Single leg hop for distance symmetry masks lower limb biomechanics: time to discuss hop distance as decision criterion for return to sport after ACL reconstruction?

BACKGROUND: We evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls). METHODS: We captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively. RESULTS: Significant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion. CONCLUSION: Symmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.

Reliability, Validity, and Performance Characteristics of Elite Adolescent Athletes at Different Stages of Maturity in the 10 to 5 Repeated Jump Test.

PURPOSE: To examine the reliability, validity, and performance characteristics of the 10 to 5 repeated jump test (10-5 RJT) in adolescent male athletes. The 10-5 RJT has been shown to be a valid and reliable test of reactive strength index (RSI) in older adolescents (age 17-19 y), but less is known in younger adolescent athletes at different stages of maturity. METHODS: Athletes (age 11-17 y) completed the 10-5 RJT on 2 days, 1 week apart, to examine the reliability (n = 41), validity (n = 18) of the test. Athletes were classified as pre, circa, or post peak height velocity (PHV) height velocity using maturity offset to examine the effect of maturation status on RSI, flight time (FT), ground contact time (GCT), and jump height (JH) (n = 68) using a cross-sectional design. RESULTS: Paired samples t tests showed no significant differences (P ≥ .05), and Bland-Altman analysis showed no bias and close limits of agreement for RSI, JH, FT, and GCT between the contact mat and force plate. Interday reliability was rated excellent for RSI (intraclass correlation coefficient = .91) and good for GCT, FT, and JH (intraclass correlation coefficient = .81-.85). All variables had a coefficient of variation ≤ 10%. RSI increased across maturation groups, with significant differences between pre-PHV and post-PHV groups (P = .014, d = 1.00). CONCLUSION: The 10-5 RJT is a valid and reliable test for adolescent male athletes. Greater RSI with advancing maturity was primarily due to increased FT and JH, with GCT remaining similar.

Contribution of Eccentric Strength to Cutting Performance in Female Soccer Players.

ABSTRACT: Jones, PA, Dos'Santos, T, McMahon, JJ, and Graham-Smith, P. Contribution of eccentric strength to cutting performance in female soccer players. J Strength Cond Res 36(2): 525-533, 2022-The aim of this study was to examine the contribution of eccentric strength to performance of a 70-90° cutting task (CUT) (time to complete: 5 m approach, 70-90° cut, 3 m exit). Nineteen female soccer players (mean ± SD age, height, and mass; 21.7 ± 4.3 years, 1.67 ± 0.07 m, and 60.5 ± 6.1 kg) from the top 2 tiers of English women's soccer participated in the study. Each player performed 6 trials of the CUT task whereby three-dimensional motion data from 10 Qualisys proreflex cameras (240 Hz) and ground reaction forces from 2 Advanced Mechanical Technology, Inc. force platforms (1,200 Hz) were collected. Relative eccentric knee extensor (ECC-KE) and flexor peak moments (ECC-KF) were collected from both limbs at 60°·s-1 using a Kin-Com isokinetic dynamometer. Hierarchical multiple regression revealed that minimum center of mass (CM) and approach velocities (CM velocity at touchdown of penultimate foot contact) could explain 82% (79% adjusted) of the variation in CUT completion time (F(1,16) = 36.086, p < 0.0001). ECC-KE was significantly (p < 0.05) moderately associated (R ≥ 0.610) with velocities at key instances during the CUT. High (upper 50th percentile) ECC-KE individuals (n = 9) had significantly (p ≤ 0.01; d ≥ 1.34) greater velocities at key instances during the CUT. The findings suggest that individuals with higher ECC-KE produce faster CUT performance, by approaching with greater velocity and maintaining a higher velocity during penultimate and final contact, as they are better able to tolerate the larger loads associated with a faster approach.

Stronger Subjects Select a Movement Pattern That May Reduce Anterior Cruciate Ligament Loading During Cutting.

