Knee Angle Affects Posterior Chain Muscle Activation During an Isometric Test Used in Soccer Players

The effect of knee-flexion angle on peak force and muscle activation during isometric knee-flexor strength testing using the Nordbord device in soccer players

Isometric knee-flexor testing is commonplace in soccer, yet data to inform choice of knee-flexion angle are limited. This study aimed to compare peak force production and muscle activation between two isometric knee-flexor tests. To compare peak force, 43 male soccer players (age 21.5 ± 5 years; stature 180.3 ± 6.3 cm; body mass 74.6 ± 8.9 kg) completed 3 × 5-second maximal efforts on the Nordbord device (Vald Performance) with a 0- (ISO-Prone) and 30-degree (ISO-30) knee angle, respectively. To compare peak muscle activation, a further 13 trained male participants (25 ± 6 years; 178.2 ± 5.6 cm; 79.6 ± 13.2 kg) completed 3 × 5-second maximal efforts with wireless surface electromyography electrodes placed on the Gluteus Maximus, Adductor Magnus, Semitendinosus, Biceps Femoris (long and short heads) and Medial Gastrocnemius. Paired samples t-tests were used to detect differences in force output between tests and Pearson's correlations to quantify associations. A Yuen's modified t-test estimated the trimmed mean differences in muscle activation between tests. Higher peak forces were observed in the ISO-30, with mean differences of 56.4N (36.8 to 75.9 [95% CI]) and 52.9N (33.7 to 72.3 [95% CI]) for right (367 vs 314N) and left legs (351 vs 294N), respectively. Moderate correlations were observed in peak force for left (r = 0.55 (0.29 to 0.73 [95%CI])) and right (r = 0.64 (0.42 to 0.79 [95%CI]) legs. No differences in muscle activation were observed. Peak force varies between the ISO-Prone and ISO-30, with moderate associations between tests, indicating that the tests should not be used interchangeably.

Low-load strength resistance training with blood flow restriction compared with high-load strength resistance training on performance of professional soccer players: a randomized controlled trial

BACKGROUND

The aim of this study is to evaluate the effectiveness of low-load blood flow restriction strength resistance training (LL-BFR) compared to high load strength resistance training (HL) on performance of professional soccer players.

METHODS

Eighteen male players from National Soccer Professional League were randomly allocated into two groups: LL-BFR, who performed a 6-weeks strength training program with low load (20-35% of one-repetition maximum-[1RM]), or HL, who performed a 6-week resistance training program with high load (70-85% 1RM). Before and after, thigh girth, vertical jump, lower limb strength, vertical force-velocity profile (F-v), and 30-m sprint were evaluated.

RESULTS

After the training program, both LL-BFR and HL induced significant increases compared to baseline in thigh girth (+3.3% for LL-BFR and +3.1% for HL) and maximal velocity during sprinting (+6.0 and +6.2%, respectively), without between-group differences. In reference to FV, only HL players improved imbalance (-54.4%), maximal theoretical force production (+10.4%) and decreased extension velocity (-20.5%) compared to baseline, without between-group differences. Only LL-BFR induced increases in maximum voluntary contraction of left hamstring compared to baseline (+13.8%), without between-group differences. No differences were shown for the rest of variables (P>0.05).

CONCLUSIONS

Although LL-BFR may increase muscle circumference and sprint ability, these results are similar to those induced with HL in male professional soccer. In terms of F-v, only HL induced improvements, but these changes were not greater than those observed after LL-BFR.

Progressing On-Court Rehabilitation After Injury: The Control-Chaos Continuum Adapted to Basketball

