Changes in Lower Limb Biomechanics Across Various Stages of Maturation and Implications for ACL Injury Risk in Female Athletes: a Systematic Review.

BACKGROUND: Female athletes are four to six times more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Jump-landing biomechanics are influenced by maturation, with post-pubertal female athletes at a heightened risk of ACL injuries. OBJECTIVE: The aim of our systematic review was to identify and summarise the current evidence regarding the changes in kinematic and kinetic risk factors associated with ACL injuries during jump-landing tasks in female athletes at various stages of maturity. METHODS: A systematic search was conducted in PubMed, CINAHL, Web of Science, SPORTDiscus, EMBASE and Scopus. Articles were included if they: (1) conducted the research on uninjured female athletes with no restriction on playing level/experience; (2) provided information regarding the stage of the maturity and the scale used for estimating the maturity status of the participants; and (3) reported a biomechanical risk factor associated with ACL injuries during jump-landing tasks across at least two different maturity groups (e.g. pre-pubertal vs post-pubertal). RESULTS: Sixteen articles involving 2323 female athletes were included in our review. A total of 12 kinematic and 8 kinetic variables were identified across these studies. Of the 12 kinematic variables reported in our review, we found strong evidence for higher peak knee abduction angle in post-pubertal female individuals compared with pre-pubertal girls (p < 0.05). With regard to the 8 kinetic variables, we found strong evidence for lower relative peak vertical ground reaction force, higher external knee abduction moment and internal rotation moment in post-pubertal compared with pre-pubertal athletes. The strength of evidence for the remaining kinematic and kinetic variables ranged from conflicting to moderate and, in some instances, could not be determined. CONCLUSIONS: Our study provides an overview of the changes in biomechanical risk factors in female athletes during jump-landing tasks at various stages of maturity. We found moderate-to-limited evidence for most kinematic and kinetic variables, highlighting the need for further research.

Youths Are Less Susceptible to Exercise-Induced Muscle Damage Than Adults: A Systematic Review With Meta-Analysis.

PURPOSE: This meta-analysis aimed to (1) provide a comparison of peak changes in indirect markers of exercise-induced muscle damage (EIMD) in youths versus adults and (2) determine if the involved limb moderated this effect. METHOD: Studies were eligible for inclusion if they (1) provided a human youth versus adult comparison; (2) provided data on muscle strength, soreness, or creatine kinase markers beyond ≥24 hours; and (3) did not provide a recovery treatment. Effect sizes (ES) were presented alongside 95% confidence intervals. RESULTS: EIMD exhibited larger effects on adults than in youths for muscle strength (ES = -2.01; P < .001), muscle soreness (ES = -1.52; P < .001), and creatine kinase (ES = -1.98; P < .001). The random effects meta-regression indicated that the effects of upper- and lower-limb exercise in youths and adults were significant for muscle soreness (coefficient estimate = 1.11; P < .001) but not for muscle strength or creatine kinase (P > .05). As such, the between-group effects for muscle soreness (ES = -2.10 vs -1.03; P < .05) were greater in the upper than lower limbs. CONCLUSION: The magnitude of EIMD in youths is substantially less than in their adult counterparts, and this effect is greater in upper than lower limbs for muscle soreness. These findings help guide practitioners who may be concerned about the potential impact of EIMD when training youth athletes.

Injury Pathology in Young Gymnasts: A Retrospective Analysis.

Gymnastics has a history of high injury incidence rates. However, little is known about the injury pathology in young gymnasts. The purpose of this study was to fill gaps in the literature by providing insight into the injury pathology in gymnasts aged 6 to 17 years. This study was retrospective in design, where injury data were collected using a Qualtrics questionnaire and distributed via social media. The findings revealed that the most common injury site was the lower limb (60.5%), in particular, the ankle/foot (49%) and knee (27%). Overuse injuries and sprains were most prevalent among the lower limb (25% and 18.4%, respectively), and gymnasts seemed to have a tendency to train through injury with modifications to training. In conclusion, lower limb joint sprain and overuse injuries accounted for the majority of injuries in youth gymnasts. These injuries were more frequently reported in girls in the years associated with peak height velocity and beyond.