ABSTRACT: Davies, WT, Ryu, JH, Graham-Smith, P, Goodwin, JE, and Cleather, DJ. Stronger subjects select a movement pattern that may reduce anterior cruciate ligament loading during cutting. J Strength Cond Res 36(7): 1853-1859, 2022-Increased strength has been suggested to reduce the incidence of anterior cruciate ligament (ACL) injury as part of wider neuromuscular training programs; however, the mechanism of this is not clear. Cutting is a high-risk maneuver for ACL injury, but limited research exists as to how strength affects sagittal plane biomechanics during this movement. Sixteen subjects were split into a stronger and weaker group based on their relative peak isometric strength in a unilateral squat (stronger: 29.0 ± 3.4 N·kg-1 and weaker: 18.3 ± 4.1 N·kg-1). Subjects performed 45° cuts with maximal intent 3 times, at 3 different approach velocities (2, 4, and 6 m·s-1). Kinematics and ground reaction forces were collected using optical motion capture and a force platform. The stronger group had lower knee extensor moments, larger hip extensor moments, and a greater peak knee flexion angle than the weaker group (p < 0.05). There was a trend for greater knee flexion at initial contact in the stronger group. There were no differences in resultant ground reaction forces between groups. The stronger group relied more on the hip than the knee during cutting and reached greater knee flexion angles. This could decrease ACL loading by reducing the extensor moment required at the knee during weight acceptance. Similarly, the greater knee flexion angle during weight acceptance is likely to be protective of the ACL.

The kinematic differences between skill levels in the squash forehand drive, volley and drop strokes.

Knowledge of the kinematic differences that separate highly skilled and less-skilled squash players could assist the progression of talent development. This study compared trunk, upper-limb and racket kinematics between two groups of nine highly skilled and less-skilled male athletes for forehand drive, volley and drop strokes. A 15-camera motion analysis system recorded three-dimensional trajectories, with five shots analysed per participant per stroke. The highly skilled group had significantly (p < 0.05) larger forearm pronation/supination range-of-motion and wrist extension angles at impact than the less-skilled. The less-skilled group had a significantly more "open" racket face and slower racket velocities at impact than the highly skilled. Rates of shoulder internal rotation, forearm pronation, elbow extension and wrist flexion at impact were greater in the drive stroke than in the other strokes. The position of the racket at impact in the volley was significantly more anterior to the shoulder than in the other strokes, with a smaller trunk rotation angular velocity. Players used less shoulder internal/external rotation, forearm pronation/supination, elbow and wrist flexion/extension ranges-of-motions and angular velocities at impact in the drop stroke than in the other strokes. These findings provide useful insights into the technical differences that separate highly skilled from less-skilled players and provide a kinematic distinction between stroke types.

The kinematic differences between accurate and inaccurate squash forehand drives for athletes of different skill levels.

To maintain the accuracy of squash shots under varying conditions, such as the oncoming ball's velocity and trajectory, players must adjust their technique. Although differences in technique between skilled and less-skilled players have been studied, it is not yet understood how players vary their technique in a functional manner to maintain accuracy under varying conditions. This study compared 3-dimensional joint and racket kinematics and their variability between accurate and inaccurate squash forehand drives of 9 highly skilled and 9 less-skilled male athletes. During inaccurate shots, less-skilled players hit the ball with a more open racket, demonstrating a difference in this task-relevant parameter. No joint kinematic differences were found for accuracy for either group. Coordinated joint rotations at the elbow and wrist both displayed a "zeroing-in" effect, whereby movement variability was reduced from the initiation of propulsive joint rotation to a higher consistency at ball-impact; potentially highlighting the "functionality" of the variability prior to the impact that enabled consistent task-relevant parameters (racket orientation and velocity) under varying conditions. Further, highly skilled players demonstrated greater consistency of task-relevant parameters at impact than less-skilled players. These findings highlight the superior ability of highly skilled players to adjust their technique to achieve consistent task-relevant parameters and a successful shot.

The validity of the nordic hamstring lower for a field-based assessment of eccentric hamstring strength.

