Inter-limb asymmetries are associated with decrements in physical performance in youth elite team sports athletes

Unilateral plyometric training effectively reduces lower limb asymmetry in athletes: a meta-analysis

Background

Lower limb asymmetry in athletes is associated with impaired performance and elevated injury risk. Plyometric training (PT) and complex training (CT) are commonly used interventions for this problem, but existing evidence on their effectiveness remains inconsistent.

Objective

This meta-analysis aimed to evaluate PT and CT's effects on athletes' lower limb asymmetry. The findings could help optimize training protocols and reduce the risk of sports injuries.

Methods

A systematic search of Web of Science, PubMed, ProQuest, Scopus, EBSCO, CNKI, and Wanfang databases was conducted up to March 2024. Two researchers independently performed the literature screening, data extraction, and quality assessment processes. A meta-analysis was conducted via Review Manager 5.3 software, including heterogeneity tests, effect size pooling, subgroup analysis, and funnel plot construction.

Results

A total of eight randomized controlled trials (RCTs) involving 157 participants were included. PT effectively reduced lower limb asymmetry, particularly improving single-leg countermovement jump (SLCMJ) (SMD = 0.51, P = 0.05), single-leg broad jump (SLBJ) (SMD = 0.56, P = 0.01), and single-leg lateral jump (SLLJ) (SMD = 1.24, P = 0.01), but did not affect single-leg horizontal triple jumps (SLH3J) (SMD = 0.24, P = 0.60). In contrast, CT showed no meaningful reduction in asymmetry. Subgroup analysis indicated that unilateral PT alone significantly decreased asymmetry (SMD = 0.71, P < 0.01), whereas bilateral PT (SMD = 0.23, P = 0.45), unilateral CT (SMD = -0.15, P = 0.15) and bilateral CT (SMD = -0.09, P = 0.78) interventions all failed to demonstrate efficacy.

Conclusion

Unilateral PT effectively reduces lower limb asymmetry in athletes. Coaches should integrate this method into training programs to address asymmetry-related performance deficits and injury risks. Further high-quality trials are required to validate clinical applicability.

Assessment of shoulder joint and muscle characteristics side-asymmetry in professional padel players

Padel is a worldwide racket sport that is growing each year. The unilateral upper limb repetitive movements of this sport may lead to shoulder structural and functional adaptations, which may alter muscle mechanics, however evidence is limited. We aimed to investigate if there is morphological, mechanical and functional shoulder symmetry between upper limbs of professional padel players. Fourthteen (7♂ and 7♀) professional Brazilian padel players were evaluated at supraspinatus muscle thickness (MT), stiffness, shoulder rotation range of motion (ROM), shoulder internal and external rotation peak torques and their ratios (ER/IR) and fatigue index torque. Subsequently, were compared all variables between dominant and non-dominant sides (α = 0.05). Total work, IR and ER absolute and normalised torque were higher in the dominant limb (p < 0.05). Moreover, 78% and 64% of the athletes presented reduced ER/IR peak torque ratio values in the dominant and non-dominant upper limb, respectively. No differences in supraspinatus MT, stiffness and shoulder ROM were found. Our study found that Brazilian professional padel players have asymmetrical shoulder ER/IR peak torques ratio. Therefore, it's recommended for padel players to strengthen the ER of the dominant shoulder and both IR and ER of the non-dominant shoulder to address side-asymmetry and reduced ER peak torques.

Is limb asymmetry an intrinsic risk factor for time-loss groin injury in professional male soccer players?

OBJECTIVES

To provide normative values for between-limb asymmetry of hip strength and range of motion (ROM) in professional male soccer players and evaluate the relationship between these asymmetries and groin injury.

DESIGN

Secondary analysis of a prospective cohort study.

METHODS

A total of 438 professional male soccer players underwent musculoskeletal screening, injury and exposure surveillance over two consecutive seasons. Between-limb asymmetry for two hip strength (eccentric adduction and abduction) and six ROM measures were calculated, and normal asymmetry considered within 1 standard deviation (SD) of the mean. Cox proportional hazard regression analysis estimated the association between asymmetry and time-loss groin injury.

RESULTS

Normal asymmetry ranged between 0.3% and 27.3% across strength and ROM variables. No association was found between groin injuries and asymmetry in eccentric hip adduction (HR = 0.99, 95%CI = 0.98-1.00; p = 0.167) or abduction strength (HR = 1.00, 95%CI = 0.99-1.01; p = 0.745). For five of the six ROM measures, no association with groin injuries were determined. A statistically significant, though likely clinically irrelevant, association was found between groin injury and dominant leg total hip rotation ROM (HR = 1.03, 95% CI = 1.00-1.05; p = 0.040).

CONCLUSION

Normal hip strength and ROM asymmetry ranged between -27 and +20%. No clinically relevant associations were found between asymmetry in hip strength or ROM and time-loss groin injuries.

LEVEL OF EVIDENCE: 2

Effects of Maturation on the Magnitude and Direction of Asymmetry in Jumping and Change of Direction Speed in Young Elite Football Players

ABSTRACT

Gonzalo-Skok, O and Bishop, C. Effects of maturation on the magnitude and direction of asymmetry in jumping and change of direction speed in young elite football players. J Strength Cond Res 39(1): 70-78, 2025-Physical performance is often affected by maturation in young athletes and provides an interesting challenge to optimize performance. The present study analyzed whether maturation affects directional dominance, chronological age, body mass, and biological age predictors and assessed between chronological or biological age-group differences in young footballers. One hundred eight elite male players (U-15 to U-19) were tested on bilateral vertical and unilateral vertical and horizontal jumping, sprinting (40 m), and change of direction (COD) ability over single and multiple CODs (times and the percentage-based COD deficit [%CODD]). Almost half of the players (45%) at post-peak height velocity (PHV) showed consistency in the direction of asymmetry (jumping and COD). Ten-meter sprint time was the main predictor to explain the %CODD. Standing height affects unilateral horizontal jumping, and peak speed and unilateral horizontal jumping were the main predictors for unilateral vertical jumping. Post-PHV reported significantly (p < 0.05, effect size [ES] = 0.76-1.50) greater vertical and horizontal jumping, and linear and COD speed performance than mid-PHV. Significant differences (p < 0.05) in jumping, sprinting, and COD performance were found between U-15 and the rest of groups. Furthermore, the U-16 group showed a significant difference (p < 0.05) to the U-19 (for peak speed) and U-18 groups (for 40-m sprint and peak speed). Significantly (p = 0.04, ES = 0.47) lower %CODD asymmetries were found in mid-PHV compared with post-PHV. The study highlights the impact of maturation on the direction of asymmetry, tending to show the same weak side as maturation increases (i.e., older, and more experienced and mature players). Finally, decreasing between-limbs asymmetry should be considered during maturation, especially as greater football specialization.

'Athletes', 'Talents', and 'Players': Conceptual Distinctions and Considerations for Researchers and Practitioners

A clearer understanding of, and tighter boundaries between, terms are important for researchers designing studies as well as for other sport stakeholders creating evidence-informed policies. This article considers the terms 'athlete', 'talent', and 'player' from psychological and sociocultural perspectives and in different sporting communities to highlight the importance of terminological clarity in sport research. We present considerations to clarify the use of these terms within different contexts and how the use of specific terms may affect knowledge mobilization in diverse sporting populations. A conceptual discussion is provided to help operationalize development-related terminology and its associated stages, to better reflect contemporary academic thought, and enhance practical interpretations. Importantly, we also call for greater transparency from researchers when presenting findings and encourage practitioners to clearly define key terms when working in sport. Our intention in this paper is to energize readers to consider how we use language in athlete identification and development contexts, to stimulate deeper thought and discourse around the possible implications these terms may have at any point of an individual's development in sport. Greater deliberation, identification, and acknowledgment of the drawbacks accompanying these terms will be needed before more confident assertions can be made on how researchers and practitioners could (or even should) implement certain terminology across youth sport contexts moving forward. This paper adds to a growing literature on the importance of clarity in terminology and acts as an impetus for those working in specific sports to co-design key terms used by researchers, practitioners, and policy makers.

Effects of Unilateral, Bilateral and Combined Plyometric Jump Training on Asymmetry of Muscular Strength and Power, and Change-of-Direction in Youth Male Basketball Players

This study aimed to compare the effects of unilateral (UT), bilateral (BT), and combined (UBT) plyometric training on muscular strength, power, and change-of-direction performance in youth male basketball players. Sixty-six male youth basketball players (age: 16.1 ± 0.8 years) participated in this randomized experimental study, which lasted 8 weeks with a training frequency of 2 sessions per week. The UT group performed only single-leg plyometric exercises, while the BT group conducted similar plyometric drills using both feet. The UBT group combined both approaches, performing one session of UT and one session of BT each week. The players were evaluated at baseline and after the 8-week period using a force platform for the unilateral countermovement jump test (UCMJ), isometric squat test (IST), isometric knee flexor strength test (KFS), leg land and hold test (LHT), and 5-0-5 tests. The asymmetry between legs per outcome was measured using the symmetry angle. The UT, BT, and UBT all significantly improved outcomes in the IST, UCMJ, KFS, LHT, and 5-0-5 tests (p < 0.05) following the intervention, with no significant differences among the three methods. However, while UT and UBT significantly reduced asymmetries in the tests (p < 0.05), BT increased asymmetries. Only, the UT group showed significant improvements over the control group in asymmetry measures: IST asymmetry (mean difference: 1.2%, p = 0.049), KFS asymmetry (mean difference: 2.5%, p < 0.001), and LHT asymmetry (mean difference: 1.1%, p = 0.013). While there are no substantial differences among UT, BT, and UBT in terms of improvements in unilateral tests and symmetry levels, UT stands out for its effectiveness in enhancing neuromuscular performance and reducing asymmetries among basketball players compared to the control condition. UT was the only method that showed significant benefits in this context. Strength and conditioning coaches might consider incorporating UT, either alone or alongside BT, to optimize individual limb strength and coordination.

