Does Chronic Ankle Instability Influence Knee Biomechanics of Females during Inverted Surface Landings?

2018 ◽  
Vol 39 (13) ◽  
pp. 1009-1017 ◽  
Author(s):  
Yumeng Li ◽  
Jupil Ko ◽  
Marika Walker ◽  
Cathleen Brown ◽  
Julianne Schmidt ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Knee Extension ◽  
Chronic Ankle Instability ◽  
Initial Contact ◽  
Knee Biomechanics ◽  
Peak Knee ◽  
Eccentric Work

AbstractThe primary purpose of the study was to determine whether atypical knee biomechanics are exhibited during landing on an inverted surface. A seven-camera motion analysis system and two force plates were used to collect lower extremity biomechanics from two groups of female participants: 21 subjects with chronic ankle instability (CAI) and 21 with pair-matched controls. Subjects performed ten landings onto inverted and flat platforms on the CAI/matched and non-test limbs, respectively. Knee and ankle joint angles, joint angular displacements, joint moments and eccentric work were calculated during the landing phase and/or at the initial contact. Paired t-tests were used to compare between-group differences (p<0.05). We observed that CAI group displayed a significantly increased knee flexion angle, knee flexion displacement, peak knee extension moment and internal rotation moment, and eccentric work in the sagittal plane, possibly due to altered ankle biomechanics. Participants with CAI employed some compensatory strategy to improve their ankle and postural stability during landing onto the tilted surface. The increased knee extension and internal rotation moments of CAI participants could potentially result in a greater ACL loading. In future studies, it may be worthwhile to measure or estimate the ACL loading to confirm whether CAI could relate to the mechanism of ACL injury.

Knee Flexion Angle at Initial Contact During Jump Landing in Individuals With and Without Chronic Ankle Instability: A Critically-Appraised Topic

2019 ◽  
Vol 24 (4) ◽  
pp. 151-155
Author(s):  
Jacob T. Hartzell ◽  
Kyle B. Kosik ◽  
Matthew C. Hoch ◽  
Phillip A. Gribble
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Knee Kinematics ◽  
Chronic Ankle Instability ◽  
Flexion Angle ◽  
Initial Contact ◽  
Knee Flexion Angle ◽  
Bottom Line ◽  
Jump Landing

Clinical Scenario: Chronic ankle instability (CAI) is characterized by the residual symptoms and feelings of instability that persist after an acute ankle sprain. Current literature has identified several neuromuscular impairments associated with CAI that may negatively impact sagittal plane knee kinematics during dynamic activities. This has led researchers to begin examining sagittal plane knee kinematics during jump landing tasks. Understanding changes in movement patterns at the knee may assist clinicians in designing rehabilitation plans that target both the ankle and more proximal joints, such as the knee. Clinical Question: What is the evidence to support the notion that patients with CAI have decreased sagittal plane knee flexion angle at initial contact during a jump-landing task compared to healthy individuals? Summary of Key Findings: The literature was systematically searched for level 4 evidence or higher. The search yielded two case-control studies which met the inclusion criteria. Based on limited evidence, there are mixed results for whether sagittal plane knee kinematic at initial contact differ between those with and without CAI. Clinical Bottom Line: There is weak evidence to support changes in sagittal plane knee kinematics at initial contact during a jump landing in individuals with CAI compared to healthy controls. Strength of Recommendation: In accordance with the Centre for Evidence-Based Medicine, a grade of C for level 4 evidence is recommended due to variable findings.

Effects of Prophylactic Knee Bracing on Lower Limb Kinematics, Kinetics, and Energetics During Double-Leg Drop Landing at 2 Heights

2016 ◽  
Vol 44 (7) ◽  
pp. 1753-1761 ◽  
Author(s):  
Katie A. Ewing ◽  
Rezaul K. Begg ◽  
Mary P. Galea ◽  
Peter V.S. Lee
Keyword(s):  
Knee Flexion ◽  
Knee Extension ◽  
Flexion Angle ◽  
Initial Contact ◽  
Knee Brace ◽  
Acl Injuries ◽  
Negative Power ◽  
Peak Knee ◽  
Knee Braces ◽  
Biomechanical Factors