CONTEXT: Hamstring injury-risk assessment has primarily been investigated using isokinetic dynamometry. However, practical issues such as cost and availability limit the widespread application of isokinetics for injury-risk assessment; thus, field-based alternatives for assessing eccentric hamstring strength are needed. OBJECTIVE: The aim of this study was to investigate the validity of the angle achieved during Nordic hamstring lowers (break-point angle) as a field-based test for eccentric hamstring strength. DESIGN: Exploratory study. SETTING: Laboratory. PARTICIPANTS: Sixteen male (n = 7) and female (n = 9) soccer players (mean ± SD age 24 ± 6 y, height 1.77 ± 0.12 m, and body mass 68.5 ± 16.5 kg) acted as subjects for the study. MAIN OUTCOME MEASURES: The authors explored relationships between the Nordic break-point angle (the point at which the subject can no longer resist the increasing gravitational moment during a Nordic hamstring lower) measured from video and isokinetic peak torque and angle of peak torque of right- and left-knee flexors. RESULTS: The results revealed a meaningful relationship between eccentric knee-flexor peak torque (average of right and left limbs) and the Nordic break-point angle (r = -.808, r2 = 65%, P < .00001). However, there was a weak relationship observed (r = .480, r2 = 23%, P = .06) between break-point angle and the angle of peak torque (average of right and left limbs). CONCLUSIONS: The results suggest that the break-point angle achieved during Nordic hamstring lowers could be used as a field-based assessment of eccentric hamstring strength.

Comparison of Strength and Power Characteristics Before ACL Rupture and at the End of Rehabilitation Before Return to Sport in Professional Soccer Players.

BACKGROUND: Strength and power is often reduced on the involved versus contralateral limb and healthy controls after anterior cruciate ligament (ACL) reconstruction, but no study has compared with preinjury values at the time of return to sport (RTS). HYPOTHESIS: Divergent recovery patterns in strength and power characteristics will be present at RTS relative to preinjury baseline data and healthy matched controls. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Isokinetic strength tests, bilateral and single-leg countermovement jumps (CMJ; SLCMJ) were measured before ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow-up testing before RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group preinjury. Values recorded at RTS of the ACL group were compared with preinjury. We also compared the uninjured and ACL groups at baseline and RTS. RESULTS: Compared with preinjury, ACL normalized quadriceps peak torque of the involved limb (difference = -7%), SLCMJ height (difference = -12.08%), and Reactive Strength Index modified (RSImod) (difference = -5.04%) were reduced after ACL reconstruction. No significant reductions in CMJ height, RSImod, and relative peak power were indicated at RTS in the ACL group when compared with preinjury values, but deficits were present relative to controls. The uninvolved limb improved quadriceps (difference = 9.34%) and hamstring strength (difference = 7.36%) from preinjury to RTS. No significant differences from baseline were shown in SLCMJ height, power, and reactive strength of the uninvolved limb after ACL reconstruction. CONCLUSION: Strength and power in professional soccer players at RTS after ACL reconstruction were often reduced compared with preinjury values and matched healthy controls. CLINICAL RELEVANCE: Deficits were more apparent in the SLCMJ, suggesting that dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.

Vertical and Horizontal Hop Performance: Contributions of the Hip, Knee, and Ankle.

BACKGROUND: Single-leg vertical and horizontal hop tests are commonly used to assess performance of healthy athletes and as a measure of progress during rehabilitation from knee injury. It is unclear if they measure similar aspects of leg function, as the relative joint contributions of the hip, knee, and ankle joints during propulsion and landing are unknown. HYPOTHESIS: The proportion of work done by the hip, knee, and ankle will not be the same for these 2 jump types and will vary for propulsive and landing phases. STUDY DESIGN: Cross-sectional cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Twenty physically active participants completed instrumented single-leg hop analysis in both vertical and horizontal directions. Joint peak power, work generated or absorbed, and percentage contribution of each joint during propulsive and landing phases were compared between tasks using paired t tests. RESULTS: Vertical hop was performed with roughly similar contributions of the hip, knee, and ankle for both propulsion (31%, 34%, 35%, respectively) and landing (29%, 34%, 37%, respectively). Horizontal hop distance was mostly (87%) determined by the hip and ankle (44% and 43%), but landing was mostly (65%) performed by the knee with lesser contribution from the hip and ankle (24% and 11%). Propulsive phase showed a proximal-to-distal temporal sequence for both hop types, but landing was more complex. CONCLUSION: Performance during vertical and horizontal hops (jump height and jump distance, respectively) measures different aspects of hip, knee, and ankle function during the propulsive and landing phases. CLINICAL RELEVANCE: Assessment of knee joint function during rehabilitation should not be done using a horizontal hop. The knee contributes about a third to vertical hop height, but only about an eighth to horizontal hop distance. Practitioners carrying out performance testing using either vertical or horizontal hops should be mindful of the relative contributions for meaningful training inferences to be derived.