The Influence of Competitive Level on Stretch-Shortening Cycle Function in Young Female Gymnasts.

This cross-sectional study investigated how stretch-shortening cycle (SSC) function and kinetic variables differed between young female gymnasts of varying competitive levels. Drop jump (DJ) force−time profiles were examined in 118 female gymnasts, sub-divided by competitive level (n = 21 recreational, n = 41 regional and n = 50 elite). DJ force−time data were analyzed to calculate performance and kinetic variables. Participants' SSC function was categorized as poor, moderate, or good, depending on the presence of an impact peak and spring-like behavior. A high proportion of gymnasts across each group were categorized as having "good" or "moderate" SSC function (i.e., >94.8%), with a trend of increasingly better SSC function observed with competitive level. Significant differences in reactive strength index, contact time, time of landing peak force, relative propulsive peak force, impulse, and ratio of braking: propulsive impulse were found between the elite and recreational group (p < 0.05). While SSC function was generally good to moderate, elite gymnasts had a more desirable kinetic jump-landing strategy than recreational level gymnasts. Drop jump kinetic variables appear to distinguish between elite and recreational gymnasts but not between regional standard gymnasts. Practitioners should consider the kinetic profile of gymnasts when benchmarking and setting training objectives.

Effects of a 10-Month Neuromuscular Training Program on Strength, Power, Speed, and Vault Performance in Young Female Gymnasts.

PURPOSE: This study aimed to evaluate a 10-month neuromuscular training (NMT) intervention on isometric and dynamic kinetics, standing long jump (SLJ) distance, speed, and sport-specific performance. METHODS: Forty-three prepubertal female gymnasts were allocated into either a gymnastics + NMT (gNMT; n = 16), gymnastics only (GYM, n = 15), or maturity-matched control (CON; n = 12) group. The gNMT followed a 10-month, twice-weekly NMT program that targeted movement competency, strength, power, and speed. Vaulting vertical take-off velocity, speed, SLJ distance, and kinetics during an isometric mid-thigh pull (IMTP), countermovement jump (CMJ), and drop jump (DJ) were measured at baseline and thereafter at 4, 7, and 10 months. Within-group differences were calculated using 3 × 4 repeated-measures ANCOVA. RESULTS: Interaction effects were observed for SLJ distance and various IMTP, DJ, and vaulting variables. The gNMT showed significant improvements in IMTP absolute force and SLJ distance after 4 months and each subsequent testing session. IMTP relative force and various CMJ and DJ kinetics significantly improved in the gNMT from 7 months. Significant gains in speed and vaulting take-off velocity occurred after 10 months. The GYM group achieved some significant improvements in CMJ impulse, absolute isometric strength, and DJ spring-like behavior, whereas the CON group did not experience any changes. CONCLUSIONS: The addition of NMT to gymnastics training improved various isometric and dynamic kinetics, SLJ distance, speed, and vaulting take-off velocity in the gNMT, changes that were not equally evidenced for GYM or CON. The threshold for most of the training-induced adaptations observed in IMTP relative force, CMJ and DJ kinetics, sprint speed, and vaulting were achieved after 7 months, emphasizing the efficacy of long-term NMT programs for young gymnasts.

The Influence of Biological Maturity on Sprint Speed, Standing Long Jump, and Vaulting Performance in Young Female Gymnasts.

