ArticlePDF Available

Lower extremity kinematics and kinetics of Division III collegiate baseball and softball players while performing a modified pro-agility task

Authors:
Brian Wallace at University of Wisconsin - Oshkosh
Brian Wallace
Thomas W Kernozek at University of Wisconsin - La Crosse
Thomas W Kernozek
E C Bothwell
E C Bothwell
E C Bothwell
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDFDownload full-text PDF
Read full-text
Download citation

Abstract

Females experience at least twice as many non-contact anterior cruciate ligament (ACL) injuries as males. The aim of this study was to investigate if males and females exhibited different characteristics while performing a modified pro-agility test. Collegiate Division III male baseball (n=14) and female softball (n=13) players performed 4 trials of a modified pro-agility task, which consisted of running toward a force platform target for 5 steps, planting their right foot, and propelling themselves off of the target with their left foot. Kinematic and kinetic parameters were compared using a multivariate analysis of variance between gender with the level of significance set at P<0.05. Males and females exhibited similar knee valgus angles. Females had a greater maximum knee extension angle (10.14 degrees vs 17.43 degrees ), and greater knee range of motion (46.12 degrees vs 40.12 degrees ). Both groups reached maximum knee flexion at 52% of stance. Females had significantly more maximum hip flexion than males (28.86 degrees vs 22.75 degrees ). Females had significantly smaller minimum internal knee varus moments than their male counterparts (1.12 Nm/kg vs 1.55 Nm/kg). Vertical ground reaction forces as a percentage of bodyweight, and stance time, were not statistically different. The female group displayed an external knee rotation angle (2.49 degrees ) during the beginning of their stance, which was significantly different than the internal rotation angle (4.11 degrees ) in the male group. Early in stance knee rotation angle was highly correlated with the lack of internal knee varus moment (males R(2)=0.75, females R(2)=0.88). Females displayed knee moments and kinematics that may place them at greater risk for ACL injury during a stop-cut task. Females should be coached to perform stop cuts with more knee flexion and a more neutral knee rotation angle upon foot contact in an effort to reduce moments that may place the ACL at risk.
Wallaceetal20
07.pdf
Content uploaded by Thomas W Kernozek
Author content
All content in this area was uploaded by Thomas W Kernozek
Content may be subject to copyright.
Wallaceetal20
07.pdf
Content uploaded by Brian Wallace
Author content
All content in this area was uploaded by Brian Wallace
Content may be subject to copyright.
... The panelists were surveyed regarding several measures that were identified through our systematic review and about functional testing that had been used in our RTP protocols. These tests include the Functional Movement Screen, 10,11 Pro Agility, 32,41,42 and an internally generated quality-ofmovement assessment that objectively scores 5 aspects of biomechanics during hop testing and a 12-inch (30.5 cm) box jump: hip stability, shock absorption, hip strategy, pelvic stability, and trunk stability. ...
... Parameters included clinically acceptable range of motion (ROM), isokinetic strength measurement, lack of effusion, lack of pain, lack of instability, KT-1000 arthrometer side-to-side laxity comparison, thigh circumference difference, International Knee Documentation Committee (IKDC) score, 9 and 4 dynamic functional tests used to further evaluate an athlete's risk of reinjury: hop tests, the Functional Movement Screen, 10,11 our movement assessment, and the Pro Agility test. 32,41,42 The experts were asked to consider clinical experience, published literature, and practicality to generate their grades for each RTP parameter. Scores were aggregated for each measure and used to supplement the results of the systematic review in the generation of the checklist. ...
Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist
Article
Full-text available
  • Apr 2022
Background Questions remain regarding the traditional protocols used in rehabilitation and clearance for return to sports after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis To investigate the impact on injury rates after return to sports by developing and validating a Safer Return to Play Following ACL Reconstruction Checklist consisting of subjective and objective functional tests that can be quickly and easily implemented into a sports medicine practice. It was hypothesized that patients who successfully passed the checklist before returning to sports would experience lower rates of ipsilateral and contralateral knee injuries at a 2-year follow-up as compared with patients who returned to play before completing the checklist. Study Design Cohort study; Level of evidence, 2. Methods First, a systematic review was performed to generate a list of the most common outcome measures used to assess return to play after ACLR. To refine our checklist, we conducted a survey with an expert panel of 10 medical professionals utilizing the Delphi technique. After the creation of the checklist, validation was performed by prospectively evaluating patients who had undergone ACLR for injury of the ipsilateral or contralateral knee, with a minimum 2-year follow-up. Results After our systematic review of 60 studies, 7 criteria were included in the final checklist. During the period studied, October 2014 to December 2017, a total of 222 patients met the inclusion criteria and were enrolled in the study. At a minimum 2 years of follow-up, there were 146 patients who successfully passed the checklist and 38 who did not. Overall, 24 (16.4%) patients who had passed the checklist sustained an injury to either knee, as compared with 10 (26.3%) from the group that did not pass the checklist ( P = .162). Of the group that passed the checklist, 8 (5.5%) patients sustained an injury to the ipsilateral knee, as compared with 7 (18.4%) in the group that did not pass ( P = .017). Conclusion Prospective validation of our checklist demonstrated that patients who successfully passed the checklist before returning to play experienced a significantly lower incidence of ipsilateral anterior cruciate ligament injury as compared with patients who did not pass the checklist.
View
... Cutting 3-D peak 11/19 (58%) Wallace 2007 [92] 14 women, 13 men Women: 19.33 Men: 19.62 Women: 23.2 Men: 26.6 Cutting 3-D IC, peak, excursion 10/19 (53%) ...
Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis
Article
Background Increased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive. Objective To systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury. Methods A systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity. Results Fifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; −1.34, 95%CI; −1.83 to −0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; − 0.68 to −0.79, 95%CI; −1.04 to −0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis. Conclusion The gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury. The final publication is available at: http://www.sciencedirect.com/science/article/pii/S0966636216302442
View
... [2][3][4] Several functional performance tests have assessed athletic agility and evaluated the effectiveness of training programs, including the figure-8 run, T-test, 505 Agility Test, and Illinois Agility Test. [5][6][7][8][9][10][11][12] Normative values for many of these tests have been reported for athletes based on gender, age ranges, and sport. 3 The Lower-Extremity Functional Test (LEFT) is a functional performance test that has been used as a component of a return-to-sport rehabilitation testing algorithm. ...
The Lower Extremity Functional Test (LEFT) and Lower Quadrant Injury in Division III Athletes: A Descriptive and Epidemiologic Report
Article
Full-text available
The lower extremity functional test (LEFT) has been used to assess readiness to return to sport after a lower extremity (LE) injury. Current recommendations suggest that females should complete the LEFT in 135 s (average) (range 120 s - 150 s) and males should complete the test in 100 s (average) (range 90 s to 125 s). However, these estimates are based on limited data and may not be reflective of collegiate athletes. Thus additional assessment, including normative data, of the LEFT in sport populations is warranted. The purpose of this study was to examine LEFT times based on descriptive information and off-season training habits in Division III (D III) athletes. In addition, this study prospectively examined the LEFT's ability to discriminate sport-related injury occurrence. Descriptive epidemiology. Division III university. One-hundred and eighty-nine D III collegiate athletes (106 females, 83 males) from 15 teams participated. LEFT times, preseason questionnaire, and time-loss injuries during the sport season. Males completed the LEFT (105 s ± 9) significantly faster than their female counterparts (117 s ± 10) (p < 0.0001). Female athletes who reported >3-5 hr/wk of plyometric training during the off-season had significantly slower LEFT scores than females who performed ≤ 3 hrs/wk of plyometric training (p = 0.03). The overall incidence of a lower quadrant (LQ) time-loss injury for female athletes was 4.5/1000 athletic exposures (AEs) and 3.7/1000 AEs for male athletes. Female athletes with a slower LEFT score (≥ 118 s) experienced a higher rate of LQ time-loss injuries than females with a faster LEFT score (≤ 117 s) (p = 0.03). Only off-season plyometric training practices seem to affect LEFT score times among female athletes. Females with slower LEFT scores are more likely to be injured than females with faster LEFT scores. Injury rates in males were not influenced by performance on the LEFT.