Impact of Lower-Limb Asymmetries on Physical Performance Among Adolescent Female Tennis Players

This study aimed to determine the correlation between interlimb asymmetries and physical performance metrics in adolescent female tennis players.

METHODS

Twenty-five female tennis players (age: 13.29 ± 0.98 years; weight: 52.52 ± 7.31 kg; height: 162.91 ± 6.02 cm) consented to participate in this study. Their performance was evaluated using various variables, including bilateral and unilateral countermovement jump (CMJ), bilateral and unilateral horizontal jump (HJ), 180° change of direction (180COD) conducted with both the right and left legs, and a 20 m sprint. The systematic bias was evaluated by one-way repeated measure analysis of variance, Pearson's correlation test for relationships between variables, and the kappa coefficient for consistency in the asymmetrical direction.

RESULTS

Significant relationships were found between CMJ asymmetry and the variables HJR (r = -0.47) and HJL (r = -0.44). In addition, significant relationships were found between HJ asymmetry and the variables CMJR (r = -0.60) and CMJL (r = -0.54), HJR (r = -0.64), HJL (r = -0.67), CMJ (r = -0.55), and HJ (r = -0.52).

CONCLUSION

Jumping tests are important indicators of performance loss in female tennis players. In addition, no significant correlation was found between the 180COD and performance tests, suggesting that asymmetries in COD do not affect jump performance or speed. Based on these results, it is recommended to integrate individualized programs for each athlete to reduce asymmetries.

Association Between Inter-Limb Asymmetry and Determinants of Middle- and Long-distance Running Performance in Healthy Populations: A Systematic Review

BACKGROUND

The presence of inter-limb asymmetry in the human body has traditionally been perceived to be detrimental for athletic performance. However, a systematic review addressing and comprehensively assessing the association of asymmetry between the lower limbs and middle- and long-distance running performance-related metrics is currently lacking.

OBJECTIVE

The main purpose of this systematic review was to examine the relationship between lower inter-limb asymmetry and determinants of running performance in healthy middle- and long-distance runners. The secondary objective was to identify possible avenues for further research in this area.

METHODS

PubMed, Web of Science and SPORTDiscus were systematically searched for studies investigating the relationship between lower inter-limb asymmetry and (determinants of) running performance in healthy and injury-free middle- and long-distance runners. The quality of studies eligible for inclusion was assessed using the Downs and Black Quality Index Tool.

RESULTS

Out of 4817 articles screened, 8 studies were included in this review which assessed the association between functional, morphological, kinematic and kinetic asymmetry and running performance-related metrics. The quality score of the included research varied between 5/10 and 9/10. Our results revealed mixed findings, showing both significant negative (n = 16) and positive (n = 1) associations as well as no significant associations (n = 30) between inter-limb asymmetry and running performance-related metrics.

CONCLUSIONS

A high heterogeneity across study methods and outcomes was apparent, making it difficult to draw a straightforward conclusion. Our results indicate that the majority of metrics of functional, morphological, kinematic and kinetic inter-limb asymmetry are negatively or not associated with running performance (and/or its determinants). Thus, a more extensive high-quality body of research using standardised asymmetry magnitude metrics is essential to determine whether, and to what extent asymmetry between the lower limbs could affect middle- and long-distance running performance. Future studies should establish potential trade-off values to help practitioners develop evidence-based training programs.

KEY POINTS

In the majority of the metrics, the magnitude of lower inter-limb asymmetry was negatively or not associated with middle- and long-distance running performance. Coaches, athletes and researchers should be attentive of the task, time- and metric-specificity as well as the inter- and intra- individual variability of magnitude outcomes, when assessing inter-limb asymmetries.

Association and Predictive Ability of Jump Performance with Sprint Profile of Collegiate Track and Field Athletes

This study examined the relationship between broad jump (BJ), countermovement jump (CMJ) and light load countermovement jump (LL-CMJ) performance and sprint performance and Sprint Profile measures in athletes. Additionally, this study aimed to determine the predictive ability of jump measures on Sprint Profile components. Twenty-five athletes performed BJ, CMJ, LL-CMJ, 30-metre acceleration and 30-metre maximal speed fly-by sprints. Results revealed moderate to very large correlations between BJ, CMJ and LL-CMJ performance with acceleration sprint completion times (r = -0.423 to -0.807; p < 0.05), fly-by sprint completion times (r = -0.452 to -0.838; p < 0.05) and maximal sprint speed (r = 0.424 to 0.794; p < 0.05). Additionally, associations were observed with multiple jumping measures and components of the Sprint Profile (r = 0.431 to 0.777; p < 0.05) during acceleration sprints. Furthermore, the BJ distance was the best predictor of Sprint Profile components during acceleration sprints (R2 = 0.57-0.76; p < 0.01) and maximal speed fly-by sprints (R2 = 0.775; p < 0.001). The forces and the manner of force application during the BJ to propel the athlete forwards and upwards are similar to those necessary to exhibit superior sprint performance. This may be due to the rapid generation of forces and orientation of force application during both movements.

Bilateral deficit in countermovement jump and its association with change of direction performance in basketball and tennis players

The purpose of this study was to assess the association between bilateral deficit (BLD) in countermovement jump and change of direction (CoD) performance. Therefore, 165 young basketball players (60 females) and 95 young tennis players (39 females) performed two different CoD tasks (90° and 180° turns) and bilateral and unilateral countermovement jumps. BLD was calculated based on jump height, peak power and several phase-specific force impulses (FI). For male athletes, several statistically significant small to moderate associations were found between the CoD performance and BLD (r = 0.21-0.52). While the BLD in the propulsive phase FI seems to be most consistently associated with CoD performance, all associations were weak (r = 0.21-0.28 in basketball, 0.28-0.36 in tennis). Associations between BLD in total positive (braking and propulsive phase) FI and CoD performance were moderate (r = 0.45-0.52) in male tennis players. For female athletes, the associations were even smaller and almost exclusively statistically non-significant. Although indirectly, our results imply that resistance training based on unilateral exercises could be useful to improve CoD performance. It has to be stressed that further training studies are needed to directly confirm this assumption.

Seasonal Variations in Performance and Asymmetry Data for Jump and Change of Direction Abilities in Female Soccer Players

ABSTRACT

Mainer-Pardos, E, Bishop, C, and Gonzalo-Skok, O. Seasonal variations in performance and asymmetry data for jump and change of direction abilities in female soccer players. J Strength Cond Res 38(10): 1768-1777, 2024-The study aimed to evaluate the progression of the percentage-based change of direction (COD) deficit (%CODD) over a competitive season, along with its correlation with performance tests and to examine the impact of the magnitude and direction of asymmetry at 4 stages of the season. Forty-seven (U-16, U-18, and U-20), highly trained, female soccer players performed unilateral vertical jumping (countermovement jump [CMJ]) and horizontal jumping (HJ), 10-m sprint, and 180° change of direction (COD180) tests. The %CODD was also calculated. Significant group and time effects ( p < 0.05) were observed in CMJ, HJ, 10-m sprint, and COD180 tests, with U-20 players generally outperforming the U-18 and U-16 groups. Nonsignificant differences were reported in the %CODD between any time point or groups throughout the season. Moderate or large significant ( r = 0.44-0.64; p < 0.05) relationships were found between %CODD and 10 m. The direction of asymmetry within and between tests at all time points was slight to moderate (k = -0.29 to 0.57). Notwithstanding, 51% of the players showed the best performance in the horizontal jump with the same leg throughout the season, whereas only 36% in %CODD. This study highlights the importance of developing strategies to improve %CODD depending on the player's position demands. Finally, individually monitoring the magnitude and direction of asymmetry can help practitioners monitor the effects of training and competition throughout the season.

Validity and reliability of the My Jump 2 app for detecting interlimb asymmetry in young female basketball players

Introduction

The aim of this study was to examine the validity and reliability of the My Jump 2 app for the assessment of interlimb jump asymmetry in young female basketball players.

Methods

Nine athletes (age 15 ± 0.9 years; weight 62.9 ± 5.8 kg; height 173.6 ± 6.1 cm) performed single-leg drop jumps (DJs) and both-leg drop jumps on a force plate (Kistler Quattro jump) and were simultaneously recorded on two smartphones using the My Jump 2 app. Jump height from flight time and contact time data were statistically analyzed to evaluate the validity of two different camera settings, drop jump performance, and interlimb jump asymmetry in basketball players. The testing was repeated after 1 week for test retest reliability.