Racket orientation angle differences between accurate and inaccurate squash shots, as determined by a racket embedded magnetic-inertial measurement unit.

Ascertaining how racket orientation angle differences at ball-impact influence the accuracy of different squash strokes could assist player skill development and possibly reduce the number of unforced errors hit within a match. The purpose of this study was to identify differences in racket orientation angles of accurate and inaccurate forehand and backhand drive, volley and drop shots. A magnetic-inertial measurement unit embedded in a racket output orientation angles of twelve male junior players, with five accurate and five inaccurate shots per player per stroke analysed. Paired samples t-tests revealed that inaccurate backhand drop shots exhibited significantly (p < 0.05) less racket roll angle (racket face less open) at impact than accurate shots, indicating this parameter was a determining factor in the accuracy of this stroke. Racket orientation angle differences between accurate and inaccurate shots of the remaining strokes were too small to be used to distinguish shot accuracy. There was significantly greater variability in racket orientation angles during inaccurate forehand drop and backhand drive shots compared to accurate shots. These findings demonstrate how racket orientation angle differences at ball-impact can influence the accuracy of shots and highlights the need for consistent racket orientations to allow for an accurate shot.

Lower Limb Kinetic Asymmetries in Professional Soccer Players With and Without Anterior Cruciate Ligament Reconstruction: Nine Months Is Not Enough Time to Restore "Functional" Symmetry or Return to Performance.

BACKGROUND: Residual between-limb deficits are a possible contributing factor to poor outcomes in athletic populations after anterior cruciate ligament reconstruction (ACLR). Comprehensive appraisals of movement strategies utilized by athletes at key clinical milestones during rehabilitation are warranted. PURPOSE: To examine kinetic parameters recorded during a countermovement jump with a force platform in healthy professional soccer players and to compare their performance with those who had undergone ACLR at different stages of their rehabilitation. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 370 male professional soccer players attended a physical screening assessment where they performed at counter jump movement protocol on dual force plates and were divided into 4 groups: group 1 (<6 months post-ACLR), group 2 (6-9 months post-ACLR), group 3 (>9 months post-ACLR), and group 4 (healthy matched controls). RESULTS: Players in the later phases of rehabilitation increased their jump performance; however, values were significantly lower than those of healthy matched controls (P > .05). Significant between-limb differences were present for both eccentric- and concentric-phase variables (P < .05), with effect sizes ranging from moderate to very large (d = 0.42-1.35). Asymmetries were lower in players who were further away from surgery; however, between-limb differences remained significantly greater in players >9 months after ACLR versus matched controls-specifically, for concentric impulse, concentric peak force, eccentric deceleration impulse, and eccentric deceleration rate of force development asymmetry (P < .05). Logistic regression identified concentric impulse asymmetry as being most strongly associated with a history of ACLR when group prediction analysis was performed (ACLR group 1, 2, or 3 vs matched controls), with odds ratios ranging from 1.50 to 1.91. CONCLUSION: Between-limb deficits in key eccentric and concentric loading parameters remain >9 months after ACLR, indicating a compensatory offloading strategy to protect the involved limb during an athletic performance task. Concentric impulse asymmetry could be considered an important variable to monitor during rehabilitation.

Static and dynamic accuracy of a magnetic-inertial measurement unit used to provide racket swing kinematics.

