Sagittal knee joint kinematics and energetics in response to different landing heights and techniques

Higher knee joint work is a risk factor for patellar tendinopathy in male volleyball players: A prospective study

This study aimed to prospectively investigate knee jump-landing biomechanics associated as risk factors for patellar tendinopathy (PT) in volleyball players. Seventy-nine healthy male volleyball players were followed during one season. Pre-season, three-dimensional full-body biomechanics were collected during spike jump, block jump and drop vertical jump. During follow-up, injury data were collected by using a weekly and 3-monthly online retrospective control questionnaire. Univariate cox regression with competing risk analysis was used to identify contributors to the development of PT (p < 0.05). Ten volleyball players (13%) developed PT during follow-up. No knee kinematic risk factors for PT were identified. Increased concentric knee joint work during all jump-landing tasks (block jump Hazard Ratio (HR) = 1.323, p = 0.012; spike jump HR = 1.200, p = 0.033; drop vertical jump HR = 1.240, p = 0.036) and increased eccentric knee joint work during the block jump (HR = 1.246, p = 0.035) were predictive parameters to develop PT. The results of this study suggest that knee joint work is an important measure in the prevention of PT, whereas the evaluation of joint kinematics is not sensitive enough to predict this overuse injury. Further research is needed to investigate if adaptation of the defined risk factors could prevent PT.

Sponge Mats, but not Taekwondo Mats, Reduce Landing Impact From Heights of 0.45, 0.90, and 1.35 m in Taekwondo Gyeokpa Players

CONTEXT

This study compared landing impact between 3 landing heights on 3 landing surfaces by quantifying vertical ground reaction force (vGRF) profile and knee joint angle.

DESIGN

Crossover.

METHODS

Nineteen healthy male college Taekwondo (TKD) Gyeokpa players (age: 20.7 [2.6] y, height: 1.73 [0.05] m, mass: 65.5 [7.1] kg, and athletic careers: 5.9 [3.2] y) performed 2-leg landings from 3 different heights (0.45, 0.90, and 1.35 m) on 3 different surfaces (uncovered force plates on the ground, a 2-cm thick TKD or a 14-cm thick sponge mat over the force plates). Peak vGRF, time to peak vGRF, and knee joint angle in the dominant leg were analyzed using analysis of variance and functional data analysis (α = .05).

RESULTS

There was a height by surface interaction in peak vGRF (F4,144 = 2.54, P = .04) and time to peak vGRF (F4,144 = 7.62, P < .0001), but not for knee joint angle (F4,144 = 0.51, P = .73). Increased peak vGRF and shortened time to peak vGRF were observed as landing height increased on each landing surface (P < .0001 for all tests). Functional data analysis revealed that landing on the TKD mat increased vGRF by 0.4× body weight (P < .0001) at a landing height of 0.90 m or higher, whereas landing on the sponge mat reduced vGRF (<0.9× body weight), delayed time to reach peak vGRF (<30 ms, P < .0001), and maintained knee flexion angle (<10.3°, P < .01), compared with landing on the ground.

CONCLUSIONS

The TKD mat was ineffective in reducing the landing impact as similar landing biomechanics were observed between landing on the ground and the TKD mat. We recommend the use of the sponge mat to reduce landing impact as it attenuated vGRF, delayed time to reach peak vGRF, and maintained sagittal plane landing posture, as compared with landing on the ground and the TKD mat.

The effect of fatigue on peak Achilles tendon force in Irish dancing-specific landing tasks

Achilles tendinopathy is prevalent among Irish dancers, believed to be due to aesthetic technical requirements and high-impact landing tasks. However, the peak Achilles tendon force during Irish dancing-specific landing tasks has not been quantified. Furthermore, the influence of fatigue is unclear. This study aimed to quantify the peak Achilles tendon force during three common Irish dancing landing tasks and investigate the effects of fatigue on this force. Twelve nationally competitive Irish dancers completed the landing tasks prior to and following a fatigue protocol. A Vicon motion analysis system and AMTI force plates were used to calculate sagittal plane ankle joint kinematics during landing to estimate peak Achilles tendon force. Three independent measures (Rating-of-Fatigue scale, Flight time: Contraction during a counter movement jump and jump height during the landing trials) were used to evaluate participant fatigue between conditions. Results revealed a significant difference in peak Achilles tendon force between the three landing tasks, however, no significant difference was observed between pre- and post-fatigue. Further research is required to investigate the effects of the landing technique used in Irish Dancing on peak Achilles tendon force with the aim to reduce peak Achilles tendon force and the risk of developing Achilles tendinopathy.

Different strategies for landing from different heights among people with chronic ankle instability

BACKGROUND

Lateral ankle sprain (LAS) usually occurs during landing from heights among people with chronic ankle instability (CAI). Although the kinematics when landing on the flat surface has been reported, no studies have explored the effect of different heights on the landing strategies using a trapdoor device among people with CAI.

RESEARCH QUESTION

Do people with CAI adopt different landing strategies when drop-landing on the trapdoor device from three heights?

METHODS

Thirty-one participants with CAI (24 males and 7 females, age=21.1±1.8 years, height=176.9±7.4 cm, body mass=71.9±9.2 kg, injured side=18 R&13 L) were recruited. They dropped from three different heights (low height (16 cm), medium height (23 cm), high height (30 cm)) with their affected foot landing on a movable surface of a trapdoor device, which was tilted 24° inward and 15° forward to simulate LAS. Kinematic data was collected using a twelve-camera motion capture system. One-way analysis of variance with repeated measures was used to compare the differences between the three heights.

RESULTS

Significant height effects were detected in the peak ankle inversion angle (p=0.009, η2p=0.280) and angular velocity (p<0.001, η2p=0.444), and the peak ankle plantarflexion (p=0.002, η2p=0.360), knee flexion (p<0.001, η2p=0.555), and hip flexion (p=0.030, η2p=0.215) angles at the time of peak ankle inversion. Post-hoc tests showed that all the angles and velocities were higher at a low height than at medium (p: 0.001-0.045, d: 0.14-0.44) and high heights (p: 0.001-0.023, d: 0.28-0.66), except for the ankle plantarflexion angle, which was lower at a low height than at medium (p<0.001, d=0.44) and high (p=0.021, d=0.38) heights.

SIGNIFICANCE

People with CAI adopt a protective strategy during drop-landing at medium and high heights compared to a low height. This strategy involves increased ankle dorsiflexion angle as well as knee and hip flexion angles.

The impact of landing forces on repeated jumping performance

BACKGROUND

High-velocity concentric actions can be negatively impacted by cumulative fatigue during plyometric training. Reducing vertical ground reaction forces (GRF) upon landing could decrease eccentric demands, potentially minimizing fatigue, maintaining concentric performance, and benefiting concentric training adaptations. Therefore, this study examined the effect of intentionally higher and lower landing vertical GRF on the ability to sustain concentric jumping performance.

