Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ± 188 vs. 152 ± 106); VM (363 ± 192 vs. 140 ± 96); BF (229 ± 60 vs. 150 ± 63); MH (231 ± 88 vs. 203 ± 89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols.

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The Accuracy of Hand-to-Hand Bioelectrical Impedance Analysis in Predicting Body Composition in College-Age Female Athletes

The Journal of Strength and Conditioning Research ◽

10.1519/jsc.0b013e3181cc224a ◽

2011 ◽

Vol 25 (4) ◽

pp. 1040-1045 ◽

Cited By ~ 17

Author(s):

Michael R Esco ◽

Michele S Olson ◽

Henry N Williford ◽

Suheil N Lizana ◽

Angela R Russell

Keyword(s):

Body Composition ◽

Bioelectrical Impedance Analysis ◽

Female Athletes ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

College Age

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Confidence to Return to Play After ACL Reconstruction: An Evaluation of Quadriceps Strength Symmetry and Injury Mechanism in Male Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211043854 ◽

2021 ◽

pp. 194173812110438

Author(s):

Rachel K. Straub ◽

Francesco Della Villa ◽

Bert Mandelbaum ◽

Christopher M. Powers

Keyword(s):

Female Athletes ◽

Cruciate Ligament ◽

Linear Regression Analysis ◽

Return To Sport ◽

Quadriceps Strength ◽

Injury Mechanism ◽

Return To Play ◽

Negative Consequences ◽

Male Athletes ◽

The Relationship

Background: After anterior cruciate ligament reconstruction (ACLR), diminished quadriceps strength symmetry and reduced psychological readiness to return to play (RTP) increase the risk for subsequent injury. Although the relationship between quadriceps strength symmetry and psychological readiness to RTP has been reported to be influenced by injury mechanism in female athletes, it is unclear whether such a relationship exists in male athletes. Hypothesis: Quadriceps strength symmetry would be positively associated with greater psychological readiness to RTP after ACLR, regardless of injury mechanism. Study Design: Retrospective cohort. Level of Evidence: Level 3 (cohort study). Methods: Sixty male patients completed strength testing and the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS) at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism). Results: For all patients combined, no symmetry × mechanism interaction was found ( P = 0.11). A significant positive relationship was found between quadriceps strength symmetry and the I-PRRS score ( P < 0.001, R2 = 0.31), after adjusting for time post-ACLR and injury mechanism. Conclusion: Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP after ACLR in male athletes. In contrast to what has been reported in female athletes, this relationship was independent of injury mechanism. Clinical Relevance: Given the potential negative consequences of quadriceps strength deficits on one’s confidence to RTP, the need to restore quadriceps symmetry during the postoperative period is readily apparent. Low confidence or low psychological readiness to RTP may be indicative of quadriceps strength asymmetry or poor physical function in general.

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Returning a Division I Hurdler to Sport After Multiple Knee Ligament Injuries

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2019-0121 ◽

2020 ◽

pp. 1-6

Author(s):

Xavier D. Thompson ◽

Brianna DiAntonio

Keyword(s):

Cruciate Ligament ◽

Lateral Collateral Ligament ◽

Neuromuscular Control ◽

Biceps Femoris ◽

Patient Reported Outcome ◽

Return To Play ◽

Knee Ligament ◽

Patient Reported ◽

Anterior Cruciate ◽

Knee Ligament Injuries

An 18-year-old male hurdler reported to preparticipation physicals, with a history of anterior cruciate ligament, lateral collateral ligament, and posterior cruciate ligament sprain; medial meniscocapsular sprain; and biceps femoris tendon avulsion. The patient received full clearance from his surgeon, despite functional deficits. Rehabilitation and return-to-play decision making included analysis of patient-reported outcome scores and tests of symmetry and neuromuscular control. After graduated intervention and multiple batteries of assessments, the patient was allowed to return to full participation. The nature of this sport and the time between surgery and the intervention made thorough evaluation of function and graduated progression a necessity.

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Reliability and validity of body composition measures in female athletes

Journal of Applied Physiology ◽

10.1152/jappl.1999.87.3.1114 ◽

1999 ◽

Vol 87 (3) ◽

pp. 1114-1122 ◽

Cited By ~ 50

Author(s):

Willa C. Fornetti ◽

James M. Pivarnik ◽

Jeanne M. Foley ◽

Justus J. Fiechtner

Keyword(s):

Body Composition ◽

Near Infrared ◽

Female Athletes ◽

Reliability And Validity ◽

Bioelectrical Impedance ◽

Single Equation ◽

Dual Energy ◽

Fat Free Mass ◽

Prediction Errors ◽

X Ray

The purpose of this investigation was to determine the reliability and validity of bioelectrical impedance (BIA) and near-infrared interactance (NIR) for estimating body composition in female athletes. Dual-energy X-ray absorptiometry was used as the criterion measure for fat-free mass (FFM). Studies were performed in 132 athletes [age = 20.4 ± 1.5 (SD) yr]. Intraclass reliabilities (repeat and single trial) were 0.987–0.997 for BIA (resistance and reactance) and 0.957–0.980 for NIR (optical densities). Validity of BIA and NIR was assessed by double cross-validation. Because correlations were high ( r = 0.969–0.983) and prediction errors low, a single equation was developed by using all 132 subjects for both BIA and NIR. Also, an equation was developed for all subjects by using height and weight only. Results from dual-energy X-ray absorptiometry analysis showed FFM = 49.5 ± 6.0 kg, which corresponded to %body fat (%BF) of 20.4 ± 3.1%. BIA predicted FFM at 49.4 ± 5.9 kg ( r = 0.981, SEE = 1.1), and NIR prediction was 49.5 ± 5.8 kg ( r = 0.975, SEE = 1.2). Height and weight alone predicted FFM at 49.4 ± 5.7 kg ( r = 0.961, SEE = 1.6). When converted to %BF, prediction errors were ∼1.8% for BIA and NIR and 2.9% for height and weight. Results showed BIA and NIR to be extremely reliable and valid techniques for estimating body composition in college-age female athletes.

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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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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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Behandlung von Sportverletzungen bei Frauen – Anders? Öfter? Länger?

Sports & Exercise Medicine Switzerland ◽

10.34045/sems/2020/45 ◽

2020 ◽

Keyword(s):

Anterior Cruciate Ligament ◽

Female Athletes ◽

Sports Injuries ◽

Cruciate Ligament ◽

Return To Play ◽

Associated Injuries ◽

Acl Injuries ◽

Women In Sport ◽

Long Time ◽

Anterior Cruciate

Women in sport – an almost inexhaustible topic that has been neglected for a long time. Female Athletes conquer discipline after discipline – including the associated injuries. Common sports injuries in female athletes include stress fractures, anterior cruciate ligament (ACL) injuries and sport related concussions (SRC). Less commonly recognized are the specific sex differences that lead to these injuries. An understanding of these factors can improve their clinical management including surgical treatment, the rehabilitation phase and return to play.

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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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