Magnetic-inertial measurement units (MIMUs) are becoming more prevalent in sports biomechanics and may be a viable tool to evaluate kinematic parameters. This study examined the accuracy of a MIMU to estimate orientation angles under static conditions and dynamically from a squash racket during a forehand drive shot. A MIMU was mounted onto a goniometer and moved through 0-90°, with static data collected at 10° increments during 10 repetitions of all three axes. Typical error analyses showed the MIMU to be very reliable (TE ≤ 0.03°). MIMU accuracy was determined via intraclass correlation coefficients (ICC) (r > 0.999, p < 0.001). An ordinary least products regression showed no proportional bias and minimal fixed bias for all axes. Dynamic accuracy was assessed by comparing MIMU and optical motion capture data of squash racket swing kinematics. A MIMU was fixed onto a racket and 10 participants each hit 10 forehand shots. Mean orientation angle error at ball impact was <0.50° and ICC showed very high correlations (r ≥ 0.988, p < 0.001) for all orientations. Swing phase root mean squared errors were ≤2.20°. These results indicate that a MIMU could be used to accurately and reliably estimate selected racket swing kinematics.

The influence of gluteus maximus on transverse plane tibial rotation.

There is a common clinical belief that transverse plane tibial rotation is controlled by the rearfoot. Although distal structures may influence the motion of the tibia, transverse plane tibial rotation could be determined by the proximal hip musculature. Cadaver studies have identified gluteus maximus as having the largest capacity for external rotation of the hip. This study was therefore undertaken to investigate the effect of gluteus maximus on tibial motion. Kinematic data were collected from the foot and tibia along with EMG data from gluteus maximus for 17 male subjects during normal walking. A number of kinematic parameters were derived to characterise early stance phase. Gluteus maximus function was characterised using RMS EMG and EMG on/off times. No differences in muscle timing were found to be associated with any of the kinematic parameters. In addition, no differences in gluteal activation levels were found between groups of subjects who had different amounts of tibial rotation. However, there was a significant difference (p<0.001) in gluteus maximus activation when groups were defined by the time taken to decelerate the tibia (time to peak internal velocity). Specifically, subjects with greater gluteus maximus activity had a lower time to decelerate the tibia. We suggest that a high level of gluteus maximus activity results in a larger external torque being applied to the femur, which ultimately leads to a more rapid deceleration of the tibia.

Variation in pelvic morphology may prevent the identification of anterior pelvic tilt.

Pelvic tilt is often quantified using the angle between the horizontal and a line connecting the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Although this angle is determined by the balance of muscular and ligamentous forces acting between the pelvis and adjacent segments, it could also be influenced by variations in pelvic morphology. The primary objective of this anatomical study was to establish how such variation may affect the ASIS-PSIS measure of pelvic tilt. In addition, we also investigated how variability in pelvic landmarks may influence measures of innominate rotational asymmetry and measures of pelvic height. Thirty cadaver pelves were used for the study. Each specimen was positioned in a fixed anatomical reference position and the angle between the ASIS and PSIS measured bilaterally. In addition, side-to-side differences in the height of the innominate bone were recorded. The study found a range of values for the ASIS-PSIS of 0-23 degrees, with a mean of 13 and standard deviation of 5 degrees. Asymmetry of pelvic landmarks resulted in side-to-side differences of up to 11 degrees in ASIS-PSIS tilt and 16 millimeters in innominate height. These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry.

The Role of Eccentric Strength in 180° Turns in Female Soccer Players.

Previous studies have reported an association between eccentric strength (ECC-STR) and change of direction (COD) ability. Little is known about how ECC-STR facilitates COD maneuvers. The aim of this study was to examine the role of ECC-STR during a 180° COD task in 18 female soccer players. Each player performed six trials of a 180° COD task whereby three-dimensional motion data from 10 Qualisys Pro-Reflex infrared cameras (240 Hz) and ground reaction forces (GRFs) from two AMTI force platforms (1200 Hz) were collected. Relative eccentric knee extensor (ECC-EXT) and flexor (ECC-FLEX) peak torque was collected from both limbs at 60°·s-1 using a Kin Com isokinetic dynamometer. Large correlations were revealed between COD performance (time to complete 5 m approach, 180° turn, 5 m return) and ECC-EXT (R = -0.674) and ECC-FLEX (R = -0.603). Moderate to large correlations were observed between approach velocity (AV) and COD performance (R = -0.484) and ECC-EXT (R = 0.724). Stronger participants (n = 9) recorded significantly (p < 0.05) faster AV (4.01 ± 0.18 vs. 3.74 ± 0.24 m·s-1, d = 1.27) and a greater reduction in velocity (-1.55 ± 0.17 vs. -1.37 ± 0.21 m·s-1, d = -0.94) during penultimate contact than weaker (n = 9) subjects. Greater ECC-STR is associated with faster COD performance in female soccer players, as stronger players are better able to decelerate during penultimate contact from faster approach velocities.

