Quadriceps and Hamstrings Fatigue Alters Hip and Knee Mechanics

2010 ◽  
Vol 26 (2) ◽  
pp. 159-170 ◽  
Author(s):  
Abbey C. Thomas ◽  
Scott G. McLean ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Repeated Measures ◽  
Injury Risk ◽  
Mixed Model ◽  
External Rotation ◽  
Reaction Force ◽  
Acl Injury ◽  
Knee Extension ◽  
Initial Contact ◽  
Knee Mechanics ◽  
Acl Injury Risk

Neuromuscular fatigue exacerbates abnormal landing strategies, which may increase noncontact anterior cruciate ligament (ACL) injury risk. The synergistic actions of quadriceps and hamstrings (QH) muscles are central to an upright landing posture, though the precise effect of simultaneous fatigue of these muscles on landing and ACL injury risk is unclear. Elucidating neuromechanical responses to QH fatigue thus appears important in developing more targeted fatigue-resistance intervention strategies. The current study thus aimed to examine the effects of QH fatigue on lower extremity neuromechanics during dynamic activity. Twenty-five healthy male and female volunteers performed three single-leg forward hops onto a force platform before and after QH fatigue. Fatigue was induced through sets of alternating QH concentric contractions, on an isokinetic dynamometer, until the first five repetitions of a set were performed at least 50% below QH peak torque. Three-dimensional hip and knee kinematics and normalized (body mass × height) kinetic variables were quantified for pre- and postfatigue landings and subsequently analyzed by way of repeated- measures mixed-model ANOVAs. QH fatigue produced significant increases in initial contact (IC) hip internal rotation and knee extension and external rotation angles (p< .05), with the increases in knee extension and external rotation being maintained at the time of peak vertical ground reaction force (vGRF) (p< .05). Larger knee extension and smaller knee fexion and external rotation moments were also evident at peak vGRF following fatigue (p< .05). Females landed with greater hip fexion and less abduction than males at both IC and peak vGRF as well as greater knee fexion at peak vGRF (p< .05). The peak vGRF was larger for females than males (p< .05). No sex × fatigue effects were found (p> .05). Fatigue of the QH muscles altered hip and knee neuromechanics, which may increase the risk of ACL injury. Prevention programs should incorporate methods aimed at countering QH fatigue.

scholarly journals NEURAL ACTIVITY PROFILES ASSOCIATED WITH ACL INJURY-RISK MECHANICS IN ECOLOGICAL SPORT SPECIFIC VIRTUAL REALITY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0015
Author(s):  
Dustin R. Grooms ◽  
Jed A. Diekfuss ◽  
Alexis B. Slutsky-Ganesh ◽  
Cody R. Criss ◽  
Manish Anand ◽  
...  
Keyword(s):  
Motor Control ◽  
Neural Activity ◽  
Injury Risk ◽  
Neural Control ◽  
Acl Injury ◽  
Initial Contact ◽  
Leg Press ◽  
Visual Spatial ◽  
Peak Knee ◽  
Acl Injury Risk

Background: Anterior cruciate ligament (ACL) injury is secondary to a multifactorial etiology encompassing anatomical, biological, mechanical, and neurological factors. The nature of the injury being primarily due to non-contact mechanics further implicates neural control as a key injury-risk factor, though it has received considerably less study. Purpose: To determine the contribution of neural activity to injury-risk mechanics in ecological sport-specific VR landing scenarios. Methods: Ten female high-school soccer players (15.5±0.85 years; 165.0±6.09 cm; 59.1±11.84 kg) completed a neuroimaging session to capture neural activity during a bilateral leg press and a 3D biomechanics session performing a header within a VR soccer scenario. The bilateral leg press involved four 30 s blocks of repeated bilateral leg presses paced to a metronome beat of 1.2 Hz with 30 s rest between blocks. The VR soccer scenario simulated a corner-kick, requiring the participant to jump and head a virtual soccer ball into a virtual goal (Figure 1A-E). Initial contact and peak knee flexion and abduction angles were extracted during the landing from the header as injury-risk variables of interest and were correlated with neural activity. Results: Evidenced in Table 1 and Figure 1 (bottom row), increased initial contact abduction, increased peak abduction, and decreased peak flexion were associated with increased sensory, visual-spatial, and cerebellar activity (r2= 0.42-0.57, p corrected < .05, z max > 3.1, table & figure 1). Decreased initial contact flexion was associated with increased frontal cortex activity (r2= 0.68, p corrected < .05, z max > 3.1). Conclusion: Reduced neural efficiency (increased activation) of key regions that integrate proprioceptive, visual-spatial, and neurocognitive activity for motor control may influence injury-risk mechanics in sport. The regions found to increase in activity in relation to higher injury-risk mechanics are typically activated to assist with spatial navigation, environmental interaction, and precise motor control. The requirement for athletes to increase their activity for more basic knee motor control may result in fewer neural resources available to maintain knee joint alignment, allocate environmental attention, and handle increased motor coordination demands. These data indicate that strategies to enhance efficiency of visual-spatial and cognitive-motor control during high demand sporting activities is warranted to improve ACL injury-risk reduction. [Figure: see text][Table: see text]

