Team Behavior and Performance: An Exploration in the Context of Professional Rugby Union.

PURPOSE: To explore complex system behavior and subsequent team performance in professional rugby union. METHODS: Here, we present 2 studies. In the first, we used global positioning system technology to measure player clustering during stoppages in play in nearly 100 games of professional rugby union to explore team (complex system) behavior and performance. In the second, we measured stress hormones (cortisol and testosterone) prior to team meetings and analyzed these relative to amount of time and the frequency with which players looked at peer presenters, as well as subsequent training performance, to explain how stress may lead to behaviors observed in the first study and subsequent match performance. RESULTS: No link between player clustering during stoppages of play and performance was observed. When players (complex system agents) demonstrated greater levels of stress (as indicated by greater cortisol-awakening response and a greater decline in testosterone-to-cortisol ratio across the morning), they tended to look at peer presenters more; however, training quality declined (P = .02). Correlational analysis also showed that training quality was related to testosterone-to-cortisol ratio (P = .04). CONCLUSIONS: Team behavior is complex and can be unpredictable. It is possible that under stress, complex system agents (ie, rugby union players) look at (and cluster toward) their teammates more; however, meaningful interaction may not necessarily occur. Furthermore, while complex system (team) analysis may be valuable strategically in rugby union in the context of describing behavior, without understanding "how" or "why" intrateam/interagent behaviors emerge it may have little meaning.

Statistical shape modelling reveals differences in hamstring morphology between professional rugby players and sprinters.

Hamstring morphology may play an important role in understanding the aetiology of hamstring injury. Currently, the methods available to capture detailed morphological data such as muscle shape have not been utilized for the hamstring muscles. The aim of this study was to examine the utility of statistical shape modelling (SSM) for describing and comparing hamstring muscle shape in rugby and sprinting athletes. Magnetic resonance images of both thighs of nine elite male rugby players and nine track and field sprinters were analysed. Images were converted to three-dimensional models enabling generation of four statistical shape models. Principal components describing the shape variation in the cohort were derived and evaluated. Six principal components were sufficient to discriminate differences in the shape of the hamstring muscles of rugby and sprinting athletes with 89% classification accuracy. Distinct shape features distinguishing rugby players from sprinters included size, curvature and axial torsion. These data demonstrate that SSM is useful for understanding hamstring muscle shape and that meaningful variation can be identified within a small sample. This method can be used in future research to enhance the anatomical specificity of musculoskeletal modelling and to understand the relationship between hamstring shape and injury.

Hamstring musculotendon mechanics of prospectively injured elite rugby athletes.

The musculotendon mechanics of the hamstrings during high-speed running are thought to relate to injury but have rarely been examined in the context of prospectively occurring injury. This prospective study describes the hamstring musculotendon mechanics of two elite rugby players who sustained hamstring injuries during on-field running. Athletes undertook biomechanical analyses of high-speed running during a Super Rugby pre-season, prior to sustaining hamstring injuries during the subsequent competition season. The biceps femoris long head muscle experienced the greatest strain of all hamstring muscles during the late swing phase. When expressed relative to force capacity, biceps femoris long head also experienced the greatest musculotendon forces of all hamstring muscles. Musculotendon strain and force may both be key mechanisms for hamstring injury during the late swing phase of running.

Exploring Finger Digit Ratios (2D:4D) in Surgeons, Professional Rugby Players, and Political Journalists to Form a Directional Hypothesis: Could Finger Length Predict Attention and Focus?