Technique determinants of knee abduction moments during pivoting in female soccer players.

BACKGROUND: No previous studies have investigated the optimal technique for pivoting with regard to reducing peak knee abduction moments and potential knee injury risk. The aim of this study was to investigate the relationships between technique characteristics and peak knee abduction moments during pivoting. METHODS: Twenty-seven female soccer players [mean (SD); age: 21 (3.8) years, height: 1.67 (0.07) m, and mass: 60.0 (7.2) kg] participated in the study. Three dimensional motion analyses of pivots on the right leg were performed using 10 Qualysis 'Pro reflex' infrared cameras (240Hz). Ground reaction forces were collected from two AMTI force platforms (1200Hz) embedded into the running track to examine penultimate and final contact. Pearson's correlation coefficients, co-efficients of determination and stepwise multiple regression were used to explore relationships between a range of technique parameters and peak knee abduction moments. Significance was set at P<0.05. FINDINGS: Stepwise multiple regression found that initial foot progression and initial knee abduction angles together could explain 35% (30% adjusted) of the variation in peak knee abduction moments (F(2,26)=6.499, P=0.006). INTERPRETATION: The results of the present study suggest that initial-foot progression and knee abduction angles are potential technique factors to lower knee abduction moments during pivoting.

Braking characteristics during cutting and pivoting in female soccer players.

Most biomechanical studies into changing direction focus on final contact (FC), whilst limited research has examined penultimate contact (PEN). The aim of this study was to explore the kinematic and kinetic differences between PEN and FC of cutting and pivoting in 22 female soccer players (mean±SD; age: 21±3.1years, height: 1.68±0.07m, mass: 58.9±7.3kg). Furthermore, the study investigated whether horizontal force-time characteristics during PEN were related to peak knee abduction moments during FC. Three dimensional motion analyses of cutting and pivoting on the right leg were performed using Qualysis 'Proreflex' infrared cameras (240Hz). Ground reaction forces (GRF) were collected from two AMTI force platforms (1200Hz) to examine PEN and FC. Both manoeuvres involved significantly (P<0.05) greater knee joint flexion angles, peak horizontal GRF, but lower average horizontal GRF during PEN compared to FC. Average horizontal GRF during PEN (R=-0.569, R(2)=32%, P=0.006) and average horizontal GRF ratio (R=0.466, R(2)=22%, P=0.029) were significantly related to peak knee abduction moments during the FC of cutting and pivoting, respectively. The results indicate PEN during pre-planned changing direction helps reduce loading on the turning leg where there is greater risk of injuries to knee ligaments.

Technique determinants of knee joint loads during cutting in female soccer players.

The aim of this study was to investigate the relationships between technique characteristics and knee abduction moments during 90° cuts. A cross sectional design involving 26 elite and sub-elite female soccer players (mean ± SD; age: 21 ± 3.2 years, height: 1.68 ± 0.07 m, and mass: 59.1 ± 6.8 kg) was used to explore relationships between pre-determined technical factors on knee abduction moments during cutting. Three dimensional motion analyses of 90° cuts on the right leg were performed using 'Qualisys Pro Reflex' infrared cameras (240 Hz). Ground reaction forces were collected from two AMTI force platforms (1200 Hz) embedded into the running track to examine 2nd last and last footfalls. Pearson's correlation coefficients, co-efficients of determination and hierarchical multiple regression were used to explore relationships between a range of technique parameters and peak knee abduction moments. Significance was set at p < .05. Hierarchical multiple regression revealed that initial knee abduction angle, lateral leg plant distance and initial lateral trunk lean could explain 67% (62% adjusted) of the variation in peak knee abduction moments (F(1,22) = 8.869, p = .007). These findings reveal potential modifiable technical factors to lower peak knee abduction moments during cutting.

