Measurement of uni-planar and sport specific trunk motion using magneto-inertial measurement units: The concurrent validity of Noraxon and Xsens systems relative to a retro-reflective system.

BACKGROUND: There is a range of magneto-inertial measurement unit (MIMU) systems commercially available, however sensor specifications and fusion methods vary considerably between manufacturers. Such variability can influence the concurrent validity of MIMUs relative to reference standard measurement devices. Different MIMUs have been compared during static or low-velocity conditions, with higher-velocity movements assessed in robotic-based studies. However, there is a need for the concurrent validity of higher-velocity movements to be established in human-based studies. RESEARCH QUESTION: This study aimed to assess the concurrent validity of two commercial MIMU systems (Noraxon and Xsens), relative to a 'gold-standard' retro-reflective motion capture system, when measuring trunk angles during uni-planar range of motion (ROM) and cricket bowling, which involves high-speed, multi-planar movements. METHODS: For this criterion-based validity study, both MIMU systems incorporated comparable sensor specifications and employed Kalman filter sensor fusion algorithms. The MIMU based angles were compared with angles derived from concurrently captured three-dimensional retro-reflective data for 10 fast-medium bowlers. Statistical parametric mapping and root mean squared differences (RMSD) were computed for both MIMU systems. RESULTS: One-dimensional statistical parametric mapping showed no significant differences for angles from both MIMU systems when compared with retro-reflective based angle outputs. The MIMU systems produced ROM RMSDs between 1.4 ± 1.0° and 2.6 ± 1.5°. One system displayed RMSDs between 4.6 ± 1.4° and 7.4 ± 1.9° during bowling, indicating functionally relevant differences to retro-reflective derived angles. There were some small but statistically significant differences in RMSDs between the MIMU systems. SIGNIFICANCE: MIMU-based angle accuracy is poorer during high-speed, multi-planar movement than uni-planar tasks. Comparable MIMU systems can produce varying measurements during ROM and bowling tasks. It is likely that varying sample rates and sensor fusion algorithm parameters contributed to the differences.

Functional calibration does not improve the concurrent validity of magneto-inertial wearable sensor-based thorax and lumbar angle measurements when compared with retro-reflective motion capture.

 Magneto-inertial measurement unit (MIMU) systems allow calculation of simple sensor-to-sensor Euler angles, though this process does not address sensor-to-segment alignment, which is important for deriving meaningful MIMU-based kinematics. Functional sensor-to-segment calibrations have improved concurrent validity for elbow and knee angle measurements but have not yet been comprehensively investigated for trunk or sport-specific movements. This study aimed to determine the influence of MIMU functional calibration on thorax and lumbar joint angles during uni-planar and multi-planar, sport-specific tasks. It was hypothesised that functionally calibrating segment axes prior to angle decomposition would produce smaller differences than a non-functional method when both approaches were compared with concurrently collected 3D retro-reflective derived angles. Movements of 10 fast-medium cricket bowlers were simultaneously recorded by MIMUs and retro-reflective motion capture. Joint angles derived from four different segment definitions were compared, with three incorporating functionally defined axes. Statistical parametric mapping and root mean squared differences (RMSD) quantified measurement differences one-dimensionally and zero-dimensionally, respectively. Statistical parametric mapping found no significant differences between MIMU and retro-reflective data for any method across bowling and uni-planar trunk movements. The RMSDs for the functionally calibrated methods and non-functional method were not significantly different. Functional segment calibration may be unnecessary for MIMU-based measurement of thorax and lumbar joint angles.

The inter-tester repeatability of a model for analysing elbow flexion-extension during overhead sporting movements.

This study investigates the inter-tester repeatability of an upper limb direct kinematic (ULDK) model specifically for the reporting of elbow flexion-extension (FE) during overhead sporting movements, such as cricket bowling. The ULDK model consists of an upper arm and a forearm connected with a 6° of freedom elbow joint. The ULDK model was assessed for inter-tester repeatability by calculating elbow FE during cricket bowling in two sessions, with unique testers applying the kinematic marker set in each session. Analysis of both elbow FE time-varying waveforms (statistical parametric mapping = 0% time different) and extracted discrete events (no statistical differences, strong correlations > 0.9) support that this model is inter-tester repeatable at assessing elbow FE within the context of cricket bowling. This model is recommended as a framework in future studies for measuring elbow kinematics during other overhead sporting tasks, with recommendations for further participant-specific considerations. Graphical abstract ᅟ.