Results

High test-retest reliability [intraclass correlation coefficient (ICC) > 0.88] was observed in DJ height. High correlation between the force plate and the My Jump 2 app was observed in DJ height (r = 0.99) and DJ contact time (r = 0.98). For the interlimb jump height asymmetries, mean differences were 0.6 percentages for the My Jump 2 app and the force plate, respectively (p = 0.77). Inter-device reliability revealed almost perfect correlation for the DJ height (ICC = 0.99, r = 0.98).

Conclusion

The My Jump 2 app is a valid and reliable tool to assess drop jump performance and interlimb asymmetry in young female basketball players.

Analysing the Influence of Speed and Jumping Performance Metrics on the Percentage Change of Direction Deficit in Adolescent Female Soccer Players

Studies show that although female soccer players often have shorter change of direction (COD) deficits than males, indicating different biomechanical profiles, there is a lack of research on the impact of physical metrics on COD performance in females. The purpose of this work was to analyse whether performance metrics based on speed and jumping could explain the variation in %CODD in young female soccer players. Thirty-three highly trained adolescent female soccer players with an age of 16 ± 0.95 years, a body mass of 55.7 ± 7.22 kg, and a height of 160.4 ± 5.22 cm performed COD180 tests, 10 m and 30 m sprint tests, single-leg countermovement, and horizontal jumps. Acceleration in the first 10 m of a sprint was identified as a significant predictor of COD180 performance (R2 = 28%), (R2 = 50%), (p < 0.01), indicating that early sprint performance may largely determine an individual's ability to change direction. However, no predictors were found for %CODD. Significant correlations were observed between COD180 performance and %CODD, acceleration, linear speed, and horizontal jump performance (r = -0.59 to 0.70; p < 0.05). The study suggests that specific physical performance metrics, particularly early acceleration, are crucial for enhancing COD skills in female soccer players, emphasizing the need for targeted training interventions.

Are lower limb symmetry and self-reported symptoms associated with functional and neuromuscular outcomes in Brazilian adults with anterior cruciate ligament reconstruction? A cross-sectional study

INTRODUCTION

After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return.

OBJECTIVES

To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry.

METHOD

Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb.

RESULTS

There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance).

CONCLUSION

Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms.

Exploring the Implications of Inter-Limb Asymmetries on Sprint, Agility, and Jump Performance in Young Highly-Trained Basketball Athletes: Is There a Relevant Threshold?

Background and Objectives: This study aimed to investigate the magnitude of vertical jump inter-limb asymmetries among young highly-trained basketball athletes and to analyze its impact on sport performance, specifically in sprints, agility, and vertical jumps. Materials and Methods: A unilateral countermovement jump (CMJ) was employed to determine Inter-limb Index Asymmetry (IAI) in 320 participants aged from 14 to 18 years, from the Valencia Basket youth academy. IAI was categorized into three groups: 0-9.9%, 10-14.9%, and >15%. The relationship between IAI and performance variables was analyzed through correlation studies (Pearson or Spearman's). The influence of IAI magnitude was assessed using ANOVA or Kruskal-Wallis analysis, with leg dominance as a covariable. SPSS Statistics version 26 was used for analysis. Results: Among all the participants, the mean IAI was 10.6%. Correlation studies revealed non-significant values (p < 0.05) between IAI and sport performance variables. The three IAI magnitude groups did not show statistically significant differences in sprint, agility, and jump outcomes. Leg dominance did not seem to influence performance outcomes, except for unilateral CMJ. Conclusions: The results obtained challenge the assumption that an IAI above 10% negatively affects sprint, agility, or jump performance in young basketball athletes. Notably, the magnitude of IAI did not influence sport performance parameters, suggesting that the 10-15% threshold from previous studies may not be applicable to this population. The study emphasizes the need to understand lower-limb asymmetries in the context of specific sport task performance, considering the potential evolution over time among affected young athletes.

Assessing Limb Dominance and Interlimb Asymmetries Over Multiple Angles During Change of Direction Speed Tests in Basketball Players

ABSTRACT

Gonzalo-Skok, O, Dos' Santos, T, and Bishop, C. Assessing limb dominance and interlimb asymmetries over multiple angles during change of direction speed tests in basketball players. J Strength Cond Res 37(12): 2423-2430, 2023-The aims of this study were to establish whether directional dominance is displayed during change of direction (COD) tasks across various angles, to determine the angle-variation data for the asymmetry magnitude and direction, and to analyze the relationships in COD performance (completion time and COD deficit) across tasks. Twenty-four young (U-16 to U-20), highly trained male basketball players performed a 10-m linear sprint test and four 10-m COD tests (45°, 90°, 135°, and 180°) in left and right directions. Change of direction performance was determined via total times and COD deficit, and asymmetry comparisons were made between faster and slower directions and dominant leg (DL) (i.e., first step leg in lay-up) and nondominant leg (NDL). No significant differences (p > 0.05) were found between DL and NDL for any task excluding 45° COD (p < 0.05, effect size [ES] = 0.44-0.78), but significant differences were established between faster and slower sides for all angles (p < 0.05, ES = 0.70-1.28). Levels of the agreement in directional dominance during COD tasks were generally poor to slight (k = -0.14 to 0.14), excluding a fair agreement between COD45 and COD90 (k = 0.34). Correlations between COD total times and COD deficits between angles were moderate to very large (r = 0.32 to 0.81) and moderate to large (r = -0.30 to 0.55), respectively. Players displayed superior COD performance in a particular direction across various angles. This directional dominance is not necessarily consistent between angles, thus highlighting the angle-dependent nature of COD performance. Consequently, practitioners should investigate multiple angles and directions to create a COD angle profile for their athletes.

The Effects of Workload Difference Between Limbs in Plyometric and Strength Exercises in Reducing Asymmetry in Change of Direction Ability During Basketball Season

ABSTRACT

Ujaković, F, and Šarabon, N. The effects of workload difference between limbs in plyometric and strength exercises in reducing asymmetry in change of direction ability during basketball season. J Strength Cond Res 37(11): 2282-2288, 2023-The topic of interlimb asymmetries has recently been extensively investigated; despite that, intervention for purpose of reducing them have been narrowly examined. The present study investigated the effects of maximal strength and plyometric resistance training program with 3:1 workload ratio (nondominant to dominant side) on change of direction deficit (CoDdef) asymmetry during the basketball season. Thirty-six highly trained male basketball players (19.3 ± 4.9 years) from different age categories (U-17, U-19, and senior) were divided into 2 groups: the control group ( n = 18) and the intervention group ( n = 18). The intervention group performed once-a-week training that consisted of strength (Bulgarian split squats) and jumping (single-leg countermovement jumps [SLCMJs]) part in which nondominant-to-dominant workload ratio was 3:1 during the 8-week period. Preintervention and postintervention testing included single-leg isometric squat, SLCMJ, 10-m sprint, and 505 test. Analysis of covariance results showed a statistically significant difference with large effect size ( p < 0.05; η2 = 0.26) when preintervention asymmetry was included as covariate. Post hoc analysis showed a statistically significant decrease in mean CoDdef asymmetry between preintervention (11.88%) and postintervention (4.47%) testing ( p < 0.01, effect size [ES] = -1.37). Isometric squat strength increased on nondominant side in the intervention group ( p < 0.05; ES = 0.77). No other performance or asymmetry variable showed significant change. In conclusion, a 3:1 workload of nonspecific movement task in favor of nondominant limb is an effective training strategy to reduce CoDdef asymmetry during basketball season.

Movement Asymmetries: From Their Molecular Origin to the Analysis of Movement Asymmetries in Athletes

Asymmetry plays a major role in biology at all scales. This can be seen in the helix of DNA, the fact that the human heart is on the left side, or that most people use their right hand. A single protein such as Myosin 1D can induce helical motion in another molecule. This causes cells, organs, and even entire bodies to twist in a domino effect, causing left-right behaviour. More generally, athlete movements are often asymmetric and, during the physical rehabilitation after injury, the asymmetry is visually discernible. Herein, we review the molecular basis of the movement asymmetries and report on the available knowledge on the few therapeutics investigated so far such as meloxicam. From a more rehabilitative perspective, it is very important to use effective methods to control the process of resolving the injury-related movement asymmetry through the complex use of specialised exercises, measurements, and gait analysis, which can all provide useful information on the effectiveness of the rehabilitation plans. If for each athlete, the normal range of asymmetry is known, the asymmetry can be individually treated and the evolution can be monitored over time. Appropriate measures should be taken if the movement asymmetry is outside this range. In addition, genetic, physiological, and psychological factors relevant to athlete health should be considered in the process of assessing and improving exercise asymmetry, which we also discuss in this review. The main proposal of this work is that the movement asymmetries in athletes should be individually treated, while taking into account the athlete's genetics, physical condition, and previous injuries.

