

2b.

Development of upper and lower extremity functional asymmetries in male and female elite youth tennis players: a longitudinal study

BACKGROUND

This longitudinal study aimed to examine the development of both upper and lower extremity functional performances, together with asymmetry magnitudes and directionality in youth tennis players.

METHODS

Dominant and non-dominant physical performance values of 90 players (53 males, 37 females) were determined yearly (with monitoring up to 3 years) using unilateral strength, power, speed and agility tests from which asymmetry magnitude percentages were calculated. Linear mixed effect models examined the development of performance values according to youth players' maturity offset, performance dominance, sex and training volume. Similarly, the development of functional asymmetry magnitudes was examined according to players' maturity offset, sex and training volume. Kappa coefficients (k) examined the consistency in directionality across test occasions.

RESULTS

Regardless of sex, the dominant and non-dominant physical performance values of every test significantly (P<0.05) improved with increasing maturity offset. No sex differences were apparent except for strength and power related tests where male players performed significantly better. Functional asymmetry magnitudes (ranging from 2.0 to 15.9%) did not significantly change with increasing maturity offset (range=-0.3-0.4% per year). Training volume was not significantly associated with the performance values and asymmetry magnitudes. The dominant upper extremity (which holds the tennis racket) consistently displayed the dominant performance value (k value: 1.00) across test occasions, which was not the case at lower extremity level (k value range: -0.28-0.31).

CONCLUSIONS

The functional asymmetry magnitudes did not change significantly with youth tennis players' maturity offset over a 3-year period.

Change-of-Direction Speed Assessments and Testing Procedures in Tennis: A Systematic Review

ABSTRACT

Schneider, C, Rothschild, J, and Uthoff, A. Change-of-direction speed assessments and testing procedures in tennis: a systematic review. J Strength Cond Res 37(9): 1888-1895, 2023-Change-of-direction speed (CODS) plays an essential role in tennis match play, and CODS performance is, therefore, commonly assessed and monitored in tennis players. Thus, the aim of this systematic review was to describe test characteristics, performance metrics, test-retest reliability, construct validity, and test outcomes of tests that are used to assess CODS in tennis players. A literature search conducted on PubMed and SPORTDiscus yielded 563 results. After applying the eligibility criteria, a total of 27 studies were included in the present review. Ten unique CODS tests were identified. 505 test variations were most frequently used across all studies, and total time required to complete the test was the predominant performance metric investigated. Intrasession test-retest reliability ranged from "moderate" to "excellent." Intersession test-retest reliability as well as the effects of tennis performance, sex, and age on CODS performance were unclear given the subject demographics and the limited number of studies that investigated these aspects. In conclusion, most studies included CODS tests that exhibit longer COD entry and total distances but similar COD angles to those seen during tennis match play. All CODS tests have at least "moderate" intrasession test-retest reliability. However, to improve CODS assessment methods and to increase our current understanding of CODS performance in tennis players, there is a need to conduct more research on the intersession test-retest reliability, construct validity, and the effects of sex, age, and tennis performance and to investigate other performance metrics that might provide additional insights into CODS (e.g., phase-specific performance variables).

Relationship between Asymmetry Profiles and Jump Performance in Youth Female Handball Players

The relationships between asymmetries and performance or the identification of the asymmetry profile that has been routinely studied during jumping tests are largely derived from male-only and small sample size studies. Therefore, the aims of this study were: 1) to evaluate the magnitude and the direction of jump asymmetries (vertical and lateral) in three different age groups of adolescent female handball players, and 2) to identify the effect of asymmetry between limbs on jump performance in the three age groups. One hundred and eighty-five adolescent female handball players (age: 14.88 ± 1.49 years) were distributed in three groups: U14, U16 and U18 and performed two tests to assess jumping ability which were the single leg countermovement jump (SL-CMJ) and the single leg hop lateral (SL-HL). The magnitude of asymmetry in the SL-CMJ test (10.80%) was higher compared to that of the SL-LH test (6.47%), and there were no significant differences between particular categories. The direction of asymmetry represented by the Kappa values showed "poor" and "fair" levels of agreement in U14 and U16 categories, which means that asymmetries rarely favored the same side during each jumping test, but in contrast, in the U18 category the Kappa value result was "slight". There were significant correlations between SL-CMJ jumping asymmetries and jumping performance in the U18 category (r = 0.31 to 0.49). These data indicate that in order to identify the player's asymmetry profile, we need to consider the magnitude and the direction of different tests which will help better understand the natural deficits, contextualize them and consider appropriate training interventions for the reduction of inter-limb asymmetries.

Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes

Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.

Validity and Reliability of the V-Cut Dribbling Test in Young Basketball Players

PURPOSE

Change of direction while dribbling appears to be of interest for on-court performance in basketball. The study aim was to assess the validity and reliability of the V-cut dribbling test (VcutBk) in young basketball players.

METHODS

Ninety-two young basketball players from 8 to 21 years old (74% male) were classified in relation to peak height velocity (PHV) offset. To examine validity and test-retest reliability, VcutBk was performed in 2 identical sessions separated by 1 week. Participants also performed the V-cut test and linear sprint test with and without dribbling to analyze correlations between tests in different somatic maturity stages.