Preliminary Evaluation of Knee Kinetics in Female Athletes on Hormonal Contraceptives

2019 ◽  
Vol 41 (02) ◽  
pp. 113-118
Author(s):  
Gabrielle Gilmer ◽  
Gretchen D. Oliver
Keyword(s):  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Acl Injury ◽  
Hormonal Contraceptives ◽  
Preliminary Evaluation ◽  
Knee Valgus ◽  
Time Points ◽  
Acl Injury Risk

AbstractRecently, an emphasis has been placed on understanding how ovarian sex hormones and hormonal contraceptives affect risk for anterior cruciate ligament (ACL) injury. The literature presents large discrepancies in whether or not hormonal contraceptives affect ACL injury risk; therefore, the purpose of this study was to evaluate whether vertical ground reaction force (GRF) and knee valgus force are different between athletes who do and do not use hormonal contraceptives. Twenty-two female athletes volunteered to participate and were divided into two groups based on their answers to a health history questionnaire: those who use hormonal contraceptives and those who do not. Participants performed a drop vertical jump (DVJ) and single leg crossover dropdown (SCD) at two different time points in their menstrual cycle (pre-ovulatory phase and mid-luteal phase). Kinetic data were collected at 1000 Hz. Independent samples t-tests revealed no significant differences between groups in vertical GRF and knee valgus force at both time points. Findings from this study suggest that hormonal contraceptives do not elicit detectable changes in vertical GRF and knee valgus force. Ultimately, this calls for further studies on the relationship between hormones and ACL injury risk and physicians to consider hormonal screening in addition to neuromuscular and biomechanical screening.

scholarly journals Lower Extremity Energy Absorption and Biomechanics During Landing, Part I: Sagittal-Plane Energy Absorption Analyses

2013 ◽  
Vol 48 (6) ◽  
pp. 748-756 ◽  
Author(s):  
Marc F. Norcross ◽  
Michael D. Lewek ◽  
Darin A. Padua ◽  
Sandra J. Shultz ◽  
Paul S. Weinhold ◽  
...  
Keyword(s):  
Energy Absorption ◽  
Injury Risk ◽  
Sagittal Plane ◽  
Frontal Plane ◽  
Acl Injury ◽  
Knee Extension ◽  
Landing Biomechanics ◽  
Anterior Tibial ◽  
Acl Injury Risk ◽  
Risk Potential

Context: Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. Objective: To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. Intervention(s): We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. Main Outcome Measure(s): Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ2 analysis to compare male and female representation in the high and low groups. Results: The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P &lt; .05) and low (P &lt; .05) groups and greater anterior tibial shear force than the low group (P &lt; .05). No other group differences were noted. Women were not represented more than men in the high group (χ2 = 1.20, P = .27). Conclusions: Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential.

Examination of the Feasibility of a 2-Dimensional Portable Assessment of Knee Joint Stability: A Pilot Study

2020 ◽  
Vol 36 (6) ◽  
pp. 381-389
Author(s):  
Ryan Zerega ◽  
Carolyn Killelea ◽  
Justin Losciale ◽  
Mallory Faherty ◽  
Timothy Sell
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Initial Contact ◽  
Ground Reaction Forces ◽  
Joint Stability ◽  
Reaction Forces ◽  
Acl Injury Risk

Rupture of the anterior cruciate ligament (ACL) remains extremely common, with over 250,000 injuries annually. Currently, clinical tests have poor utility to accurately screen for ACL injury risk in athletes. In this study, the position of a knee marker was tracked in 2-dimensional planes to predict biomechanical variables associated with ACL injury risk. Three-dimensional kinematics and ground reaction forces were collected during bilateral, single-leg stop-jump tasks for 44 healthy male military personnel. Knee marker position data were extracted to construct 2-dimensional 95% prediction ellipses in each anatomical plane. Knee marker variables included: ellipse areas, major/minor axes lengths, orientation of ellipse axes, absolute ranges of knee position, and medial knee collapse. These variables were then used as predictor variables in stepwise multiple linear regression analyses for 7 biomechanical variables associated with ACL injury risk. Knee flexion excursion, normalized peak vertical ground reaction forces, and knee flexion angle at initial contact were the response variables that generated the highest adjusted R2 values: .71, .37, and .31, respectively. The results of this study provide initial support for the hypothesis that tracking a single marker during 2-dimensional analysis can accurately reflect the information gathered from 3-dimensional motion analysis during a task assessing knee joint stability.