Magnitude and direction of elbow torque asymmetries in manual wheelchair users

The aims of the present study are to investigate the magnitude and direction of the elbow torque asymmetries in manual wheelchair users and to verify the agreement levels of the asymmetry's direction between different velocities and contraction modes in the isokinetic test. The sample was composed of 14 manual wheelchair users (four women, 10 men). The peak torque of the elbow flexors and extensors were measured on the dominant and non-dominant limbs, using a set of concentric/eccentric contractions at speeds of 60° s-1 and 180° s-1. Asymmetries were calculated by a specific equation, and the levels of agreement of the asymmetry's direction were calculated using Kappa coefficient. The main results showed a large variability in the magnitude of the asymmetries, ranging from -73.1% (ND) to 59.9% (D) between participants. The agreement levels of the elbow flexors and extensors between the different contraction modes were great (k = 0.71-0.85) for most of the velocities [except for flexors of 60° s-1 (k = 0.29)], but the agreement levels were only slight to fair (k = 0.16-0.31) for most of the contraction modes when comparing between velocities [except for flexors eccentric (k = 0.71)]. In conclusion, the elbow torque asymmetries are highly variable between subjects in terms of magnitude. In addition, in general, the limb favored by the asymmetry is the same when comparing between velocities, but not when comparing between contraction modes.

The profiles of single leg countermovement jump kinetics and sprinting in female soccer athletes

The purposes were to evaluate kinetics in lower limbs using single leg countermovement jump (SLCMJ) and to identify the differences in SLCMJ kinetics between sprinting fast players and sprinting slow players in elite university female soccer players. Seventeen participants at the national tournament level completed the survey. SLCMJ and 30 m sprinting tests were performed. A force-plate was used to collect the data of the SLCMJ test. Significant differences of concentric maximum rate of force development (RFD), concentric RFD, concentric RFD/body weight (BW), peak net takeoff force/BW, peak power, and peak power/BW existed between both legs during the SLCMJ among all the participants. For further analysis, the participants were divided into fast group and slow group based on sprinting performance. Significant differences existed between the two groups in concentric peak velocity (nondominant, p = 0.028) and vertical velocity at takeoff (nondominant, p = 0.021). Concentric maximum RFD (p = 0.036) was significantly different between both legs in the slow group. Among elite university female soccer players, the players who presented more increased asymmetry of kinetic characteristics of jumping, also showed weak sprinting performance. Moreover, the players presented the best performance in velocity of the jumping variables and also had the best sprinting performance. Coaches and players should focus on keeping inter-limb balance and developing jumping velocity to improve sports performance. In future, the cause-and-effect relationship between jumping and sprinting should be identified.

Association between the Upper Quarter Dynamic Balance, Anthropometrics, Kinematics, and Swimming Speed

Besides recurrently assessed water-based parameters, there are also some individual characteristics that affect swimming performance that are not water related. In the past few years, dynamic balance has been associated with land sports performance. Conversely, evidence on this topic in swimming is scarce. The purpose of this study was to assess the association between on-land dynamic balance and swimming performance. Sixteen young adults and recreational swimmers were recruited for the present study (8 males 20.8 ± 2.0 years, and 8 females 20.1 ± 1.9 years). A set of anthropometric features were measured. The upper quarter Y-balance test was selected as a dynamic balance outcome, and swimming speed as the swimming performance indicator. The results showed a moderate and positive correlation between dynamic balance and swimming performance (p < 0.05). Speed fluctuation was highly and negatively related to swimming speed (p < 0.001), i.e., swimmers who had higher scores in the dynamic balance were more likely to deliver better performances. This suggests that in recreational swimmers, the stability and mobility of the upper extremity had a greater influence on swimming performance. Therefore, swimming instructors are advised to include dynamic balance exercises in their land-based training sessions to improve their swimmers' performance.

Horizontal jump asymmetries are associated with reduced range of motion and vertical jump performance in female soccer players

BACKGROUND

Performance in jumping and change of direction tests are good proxies to reflect the skill level during soccer-specific actions. Greater inter-leg asymmetries have been identified as a risk factor for developing acute and overuse injuries and jeopardizing soccer performance. The aim of this study was to assess the association between asymmetry in the unilateral vertical and horizontal jump tests, ankle range of motion, linear velocity, and change of direction in a sample of highly trained adult female soccer players.

METHODS

Thirty-eight highly trained female soccer players underwent a testing protocol including ankle dorsiflexion, single leg jumps for height (CMJ), distance (HJ), 40 m sprint and 180° change of direction tests.

RESULTS

Within-session reliability was acceptable (CV ≤ 7.9%), and relative reliability showed good to excellent (ICC: 0.83 to 0.99). The one-way ANOVA reported higher inter-limb differences for change of direction deficit (10.9 ± 8.04%) and single leg CMJ (5.70 ± 5.22%). Pearson correlations highlighted significant relationships between horizontal jump asymmetries and ankle dorsiflexion (r = -0.41), CMJ (r = -0.36 to -0.49) and HJ (r = -0.28 to -0.56).

CONCLUSIONS

Assessing inter-limb asymmetries through different methods can help scientists understand the specificity of their detrimental effects on soccer performance. Practitioners should be aware of these specificities as well as the magnitude and direction of the asymmetries when aiming to improve specific on-field skills.

Evaluation of the Back-in-Action test Battery In Uninjured High School American Football Players

Background

Return to sport testing is an established routine, especially for athletes who have ruptured their anterior cruciate ligament (ACL). Various tests are performed, often combined in test batteries, such as the Back-in-action (BIA) test battery. Unfortunately, pre-injury performance is often unknown, and only few athletes pass the high demands of these test batteries.

Purpose

The aim of the study was to determine the performance of under 18 American football players on the BIA to establish pre-injury sport specific benchmarks for future RTS testing and to compare these values to data from an age-matched reference group.

Methods

Fifty-three healthy male American football players underwent a functional assessment using the "Back-in-action" test battery evaluating agility, speed (Parkour-Jumps and Quick-Feet test), balance (using a PC based balance board), and power (Counter-Movement-Jump [CMJ]) as objective measures. Their results were compared with a previously tested reference group (RP) and within the american football players (AF) through three subgroups according to field playing position.

Results

Overall, the American football (AF) athletes showed lower balance scores for both legs (AF: 3.71/3.57/3.61; RP: 3.4/3.2/3.2; p<0.002) compared to the reference population (RP). CMJ height and Quick-Feet results were not statistically different (p>0.05), Parkour-Jump times (AF: 8.18/ 8.13 sec.; RP: 5.9/5.9sec.; p<0.001) were significantly slower. Power output in all CMJ's (AF: 46.86/36.94/37.36 W/kg; RP: 43.2/29.5/29 W/kg; p<0.001) was significantly higher than the RP. Passing and running game involved players (G2 & G3) showed significantly better balance scores (G2+G3: 3.36/3.27/3.33; G1: 4.22/4.06/4.10; p<0.001), higher jump height (G2&G3: 38.87/24.02/24.96 cm; G1: 32.03/19.50/18.96 cm; p<0.001) and more watts/kg (G2&G3: 48.83/37.21/37.64 W/kg; G1: 43.95/36.88/36.53 W/kg; p<0.001) compared to blocking players like Linemen (G1) and to the age matched reference population (RP).

Conclusion

Only 53% of the healthy athletes would have been cleared for sport using the BIA test criteria, which highlights the challenging passing criteria. Despite significantly greater power measurements, scores of balance and agility were poorer compared to the reference group, especially for linemen. These data may serve as sport and position specific reference for high school American football players, instead of using the non-specific reference group data.

Study design

cross-sectional study.

Level of evidence

IIb.

Using Wearable Inertial Sensors to Monitor Effectiveness of Different Types of Customized Orthoses during CrossFit® Training

BACKGROUND

Dynamic balance plays a key role in high-impact sports, such as CrossFit, where athletes are required to maintain balance in various weightlifting exercises. The loss of balance in these sport-specific movements may not only affect athlete performance, but also increase the risk of injuries.

OBJECTIVES

The aim of the study is to achieve greater insight into the balance and athlete position during the CrossFit training by means of inertial sensors, with a particular focus on the role of different custom foot orthoses (CFOs) in order to detect correlations with the role of the cavus foot.

METHODS

A total of 42 CrossFit^® athletes, aged 25 to 42 years, were enrolled in this study. One-way ANOVA tests with post-hoc analysis of variance were used to compare foot posture groups and effects of different types of customized foot orthoses.

RESULTS

When comparing the effects of CFOs with the respective balance basal level during the pistol squat exercise, we observed a significant (p = 0.0001) decrease in the sway area, antero-posterior displacement (APD) and medio-lateral displacement (MLD) compared to the basal using both types of CFOs.

CONCLUSION

No significant positive effects of CFOs were observed in some static tests. On the contrary, positive effects of CFOs and, in particular, postural insoles, are relevant to dynamic balance.