RESULTS

The relationships of the VcutBk with the other tests and skill-time-related deficits were interpreted from large (r > .51) to very large (r > .71). The comparisons between pre-PHV and post-PHV groups of basketball players showed significant and large effect in the VcutBk (d = 2.04; mean difference = 2.59; 95% CI, 1.86 to 3.32). Also, significant main effects when comparing PHV groups were reported in all skill-time-related deficits (P < .001, ηp2=.13-.28, moderate to large effect size). Test-retest reliability and signal-to-noise ratio analysis did not show substantial between-trials differences in VcutBk. Reliability scores showed high intraclass correlation coefficient (.95) and low coefficient of variation (0.23%).

CONCLUSIONS

The VcutBk seems to be a valid and reliable test to assess change of direction while dribbling. VcutBk performance and skill-time-related deficits seem to be sensitive to somatic maturity. Basketball coaches should consider the VcutBk to assess young basketball players.

The Association Between Chronological Age and Maturity Status on Lower Body Clinical Measurements and Asymmetries in Elite Youth Tennis Players

BACKGROUND

Tennis is one of the most popular sports among youths. At elite levels, a notable increase in injury incidence and a temporary decline in performance may occur when children progress through puberty. However, limited research has explored maturity-associated variations in clinical measurements suggested as predictors of injury and tennis performance in elite youth players. Therefore, the main purpose of this study was to analyze the association between chronological age and maturity status on several measures of neuromuscular capability and physical performance as well as bilateral (interlimb) asymmetries in elite youth tennis players.

HYPOTHESIS

Youth tennis players around peak height velocity (PHV) will show higher growth-related impairments or deficits in measures of neuromuscular capability and physical performance than their less (pre-PHV) and more (post-PHV) mature counterparts irrespective of sex.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 68 male (age, 13.7 ± 1.1 years; height, 162.4 ± 9.4 cm; body mass, 51.4 ± 10.3 kg [Mean values ± SD]) and 60 female (age, 13.6 ± 1.1 years; height, 162.8 ± 7.2 cm; body mass, 52.7 ± 7.5 kg [Mean values ± SD]) elite youth tennis players from 2 different age groups (under 13 [U13] and under 15 [U15]) and maturity status (pre-PHV, around PHV, and post-PHV), were tested during national training camps. Tests included the Y Balance Test, isometric hip abduction and adduction strength, hip ranges of motion (ROMs), and countermovement jump (CMJ) height. Bayesian analysis was used to establish any significant between-group differences.

RESULTS

Only dynamic balance (in boys; Bayesian factor [BF₁₀] = 88.2) and jump height (in both boys and girls; BF₁₀ >100) were significatively associated with chronological age, whereby the U15 group showed lower Y Balance Test reach distances (-6%; standardized effect size δ = 0.62) but higher CMJ height scores (+18%; δ = 0.73) than the U13 group. Although boys jump higher (+11%; δ = 0.62) and were stronger in isometric hip adduction strength (+14%; δ = 0.92) than girls, the latter had greater hip internal ROM values (+15%; δ = 0.75). Furthermore, relevant maturity-associated effects (BF₁₀ = 34.6) were solely observed for the CMJ test in boys, with the most mature players demonstrating higher jump height scores (+12%; δ = 0.93). Finally, a significant percentage (>25%) of tennis players, independent of sex, demonstrated bilateral asymmetries in hip ROM, hip strength, and jump height values.

CONCLUSION

The findings of this study show that in U13 and U15 male and female tennis players, there were neither positive nor negative maturity-associated variations in the clinical measurements analyzed (with the exception of jump height in male players). The high proportion of tennis players showing bilateral asymmetries in dynamic balance, hip ROM, and strength and jump performance highlight the need of future studies to analyze these factors in relation to unilateral tennis-specific adaptations in the musculoskeletal and sensorimotor systems.

CLINICAL RELEVANCE

These results may help to better understand how different clinical measurements are associated with the process of growth and maturation in elite youth tennis players and may aid in the design of specific training interventions during these stages of development.

Maturation Stage Does Not Affect Change of Direction Asymmetries in Young Soccer Players

ABSTRACT

Asimakidis, ND, Dalamitros, AA, Ribeiro, J, Lola, AC, and Manou, V. Μaturation stage does not affect change of direction asymmetries in young soccer players. J Strength Cond Res 36(12): 3440-3445, 2022-This study examined whether the stage of biological maturation can affect interlimb asymmetries during a change of direction (COD) test. Seventy-six young soccer players were divided into 2 different groups according to their peak height velocity stage (PHV): pre-PHV (n = 45, age = 11.8 ± 1.2 years, height = 149.8 ± 9.3 cm, body mass = 43.9 ± 11.2 kg) and post-PHV (n = 31, age = 14.4 ± 0.9 years, height = 170.0 ± 4.9 cm, body mass = 61.5 ± 8.9 kg). Subjects performed a 505 test to measure the completion time in both directions and a 20-m maximum sprint test. Change of direction deficit (CODD) was used as a measure for isolating COD ability. An independent sample t-test detected no significant differences between the asymmetry index values for the 505 test completion time when the pre-PHV group and the post-PHV group were compared (-3.49 ± 2.49% vs. -3.45 ± 2.47%, effect size [ES] = 0.02, p = 0.923). Similarly, the CODD asymmetry index indicated no differences between the 2 groups (-8.21 ± 5.95% vs. -7.37 ± 5.12%, ES = 0.15, p = 0.457). A paired sample t-test revealed that the values of the CODD asymmetry index were larger than those of the 505 asymmetry index (-7.88 ± 5.61% vs. -3.49 ± 2.46%, ES = 1.09, p < 0.001). According to these results, maturational status has no influence on the interlimb asymmetries of COD ability. Furthermore, subjects showed greater asymmetry values in CODD compared with the 505 test completion time, reinforcing that the evaluation of COD asymmetries should be based on CODD. As interlimb asymmetries are not altered during the maturation process, practitioners should address abnormal COD asymmetries early on during athletes' development processes.