BACKGROUND: Sport-specific training is an integral component of returning to sport following injury. Frameworks designed to guide sport-specific rehabilitation need to integrate and adapt to the specific context of elite sport. The control-chaos continuum (CCC) is a flexible framework originally designed for on-pitch rehabilitation in elite football (soccer). The concepts underpinning the CCC transfer to other elite sport rehabilitation environments. CLINICAL QUESTION: How can practitioners and clinicians transfer the CCC to elite basketball, to support planning and return to sport? On-court rehabilitation is a critical sport-specific rehabilitation component of return to sport, yet there are no frameworks to guide practitioners when planning and delivering on-court rehabilitation. KEY RESULTS: Based on our experience working in the National Basketball Association, we report how the CCC framework can apply to elite basketball. We focus on the design and delivery of progressive training in the presence of injury in this basketball-specific edition of the CCC. Given the challenges when quantifying "load" in basketball, we encourage practitioners and clinicians to consider the qualitative aspects of performance such as skill, sport-specific movement, contact, and decision making. CLINICAL APPLICATION: The 5-phase framework describes training progression from high control, a return to on-court running, to high chaos, a return to "live" unrestricted basketball. The model can be adapted to both short- and long-term injuries based on injury and progression criteria. Strength and power "diagnostics" can be strategically implemented to enhance decision making throughout the return to sport continuum. J Orthop Sports Phys Ther 2023;53(9):1-12. Epub: 9 August 2023. doi:10.2519/jospt.2023.11981.

Hamstrings force-length relationships and their implications for angle-specific joint torques: a narrative review

Temporal biomechanical and physiological responses to physical activity vary between individual hamstrings components as well as between exercises, suggesting that hamstring muscles operate differently, and over different lengths, between tasks. Nevertheless, the force-length properties of these muscles have not been thoroughly investigated. The present review examines the factors influencing the hamstrings’ force-length properties and relates them to in vivo function. A search in four databases was performed for studies that examined relations between muscle length and force, torque, activation, or moment arm of hamstring muscles. Evidence was collated in relation to force-length relationships at a sarcomere/fiber level and then moment arm-length, activation-length, and torque-joint angle relations. Five forward simulation models were also used to predict force-length and torque-length relations of hamstring muscles. The results show that, due to architectural differences alone, semitendinosus (ST) produces less peak force and has a flatter active (contractile) fiber force-length relation than both biceps femoris long head (BFlh) and semimembranosus (SM), however BFlh and SM contribute greater forces through much of the hip and knee joint ranges of motion. The hamstrings’ maximum moment arms are greater at the hip than knee, so the muscles tend to act more as force producers at the hip but generate greater joint rotation and angular velocity at the knee for a given muscle shortening length and speed. However, SM moment arm is longer than SM and BFlh, partially alleviating its reduced force capacity but also reducing its otherwise substantial excursion potential. The current evidence, bound by the limitations of electromyography techniques, suggests that joint angle-dependent activation variations have minimal impact on force-length or torque-angle relations. During daily activities such as walking or sitting down, the hamstrings appear to operate on the ascending limbs of their force-length relations while knee flexion exercises performed with hip angles 45–90° promote more optimal force generation. Exercises requiring hip flexion at 45–120° and knee extension 45–0° (e.g. sprint running) may therefore evoke greater muscle forces and, speculatively, provide a more optimum adaptive stimulus. Finally, increases in resistance to stretch during hip flexion beyond 45° result mainly from SM and BFlh muscles.

The ballistic hip thrust test: a potential tool to monitor neuromuscular performance

To investigate the reliability of the ballistic hip thrust (BHT) test performed on force plates as a diagnostic tool to monitor posterior chain neuromuscular status and compare its usefulness with the counter movement jump (CMJ). Twenty-two male football players from an elite Under-19 French Ligue 1 football club (16.4 ± 0.6 years) performed two assessments; Assessment 1: Two testing sessions separated by one week were performed to assess the reliability of the test. Participants performed a 3-set workout of 4 repetitions of the BHTs each session. Intra-day (between set) and inter-day (between testing day) reliability of concentric mean force, takeoff peak force and peak power were assessed. Assessment 2: Participants performed a 1-set workout of 3 repetitions of the CMJ and 4 repetitions of the BHT tests pre- and post-training to compare the usefulness of both tests. Concentric mean force and takeoff peak force showed small-to-moderate standardised typical errors (TE: 0.2-0.7) for inter- and intra-day reliability. Inter-day concentric mean force showed a coefficient of variation (CV) of 7.2%. Intra-day concentric mean force and take-off peak force showed a CV of 4.2% and 5.5%. BHT and CMJ showed similar moderate levels of usefulness. The BHT test showed moderate levels of reliability and usefulness. This test could be a useful addition to a testing battery to monitor posterior chain neuromuscular status.

