scholarly journals Association of Quadriceps and Hamstrings Cocontraction Patterns With Knee Joint Loading

2009 ◽  
Vol 44 (3) ◽  
pp. 256-263 ◽  
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.

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

2005 ◽  
Vol 33 (4) ◽  
pp. 492-501 ◽  
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.

scholarly journals Neuromuscular Control of Vertical Jumps in Female Adolescents

2019 ◽  
Vol 11 (4) ◽  
pp. 343-349 ◽  
Author(s):  
Donna Moxley Scarborough ◽  
Shannon E. Linderman ◽  
Valerie A. Cohen ◽  
Eric M. Berkson ◽  
Mary M. Eckert ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Lower Extremity Injury ◽  
Ligament Injury ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Landing Mechanics ◽  
Significant Difference

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.

Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing

2021 ◽  
pp. 194173812110196
Author(s):  
Jeffrey B. Taylor ◽  
Elena S. Wright ◽  
Justin P. Waxman ◽  
Randy J. Schmitz ◽  
James D. Groves ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Knee Flexion ◽  
Injury Risk ◽  
Female Athletes ◽  
Knee Extensor ◽  
Ankle Dorsiflexion ◽  
Level Of Evidence ◽  
Peak Knee ◽  
Knee Abduction ◽  
Lower Extremity Biomechanics

Background: Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. Hypothesis: We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. Results: For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion ( r2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles ( r2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion ( r2 = 0.40, P = 0.004), 0.002 N·m·N−1·cm−1 decrease in hip extensor work ( r2 = 0.28, P = 0.02), and 0.001 N·m·N−1·cm−1 decrease in knee extensor work ( r2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles ( r2 = 0.26, P = 0.03) and 0.01 N·m·N−1·cm−1 lesser knee extensor work ( r2 = 0.25, P = 0.03). Conclusion: Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. Clinical Relevance: While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.

scholarly journals NEURAL ACTIVITY AND LANDING BIOMECHANICS: EXPLORING THE RELATIONSHIPS BETWEEN THE BRAIN, BODY, AND ACL INJURY-RISK

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0015
Author(s):  
Cody R. Criss ◽  
Dustin R. Grooms ◽  
Jed A. Diekfuss ◽  
Manish Anand ◽  
Alexis B. Slutsky-Ganesh ◽  
...  
Keyword(s):  
Neural Activity ◽  
Injury Risk ◽  
Neural Control ◽  
Motor Coordination ◽  
Cruciate Ligament ◽  
Vertical Jump ◽  
Frontal Plane ◽  
Peak Knee ◽  
Knee Abduction ◽  
Drop Vertical Jump

Background: Anterior cruciate ligament (ACL) injuries predominantly occur via non-contact mechanisms, secondary to motor coordination errors resulting in aberrant frontal plane knee loads that exceed the thresholds of ligament integrity. However, central nervous system processing underlying high injury-risk motor coordination errors remain unknown, limiting the optimization of current injury reduction strategies. Purpose: To evaluate the relationships between brain activity during motor tasks with injury-risk loading during a drop vertical jump. Methods: Thirty female high school soccer players (16.10 ± 0.87 years, 165.10 ± 4.64 cm, 63.43 ± 8.80 kg) were evaluated with 3D biomechanics during a standardized drop vertical jump from a 30 cm box and peak knee abduction moment was extracted as the injury-risk variable of interest. A neuroimaging session to capture neural activity (via blood-oxygen-level-dependent signal) was then completed which consisted of 4 blocks of 30 seconds of repeated bilateral leg press action paced to a metronome beat of 1.2 Hz with 30 seconds rest between blocks. Knee abduction moment was evaluated relative to neural activity to identify potential neural contributors to injury-risk. Results: There was a direct relationship between increased landing knee abduction moment and increased neural activation within regions corresponding to the lingual gyrus, intracalcarine cortex, posterior cingulate cortex, and precuneus (r2= 0.68, p corrected < .05, z max > 3.1; Table 1 & Figure 1). Conclusion: Elevated activity in regions that integrate sensory, spatial, and attentional information may contribute to elevated frontal plane knee loads during landing. Interestingly, a similar activation pattern related to high-risk landing mechanics has been found in those following injury, indicating that predisposing factors to injury may be accentuated by injury or that modern rehabilitation does not recover prospective neural control deficits. These data uncover a potentially novel brain marker that could guide the discovery of neural-therapeutic targets that reduce injury risk beyond current prevention methods. [Table: see text][Figure: see text]

Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk

2021 ◽  
pp. 1-8
Author(s):  
Dhruv Gupta ◽  
Jeffrey A. Reinbolt ◽  
Cyril J. Donnelly
Keyword(s):  
Internal Rotation ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Whole Body ◽  
Jump Landing ◽  
Peak Knee ◽  
Knee Abduction ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.