Background: Anterior cruciate ligament (ACL) injuries commonly occur during landing maneuvers. Prophylactic knee braces were introduced to reduce the risk of ACL injuries, but their effectiveness is debated. Hypotheses: We hypothesized that bracing would improve biomechanical factors previously related to the risk of ACL injuries, such as increased hip and knee flexion angles at initial contact and at peak vertical ground-reaction force (GRF), increased ankle plantar flexion angles at initial contact, decreased peak GRFs, and decreased peak knee extension moment. We also hypothesized that bracing would increase the negative power and work of the hip joint and would decrease the negative power and work of the knee and ankle joints. Study Design: Controlled laboratory study. Methods: Three-dimensional motion and force plate data were collected from 8 female and 7 male recreational athletes performing double-leg drop landings from 0.30 m and 0.60 m with and without a prophylactic knee brace. GRFs, joint angles, moments, power, and work were calculated for each athlete with and without a knee brace. Results: Prophylactic knee bracing increased the hip flexion angle at peak GRF by 5.56° ( P < .001), knee flexion angle at peak GRF by 4.75° ( P = .001), and peak hip extension moment by 0.44 N·m/kg ( P < .001). Bracing also increased the peak hip negative power by 4.89 W/kg ( P = .002) and hip negative work by 0.14 J/kg ( P = .001) but did not result in significant differences in the energetics of the knee and ankle. No differences in peak GRFs and peak knee extension moment were observed with bracing. Conclusion: The application of a prophylactic knee brace resulted in improvements in important biomechanical factors associated with the risk of ACL injuries. Clinical Relevance: Prophylactic knee braces may help reduce the risk of noncontact knee injuries in recreational and professional athletes while playing sports. Further studies should investigate different types of prophylactic knee braces in conjunction with existing training interventions so that the sports medicine community can better assess the effectiveness of prophylactic knee bracing.

scholarly journals Quadriceps Neuromuscular Function and Jump-Landing Sagittal-Plane Knee Biomechanics After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 53 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Sarah H. Ward ◽  
J. Troy Blackburn ◽  
Darin A. Padua ◽  
Laura E. Stanley ◽  
Matthew S. Harkey ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Neuromuscular Function ◽  
Knee Extension ◽  
Spinal Reflex ◽  
Flexion Angle ◽  
Voluntary Activation ◽  
Knee Flexion Angle ◽  
Jump Landing ◽  
Peak Knee

Context:  Aberrant biomechanics may affect force attenuation at the knee during dynamic activities, potentially increasing the risk of sustaining a knee injury or hastening the development of osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps neuromuscular function has been hypothesized to influence the development of aberrant biomechanics. Objective:  To determine the association between quadriceps neuromuscular function (strength, voluntary activation, and spinal-reflex and corticomotor excitability) and sagittal-plane knee biomechanics during jump landings in individuals with ACLR. Design:  Cross-sectional study. Setting:  Research laboratory. Patients or Other Participants:  Twenty-eight individuals with unilateral ACLR (7 men, 21 women; age = 22.4 ± 3.7 years, height = 1.69 ± 0.10 m, mass = 69.4 ± 10.1 kg, time postsurgery = 52 ± 42 months). Main Outcome Measure(s):  We quantified quadriceps spinal-reflex excitability via the Hoffmann reflex normalized to maximal muscle response (H : M ratio), corticomotor excitability via active motor threshold, strength as knee-extension maximal voluntary isometric contraction (MVIC), and voluntary activation using the central activation ratio (CAR). In a separate session, sagittal-plane kinetics (peak vertical ground reaction force [vGRF] and peak internal knee-extension moment) and kinematics (knee-flexion angle at initial contact, peak knee-flexion angle, and knee-flexion excursion) were collected during the loading phase of a jump-landing task. Separate bivariate associations were performed between the neuromuscular and biomechanical variables. Results:  In the ACLR limb, greater MVIC was associated with greater peak knee-flexion angle (r = 0.38, P = .045) and less peak vGRF (r = −0.41, P = .03). Greater CAR was associated with greater peak internal knee-extension moment (ρ = −0.38, P = .045), and greater H : M ratios were associated with greater peak vGRF (r = 0.45, P = .02). Conclusions:  Greater quadriceps MVIC and CAR may provide better energy attenuation during a jump-landing task. Individuals with greater peak vGRF in the ACLR limb possibly require greater spinal-reflex excitability to attenuate greater loading during dynamic movements.