In this short report we explore the predictive nature of finger digit ratio (i.e., second/index finger length divided by fourth/ring finger length; 2D:4D) and achievement. This research, with niche and specialized populations, was intended to support and grow on knowledge obtained from other large population 2D:4D studies and help form a directional hypothesis for future work exploring finger digit ratio and "success." Twenty-nine professional rugby players aged 25.1 ± 4.2 years, height 185.2 ± 6.3 cm and weight 101.9 ± 11.8 kg; n = 16 orthopedic surgeons aged 55.3 ± 9.3 years with height 183.8 ± 10.2 cm and weight 90.8 ± 14.0 kg; and n = 18 political journalists with age, height and weight of 38.8 ± 7.3 years, 182.8 ± 7.8 cm, and 84.4 ± 11.4 kg, respectively, were recruited. Three experiments were conducted where we (1) explored relationships for 2D:4D with testosterone and cortisol responsiveness to low stress exercise, (2) explored relationships for 2D:4D with pupil constriction and pupil constriction latency (pupillometry measures related to testosterone and cortisol responsiveness and to attentiveness), and (3) compared 2D:4D between rugby players, surgeons, and journalists. Our results revealed 2D:4D was not predictive of testosterone and cortisol responsiveness to low-level exercise stress. However, relationships exist for 2D:4D and pupillometry measures (p < 0.05). Journalists right minus left 2D:4D difference was significantly different to rugby players' and surgeons (p < 0.05). We argue 2D:4D is likely predictive of testosterone sensitivity and associated ability to focus attention; a skill important to high achievement in various contexts.

Factors Influencing Team Performance: What Can Support Teams in High-Performance Sport Learn from Other Industries? A Systematic Scoping Review.

BACKGROUND: The primary aim of our systematic scoping review was to explore the factors influencing team function and performance across various industries and discuss findings in the context of the high-performance sport support team setting. These outcomes may also be used to inform future research into high-performance teamwork in sport. METHODS: A systematic scoping review of literature published in English since 2000 reporting team-based performance outcomes and included a performance metric that was 'team outcome based' was conducted using search of the Academic Search Ultimate, Medline, Business Source Ultimate, APA PsycInfo, CINAHL, SPORTDiscus, and Military database (ProQuest) using the terms: 'team', 'function' OR 'dysfunction', 'Perform*' OR 'outcome'. RESULTS: Application of the search strategy identified a total of 11,735 articles for title and abstract review. Seventy-three articles were selected for full-text assessment with the aim to extract data for either quantitative or qualitative analysis. Forty-six of the 73 articles met our inclusion criteria; 27 articles were excluded as they did not report a performance metric. Eleven studies explored leadership roles and styles on team performance, three studies associated performance feedback to team performance, and 12 studies explored the relationship between supportive behaviour and performance. Team orientation and adaptability as key figures of team performance outcomes were explored in 20 studies. CONCLUSIONS: Our findings identified 4 key variables that were associated with team function and performance across a variety of industries; (i) leadership styles, (ii) supportive team behaviour, (iii) communication, and (iv) performance feedback. High-performance teams wishing to improve performance should examine these factors within their team and its environment. It is widely acknowledged that the dynamics of team function is important for outcomes in high-performance sport, yet there is little evidence to provide guidance. This inequality between real-world need and the available evidence should be addressed in future research.

Testosterone and Dihydrotestosterone Changes in Male and Female Athletes Relative to Training Status.

PURPOSE: To establish if training volume was associated with androgen baselines and androgen responsiveness to acute exercise. METHODS: During a "high-volume" training phase, 28 cyclists (14 men and 14 women) undertook oxygen-uptake and maximal-work-capacity testing. Two days later, they completed a repeat-sprint protocol, which was repeated 3 weeks later during a "low-volume" phase. Blood and saliva samples were collected before and after (+5 and +60 min) the repeat-sprint protocol. Blood was assayed for total testosterone (TT), free testosterone (FT), and dihydrotestosterone (DHT) and saliva, for testosterone and DHT. RESULTS: Pretrial TT, FT, and DHT concentration was greater for males (P < .001, large effect size differences), and in both genders TT, DHT, and saliva for DHT was higher during high-volume loading (moderate to large effect size). Area-under-the-curve analysis revealed larger TT, FT, and DHT responses to the repeat-sprint protocol among females, and high-volume training was linked to larger TT, DHT, and saliva for DHT responses (moderate to large effect size). Baseline TT and FT correlated with oxygen uptake and work capacity in both genders (P < .05). CONCLUSION: DHT showed no acute performance correlation but was responsive to volume of training, particularly in females. This work informs on timelines and relationships of androgenic biomarkers in males and females across different training loads, adding to the complexity that should be considered in interpretation thereof. The authors speculate that testosterone may impact acute performance via behavioral mechanisms of motivation and attention; DHT, via training volume-induced androgenic promotion, may facilitate long-term adaptive changes, especially for females.

