Effects of Warm-Up and Fatigue on Knee Joint Position Sense and Jump Performance

Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta-analysis

Purpose

The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests.

Methods

Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18-60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool.

Results

Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = -0.56; 95% CI = -1.00 to -0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18-1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04-1.75).

Conclusion

Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting.

Level of Evidence

Level III, systematic review with meta-analysis.

The Effect of Muscle Fatigue on the Knee Proprioception: A Systematic Review

This study aimed to systematically review and summarise the evidence about the effect of muscle fatigue on the knee proprioception of trained and non-trained individuals. A search in PubMed, Scopus, Web of Science and EBSCO databases and Google Scholar was conducted using the expression: "fatigue" AND ("proprioception" OR "position sense" OR "repositioning" OR "kinesthesia" OR "detection of passive motion" OR "force sense" OR "sense of resistance") AND "knee". Forty-two studies were included. Regarding joint-position sense, higher repositioning errors were reported after local and general protocols. Kinesthesia seems to be more affected when fatigue is induced locally, and force sense when assessed at higher target forces and after eccentric protocols. Muscle fatigue, both induced locally or generally, has a negative impact on the knee proprioception.

The effectiveness of fatigue on repositioning sense of lower extremities: systematic review and meta-analysis

INTRODUCTION

An injury can significantly harm both individual and team performance. One of the most important risk factors for sports-related injuries, especially non-collision injuries, is fatigue. It seems that poor proprioception may play an essential role to impose athletes to further injuries. This systematic review and meta-analysis aimed to examine the effectiveness of fatigue on the repositioning sense of the lower extremity joints.

METHOD

The electronic databases, including PubMed, Web of Science, Scopus, and Google Scholar were systematically searched from inception to 11January 2024. The obtained records were exported to the EndNote Software version 8. Then, two investigators examined the records independently to find eligible studies based on the inclusion/exclusion criteria. In the case of disagreements, a consequence method was utilized. The quality of the eligible studies was evaluated using the Downs and Black checklist. Comprehensive Meta-Analysis (CMA) software ver. 3 software was used for statistical analysis. Q-test and I2 were employed to examine the data homogeneity. In addition, considering the risk of bias, the Funnel Plot and trim-and-fill method were used.

RESULTS

After reviewing the titles and abstracts of 3883 studies found in the selected databases, 43 articles were found to be eligible to include in meta-analyses. The results showed that fatigue led to a significant increase in the active absolute error of the knee (SDM = 0.524, 95% CI = 0.406-0.841), ankle in the horizontal plane (SDM = 0.541, 95% CI = 0.367-0.715), ankle in the sagittal plane (SDM = 0.443, 95% CI = 0.088-0.798), and hip (SDM = 0.988, 95% CI = 0.135-1.841). However, fatigue had no significant effects on the passive absolute error of the knee and ankle in horizontal plane and relative angular error of the knee.

CONCLUSION

Fatigue can diminish the active joint position sense of the lower extremities and thus may increase the risk of injury by reducing proprioception. Therefore, future research could be conducted to investigate the potential impact of integrated fatigue-mitigating exercises into athletes' training programs, with the aim of reducing the incidence of sports-related injuries.

FATIGUE AND THE RECOVERY WAYS IN ATHLETE RUNNERS

ABSTRACT Introduction: With the continuous development of running, great changes have occurred in training media, equipment, and training concepts. Running fatigue and recovery have increasingly become the direction of research by scientists worldwide. Objective: In this paper, the mechanism, causes, and measures of biological recovery in athletes during training are discussed. Method: The effects of different interventions on athletes' recovery after training were analyzed through protocoled experiments. Effective methods of fatigue recovery were presented. The study compared the variables of the sprinter's morning heart rate, blood pressure, body temperature, CK, BUN, RPE, and other indicators to understand the recovery of middle and long-distance runners after training. Results: Recovery measures are effective when combined with exercise training based on the fatigue mechanism. Conclusion: Subjective sensory, physiological, and biochemical indicators are used to judge the intensity of fatigue in exercise training, and the fatigue recovery phase of exercise training is an important item to consider during training activities. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Acute Impact of Proprioceptive Exercise on Proprioception and Balance in Athletes