Differential Repeated Sprinting Training in Youth Basketball Players: An Analysis of Effects According to Maturity Status

The differential learning approach, which includes fluctuations that occur without movement repetitions and without corrections has received growing interest in the skill acquisition field. This study aimed to determine the effects of a 9-week training intervention involving differential repeated sprint training on a series of physical tests in youth basketball players. A total of 29 participants with different maturity statuses (pre-peak height velocity (PHV), n = 7; mid-PHV, n = 6; post-PHV, n = 16) completed 2 sessions per week of differential repeated sprint training for a period of 9 weeks. Sessions consisted of 2 × 10 repetitions sprints of 20-m whereby participants were instructed to perform various additional fluctuations for each repetition. Before and after the training intervention, participants completed jumping tests (countermovement jump (CMJ), single-leg CMJs, the modified 505 agility test, and straight sprinting tests (0-10 splits time), and maturity status was evaluated as well. Within-group analysis showed improvement in CMJ asymmetries and changes in direction asymmetries and 10-m sprint performance for the pre-, mid-, and post-PHV groups, respectively (p < 0.05), with large to very large effects. Analysis of covariance demonstrated that changes in sprint time in post-PHV players were greater than in the pre- and mid-PHV groups (p < 0.05), with moderate effect. Adding random fluctuations during repeated sprint training appear to be a suitable and feasible training strategy for maintaining and enhancing physical performance in youth basketball players, irrespective of maturity status. Furthermore, the present findings encourage practitioners to implement the present approach in youth athletes to improve their physical performance, but they should be aware that training response can vary according to maturity status.

Effects of 8 Weeks of Isoinertial vs. Cable-Resistance Training on Motor Skills Performance and Interlimb Asymmetries

ABSTRACT

Madruga-Parera, M, Bishop, C, Fort-Vanmeerhaeghe, A, Beato, M, Gonzalo-Skok, O, and Romero-Rodríguez, D. Effects of 8-weeks of Isoinertial vs. Cable-resistance Training on Motor Skills Performance and Interlimb Asymmetries. J Strength Cond Res 36(5): 1200-1208, 2022-The aim of this study was to compare the effects of 8 weeks of isoinertial vs. cable-resistance training on motor skills performance and interlimb asymmetries in handball players. Thirty-four young male handball players (mean ± SD: age: 15.96 ± 1.39 years; height: 1.74 ± 0.73 m; body mass: 70.5 ± 13.3 kg) participated in a randomized trial. The players performed an isoinertial program using a portable flywheel device or a cable-resistance device. Performance variations and interlimb asymmetries in dominant (D) and nondominant (ND) limb means of the unilateral countermovement jump (UCMJ), the unilateral lateral jump (ULJ), the unilateral broad jump (UBJ), handball throwing (HT), change of direction speed (COD180), the linear sprint (S20), the V-CUT test, and the repeated change of direction (RCOD) were recorded. Significant interactions were shown in RCODD (p = 0.003, ηp = 0.25), HT (p = 0.015, ηp = 0.17) and UCMJASY (p = 0.037, ηp = 0.13). Post-hoc testing revealed higher effect sizes in the isoinertial group (p < 0.05) for the performance improvements in RCODD (-1.35 large vs. -0.22, small) and HT (0.88, moderate vs. 0.00, trivial), in addition to interlimb asymmetry reductions in UCMJASY (-0.70 moderate vs. -0.32, small). Significant main effects of time in COD180, RCOD, UCMJ, and UBJ for both limbs (p < 0.05, from moderate to large effect size), and in ULJND (p < 0.001, large), UCMJASY (p < 0.001, moderate), V-CUT (p = 0.014, small), and HT (p = 0.015, large) were found. The effect sizes revealed greater magnitudes in the isoinertial group. In conclusion, although both resistance training programs improve players' to physical performance and reduce interlimb asymmetries, greater improvements were recorded with the isoinertial resistance training than with the cable-resistance methodology.