METHODS

Twenty men (25.2±3.5 years) performed 30 maximal effort jumps over a 50 cm hurdle (high-landing GRF) and onto a 50 cm box (low-landing GRF), on two separate occasions in a counter-balanced order. Jumps were measured using two force platforms (one for takeoff and one for landing) and a linear position transducer. The 30 jumps were divided into 5 groups of 6 repetitions, and the mean value for each group was analyzed.

RESULTS

There was no significant condition × repetition group interaction for any parameters, indicating that the greater landing GRF during hurdle jumps did not negatively affect concentric jump performance throughout the 30 jumps. Concentric velocities and jump height were significantly greater during box jumps compared to hurdle jumps.

CONCLUSIONS

Thirty maximal-effort jumps did not cause fatigue-related decrease of performance, independent of jump type (i.e., the magnitude of landing GRF). Although, reduced vertical GRF upon landing appears to have a neutral-to-positive effect on concentric jumping performance. Therefore, reducing landing GRF, such as by using BJs, could acutely augment jumping performance and help to reduce cumulative training load.

Differences in lower extremity joint stiffness during drop jump between healthy males and females

The primary purpose of this study was to examine sex differences in lower extremity joint stiffness during vertical drop jump performance. A secondary purpose was to examine the potential influence of sex on the relationship between joint stiffness and jump performance. Thirty healthy and active individuals performed 15-drop jumps from 30 and 60 cm boxes. Hip, knee, and ankle joint stiffnesses were calculated for subphases of landing using a 2nd order polynomial regression model. Males had greater hip stiffness during the loading phase in drop jumps from both box heights than females' drop jump from 60 cm box. Also, males had a greater ground reaction force at the end of eccentric phase, net jump impulse, and jump height regardless of box height. The 60 cm box height increased knee stiffness during the loading phase, but reduced hip stiffness during the loading phase and knee and ankle stiffness during the absorption phase regardless of sex. Joint stiffnesses significantly predicted drop jump height for females (p < .001, r2 = 0.579), but not for males (p = .609, r2 = -0.053). These results suggest that females may have different strategies to maximize drop jump height as compared to males.

Dorsiflexion shoes affect joint-level landing mechanics related to lower extremity injury risk in females

Athletic shoes that induce dorsiflexion in standing can improve jump height compared to traditional athletic shoes that induce plantarflexion, but it is unknown if dorsiflexion shoes (DF) also affect landing biomechanics associated with lower extremity injury risk. Thus, the purpose of this study was to investigate if DF adversely affect landing mechanics related to patellofemoral pain and anterior cruciate ligament injury risk compared to neutral (NT) and plantarflexion (PF) shoes. Sixteen females (21.65 ± 4.7 years, 63.69 ± 14.3 kg, 1.60 ± 0.05 m) performed three maximum vertical countermovement jumps in DF (-1.5°), NT (0°) and PF (8°) shoes as 3D kinetics and kinematics were recorded. One-way repeated-measures ANOVAs revealed peak vertical ground reaction force, knee abduction moment and total energy absorption were similar between conditions. At the knee, peak flexion and joint displacement were lower in DF and NT, while relative energy absorption was greater in PF (all p < .01). Conversely, relative ankle energy absorption was greater in DF and NT compared to PF (p < .01). Both DF and NT induce landing patterns that may increase strain on passive structures in the knee, emphasising the need for landing mechanics to be considered when testing footwear as gains in performance could come at the cost of injury risk.

Prelanding Knee Kinematics and Landing Kinetics During Single-Leg and Double-Leg Landings in Male and Female Recreational Athletes

Biomechanical behavior prior to landing likely contributes to anterior cruciate ligament (ACL) injuries during jump-landing tasks. This study examined prelanding knee kinematics and landing ground reaction forces (GRFs) during single-leg and double-leg landings in males and females. Participants performed landings with the dominant leg or both legs while kinematic and GRF data were collected. Single-leg landings demonstrated less time between prelanding minimal knee flexion and initial ground contact, decreased prelanding and early-landing knee flexion angles and velocities, and increased peak vertical and posterior GRFs compared with double-leg landings. Increased prelanding knee flexion velocities and knee flexion excursion correlated with decreased peak posterior GRFs during both double-leg and single-leg landings. No significant differences were observed between males and females. Prelanding knee kinematics may contribute to the increased risk of ACL injuries in single-leg landings compared with double-leg landings. Future studies are encouraged to incorporate prelanding knee mechanics to understand ACL injury mechanisms and predict future ACL injury risks. Studies of the feasibility of increasing prelanding knee flexion are needed to understand the potential role of prelanding kinematics in decreasing ACL injury risk.

The Effect of Two Types of Foot Orthoses on the Knee Valgus Angle Within Single-Leg Landing: Implications for ACL Damage Hazard Decrease

Background: Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The impact of foot orthoses during exercises that recreate a non-contact ACL harm system (i.e., landing) in any case will be obscured. Objectives: The purpose of the current study research was to evaluate the effect of two foot orthoses (semi-hard foot orthoses and hard foot orthoses) on knee valgus angle during single-leg drop landing. Methods: Twenty male leisure volleyball gamers performed landing in one-leg step from 30 cm height in 3 conditions (without foot orthoses, mid-hard foot orthoses, and hard foot orthoses). A motion capture system was used to measure lower extremity kinematics. Two risk factors of ACL injury, maximum knee valgus angle (KVA), and maximum knee flexion was measured. ANOVA was used for statistical analysis (P < 0.05). Results: With mid-hard foot, orthoses provide the maximum level of knee flexion and the minimum level of knee valgus during single-leg drop landing. Conclusions: It may be concluded showed that foot orthoses affect knee kinematics. More knee flexion and less knee valgus brought about by mid-hard foot orthoses can reduce injuries of the anterior cruciate ligament (ACL).

Muscle function during single leg landing

Landing manoeuvres are an integral task for humans, especially in the context of sporting activities. Such tasks often involve landing on one leg which requires the coordination of multiple muscles in order to effectively dissipate kinetic energy. However, no prior studies have provided a detailed description of the strategy used by the major lower limb muscles to perform single-leg landing. The purpose of the present study was to understand how humans coordinate their lower limb muscles during a single-leg landing task. Marker trajectories, ground reaction forces (GRFs), and surface electromyography (EMG) data were collected from healthy male participants performing a single-leg landing from a height of 0.31 m. An EMG-informed neuromusculoskeletal modelling approach was used to generate neuromechanical simulations of the single-leg landing task. The muscular strategy was determined by computing the magnitude and temporal characteristics of musculotendon forces and energetics. Muscle function was determined by computing muscle contributions to lower limb net joint moments, GRFs and lower limb joint contact forces. It was found that the vasti, soleus, gluteus maximus and gluteus medius produced the greatest muscle forces and negative (eccentric) mechanical work. Downward momentum of the centre-of-mass was resisted primarily by the soleus, vasti, gastrocnemius, rectus femoris, and gluteus maximus, whilst forward momentum was primarily resisted by the quadriceps (vasti and rectus femoris). Flexion of the lower limb joints was primarily resisted by the uni-articular gluteus maximus (hip), vasti (knee) and soleus (ankle). Overall, our findings provide a unique insight into the muscular strategy used by humans during a landing manoeuvre and have implications for the design of athletic training programs.