This study aimed to compare the acute effect of a proprioceptive exercise session and a non-specific exercise session on knee position sense, and the static and dynamic balance of athletes. Sixty male athletes (19.4 ± 1.2 years) participated in a within-subjects repeated-measures study. Knee position sense in closed kinetic chain, and static (BESS test) and dynamic balance (Y-balance test) were measured before and after two exercise sessions, consisting of 10 min of non-specific exercise in a cycle-ergometer or proprioceptive exercise with an unstable platform. Overall, both exercise sessions significantly improved knee position sense, BESS score, and YBT composite score, and no differences were detected between proprioceptive and non-specific sessions (knee position sense, −6.9 ± 65.2% vs. −11.5 ± 75.0%, p = 0.680; BESS, −19.3 ± 47.7% vs. −29.03 ± 23.5%, p = 0.121; YBT, 2.6 ± 2.7% vs. 2.2 ± 2.2%, p = 0.305). Twenty athletes did not improve knee position sense after the exercise session (non-responders). When analyzing only the exercise responders, both sessions improved knee position sense, but the improvement was greater after the proprioceptive exercise session (56.4 ± 25.6% vs. 43.8 ± 18.9%, p = 0.023). In conclusion, a single proprioceptive, as well as non-specific, exercise session increased knee position sense and balance. The proprioceptive exercise seems to be more effective in improving joint position sense when considering only athletes who respond to the intervention.

The effect of static stretching of agonist and antagonist muscles on knee joint position sense

Background/Aims

Proprioception acuity is important in sports activities and stretching is widely used in warm-up programmes. The main objective of this study was to evaluate if a warm-up programme with and without stretching flexors and extensors muscles could affect knee joint position sense.

Methods

The effects of different stretching regimens on joint position sense were examined. A total of 12 semi-professional football players completed four warm-up sessions over 4 weeks: standard warm-up programme; standard warm-up programme with quadriceps stretching; standard warm-up programme with hamstring stretching; and standard warm-up programme with stretching of both quadriceps and hamstrings. Open kinetic chain knee joint position sense was estimated from the ability to reproduce the three target angles (20°, 45° and 60° knee flexion) in the dominant limb before and after the intervention.

Results

In the absolute angular error, there was a statistically significant three-way interaction between the warm-up programme, target angle and time (F (6, 54)=6.88, P=0.001). Findings of post-hoc analysis demonstrated that there was a statistically significant difference between the pre- and post-stretching of hamstrings for the target angles of 20° (4.70 vs 1.57, P=0.01), 45° (1.70 vs 4.50, P=0.02), and 60° (1.93 vs 4.20, P=0.02). In the relative angular error, interaction of time by the warm-up programme was significant (F (3, 27)=3.41, P=0.03).

Conclusions

The warm-up programme with static stretching of hamstrings had a negative effect on open kinetic chain knee joint position sense during the flexion to extension repositioning task, which may not only have a negative effect on performance of athletes as a part of warm-up exercises, but may also lead to further injuries.

Warm-up durations in a hot-dry climate affect thermoregulation, mean power-output and fatigue, but not peak power in specific soccer repeated-sprint ability

Background

This study addressed the lack of data on the effect of warm-up (WU) duration in hot-dry climate (~ 30 °C; ~ 18% RH), on thermoregulation, muscular power-output, and fatigue after specific soccer repeated-sprint test (RSA).

Methods

Eleven amateur soccer players participated in a cross-over randomized study and they underwent the Bangsbo repeated-sprint test, after three WU durations (i.e. WU10, WU15 and WU20 min) at 70% of MAV, and on different days. Peak power (PP), mean power (MP) and the fatigue index (FI) were recorded and analyzed. Likewise, heart rate (HR), tympanic temperature (T_tym), mean body temperature (MBT) and rating of perceived exertion (RPE) were recorded during each session.

Results

The repeated measure ANOVA showed that MP improved after WU15 in comparison to WU10 and WU20 (p = 0.04 and p = 0.001; respectively). Nonetheless, no significant effect on PP was recorded after all WU durations. FI during RSA increased after WU20 in comparison to WU15 and WU10 (p < 0.001 and p = 0.003; respectively). Higher RPE values (p < 0.001) were recorded after WU15 and WU20 in comparison to WU10 duration. The two-way ANOVA showed higher ΔT_tym and ΔMBT values after WU15 and WU20 compared to WU10 (p = 0.039 and p < 0.001for T_tym; p = 0.005 and p < 0.001 for MBT, respectively).

Conclusions

The WU15 at 70% of MAV better assists mean power-output during soccer RSA in hot-dry (~ 30 °C; 18% RH) climate, but not peak power. Reducing WU duration up to 10 min seems to be insufficient to induce beneficial physiological changes necessary for optimizing repeated-sprint performance, while its extension up to 20 min remains detrimental for muscular power and induces higher fatigue.

A below-knee compression garment reduces fatigue-induced strength loss but not knee joint position sense errors

PURPOSE

We examined the possibility that wearing a below-knee compression garment (CG) reduces fatigue-induced strength loss and joint position sense (JPS) errors in healthy adults.

METHODS

Subjects (n = 24, age = 25.5 ± 4 years) were allocated to either one of the treatment groups that performed 100 maximal isokinetic eccentric contractions at 30°^-1 with the right-dominant knee extensors: (1) with (EXPCG) or (2) without CG (EXP) or to (3) a control group (CONCG: CG, no exercise). Changes in JPS errors, and maximal voluntary isometric contraction (MVIC) torque were measured immediately post-, 24 h post-, and 1 week post-intervention in each leg. All testing was done without the CG.