scholarly journals Mulligan Knee Taping Using Both Elastic and Rigid Tape Reduces Pain and Alters Lower Limb Biomechanics in Female Patients With Patellofemoral Pain

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712092167
Author(s):  
Grant J.K. Mackay ◽  
Sarah M. Stearne ◽  
Catherine Y. Wild ◽  
Erin P. Nugent ◽  
Alexander P. Murdock ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Lower Limb ◽  
Repeated Measures ◽  
Knee Flexion ◽  
Rating Scales ◽  
Patellofemoral Pain ◽  
Initial Contact ◽  
Female Patients ◽  
Tibiofemoral Rotation ◽  
Peak Knee

Background: Evidence supports the use of Mulligan knee taping in managing patellofemoral pain (PFP). However, no studies have compared the efficacy of rigid and elastic tape using this technique. Hypothesis: Mulligan knee taping applied with both rigid and elastic tape will produce similar reductions in knee pain, hip internal rotation, and knee flexion moments compared with no tape. Elastic tape will also be more comfortable than rigid tape. Study Design: Controlled laboratory study. Methods: A total of 19 female patients (mean age, 26.5 ± 4.5 years) with PFP performed a self-selected pain provocative task, single-leg squat (SLSq) task, and running task while wearing Mulligan knee taping applied with rigid tape, elastic tape at 100% tension, and no tape. Pain and taping comfort were recorded using 11-point numeric rating scales. An 18-camera motion capture system and in-ground force plates recorded 3-dimensional lower limb kinematics and kinetics for the SLSq and running tasks. Statistical analysis involved a series of repeated-measures analyses of variance. The Wilcoxon signed rank test was used for analyzing taping comfort. Results: Compared with no tape, both rigid and elastic tape significantly reduced pain during the pain provocative task (mean difference [MD], –0.97 [95% CI, –1.57 to –0.38] and –1.42 [95% CI, –2.20 to –0.64], respectively), SLSq (MD, –1.26 [95% CI, –2.23 to –0.30] and –1.13 [95% CI, –2.09 to –0.17], respectively), and running tasks (MD, –1.24 [95% CI, –2.11 to –0.37] and –1.16 [95% CI, –1.86 to –0.46], respectively). Elastic tape was significantly more comfortable than rigid tape generally ( P = .005) and during activity ( P = .022). Compared with no tape, both rigid and elastic tape produced increased knee internal rotation at initial contact during the running task (MD, 5.5° [95% CI, 3.6° to 7.4°] and 5.9° [95% CI, 3.9° to 7.9°], respectively) and at the commencement of knee flexion during the SLSq task (MD, 5.8° [95% CI, 4.5° to 7.0°] and 5.8° [95% CI, 4.1° to 7.4°], respectively), greater peak knee internal rotation during the running (MD, 1.8° [95% CI, 0.4° to 3.3°] and 2.2° [95% CI, 0.9° to 3.6°], respectively) and SLSq tasks (MD, 3.2° [95% CI, 2.1° to 4.3°] and 3.8° [95% CI, 2.3° to 5.2°], respectively), and decreased knee internal rotation range of motion during the running (MD, –3.6° [95% CI, –6.1° to –1.1°] and –3.7° [95% CI, –6.2° to –1.2°], respectively) and SLSq tasks (MD, –2.5° [95% CI, –3.9° to –1.2°] and –2.0° [95% CI, –3.2° to –0.9°], respectively). Conclusion: Mulligan knee taping with both rigid and elastic tape reduced pain across all 3 tasks and altered tibiofemoral rotation during the SLSq and running tasks. Clinical Relevance: Both taping methods reduced pain and altered lower limb biomechanics. Elastic tape may be chosen clinically for comfort reasons.

scholarly journals Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instability