Which lower limb joints compensate for destabilizing energy during walking in humans?

Current approaches to investigating stabilizing responses during locomotion lack measures that both directly relate to perturbation demands and are shared across different levels of description (i.e. joints and legs). Here, we investigated whether mechanical energy could serve as a 'common currency' during treadmill walking with transient unilateral belt accelerations. We hypothesized that by delivering perturbations in either early or late stance, we could elicit net negative or positive work, respectively, from the perturbed leg at the leg/treadmill interface, which would dictate the net demand at the overall leg level. We further hypothesized that of the lower limb joints, the ankle would best reflect changes in overall leg work. On average across all seven participants and 222 perturbations, we found early stance perturbations elicited no change in net work performed by the perturbed leg on the treadmill, but net positive work by the overall leg, which did not support our hypotheses. Conversely, late stance perturbations partially supported our hypotheses by eliciting positive work at the leg/treadmill interface, but no change in net work by the overall leg. In support of our final hypothesis, changes in perturbed ankle work, in addition to contralateral knee work, best reflected changes in overall leg work.

Effects of Squatting Speed and Depth on Lower Extremity Kinematics, Kinetics and Energetics

Squatting has received considerable attention in sports and is commonly utilized in daily activities. Knowledge of the squatting biomechanics in terms of its speed and depth may enhance exercise selection when targeting for sport-specific performance improvement and injury avoidance. Nonetheless, these perspectives have not been consistently reported. Hence, this preliminary study intends to quantify the kinematics, kinetics, and energetics in squat with different depths and speeds among healthy young adults with different physical activity levels; i.e., between active and sedentary groups. Twenty participants were administered to squat at varying depths (deep, normal, and half) and speeds (fast, normal, and slow). Motion-capture system and force plates were employed to acquire motion trajectories and ground reaction force. Joint moment was obtained via inverse dynamics, while power was derived as a product of moment and angular velocity. Higher speeds and deeper squats greatly influence higher joint moments and powers at the hip ([Formula: see text]) and knee ([Formula: see text]) than ankle, signifying these joints as the prime movers with knee as the predominant contributor. These preliminary findings show that the knee-strategy and hip-strategy were employed in compensating speed and depth manipulations during squatting. In certain contexts, appreciating these findings may provide clinically relevant implications, from the performance and injury avoidance viewpoint, which will ameliorate the physical activity level of practitioners.

Biomechanical Characteristics between Bionic Shoes and Normal Shoes during the Drop-Landing Phase: A Pilot Study

With the development of unstable footwear, more research has focused on the advantages of this type of shoe. This type of shoe could improve the muscle function of the lower limb and prevent injury risks in dynamic situations. Therefore, the purpose of this study was to investigate differences in lower-limb kinetics and kinematics based on single-leg landing (SLL) using normal shoes (NS) and bionic shoes (BS). The study used 15 male subject volunteers (age 23.4 ± 1.14 years, height 177.6 ± 4.83cm, body weight (BW) 73.6 ± 7.02 kg). To ensure the subject standardization of the participants, there were several inclusion criteria used for selection. There were two kinds of experimental shoes used in the landing experiment to detect the change of lower limbs when a landing task was performed. Kinetics and kinematic data were collected during an SLL task, and statistical parametric mapping (SPM) analysis was used to evaluate the differences between NS and BS. We found that the flexion and extension angles of the knee (p = 0.004) and hip (p = 0.046, p = 0.018) joints, and the dorsiflexion and plantarflexion of ankle (p = 0.031) moment were significantly different in the sagittal planes. In the frontal plane, the eversion and inversion of the ankle (p = 0.016), and the abduction and adduction of knee (p = 0.017, p = 0.007) angle were found significant differences. In the horizontal plane, the external and internal rotation of hip (p = 0.036) and knee (p < 0.001, p = 0.029) moment were found significant differences, and knee angle (p = 0.043) also. According to our results, we conclude that using BS can cause bigger knee and hip flexion than NS. Also, this finding indicates that BS might be considered to reduce lower-limb injury risk during the SLL phase.

Dynamic Characteristics of Approach Spike Jump Tasks in Male Volleyball Players

The approach running spike-jump (RSJ) is a crucial technique in the sport of volleyball. Two types of RSJs are commonly used for the volleyball spike attack: (1) RSJ with one leg (RSJ-1L) and (2) RSJ with two legs (RSJ-2L). The purposes of the current study were to compare the kinematic and kinetic differences between the RSJ-1L and RSJ-2L. Ten male college volleyball players performed spike jumps by striking a stationary ball at maximal jump height. Data were collected by six infrared Qualisys motion-capture cameras (180 Hz), two AMTI force platforms (1800 Hz), and recorded by Qualisys Track Manager software. The RSJ-1L demonstrated the faster three-step approach running velocity, greater vertical GRF, and ankle, knee, and hip joint moment, but less jump height, shorter last step length and push-off time, smaller knee and hip joint flexion angles at the initial foot-contact, and knee range of motion compared to the RSJ-2L. The current study contributed to the understanding of biomechanical differences of the volleyball spike jumps and can be used to adapt to the volleyball training.

Acute and Delayed Effects of Fatigue on Ground Reaction Force, Lower Limb Stiffness and Coordination Asymmetries During a Landing Task

Landing is a critical phase of movement for injury occurrence, in which lower limbs should be used equally to better absorb the shock. However, it has been suggested that fatigue can lead to the appearance of asymmetries. The aim of this study was to verify the acute and delayed effects of fatigue on the lower limb asymmetry indexes of peak ground reaction force, leg stiffness and intra-limb coordination during a landing task. Fifteen physically active men performed a fatigue protocol composed of 14 sets of 10 continuous vertical jumps, with a one-minute rest interval between the sets. A step-off landing task was performed before, immediately after, 24 h and 48 h after the fatigue protocol. Two force plates and a video analysis system were used. The symmetry index equation provided the asymmetry indexes. For statistical analysis, ANOVA and effect size analysis were utilized. Inferential statistics did not show the effect of fatigue in the asymmetry indexes for any variable or condition (p > .05). Moderate effect sizes were observed for peak ground reaction force (0.61) and leg stiffness (0.61) immediately after the application of the protocol. In conclusion, fatigue does not seem to significantly change the asymmetries of lower limbs, especially regarding intra-limb coordination. The moderate effects observed for peak ground reaction force and leg stiffness asymmetries suggest that these variables may be acutely affected by fatigue.

