Darin Padua

University of North Carolina at Chapel Hill | UNC · Department of Exercise and Sport Science

The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testi...

Objective: The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study examined the association of knee injury with radiographic features of knee OA in military officers, who have a physically-demanding profession and high rates of knee injury. Method...

Objective: To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results. Data sources: Systematic searches of PubMed and Google Scholar were undertaken in Novemb...

Head impacts and physical exertion are ubiquitous in American football, but the relationship between these factors is poorly understood across a competitive season or even within an individual session. Gameplay characteristics, including player position and session type, may contribute to these relationships but have not been prospectively examined...

Background Lower extremity stress fracture injuries are a major cause of morbidity in physically active populations. The ability to screen for modifiable risk factors associated with injury is critical in developing injury-prevention programs. Purpose To determine if baseline Landing Error Scoring System (LESS) scores are associated with the incid...

Context: Those with chronic ankle instability (CAI) demonstrate deleterious changes in talar cartilage composition, resulting in talar cartilage loading behavior alterations. Common impairments associated with CAI may play a role in cartilage behavior in response to mechanical loading. Objective: The purpose of this study was to identify mechani...

Purpose: To identify associations between dorsiflexion range of motion (DFROM), functional hop test performance, and hopping biomechanics with the magnitude of talar cartilage deformation after a standardized hopping protocol in individuals with and without chronic ankle instability (CAI). Methods: Thirty CAI and 30 healthy individuals participa...

Background: Elite female athletes who successfully return to sport after anterior cruciate ligament reconstruction (ACLR) represent a high-risk group for secondary injury. Little is known about how the functional profile of these athletes compares to their teammates who have not sustained ACL injuries. Purpose: To compare elite collegiate female...

Few investigations have evaluated the validity of current body composition technology among racially and ethnically diverse populations. This study assessed the validity of common body composition methods in a multi-ethnic sample stratified by race and ethnicity. 110 individuals (55% female, age: 26.5±6.9 yrs) identifying as Asian, African American...

Context: Anterior cruciate ligament (ACL) injuries are a common and devastating injury in women's soccer. Several risk factors for ACL injury have been identified, but have not yet been examined as potentially dynamic risk factors, which may change throughout a collegiate soccer season. Design: Prospective cohort study. Methods: Nine common cl...

Background Ankle sprains have one of the highest recurrence rates among all lower extremity injuries in sports. Objective Assess the association between ankle sprain history in the past year and incident ankle sprain in games. Design Retrospective Cohort Study Setting U.S. National Basketball Association (NBA) Participants All players who parti...

Background Injury incidence for physically active populations with a high volume of physical load can exceed 79%. There is little existing research focused on timing of injury and how that timing differs based on certain risk factors. Purpose/Hypothesis The purpose of this study was to report both the incidence and timing of lower extremity injuri...

Context: Lower extremity bone stress injuries (BSI) place a significant burden on the health and readiness of the US Armed Forces. Objective: To determine if pre-injury baseline performance on an expanded and automated 22-item version of the Landing Error Scoring System (LESS-22) is associated with the incidence of BSI in a military training popula...

Background: Excessively high joint loading during dynamic movements may negatively influence articular cartilage health and contribute to the development of posttraumatic osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Little is known regarding the link between aberrant jump-landing biomechanics and articular cartilage healt...

(1) Background: Biomechanics during landing tasks, such as the kinematics and kinetics of the knee, are altered following anterior cruciate ligament (ACL) injury and reconstruction. These variables are recommended to assess prior to clearance for return to sport, but clinicians lack access to the current gold-standard laboratory-based assessment. I...

Purpose: This study aimed 1) to determine whether talar cartilage deformation measured via ultrasonography (US) after standing and hopping loading protocols differs between chronic ankle instability (CAI) patients and healthy controls and 2) to determine whether the US measurement of cartilage deformation reflects viscoelasticity between standing...

Context: Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes. Objective: The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar...

Background Sport specialization in youth athletes is associated with increased risk for musculoskeletal injury; however, little is known about whether sport specialization is associated with lower extremity movement quality. The purpose of this study was to examine differences in lower extremity movement quality by level of sport specialization in...

Context Field-based, portable motion-capture systems can be used to help identify individuals at greater risk of lower extremity injury. Microsoft Kinect-based markerless motion-capture systems meet these requirements; however, until recently, these systems were generally not automated, required substantial data postprocessing, and were not commerc...

Objectives The purpose of this article was to determine if differences in kinematic and kinetic variables observed in a double-leg screen carried over to a single-leg task. Design We used a case-control design with grouping based on performance during a double-leg jump landing. Setting All participants were selected from a large university settin...

Objectives This study seeks to determine if there were significant trends in lower extremity movement quality, as assessed by the Landing Error Scoring System (LESS) scores and plane-specific LESS subscales, across 12 recent cohorts of incoming USMA cadets. Design prospective cohort study. Setting United States Military Academy Participants 7,59...