scholarly journals One-leg rise performance and associated knee kinematics in ACL-deficient and ACL-reconstructed persons 23 years post-injury

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrew Strong ◽  
Eva Tengman ◽  
Divya Srinivasan ◽  
Charlotte K. Häger
Keyword(s):  
Cruciate Ligament ◽  
Scientific Evidence ◽  
Knee Kinematics ◽  
Acl Injury ◽  
Cross Sectional Study ◽  
Knee Function ◽  
Post Injury ◽  
Discriminative Ability ◽  
Cross Sectional ◽  
Knee Abduction

Abstract Background Research indicates reduced knee function and stability decades after anterior cruciate ligament (ACL) injury. Assessment requires reliable functional tests that discriminate such outcomes from asymptomatic knees, while providing suitable loading for different populations. The One-leg rise (OLR) test is common in clinics and research but lacks scientific evidence for its implementation. Our cross-sectional study compared performance including knee kinematics of the OLR between ACL-injured persons in the very long term to controls and between legs within these groups, and assessed the within-session reliability of the kinematics. Methods Seventy ACL-injured individuals (mean age 46.9 ± 5.4 years) treated with either reconstructive surgery and physiotherapy (ACLR; n = 33) or physiotherapy alone (ACLPT; n = 37), on average 23 years post-injury, and 33 age- and sex-matched controls (CTRL) attempted the OLR. Participants completed as many repetitions as possible to a maximum of 50 while recorded by motion capture. We compared between all groups and between legs within groups for total repetitions and decomposed the OLR into movement phases to compare phase completion times, maximum and range of knee abduction and adduction angles, and mediolateral knee control in up to 10 repetitions per participant. Results ACLPT performed significantly fewer OLR repetitions with their injured leg compared to the CTRL non-dominant leg (medians 15 and 32, respectively) and showed significantly greater knee abduction than ACLR and CTRL (average 2.56°-3.69° depending on phase and leg). Distribution of repetitions differed between groups, revealing 59% of ACLPT unable to complete more than 20 repetitions on their injured leg compared to 33% ACLR and 36% CTRL for their injured and non-dominant leg, respectively. Within-session reliability of all kinematic variables for all groups and legs was high (ICC 3,10 0.97–1.00, 95% CI 0.95–1.00, SEM 0.93–1.95°). Conclusions Negative outcomes of OLR performance, particularly among ACLPT, confirm the need to address aberrant knee function and stability even decades post-ACL injury. Knee kinematics derived from the OLR were reliable for asymptomatic and ACL-injured knees. Development of the OLR protocol and analysis methods may improve its discriminative ability in identifying reduced knee function and stability among a range of clinical populations.

scholarly journals The Influence of Asymptomatic Hypermobility on Unanticipated Cutting Biomechanics

2021 ◽  
pp. 194173812199906
Author(s):  
Ivana Hanzlíková ◽  
Jim Richards ◽  
Josie Athens ◽  
Kim Hébert-Losier
Keyword(s):  
Injury Risk ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Joint Hypermobility ◽  
Mean Difference ◽  
Initial Contact ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Acl Injuries ◽  
Peak Knee

Background: Generalized joint hypermobility is an important risk factor for knee injuries, including to the anterior cruciate ligament (ACL). Examining movement patterns specific to hypermobile individuals during sport-specific movements could facilitate development of targeted recommendations and injury prevention programs for this population. Hypothesis: Asymptomatic hypermobile participants will present kinematics measures suggestive of a greater risk of noncontact knee or ACL injuries. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Forty-two (15 asymptomatic hypermobile and 27 nonhypermobile) individuals performed unanticipated side-step cutting on their dominant and nondominant legs. Ankle, knee, hip, pelvis, and trunk angles in all planes of motion were collected during the first 100 ms after initial contact using a 3-dimensional infrared system. Precontact foot-ground angles were also extracted. Data from hypermobile and nonhypermobile groups were compared using multiple regression models with sex as a confounder. When nonsignificant, the confounder was removed from the model. Effect sizes (Hedge g) were calculated in the presence of significant between-group differences. Results: Hypermobile individuals presented with lower minimum knee valgus angles with a mean difference of 3.5° ( P = 0.03, Hedge g = 0.69) and greater peak knee external rotation angles with a mean difference of −4.5° ( P = 0.04, Hedge g = 0.70) during dominant leg cutting, and lower peak ankle plantarflexion angles with a mean difference of 4.5° ( P = 0.03, Hedge g = 0.73) during nondominant leg cutting compared with nonhypermobile individuals. Conclusions: Based on current scientific evidence, however, the identified differences are not crucial biomechanical injury risk factors that could predispose asymptomatic hypermobile individuals to noncontact knee or ACL injuries. Clinical Relevance: Further research is needed to highlight differences between hypermobility groups. Knowledge of the differences between these groups may change the physical activity recommendations, prevention of injury, and rehabilitation approaches.