Joint Coordination and Stiffness During Landing in Individuals With Chronic Ankle Instability

The purpose of the present study was to examine the effect of chronic ankle instability (CAI) on lower-extremity joint coordination and stiffness during landing. A total of 21 female participants with CAI and 21 pair-matched healthy controls participated in the study. Lower-extremity joint kinematics were collected using a 7-camera motion capture system, and ground reaction forces were collected using 2 force plates during drop landings. Coupling angles were computed based on the vector coding method to assess joint coordination. Coupling angles were compared between the CAI and control groups using circular Watson-Williams tests. Joint stiffness was compared between the groups using independent t tests. Participants with CAI exhibited strategies involving altered joint coordination including a knee flexion dominant pattern during 30% and 70% of their landing phase and a more in-phase motion pattern between the knee and hip joints during 30% and 40% and 90% and 100% of the landing phase. In addition, increased ankle inversion and knee flexion stiffness were observed in the CAI group. These altered joint coordination and stiffness could be considered as a protective strategy utilized to effectively absorb energy, stabilize the body and ankle, and prevent excessive ankle inversion. However, this strategy could result in greater mechanical demands on the knee joint.

Acute Effect of Ankle Kinesio™ Taping on Lower-Limb Biomechanics During Single-Legged Drop Landing

CONTEXT

Chronic ankle instability is documented to be followed by a recurrence of giving away episodes due to impairments in mechanical support. The application of ankle Kinesiotaping (KT) as a therapeutic intervention has been increasingly raised among athletes and physiotherapists.

OBJECTIVES

This study aimed to investigate the impacts of ankle KT on the lower-limb kinematics, kinetics, dynamic balance, and muscle activity of college athletes with chronic ankle instability.

DESIGN

A crossover study design.

PARTICIPANTS

Twenty-eight college athletes with chronic ankle sprain (11 females and 17 males, 23.46 [2.65] y, 175.36 [11.49] cm, 70.12 [14.11] kg) participated in this study.

SETTING

The participants executed 3 single-leg drop landings under nontaped and ankle Kinesio-taped conditions. Ankle, knee, and hip kinematics, kinetics, and dynamic balance status and the lateral gastrocnemius, medial gastrocnemius, tibialis anterior, and peroneus longus muscle activity were recorded and analyzed.

RESULTS

The application of ankle KT decreased ankle joint range of motion (P = .039) and angular velocities (P = .044) in the sagittal plane, ground reaction force rate of loading (P = .019), and mediolateral time to stability (P = .035). The lateral gastrocnemius (0.002) and peroneus longus (0.046) activity amplitudes also experienced a significant decrease after initial ground contact when the participants' ankles were taped, while the application of ankle KT resulted in an increase in the peroneus longus (0.014) activity amplitudes before initial ground contact.

CONCLUSIONS

Ankle lateral supports provided by KT potentially decreases mechanical stresses applied to the lower limbs, aids in dynamic balance, and lowers calf muscle energy consumption; therefore, it could be offered as a suitable supportive means for acute usage in athletes with chronic ankle instability.

Ankle-knee coupling responses to ankle Kinesio™ taping during single-leg drop landings in collegiate athletes with chronic ankle instability

BACKGROUND

Ankle Kinesio-taping (KT) is being globally used an intervention to provide the ankle joint complex with sufficient support against sudden excessive mechanical stress during various activities. However, its effects on proximal joints are unclear. This study investigated the impact of ankle KT on ankle-knee joint coupling in sagittal, frontal and transverse planes.

METHODS

Adopting a pretest post-test study design, 30 collegiate athletes with chronic ankle instability performed 3 single-leg drop landings in each non-taped and Kinesio-taped conditions and their movement kinematics were recorded using 6 optoelectronic cameras.

RESULTS

The ankle angular velocities in sagittal (P=0.038, d=0.64) and transverse planes (P=0.001, d=0.95) decreased after KT application, while the knee internal rotation velocities increased (P=0.020, d=0.51). The coupling angles revealed that the ankle movement ratios significantly decreased in 3 planes in comparison with knee movement ratios.

CONCLUSIONS

Outcomes of this study illustrated that application of ankle KT leaves the individuals with a stiffer ankle joint, which increases the mechanical stresses to this joint and decreases its stiffness in absorbing the applied shocks. Further, ankle KT application resulted in more knee internal rotation moments and may increase the risk of knee injuries during landing after a long-term usage in patients with instability ankle sprain.

Falling as a strategy to decrease knee loading during landings: Implications for ACL injury prevention

Anterior cruciate ligament (ACL) injuries often occur when individuals land primarily on a single leg. Falling has been proposed as a potential strategy to decrease knee loading during landings. The purpose of this study was to compare impact forces, knee angles, and knee moments during natural landings, soft landings, and landings followed by falling after forward and vertical jumps, each under single or double-leg conditions. Sixteen male and sixteen female participants (age: 22.0 ± 2.9 years) completed each landing condition while kinematics and ground reaction forces were collected. In the natural landing condition, participants landed as they would in a sport setting. In the soft landing condition, participants landed as softly as possible with increased knee and hip flexion. In the falling condition, participants landed softly and then fell forward or backward onto a mat after forward and vertical jumps, respectively. The falling condition demonstrated the greatest initial and peak knee flexion angles, the least peak vertical ground reaction forces, and the least peak knee extension and adduction moments compared to the natural landing and soft landing conditions. The soft landing condition resulted in similar changes in landing mechanics compared to the natural landing, but the effect was limited for single-leg landings compared to double-leg landings. When the sports environment allows, falling appears to be a potential strategy to decrease knee loading when individuals must land on a single leg with sub-optimal body postures. Future studies are needed to develop progressive training of effective and safe falling techniques.

Can kinematic and kinetic differences between planned and unplanned volleyball block jump-landings be associated with injury risk factors?

INTRODUCTION

Injury prevention programs for athletes are still limited by a lack of understanding of specific risk factors that can influence injuries within different sports. The majority of studies on volleyball have not considered the movement patterns when moving in different directions or in planned and unplanned block jump-landings.

METHODS

This study investigated all planes mechanics between the lead and trail limb when moving in dominant and non-dominant directions, for both planned and unplanned jump-landings in thirteen semi-professional female volleyball players. Ankle, knee and hip joint kinematics, kinetics and joint stiffness were recorded.

RESULTS

Our results showed statistically significant differences between the lead limb and the trail limb in the hip flexion angles, moments and velocity; in the knee flexion angles, moments, stiffness, power and energy absorption and in the ankle dorsiflexion, power and energy absorption, showing a tendency where the lead limb has a higher injury risk than the trail limb. When considering planned versus unplanned situations, there were statistically significant differences in knee flexion angles, moments, power and energy absorption; and hip contact angle, flexion angular velocity and energy absorption, with musculoskeletal adaptations in the planned situations.

DISCUSSION

It appears that the role of the limb, either lead or trail, is more important than the limb dominance when performing directional jump-landings, with the lead limb having a higher implication on possible overuse injuries than the trail limb. Furthermore, planned movements showed a difference in strategy indicating greater implications to possible overuse injuries than in the unplanned situations which may be associated with more conscious thought about the movements.

