Association between Inter-Limb Asymmetries in Lower-Limb Functional Performance and Sport Injury: A Systematic Review of Prospective Cohort Studies

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.

Plyometric Training's Effects on Young Male Karatekas' Jump, Change of Direction, and Inter-Limb Asymmetry

This study analysed the effects of performing a plyometric training programme on different types of jumping and specific changes of direction, and their respective asymmetries in karatekas. Twenty male karatekas (age 19 ± 4 years) were distributed in two groups, the control group (CG) and the experimental group (EG). The EG group (n = 10) performed a 6-week intervention of unilateral plyometric training, performing countermovement jumps (CMJ), drop jumps (DJ), and long jumps (SH). The tests performed at the beginning and at the end of the intervention were a unilateral and bilateral countermovement jump test (CMJ), single-leg hop test (SH), single-leg side-hop test (SSH), triple hop test (TH), and change of direction in a karate position test (MKUKS). The EG group obtained improvements in the CMJ with the stronger (p = 0.01; ES = 0.39) and weaker leg (p = 0.01; ES = 0.59), in the SH with the weaker leg (p = 0.01; ES = 0.45), in the SSH with the weaker leg (p = 0.03; ES = 0.33), in the MKUKS (p = 0.00; ES = 0.98), and improved the asymmetries obtained in the TH (p = 0.02; ES = -0.85). The GC group obtained significant differences in the CMJ with the stronger (p = 0.03; ES = 0.46) and weaker leg (p = 0.00; ES = 0.69), in the bilateral CMJ (p = 0.02; ES = 0.24), in the SH with the weaker leg (p = 0.00; ES = 0.34), in the TH with the stronger (p = 0.00; ES = -0.15) and weaker leg (p = 0.01; ES = 0.09), and in the MKUKS test (p = 0.04; ES = -0.94). A between-group analysis showed improvements of the EG over the GC in the TH with the stronger leg (p = 0.02; ES = 1.05). Performing plyometric training provides improvements in jumping, mainly in horizontal jumps, reducing inter-limb asymmetries in repetitive jumps.

Variability analysis of muscle activation symmetry to identify indicators of individual motor strategy: a case series on elite Paralympic powerlifters

Introduction

In Paralympic powerlifting competitions, movement execution symmetry is a technical requirement influenced by individual athlete characteristics and motor strategies. Identifying the elements associated with individual motor strategies can offer valuable insight for improving sport performance. Therefore, this case series study aimed to explore muscle activation symmetry and its intra- and inter-individual variability to determine the muscles mostly related to individual motor strategies in elite Paralympic powerlifters.

Methods

Bilateral electromyographic activation of the anterior deltoid (AD), pectoralis major (PM), latissimus dorsi (LD), triceps (TRI) and external oblique (EO) muscles were analysed in five elite Paralympic powerlifters while performing four sets of one-repetition maximum of Paralympic bench press. Muscle activation symmetry indexes (SI) were obtained and transformed to consider individual-independent evaluation. The coefficient of variation (CV), variance ratio (VR), and mean deviation (MD) were computed to assess inter- and intra-individual variability in electromyographic waveforms and SI.

Results

Both transformed and non-transformed SI indicated overall symmetric activation in DA, PM, TRI, and LD. Transformed SI revealed asymmetrical muscle activation of EO when grouping data (mean bilateral difference: 10%). Athletes exhibited low intra-individual SI variability in all analysed muscles (CV < 10%) and low inter-individual variability in DA, PM, LD, and TRI (CV < 10%; VR: 4%-11%; MD: 29%-43%). In contrast, higher inter-individual variability was observed in EO (CV: 23%; VR: 23%; MD: 72%-81%).

Conclusion

The highest variability and asymmetry in abdominal muscle activation among athletes emphasize the importance of personalized training approaches for targeting these muscles due to their role in individualizing motor strategies.

Relationship between latent trigger points, lower limb asymmetry and muscle fatigue in elite short-track athletes

BACKGROUND

Short-track speed skating movement involves asymmetric overloading of the lower left side of the body. The gluteus maximus fatigue limits the physical and mental athletic capacity to perform set tasks. A possible link between the presence of latent trigger points (LTrPs) and muscle fatigue development/persistence has been posited. The aim of the study was to determine whether elite short-track speed skating can result in the impairment of the musculoskeletal system of the lower limbs.