Inter-Limb Muscle Property Differences in Junior Tennis Players

The goal of this study was to investigate side-to-side differences and asymmetries regarding muscle characteristics in young tennis players. Thirty-four participants performed contractile property measurements (stiffness, tone, elasticity and time to relaxation) on the dominant and non-dominant extremities including nine muscle groups involved in the kinetic chain of main tennis strokes. Significant differences (p≤0.05) and small-to-moderate effect sizes for greater stiffness and tone were found for the dominant biceps femoris (-11.1% and -5.6%; ES=0.53 and 0.54) and the non-dominant vastus medialis (5.4% and 3.2%; ES=-0.33 and -0.41), while greater tone was present in the non-dominant pectoralis major (4.0%; ES=-0.56). Time to relaxation was increased in the dominant biceps femoris (10.3%; ES=-0.58), the non-dominant pectoralis major (5.1%; ES=-0.56) and the gastrocnemius (9.1%; ES=-0.5). The non-dominant infraspinatus and dominant rectus abdominis showed greater elasticity than contralateral muscles (9.9% and -8.0%; ES=-0.58 and 0.6, respectively). These results reflect the existence of small-to-moderate differences when comparing side-to-side values of contractile characteristics in a small amount of the muscle groups tested. However, passive measurements of a relaxed muscle do not seem to fully reflect possible adaptation and changes derived from gameplay in young tennis players.

Effects of Direction-Specific Training Interventions on Physical Performance and Inter-Limb Asymmetries

This study analyzed the effects of two different training programs on functional performance and inter-limb asymmetries in basketball players. Twenty-four elite youth basketball players were randomly assigned to a training program including variable unilateral horizontal movements (VUH, n = 12) or unilateral lateral movements (VUL, n = 12). Eccentric-overload training (EOT) was performed twice a week for a six-week period. Functional performance assessment included a countermovement jump test, unilateral multidirectional jumping tests (i.e., lateral, horizontal, and vertical), a rebound jump test, a limb symmetry index, a 25 m linear sprint test, and several change of direction (COD) tests. Within-group analysis showed substantial improvements in almost all functional tests in both groups (ES = 0.35–0.89). Furthermore, almost all jumping asymmetries were improved in both groups (ES = 0.38–0.69) except for vertical jumping asymmetry in VUL (ES = −0.04). Between-group analyses showed a substantial and possibly better performance in vertical jumping asymmetry and 5 m in VUH compared to that of VUL, respectively. In contrast, lateral jumping with left (ES = 1.22) and right leg (ES = 0.49) were substantially greater in VUL than in VUH. Specific force-vector training programs induced substantial improvements in both functional performance tests and inter-limb asymmetries, although greater improvements of lateral and horizontal variables may depend on the specific force vector targeted.

The Calculation, Thresholds and Reporting of Inter-Limb Strength Asymmetry: A Systematic Review

The prevalence of inter-limb strength differences is well documented in the literature however, there are inconsistencies related to measurement and reporting, and the normative values and effects associated with inter-limb asymmetry. Therefore, the aims of this systematic review were to: 1) assess the appropriateness of existing indices for the calculation of asymmetry, 2) interrogate the evidence basis for literature reported thresholds used to define asymmetry and 3) summarise normative levels of inter-limb strength asymmetry and their effects on injury and performance. To conduct this systematic review, scientific databases (PubMed, Scopus, SPORTDiscus and Web of Science) were searched and a total of 3,594 articles were retrieved and assessed for eligibility and article quality. The robustness of each identified asymmetry index was assessed, and the evidence-basis of the identified asymmetry thresholds was appraised retrospectively using the references provided. Fifty-three articles were included in this review. Only four of the twelve identified indices were unaffected by the limitations associated with selecting a reference limb. Eighteen articles applied a threshold to original research to identify "abnormal" asymmetry, fifteen of which utilised a threshold between 10-15%, yet this threshold was not always supported by appropriate evidence. Asymmetry scores ranged between and within populations from approximate symmetry to asymmetries larger than 15%. When reporting the effects of strength asymmetries, increased injury risk and detriments to performance were often associated with larger asymmetry, however the evidence was inconsistent. Limitations of asymmetry indices should be recognised, particularly those that require selection of a reference limb. Failure to reference the origin of the evidence for an asymmetry threshold reinforces doubt over the use of arbitrary thresholds, such as 10-15%. Therefore, an individual approach to defining asymmetry may be necessary to refine robust calculation methods and to establish appropriate thresholds across various samples and methodologies that enable appropriate conclusions to be drawn.

No Relationship between Lean Mass and Functional Asymmetry in High-Level Female Tennis Players

The relationship between lean mass and functional asymmetry in terms of their magnitude and direction was examined in 22 high-level female tennis players (20.9 ± 3.6 years). Lean mass of both upper and lower extremities was examined using Dual X-ray Absorptiometry. Functional asymmetry was assessed using a battery of field tests (handgrip strength, seated shot-put throw, plate tapping, single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, and 505 change of direction (time and deficit)). Paired sample t-tests compared the dominant (overall highest/best (performance) value) against the non-dominant value (highest/best (performance) value of the opposing extremity). Linear regressions were used to explore the relationship between lean mass and functional asymmetry magnitudes. Kappa coefficients were used to examine the consistency in direction between the extremity displaying the highest lean mass value and the extremity performing dominantly across tests. Significant asymmetry magnitudes (p < 0.05) were found for all upper and lower extremity lean mass and functional values. No relationship was apparent between lean mass and functional asymmetry magnitudes (p-value range = 0.131–0.889). Despite finding perfect consistency in asymmetry direction (k-value = 1.00) for the upper extremity, poor to fair consistency (k-value range = −0.00–0.21) was found for the lower extremity. In conclusion, lean mass and functional asymmetries should be examined independently.