CONCLUSION

Coaches should consider unilateral coordination training in both landing directions for the lead and trail limb, and should adapt training to replicate the competition environment, using unplanned situations to minimize asymmetries to might reduce injury risks.

Effects of synthetic turf and shock pad on impact attenuation related biomechanics during drop landing

Adding a shock pad as an underlayment to synthetic turf aims to improve attenuation of impact forces. The purpose of this research was to investigate effects of an infilled synthetic turf with three different shock pads on impact attenuation related biomechanics of lower extremity during the drop landing. Twelve active and healthy recreational male athletes performed 60 cm drop landing with a controlled landing technique on five surface conditions: a baseline surface (force platform), an infilled synthetic turf surface, turf plus foam shock pad, turf plus a low-density shock pad, and turf plus a high-density shock pad. Furthermore, a mechanical impact test was conducted (ASTM F355). Turf plus foam shock pad, turf plus low-density shock pad, and turf plus high-density shock pad all resulted in significantly lower 1st vertical peak ground reaction force (13.3%, 13.3%, and 12.7% reductions, respectively) and loading rate (20.4%, 25.4%, and 21.1% reductions, respectively) compared to baseline surface. Significantly greater trunk extension moment was found on turf plus low-density shock pad compared to turf surface (21.2%) and turf plus foam shock pad (12.0%). These results suggest that synthetic turf plus shock pad surfaces provide improved impact attenuation compared to baseline surface in the early landing phase.

Mechanisms to Attenuate Load in the Intact Limb of Transtibial Amputees When Performing a Unilateral Drop Landing

Individuals with unilateral transtibial amputations experience greater work demand and loading on the intact limb compared with the prosthetic limb, placing this limb at a greater risk of knee joint degenerative conditions. It is possible that increased loading on the intact side may occur due to strength deficits and joint absorption mechanics. This study investigated the intact limb mechanics utilized to attenuate load, independent of prosthetic limb contributions and requirements for forward progression, which could provide an indication of deficiencies in the intact limb. Amputee and healthy control participants completed 3 unilateral drop landings from a 30-cm drop height. Joint angles at touchdown; range of motion; coupling angles; peak powers; and negative work of the ankle, knee, and hip were extracted together with isometric quadriceps strength measures. No significant differences were found in the load or movement mechanics (P ≥ .31, g ≤ 0.42), despite deficits in isometric maximum (20%) and explosive (25%) strength (P ≤ .13, g ≥ 0.61) in the intact limb. These results demonstrate that, when the influence from the prosthetic limb and task demand are absent, and despite deficits in strength, the intact limb adopts joint mechanics similar to able-bodied controls to attenuate limb loading.

Surface properties affect the interplay between fascicles and tendinous tissues during landing

PURPOSE

Muscle-tendon units are forcefully stretched during rapid deceleration events such as landing. Consequently, tendons act as shock absorbers by buffering the negative work produced by muscle fascicles likely to prevent muscle damage. Landing surface properties can also modulate the amount of energy dissipated by the body, potentially effecting injury risk. This study aimed to evaluate the influence of three different surfaces on the muscle-tendon interactions of gastrocnemius medialis (GM), and vastus lateralis (VL) during single- and double-leg landings from 50 cm.

METHODS

Ultrasound images, muscle activity and joint kinematics were collected for 12 participants. Surface testing was also performed, revealing large differences in mechanical behavior.

RESULTS

During single-leg landing, stiffer surfaces increased VL fascicle lengthening and velocity, and muscle activity independent of joint kinematics while GM length changes showed no difference between surfaces. Double-leg landing resulted in similar fascicle and tendon behavior despite greater knee flexion angles on stiffer surfaces.

CONCLUSION

This demonstrates that VL fascicle lengthening is greater when the surface stiffness increases, when performing single-leg landing. This is due to the combination of limited knee joint flexion and lower surface absorption ability which resulted in greater mechanical demand mainly withstood by fascicles. GM muscle-tendon interactions remain similar between landing surfaces and types. Together, this suggests that surface damping properties primarily affect the VL muscle-tendon unit with a potentially higher risk of injury as a result of increased surface stiffness when performing single-leg landing tasks.

Altered Movement Biomechanics in Chronic Ankle Instability, Coper, and Control Groups: Energy Absorption and Distribution Implications

CONTEXT

Patients with chronic ankle instability (CAI) exhibit deficits in neuromuscular control, resulting in altered movement strategies. However, no researchers have examined neuromuscular adaptations to dynamic movement strategies during multiplanar landing and cutting among patients with CAI, individuals who are ankle-sprain copers, and control participants.

OBJECTIVE

To investigate lower extremity joint power, stiffness, and ground reaction force (GRF) during a jump-landing and cutting task among CAI, coper, and control groups.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 22 patients with CAI (age = 22.7 ± 2.0 years, height = 174.6 ± 10.4 cm, mass = 73.4 ± 12.1 kg), 22 ankle-sprain copers (age = 22.1 ± 2.1 years, height = 173.8 ± 8.2 cm, mass = 72.6 ± 12.3 kg), and 22 healthy control participants (age = 22.5 ± 3.3 years, height = 172.4 ± 13.3 cm, mass = 72.6 ± 18.7 kg).

INTERVENTION(S)

Participants performed 5 successful trials of a jump-landing and cutting task.

MAIN OUTCOME MEASURE(S)

Using motion-capture cameras and a force plate, we collected lower extremity ankle-, knee-, and hip-joint power and stiffness and GRFs during the jump-landing and cutting task. Functional analyses of variance were used to evaluate between-groups differences in these dependent variables throughout the contact phase of the task.

RESULTS

Compared with the coper and control groups, the CAI group displayed (1) up to 7% of body weight more posterior and 52% of body weight more vertical GRF during initial landing followed by decreased GRF during the remaining stance and 22% of body weight less medial GRF across most of stance; (2) 8.8 W/kg less eccentric and 3.2 W/kg less concentric ankle power, 6.4 W/kg more eccentric knee and 4.8 W/kg more eccentric hip power during initial landing, and 5.0 W/kg less eccentric knee and 3.9 W/kg less eccentric hip power; and (3) less ankle- and knee-joint stiffness during the landing phase. Concentric power patterns were similar to eccentric power patterns.

CONCLUSIONS

The CAI group demonstrated altered neuromechanics, redistributing energy absorption from the distal (ankle) to the proximal (knee and hip) joints, which coincided with decreased ankle and knee stiffness during landing. Our data suggested that although the coper and control groups showed similar landing and cutting strategies, the CAI group used altered strategies to modulate impact forces during the task.