Testosterone and cortisol are more predictive of choice behavior than a social nudge in adult males on a simple gift give-get task.

Reproducibility of social research is ambitious, and evidence supporting this argument is increasing in psychology and social science research. This may be attributed to, in part, the high volume of qualitative research methodology used in social research along with difficulties in the reliability of measurement techniques. Therefore, use of more and better objective measures to complement existing techniques in social research are necessitated. To highlight this point we explored the success of give-get nudge in adults. Nudge being a subtle intervention to influence choice, without restricting choice. We also wanted to explore whether testosterone and cortisol, as objective psychophysiological markers, could explain nudge outcome. Participants were asked what they would like to get for Christmas, or what they would like to give. They were then presented with two chocolates, one big and one small, and instructed to take as a "reward" for their participation with the knowledge there was one other participant to take chocolate after them. It was hypothesized that those asked to give something for Christmas would take the smaller reward and vice versa. Salivary testosterone and cortisol were measured prior to, and 10 min after completing the exercise. The nature of the nudge itself did not predict behavior, but the hormone measures did. We speculate that testosterone may focus an individual on the nature of the question (nudge), while cortisol encourages self-focus. These results support the need to combine existing social research techniques with more objective markers.

Is There a Link between Stress and Cognition, and Capacity to Execute Motor Skill?

PURPOSE: This study aimed to examine the link between stress (measured via salivary cortisol and testosterone), cognition (measured via pupillometry, with greater pupil constriction and reduced pupil constriction latency associated with increased attention and improved information processing), and motor skill capacity (measured via somatosensory processing). METHODS: Twenty-five professional rugby players participated in this study. Saliva samples were collected upon waking, before pupillometry and somatosensory processing testing, and after testing. Testing times varied for participants; however, it was always in the morning, and the order of testing was randomized. RESULTS: Very small differences in hormone concentrations were seen across the morning (effect size = 0.01). Moderate to large differences in left eye pupil constriction for direct (left eye) versus consensual (right eye) stimulus were also seen (P < 0.01; effect size = 0.51 to 1.04). No differences for pupil constriction latency were seen for direct versus consensual stimulus. Some positive weak to moderate relationships were seen for testosterone and pupil constriction latency (r = 0.37 to 0.39, P < 0.05). Moderate to strong inverse relationships were seen for hormones with left eye pupil constriction difference between direct and consensual stimulus, and for pre- to posttest testosterone-to-cortisol ratio decline with left eye pupil constriction for direct and consensual stimulus (r = 0.41 to 0.52, P < 0.05). Weak to moderate inverse relationships for testosterone-to-cortisol ratio decline and somatosensory processing were seen (r = 0.36 to 0.47, P < 0.05). CONCLUSION: Stress may affect ability to receive information and ability to execute motor tasks. Thus, stress may compromise ability to make appropriate objective decisions and consequently execute skill/task behavior. Strategies to help mitigate negative stress responses are noted.

Performance Analysis in Rugby Union: a Critical Systematic Review.