scholarly journals Lower Extremity Landing Biomechanics in Both Sexes After a Functional Exercise Protocol

2015 ◽  
Vol 50 (9) ◽  
pp. 914-920 ◽  
Author(s):  
Caroline A. Wesley ◽  
Patricia A. Aronson ◽  
Carrie L. Docherty
Keyword(s):  
Sex Differences ◽  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Movement Analysis ◽  
Acl Injury ◽  
Analysis Tool ◽  
Exercise Protocol ◽  
Cross Sectional ◽  
Landing Biomechanics

Context Sex differences in landing biomechanics play a role in increased rates of anterior cruciate ligament (ACL) injuries in female athletes. Exercising to various states of fatigue may negatively affect landing mechanics, resulting in a higher injury risk, but research is inconclusive regarding sex differences in response to fatigue. Objective To use the Landing Error Scoring System (LESS), a valid clinical movement-analysis tool, to determine the effects of exercise on the landing biomechanics of males and females. Design Cross-sectional study. Setting University laboratory. Patients or Other Participants Thirty-six (18 men, 18 women) healthy college-aged athletes (members of varsity, club, or intramural teams) with no history of ACL injury or prior participation in an ACL injury-prevention program. Intervention(s) Participants were videotaped performing 3 jump-landing trials before and after performance of a functional, sportlike exercise protocol consisting of repetitive sprinting, jumping, and cutting tasks. Main Outcome Measure(s) Landing technique was evaluated using the LESS. A higher LESS score indicates more errors. The mean of the 3 LESS scores in each condition (pre-exercise and postexercise) was used for statistical analysis. Results Women scored higher on the LESS (6.3 ± 1.9) than men (5.0 ± 2.3) regardless of time (P = .04). Postexercise scores (6.3 ± 2.1) were higher than preexercise scores (5.0 ± 2.1) for both sexes (P = .01), but women were not affected to a greater degree than men (P = .62). Conclusions As evidenced by their higher LESS scores, females demonstrated more errors in landing technique than males, which may contribute to their increased rate of ACL injury. Both sexes displayed poor technique after the exercise protocol, which may indicate that participants experience a higher risk of ACL injury in the presence of fatigue.

scholarly journals Is There a Sex Difference in Trunk Neuromuscular Control among Recreational Athletes during Cutting Maneuvers?

2021 ◽  
pp. 743-750
Author(s):  
Guillaume Mornieux ◽  
Dominic Gehring ◽  
Albert Gollhofer
Keyword(s):  
Injury Risk ◽  
Neuromuscular Control ◽  
Trunk Muscles ◽  
Trunk Control ◽  
Joint Injury ◽  
Recreational Athletes ◽  
Peak Knee ◽  
Knee Abduction ◽  
Knee Joint Injury ◽  
Weight Acceptance

Trunk motion is most likely to influence knee joint injury risk, but little is known about sex-related differences in trunk neuromuscular control during changes of direction. The purpose of the present study was to test whether differences in trunk control between males and females during changes of direction exist. Twelve female and 12 male recreational athletes (with at least 10 years of experience in team sport) performed unanticipated changes of direction with 30° and 60° cut angles, while 3D trunk and leg kinematics, ground reaction forces and trunk muscles electromyography were recorded. Trunk kinematics at the time of peak knee abduction moment and directed co-contraction ratios for trunk muscles during the pre-activation and weight acceptance phases were determined. None of the trunk kinematics and co-contraction ratio variables, nor peak knee abduction moment differed between sexes. Compared to the 30° cut, trunk lateral flexion remained unchanged and trunk external rotation was reduced (p < 0.001; η²p (partial eta squared for effect size) = 0.78), while peak knee abduction moment was increased (p < 0.001; η²p = 0.84) at 60°. The sharper cutting angle induced muscle co-contraction during the pre-activation directed less towards trunk flexors (p < 0.01; η²p = 0.27) but more towards trunk medial flexors and rotators opposite to the movement direction (p < 0.001; η²p > 0.46). However, muscle co-contraction during the weight acceptance phase remained comparable between 30° and 60°. The lack of sex-related differences in trunk control does not explain knee joint injury risk discrepancies between sexes during changes of direction. Trunk neuromuscular strategies during sharper cutting angles revealed the importance of external oblique muscles to maintain trunk lateral flexion at the expense of trunk rotation. This provides new information for trunk strength training purposes for athletes performing changes of direction.

Sign in / Sign up

Export Citation Format

Share Document