Long-Term Changes in Vertical Jump, H:Q Ratio and Interlimb Asymmetries in Young Female Volleyball Athletes

The present study aimed to examine the changes that occurred in vertical jump and isokinetic dynamometer (ISK) performances at the beginning of a preparatory period (PRE) and at the start of the competitive period (POST). Sixteen U-17 elite female volleyball players, from a national level (15.34 ± 1.19 years; 66.35 ± 7.95 kg; 169.22 ± 24.79 cm), performed bilateral squat jump (SJ), bilateral and unilateral countermovement jump (CMJ) and unilateral ISK tests for knee flexors (Fl) and extensors (Ex) both at 60°/s and at 300°/s. Peak torque (PT) and the hamstring-to-quadriceps (H:Q) ratio were assessed by concentric actions. Asymmetries were calculated by the percentage differences between dominant (DOM) and nondominant legs (NDOM). The paired Student's t-test was used for comparisons at a level of significance of 5%. The effect size was also calculated. A significant increase was found for both SJ (15%; p = 0.004; ES = 0.82) and CMJ (12%; p = 0.017; ES = 0.62). The PT of NDOM flexors at 60°/s was significantly lower than DOM both at PRE (4.6%; p = 0.048; ES = -0.22) and POST (6.3%; p = 0.037; ES = -0.33). The NDOM extensors at 60°/s had a significantly lower PT than DOM at POST (7.0%; p = 0.048; ES = -0.23). Both DOM and NDOM flexors at 60°/s had a PT enhancement at POST related to PRE (6.7%; p = 0.031; ES = 0.51 and 5.6%; p = 0.037; ES = 0.48, respectively). The PT of NDOM extensors at 300°/s increased at POST in comparison to PRE (7.9%; p = 0.038; ES = 0.27). The NDOM at 300°/s had a H:Q ratio higher than DOM both in PRE and POST (8.6%; p = 0.041; ES = 0.37 and 11.6%; p = 0.013; ES = 0.71, respectively), and the highest H:Q ratios were lower than the reference values (<80%). The asymmetry of the unilateral CMJ was higher at POST than at PRE (102%; p = 0.03; ES = 0.81). The PT for the flexors at 300°/s and the H:Q ratio at POST exceeded 10%. In conclusion, a training program of 15 weeks increased the neuromuscular performance of young volleyball athletes, but many H:Q ratios and asymmetries remained out of the normal recommendation. Volleyball professionals should carefully apply an adequate training program to enhance physical fitness performance without increasing the risk of lower limb injuries concurrently.

Shoulder Torque Production and Muscular Balance after Long and Short Tennis Points

Tennis is an asymmetric sport characterized by a systematic repetition of specific movements that may cause disturbances in muscular strength, power, and torque. Thus, we assessed (i) the torque, power, ratio production, and bilateral asymmetries in the shoulder's external and internal rotations at 90 and 180°/s angular velocities, and (ii) the point duration influence of the above-mentioned variables. Twenty competitive tennis players performed external and internal shoulder rotations; an isokinetic evaluation was conducted of the dominant and non-dominant upper limbs before and after five and ten forehands. A higher torque production in the shoulder's internal rotations at 90 and 180°/s was observed for the dominant vs. non-dominant sides (e.g., 63.1 ± 15.6 vs. 45.9 ± 9.8% and 62.5 ± 17.3 vs. 44.0 ± 12.6% of peak torque/body mass, p < 0.05). The peak torque decreased only after ten forehands (38.3 ± 15.8 vs. 38.2 ± 15.8 and 39.3 ± 16.1 vs. 38.1 ± 15.6 Nm, respectively, p < 0.05), but without impacting speed or accuracy. Unilateral systematic actions of tennis players caused contralateral asymmetries, evidencing the importance of implementing compensatory training. The forehand kinematic assessment suggests that racket and wrist amplitude, as well as speed, are important success determinants in tennis.

Morphological and functional asymmetry in elite youth tennis players compared to sex- and age-matched controls

Besides examining upper and lower limb morphological and functional asymmetry magnitudes, this study examined the relationship between lean mass and functional asymmetry in terms of magnitude and direction in 41 youth tennis players versus 41 controls. Asymmetry magnitude was determined using anthropometric measurements (circumferences, widths), bioelectrical impedance analysis (lean mass) and a test battery (handgrip strength, seated medicine ball throw, plate tapping, single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, 505 change of direction). ANOVAs compared the dominant (overall highest/best value) against the non-dominant (highest/best value of opposing limb) result. Linear regressions explored the relationship between lean mass and functional asymmetry magnitudes. Kappa coefficients examined asymmetry direction consistency between the limb displaying the highest lean mass value and the limb performing dominantly across tests. Significant asymmetry magnitudes (p < 0.05) were found for all upper and lower limb outcome measures. No significant relationship was apparent between lean mass and functional asymmetry magnitude (r-value = -0.283-0.262). Despite finding (almost) perfect consistency in asymmetry direction (k-value = 0.84-1.00) for the upper limb, poor to slight consistency (k-value = -0.03-0.15) was found for the lower limb. Therefore, lean mass and functional asymmetry should be examined independently.

Relationship between Performance and Inter-Limb Asymmetries Using Flywheel Resistance Device in Elite Youth Female Basketball Players

The purposes of this study were to quantify inter-limb asymmetries from unilateral jumps, change of direction (COD) speed, and flywheel resistance skill tests and to examine their relationship with physical performance in a sample of elite youth female basketball players. Eleven female basketball players (age = 17.56 ± 0.60 year; body mass = 75.13 ± 12.37 kg; height = 1.83 ± 0.08 m; BMI = 22.42 ± 2.28; sports experience = 6.31 ± 1.73 year; years post-peak height velocity = 4.79 ± 0.68 year) performed a battery of fitness tests in the post-season consisting of the Single Leg Countermovement Jump in vertical (SLCJ-V), horizontal (SLCJ-H), and lateral (SLCJ-L) directions, 135° and 90° COD tests, and four skills (acceleration step, deceleration step, sidestep, and crossover step) with an flywheel resistance device. The results showed significant differences between the higher performing and lower performing limbs across all tasks (p < 0.05). The mean asymmetry index values ranged from 1.26% (COD 135°) to 11.75% (SLC-V). Inter-limb asymmetries were greatest during the flywheel resistance skills. Spearman’s correlations (ρ) for all tests were only significant for inter-limb asymmetries during the sidestep test and reduced performance in SLCJ-L (ρ = −0.61; p = 0.046) and all COD deficits (ρ range = −0.72 to −0.81). The findings of the present study showed that inter-limb asymmetries are task-specific in female youth basketball players and suggest that the use of flywheel devices can be included in the battery of tests to detect inter-limb asymmetry.

Return to play in elite rugby players after severe knee injuries

Background

Medical professionals working in an elite sport environment have the challenging task to balance the athlete's readiness to return to the playing field after severe injury with other stakeholders' (coaches, sponsors, teammates) opinions and objectives.

Objectives

Our study aimed to evaluate differences in the physical profiles of elite rugby players at return to play (RTP) after a severe knee injury, compared with their pre-injury profiles and matched controls.

Method

Before the injury, participants performed four performance tests during their preseason screening. These tests were repeated and compared to baseline once a player was declared fit to play.

Results

Significant differences (p ≤ 0.05) were found in the injured players' group who were slower over 10 m speed, in their decision-making time and the total time of the reactive agility tests at RTP, whilst controls were significantly faster over 10 m and 30 m speed tests. The countermovement jump outcomes showed significant improvement in the uninjured participants (p ≤ 0.05).

Conclusion

Our study highlights that injured players' running speeds and decision-making times are slower after injury. The uninjured players have a positive outcome to training and match stimulus by improving their running speed and lower body explosive power during the season.

Clinical implications

Our study provides insight into the RTP profile of elite rugby players, and a novel finding was the decision-making time deficit. This highlights the importance of cognitive training during injury rehabilitation as athletes make numerous decisions in a pressured and uncontrolled environment during a match. Speed training development is recommended as the athletes were slower after severe knee injury.

Warm-Up Improves Balance Control Differently in the Dominant and Non-Dominant Leg in Young Sportsmen According to Their Experience in Asymmetric or Symmetric Sports

The aim of this study was to investigate the acute effects of a warm-up on balance control and inter-limb balance asymmetries by analyzing the influence of the nature of the sport practiced by participants. Twelve sportspeople were recruited. They had to stand on a force plate for 30 s in a one-leg stance on their dominant (used to perform skilled movements) and non-dominant leg (used to support the body) before and 2, 5, 10, 15 and 20 min after a 10 min warm-up exercise performed at moderate intensity on a cycle ergometer. The center of foot pressure displacements was recorded. Statistical analysis was performed by considering one group of all participants and with two subgroups according to the symmetrical or asymmetrical nature of the sport they practiced. The warm-up exercise improved acute balance control only on the dominant leg after a 20 min rest without significantly reducing inter-limb balance asymmetries. This effect was more characteristic of participants with experience in asymmetric sports. These results confirm previous findings of the greater sensitivity of the dominant leg to the physiological state and reveal that between-leg differences in balance control appear mainly in subjects with experience in asymmetric sports in a specific physiological condition (post-warm-up state).

Can Compression Garments Reduce Inter-Limb Balance Asymmetries?