Intra- and Inter-Limb Strength Asymmetry in Soccer: A Comparison of Professional and Under-18 Players

(1) Background: the present study examined the isokinetic peak torque exerted by both knee extensors and flexors, anterior–posterior imbalance and the magnitude and direction of inter-limb asymmetry in professional and academy soccer players. (2) Methods: one hundred soccer players (professional = 50, elite academy = 50) volunteered to take part in this investigation. An isokinetic dynamometer was used to measure the knee extensor (quadriceps) and flexors muscle (hamstrings) torques of the limbs as well as inter-limb asymmetries—using a standard percentage difference equation. (3) Results: professional players exhibited significantly greater (effect size [ES] = large) strength levels in the quadriceps and hamstrings under both testing conditions, significantly higher (small to moderate) intra-limb ratio values for 60°·s⁻¹ but not for the 300°·s⁻¹ test condition, significantly (small to moderate) lower inter-limb asymmetry values for all test conditions, with the exception of the hamstrings at 60°·s⁻¹ and the direction of asymmetry was poor to slight, indicating that limb dominance was rarely the same between groups. (4) Conclusions: this study shows that isokinetic assessments, i.e., peak torque exerted by both knee extensors and flexors and intra-limb ratio, and the subsequent inter-limb asymmetry, i.e., magnitude and direction, can differentiate between professional and academy soccer players.

Assessing the Magnitude and Direction of Asymmetry in Unilateral Jump and Change of Direction Speed Tasks in Youth Female Team-Sport Athletes

The direction of inter-limb asymmetries and the change of direction (COD) deficit are two aspects that have increased in recent years. The main objective of the present study was to assess the magnitude of neuromuscular asymmetries in an elite youth female team-sports sample and determine its directionality. Secondary objectives were to evaluate the relationship between COD deficit, linear speed and COD time performance. Elite female youth basketball and handball players (n = 33, age = 16 ± 1.17 y) performed the Single Leg Countermovement Jump in vertical (SLCJ-V), horizontal (SLCJ-H), and lateral (SLCJ-L) directions, the COD and the 10-m sprint. Results showed statistical differences between limbs in all the neuromuscular tests (p < 0.001). The Kappa coefficient showed poor to fair levels of agreement between tasks (K range = -0.087 to 0.233), indicating that asymmetries rarely favoured the same limb between skills. Additionally, small and non-significant correlations were found between the linear sprint capacity and the COD ability. The findings of the present study highlight the independent directionality of asymmetries across tests. The COD deficit does not appear to be much more advantageous than COD total time to measure asymmetry. Practitioners are encouraged to use a fitness testing battery to detect existing side differences and each ability should be specifically trained with functional tasks.

Postural orientation, what to expect in youth athletes? A cohort study on data from the Malmö Youth Sport Study

BACKGROUND

Studies investigating postural orientation in uninjured youth athletes are scarce. Understanding how postural orientation during functional performance tests change with age in uninjured athletes has the potential to enhance awareness of changes in performance after injury and to set realistic goals for injured athletes. Thus, the aim of this study was to explore postural orientation during functional tasks at early adolescence, and changes in postural orientation from early to middle adolescence and relate this to sex, type of sport and right leg lean body mass (RLLBM).

METHODS

In this cohort study 144 (38% female) youth athletes (mean age 13.5 years, SD 0.3) were included at baseline and 86 of these at follow up 2 years later. Four functional performance tests were visually evaluated for Postural Orientation Errors (POEs) with an ordinal scale, ranging from 0 (good) to 2 (poor), yielding a maximum total POE score of 51, and RLLBM by dual energy X-ray absorptiometry.

RESULTS

Improvements were observed in the total POE score from baseline to follow-up, median difference - 10 and - 7 (p < 0.001) for female and male athletes, respectively. At follow-up, female athletes had lower total POE score (median 18) than males (median 24) (p = 0.01). There were no differences in POE scores between sports type (team, individual, aesthetic) (p = 0.20-0.98) and no relationship between total POE score and RLLBM (r_s = 0.09, p = 0.42).

CONCLUSIONS

POEs appear to be quite common in young athletic population, but improvements are achieved over time. At mid-adolescence, female athletes seem to have less POEs than males. Neither sport type nor RLLBM seem to influence postural orientation.

Assessing Inter-Limb Asymmetries in Soccer Players: Magnitude, Direction and Association with Performance

In this study, we aimed to analyze the magnitude and direction of inter-limb asymmetries in ankle dorsiflexion range of motion (ROM), power (using iso-inertial devices), and a neuromuscular skill (change of direction). Secondarily, we aimed to determine the relationship between inter-limb asymmetry scores for each test and also between these scores and the scores for the different performance tests. Sixteen semiprofessional male soccer players (age: 25.38 ± 6.08 years; body height: 1.78 ± 0.64 m; body mass: 79.5 ± 14.9 kg) participated in this study. We calculated inter-limb asymmetries using five tests: ankle dorsiflexion ROM, change of direction (COD 180º), and iso-inertial resistance tasks in the open (leg extension strength (LE), leg curl strength (LC)) and closed (crossover step (CRO)) kinetic chain. Our results showed that asymmetry magnitudes differed between all tests with highest inter-limb asymmetries displayed during iso-inertial overloading. In addition, we observed that the direction of asymmetries varied depending on the test-specificity, and that the CRO asymmetries had a negative association with LE and CRO performance. These findings highlight the independent nature of asymmetries and that CRO could be an appropriate test to detect asymmetries related with the performance of soccer-specific actions (such as changes of direction). Practitioners are encouraged to use multiple tests to detect existing inter-limb differences according to the specific characteristics of each sport.