A Review of Field-Based Assessments of Neuromuscular Control and Their Utility in Male Youth Soccer Players

Read, PJ, Oliver, JL, Croix, MS, Myer, GD, and Lloyd, RS. A review of field-based assessments of neuromuscular control and their utility in male youth soccer players. J Strength Cond Res 33(1): 283-299, 2019-Lower-extremity injuries in male youth soccer are common and equate to a substantial time loss from training and competitions during the course of a season. Extended periods of absence will impact player involvement in skill and physical development activities, as well as participation in competitive match play. Neuromuscular risk factors for lower-extremity injury in male youth soccer players can be categorized into quadriceps dominance, leg dominance, ligament dominance, trunk dominance, and reduced dynamic stability. Valid screening methods to identify risk factors that are practically viable are needed for youth athletes who may be at a greater risk of injury in soccer. Although field-based tests of neuromuscular control provide a reliable option for the assessment of injury risk in adults and females, less data are available in male youth soccer players, and further research is required to examine their ability to predict injury risk. This article provides a review of the current literature pertaining to field-based screening tests and critically appraises their suitability for use with male youth soccer players. Currently, the only method that has been validated in male youth soccer players is the landing error scoring system. Asymmetrical anterior reach measured during the Y-Balance test may also be considered because of its strong predictive ability in male youth basketball players; however, further research is required to fully support its use with soccer players.

Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping

INTRODUCTION

Skeletal muscles absorb and transfer kinetic energy during landing and jumping, which are common requirements of various forms of physical activity. Chronic ankle instability (CAI) is associated with impaired neuromuscular control and dynamic stability of the lower extremity. Little is known regarding an intralimb, lower-extremity joint coordination of kinetics during landing and jumping for CAI patients. We investigated the effect of CAI on lower-extremity joint stiffness and kinetic and energetic patterns across the ground contact phase of landing and jumping.

METHODS

One hundred CAI patients and 100 matched able-bodied controls performed five trials of a landing and jumping task (a maximal vertical forward jump, landing on a force plate with the test leg only, and immediate lateral jump toward the contralateral side). Functional analyses of variance and independent t-tests were used to evaluate between-group differences for lower-extremity net internal joint moment, power, and stiffness throughout the entire ground contact phase of landing and jumping.

RESULTS

Relative to the control group, the CAI group revealed (i) reduced plantarflexion and knee extension and increased hip extension moments; (ii) reduced ankle and knee eccentric and concentric power, and increased hip eccentric and concentric power, and (iii) reduced ankle and knee joint stiffness and increased hip joint stiffness during the task.

CONCLUSIONS

CAI patients seemed to use a hip-dominant strategy by increasing the hip extension moment, stiffness, and eccentric and concentric power during landing and jumping. This apparent compensation may be due to decreased capabilities to produce sufficient joint moment, stiffness, and power at the ankle and knee. These differences might have injury risk and performance implications.

Effects of Corrective Training on Drop Landing Ground Reaction Force Characteristics and Lower Limb Kinematics in Older Adults With Genu Valgus: A Randomized Controlled Trial

The aim of this study was to identify the effects of a corrective exercise program on landing ground reaction force characteristics and lower limb kinematics in older adults with genu valgus. A total of 26 older male adults with genu valgus were randomized into two groups. An experimental group conducted a 14-week corrective exercise program, whereas a control group did not perform any exercise. The experimental group displayed lower peak vertical, peak anterior and posterior, and peak medial ground reaction force components during the posttest compared with the pretest. The vertical loading rate, impulses, and free moment amplitudes were not statistically different between groups. In the experimental group, the peak knee abduction during the posttest was significantly smaller and the peak hip flexion angle was significantly greater than during the pretest. The authors suggest that this corrective exercise program may be a suitable intervention to improve landing ground reaction forces and lower limb kinematics in older male adults with genu valgus.

Evaluating Performance During Maximum Effort Vertical Jump Landings

The ability to rapidly complete a jump landing has received little attention in the literature despite the need for rapid performance in a number of sports. As such, our purpose was to investigate differences between groups of individuals who land quickly (FAST) and slowly (SLOW) relative to peak vertical ground reaction forces (vGRFs), loading rates, rates of vGRF attenuation, contributions to lower extremity mechanical energy absorption at the involved joints, and the onsets of preparatory joint flexion/dorsiflexion. Twenty-four healthy adults (26.1 [3.3] y, 75.7 [18.9] kg, 1.7 [0.1] m) were stratified into FAST and SLOW groups based on landing time across 8 jump-landing trials. Independent t tests (α = .05) and effect sizes (ESs; large ≥ 0.8) compared differences between groups. A greater rate of vGRF attenuation (P = .02; ES = 0.95) was detected in the FAST group. The FAST group also exhibited greater contributions to lower extremity energy absorption at the ankle (P = .03; ES = 0.98) and knee (P = .03; ES = 0.99) during loading and attenuation, respectively. The SLOW group exhibited greater contributions to energy absorption at the hip during loading (P = .02; ES = 1.10). Results suggest that individuals who land quickly utilize different energy absorption strategies than individuals who land slowly. Ultimately, the FAST group’s strategy resulted in superior landing performance (more rapid landing time).

The Effect of Angle and Velocity on Change of Direction Biomechanics: An Angle-Velocity Trade-Off

Changes of direction (CODs) are key manoeuvres linked to decisive moments in sport and are also key actions associated with lower limb injuries. During sport athletes perform a diverse range of CODs, from various approach velocities and angles, thus the ability to change direction safely and quickly is of great interest. To our knowledge, a comprehensive review examining the influence of angle and velocity on change of direction (COD) biomechanics does not exist. Findings of previous research indicate the biomechanical demands of CODs are 'angle' and 'velocity' dependent and are both critical factors that affect the technical execution of directional changes, deceleration and reacceleration requirements, knee joint loading, and lower limb muscle activity. Thus, these two factors regulate the progression and regression in COD intensity. Specifically, faster and sharper CODs elevate the relative risk of injury due to the greater associative knee joint loading; however, faster and sharper directional changes are key manoeuvres for successful performance in multidirectional sport, which subsequently creates a 'performance-injury conflict' for practitioners and athletes. This conflict, however, may be mediated by an athlete's physical capacity (i.e. ability to rapidly produce force and neuromuscular control). Furthermore, an 'angle-velocity trade-off' exists during CODs, whereby faster approaches compromise the execution of the intended COD; this is influenced by an athlete's physical capacity. Therefore, practitioners and researchers should acknowledge and understand the implications of angle and velocity on COD biomechanics when: (1) interpreting biomechanical research; (2) coaching COD technique; (3) designing and prescribing COD training and injury reduction programs; (4) conditioning athletes to tolerate the physical demands of directional changes; (5) screening COD technique; and (6) progressing and regressing COD intensity, specifically when working with novice or previously injured athletes rehabilitating from an injury.

Altered landing mechanics are shown by male youth soccer players at different stages of maturation

OBJECTIVES

Examine the effects of maturation on single leg jumping performance in elite male youth soccer players.

DESIGN

Cross sectional.

SETTING

Academy soccer clubs.

PARTICIPANTS

347 male youth players classified as either pre, circa or post-peak height velocity (PHV).