RESULTS

CG afforded no protection against JPS errors. Mixed analysis of variance (ANOVA) revealed that absolute JPS errors increased post-intervention in EXPCG and EXP not only in the right-exercised (52%, p = 0.013; 57%, p = 0.007, respectively) but also in the left non-exercised (55%, p = 0.001; 58%, p = 0.040, respectively) leg. Subjects tended to underestimate the target position more in the flexed vs. extended knee positions (75-61°: - 4.6 ± 3.6°, 60-50°: - 4.2 ± 4.3°, 50-25°: - 2.9 ± 4.2°), irrespective of group and time. Moreover, MVIC decreased in EXP but not in EXPCG and CONCG at immediately post-intervention (p = 0.026, d = 0.52) and 24 h post-intervention (p = 0.013, d = 0.45) compared to baseline.

CONCLUSION

Altogether, a below-knee CG reduced fatigue-induced strength loss at 80° knee joint position but not JPS errors in healthy younger adults.

A Review of Countermovement and Squat Jump Testing Methods in the Context of Public Health Examination in Adolescence: Reliability and Feasibility of Current Testing Procedures

BACKGROUND

In the context of a public health physical fitness (PF) examination in adolescence, a countermovement jump (CMJ) and a squat jump (SJ) are two vertical jump (VJ) tests widely used to evaluate lower limb muscle strength and power, respectively. The main criticism of both the CMJ and SJ test is the lack of test standardization. Therefore, the objectives of this review are: (a) to gather information about both jumps; (b) to investigate whether it is possible to identify common procedures referred to in the CMJ and SJ technical execution, and (c) to design standard operating procedures (SOPs) to promote CMJ and SJ standardization in an adolescent population aged 12-18 years.

METHODS

The review partially adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Due to growing attention in monitoring physical health through field tests in recent years, articles were collected using the PubMed, Web of Science, and Scopus databases from January 2009 to July 2019. Original articles in which CMJ or SJ were used to assess the muscular strength in adolescents were eligible for further analysis. Articles written in English was imposed as a limit.

RESULTS

A total of 117 studies met the inclusion criteria. The description of the CMJ and SJ test procedures was different within the literature, with discrepancies in the jump technique, number of jumps, and measurement devices used.

CONCLUSIONS

A lack of method standardization for both the CMJ and the SJ test was identified. Based on the literature, SOPs for both VJs were proposed. These are useful in the context of public health PF examination in adolescents, as they facilitate an unbiased comparison of jump performance data between published studies.

Jogging and Practical-Duration Foam-Rolling Exercises and Range of Motion, Proprioception, and Vertical Jump in Athletes

CONTEXT

Foam-rolling exercises are frequently included in warmups due to their benefits for increasing range of motion (ROM). However, their effects on proprioception and vertical jump have not been analyzed and therefore remain unclear. Moreover, the effects of performing practical-duration foam-rolling exercises after typical warmup exercises such as jogging are unknown.

OBJECTIVE

To analyze the effects of jogging and practical-duration foam-rolling exercises on the ROM, knee proprioception, and vertical jump of athletes.

DESIGN

Randomized controlled study.

SETTING

Sports laboratory and university track.

PATIENTS OR OTHER PARTICIPANTS

Thirty athletes were randomly classified into an experimental group (EG) or control group (CG).

INTERVENTION(S)

The EG performed 8-minute jogging and foam-rolling exercises. The CG performed 8-minute jogging.

MAIN OUTCOME MEASURE(S)

Knee flexion, hip extension, active knee extension, ankle dorsiflexion (ADF), knee-joint position sense, and countermovement jump (CMJ) were evaluated before the intervention (baseline), after (post 0 min), and 10 minutes later.

RESULTS

The EG exhibited higher values for ADF and CMJ at post 0 min (ADF: P < .001, d = 0.88; CMJ: P < .001, d = 0.52) and 10 minutes later (ADF: P = .014, d = 0.41; CMJ: P = .006, d = 0.22) compared with baseline. Although the CG also showed increased CMJ at post 0 min (P = .044, d = 0.21), the EG demonstrated a greater increase (P = .021, d = 0.97). No differences were found in the remaining ROM variables (knee flexion, hip extension, active knee extension: P values > .05). For knee-joint position sense, no differences were found (P > .05).

CONCLUSIONS

Combining jogging and practical-duration foam rolling may increase ADF and CMJ without affecting knee proprioception and hip or knee ROM. Jogging by itself may slightly increase ADF and CMJ, but the results were better and were maintained after 10 minutes when foam rolling was added.