PURPOSE: To quantify speed, peak momentum, standing long jump (SLJ), and the ratio of vertical to horizontal take-off velocity (Ratiovert-hori TOV) in young female gymnasts of different maturity status and their influence on vaulting vertical TOV. METHODS: One hundred twenty gymnasts age 5-14 years were subdivided into maturity groupings using percentage of predicted adult height. Participants performed three 20-m sprints, SLJ, and straight jump vaults that were recorded using 2-dimensional video and analyzed using digitizing software. RESULTS: All speed intervals, peak speed, peak momentum, SLJ distance, vault height, and vertical TOV increased between the early prepubertal and late prepubertal (P < .001; d = 0.65-1.10) and early prepubertal and pubertal (P < .001; d = 0.75-1.00) groups. No differences between these metrics were observed between the 2 most mature groups (d = 0.01-0.55). Multiple regression analyses revealed peak speed had the strongest association with vertical TOV (R2 = 59%) and also identified the Ratiovert-hori as a secondary determinant (R2 = 12%). A separate regression model indicated that maturity status (percentage of predicted adult height) moderately influences vertical TOV during vaulting (R2 = 41%). CONCLUSION: Speed and SLJ performance increase between the early prepubertal and late prepubertal years in young female gymnasts. However, given that peak speed and Ratiovert-hori combined to explain 71% of the total variance in vaulting vertical TOV, in order to increase aerial time for more advanced vaulting, practitioners should attempt to enhance peak speed alongside takeoff technique to develop gymnasts' ability to transfer linear speed to vertical TOV.

The Influence of Biological Maturity and Competitive Level on Isometric Force-Time Curve Variables and Vaulting Performance in Young Female Gymnasts.

Moeskops, S, Oliver, JL, Read, PJ, Cronin, JB, Myer, GD, Haff, GG, and Lloyd, RS. The influence of biological maturity and competitive level on isometric force-time curve variables and vaulting performance in young female gymnasts. J Strength Cond Res 34(8): 2136-2145, 2020-This cross-sectional study investigated isometric force-time curve variables and vaulting performance in young female gymnasts of varying maturity and competitive levels. One hundred twenty gymnasts aged 5-14 years were subdivided into maturity groupings and also according to their competitive level. Subjects performed isometric midthigh pulls (IMTP) before completing straight jump vaults that were recorded using two-dimensional video. All significance values were accepted at p < 0.05. Absolute peak force (PF abs) and force at various time epochs were significantly greater in more mature gymnasts, although no significant differences were observed in relative peak force (PF rel). When grouped by competitive level, elite gymnasts produced a significantly greater absolute rate of force development (RFD abs) at 0-150, 0-200, and 0-250 ms as well as relative RFD (RFD rel) at 0-200 and 0-250 ms than recreational gymnasts. Based upon regression analyses, force at 50 ms during the IMTP test explained 15% of vertical takeoff velocity during vaulting. Biological maturation seems to impact isometric force-time curve characteristics in young female gymnasts, and higher-level gymnasts produce greater RFD than those competing at a lower level. Vaulting vertical takeoff velocity seems to be largely independent of isometric force-time characteristics with only a small amount of variance explained by force at 50 ms.

Lower-Limb Stiffness and Maximal Sprint Speed in 11-16-Year-Old Boys.

Meyers, RW, Moeskops, S, Oliver, JL, Hughes, MG, Cronin, JB, and Lloyd, RS. Lower-limb stiffness and maximal sprint speed in 11-16-year-old boys. J Strength Cond Res 33(7): 1987-1995, 2019-The purpose of the study was to examine the relationship between vertical stiffness, leg stiffness, and maximal sprint speed in a large cohort of 11-16-year-old boys. Three-hundred thirty-six boys undertook a 30-m sprint test using a floor-level optical measurement system, positioned in the final 15-m section. Measures of speed, step length, step frequency, contact time, and flight time were directly measured while force, displacement, vertical stiffness, and leg stiffness, were modeled from contact and flight times, from the 2 fastest consecutive steps for each participant over 2 trials. All force, displacement, and stiffness variables were significantly correlated with maximal sprint speed (p ≤ 0.05). Relative vertical stiffness had a very large (r > 0.7) relationship with sprint speed, whereas vertical center of mass displacement, absolute vertical stiffness, relative peak force, and maximal leg spring displacement had large (r > 0.5) relationships. Relative vertical stiffness and relative peak force did not significantly change with advancing age (p > 0.05), but together with maximal leg spring displacement accounted for 96% of the variance in maximal speed. It seems that relative vertical stiffness and relative peak force are important determinants of sprint speed in boys aged 11-16 years, but are qualities that may need to be trained because of no apparent increases from natural development. Practitioners may wish to use training modalities such as plyometrics and resistance training to enable adaptation to these qualities because of their importance as predictors of speed in youth.