2015 ◽  
Vol 50 (8) ◽  
pp. 833-839 ◽  
Author(s):  
Matthew C. Hoch ◽  
Kelley E. Farwell ◽  
Stacey L. Gaven ◽  
Joshua T. Weinhandl
Keyword(s):  
Range Of Motion ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Chronic Ankle Instability ◽  
Coefficient Of Determination ◽  
Initial Contact ◽  
Landing Biomechanics ◽  
Maximum Angle ◽  
The Relationship

Context  People with chronic ankle instability (CAI) exhibit less weight-bearing dorsiflexion range of motion (ROM) and less knee flexion during landing than people with stable ankles. Examining the relationship between dorsiflexion ROM and landing biomechanics may identify a modifiable factor associated with altered kinematics and kinetics during landing tasks. Objective  To examine the relationship between weight-bearing dorsiflexion ROM and single-legged landing biomechanics in persons with CAI. Design  Cross-sectional study. Setting  Laboratory. Patients or Other Participants  Fifteen physically active persons with CAI (5 men, 10 women; age = 21.9 ± 2.1 years, height = 168.7 ± 9.0 cm, mass = 69.4 ± 13.3 kg) participated. Intervention(s)  Participants performed dorsiflexion ROM and single-legged landings from a 40-cm height. Sagittal-plane kinematics of the lower extremity and ground reaction forces (GRFs) were captured during landing. Main Outcome Measure(s)  Static dorsiflexion was measured using the weight-bearing–lunge test. Kinematics of the ankle, knee, and hip were observed at initial contact, maximum angle, and sagittal displacement. Sagittal displacements of the ankle, knee, and hip were summed to examine overall sagittal displacement. Kinetic variables were maximum posterior and vertical GRFs normalized to body weight. We used Pearson product moment correlations to evaluate the relationships between dorsiflexion ROM and landing biomechanics. Correlations (r) were interpreted as weak (0.00–0.40), moderate (0.41–0.69), or strong (0.70–1.00). The coefficient of determination (r2) was used to determine the amount of explained variance among variables. Results  Static dorsiflexion ROM was moderately correlated with maximum dorsiflexion (r = 0.49, r2 = 0.24), ankle displacement (r = 0.47, r2 = 0.22), and total displacement (r = 0.67, r2 = 0.45) during landing. Dorsiflexion ROM measured statically and during landing demonstrated moderate to strong correlations with maximum knee (r = 0.69–0.74, r2 = 0.47–0.55) and hip (r = 0.50–0.64, r2 = 0.25–0.40) flexion, hip (r = 0.53–0.55, r2 = 0.28–0.30) and knee (r = 0.53–0.70, r2 = 0.28–0.49) displacement, and vertical GRF (−0.47– −0.50, r2 = 0.22–0.25). Conclusions  Dorsiflexion ROM was moderately to strongly related to sagittal-plane kinematics and maximum vertical GRF during single-legged landing in persons with CAI. Persons with less dorsiflexion ROM demonstrated a more erect landing posture and greater GRF.

scholarly journals Alterations in Knee Kinematics and Dynamic Stability Associated With Chronic Ankle Instability

2009 ◽  
Vol 44 (4) ◽  
pp. 350-355 ◽  
Author(s):  
Phillip A. Gribble ◽  
Richard H. Robinson
Keyword(s):  
Dynamic Stability ◽  
Repeated Measures ◽  
Knee Flexion ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Reaction Force ◽  
Rest Period ◽  
Chronic Ankle Instability ◽  
Therapeutic Interventions ◽  
Initial Contact