Unilateral vs. bilateral hamstring strength assessments: comparing reliability and inter-limb asymmetries in female soccer players

The aims in the present study were to assess reliability for two unilateral and two bilateral field-based hamstring assessments and compare magnitude, direction and agreement of inter-limb asymmetry between tests and sessions. Twenty-nine female soccer players (age: 21.1 ± 4.5 years; height: 169.7 ± 5.8 cm; body mass: 66.2 ± 6.4 kg) performed three repetitions per leg of unilateral isometric 30° and 90° knee flexion (KF) tasks, and three repetitions total for a bilateral 90° isometric KF and Nordic hamstring exercise. Absolute reliability of most methods were acceptable (<10%). Relative reliability within-session was fair to excellent (ICC≥0.784; lower bound 95%CI ≥0.623). Greater variability in between-session relative reliability was observed during the unilateral tests, demonstrating poor to good (ICC = 0.698-0.798; lower bound 95%CI = 0.274-0.638). Bilateral assessments demonstrated similar ranges of poor to excellent (ICC = 0.679-0.963; lower bound 95%CI = 0.231-0.790). Agreement between-session for inter-limb asymmetry identification was slight and fair in the unilateral tests, with moderate to substantial agreement demonstrated in the bilateral. Being the most reliable within- and between-sessions, demonstrating substantial agreement in asymmetry between-sessions, the NHE would be most appropriate to identify inter-limb asymmetry and assess chronic changes in hamstring strength.

Managing the return to sport of the elite footballer following semimembranosus reconstruction

Hamstring strains are the most common injury in elite football and typically occur during high-speed running. Despite its important contribution to power production in the late swing phase, injury to the semimembranosus (SM) is less common than to the biceps femoris, but may involve the free tendon and depending on the degree of retraction, warrant surgical repair. Few case reports detail clinical reasoning, supported by objective data during rehabilitation in elite footballers, and none have described the return to sport (RTS) process following this type of hamstring injury. In this article, we outline the management and RTS of an English Premier League (EPL) footballer who suffered a high-grade SM proximal tendon tear during training. Due to the degree of retraction of the free tendon, the player underwent surgical reconstruction at the recommendation of an orthopaedic surgeon. Early physiotherapy care, nutritional support, on- and off-pitch injury-specific reconditioning and global athletic development are outlined, alongside strength and power diagnostic and global positioning systems data, assessment of pain, player feedback and MRI informed clinical reasoning and shared decision-making during the RTS process. 18 weeks post-surgery the player returned to team training, transferring to a new club 3 weeks later. 2.5 years post RTS, the player remains free of re-injury playing regularly in the EPL.

Isometric Posterior Chain Peak Force Recovery Response Following Match-Play in Elite Youth Soccer Players: Associations with Relative Posterior Chain Strength

The purpose of this study was to determine changes in two tests of lower limb isometric posterior chain force (IPC-F) following 90 min of match-play in elite youth soccer players and the interaction between relative strength and recovery profile. 14 players (age: 16 ± 2 years) performed 3 × 3 second IPC-F tests unilaterally at 30° and 90° of knee and hip flexion pre- and post-match, +24 h, +48 h, and +72 h post-match. Peak force was recorded for both limbs, combined and expressed relative to bodyweight (N/kg). A two-way repeated measures analysis of variance was performed to determine differences in force output between joint angles, time intervals and subjects. As there was no interaction between angle and time (p = 0.260), we report the change between timepoints as mean ∆ in 90° + 30° IPC-F. Relative to pre-match IPC-F, there were significant decreases post (∆ = −18%; p > 0.001) and at +24 h (∆ = −8%; p = 0.040), no significant difference at +48 h (∆ = 0%; p = 0.992) and a significant increase at +72 h (∆ = +12%; p = 0.005). There was a large inter-individual variability in recovery profile at both angles and substantial differences between post-match deficits at 90° (−10.8%) compared to 30° (−20.7%). Higher pre-match IPC-F was correlated with the magnitude of IPC-F deficits at both angles and all time points (r = 0.56 to 0.70, p = < 0.01) except for post-match 90°. Regular IPC-F monitoring to determine the magnitude of match-induced fatigue and track recovery may help inform decision-making regarding modifications to individual players training load, particularly as there is a large inter-individual variability in response to competition. Further research is warranted to better understand and address the finding that stronger players showed larger force deficits and slower recovery following match-play.