Sensory cues provided by compression garments (CG) can improve movement accuracy and potentially reduce inter-limb balance asymmetries and the associated risk of injury. The aim of this study was to analyze the effects of CG wearing on inter-limb balance asymmetries. The hypothesis was that CG would reduce inter-limb balance asymmetries, especially in subjects with high level of asymmetries. Twenty-five sportsmen were recruited. They had to stand as motionless as possible in a one-leg stance in two postural tasks (stable and unstable), while wearing CG or not. Asymmetry indexes were calculated from center of foot pressure parameters. The effects of CG wearing were analyzed according to participants’ baseline level of asymmetry (i.e., without wearing CG) with correlation analyses. A qualitative analysis was also performed after a dichotomization procedure to check for a specific influence of CG on the dominant and non-dominant leg. Inter-limb balance asymmetries were reduced with CG in participants with high levels of asymmetries at baseline. However, asymmetries were increased with CG in participants with low levels of asymmetries at baseline. The dominant leg was more affected by this negative effect. CG wearing could reduce inter-limb balance asymmetries and the related injury risk in subjects with high levels of inter-limb balance asymmetries at baseline. Nevertheless, CG should not be used in individuals with low baseline balance asymmetries since it can increase asymmetries in these subjects, likely by confusing and overloading the sensorimotor processing on the dominant leg.

Effects of Direction-Specific Training Interventions on Physical Performance and Inter-Limb Asymmetries

This study analyzed the effects of two different training programs on functional performance and inter-limb asymmetries in basketball players. Twenty-four elite youth basketball players were randomly assigned to a training program including variable unilateral horizontal movements (VUH, n = 12) or unilateral lateral movements (VUL, n = 12). Eccentric-overload training (EOT) was performed twice a week for a six-week period. Functional performance assessment included a countermovement jump test, unilateral multidirectional jumping tests (i.e., lateral, horizontal, and vertical), a rebound jump test, a limb symmetry index, a 25 m linear sprint test, and several change of direction (COD) tests. Within-group analysis showed substantial improvements in almost all functional tests in both groups (ES = 0.35–0.89). Furthermore, almost all jumping asymmetries were improved in both groups (ES = 0.38–0.69) except for vertical jumping asymmetry in VUL (ES = −0.04). Between-group analyses showed a substantial and possibly better performance in vertical jumping asymmetry and 5 m in VUH compared to that of VUL, respectively. In contrast, lateral jumping with left (ES = 1.22) and right leg (ES = 0.49) were substantially greater in VUL than in VUH. Specific force-vector training programs induced substantial improvements in both functional performance tests and inter-limb asymmetries, although greater improvements of lateral and horizontal variables may depend on the specific force vector targeted.

Is There Any Effect of Symmetry on Velocity of the Four Swimming Strokes?

The different characteristics of the four swimming strokes affect the interplay between the four limbs, acting as a constraint to the force produced by each hand and foot. The purpose of this study was to analyze the symmetry of force production with a varying number of limbs in action and see its effect on velocity. Fifteen male swimmers performed four all-out bouts of 25-m swims in the four strokes in full-body stroke and segmental actions. A differential pressure system was used to measure the hands/feet propulsive force and a mechanical velocity meter was used to measure swimming velocity. Symmetry index was calculated based on the force values. All strokes and conditions presented contralateral limb asymmetries (ranging from 6.73% to 28% for the peak force and from 9.3% to 35.7% for the mean force). Backstroke was the most asymmetric stroke, followed-up by butterfly, front crawl, and breaststroke. Kicking conditions elicited the higher asymmetries compared with arm-pull conditions. No significant associations were found between asymmetries and velocity. The absence of such association suggests that, to a certain and unknown extent, swimming may benefit from contralateral limb asymmetry.

Effects of Three Different Combined Training Interventions on Jump, Change of Direction, Power Performance, and Inter-Limb Asymmetry in Male Youth Soccer Players

BACKGROUND

This study compared the effects of performing different unilateral combined training interventions on diverse vertical and horizontal jumping performance parameters, change of direction, concentric and eccentric mean power, and their associated inter-limb asymmetries in young soccer players.

METHODS

Forty-seven young male soccer players (age: 15.5 ± 0.9 years) were distributed into three groups. Two groups performed the same training volume with both legs, beginning with the weaker leg (Stronger Volume Weaker leg group (SVW), n = 14) or with the stronger leg (Stronger Volume Stronger leg group, (SVS), n = 15). The third group executed double the volume with the weaker leg and also commenced with such leg (Double Volume Weaker leg group (DVW), n = 16) during a 10-week period. Pre- and post-intervention tests included a single-leg hop, single-leg lateral hop, triple hop, bilateral and unilateral countermovement jumps, a change of direction speed test, concentric and eccentric mean power during the lateral squat test, and their corresponding asymmetries.

RESULTS

Single-leg hop weaker leg, triple hop weaker leg, and bilateral countermovement jump improvements were achieved in the SVW (ES: 0.29 to 0.46) and DVW (ES: 0.55 to 0.73) groups. Between-groups analysis showed better results in single-leg hop in the SVW and DVW compared to group SVS. The DVW group achieved better improvements in countermovement jump in comparison to groups SVS and SVW.

CONCLUSIONS

Groups that started with the weaker leg seemed to achieve a greater volume of significant changes than when starting with the stronger leg. Performing a double volume on the weaker limb does not guarantee further improved performance compared to other groups.

No Relationship between Lean Mass and Functional Asymmetry in High-Level Female Tennis Players

The relationship between lean mass and functional asymmetry in terms of their magnitude and direction was examined in 22 high-level female tennis players (20.9 ± 3.6 years). Lean mass of both upper and lower extremities was examined using Dual X-ray Absorptiometry. Functional asymmetry was assessed using a battery of field tests (handgrip strength, seated shot-put throw, plate tapping, single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, and 505 change of direction (time and deficit)). Paired sample t-tests compared the dominant (overall highest/best (performance) value) against the non-dominant value (highest/best (performance) value of the opposing extremity). Linear regressions were used to explore the relationship between lean mass and functional asymmetry magnitudes. Kappa coefficients were used to examine the consistency in direction between the extremity displaying the highest lean mass value and the extremity performing dominantly across tests. Significant asymmetry magnitudes (p < 0.05) were found for all upper and lower extremity lean mass and functional values. No relationship was apparent between lean mass and functional asymmetry magnitudes (p-value range = 0.131–0.889). Despite finding perfect consistency in asymmetry direction (k-value = 1.00) for the upper extremity, poor to fair consistency (k-value range = −0.00–0.21) was found for the lower extremity. In conclusion, lean mass and functional asymmetries should be examined independently.

Seasonal variation of inter-limb jumping asymmetries in youth team-sport athletes

The main objective of the present study was to provide seasonal variation data for inter-limb asymmetry in youth elite team-sport athletes. Fifty-nine players performed the single-leg countermovement jump (SLCMJ) and the one leg hop for distance (OLHT) tests during pre-season, mid-season and end-season. A repeated-measures analysis of variance was conducted to determine magnitude differences in asymmetry scores between time points. Kappa coefficients (κ) were calculated to determine the levels of agreement for the direction of asymmetry. When comparing inter-limb asymmetry magnitudes across the season, the SLCMJ test showed significantly higher asymmetries at mid-season in comparison with pre-season and end-season (p< 0.01, d= -1.03 for pre to mid; p< 0.01, d= 1.12 for pre to end). However, OLHT inter-limb asymmetry magnitude remained consistent throughout the season (ES range = -0.02 to -0.06). For the direction of asymmetry, levels of agreement ranged from poor to slight in the SLCMJ (k= -0.10 to 0.18) and in the OLHT (k= -0.21 to 0.18). No significant differences were found between mean asymmetry values at any time point or for either test when comparing males and females. In conclusion, jump height asymmetry during the SLCMJ was the only metric to show significant magnitude changes across the season.

Between-session reliability of performance and asymmetry variables obtained during unilateral and bilateral countermovement jumps in basketball players

This study aimed to evaluate the between-session reliability of single-leg performance and asymmetry variables during unilateral and bilateral countermovement jumps (CMJ). Twenty-three basketball players completed two identical sessions which consisted of four unilateral CMJs (two with each leg) and two bilateral CMJs. Mean and peak values of force, velocity and power, impulse, and jump height were obtained separately for each leg using a dual force platform. All performance variables presented an acceptable reliability (CVrange = 4.05-9.98%) with the exceptions of jump height for the unilateral CMJs and mean power, peak velocity, peak power, and impulse for the left leg during the bilateral CMJ (CV≥11.0%). Nine out of 14 variables were obtained with higher reliability during the unilateral CMJ (CVratio≥1.16), and 4 out of 14 during the bilateral CMJ (CVratio≥1.32). Asymmetry variables always showed an unacceptable reliability (ICCrange = 0.15-0.64) and poor/slight levels of agreement in direction (Kapparange = -0.10 to 0.15) for the unilateral CMJ, while an acceptable reliability (ICCrange = 0.74-0.77) and substantial levels of agreement in direction (Kapparange = 0.65 to 0.74) were generally obtained for the bilateral CMJ. These results suggest that single-leg performance can be obtained with higher reliability during the unilateral CMJ, while the bilateral CMJ provides more consistent measures of inter-limb asymmetries.