Abstract Chronic ankle instability (CAI) has been previously and separately associated with deficits in dynamic stability and proximal joint neuromuscular alterations, but how the 2 factors relate is unclear.Context: To examine the contributions of lower extremity kinematics during an assessment of dynamic stability in participants with CAI.Objective: Repeated-measures case-control design.Design: Research laboratory.Setting: Thirty-eight volunteers were categorized into groups of those with unilateral CAI (10 men, 9 women; age  =  20.3 ± 2.9 years, height  =  1.77 ± 0.1 m, mass  =  76.19 ± 13.19 kg) and those without (10 men, 9 women; age  =  23.1 ± 3.9 years, height  =  1.72 ± 0.1 m, mass  =  72.67 ± 16.0 kg).Patients or Other Participants: Participants performed 10 jump landings on each limb with a rest period between test limbs.Intervention(s): Ankle plantar flexion, knee flexion, and hip flexion were captured with an electromagnetic tracking device at the point of ground impact. Ground reaction force data were used to calculate time to stabilization in the anteroposterior and mediolateral planes.Main Outcome Measure(s): For the anteroposterior plane, we found a group-by-side interaction (P  =  .003), with the injured side of the CAI group demonstrating reduced dynamic stability. For knee flexion, a group main effect (P  =  .008) showed that the CAI group landed with less knee flexion than the control group.Results: Diminished dynamic stability and decreased knee flexion angle at initial contact were apparent in the CAI group and may play a role in contributing to CAI. This altered kinematic pattern may influence preventive and therapeutic interventions for those with CAI.Conclusions:

scholarly journals Sagittal Plane Gait Kinematics in Individuals With Chronic Ankle Instability

2016 ◽  
Vol 21 (5) ◽  
pp. 28-35 ◽  
Author(s):  
Matthew C. Hoch ◽  
David R. Mullineaux ◽  
Kyoungkyu Jeon ◽  
Patrick O. McKeon
Keyword(s):  
Lower Extremity ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Three Dimensional ◽  
Chronic Ankle Instability ◽  
Initial Contact ◽  
Healthy Individuals ◽  
Gait Kinematics ◽  
Ankle Kinematics ◽  
Absorption Phase

Single joint kinematic alterations have been identified during gait in those with chronic ankle instability (CAI). The purpose of this study was to compare sagittal plane hip, knee, and ankle kinematics during walking in participants with and without CAI. Twelve individuals with CAI and 12 healthy individuals walked on a treadmill at 1.5 m/s. Three-dimensional kinematics were analyzed using mean ensemble curves and independent t tests. Participants with CAI demonstrated less lower extremity flexion during the absorption phase of stance and the limb placement phase of swing, which may have implications for limb placement at initial contact.

Altered Ankle Kinematics and Shank-Rear-Foot Coupling in Those with Chronic Ankle Instability

2009 ◽  
Vol 18 (3) ◽  
pp. 375-388 ◽  
Author(s):  
Lindsay K. Drewes ◽  
Patrick O. McKeon ◽  
Gabriele Paolini ◽  
Patrick Riley ◽  
D. Casey Kerrigan ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Ankle Instability ◽  
External Rotation ◽  
Chronic Ankle Instability ◽  
Initial Contact ◽  
3 Dimensional ◽  
Joint Coupling ◽  
Ankle Inversion ◽  
Ankle Kinematics ◽  
Phase Angles

Context:Kinematic patterns during gait have not been extensively studied in relation to chronic ankle instability (CAI).Objective:To determine whether individuals with CAI demonstrate altered ankle kinematics and shank-rear-foot coupling compared with controls during walking and jogging.Design:Case control.Setting:Motion-analysis laboratory.Participants:7 participants (3 men, 4 women) suffering from CAI (age 24.6 ± 4.2 y, height 172.6 ± 9.4 cm, mass 70.9 ± 8.1 kg) and 7 (3 men, 4 women) healthy, matched controls (age 24.7 ± 4.5 y, height 168.2 ± 5.9 cm, mass 66.5 ± 9.8 kg).Interventions:Subjects walked and jogged on a treadmill while 3-dimensional kinematics of the lower extremities were captured.Main Outcome Measures:The positions of rear-foot inversion–eversion and shank rotation were calculated throughout the gait cycle. Continuous relative-phase angles between these segments were calculated to assess coupling.Results:The CAI group demonstrated more rear-foot inversion and shank external rotation during walking and jogging. There were differences between groups in shank-rear-foot coupling during terminal swing at both speeds.Conclusions:Altered ankle kinematics and joint coupling during the terminal-swing phase of gait may predispose a population with CAI to ankle-inversion injuries. Less coordinated movement during gait may be an indication of altered neuromuscular recruitment of the musculature surrounding the ankle as the foot is being positioned for initial contact.