BACKGROUND: Performance analysis in rugby union has become an integral part of the coaching process. Although performance analysis research in rugby and data collection has progressed, the utility of the insights is not well understood. The primary objective of this review is to consider the current state of performance analysis research in professional rugby union and consider the utility of common methods of analysing performance and the applicability of these methods within professional coaching practice. METHODS: SPORTDiscus electronic database was searched for relevant articles published between 1 January 1997 and 7 March 2019. Professional, male 15-a-side rugby union studies that included relevant data on tactical and performance evaluation, and statistical compilation of time-motion analysis were included. Studies were categorised based on the main focus and each study was reviewed by assessing a number of factors such as context, opposition analysis, competition and sample size. RESULTS: Forty-one studies met the inclusion criteria. The majority of these studies measured performance through the collection and analysis of performance indicators. The majority did not provide context relating to multiple confounding factors such as field location, match location and opposition information. Twenty-nine performance indicators differentiated between successful match outcomes; however, only eight were commonly shared across some studies. Five studies considered rugby union as a dynamical system; however, these studies were limited in analysing lower or national-level competitions. CONCLUSIONS: The review highlighted the issues associated with assessing isolated measures of performance, lacking contextual information such as the opposition, match location, period within match and field location. A small number of studies have assessed rugby union performance through a dynamical systems lens, identifying successful characteristics in collective behaviour patterns in attacking phases. Performance analysis in international rugby union can be advanced by adopting these approaches in addition to methods currently adopted in other team sports.

Altitude exposure as a training & iron overload management strategy post leukemia.

OBJECTIVES: To examine iron stores, hemoglobin mass, and performance before, during and after intermittent altitude exposure in a professional male rugby player experiencing iron overload following blood transfusions for treatment for acute myeloid leukemia. DESIGN: Longitudinal, repeated measures, single case-study. METHODS: The player was followed prior to (control), and during (study), an in-season block of altitude training. During the control period two venesections were performed for a total of 750mL of blood removal. Internal and external training load, match statistics, blood volume, plasma volume, haemoglobin mass, serum ferritin and reticulocyte count were monitored throughout. RESULTS: During the control period serum ferritin declined following the two venesections (∼51%) as did haemoglobin mass (∼2%), reticulocyte count remained stable. During the study period serum ferritin further declined (∼30%), however haemoglobin mass and reticulocyte count increased (∼4% and ∼14% respectively). Internal training load for the control and study period was similar, however external training load was lower in the study period. Match statistics were not favourable for the player during the control period, however they improved during the study period. CONCLUSIONS: This case supports the theory that individuals with elevated iron availability are well placed to achieve increases in haemoglobin mass. Furthermore, although therapeutic venesections may still be required to manage iron overload, the addition of altitude exposure may be a method to assist in reducing total body iron by means of mobilising available (excessive) iron to incorporate into haemoglobin. Altitude exposure did not hinder the players' performance. Further research is encouraged.

A retrospective analysis of hamstring injuries in elite rugby athletes: More severe injuries are likely to occur at the distal myofascial junction.

OBJECTIVES: To describe the most common hamstring injury scenarios and outcomes in elite rugby union. DESIGN: Retrospective investigation. SETTING: Hamstring injury data from an elite rugby union team was collected over five seasons and retrospectively analysed. PARTICIPANTS: 74 professional rugby players. MAIN OUTCOME MEASURES: Injuries were classified as new or recurrent. Injury severity, activity, player position, and whether the injury occurred during a match or training was determined for each injury. Injury location and grade were determined for more clinically severe injuries where Magnetic Resonance Imaging (MRI) data was available (15 injuries). RESULTS: Thirty hamstring injuries were sustained over the five seasons. The majority of injuries were new (93%), moderate in severity (60%) and occurred during running (77%). For more clinically severe injuries, the biceps femoris long head (BFlh) was the most commonly injured muscle (73%) and the distal myofascial junction (DMFJ) was the most common injury site (58% of BFlh injuries). CONCLUSIONS: Hamstring injuries most commonly occurred while running and in the BFlh muscle, which is similar to other sports. However, the most common intramuscular injury site was the DMFJ, which contrasts with reports from other cohorts. Future studies should ensure to include the myofascial junction when classifying injury location.

Late swing running mechanics influence hamstring injury susceptibility in elite rugby athletes: A prospective exploratory analysis.