Individual Responses to an 8-Week Neuromuscular Training Intervention in Trained Pre-Pubescent Female Artistic Gymnasts.

This study examined individual responses in leg stiffness, reactive strength index (RSI), movement proficiency (deep overhead squat and in-line lunge), and trunk muscular endurance (flexor and extensor tests) in young female gymnasts following an 8-week neuromuscular training intervention. Thirty-four pre-peak height velocity (PHV) female gymnasts were divided into either an experimental group (EXP n = 17) or control group (CON n = 17). The EXP replaced their normal gymnastics physical preparation with a neuromuscular training program, while the CON continued with their habitual gymnastics program. Chi square analysis showed that the EXP resulted in significantly more positive responders compared to CON for measures of leg stiffness (41% versus 12% responded positively), extensor muscular endurance, (76% versus 29%), and competency in the deep overhead squat, (76% versus 29%) and in-line lunge (left lead leg) (65% versus 18%). Conversely, the number of positive responders for RSI (53% versus 61%), the flexor endurance test (88% versus 53%), and the right in-line lunge (47% versus 35%) were not significantly different between groups. These findings suggest that most young gymnasts responded positively to neuromuscular training from the perspective of improving movement proficiency and trunk endurance; however, changes in leg stiffness and RSI were more variable and may require higher intensities to realise further adaptations.

Within- and Between-Session Reliability of the Isometric Midthigh Pull in Young Female Athletes.

Moeskops, S, Oliver, JL, Read, PJ, Cronin, JB, Myer, GD, Haff, GG, and Lloyd, RS. Within- and between-session reliability of the isometric midthigh pull in young female athletes. J Strength Cond Res 32(7): 1892-1901, 2018-To investigate the within- and between-session reliability of the isometric midthigh pull (IMTP) in pre- and post-peak height velocity (PHV) female athletes. Nineteen pre- and 19 post-PHV athletes performed bilateral IMTPs using a custom-designed isometric testing system. Participants attended 3 separate testing sessions and performed 3 trials within each session. Peak force, relative peak force, force at 30, 50, 90, 100, 150, 200, and 250 ms, rate of force development (RFD) within time-specific bands, time to peak force (TPF), and time to peak RFD were obtained for analysis. Within- and between-session reliability for each variable was calculated from repeated-measures analysis of variance, intraclass correlation coefficients (ICCs), and coefficients of variation (CV) with 95% confidence intervals. Within- and between-session measures of absolute and relative peak force were found to be reliable for both pre-PHV (CV ≤ 9.4%, ICC ≥ 0.87) and post-PHV (CV ≤ 7.3%, ICC ≥ 0.92), but systematic bias was evident between sessions in the pre-PHV group, from session 1 to 2. Analyses of force at the specific time points revealed CVs between 19-37% and 5-24% for pre-PHV and post-PHV athletes, respectively. Greater variability was evident in TPF, and all RFD-related variables for pre-PHV (CV ≥ 38%) and post-PHV (CV ≥ 27%) athletes, respectively. The IMTP appears a reliable and safe method for evaluating peak force in young female athletes. Overall, post-PHV athletes were more reliable than pre-PHV athletes, with pre-PHV athletes needing additional familiarization to minimize the influence of systematic bias.