Neuromuscular Control of Vertical Jumps in Female Adolescents

Background: Poor landing mechanics are considered deficits in neuromuscular control and risk factors for lower extremity injury. The Landing Error Scoring System (LESS) has been used to assess the neuromuscular control of landing mechanics for the first landing in a drop vertical jump (DVJ) task. However, the second DVJ landing may provide different results, warranting assessment. Hypotheses: (1) LESS scores will differ between first and second DVJ landings across all female participants with (2) greater intraparticipant variability among the second landing compared with the first landing scores. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: A total of 13 gymnasts and 31 softball players (N = 44) performed 3 DVJ trials. The mean ± SD age of 44 female athletes was 16.46 ± 2.59 years. The LESS was scored using 2-dimensional video of each trial. Results: There was a significant difference between the first and second DVJ landings ( P < 0.01). All participants demonstrated higher LESS scores (worse landing mechanics) during the second DVJ landing (10.10 ± 2.25) than the first landing (6.97 ± 2.72). Conclusion: The initial landing in a DVJ has been the focus of neuromuscular control studies using the LESS. This study found worse neuromuscular control during the second DVJ landing, which highlights the importance of evaluating landing mechanics beyond the initial landing. Clinical Relevance: LESS analysis of both DVJ landings might improve neuromuscular control screening in female athletes and augment lower extremity and anterior cruciate ligament injury prevention programs.

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Association of Quadriceps and Hamstrings Cocontraction Patterns With Knee Joint Loading

Journal of Athletic Training ◽

10.4085/1062-6050-44.3.256 ◽

2009 ◽

Vol 44 (3) ◽

pp. 256-263 ◽

Cited By ~ 47

Author(s):

Riann M. Palmieri-Smith ◽

Scott G. McLean ◽

James A. Ashton-Miller ◽

Edward M. Wojtys

Keyword(s):

Lower Extremity ◽

Injury Risk ◽

Female Athletes ◽

Vastus Lateralis ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Cross Sectional Study ◽

Cross Sectional ◽

Peak Knee ◽

Knee Abduction

Abstract Context: Sex differences in neuromuscular control of the lower extremity have been identified as a potential cause for the greater incidence of anterior cruciate ligament (ACL) injuries in female athletes compared with male athletes. Women tend to land in greater knee valgus with higher abduction loads than men. Because knee abduction loads increase ACL strain, the inability to minimize these loads may lead to ACL failure. Objective: To investigate the activation patterns of the quadriceps and hamstrings muscles with respect to the peak knee abduction moment. Design: Cross-sectional study. Setting: Neuromuscular research laboratory. Patients or Other Participants: Twenty-one recreationally active adults (11 women, 10 men). Main Outcome Measure(s): Volunteers performed 3 trials of a 100-cm forward hop. During the hop task, we recorded surface electromyographic data from the medial and lateral hamstrings and quadriceps and recorded lower extremity kinematics and kinetics. Lateral and medial quadriceps-to-hamstrings (Q∶H) cocontraction indices, the ratio of medial-to-lateral Q∶H cocontraction, normalized root mean square electromyographic data for medial and lateral quadriceps and hamstrings, and peak knee abduction moment were calculated and used in data analyses. Results: Overall cocontraction was lower in women than in men, whereas activation was lower in the medial than in the lateral musculature in both sexes (P < .05). The medial Q∶H cocontraction index (R2 = 0.792) accounted for a significant portion of the variance in the peak knee abduction moment in women (P = .001). Women demonstrated less activation in the vastus medialis than in the vastus lateralis (P = .49) and less activation in the medial hamstrings than in the lateral hamstrings (P = .01). Conclusions: Medial-to-lateral Q∶H cocontraction appears to be unbalanced in women, which may limit their ability to resist abduction loads. Because higher abduction loads increase strain on the ACL, restoring medial-to-lateral Q∶H cocontraction balance in women may help reduce ACL injury risk.