Bone Microarchitecture and Strength Adaptation to Physical Activity: A Within-Subject Controlled HRpQCT Study

PURPOSE

Physical activity benefits bone mass and cortical bone size. The current study assessed the impact of chronic (≥10 yr) physical activity on trabecular microarchitectural properties and microfinite element analyses of estimated bone strength.

METHODS

Female collegiate-level tennis players (n = 15; age = 20.3 ± 0.9 yr) were used as a within-subject controlled model of chronic unilateral upper-extremity physical activity. Racquet-to-nonracquet arm differences at the distal radius and radial diaphysis were assessed using high-resolution peripheral quantitative computed tomography. The distal tibia and the tibial diaphysis in both legs were also assessed, and cross-country runners (n = 15; age = 20.8 ± 1.2 yr) included as controls.

RESULTS

The distal radius of the racquet arm had 11.8% (95% confidence interval [CI] = 7.9% to 15.7%) greater trabecular bone volume/tissue volume, with trabeculae that were greater in number, thickness, connectivity, and proximity to each other than that in the nonracquet arm (all P < 0.01). Combined with enhanced cortical bone properties, the microarchitectural advantages at the distal radius contributed a 18.7% (95% CI = 13.0% to 24.4%) racquet-to-nonracquet arm difference in predicted load before failure. At the radial diaphysis, predicted load to failure was 9.6% (95% CI = 6.7% to 12.6%) greater in the racquet versus nonracquet arm. There were fewer and smaller side-to-side differences at the distal tibia; however, the tibial diaphysis in the leg opposite the racquet arm was larger with a thicker cortex and had 4.4% (95% CI = 1.7% to 7.1%) greater strength than the contralateral leg.

CONCLUSION

Chronically elevated physical activity enhances trabecular microarchitecture and microfinite element estimated strength, furthering observations from short-term longitudinal studies. The data also demonstrate that tennis players exhibit crossed symmetry wherein the leg opposite the racquet arm possesses enhanced tibial properties compared with in the contralateral leg.

International vs. National female tennis players: a comparison of upper and lower extremity functional asymmetries

BACKGROUND

Asymmetries have been reported to negatively impact sport performance. This study examined the magnitude and direction of whole-body functional asymmetry in international versus national female tennis players.

METHODS

Ten internationally and twelve nationally ranked tennis players participated. Upper extremity functional asymmetries (or side-to-side performance differences) were evaluated using handgrip strength, seated shot-put throw and plate tapping. Lower extremity functional asymmetries were determined using the single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, 505 changes of direction (time and deficit), and Y-balance test (anterior, posteromedial, posterolateral). ANOVAs were used to compare the dominant (overall best or fastest result of a specific test) versus non-dominant performance values (best or fastest result of the corresponding extremity) within the internationally versus nationally ranked players. Functional asymmetry magnitudes differences (expressed as a %) were examined using Mann-Whitney U tests. Kappa coefficients examined the consistency as to which extremity performed dominantly across tests.

RESULTS

Significant asymmetries for every upper and lower extremity test were found. The functional asymmetry magnitude was significantly (p=0.020) higher on the single leg forward hop test for the nationally (6.3%) versus internationally ranked players (2.9%). Kappa coefficients showed perfect levels of consistency regarding all upper extremity tests (k=1.00), indicating true limb dominance whereas more variance was found as to which lower extremity performed dominantly across tests (k range=-0.067-0.174).

CONCLUSIONS

The included female tennis players displayed significant whole-body functional asymmetries. Poor consistency as to which lower extremity performed dominantly across tests warrants individual asymmetry monitoring.

Healthy Pediatric Athletes Have Significant Baseline Limb Asymmetries on Common Return-to-Sport Physical Performance Tests

Background:

Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a much higher risk (∼30%) of subsequent ACL injury than in adults. Most RTS testing protocols use a limb symmetry index (LSI) ≥90% on physical performance tests (PPTs) to assess an athlete’s readiness for sport. This assumes that, in a healthy state, the physical performances across both lower extremities are and should be equal.

Purpose:

To determine the prevalence of limb asymmetries >10% in the uninjured pediatric population on common PPTs as well as to explore the relationship between athlete variables, limb preference, and LSI values.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

This study included healthy volunteers (N = 100) evenly distributed between the ages of 6 and 18 years (mean age, 11.7 ± 3.6 years; 52% female). Participants performed 9 common PPTs. For analysis, we developed a composite score for each limb by averaging trials. We then calculated the LSI for each test. Univariable and multivariable linear regression analyses were performed to assess the relationship between athlete variables (age, sex, height, and weight) and LSI for each PPT.