View
... However, previous studies have not reached a consensus on tibial rotation during cutting. Some studies reported that female athletes had smaller internal rotation during cutting (McLean et al., 2004;Wallace, Kernozek, & Bothwell, 2007). Other studies reported no differences between the sexes in knee rotation (McLean, Neal, Myers, & Walters, 1999;McLean, Walker, & van den Bogert, 2005;Pollard, Davis, & Hamill, 2004;Sigward & Powers, 2006). ...
Relationship between three-dimensional kinematics of knee and trunk motion during shuttle run cutting
Article
Full-text available
Female athletes are considered to exhibit knee and trunk motion that is characteristic of anterior cruciate ligament (ACL) injury. The aim of this study was to examine the in vivo motion of the trunk and knee during a cutting manoeuvre and determine the relationship between them. All participants (10 male and 10 female college athletes) performed a shuttle run cutting task with the left limb. Trunk inclination (forward and lateral) and knee joint angles (flexion/extension, abduction/adduction, and internal/external tibial rotation) were calculated. Differences between the sexes and associations between knee motion and trunk inclination were examined. An increase in trunk forward inclination was strongly correlated with an increase in knee flexion angle and moderately correlated with a decrease in the excursion of internal tibial rotation. An increase in right trunk lateral inclination was moderately correlated with an increase in excursion of internal tibial rotation. The results also showed differences between the sexes in trunk forward inclination, lateral inclination, and knee flexion angle, but no such differences in knee abduction or internal tibial rotation. Trunk inclination is related to knee flexion and excursion of internal tibial rotation. Female athletes demonstrate a low trunk forward inclination and knee flexion angle, a posture that resembles that of ACL injury.
View
... The present results demonstrated that the natural resting position for females was in a significantly greater degree of tibial external rotation than males, which is consistent with a previous study of rotational knee stability in healthy volunteers [21]. Dynamically, females tend to have initial tibial external rotation when initiating anticipated or planned side step cutting maneuvers, whereas male athletes demonstrate an initial position of tibial internal rotation [25]. By externally rotating the tibia, less strain is placed on the ACL than when in an internally rotated position, and this movement pattern may be protective in nature. ...
Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers
Article
Full-text available
Rotational stability of the knee has been traditionally difficult to quantify, limiting the ability of the orthopedic community to determine the potential role of rotational laxity in the etiology of anterior cruciate ligament (ACL) injuries. The purposes of this multicenter cohort study were to evaluate the reliability of a robotic axial rotation measurement system, determine whether the uninjured knees of patients that had previous contralateral ACL reconstruction demonstrated different rotational biomechanical characteristics than a group of healthy volunteers, and determine whether knee rotational biomechanical characteristics differ between male and female non-injured limbs in groups of both healthy volunteers and patients with a previous contralateral ACL injury. Fourteen healthy volunteers and 79 patients with previous unilateral ACL injury participated in this study. Patients were tested using a computerized tibial axial rotation system. Only the normal (non-operated) knee data were used for analysis. In order to assess the reliability of the robotic measurement system, 10 healthy volunteers were tested daily over four consecutive days by four different examiners. Rotational laxity and compliance measures demonstrated excellent reliability (ICC = 0.97). Patients with a contralateral ACL injury demonstrated significantly increased tibial internal rotation (20.6° vs. 11.4°, P < 0.001) and reduced external rotation (16.7° vs. 26.6°, P < 0.001) compared to healthy volunteers. Females demonstrated significantly increased internal and external rotation, as well as significantly increased rotational compliance compared with males (P < 0.05). Computer-assisted measurement techniques may offer clinicians an accurate, reliable, non-invasive method to select the most appropriate preventative or surgical interventions for patients with increased knee rotational laxity.