Assessing Inter-Limb Asymmetries in Soccer Players: Magnitude, Direction and Association with Performance

In this study, we aimed to analyze the magnitude and direction of inter-limb asymmetries in ankle dorsiflexion range of motion (ROM), power (using iso-inertial devices), and a neuromuscular skill (change of direction). Secondarily, we aimed to determine the relationship between inter-limb asymmetry scores for each test and also between these scores and the scores for the different performance tests. Sixteen semiprofessional male soccer players (age: 25.38 ± 6.08 years; body height: 1.78 ± 0.64 m; body mass: 79.5 ± 14.9 kg) participated in this study. We calculated inter-limb asymmetries using five tests: ankle dorsiflexion ROM, change of direction (COD 180º), and iso-inertial resistance tasks in the open (leg extension strength (LE), leg curl strength (LC)) and closed (crossover step (CRO)) kinetic chain. Our results showed that asymmetry magnitudes differed between all tests with highest inter-limb asymmetries displayed during iso-inertial overloading. In addition, we observed that the direction of asymmetries varied depending on the test-specificity, and that the CRO asymmetries had a negative association with LE and CRO performance. These findings highlight the independent nature of asymmetries and that CRO could be an appropriate test to detect asymmetries related with the performance of soccer-specific actions (such as changes of direction). Practitioners are encouraged to use multiple tests to detect existing inter-limb differences according to the specific characteristics of each sport.

A Technical Report on Reliability Measurement in Asymmetry Studies

ABSTRACT

Bailey, CA, Sato, K, and McInnis, TC. A Technical report on reliability measurement in asymmetry studies. J Strength Cond Res 35(7): 1779-1783, 2021-Much of the current literature on asymmetry in sport performance may be biased by evaluating reliability before quantifying the asymmetry metric. This technical report aimed to evaluate the reliability of asymmetry measurements in countermovement jumps (CMJs) by providing measures before production of asymmetry metrics, after production of scalar- and vector-based asymmetry metrics, and to analyze the resulting differences that can lead to misinformed decision making. Thirteen collegiate baseball players (19.9 ± 1.3 years, 82.2 ± 10.9 kg) participated in CMJ testing on 2 force plates to evaluate symmetry index (SI) scores as scalar (asymmetry magnitude only) and vector (asymmetry magnitude and direction) quantities. Relative and absolute reliability were evaluated for peak force (PF), scalar PF SI, and vector PF SI. Results showed that reliability measures produced on the constituent force-time variable provide much more favorable results compared with evaluating reliability of the asymmetry measure itself (coefficients of variation of 10.4-15.7% vs. 63.2-1,497.1%). Findings also showed that reliability is altered depending on whether asymmetry is quantified as a scalar or vector. Asymmetry should likely be quantified as a vector for reliability purposes because that allows variability in both magnitude and direction. These findings demonstrate that inadequate evaluation of reliability in asymmetry leads to biased results. Practitioners should use caution when considering the results of asymmetry assessments as they may not be as reliable as they are often portrayed.

Impact of Patellar Tendinopathy on Isokinetic Knee Strength and Jumps in Professional Basketball Players

Patellar tendinopathy is characterized by tendon pain which may reduce the level of performance. This study's main aim was to compare isokinetic knee strength and jump performances at the start of the sport season between players with patellar tendinopathy and those without. Secondary aims were to assess the relationship between knee strength and jump function. Sixty-two professional basketball players were enrolled (mean age: 25.0 ± 4.0). All players performed knee isokinetic measurements, single leg countermovement jumps, and one leg hop tests. Correlations between knee strength and jump performances were examined. Twenty-four players declared a patellar tendinopathy and were compared to the 38 players without tendinopathy. The isokinetic quadriceps strength was lower in cases of patellar tendinopathy, and a camel's back curve was observed in 58% of the cases of patellar tendinopathy. However, jump performances were preserved. No link was found between quadriceps and hamstring limb symmetry indexes at 60 and 180°/s with jumps. This preseason screening enabled us to identify the absence of consequences of patellar tendinopathy in professional basketball players. Jump performances were not altered, possibly due to compensatory strategies.

International vs. National female tennis players: a comparison of upper and lower extremity functional asymmetries

BACKGROUND

Asymmetries have been reported to negatively impact sport performance. This study examined the magnitude and direction of whole-body functional asymmetry in international versus national female tennis players.

METHODS

Ten internationally and twelve nationally ranked tennis players participated. Upper extremity functional asymmetries (or side-to-side performance differences) were evaluated using handgrip strength, seated shot-put throw and plate tapping. Lower extremity functional asymmetries were determined using the single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, 505 changes of direction (time and deficit), and Y-balance test (anterior, posteromedial, posterolateral). ANOVAs were used to compare the dominant (overall best or fastest result of a specific test) versus non-dominant performance values (best or fastest result of the corresponding extremity) within the internationally versus nationally ranked players. Functional asymmetry magnitudes differences (expressed as a %) were examined using Mann-Whitney U tests. Kappa coefficients examined the consistency as to which extremity performed dominantly across tests.

RESULTS

Significant asymmetries for every upper and lower extremity test were found. The functional asymmetry magnitude was significantly (p=0.020) higher on the single leg forward hop test for the nationally (6.3%) versus internationally ranked players (2.9%). Kappa coefficients showed perfect levels of consistency regarding all upper extremity tests (k=1.00), indicating true limb dominance whereas more variance was found as to which lower extremity performed dominantly across tests (k range=-0.067-0.174).

CONCLUSIONS

The included female tennis players displayed significant whole-body functional asymmetries. Poor consistency as to which lower extremity performed dominantly across tests warrants individual asymmetry monitoring.

Associations between Inter-Limb Asymmetries in Jump and Change of Direction Speed Tests and Physical Performance in Adolescent Female Soccer Players

The association between asymmetries in jump and change of direction (COD) with physical performance in several sports show inconclusive results. The purposes of this study were to: (1) measure inter-limb asymmetries in three distinct groups in adolescent female soccer players and, (2) to determine the association between inter-limb asymmetries and physical performance in different age groups. Fifty-four players were distributed in three age groups: U-18, U-16 and U-14. All of them performed a series of jumps, sprints and change of direction speed tests. Asymmetries were assessed as the percentage difference between limbs, with the equation: 100/Max value (right and left) * in value (right and left) * -1 + 100. Mean inter-limb asymmetries were 2.91%, 4.82% and 11.6% for 180° COD, single leg hop and single leg countermovement jump tests respectively, but higher percentages of asymmetries were observed in many players individually. U-18 and U-16 showed significant differences on 180° left COD compared to U-14. Effect size (ES): 0.80 and 0.74, respectively; U-18 presented differences on single left leg hop test compared to U-14, ES: -0.72; U-16 also showed differences on 40 m speed compared to U-14, ES 0.87 (All p < 0.05). Jumping and COD physical tests show asymmetries in adolescent female soccer players, but these asymmetries do not interfere with physical performance. The largest asymmetry was observed in the single leg countermovement jump, and no asymmetries between groups were found. Due to the high variability in the direction of asymmetries, it is recommended to consider players' individual asymmetries for designing specific training programs.

Fatigue-Induced Inter-Limb Asymmetries in Strength of the Hip Stabilizers, Postural Control and Gait Following a Unilateral Countermovement Vertical Jump Protocol

It is generally accepted that neuromuscular overload and fatigue of one lower limb can affect the functional ability of the ipsilateral limb, and possibly the contralateral limb, increasing the likelihood of injury. The purpose of the current study was to examine the effect of a unilateral countermovement vertical jump (UCVJ) fatigue protocol on the neuromuscular function of the ipsilateral as well as the contralateral lower limb. The isometric strength of the hip stabilizers, postural control via posturographic analysis during the Y-Balance-Test (YBT), and the stance-phase-of-gait were assessed in 24 healthy physical active males and females before and after execution of a UCVJ fatigue protocol. The fatigue protocol included 5 sets of 20 maximum UCVJs performed on the supportive leg, with a 30-s break between sets. Following a 16.8% decline in vertical jump performance and an associated 2.3-fold increase in perceived exertion, our findings revealed significant post-fatigue inter-limb differences regarding postural control. The post-fatigue inter-limb differences regarding the isometric strength of the hip stabilizers and the stance-phase-of-gait parameters were not significant. Our findings showed that a 100 UCVJs session is likely to induce significant inter-limb differences in postural control, possibly increasing the risk of lower limb injury.

Influence of Dynamic Balance on Jumping-Based Asymmetries in Team Sport: A between-Sports Comparison in Basketball and Handball Athletes

The aims of the present study were to analyze mobility, dynamic balance and lower-limb strength and the prevalence of asymmetry according to the type of sport and assess the association between inter-limb asymmetry and sports performance. A total of 23 basketball and 25 handball players performed a test battery consisting of functional movements and a jump test. Inter-limb asymmetry was calculated using a standard percentage difference equation. A between-groups comparison analysis was carried out, and Pearson’s correlation coefficients (r) were calculated to establish a relationship between asymmetries and physical performance. The results found athletes in different sports to exhibit different performance in functional movements and the jump test, but no bilateral asymmetries. The reactive strength index (RSI) and stiffness asymmetries were significantly associated with the anterior reach Y-balance test (YBT) (r = −0.412; p < 0.01 and r = −0.359; p < 0.05, respectively), and the unilateral triple hop test (THTU) was negatively correlated to anterior reach, posterior lateral reach YBT and YBT composite YBT (r = −0.341 to −0.377; p < 0.05). These findings suggest that the asymmetries exhibited important dispersion not dependent upon the type of sport but on each individual and the applied test. In addition, asymmetry in anterior direction YBT showed the strongest association to the rest of the sports performance variables.