The association between lower limb biomechanics and ball release speed in cricket fast bowlers: a comparison of high-performance and amateur competitors.

The aim of this study was to compare the associations between lower limb biomechanics and ball release speed in 15 high-performance (HP) and 15 amateur fast bowlers. Kinematic and kinetic variables of the lower limbs collected in the laboratory environment with a 3D Vicon motion analysis system were compared between groups, as well as their associations with ball release speed. HP bowlers had a significantly higher run-up velocity at back foot impact but this difference became non-significant at ball release. Front knee kinematics were not statistically different, however effect sizes revealed medium-large differences with the HP group displaying a more extended knee joint at maximum flexion (d = 0.72) and ball release (d = 0.76). Only front hip positive power was significantly higher in the HP group and it was suggested that the probable cause was the HP bowlers having less knee flexion after front foot impact. From a joint power analysis, the extensor muscle groups of the hip and knee were shown to be important in developing ball release speed. This highlights the need for lower limb/core strength programmes to be multifaceted and focus on the muscles associated with both power and stability.

Preventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trial.

BACKGROUND: Exercise-based training programmes are commonly used to prevent sports injuries but programme effectiveness within community men's team sport is largely unknown. OBJECTIVE: To present the intention-to-treat analysis of injury outcomes from a clustered randomised controlled trial in community Australian football. METHODS: Players from 18 male, non-elite, community Australian football clubs across two states were randomly allocated to either a neuromuscular control (NMC) (intervention n=679 players) or standard-practice (control n=885 players) exercise training programme delivered as part of regular team training sessions (2× weekly for 8-week preseason and 18-week regular-season). All game-related injuries and hours of game participation were recorded. Generalised estimating equations, adjusted for clustering (club unit), were used to compute injury incidence rates (IIRs) for all injuries, lower limb injuries (LLIs) and knee injuries sustained during games. The IIRs were compared across groups with cluster-adjusted Injury Rate Ratios (IRRs). RESULTS: Overall, 773 game injuries were recorded. The lower limb was the most frequent body region injured, accounting for 50% of injuries overall, 96 (12%) of which were knee injuries. The NMC players had a reduced LLI rate compared with control players (IRR: 0.78 (95% CI 0.56 to 1.08), p=0.14.) The knee IIR was also reduced for NMC compared with control players (IRR: 0.50 (95% CI 0.24 to 1.05), p=0.07). CONCLUSIONS: These intention-to-treat results indicate that positive outcomes can be achieved from targeted training programmes for reducing knee and LLI injury rates in men's community sport. While not statistically significant, reducing the knee injury rate by 50% and the LLI rate by 22% is still a clinically important outcome. Further injury reductions could be achieved with improved training attendance and participation in the programme.

Dance floor force reduction influences ankle loads in dancers during drop landings.

OBJECTIVES: Dance floor mechanical properties have the potential to influence the high frequency of ankle injuries in dancers. However, biomechanical risk factors for injury during human movement on hard, low force reduction floors have not been established. The aim of this study was to examine the ankle joint mechanics of dancers performing drop landings on dance floors with varied levels of force reduction. DESIGN: Repeated measures cross sectional study. METHODS: Fourteen dancers performed drop landings on five custom built dance floors. Ankle joint mechanics were calculated using a three dimensional kinematic model and inverse dynamics approach. RESULTS: Ankle joint kinematic (dorsiflexion; range of motion, peak angular velocity and acceleration) and kinetic (plantar flexion; peak joint moments and power) variables significantly increased with a decrease in floor force reduction. Many of the observed changes occurred within a latency of <0.1s post-contact with the floor and were associated with increased vertical ground reaction forces and decreased floor vertical deformation. CONCLUSIONS: The observed mechanical changes are interpreted as an increase in the load experienced by the energy absorbing structures that cross the ankle. The short latency of the changes represents a high intensity movement at the ankle during a period of limited cognitive neuromuscular control. It is suggested that these observations may have injury risk implications for dancers that are related to joint stabilization. These findings may be of benefit for further investigation of dance injury prevention and support the notion that bespoke force reduction standards for dance floors are necessary.

Dance floor mechanical properties and dancer injuries in a touring professional ballet company.