MAIN OUTCOME MEASURES

Single leg countermovement jump (SLCMJ) height, peak vertical landing forces (pVGRF), knee valgus and trunk side flexion.

RESULTS

Vertical jump height and absolute pVGRF increased with each stage of maturation (p < 0.001; d = 0.85-2.35). Relative to body weight, significantly higher landing forces were recorded on the left leg in circa versus post-PHV players (p < 0.05; d = -0.40). Knee valgus reduced with maturation but the only notable between-group differences were shown in post-PHV players (p < 0.05; d = 0.67); however, greater ipsilateral lateral trunk flexion angles was also present and these differences were significantly increased relative to circa-PHV players (p < 0.05; d = 0.85).

CONCLUSION

Periods of rapid growth are associated with landing kinetics which may heighten injury risk. While reductions in knee valgus were displayed with maturation; a compensatory strategy of greater trunk lateral flexion was evident in post-PHV players and this may increase the risk of injury.

Two-dimensional motion analysis of dynamic knee valgus identifies female high school athletes at risk of non-contact anterior cruciate ligament injury

PURPOSE

Female athletes are at greater risk of non-contact ACL injury. Three-dimensional kinematic analyses have shown that at-risk female athletes have a greater knee valgus angle during drop jumping. The purpose of this study was to evaluate the relationship between knee valgus angle and non-contact ACL injury in young female athletes using coronal-plane two-dimensional (2D) kinematic analyses of single-leg landing.

METHODS

Two hundred ninety-one female high school athletes newly enrolled in basketball and handball clubs were assessed. Dynamic knee valgus was analysed during single-leg drop jumps using 2D coronal images at hallux-ground contact and at maximal knee valgus. All subjects were followed up for 3 years for ACL injury. Twenty-eight (9.6%) of 291 athletes had ACL rupture, including 27 non-contact ACL injuries. The injured group of 27 knees with non-contact ACL injury was compared with a control group of 27 randomly selected uninjured knees. The relationship between initial 2D movement analysis results and subsequent ACL injury was investigated.

RESULTS

Dynamic knee valgus was significantly greater in the injured group compared to the control group at hallux-ground contact (2.1 ± 2.4 vs. 0.4 ± 2.2 cm, P = 0.006) and at maximal knee valgus (8.3 ± 4.3 vs. 5.1 ± 4.1 cm, P = 0.007).

CONCLUSION

The results of this study confirm that dynamic knee valgus is a potential risk factor for non-contact ACL injury in female high school athletes. Fully understanding the risk factors that increase dynamic knee valgus will help in designing more appropriate training and interventional strategies to prevent injuries in at-risk athletes.

LEVEL OF EVIDENCE

Prognostic studies, Level II.

The effect of knee flexor and extensor fatigue on shock absorption during cutting movements after a jump landing

BACKGROUND

Sporting situations include instances of continuous and/or integrated movements. However, the effect of fatigue on the performance of these movements remains unclear.

PURPOSE

To investigate the effect of knee flexor and extensor fatigue on the shock absorption strategy of the lower limb during cutting movements performed after jump landings.

METHODS

Twenty-four healthy participants performed cutting movements following jump landings from two heights - 30cm and 40cm - and under three levels of lower limb fatigue: pre-fatigue (100% peak knee extension torque), and post-fatigue 50% (post-50%) and 30% (post-30%) peak knee extension torque. Fatigue was induced by repeated isokinetic flexion/extension of the knee (60°/s).

RESULTS

Compared to the pre-fatigue condition, power and work at the knee joint decreased under both post-50% and post-30% conditions (P<0.001), while the work performed by the ankle (P<0.001) increased significantly. An increase in height from 30cm to 40cm was associated with an increase in the range of motion of the ankle (P<0.001) and knee (P=0.022), peak vertical ground reaction force (P<0.001), rate of loading (P<0.001), knee stiffness (P=0.026) and peak power of the knee (P<0.001), as well as the work performed by the knee (P<0.001) and hip (P<0.001) joints.

CONCLUSIONS

Under substantial muscle fatigue the proportion of shock absorption contributed by the knee for cutting movements performed after jump landings from a height of 40cm decreased; there was an adaptive increase in the contribution by the ankle.

Does chronic ankle instability influence lower extremity muscle activation of females during landing?

Much remains unclear about how chronic ankle instability (CAI) could affect knee muscle activations and interact with knee biomechanics. Therefore, the purpose of this study was to assess the influence of CAI on the lower extremity muscle activation at the ankle and knee joints during landings on a tilted surface. A surface electromyography system and two force plates were used to collect lower extremity muscle activation of 21 young female individuals with CAI and 21 pair-matched controls during a double-leg landing with test limb landing on the tilted surface. In the pre-landing phase, compared to controls, CAI participants displayed a reduced ankle evertor activation that could place CAI at a high risk of giving way or sprain injury. In the landing phase, an increased tibialis anterior activation of CAI led to increased co-contraction of ankle muscles in the sagittal and frontal plane. A greater ankle muscle co-contraction could increase the ankle stability during landings but may adversely influence the knee muscle activations (e.g., a greater co-contraction ratio of quadriceps to hamstrings). Relevant training programs (e.g., increasing pre-landing peroneal activation, and optimizing activation ratio of quadriceps to hamstrings) may help individuals with CAI improving ankle stability and reduce atypical knee loading during landings.

Blocking landing techniques in volleyball and the possible association with anterior cruciate ligament injury

The number and type of landings performed after blocking during volleyball matches has been related to the potential risk of ACL injury. The aim of the present study was to determine whether gender affects the frequency of specific blocking landing techniques with potential risk of ACL injury from the perspective of foot contact and subsequent movement after the block used by volleyball players during competitive matches. Three matches involving four female volleyball teams (fourteen sets) and three matches involving four male volleyball teams (thirteen sets) in the Czech Republic were analyzed for this study. A Pearson chi-square test of independence was used to detect the relationship between gender and different blocking techniques. The results of the present study showed that gender affected single-leg landings with subsequent movement in lateral direction and double-leg landings. Although the total number of landings was lower for male athletes than for female athletes, a larger portion of male athletes demonstrated single leg landings with a subsequent movement than female athletes. Single leg landings with a subsequent movement have a higher potential risk of ACL injury.

Lower extremity variability changes with drop-landing height manipulations

Landing is a common lower extremity injury mechanism in sport, with potential connections to movement control accessed through variability measures. We investigated intra-subject lower extremity variability changes following drop-landing height manipulations using standard deviation (SD) and coefficient of variation (CV) among lower extremity peak sagittal joint angles and moments. Fourteen healthy participants completed five drop-landing trials from five heights 20%, 60%, 100%, 140% and 180% maximum vertical jump height (MVJH). Peak joint angles and moments increased with greater landing height (p < 0.001), highlighting inter-joint differences (Flexion: Knee > Hip > Ankle, p < 0.001; Extensor Moment: Hip > Knee > Ankle, in excess of 60% MVJH, p < 0.05). Kinematic and kinetic SD increased with variable magnitudes, while CV decreased at greater landing heights (p ≤ 0.016). Decreased relative variability under greater task demands may underscore non-contact injury mechanisms from repetitive loading of identical structures.