Hamstring injuries are one of the most prevalent injuries in rugby union and many other running-based sports, such as track sprinting and soccer. The majority of these injuries occur during running; however, the relationship between running mechanics and hamstring injury is unclear. Obtaining large samples of prospective injury data to examine this relationship is difficult, and therefore exploratory analysis frameworks may assist in deriving valuable information from studies with small but novel samples. The aim of this study was to undertake a prospective exploratory analysis of the relationship between running mechanics and hamstring injury. Kinematic and kinetic data of the trunk, pelvis and lower limbs were collected during maximal overground running efforts for ten elite rugby union athletes. Subsequently, hamstring injury occurrence was recorded for the following Super Rugby season, during which three athletes sustained a running-based hamstring injury. Functional principal component analysis was used to visualise patterns of variability in running mechanics during the late swing phase between athletes. Results indicated that subsequently injured athletes demonstrated a tendency for greater thoracic lateral flexion, greater hip extension moments and greater knee power absorption, compared to uninjured athletes. All variables demonstrated an ability to descriptively differentiate between injured and uninjured athletes at approximately 60% of the late swing phase. Therefore, we hypothesize that greater thoracic lateral flexion, a greater hip extension moment and greater knee power absorption between peak hip flexion and peak knee extension during the late swing phase may put rugby athletes at greater risk of running-based hamstring injury.

Late swing or early stance? A narrative review of hamstring injury mechanisms during high-speed running.

Hamstring injuries are highly prevalent in many running-based sports, and predominantly affect the long head of biceps femoris. Re-injury rates are also high and together lead to considerable time lost from sport. However, the mechanisms for hamstring injury during high-speed running are still not fully understood. Therefore, the aim of this review was to summarize the current literature describing hamstring musculotendon mechanics and electromyography activity during high-speed running, and how they may relate to injury risk. The large eccentric contraction, characterized by peak musculotendon strain and negative work during late swing phase is widely suggested to be potentially injurious. However, it is also argued that high hamstring loads resulting from large joint torques and ground reaction forces during early stance may cause injury. While direct evidence is still lacking, the majority of the literature suggests that the most likely timing of injury is the late swing phase. Future research should aim to prospectively examine the relationship between hamstring musculotendon dynamics and hamstring injury.

The Effect of Speed, Power, and Strength Training and a Group Motivational Presentation on Physiological Markers of Athlete Readiness: A Case Study in Professional Rugby.

OBJECTIVE: To examine the effect of a physical treatment (speed, power, and strength [SPS] training) and psychosocial treatment (group motivational presentation) on salivary testosterone (sal-T), salivary cortisol (sal-C), and sal-T-to-sal-C ratio (T:C) in professional rugby. METHODS: Fourteen male rugby players (age = 25.9 [2.5] y, height = 186.1 [6.7] cm, and body mass = 104.1 [12.7] kg) participated in this study. Testing occurred across 2 d on 2 separate occasions (week 1 and week 2). On day 1 of both weeks, participants completed an SPS training session. On day 2 of both weeks, participants undertook a field-based rugby training session. In week 2, participants underwent an additional treatment in the form of a motivational presentation given by a respected former player before the rugby session. Saliva was collected before and after SPS training and before and after the rugby session and was assayed for testosterone and cortisol. RESULTS: No differences were found between weeks for sal-T at any time point, but sal-C was higher in week 2 before and after SPS and before rugby on day 2 (P < .05). In both weeks, T:C increased following SPS (P < .02, ES > 0.91 [0.13, 1.69]). T:C increased when the motivational presentation accompanied rugby training (P = .07, ES = 1.06 [0.27, 1.85]). Sal-C, not sal-T, drove changes in T:C (P < .001). CONCLUSIONS: Physical or psychosocial treatments may affect sal-T, sal-C, and T:C, and individual variation in responses to treatments may exist.

Sleep and Salivary Testosterone and Cortisol During a Short Preseason Camp: A Study in Professional Rugby Union.