OBJECTIVES: The mechanical properties of the floors used by dancers have often been suggested to be associated with injury, yet limited etiological evidence is available to support this hypothesis. The dance floors at three theatres regularly used by a touring professional ballet company were mechanically quantified with the aim of comparing floor properties with injury incidence in dancers. DESIGN: Cross sectional. METHODS: Test points on the floors were quantified in accordance with European Sports Surface Standard protocols for force reduction. Injuries and associated variables occurring within the ballet company dancers during activity on the three floors were recorded by the company's medical staff. An injury was recorded if a dancer experienced an incident that restricted the dancer from performing all normal training or performance activities for a 24 h period. Injuries were delimited to those occurring in the lower limbs or lumbar region during non-lifting tasks. RESULTS: Floor construction varied between venues and a range of floor mechanical properties were observed. None of the floors complied with the range of force reduction values required by the European Sport Surface Standards. The highest injury rate was observed on the floor with the greatest variability of force reduction magnitudes. No difference in injury frequency was observed between the venues with the highest and lowest mean force reduction magnitudes. CONCLUSIONS: Professional dancers can be required to perform on floors that may be inadequate for safe dance practice. Intra-floor force reduction variability may have a stronger association with injury risk than mean floor force reduction magnitude.

What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes.

BACKGROUND: Players are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training programme were incorporated into the regular training schedules of 40 community Australian Football teams, over two seasons. One variant replicated common training practices, while the second was an evidence-based programme to alter biomechanical and neuromuscular factors related to risk of knee injuries. This paper describes the structure of the implemented programmes and compares players' end-of-season views about the programme variants. METHODS: This study was nested within a larger group-clustered randomised controlled trial of the effectiveness of two exercise-training programmes (control and neuromuscular control (NMC)) for preventing knee injuries. A post-season self-report survey, derived from Health Belief Model constructs, included questions to obtain players' views about the benefits and physical challenges of the programme in which they participated. RESULTS: Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. Suggestions from players about potential improvements to the training programme and its future implementation included reducing duration, increasing range of drills/exercises and promoting its injury prevention and other benefits to players. CONCLUSIONS: Players provide valuable feedback about the content and focus of implemented exercise-training programmes, that will directly inform the delivery of similar, or more successful, programmes in the future.

The reach and adoption of a coach-led exercise training programme in community football.

OBJECTIVE: To determine the reach and adoption of a coach-led exercise training programme for lower limb injury prevention. DESIGN: Secondary analysis of data from a group-clustered randomised controlled trial. SETTING: A periodised exercise training warm-up programme was delivered to players during training sessions over an 8-week preseason (weeks 1-8) and 18-week playing season. PARTICIPANTS: 1564 community Australian football players. MAIN OUTCOME MEASUREMENTS: Reach, measured weekly, was the number of players who attended training sessions. Adoption was the number of attending players who completed the programme in full, partially or not at all. Reasons for partial or non-participation were recorded. RESULTS: In week 1, 599 players entered the programme; 55% attended 1 training session and 45% attended > 1 session. By week 12, 1540 players were recruited but training attendance (reach) decreased to <50%. When players attended training, the majority adopted the full programme-ranging from 96% (week 1) to above 80% until week 20. The most common reasons for low adoption were players being injured, too sore, being late for training or choosing their own warm-up. CONCLUSIONS: The training programme's reach was highest preseason and halved at the playing season's end. However, when players attended training sessions, their adoption was high and remained close to 70% by season end. For sports injury prevention programmes to be fully effective across a season, attention also needs to be given to (1) encouraging players to attend formal training sessions and (2) considering the possibility of some form of programme delivery outside of formal training.

Coding OSICS sports injury diagnoses in epidemiological studies: does the background of the coder matter?

OBJECTIVE: To compare Orchard Sports Injury Classification System (OSICS-10) sports medicine diagnoses assigned by a clinical and non-clinical coder. DESIGN: Assessment of intercoder agreement. SETTING: Community Australian football. PARTICIPANTS: 1082 standardised injury surveillance records. MAIN OUTCOME MEASUREMENTS: Direct comparison of the four-character hierarchical OSICS-10 codes assigned by two independent coders (a sports physician and an epidemiologist). Adjudication by a third coder (biomechanist). RESULTS: The coders agreed on the first character 95% of the time and on the first two characters 86% of the time. They assigned the same four-digit OSICS-10 code for only 46% of the 1082 injuries. The majority of disagreements occurred for the third character; 85% were because one coder assigned a non-specific 'X' code. The sports physician code was deemed correct in 53% of cases and the epidemiologist in 44%. Reasons for disagreement included the physician not using all of the collected information and the epidemiologist lacking specific anatomical knowledge. CONCLUSIONS: Sports injury research requires accurate identification and classification of specific injuries and this study found an overall high level of agreement in coding according to OSICS-10. The fact that the majority of the disagreements occurred for the third OSICS character highlights the fact that increasing complexity and diagnostic specificity in injury coding can result in a loss of reliability and demands a high level of anatomical knowledge. Injury report form details need to reflect this level of complexity and data management teams need to include a broad range of expertise.