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

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.

Effects of a combined inversion and plantarflexion surface on knee and hip kinematics during landing

Although landing in a plantarflexion and inversion position is a well-known characteristic of lateral ankle sprains, the associated kinematics of the knee and hip is largely unknown. Therefore, the purpose of this study was to examine the changes in knee and hip kinematics during landings on an altered landing surface of combined plantarflexion and inversion. Participants performed five drop landings from 30 cm onto a trapdoor platform in three different conditions: flat landing surface, 25° inversion, or a combined 25° plantarflexion and 25° inversion. Kinematic data were collected using a seven camera motion capture system. A 2 × 3 (leg × surface) repeated measures ANOVA was used for statistical analysis. The combined surface showed decreased knee and hip flexion range of motion (ROM) and increased knee abduction ROM (p < 0.05). The altered landing surface creates a stiff landing pattern where reductions in sagittal plane motion are transferred to the frontal plane, resulting in increased knee abduction. A stiff landing pattern is frequently related to increased risk of anterior cruciate ligament injury. It may be beneficial for athletes at risk to train for alternate methods of increasing their sagittal plane motion of the knee and hip with active knee or trunk flexion.

Effects of muscle strength asymmetry between left and right on isokinetic strength of the knee and ankle joints depending on athletic performance level

[Purpose] The aim of this study was to collect basic data on the effect of asymmetry on the muscle strength of the left and right knee and ankle joints of soccer players at varying athletic performance levels, to guide the development of improved exercise programs. [Subjects and Methods] Forty-nine soccer players at three athletic performance levels participated: 15 professional, 16 amateur, and 18 college. Knee extensor and flexor strength were measured at 60°/sec and 180°/sec, and ankle plantar flexor and dorsiflexor strength were measured at 30°/sec and at 120°/sec. Variables were analyzed by one-way ANOVA. [Results] College soccer players showed greater muscle strength at 60°/sec and 180°/sec in the knee extension muscles of both the right and the left sides, lower muscle strength at 30°/sec and 120°/sec in the dorsiflexor of the right ankle, and similar levels of asymmetry between left and right. The maximum muscle strength on the same side significantly differed in the right ankle joint, with asymmetry between left and right at 30°/sec and 120°/sec. [Conclusion] These findings suggest that muscle strength asymmetry in the ankle joint may lead to counterbalancing muscle strengthening of the knee joint to maintain the center of body mass.

Biomechanical and neuromuscular characteristics of male athletes: implications for the development of anterior cruciate ligament injury prevention programs

Prevention of anterior cruciate ligament (ACL) injury is likely the most effective strategy to reduce undesired health consequences including reconstruction surgery, long-term rehabilitation, and pre-mature osteoarthritis occurrence. A thorough understanding of mechanisms and risk factors of ACL injury is crucial to develop effective prevention programs, especially for biomechanical and neuromuscular modifiable risk factors. Historically, the available evidence regarding ACL risk factors has mainly involved female athletes or has compared male and female athletes without an intra-group comparison for male athletes. Therefore, the principal purpose of this article was to review existing evidence regarding the investigation of biomechanical and neuromuscular characteristics that may imply aberrant knee kinematics and kinetics that would place the male athlete at risk of ACL injury. Biomechanical evidence related to knee kinematics and kinetics was reviewed by different planes (sagittal and frontal/coronal), tasks (single-leg landing and cutting), situation (anticipated and unanticipated), foot positioning, playing surface, and fatigued status. Neuromuscular evidence potentially related to ACL injury was reviewed. Recommendations for prevention programs for ACL injuries in male athletes were developed based on the synthesis of the biomechanical and neuromuscular characteristics. The recommendations suggest performing exercises with multi-plane biomechanical components including single-leg maneuvers in dynamic movements, reaction to and decision making in unexpected situations, appropriate foot positioning, and consideration of playing surface condition, as well as enhancing neuromuscular aspects such as fatigue, proprioception, muscle activation, and inter-joint coordination.

Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

To compare the biomechanical strategies of the trunk and lower extremity during the transition period between the first and second hop of a single-leg triple hop test in women with and without patellofemoral pain (PFP).

BACKGROUND

Recent literature has shown that PFP is associated with biomechanical impairments of the lower extremities. A number of studies have analyzed the position of the trunk and lower extremities for functional activities such as walking, squatting, jumping, and the step-down test. However, studies on more challenging activities, such as the single-leg triple hop test, may be more representative of sports requiring jumping movements.

METHODS

Women between 18 and 35 years of age (control group, n = 20; PFP group, n = 20) participated in the study. Three-dimensional kinematic and kinetic data were collected during the transition period between the first and second hops while participants performed the single-leg triple hop test.

RESULTS

Compared to the control group, women with PFP exhibited greater (P<.05) anterior and ipsilateral trunk lean, contralateral pelvic drop, hip internal rotation and adduction, and ankle eversion, while exhibiting less hip and knee flexion. A significant difference (P<.05) in time to peak joint angle was also found between groups for all the variables analyzed, except anterior pelvic tilt and hip flexion. In addition, women with PFP exhibited greater (P<.05) hip and knee abductor internal moments.

CONCLUSION

Compared to the control group, women with PFP exhibited altered trunk, pelvis, hip, knee, and ankle kinematics and kinetics.

Sex differences in unilateral landing mechanics from absolute and relative heights

BACKGROUND

The prevalence of anterior cruciate ligament injuries in athletic populations and the sex disparity in injury rates are well documented. It is also recognized that landing from a jump is a common noncontact injury mechanism. Yet, most studies utilize absolute landing heights, and few have utilized landing heights equal to participants' maximal jumping ability. The purpose of this study was to examine unilateral landing mechanics from relative and absolute heights.

METHODS

Twenty-one female and twenty male participants completed a series of landings from absolute heights of 30, 40, and 50cm, as well as a height equal to their maximum jumping ability. Right leg three-dimensional kinematics, kinetics, and energetics were calculated from initial contact to maximum knee flexion.

RESULTS

Females landed with greater peak posterior ground reaction force compared to males. Additionally, both female and male participants utilized the knee as the primary energy absorber, but females appear to emphasize greater ankle energy absorption compared to males. Females also displayed increased peak knee adduction moment, while males displayed decreased peak hip abduction moment as landing height increased.

CONCLUSIONS

It appears that females and males respond to increasing landing heights differently. However, landings from 40 and 50cm may have represented an unrealistic mechanical demand for females, and influence subsequent inferences regarding ACL injury risk. Therefore, we suggest that comparisons between studies utilizing different landing heights be made with caution, and participants jumping ability be taken into account whenever possible.

CLINICAL RELEVANCE

The findings of this study offer novel insights with regard to landing height and lower extremity mechanics with the potential to inform anterior cruciate ligament injury intervention programs.