Results:

Instances of poor baseline limb symmetry (<90% LSI) were common across all PPTs. The single-leg timed hop had the highest percentage of participants, with LSI ≥90% at 73%, while the stork on a Bosu ball had the lowest percentage at 23%. After adjusting for age, female sex showed a significant association with LSI for the stork test (P = .010) and the quadrant hop–counterclockwise (P = .021). Additionally, after adjusting for sex, increasing age showed a significant association with LSI for the stork test (P < .001), single-leg squat on a Bosu ball (P = .010), quadrant hop–clockwise (P = .016), and quadrant hop–counterclockwise (P = .009).

Conclusion:

The majority of healthy athletes 18 years and younger demonstrated significant (<90%) limb asymmetries. Limb symmetry was not consistently affected by participant age or sex, and the effect sizes of these relationships were small. These findings should encourage clinicians and coaches to exercise caution in using the LSI as an isolated measure of RTS readiness after injury in pediatric athletes.

Change-of-Direction Deficit vs. Deceleration Deficit: A Comparison of Limb Dominance and Inter-limb Asymmetry between Forwards and Backs in Elite Male Rugby Union Players

The aims of the present study were to: 1) determine whether limb dominance and inter-limb asymmetry were the same across both change of direction (COD) and deceleration (DEC) deficits and, 2) determine the association between the COD and DEC-deficits and other physical performance tests in elite male rugby union players. Twenty five players performed a series of bilateral jumps, linear and COD speed tests at the end of the pre-season period. COD and DEC-deficits were calculated for both left and right sides, and inter-limb asymmetry thereafter. Kappa coefficients revealed moderate levels of agreement in limb dominance between COD and DEC-deficits (Kappa = 0.41 on left; 0.48 on right). For the direction of asymmetry, perfect levels of agreement (Kappa = 1) were evident between 505 time and COD-deficit, but only moderate levels of agreement (Kappa = 0.41) between other asymmetry measures. Pearson's r correlations showed moderate to large relationships between jumps and linear (r = -0.42 to -0.68) and COD speed (r = -0.41 to -0.58), but not with the COD-deficit (r = 0.15 to -0.31), DEC-deficit (r = 0.01 to -0.32) or asymmetry (r = 0.16 to -0.29). When analysing by playing position, backs were significantly faster than forwards over 15-m (ES = -0.86) and across all jump tests (ES = 0.86-0.94), with the exception of the squat jump. This study is the first to provide a direct comparison of the COD and DEC-deficits and highlights that limb dominance and asymmetry cannot be guaranteed between tasks.

Strength, Jumping and Change of Direction Speed Asymmetries in Soccer, Basketball and Tennis Players

Despite growing research in the field of inter-limb asymmetries (ILAs), little is known about the variation of ILAs in different populations of athletes. The purpose of this study was to compare ILAs among young basketball, soccer and tennis players. ILAs were assessed in three different types of tests (strength, jumping and change of direction (CoD) speed), each including different tasks: (1) bilateral and unilateral counter movement jump, (2) isometric strength of knee extensors (KE) and knee flexors (KF), and (3) 90° and 180° CoD. Generally, the absolute metrics showed strong reliability and revealed significant differences (p < 0.05) among the three groups in KE maximal torque, KE and KF rate of force development and in both CoD tests. For jumping ILAs, power and force impulse metrics exhibited significant between-limb differences between groups, compared to jump height. For strength and CoD speed ILAs, only KF maximal torque and 180° CoD exhibited significant differences between groups. Greater KF strength ILAs in soccer players and counter-movement jump ILAs in tennis players are most probably the result of sport-specific movement patterns and training routines. Sport practitioners should be aware of the differences in ILAs among sports and address training programs accordingly.

Injury risk and injury incidence rates in CrossFit

INTRODUCTION

Despite completing complex movements under cardiovascular and muscular fatigued conditions, CrossFit suggested safety of participants is one of the most important factors to consider. Therefore, the aim of this brief review was to provide an overview of the injury incidence and incidence rates reported in the current literature as well as to assess the injury risks associated with CrossFit.

EVIDENCE ACQUISITION

Research papers were searched using the following databases: Scopus, SPORTDiscus, Web of Science, PubMed, and MEDLINE. The search identified 718 potential articles across all databases. After the application of inclusion criteria, a total of 14 articles were included in this review.

EVIDENCE SYNTHESIS

The shoulder, spine, and knee are the most commonly injured areas in CrossFit. Injury incidence of each study ranges from 12.8-73.5% and reported injury rates ranging from 0.27-3.3/1000 training hours.

CONCLUSIONS

Reported findings in the current literature would suggest CrossFit has a relatively low injury risk. The current review highlights three important factors associated with injury incidence and incidence rates in CrossFit: 1) training frequency; 2) duration of CrossFit experience; 3) individuals that compete in CrossFit competitions. Due to recall bias and selection bias further research is warranted over a longitudinal prospective study. Additionally, further research is needed to investigate mechanisms of injury and the relationship between training load and injury risk in CrossFit.

Vastus lateralis and medialis muscular activation during frontal and sagittal single-leg jumps in sportswomen

Introducción.

Las diferencias en la activación muscular de las porciones lateral y medial del cuádriceps durante la ejecución del salto, pueden convertirse en un factor de riesgo neuromuscular al aumentar el valgo dinámico de rodilla y, en consecuencia, el riesgo de lesión del ligamento cruzado anterior de la rodilla.