Can technique modification training reduce knee moments in a landing task?

Anterior cruciate ligament (ACL) injuries are costly. Sidestep technique training reduces knee moments that load the ACL. This study examined whether landing technique training alters knee moments. Nineteen team sport athletes completed the study. Motion analysis and ground reaction forces were recorded before and after 6 weeks of technique modification. An inverse dynamic model was used to calculate three-dimensional knee loading. Pre- and postintervention scores were compared using paired t tests. Maximal knee flexion angle during landing was increased following training. There was no change in valgus or flexion moments, but an increase in peak internal rotation moment. This increase in internal rotation moment may increase the risk of ACL injury. However, the increased angle at which the peak internal rotation moment occurred at follow up may mitigate any increase in injury risk by reducing load transmission.

Lower limb kinematic variability in dancers performing drop landings onto floor surfaces with varied mechanical properties.

Elite dancers perform highly skilled and consistent movements. These movements require effective regulation of the intrinsic and extrinsic forces acting within and on the body. Customized, compliant floors typically used in dance are assumed to enhance dance performance and reduce injury risk by dampening ground reaction forces during tasks such as landings. As floor compliance can affect the extrinsic forces applied to the body, secondary effects of floor properties may be observed in the movement consistency or kinematic variability exhibited during dance performance. The aim of this study was to investigate the effects of floor mechanical properties on lower extremity kinematic variability in dancers performing landing tasks. A vector coding technique was used to analyze sagittal plane knee and ankle joint kinematic variability, in a cohort of 12 pre-professional dancers, through discrete phases of drop landings from a height of 0.2m. No effect on kinematic variability was observed between floors, indicating that dancers could accommodate the changing extrinsic floor conditions. Future research may consider repeat analysis under more dynamic task constraints with a less experienced cohort. However, knee/ankle joint kinematic variability was observed to increase late in the landing phase which was predominantly comprised of knee flexion coupled with the terminal range of ankle dorsiflexion. These findings may be the result of greater neural input late in the landing phase as opposed to the suggested passive mechanical interaction of the foot and ankle complex at initial contact with a floor. Analysis of joint coordination in discrete movement phases may be of benefit in identifying intrinsic sources of variability in dynamic tasks that involve multiple movement phases.

Changes in knee joint biomechanics following balance and technique training and a season of Australian football.

PURPOSE: Determine if balance and technique training (BTT) implemented adjunct to normal Australian football (AF) training reduces external knee loading during sidestepping. Additionally, the authors determined if an athlete's knee joint kinematics and kinetics change over a season of AF. METHODOLOGY: Eight amateur-level AF clubs (n=1,001 males) volunteered to participate in either 28 weeks of BTT or a 'sham' training (ST) adjunct to their normal preseason and regular training. A subset of 34 athletes (BTT, n=20; ST, n=14) were recruited for biomechanical testing in weeks 1-7 and 18-25 of the 28-week training intervention. During biomechanical testing, participants completed a series running, preplanned (PpSS) and unplanned sidestepping (UnSS) tasks. A linear mixed model (α=0.05) was used to determine if knee kinematics and peak moments during PpSS and UnSS were influenced by BTT and/or a season of AF. RESULTS: Both training groups significantly (p=0.025) decreased their peak internal-rotation knee moments during PpSS, and significantly (p=0.022) increased their peak valgus knee moments during UnSS following their respective training interventions. CONCLUSIONS: BTT was not effective in changing an athlete's knee joint biomechanics during sidestepping when conducted in 'real-world' training environments. Following normal AF training, the players had different changes to their knee joint biomechanics during both preplanned and unplanned sidestepping. When performing an unplanned sidestepping task in the latter half of a playing season, athletes are at an increased risk of ACL injury. The authors therefore recommend both sidestepping tasks are performed during biomechanical testing when assessing the effectiveness of prophylactic training protocols.