A mechanical protocol to replicate impact in walking footwear.

Impact testing is undertaken to quantify the shock absorption characteristics of footwear. The current widely reported mechanical testing method mimics the heel impact in running and therefore applies excessive energy to walking footwear. The purpose of this study was to modify the ASTM protocol F1614 (Procedure A) to better represent walking gait. This was achieved by collecting kinematic and kinetic data while participants walked in four different styles of walking footwear (trainer, oxford shoe, flip-flop and triple-density sandal). The quantified heel-velocity and effective mass at ground-impact were then replicated in a mechanical protocol. The kinematic data identified different impact characteristics in the footwear styles. Significantly faster heel velocity towards the floor was recorded walking in the toe-post sandals (flip-flop and triple-density sandal) compared with other conditions (e.g. flip-flop: 0.36±0.05 ms(-1) versus trainer: 0.18±0.06 ms(-1)). The mechanical protocol was adapted by altering the mass and drop height specific to the data captured for each shoe (e.g. flip-flop: drop height 7 mm, mass 16.2 kg). As expected, the adapted mechanical protocol produced significantly lower peak force and accelerometer values than the ASTM protocol (p<.001). The mean difference between the human and adapted protocol was 12.7±17.5% (p<.001) for peak acceleration and 25.2±17.7% (p=.786) for peak force. This paper demonstrates that altered mechanical test protocols can more closely replicate loading on the lower limb in walking. This therefore suggests that testing of material properties of footbeds not only needs to be gait style specific (e.g. running versus walking), but also footwear style specific.

Does flip-flop style footwear modify ankle biomechanics and foot loading patterns?

BACKGROUND: Flip-flops are an item of footwear, which are rubber and loosely secured across the dorsal fore-foot. These are popular in warm climates; however are widely criticised for being detrimental to foot health and potentially modifying walking gait. Contemporary alternatives exist including FitFlop, which has a wider strap positioned closer to the ankle and a thicker, ergonomic, multi-density midsole. Therefore the current study investigated gait modifications when wearing flip-flop style footwear compared to barefoot walking. Additionally walking in a flip-flop was compared to that FitFlop alternative. METHODS: Testing was undertaken on 40 participants (20 male and 20 female, mean ± 1 SD age 35.2 ± 10.2 years, B.M.I 24.8 ± 4.7 kg.m(-2)). Kinematic, kinetic and electromyographic gait parameters were collected while participants walked through a 3D capture volume over a force plate with the lower limbs defined using retro-reflective markers. Ankle angle in swing, frontal plane motion in stance and force loading rates at initial contact were compared. Statistical analysis utilised ANOVA to compare differences between experimental conditions. RESULTS: The flip-flop footwear conditions altered gait parameters when compared to barefoot. Maximum ankle dorsiflexion in swing was greater in the flip-flop (7.6 ± 2.6°, p = 0.004) and FitFlop (8.5 ± 3.4°, p < 0.001) than barefoot (6.7 ± 2.6°). Significantly higher tibialis anterior activation was measured in terminal swing in FitFlop (32.6%, p < 0.001) and flip-flop (31.2%, p < 0.001) compared to barefoot. A faster heel velocity toward the floor was evident in the FitFlop (-.326 ± .068 m.s(-1), p < 0.001) and flip-flop (-.342 ± .074 m.s(-1), p < 0.001) compared to barefoot (-.170 ± .065 m.s(-1)). The FitFlop reduced frontal plane ankle peak eversion during stance (-3.5 ± 2.2°) compared to walking in the flip-flop (-4.4 ± 1.9°, p = 0.008) and barefoot (-4.3 ± 2.1°, p = 0.032). The FitFlop more effectively attenuated impact compared to the flip-flop, reducing the maximal instantaneous loading rate by 19% (p < 0.001). CONCLUSIONS: Modifications to the sagittal plane ankle angle, frontal plane motion and characteristics of initial contact observed in barefoot walking occur in flip-flop footwear. The FitFlop may reduce risks traditionally associated with flip-flop footwear by reducing loading rate at heel strike and frontal plane motion at the ankle during stance.