Purpose: To examine changes in, and relationships between, sleep quality and quantity, salivary testosterone, salivary cortisol, testosterone-to-cortisol ratio (T:C), and self-reported muscle soreness during a residential-based training camp in elite rugby players. Methods: Nineteen male rugby players age 26.4 (3.9) years, height 186.0 (9.4) cm, and weight 104.1 (13.4) kg (mean [SD]) participated in this study. Wrist actigraphy devices were worn for 8 nights around a 4-d training camp (2 nights prior, during, and 2 nights after). Sleep-onset latency, sleep duration, sleep efficiency, and waking time were measured. Participants provided saliva samples during camp on waking and again 45 min later, which were then assayed for testosterone and cortisol levels. They also rated their general muscle soreness daily. Results: Little variation was observed for sleep quality and quantity or testosterone. However, significant differences were observed between and within days for cortisol, T:C, and muscle soreness (P < .001). Few relationships were observed for sleep and hormones; the strongest, an inverse relationship for sleep efficiency and T:C (r = -.372, P < .01). Conclusions: There may be no clear and useful relationship between sleep and hormone concentration in a short-term training camp context, and measures of sleep and testosterone and cortisol should be interpreted with caution because of individual variation. Alterations in hormone concentration, particularly cortisol, may be affected by other factors including anticipation of the day ahead. This study adds to our knowledge that changes in hormone concentration are individual and context specific.

Effect of Physical and Psychosocial Interventions on Hormone and Performance Outcomes in Professional Rugby Union Players: A Systematic Review.

Strahorn, J, Serpell, BG, McKune, A, and Pumpa, KL. Effect of physical and psychosocial interventions on hormone and performance outcomes in professional rugby union players: a systematic review. J Strength Cond Res 31(11): 3158-3169, 2017-This systematic review investigates the acute effects of physical or psychosocial interventions on testosterone and cortisol responses in elite male rugby union players, and the subsequent association with physical performance areas (e.g., strength, power, sprint performance) or key performance indicators (e.g., coach-identified skills). Medline (via EBSCO), SPORTDiscus, Web of Science, InformIT, ProQuest, Cochrane, and Scopus were searched for relevant articles. Nine articles met the inclusion criteria, with 6 articles examining the effect of speed, strength or power training, and the remaining 3 psychosocial interventions. Quality assessment of the articles as determined by their PEDro score was either 6 or 7 out of 11. This review found that both physical and psychosocial interventions can alter testosterone and cortisol, and physical performance areas important for rugby union are affected by these changes. The limited literature in the field supports the notion that physical interventions of short duration and high intensity, and psychosocial interventions that create a positive environment may elicit a hormonal response that is associated with favorable performance outcomes. Studies that reported psychosocial interventions suggest that testosterone and cortisol may be altered in elite rugby players without metabolic stress, something of great interest to elite athletes and coaches who are looking to elicit a performance advantage without increasing athlete load. Overall, this review identified that when the testosterone responses to an intervention are notably greater than that of cortisol, favorable outcomes are likely. Further research is required to improve our understanding on how to best manipulate training to induce these favorable changes.

Vertical stiffness is not related to anterior cruciate ligament elongation in professional rugby union players.

BACKGROUND: Novel research surrounding anterior cruciate ligament (ACL) injury is necessary because ACL injury rates have remained unchanged for several decades. An area of ACL risk mitigation which has not been well researched relates to vertical stiffness. The relationship between increased vertical stiffness and increased ground reaction force suggests that vertical stiffness may be related to ACL injury risk. However, given that increased dynamic knee joint stability has been shown to be associated with vertical stiffness, it is possible that modification of vertical stiffness could help to protect against injury. We aimed to determine whether vertical stiffness is related to measures known to load, or which represent loading of, the ACL. METHODS: This was a cross-sectional observational study of 11 professional Australian rugby players. Knee kinematics and ACL elongation were measured from a 4-dimensional model of a hopping task which simulated the change of direction manoeuvre typically observed when non-contact ACL injury occurs. The model was generated from a CT scan of the participant's knee registered frame by frame to fluoroscopy images of the hopping task. Vertical stiffness was calculated from force plate data. RESULTS: There was no association found between vertical stiffness and anterior tibial translation (ATT) or ACL elongation (r=-0.05; p=0.89, and r=-0.07; p=0.83, respectively). ATT was related to ACL elongation (r=0.93; p=0.0001). CONCLUSIONS: Vertical stiffness was not associated with ACL loading in this cohort of elite rugby players but a novel method for measuring ACL elongation in vivo was found to have good construct validity.