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Examining the Relationship Between a Neuromuscular Control Baseline Battery for Sport-Related Concussion and Anterior Cruciate Ligament Injury Risk

Neurology ◽

10.1212/01.wnl.0000801936.89376.f8 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S21.2-S22

Author(s):

Ryan Moran

Keyword(s):

Anterior Cruciate Ligament ◽

Lower Extremity ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Ligament Injury ◽

Jump Landing ◽

Eyes Closed ◽

Eyes Open ◽

Anterior Cruciate ◽

The Relationship

ObjectiveTo examine the relationship between the m-CTSIB and Landing Error Scoring System in a sample of collegiate female athletes.BackgroundRecent literature has linked concussion and neuromuscular deficits in the lower extremity after injury. Neuromuscular control is frequently assessed using balance measures for concussion, but also dynamically to identify anterior cruciate ligament injury (ACL) risk via jump-landing movement screening.Design/MethodsThirty-nine healthy, collegiate female soccer (n = 22) and volleyball (n = 17) athletes completed the modified-Clinical Test of Sensory Interaction of Balance (m-CTSIB) and the Landing Error Scoring System (LESS). Measures consisted of total m-CTSIB sway index scores on individual conditions (firm surface eyes open [condition 1] and eyes closed [2], foam surface eyes open [3] and eyes closed [4]), m-CTSIB overall score, and total LESS errors. LESS scores were also categorized into a low (0–4 errors) and high (5 + errors) risk to determine if athletes with worse neuromuscular control on the LESS has worse balance on the m-CTSIB. A Spearman's rank-order correlation was conducted to determine the strength of the relationship between LESS and m-CTSIB performance. A series of Mann-Whitney U test were performed to determine differences between low and high LESS performance on m-CTSIB performance.ResultsThere was a weak, negative correlation between LESS and m-CTSIB performance (rs(37) = −0.153, p = 0.35). Further, there were no differences between the low and high risk LESS groups on sway index scores on conditions 1 (U = 158.5, p = 0.39), 2 (U = 156.0, p = 0.36), 3 (U = 165.5, p = 0.51), or 4 (U = 128.5, p = 0.08), as well as overall m-CTSIB scores (U = 150.5, p = 0.28).ConclusionsThere appears to be a lack of relationship between the LESS and m-CTSIB tests, revealing the independence of static and dynamic lower extremity neuromuscular function. Athletes who may be more at risk for ACL injury due to abnormal jump-landing biomechanics, do not differ from low-risk athletes on baseline balance assessment.

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Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study

The American Journal of Sports Medicine ◽

10.1177/0363546504269591 ◽

2005 ◽

Vol 33 (4) ◽

pp. 492-501 ◽

Cited By ~ 1609

Author(s):

Timothy E. Hewett ◽

Gregory D. Myer ◽

Kevin R. Ford ◽

Robert S. Heidt ◽

Angelo J. Colosimo ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Injury Risk ◽

Female Athletes ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Ligament Injury ◽

Knee Abduction ◽

Anterior Cruciate ◽

Dynamic Valgus

Background Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes. Hypothesis Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk. Study Design Cohort study; Level of evidence, 2. Methods There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament. Results Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P <. 05) at landing was 8° greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P <. 001) and 20% higher ground reaction force (P <. 05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88. Conclusion Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes. Clinical Relevance Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.

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EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT INJURY IN SOCCER PLAYERS IN THE BRAZILIAN CHAMPIONSHIP

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212901235225 ◽

2021 ◽

Vol 29 (1) ◽

pp. 45-48

Author(s):

CONRADO TAZIMA NITTA ◽

ARTHUR RODRIGUES BALDAN ◽

LUCAS PLENS DE BRITTO COSTA ◽

MOISES COHEN ◽

JORGE ROBERTO PAGURA ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Epidemiological Data ◽