METHODS

Elite short-track athletes as the experimental group (EXP) = 9, 19.5 ± 1.8 years, and healthy subjects as the control group (CON) = 18, 20.8 ± 1.2 years, were tested for: (i) lower limb loading asymmetry using ground reaction force (GRF) measurements during quiet standing, (ii) gluteus maximus fatigue measured with surface electromyography (sEMG) during the Biering-Sorensen test, and (iii) LTrPs presence in the 14 examined muscles of the pelvic girdle and lower limbs.

RESULTS

There were between-group differences in the number of LTrPs, with the EXP group (left lower limb (LLL) n = 18, right lower limb (RLL) n = 9) showing more LTrPs compared to the CON group (LLL n = 2, RLL n = 1), (p < 0.001), and within-group differences in the EXP group only (p < 0.001). There were also significant differences in muscle fatigue for the left side (p < 0.001) both between the groups and within the EXP group (p ≤ 0.001). The vertical ground reaction force (GRF) measurement showed a loading rate of 2% (p = 0.013) in the athletes' LLL exclusively.

CONCLUSIONS

The study confirmed an increased prevalence of LTrPs, increased muscle fatigue and left-sided limb load asymmetry in elite short-track athletes.

TRIAL REGISTRATION

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Poznan University of Medical Sciences (Resolution No 110/22 of 10 March 2022).

TRIAL REGISTRATION

20/07/2022, Trial Id: ACTRN12622001016729.

Predicting the Risk of Injuries Through Assessments of Asymmetric Lower Limb Functional Performance: A Prospective Study of 415 Youth Taekwondo Athletes

Background

The impact of interlimb asymmetries on sport injuries is unclear because of inconsistent findings, and there is a lack of research on youth athletes and the sport of taekwondo.

Purpose

To examine the effects of functional interlimb asymmetries on noncontact lower limb injuries in youth athletes.

Study Design

Cohort study; Level of evidence, 2.

Methods

A total of 415 taekwondo athletes (318 boys and 97 girls) aged 6 to 17 years underwent baseline testing to determine interlimb asymmetries through the single-leg countermovement jump (CMJ), hop, and triple hop tests as well as the Star Excursion Balance Test. The athletes were then evaluated for 12 months to observe the occurrence of noncontact lower limb injuries.

Results

During the study, 98 athletes (70 boys and 28 girls) sustained at least 1 noncontact lower limb injury. Athletes with higher interlimb asymmetries in single-leg CMJ height showed a significantly increased risk of noncontact lower limb injuries (boys: odds ratio [OR], 1.053 [95% CI, 1.027-1.080], P < .001; girls: OR, 1.070 [95% CI, 1.016-1.128], P = .011). Asymmetry in single-leg CMJ height of ≥15.28% was found to be the cutoff point for predicting noncontact lower limb injuries in boys (OR, 4.652 [95% CI, 2.577-8.398]; P < .001).

Conclusion

This study highlights the utility of interlimb asymmetries in unilateral jump performance as a tool for assessing the risk of noncontact lower limb injuries in youth taekwondo athletes of both sexes. A proper evaluation of interlimb asymmetries may improve prevention strategies for youth athletes.

Body Composition and Strength Symmetry of Kettlebell Sport Athletes

Kettlebell sport (KBs) is increasingly popular, but very few studies have been focused on this discipline. This research aims to investigate the effects of KBs on body composition, strength symmetry, and segmental body composition symmetry in a sample of Italian elite athletes. Data were collected from a sample of 16 athletes of both sexes (11 men and 5 women; 34.5 ± 9.0 years of age). Anthropometric (height, weight, arm, thigh, calf, and waist circumferences), hand grip strength, and total and segmental bioelectrical variables were taken. Body composition was analysed by using specific bioelectrical impedance vector analysis (BIVA). Paired t-tests and confidence ellipses were applied to analyse bilateral differences. Elite athletes of both sexes showed high values of phase angle, indicative of high body cell mass and quality and proxy of muscle mass. Hand grip strength and body composition were symmetrical, with the only exception of a higher %FM in the right leg (Zsp: t = 3.556; p = 0.003). In conclusion, this study suggests that KBs contributes to muscle mass improvement, body composition, and strength symmetry, especially in the upper body.

Reliability of Force Plate Metrics During Standard Jump, Balance, and Plank Assessments in Military Personnel

INTRODUCTION

Prevention of musculoskeletal injury is vital to the readiness, performance, and health of military personnel with the use of specialized systems (e.g., force plates) to assess risk and/or physical performance of interest. This study aimed to identify the reliability of one specialized system during standard assessments in military personnel.