Validity of a Wearable Accelerometer Device to Measure Average Acceleration Values During High-Speed Running.

Alexander, JP, Hopkinson, TL, Wundersitz, DWT, Serpell, BG, Mara, JK, and Ball, NB. Validity of a wearable accelerometer device to measure average acceleration values during high-speed running. J Strength Cond Res 30(11): 3007-3013, 2016-The aim of this study was to determine the validity of an accelerometer to measure average acceleration values during high-speed running. Thirteen subjects performed three sprint efforts over a 40-m distance (n = 39). Acceleration was measured using a 100-Hz triaxial accelerometer integrated within a wearable tracking device (SPI-HPU; GPSports). To provide a concurrent measure of acceleration, timing gates were positioned at 10-m intervals (0-40 m). Accelerometer data collected during 0-10 m and 10-20 m provided a measure of average acceleration values. Accelerometer data was recorded as the raw output and filtered by applying a 3-point moving average and a 10-point moving average. The accelerometer could not measure average acceleration values during high-speed running. The accelerometer significantly overestimated average acceleration values during both 0-10 m and 10-20 m, regardless of the data filtering technique (p < 0.001). Body mass significantly affected all accelerometer variables (p < 0.10, partial η = 0.091-0.219). Body mass and the absence of a gravity compensation formula affect the accuracy and practicality of accelerometers. Until GPSports-integrated accelerometers incorporate a gravity compensation formula, the usefulness of any accelerometer-derived algorithms is questionable.

Medial and lateral hamstrings and quadriceps co-activation affects knee joint kinematics and ACL elongation: a pilot study.

BACKGROUND: Many injury prevention and rehabilitation programs aim to train hamstring and quadriceps co-activation to constrain excessive anterior tibial translation and protect the anterior cruciate ligament (ACL) from injury. However, despite strong clinical belief in its efficacy, primary evidence supporting training co-activation of the hamstrings and quadriceps muscles for ACL injury prevention and rehabilitation is quite limited. Therefore, the purpose of the study presented in this paper was to determine if hamstring-quadriceps co-activation alters knee joint kinematics, and also establish if it affects ACL elongation. METHODS: A computed tomography (CT) scan from each participant's dominant leg was acquired prior to performing two step-ups under fluoroscopy: one with 'natural' hamstring-quadriceps co-activation, one with deliberate co-activation. Electromyography was used to confirm increased motor unit recruitment. The CT scan was registered to fluoroscopy for 4-D modeling, and knee joint kinematics subsequently measured. Anterior cruciate ligament attachments were mapped to the 4-D models and its length was assumed from the distance between attachments. Anterior cruciate ligament elongation was derived from the change in distance between those points as they moved relative to each other. RESULTS: Reduced ACL elongation as well as knee joint rotation, abduction, translation, and distraction was observed for the step up with increased co-activation. A relationship was shown to exist for change in ACL length with knee abduction (r = 0.91; p ≤ 0.001), with distraction (r = -0.70; p = 0.02 for relationship with compression), and with anterior tibial translation (r = 0.52; p = 0.01). However, ACL elongation was not associated with internal rotation or medial translation. Medial hamstring-quadriceps co-activation was associated with a shorter ACL (r = -0.71; p = 0.01), and lateral hamstring-quadriceps co-activation was related to ACL elongation (r = 0.46; p = 0.05). CONCLUSION: Net co-activation of the hamstrings and quadriceps muscles will likely reduce ACL elongation provided that the proportion of medial hamstring-quadriceps co-activation exceeds lateral.