Soccer Players ◽

Ligament Injury ◽

Online Data ◽

Level Of Evidence ◽

Professional Soccer ◽

Significant Difference ◽

Anterior Cruciate

ABSTRACT Objective: To evaluate and collect epidemiological data on injuries of the anterior cruciate ligament of the knee in professional soccer players of the Brazilian Championship. Methods: Transversal study, with information extracted from the online data platform www.transfermrkt.com.br (Transfermarkt GmbH & Co. KG), with 5 seasons (2015 - 2019) of the Brazilian championship series A and B being analyzed and revised by 3 researchers. Results: 52 injuries of the anterior cruciate ligament were detected, with a mean age of 26,3 years, time off due to injury of 244.5 ±31.6 days, regardless of the division. Forwarders and defenders had the highest incidences of injury without statistically significant difference, but they had greater chances than goalkeepers, left/right backs and midfielders. Conclusion: The incidence of injury to the anterior cruciate ligament of the knee in professional football players in the first and second divisions of the Brazilian soccer championship between 2015 and 2019 is 0.414 per 1,000 hours of play, a value similar to described in the literature. The incidence of the injury varies according to the player’s field position, being the forwarders and defenders the most injured players. Level of Evidence II, Retrospective study.

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Biomechanical Risk Assessment of Non-Contact Anterior Cruciate Ligament Injury in Taekwondo Athletes

Journal of Advances in Medicine Science ◽

10.30564/jams.v3i3.1908 ◽

2020 ◽

Vol 3 (3) ◽

pp. 1

Author(s):

Rongqiang Zheng ◽

Jingyi Zhou ◽

Teng Zhang

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Joint Angle ◽

Female Athletes ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Acl Injury ◽

Ligament Injury ◽

Anterior Cruciate ◽

Analysis System

Non-contact anterior cruciate ligament (ACL) injury can occur in many sports. It is interrelated with gender, anatomy, biomechanics, and neuromuscular control. Taekwondo athletes have a higher incidence of ACL injury than athletes from other sports. Objective: This study aimed to determine the biomechanical gender differences and mechanism of taekwondo athletes with ACL injury. Methods: A total of 28 taekwondo athletes (aged 14–19 years) were randomly selected and grouped by gender. Feet high floor, one foot high floor, and single leg squat were analyzed by a Vicon motion analysis system and Kistler 3D force platform for action. The knee joint angle and ground force were evaluated. Results: Results demonstrated biomechanical differences in knee joint between male and female athletes. Conclusion: ACL injury in taekwondo female athletes indicated the biomechanical mechanism of the knee joint, and it can be prevented by neuromuscular control training.

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Anterior Cruciate Ligament Reconstruction in Young Female Athletes: Patellar Versus Hamstring Tendon Autografts

The American Journal of Sports Medicine ◽

10.1177/0363546519854762 ◽

2019 ◽

Vol 47 (9) ◽

pp. 2086-2092 ◽

Cited By ~ 9

Author(s):

Hytham S. Salem ◽

Vahe Varzhapetyan ◽

Nimit Patel ◽

Christopher C. Dodson ◽

Fotios P. Tjoumakaris ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Graft Failure ◽

Female Athletes ◽

Cruciate Ligament ◽

Age Groups ◽

Age Group ◽

Level Of Evidence ◽

Young Females ◽

Significant Difference ◽

Anterior Cruciate

Background: Female athletes are 2 to 8 times more prone to anterior cruciate ligament (ACL) rupture than males. Furthermore, reinjury to the ipsilateral or contralateral knee can occur in >20% of athletes. Female sex and younger age are known risk factors for graft failure. The optimal graft choice for young females remains unknown and poorly studied. Purpose/Hypothesis: The authors aimed to compare clinical outcomes in young females who underwent ACL reconstruction (ACLR) with bone–patellar tendon–bone (BTB) and quadrupled hamstring (HS) autografts. It was hypothesized that no significant differences in outcomes exist between graft choices. Study Design: Cohort study; Level of evidence, 3. Methods: Female patients aged 15 to 25 years who underwent primary ACLR with BTB or HS autograft were included for review. Patients were subdivided into 2 age groups: 15 to 20 years and 21 to 25 years. The occurrence of chondral, meniscal, or ligamentous injury to either knee was recorded for comparison. Results: A total of 256 females were included (BTB, n = 175; HS, n = 81). The majority of patients were between the ages of 15 and 20 years (BTB, 80%; HS, 77.8%). Overall, graft rupture occurred in 23 patients (9%) and contralateral ACL tear occurred in 18 (7%). Subgroup analysis showed that 75% of BTB and 100% of HS graft retears occurred in females aged 15 to 20 years. Within this age group, there was a significantly lower rate of graft ruptures in the BTB group (6.4%) as compared with the HS group (17.5%, P = .02). Allograft augmentation was used in 4 of the 11 HS grafts that retore. When allograft-augmented grafts were excluded, there was no significant difference in graft failure rate between graft choices. Fifteen patients in the BTB group (12%) as opposed to 1 in the HS group (2%) reported extreme difficulty or the inability to kneel on the front of the knee ( P = .04). Conclusion: In females aged 15 to 20 years undergoing ACLR, BTB autograft may lead to fewer graft ruptures than HS autograft. While this difference was not observed in females aged 21 to 25 years, a larger sample may be required to accept the null hypothesis in this age group. BTB autograft significantly increased the risk of kneeling pain as compared with HS regardless of age.