METHODS

Sixty-two male and ten female Australian Army soldiers performed a two-leg countermovement jump (CMJ), one-leg CMJ, one-leg balance, and one-arm plank assessments using a Sparta Science force plate system across three testing sessions. Sparta Science (e.g., total Sparta, balance and plank scores, jump height, and injury risk) and biomechanical (e.g., average eccentric rate of contraction, average concentric force, and sway velocity) variables were recorded for all sessions. Mean ± SD, intraclass correlation coefficients (ICCs), coefficient of variation, and bias and limits of agreement were calculated for all variables.

RESULTS

Mean results were similar between sessions 2 and 3 (P > .05). The relative reliability for the Sparta Science (ICC = 0.28-0.91) and biomechanical variables (ICC = 0.03-0.85) was poor to excellent. The mean absolute reliability (coefficient of variation) for Sparta Science variables was similar to or lower than that of the biomechanical variables during the CMJ (1-10% vs. 3-7%), one-leg balance (4-6% vs. 9-14%), and one-arm plank (5-7% vs. 12-17%) assessments. The mean bias for most variables was small (<5% of the mean), while the limits of agreement varied with most unacceptable (±6-87% of the mean).

CONCLUSIONS

The reliability of most Sparta Science and biomechanical variables during standard assessments was moderate to good. The typical variability in metrics documented will assist practitioners with the use of emerging technology to monitor and assess injury risk and/or training interventions in military personnel.

Why Sports Should Embrace Bilateral Asymmetry: A Narrative Review

(1) Background: Asymmetry is ubiquitous in nature and humans have well-established bilateral asymmetries in their structures and functions. However, there are (mostly unsubstantiated) claims that bilateral asymmetries may impair sports performance or increase injury risk. (2) Objective: To critically review the evidence of the occurrence and effects of asymmetry and sports performance. (3) Development: Asymmetry is prevalent across several sports regardless of age, gender, or competitive level, and can be verified even in apparently symmetric actions (e.g., running and rowing). Assessments of bilateral asymmetries are highly task-, metric-, individual-, and sport-specific; fluctuate significantly in time (in magnitude and, more importantly, in direction); and tend to be poorly correlated among themselves, as well as with general performance measures. Assessments of sports-specific performance is mostly lacking. Most studies assessing bilateral asymmetries do not actually assess the occurrence of injuries. While injuries tend to accentuate bilateral asymmetries, there is no evidence that pre-existing asymmetries increase injury risk. While training programs reduce certain bilateral asymmetries, there is no evidence that such reductions result in increased sport-specific performance or reduced injury risk. (4) Conclusions: Bilateral asymmetries are prevalent in sports, do not seem to impair performance, and there is no evidence that suggests that they increase injury risk.

Load-Induced Changes of Inter-Limb Asymmetries in Dynamic Postural Control in Healthy Subjects

Inter-limb asymmetries are associated with a higher potential risk for non-contact injuries. Differences in function or performance between the limbs might lead to imbalances and promote instability, increasing the potential risk for injuries. Consequently, an investigation of inter-limb asymmetries should be included in injury risk assessment. Furthermore, since non-contact injuries mainly occur under loaded conditions, an investigation of load-induced changes of inter-limb asymmetries can provide additional information on the athlete’s potential injury risk. Therefore, the current study aimed to investigate the influence of physical load on inter-limb asymmetries in dynamic postural control, which is essential in situations with a high risk for non-contact injuries such as landing, cutting, or stopping. In total, dynamic postural control of 128 active and healthy subjects (64 males and 64 females, age: 23.64 ± 2.44, height: 176.54 ± 8.96 cm, weight: 68.85 ± 10.98 kg) was examined. Dynamic postural control was tested with the Y-Balance Test (YBT) before and after a loading protocol on a bicycle ergometer or a treadmill. The results showed no significant increase of the inter-limb asymmetries in anterior direction [F_{(1, 126)} = 4.44, p = 0.04, η²_p = 0.03]. Moreover, there is high variation between the subjects regarding the magnitude and the direction of the asymmetries and the changes due to load. Therefore, a more individual analysis considering the magnitude and the direction of the asymmetries is required. Thereby, considering different modifying factors, e.g., sex, injury history, and baseline level of asymmetries, can be helpful. Moreover, an analysis of the changes during load might provide further insights, reveal possible differences, and help detect the reasons and mechanisms underlying inter-limb asymmetries and asymmetrical loading.