Ground hardness and injury in community level Australian football.

OBJECTIVES: To describe the risk and details of injuries associated with ground hardness in community level Australian football (AF). DESIGN: Prospective injury surveillance with periodic objective ground hardness measurement. METHODS: 112 ground hardness assessments were undertaken using a Clegg hammer at nine locations across 20 grounds, over the 2007 and 2008 AF seasons. Details of 352 injuries sustained by community level players on those grounds were prospectively collected as part of a large randomised controlled trial. The ground location of the injury was matched to the nearest corresponding ground hardness Clegg hammer readings, in gravities (g), which were classified from unacceptably low (<30 g) to unacceptably high hardness (>120 g). RESULTS: Clegg hammer readings ranged from 25 to 301 g. Clegg hammer hardness categories from low/normal to high/normal were associated with the majority of injuries, with only 3.7% (13 injuries) on unacceptably high hardness and 0.3% (1 injury) on the unacceptably low hardness locations. Relative to the preferred range of hardness, the risk of sustaining an injury on low/normal hardness locations was 1.31 (95%CI: 1.06-1.62) times higher and 1.82 (95%CI: 1.17-2.85) times higher on locations with unacceptably high hardness. The more severe injuries occurred with low/normal ground hardness. CONCLUSIONS: Despite the low number of injuries, the risk of sustaining an injury on low/normal and unacceptably hard grounds was significantly greater than on the preferred range of hardness. Notably, the severity of the injuries sustained on unacceptably hard grounds was lower than for other categories of hardness.

Whole body kinematics and knee moments that occur during an overhead catch and landing task in sport.

BACKGROUND: Athletes suffering an anterior cruciate ligament injury tend to exhibit similar body postures that in sidestep cutting are associated with increased knee moments. This relationship, however, has not been investigated in landing. Catching a ball in different overhead positions may affect landing postures and knee joint moments. This study investigated these possible relationships. It was anticipated that some joint postures would be associated increased knee loads during the landing task. METHODS: Twenty-five healthy male team sports athletes performed four variations of a landing task. Full body kinematics were identified at initial contact. Peak flexion, valgus and internal rotation moments at the knee, measured during early landing, were normalized to mass and height and statistically compared. Intra-participant correlations were performed between all kinematics and each moment. Mean slopes for each correlation were used to identify the existence of relationships between full body kinematics and knee joint moments. Findings Landing after an overhead catch when the ball moved towards a player's support leg resulted in increased peak valgus moments. These increased valgus moments were correlated with increased knee flexion, hip flexion, and torso lean, as well as torso rotation towards the support leg, and foot and knee external rotation. Increased internal rotation moments were correlated with reduced hip abduction and external rotation, increased ankle inversion, knee external rotation and torso lean away from the support leg. Interpretation Learning to land with techniques that do not reflect postures associated with high knee moments may reduce an athlete's risk of non-contact anterior cruciate ligament injury.

Kinematic perturbation in the flexion-extension axis for two lumbar rigs during a high impact jump task.

The measurement of lumbar spine motion is an important step for injury prevention research during complex and high impact activities, such as cricket fast bowling or javelin throwing. This study examined the performance of two designs of a lumbar rig, previously used in gait research, during a controlled high impact bench jump task. An 8-camera retro-reflective motion analysis system was used to track the lumbar rig. Eleven athletes completed the task wearing the two different lumbar rig designs. Flexion extension data were analyzed using a fast Fourier transformation to assess the signal power of these data during the impact phase of the jump. The lumbar rig featuring an increased and pliable base of support recorded moderately less signal power through the 0-60 Hz spectrum, with statistically less magnitudes at the 0-5 Hz (p = .039), 5-10 Hz (p = .005) and 10-20 Hz (p = .006) frequency bins. A lumbar rig of this design would seem likely to provide less noisy lumbar motion data during high impact tasks.

Lycra arm splints in conjunction with goal-directed training can improve movement in children with cerebral palsy.