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Functional Movement Screening as a Predictor of Injury in Highly Trained Female’s Martial Arts Athletes

Polish Hyperbaric Research ◽

10.2478/phr-2020-0012 ◽

2020 ◽

Vol 71 (2) ◽

pp. 67-74

Author(s):

Zenati Yacine ◽

Benbernou Othmane ◽

Belkadi Adel ◽

Sebbane Mohamed ◽

Benchehida Aabdelkader ◽

...

Keyword(s):

Lower Extremity ◽

Martial Arts ◽

Female Athletes ◽

Lower Extremity Injury ◽

National Study ◽

Body Parts ◽

Extremity Injury ◽

Injury Group ◽

Significant Difference ◽

Movement Screening

Abstract Objective. This research examines the emerging role of FMS™ in the context of predicting lower extremity injury in females University athletes. The secondary purpose of this study is to investigate the differences between FMS performance comparisons between three martial arts sports to establish baseline comparisons. Method. Forty-seven university female athletes were recruited for this study, The data collected was separated into three groups based on their sports discipline (judo N=17 age: 19±4, wrestling N=15 age: 18±5, karate N=15 age: 19±3), Independent t-tests were performed on each group with significance being set at P<0.05 to determine difference in FMS™ scores between injured and non injured athletes during the successive competitive seasons. One-way analyses of variances were used to determine if there was a significant difference between sports, ‘body parts injured’ groups, and ‘mechanisms of injury’ groups. Results. One-way analysis of variance revealed no statistically significant difference between the two (ankle, knee) injury groups, and non-injury group (F2,54= 2.34; p=0.106). There was no statistical difference between the pre-season FMS™ scores of the injured and non-injured groups (t47 = -1.68; P=.100; d=0.52; 95%CI: -0.11, 1.15). Finally, strong evidence of FMS score was found when comparing the three sports with one-way ANOVAs (F=5.83, df= 2, 54, p=0.005). Conclusion. One of the more significant findings to emerge from this study is that FMS™ has emerged as a powerful tool for identifying lower extremity injury in female athletes. Further investigation and experimentation into FMS™ are strongly recommended before implementing them into a pre-participation physical examination (PPE) for combat sports. What is now needed is a cross-national study involving other sports.

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Multiple Concussions Increase Odds and Rate of Lower Extremity Injury in National Collegiate Athletic Association Athletes After Return to Play

The American Journal of Sports Medicine ◽

10.1177/0363546519872502 ◽

2019 ◽

Vol 47 (13) ◽

pp. 3256-3262 ◽

Cited By ~ 4

Author(s):

Garrett K. Harada ◽

Caitlin M. Rugg ◽

Armin Arshi ◽

Jeremy Vail ◽

Sharon L. Hame

Keyword(s):