Context: Training load and movement quality are associated with injury risk in athletes. Given these associations, it is important to understand how movement quality may moderate training load so that appropriate prevention strategies be employed. Objectives: To determine how absolute and relative internal training load change over the course of a...

Context: Gait biomechanics are linked to biochemical changes that contribute to the development of posttraumatic knee osteoarthritis in individuals with anterior cruciate ligament reconstruction (ACLR). It remains unknown if modifying peak loading during gait using real-time biofeedback will result in acute biochemical changes related to cartilage...

Objectives: To a) determine the acute effects of a single-dose patellar tendon isometric exercise protocol on involved limb landing biomechanics in individuals with patellar tendinopathy and asymptomatic patellar tendon pathology, and b) determine if individuals with patellar tendinopathy demonstrated changes in pain following a single-dose patell...

Context A baseball-specific training load may influence strength or glenohumeral range of motion, which are related to baseball injuries. Glenohumeral reach tests and grip strength are clinical assessments of shoulder range of motion and upper extremity strength, respectively. Objective To examine changes in glenohumeral reach test performance and...

Anterior cruciate ligament reconstruction (ACLR) incurs a high risk of post‐traumatic knee osteoarthritis (PTOA). Aberrant gait biomechanics contribute to PTOA and are attributable in part to quadriceps dysfunction. Vibration improves quadriceps function following ACLR, but its effects on gait biomechanics are unknown. The purpose of this study was...

PurposeInter-limb coordination may provide insight into why patients with anterior cruciate ligament reconstructive surgery (ACLR) have an increased risk for future injury and osteoarthritis. The purpose of this study was to compare inter-limb coordination prior-to anterior cruciate ligament (ACL) injury and following ACLR.Methods Unilateral lower...

Context Military service members commonly sustain lower extremity stress fractures (SFx). How SFx risk factors influence bone metabolism is unknown. Understanding how SFx risk factors influence bone metabolism may help to optimize risk-mitigation strategies. Objective To determine how SFx risk factors influence bone metabolism. Design Cross-secti...

"Cox proportional hazards regression models with frailty found no difference in injured vs. unin-jured players with week-to-week changes of < 20, 20-60, and > 60%, controlling for scapular con-trol, isometric rotational and abduction strength, and shoulder range of motion (p value ranges 0.09-0.68).

Transcutaneous electrical nerve stimulation (TENS) facilitates quadriceps voluntary activation in experimental settings. Augmenting therapeutic exercise (TE) with TENS may enhance the benefits of TE in individuals with knee osteoarthritis (KOA) and quadriceps voluntary activation failure (QVAF). Purpose: To determine the effect of TENS+TE on pati...

Background We aimed to determine the effect of cueing an increase or decrease in the vertical ground reaction force impact peak (peak in the first 50% of stance) on vertical ground reaction force, knee flexion angle, internal knee extension moment, and internal knee abduction moment waveforms throughout stance in individuals 6–12 months after an an...

Study design: Cross-sectional cohort study. Background: Patellar tendinopathy is a load-related condition, but little is known regarding the potential differences in both biomechanical and physical activity load, measured in both laboratory and real-world environments, in individuals with and without patellar tendinopathy. Objective: To examin...

Background Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may...

Background Ankle sprains are one of the most common injuries in basketball. Despite this, the incidence and setting of ankle sprains among elite basketball players are not well described. Purpose To describe the epidemiology of ankle sprains among National Basketball Association (NBA) players. Study Design Cohort study; Level of evidence, 3. Met...

Although single-leg squats are a common dynamic balance clinical assessment, little is known about the relationship between parameters that influence squat movement and postural control performance. The objective of this study was to determine the relationships between squat parameters (speed and depth) and postural control under single task and du...

Objective: To determine the association between selected biomechanical variables and risk of patellofemoral pain (PFP) in males and females. Design: Prospective cohort. Setting: US Service Academies. Participants: Four thousand five hundred forty-three cadets (1727 females and 2816 males). Assessment of risk factors: Three-dimensional biom...

Objectives Determine the association between performance on the double-leg squat (DLS) and single-leg squat (SLS) and prospective injury incidence in athletes. Design Prospective cohort study. Setting National Collegiate Athletic Association (NCAA) Division I university. Participants 111 incoming NCAA Division I athletes from 10 varsity sports t...

Objective: Little is known about cognition’s effect on jump-landing movement patterns. Design: Participants completed three baseline cognitive tasks. Then, participants performed three jump-landing trials per condition (dual-task trials (DT)): Stroop Color Word test (SCWT), Symbol Digits Modalities test (SDMT), Brooks Visuospatial task (BVT), and n...

Background: Aberrant mechanical loading during gait is hypothesized to contribute to the development of posttraumatic osteoarthritis following anterior cruciate ligament reconstruction. Our purpose was to determine if peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate associate with the acute change i...