scholarly journals Associations Among Eccentric Hamstrings Strength, Hamstrings Stiffness, and Jump-Landing Biomechanics

2020 ◽  
Vol 55 (7) ◽  
pp. 717-723 ◽  
Author(s):  
Derek R. Dewig ◽  
Jonathan S. Goodwin ◽  
Brian G. Pietrosimone ◽  
J. Troy Blackburn
Keyword(s):  
Ground Reaction Force ◽  
Injury Risk ◽  
Reaction Force ◽  
Acl Injury ◽  
Ground Contact ◽  
Vertical Ground Reaction Force ◽  
Landing Biomechanics ◽  
Peak Knee ◽  
Acl Injury Risk ◽  
Vertical Ground

Context Anterior cruciate ligament (ACL) injury risk can be assessed from landing biomechanics. Greater hamstrings stiffness is associated with a landing-biomechanics profile consistent with less ACL loading but is difficult to assess in the clinical setting. Eccentric hamstrings strength can be easily evaluated by clinicians and may provide a surrogate measure for hamstrings stiffness. Objective To examine associations among eccentric hamstrings strength, hamstrings stiffness, and landing biomechanics linked to ACL injury risk. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants A total of 34 uninjured, physically active participants (22 women, 12 men; age = 20.2 ± 1.6 years, height = 171.5 ± 9.7 cm, mass = 67.1 ± 12.7 kg). Intervention(s) We collected eccentric hamstrings strength, active hamstrings stiffness, and double- and single-legged landing biomechanics during a single session. Main Outcome Measure(s) Bivariate associations were conducted between eccentric hamstrings strength and hamstrings stiffness, vertical ground reaction force, internal knee-extension moment, internal knee-varus moment, anterior tibial shear force, knee sagittal-plane angle at initial ground contact, peak knee-flexion angle, knee frontal-plane angle at initial ground contact, peak knee-valgus angle, and knee-flexion displacement using Pearson product moment correlations or Spearman rank-order correlations. Results We observed no association between hamstrings stiffness and eccentric hamstrings strength (r = 0.029, P = .44). We also found no association between hamstrings stiffness and landing biomechanics. However, greater peak eccentric strength was associated with less vertical ground reaction force in both the double-legged (r = −0.331, P = .03) and single-legged (r = −0.418, P = .01) landing conditions and with less internal knee-varus moment in the single-legged landing condition (r = −0.326, P = .04). Conclusions Eccentric hamstrings strength was associated with less vertical ground reaction force during both landing tasks and less internal knee-varus moment during the single-legged landing but was not an acceptable clinical estimate of active hamstrings stiffness.

scholarly journals Electromyographic Assessment of Anterior Cruciate Ligament Injury Risk in Male Tennis Players: Which Role for Visual Input? A Proof-of-Concept Study

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 997
Author(s):  
Alessandro de Sire ◽  
Nicola Marotta ◽  
Andrea Demeco ◽  
Lucrezia Moggio ◽  
Pasquale Paola ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Visual Input ◽  
Proof Of Concept ◽  
Tennis Players ◽  
Concept Study ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injury incidence is often underestimated in tennis players, who are considered as subjects conventionally less prone to knee injuries. However, evaluation of the preactivation of knee stabilizer muscles by surface electromyography (sEMG) showed to be a predictive value in the assessment of the risk of ACL injury. Therefore, this proof-of-concept study aimed at evaluating the role of visual input on the thigh muscle preactivation through sEMG to reduce ACL injury risk in tennis players. We recruited male, adult, semiprofessional tennis players from July to August 2020. They were asked to drop with the dominant lower limb from a step, to evaluate—based on dynamic valgus stress—the preactivation time of the rectus femoris (RF), vastus medialis, biceps femoris, and medial hamstrings (MH), through sEMG. To highlight the influence of visual inputs, the athletes performed the test blindfolded and not blindfolded on both clay and grass surfaces. We included 20 semiprofessional male players, with a mean age 20.3 ± 4.8 years; results showed significant early muscle activation when the subject lacked visual input, but also when faced with a less-safe surface such as clay over grass. Considering the posteromedial–anterolateral relationship (MH/RF ratio), tennis players showed a significant higher MH/RF ratio if blindfolded (22.0 vs. 17.0% not blindfolded; p < 0.01) and percentage of falling on clay (17.0% vs. 14.0% in grass; p < 0.01). This proof-of-principle study suggests that in case of absence of visual input or falling on a surface considered unsafe (clay), neuro-activation would tend to protect the anterior stress of the knee. Thus, the sEMG might play a crucial role in planning adequate athletic preparation for semiprofessional male athletes in terms of reduction of ACL injury risk.