Healthy Pediatric Athletes Have Significant Baseline Limb Asymmetries on Common Return-to-Sport Physical Performance Tests

Background:

Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a much higher risk (∼30%) of subsequent ACL injury than in adults. Most RTS testing protocols use a limb symmetry index (LSI) ≥90% on physical performance tests (PPTs) to assess an athlete’s readiness for sport. This assumes that, in a healthy state, the physical performances across both lower extremities are and should be equal.

Purpose:

To determine the prevalence of limb asymmetries >10% in the uninjured pediatric population on common PPTs as well as to explore the relationship between athlete variables, limb preference, and LSI values.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

This study included healthy volunteers (N = 100) evenly distributed between the ages of 6 and 18 years (mean age, 11.7 ± 3.6 years; 52% female). Participants performed 9 common PPTs. For analysis, we developed a composite score for each limb by averaging trials. We then calculated the LSI for each test. Univariable and multivariable linear regression analyses were performed to assess the relationship between athlete variables (age, sex, height, and weight) and LSI for each PPT.

Results:

Instances of poor baseline limb symmetry (<90% LSI) were common across all PPTs. The single-leg timed hop had the highest percentage of participants, with LSI ≥90% at 73%, while the stork on a Bosu ball had the lowest percentage at 23%. After adjusting for age, female sex showed a significant association with LSI for the stork test (P = .010) and the quadrant hop–counterclockwise (P = .021). Additionally, after adjusting for sex, increasing age showed a significant association with LSI for the stork test (P < .001), single-leg squat on a Bosu ball (P = .010), quadrant hop–clockwise (P = .016), and quadrant hop–counterclockwise (P = .009).

Conclusion:

The majority of healthy athletes 18 years and younger demonstrated significant (<90%) limb asymmetries. Limb symmetry was not consistently affected by participant age or sex, and the effect sizes of these relationships were small. These findings should encourage clinicians and coaches to exercise caution in using the LSI as an isolated measure of RTS readiness after injury in pediatric athletes.

Comparison of multidirectional jump performance and lower limb passive range of motion profile between soccer and basketball young players

This study was performed aimed at comparing multidirectional bilateral and unilateral jump performance and passive range of motion (ROM) of lower limbs between soccer and basketball young players and evaluating associations between inter-limb ROM asymmetry and bilateral jump performance. A total of 67 young male athletes participated in this study, who were classified as soccer (n = 40; 15.55 ± 1.5 y; 1.76 ± 0.12 m; 58.15 ± 10.82 kg; 19.84 ± 2.98 kg·m2) and basketball (n = 27; 15.7 ± 1.66 y; 1.76 ± 0.12 m; 62.33 ± 16.57 kg; 19.84 ± 2.98 kg·m2) players. Participants were asked to perform bilateral and unilateral multidirectional jumps, and passive ROM of hip (flexion, extension and abduction), knee (flexion) and ankle (dorsiflexion) joints was also assessed. Significant between-group differences were observed for hip extension with flexed knee ROM in dominant (soccer: 142.43 ± 7.74°; basketball: 148.63 ± 8.10°) and non-dominant (soccer: 144.38 ± 8.36°; basketball: 148.63 ± 6.45°) legs; hip flexion with flexed knee ROM in dominant (soccer: 13.26 ± 4.71°; basketball: 9.96 ± 3.42°) and non-dominant (soccer: 12.86 ± 4.55°; basketball: 9.70 ± 3.62°) legs; and for the ratio of hip abduction (soccer: 1.02 ± 0.08; basketball: 0.97 ± 0.11). However, no significant between-group differences were observed for bilateral and unilateral jump capacity, or for inter-limb asymmetries (dominant vs. non-dominant leg). Finally, no associations were observed between ROM ratio (dominant vs. non-dominant leg) and bilateral jump performance. These findings lead to the suggestion that differences on passive ROM values in young male athletes may be sport-specific. Additionally, there seems to be need for the implementation of training strategies specifically aimed at improving bilateral or unilateral jump ability, or at diminishing inter limb passive ROM differences in order to improve multidirectional jump performance for neither soccer nor basketball youth male players.

Relationship between Inter-Limb Asymmetries and Physical Performance in Rink Hockey Players

The magnitude of inter-limb asymmetries has been reported in several studies in different team sports but only some of them have analysed their effects on sports performance. The main purpose of this cross-sectional study was to determine inter-limb asymmetries and examine their relationship with different physical performance tests in rink hockey players. Nineteen rink hockey players (age: 23.37 ± 4.82 years; body height: 1.75 ± 0.06 cm; body mass: 73.16 ± 9.87 kg) performed a mid-season battery of fitness tests consisting of 30 m sprint, countermovement jump (CMJ), and half back squat. Inter-limb asymmetries were assessed using the single leg vertical countermovement jump test (SLCJ-V), single leg horizontal countermovement jump test (SLCJ-H), and 180° change of direction test (COD). Results show a significant relationship between asymmetry in the SLCJ-H test, 30 m sprint (r = 0.63, p < 0.01) and CMJ performances (r = −0.52, p < 0.05). Additionally, asymmetry in the SLCJ-V showed a significant relationship with CMJ performance (r = −0.46, p < 0.05). These findings suggest that training programs should aim to reduce the inter-limb asymmetries in rink hockey players to improve their performance. Practitioners and coaches can use this information to assess the potential impact of asymmetries on physical performance in rink hockey players.

Influence of the Amount of Instability on the Leg Muscle Activity During a Loaded Free Barbell Half-Squat

This study aimed to understand the acute responses on the muscular activity of primary movers during the execution of a half-squat under different unstable devices. Fourteen male and female high-standard track and field athletes were voluntarily recruited. A repeated measures design was used to establish the differences between muscle activity of the primary movers, the body centre of mass acceleration and the OMNI-Perceived Exertion Scale for Resistance Exercise (OMNI-Res) in a half-squat under four different stability conditions (floor, foam, BOSU-up and BOSU-down). A significant correlation was found between the highest performance limb muscle activity and body centre of mass acceleration for half-squat floor (r = 0.446, p = 0.003), foam (r = 0.322, p = 0.038), BOSU-up (r = 0.500, p = 0.001), and BOSU-down (r = 0.495, p = 0.001) exercises. For the exercise condition, the half-squat BOSU-up and BOSU-down significantly increased the muscle activity compared to half-squat floor (vastus medialis: p = 0.020, d = 0.56; vastus lateralis: p = 0.006, d = 0.75; biceps femoris: p = 0.000–0.006, d = 1.23–1.00) and half-squat foam (vastus medialis: p = 0.005–0.006, d = 0.60–1.00; vastus lateralis: p = 0.014, d = 0.67; biceps femoris: p = 0.002, d = 1.00) activities. This study contributes to improving the understanding of instability training, providing data about the acute muscular responses that an athlete experiences under varied stability conditions. The perturbation offered by the two BOSU conditions was revealed as the most demanding for the sample of athletes, followed by foam and floor executions.

Change of Direction Performance Is Influenced by Asymmetries in Jumping Ability and Hip and Trunk Strength in Elite Basketball Players

Change of direction (COD) ability is essential for sport performance in high level team sports such as basketball, however, the influence of asymmetries on COD ability is relatively unknown. Forty-three junior and senior level elite basketball players performed isometric hip and trunk strength testing, passive hip and trunk range of motion testing, and unilateral horizontal and vertical jumps, as well as the T-test to measure COD performance. Mean asymmetry values ranged from 0.76% for functional leg length up to 40.35% for rate of torque development during hip flexion. A six-variable regression model explained 48% (R2 = 0.48; p < 0.001) of variation in COD performance. The model included left hip internal/external rotation strength ratio, and inter-limb asymmetries in hip abduction rate of torque development, hip flexion range of motion, functional leg length, single leg triple jump distance, and peak torque during trunk lateral flexion. Results suggest that the magnitude of asymmetries is dependent of task and parameter, and using universal asymmetry thresholds, such as <10 %, is not optimal. The regression model showed the relationship between asymmetries and COD performance. None of tests were sufficient to explain a complex variable like COD performance.

Validity and Reliability of the New Basic Functional Assessment Protocol (BFA)

The global evaluation of motion patterns can examine the synchrony of neuromuscular control, range of motion, strength, resistance, balance and coordination needed to complete the movement. Visual assessments are commonly used to detect risk factors. However, it is essential to define standardized field-based tests that can evaluate with accuracy. The aims of the study were to design a protocol to evaluate fundamental motor patterns (FMP), and to analyze the validity and reliability of an instrument created to provide information about the quality of movement in FMP. Five tasks were selected: Overhead Squat (OHS); Hurdle Step (HS); Forward Step Down (FSD); Shoulder Mobility (SM); Active Stretching Leg Raise (ASLR). A list of variables was created for the evaluation of each task. Ten qualified judges assessed the validity of the instrument, while six external observers performed inter-intra reliability. The results show that the instrument is valid according to the experts' opinion; however, the reliability shows values below those established. Thus, the instrument was considered unreliable, so it is recommended to repeat the reliability process by performing more training sessions for the external observers. The present study creates the basic functional assessment (BFA), a new protocol which comprises five tasks and an instrument to evaluate FMP.