The purpose of this study was to examine associations between ankle dorsiflexion (ankle-DF) displacement and knee and hip kinematics and kinetics during a jump-landing task in females following anterior cruciate ligament reconstruction (ACLR). Females (n = 23) with a history of unilateral ACLR (≥ 6-months post-ACLR) underwent a three-dimensional lo...

Background: The relationship between training load and musculoskeletal injury is a rapidly advancing area of research in need of an updated systematic review. Objective: This systematic review examined the evidence for the relationship between training load and musculoskeletal injury risk in athlete, military, and first responder (i.e. law enfor...

Individuals with anterior cruciate ligament reconstruction (ACLR) often exhibit a "stiffened knee strategy" or an excessively extended knee during gait, characterized by lesser knee flexion excursion and peak internal knee extension moment (KEM). The purpose of this study was to determine the effect of real-time biofeedback (RTBF) cuing an acute ch...

The study sought to determine the association between gait biomechanics (vertical ground reaction force [vGRF], vGRF loading rate [vGRF-LR]) collected six months following anterior cruciate ligament reconstruction (ACLR) with patient-reported outcomes at twelve months following ACLR. Walking gait mechanics and all subsections of the Knee Injury and...

Objectives: Determine the influence of movement profile on systemic stress and mechanical loading before and after high training load exposure. Design: Cross-sectional cohort study. Methods: 43 physically active, college-aged field or court sport female athletes participated in this study. Participants were assigned to a "excellent" (n=22; age...

There is a critical gap between research-based evidence supporting the use of neuromuscular training programs for ACL injury prevention and real-world effectiveness due to limitations in disseminating and implementing these programs. This chapter presents an integrated approach addressing topics from public health and behavior change literature wit...

In the original publication the name of the fourth reviewer was incorrectly published.

Background: Aberrant walking-gait and jump-landing biomechanics may influence the development of post-traumatic osteoarthritis and increase the risk of a second anterior cruciate ligament injury, respectively. It remains unknown if individuals who demonstrate altered walking-gait biomechanics demonstrate similar altered biomechanics during jump-la...

Context: Aberrant biomechanics may affect force attenuation at the knee during dynamic activities, potentially increasing the risk of sustaining a knee injury or hastening the development of osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps neuromuscular function has been hypothesized to influence the devel...

Objective: To provide certified athletic trainers, physicians, and other health care and fitness professionals with recommendations based on current evidence regarding the prevention of noncontact and indirect-contact anterior cruciate ligament (ACL) injuries in athletes and physically active individuals. Background: Preventing ACL injuries duri...

Background: Lower proteoglycan density (PGD) of the articular cartilage may be an early marker of osteoarthritis following anterior cruciate ligament (ACL) reconstruction (ACL-R). The purpose this study was to determine associations between the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and PGD of the articular cartilage in the femur and...

Purpose: To determine functional movement assessments' ability to predict head impact biomechanics in college football players, and to determine whether head impact biomechanics could explain preseason to postseason changes in functional movement performance. Methods: Participants (N = 44, mass = 109.0 ± 20.8 kg, age = 20.0 ± 1.3 years) underwen...

Objective: To determine if walking speed collected at 6 and 12 months following anterior cruciate ligament reconstruction (ACLR) associates with inter-limb differences in proteoglycan density, measured via T1ρ magnetic resonance imaging (MRI), in tibiofemoral articular cartilage 12 months following ACLR METHODS: Twenty-one individuals with a unila...

Exercise-based preventive training programs are designed to improve movement patterns associated with lower extremity injury risk; however, the impact of these programs on general physical fitness has not been evaluated. The purpose of this study was to compare fitness scores between participants in a preventive training program and a control group...

Context: The Landing Error Scoring System (LESS) can be used to identify individuals with an elevated risk of lower extremity injury. The limitation of the LESS is that raters identify movement errors from video replay, which is time-consuming and, therefore, may limit its use by clinicians. A markerless motion-capture system may be capable of aut...

Context Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance...

Purpose and hypothesis: Individuals with an anterior cruciate ligament reconstruction (ACLR) are susceptible to persistent disability, weight gain and the development of knee osteoarthritis. It remains unclear whether body mass index (BMI) is a factor that influences disability following ACLR. The purpose of this study was to determine the associa...

Lower extremity injuries have immediate and long-term consequences. Lower extremity movement assessments can assist with identifying individuals at greater injury risk and guide injury prevention interventions. Movement assessments identify similar movement characteristics and evidence suggests large magnitude kinematic relationships exist between...

Background: Little research has examined the rates and patterns of hip flexor or hip adductor strains in student-athletes in the National Collegiate Athletic Association (NCAA). Purpose: To describe the epidemiology of hip flexor and adductor strains in NCAA athletes during the 2009/2010-2014/2015 academic years. Study design: Descriptive epid...

Objective: To determine if anterior cruciate ligament deficient (ACL-D) individuals and individuals with a reconstructed anterior cruciate ligament (ACL-R) rely more heavily on visual information to maintain postural control. Data sources: PubMed, CINAHL, and SPORTDiscus databases were searched from their earliest available date to May 24, 2016...