Examining the Dynamic Nature of Anterior Cruciate Ligament Injury Risk Factors in Women’s Collegiate Soccer

2021 ◽  
pp. 1-8
Author(s):  
Elena M. D’Argenio ◽  
Timothy G. Eckard ◽  
Barnett S. Frank ◽  
William E. Prentice ◽  
Darin A. Padua
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Range Of Motion ◽  
Injury Risk ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Dynamic Risk Factors ◽  
Dynamic Risk ◽  
Anterior Cruciate

Context: Anterior cruciate ligament (ACL) injuries are a common and devastating injury in women’s soccer. Several risk factors for ACL injury have been identified, but have not yet been examined as potentially dynamic risk factors, which may change throughout a collegiate soccer season. Design: Prospective cohort study. Methods: Nine common clinical screening assessments for ACL injury risk, consisting of range of motion, movement quality, and power, were assessed in 29 Division I collegiate women’s soccer players. Preseason and midseason values were compared for significant differences. Change scores for each risk factor were also correlated with cumulative training loads during the first 10 weeks of a competitive soccer season. Results: Hip external rotation range of motion and power had statistically significant and meaningful differences at midseason compared with preseason, indicating they are dynamic risk factors. There were no significant associations between the observed risk factor changes and cumulative training load. Conclusions: Hip external rotation range of motion and power are dynamic risk factors for ACL injury in women’s collegiate soccer athletes. Serial screening of these risk factors may elucidate stronger associations with injury risk and improve prognostic accuracy of screening tools.

scholarly journals Do ACL Injury Risk Reduction Exercises Reflect Common Injury Mechanisms? A Scoping Review of Injury Prevention Programs

2021 ◽  
pp. 194173812110379
Author(s):  
Steven L. Dischiavi ◽  
Alexis A Wright ◽  
Rachel A. Heller ◽  
Claire E. Love ◽  
Adam J. Salzman ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Scoping Review ◽  
Injury Risk ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Flight Phase ◽  
Targeted Interventions ◽  
Injury Mechanisms ◽  
Acl Injury Risk

Context: Anterior cruciate ligament (ACL) injury risk reduction programs have become increasingly popular. As ACL injuries continue to reflect high incidence rates, the continued optimization of current risk reduction programs, and the exercises contained within them, is warranted. The exercises must evolve to align with new etiology data, but there is concern that the exercises do not fully reflect the complexity of ACL injury mechanisms. It was outside the scope of this review to address each possible inciting event, rather the effort was directed at the elements more closely associated with the end point of movement during the injury mechanism. Objective: To examine if exercises designed to reduce the risk of ACL injury reflect key injury mechanisms: multiplanar movement, single limb stance, trunk and hip dissociative control, and a flight phase. Data Sources: A systematic search was performed using PubMed, Medline, EBSCO (CINAHL), SPORTSDiscus, and PEDro databases. Study Selection: Eligibility criteria were as follows: (1) randomized controlled trials or prospective cohort studies, (2) male and/or female participants of any age, (3) exercises were targeted interventions to prevent ACL/knee injuries, and (4) individual exercises were listed and adequately detailed and excluded if program was unable to be replicated clinically. Study Design: Scoping review. Level of Evidence: Level 4. Data Extraction: A total of 35 studies were included, and 1019 exercises were extracted for analysis. Results: The average Consensus on Exercise Reporting Template score was 11 (range, 0-14). The majority of exercises involved bilateral weightbearing (n = 418 of 1019; 41.0%), followed by single limb (n = 345 of 1019; 33.9%) and nonweightbearing (n = 256 of 1019; 25.1%). Only 20% of exercises incorporated more than 1 plane of movement, and the majority of exercises had sagittal plane dominance. Although 50% of exercises incorporated a flight phase, only half of these also involved single-leg weightbearing. Just 16% of exercises incorporated trunk and hip dissociation, and these were rarely combined with other key exercise elements. Only 13% of exercises challenged more than 2 key elements, and only 1% incorporated all 4 elements (multiplanar movements, single limb stance, trunk and hip dissociation, flight phase) simultaneously. Conclusion: Many risk reduction exercises do not reflect the task-specific elements identified within ACL injury mechanisms. Addressing the underrepresentation of key elements (eg, trunk and hip dissociation, multiplanar movements) may optimize risk reduction in future trials.

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