OBJECTIVES: To investigate the effects of lycra® arm splint wear on goal attainment and three dimensional (3D) kinematics of the upper limb and trunk in children with cerebral palsy (CP). DESIGN: Randomised clinical trial whereby participants were randomised to parallel groups with waiting list control. PARTICIPANTS: Sixteen children with CP (hypertonia) aged 9 to 14 years. INTERVENTION: Three months lycra arm splint wear combined with goal directed training. MAIN OUTCOME MEASURE: Goal attainment scale, and 3D upper limb and trunk kinematics across four upper limb movement tasks. RESULTS: 17/18 children achieved their movement goals following three months of splinting. Selected joint kinematics improved on immediate splint application. Further improvements in joint kinematics were demonstrated following 3 months of splint wear, particularly in elbow extension, shoulder flexion and abduction and in thorax flexion. Only improvements in movement compensations at the thorax remained following removal of the splint. CONCLUSIONS: The lycra® arm splint, made a quantifiable change to the attainment of movement goals of importance to the child. Furthermore, improvements were demonstrated in selected maximum range of movement and joint kinematics during functional tasks at the elbow and shoulder joints and thorax segment in children with CP.

Level of agreement between field-based data collectors in a large scale injury prevention randomised controlled trial.

In sports injury prevention field trials, data collectors are often club volunteers with considerable knowledge of the game but with limited detailed medical backgrounds or knowledge of formal scientific processes. The aim of this paper is to determine the agreement among trained primary data collectors (PDCs) with a sport science background and no prior involvement in data collection in a large randomised controlled trial. During the 'Preventing Australian Football Injury through eXercise' (PAFIX) project, player participation and injury data were collected by trained PDCs at training and games over the 2007 and 2008 playing seasons in 40 community level Australian football teams. PDC-collected data relating to player exposure and whether or not a player sustained an injury and subsequently left the field of play was compared to the same information from independent observers (IOs) who attended one randomly selected game for each of the 40 teams. There was 98% agreement between the PDC and the IO on game details (i.e., date, time, grade and score), 79% (ICC 0.9, 95% CI 0.85-0.95) agreement on the number of players per game and 76% (ICC 0.8, 95% CI 0.69-0.91) agreement on the number of injuries sustained in the games. There was 100% agreement on whether the player left the field for all injuries. This study found that exercise and sport science students are reliable data collectors in sports injury fieldwork studies.

Training affects knee kinematics and kinetics in cutting maneuvers in sport.

PURPOSE: The current study examined how different training affects the kinematics and applied moments at the knee during sporting maneuvers and the potential to reduce loading of the anterior cruciate ligament (ACL). The training programs were 1) machine weights, 2) free weights, 3) balance training, and 4) machine weights + balance training. METHODS: Fifty healthy male subjects were allocated either to a control group or to one of four 12-wk training programs. Subjects were tested before and after training, performing running and cutting maneuvers from which knee angle and applied knee moments were assessed. Data analyzed were peak applied flexion/extension, varus/valgus, and internal/external rotation moments, as well as knee flexion angles during specific phases of stance during the maneuvers. RESULTS: The balance training group decreased their peak valgus and peak internal rotation moments during weight acceptance in all maneuvers. This group also lowered their flexion moments during the sidestep to 60 degrees . Free weights training induced increases in the internal rotation moment and decreases in knee flexion angle in the peak push-off phase of stance. Machine weights training elicited increases in the flexion moment and reduced peak valgus moments in weight acceptance. Machine weights + balance training resulted in no changes to the variables assessed. CONCLUSIONS: Balance training produced reductions in peak valgus and internal rotation moments, which could lower ACL injury risk during sporting maneuvers. Strength training tended to increase the applied knee loading known to place strain on the ACL, with the free weights group also decreasing the amount of knee flexion. It is recommended that balance training be implemented because it may reduce the risk of ACL injury.

Developmental gender differences for overhand throwing in Aboriginal Australian children.

In a review of 46 meta-analyses of gender differences, overhand throwing had the largest gender difference favoring boys (ES > 3.0). Expectations for gender-specific performances may be less pronounced in female Australian Aborigines, because historical accounts state they threw for defense and hunting. Overhand throwing velocities and kinematics were recorded in 30 female and male Aboriginal Australian children 6-10 years old. Results indicated the Aboriginal girls and boys were more similar in horizontal ball velocities than U.S. girls and boys. Throwing kinematics between girls and boys were also more similar in Australian Aborigines than U.S. children. Aboriginal girls threw with greater velocities than U.S., German, Japanese, and Thai girls, while the boys were similar across cultures.