Lower Extremity ◽

National Collegiate Athletic Association ◽

Collegiate Athletes ◽

Neuromuscular Control ◽

The United States ◽

Return To Play ◽

Lower Extremity Injury ◽

Rank Test ◽

Extremity Injury ◽

Level Of Evidence

Background: Concussion in collegiate athletics is one of the most prevalent sport-related injuries in the United States, with recent studies suggesting persistent deficits in neuromuscular control after a concussion and an associated increase in risk of lower extremity injury. Purpose: To expand on the relationship between concussion and lower extremity injury by examining the effect of multiple concussions (MC) on rate and odds of future lower extremity injury in collegiate athletes after return to play (RTP) compared with matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: From 2001 to 2016, 48 National Collegiate Athletic Association Division I athletes sustaining multiple concussions at a single institution were identified. Athletes with multiple concussions (MC) were matched directly to athletes with a single concussion (SC) and to athletes with no concussion history (NC) by sex, sport, position, and games played. Incidence of, time to, and location of lower extremity injury were recorded for each group after RTP from their first reported concussion until completion of their collegiate career. Logistic regression was used to analyze odds ratios (ORs) for sustaining lower extremity injury, whereas time to injury was summarized by use of Kaplan-Meier curves and log rank test analysis. Results: The incidence of lower extremity injury after RTP was significantly greater ( P = .049) in the MC cohort (36/48, 75%) than in SC athletes (25/48 = 52%) and NC athletes (27/48 = 56%). Similarly, odds of lower extremity injury were significantly greater in the MC cohort than in SC athletes (OR, 3.00; 95% CI, 1.26-7.12; P = .01) and NC athletes (OR, 1.66; 95% CI, 1.07-2.56; P = .02). Time to lower extremity injury was significantly shorter in the MC group compared with matched controls ( P = .01). No difference was found in odds of lower extremity injury or time to lower extremity injury between SC and NC athletes. Conclusion: Collegiate athletes with MC were more likely to sustain a lower extremity injury after RTP in a shorter time frame than were the matched SC and NC athletes. This may suggest the presence of a cohort more susceptible to neuromuscular deficits after concussion or more injury prone due to player behavior, and it may imply the need for more stringent RTP protocols for athletes experiencing MC.

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An Investigation of Knee Injury Profiles among Iranian Elite Karatekas: Observations from a Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136888 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6888

Author(s):

Hamidreza Naserpour ◽

Julien S. Baker ◽

Amir Letafatkar ◽

Giacomo Rossettini ◽

Frédéric Dutheil

Keyword(s):

Knee Injury ◽

Cruciate Ligament ◽

Knee Injuries ◽

Cross Sectional Study ◽

Lower Extremity Injury ◽

Sectional Study ◽

Positive Health ◽

Sports Activity ◽

Cross Sectional ◽

National Team

Karate training, despite the many positive health benefits, carries a risk of injury for participants. The current cross-sectional study aimed to investigate knee injury profiles among Iranian elite karatekas. Participants who attended the national team qualifiers, which included 390 male Kumite karatekas (age 24 ± 3 years old and weight 63 ± 12 kg), participated in this study. Information on knee injuries (injury history, type of injury mechanisms, and effects of knee symptoms on the ability to perform daily activities and recreational activities) were obtained using the Knee Outcome Survey (KOS). Using Pearson’s correlation coefficient, the study examined the relationships between different variables, including KOS subscales and levels of self-reported knee joint function. Our findings indicated that 287 karatekas (73.6%) experienced knee injuries. The anterior cruciate ligament (ACL) rupture (6.9%), articular cartilage (5.4%), and meniscus damage (3.8%) were the main typology of injury. In addition, there were no differences in knee injuries between the non-dominant and dominant legs. Most injuries occurred during the preparatory period (n = 162, 50%), especially during training periods. The KOS subscales scores (Mean ± Sd) for activities of daily living (ADL) and sports activity (SAS) were, respectively, 89 ± 11 and 91 ± 9. The self-reported scores for both the ADL and SAS subscales were, respectively, 89 ± 11 and 90 ± 10. Pearson coefficients of ADL and SAS subscales with their self-reported score were r = 0.761 (p < 0.0001) and r = 0.782 and (p < 0.0001), respectively. The profile of knee injuries in the current investigation is similar to previous surveys that reported lower extremity injury patterns. The findings of this study could be adopted to inform practice aimed at planning interventions for the reduction and prevention of knee injuries among karatekas.

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