The effect of patellofemoral bracing on walking in individuals with patellofemoral pain syndrome

2013 ◽  
Vol 37 (6) ◽  
pp. 465-470 ◽  
Author(s):  
Mokhtar Arazpour ◽  
Tahmoures T Notarki ◽  
Ahmadali Salimi ◽  
Monireh A Bani ◽  
Hoda Nabavi ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Pain Syndrome ◽  
Step Length ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Initial Contact ◽  
Quasi Experimental ◽  
Knee Joint Kinematics ◽  
Spatial Parameters

Background: Although knee braces are used by individuals with patellofemoral pain syndrome, the effect of patellofemoral bracing on knee flexion during walking has not been elucidated. Aim: The purpose of this study was to evaluate the effect of patellofemoral bracing on sagittal plane knee joint kinematics and temporal spatial parameters during walking in individuals with patellofemoral pain syndrome. Study design: Quasi-experimental. Methods: Ten subjects with a diagnosis of patellofemoral pain syndrome were fitted with a knee brace incorporating an infrapatellar strap. Testing was performed at baseline and after 6 weeks of use. Gait analysis and a visual analog scale were used to assess outcomes in this study. Results: A 59.6% decrease in pain was reported by using bracing. Bracing significantly improved speed of walking ( p ≤ 0.001) and step length ( p ≤ 0.001). The mean cadence was also increased following 6 weeks of patellofemoral brace use, but this was not significant ( p = 0.077). Knee flexion angles improved during initial contact, loading response, and mid-swing ( p ≤ 0.001) after 6 weeks of patellofemoral brace use. Conclusion: Knee orthoses resulted in decreased pain, improved temporal spatial parameters (speed of walking and step length), and increased knee flexion angles during ambulation in patients with patellofemoral pain syndrome. Clinical relevance The results of this study demonstrate a positive effect of patellofemoral bracing in improving specific gait parameters and provide evidence to support its use as a conservative treatment.

scholarly journals Military Protein Intake Related to Strength and Fat Mass Independent of Energy Intake

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1671-e1678
Author(s):  
Jeremy A Ross ◽  
D Travis Thomas ◽  
Joshua D Winters ◽  
Scott D Royer ◽  
Christopher J Halagarda ◽  
...  
Keyword(s):  
Energy Intake ◽  
Body Mass ◽  
Knee Flexion ◽  
Protein Intake ◽  
Performance Metrics ◽  
Knee Extension ◽  
Special Operations ◽  
Knee Extension Strength ◽  
Peak Knee ◽  
Flexion Strength

ABSTRACT Introduction Kinetic military units operate in austere training environments and deprivation not commonly experienced by competitive athletes. Nutritional strategies to protect against decrements in performance and potential injury risk may differ for these two groups. A cross sectional analysis was conducted to determine energy and macronutrient characteristics associated with performance metrics. Materials and Methods 78 male subjects (age: 28.4 ± 6.0 years, height: 178.3 ± 6.7 cm, mass: 84.3 ± 9.4 kg, 8.5 ± 5.8 years of service) assigned to Marine Corps Forces Special Operations Command completed a 1-day performance assessment. Body mass, lean body mass, fat mass (FM), aerobic capacity (VO2max), lactate inflection point (LT), anaerobic power, anaerobic capacity, knee flexion strength, knee extension strength, peak knee flexion strength, and peak knee extension strength outcome values were recorded. Dietary intake was collected using automated self-administered 24-hour dietary recall (ASA24). Performance assessment scores were compared with macronutrient intake and controlled for energy intake using analysis of covariance. Results Differences in knee flexion strength, knee extension strength, peak knee flexion strength, and peak knee extension strength were significant across low (LPRO), medium (MPRO), and high (HPRO) protein intake groups (p &lt; 0.05) with LPRO performance metrics significantly lower than both MPRO and HPRO and MPRO significantly lower than HPRO. FM was significantly higher in LPRO than MPRO or HPRO (p &lt; 0.05). Low carbohydrate intake (LCHO) was associated with greater body mass and FM compared with high (HCHO) (p &lt; 0.05). There was no association between fat intake and any variable. Conclusions Increases in protein intake may have beneficial performance effects independent of total energy intake, while moderate increases in carbohydrate intake may not be sufficient to enhance physical performance in a special operations population.

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