Objetivo.

Determinar la diferencia en la activación de los vastos lateral y medial del cuádriceps mediante electromiografía de superficie durante el salto con una sola pierna en los planos sagital y frontal en mujeres deportistas.

Materiales y métodos.

Se hizo un estudio cuantitativo de corte transversal con la participación de 64 mujeres deportistas a quienes se les tomaron las medidas antropométricas. Se hicieron pruebas de salto vertical y lateral con una sola pierna evaluados mediante la activación electromiográfica de los vastos medial y lateral, y la valoración de la flexibilidad de la banda iliotibial.

Resultados.

Se encontró una relación estadísticamente significativa (p≤0,05) entre el índice de masa corporal, el porcentaje de grasa y la potencia en los saltos verticales con una sola pierna. Se encontró, asimismo, significación estadística (p≤0,05) por una mayor activación del vasto lateral en el salto vertical con la pierna derecha y en el salto lateral con las dos piernas.

Conclusión.

Las deportistas presentaron diferencias en la activación de los cuádriceps, siendo mayor la activación del vasto lateral en la mayoría de los saltos con una sola pierna tanto en el plano sagital como en el frontal, lo cual puede contribuir a un aumento del riesgo de lesión de rodilla en la práctica deportiva.

Jumping-based Asymmetries are Negatively Associated with Jump, Change of Direction, and Repeated Sprint Performance, but not Linear Speed, in Adolescent Handball Athletes

The aim of the present study was to determine the association of multi-directional jumping asymmetries with measures of physical performance. Forty-two youth handball athletes (age: 16.0 ± 1.3 years; body height: 174.11 ± 7.3 cm; body mass: 70.49 ± 13.3 kg) performed a mid-season fitness test battery consisting of single leg countermovement, lateral and broad jump tests, two change of direction speed (CODS) tests, an 8 x 10 m repeated sprint test, and a 20 m sprint. The Kappa coefficient showed only 'slight' levels of agreement (K range = -0.05 to 0.15), indicating that asymmetries rarely favoured the same side during each of the jump tests. The single leg countermovement jump showed significantly (p = 0.006) larger asymmetries (11.2 ± 8.4) than the broad jump (6.4 ± 4.6) and significant correlations were present between jumping asymmetries and jump (r = -0.32 to -0.52), CODS (r = 0.31 to 0.32) and repeated sprint (r = 0.35 to 0.40) performance. The findings of the present study highlight the independent nature of jumping asymmetries and associations with measures of physical performance. Practitioners are encouraged to use multiple tests to detect existing side differences and consider appropriate training interventions for the reduction of inter-limb asymmetries.

Eccentric Resistance Training in Youth: Perspectives for Long-Term Athletic Development

The purpose of this narrative review is to discuss the role of eccentric resistance training in youth and how this training modality can be utilized within long-term physical development. Current literature on responses to eccentric exercise in youth has demonstrated that potential concerns, such as fatigue and muscle damage, compared to adults are not supported. Considering the importance of resistance training for youth athletes and the benefits of eccentric training in enhancing strength, power, speed, and resistance to injury, its inclusion throughout youth may be warranted. In this review we provide a brief overview of the physiological responses to exercise in youth with specific reference to the different responses to eccentric resistance training between children, adolescents, and adults. Thereafter, we discuss the importance of ensuring that force absorption qualities are trained throughout youth and how these may be influenced by growth and maturation. In particular, we propose practical methods on how eccentric resistance training methods can be implemented in youth via the inclusion of efficient landing mechanics, eccentric hamstrings strengthening and flywheel inertia training. This article proposes that the use of eccentric resistance training in youth should be considered a necessity to help develop both physical qualities that underpin sporting performance, as well as reducing injury risk. However, as with any other training modality implemented within youth, careful consideration should be given in accordance with an individual's maturity status, training history and technical competency as well as being underpinned by current long-term physical development guidelines.

The validity and reliability of a novel app for the measurement of change of direction performance

The aim of the present investigation was to analyze the validity and reliability of a novel iPhone app (CODTimer) for the measurement of total time and interlimb asymmetry in the 5 + 5 change of direction test (COD). To do so, twenty physically active adolescent athletes (age = 13.85 ± 1.34 years) performed six repetitions in the COD test while being measured with a pair of timing gates and CODTimer. A total of 120 COD times measured both with the timing gates and the app were then compared for validity and reliability purposes. There was an almost perfect correlation between the timing gates and the CODTimer app for the measurement of total time (r = 0.964; 95% Confidence interval (CI) = 0.95-1.00; Standard error of the estimate = 0.03 s.; p < 0.001). Moreover, non-significant, trivial differences were observed between devices for the measurement of total time and interlimb asymmetry (Effect size < 0.2, p > 0.05). Similar levels of reliability were observed between the timing gates and the app for the measurement of the 6 different trials of each participant (Timing gates: Intraclass correlation coefficient (ICC) = 0.651-0.747, Coefficient of variation (CV) = 2.6-3.5%; CODTimer: ICC = 0.671-0.840, CV = 2.2-3.2%). The results of the present study show that change of direction performance can be measured in a valid, reliable way using a novel iPhone app.