View
Baseball-Specific Conditioning
Article
  • Sep 2009
Baseball demands speed, power, and quickness. To perform at a high level, and avoid injuries that are common among baseball players, an evaluation of current trends in strength and conditioning practices is helpful. Based on the demands of the sport and the injury risks, qualified strength and conditioning professionals can develop effective baseball-specific conditioning programs. This commentary briefly covers historical aspects of baseball conditioning, recent injury trends, current practices among elite baseball professionals, and provides suggestions for future improvements in training.
View
Muscle strength in knee varus and valgus
Article
Full-text available
Purpose: The purpose of this study was to investigate the lower-limb muscle strength in knee varus-valgus and its dependence on knee varus-valgus position. The hypothesis was that humans could differentially contract the medial and lateral muscles crossing the knee and generate significant moments in knee valgus-varus. Methods: The subjects sat with the knee at full extension and secured from the medial, lateral, anterior, and posterior sides. Both hips were clamped from the lateral sides. The subjects adducted (abducted) the ipsilateral hip during the knee valgus (varus) maximal voluntary contraction with EMG signals recorded from muscles crossing the knee and knee joint moments measured using a six-axis force sensor. Frontal plane tibiofemoral movement was evaluated using a fluoroscope. Results and conclusions: The subjects differentially contracted the medial and lateral muscles, and fluoroscope images showed the corresponding tibiofemoral movement. The subjects showed considerable strength in knee varus and valgus. The active knee varus strength increased significantly with increasing knee valgus angle, and the valgus strength was significantly higher when the knee was in varus position (P < 0.039). Active valgus muscle strength at 5 degrees knee varus was significantly higher than the active varus strength at 5 degrees valgus (P = 0.002). The passive resistance moment increased linearly with increasing knee valgus and varus angles, and it accounted for 28% and 35% of the total (active plus passive) moment at the 5 degrees varus and 5 degrees valgus, respectively. The significant varus-valgus muscle strength demonstrated in this study may play important roles in performing various functional tasks, maintaining joint stability, and preventing potential injuries, whether the major load and motion at the knee is in the frontal plane or not.
View
Knee ligament injuries in volleyball players
Article
Full-text available
The authors report a series of 52 cases of serious knee ligament injuries in volleyball players. The most frequent mechanism of injury was landing from a jump in the attack zone. Women were more affected than men. Injuries were more frequent during games than training. Volleyball must then be considered among high-risk sports according to the frequency and gravity of our surgical findings. Results are similar to those obtained in athletes in other sports who underwent the same surgical procedure.
View
Neuromuscular Performance Characteristics in Elite Female Athletes
Article
Full-text available
The purpose of this research was to identify possible predisposing neuromuscular factors for knee injuries, particularly anterior cruciate ligament tears in female athletes by investigating anterior knee laxity, lower extremity muscle strength, endurance, muscle reaction time, and muscle recruitment order in response to anterior tibial translation. We recruited four subject groups: elite female (N = 40) and male (N = 60) athletes and sex-matched nonathletic controls (N = 40). All participants underwent a subjective evaluation of knee function, arthrometer measurement of anterior tibial translation, isokinetic dynamometer strength and endurance tests at 60 and 240 deg/sec, and anterior tibial translation stress tests. Dynamic stress testing of muscles demonstrated less anterior tibial translation in the knees of the athletes (both men and women) compared with the nonathletic controls. Female athletes and controls demonstrated more anterior tibial laxity than their male counterparts and significantly less muscle strength and endurance. Compared with the male athletes, the female athletes took significantly longer to generate maximum hamstring muscle torque during isokinetic testing. Although no significant differences were found in either spinal or cortical muscle reaction times, the muscle recruitment order in some female athletes was markedly different. The female athletes appeared to rely more on their quadriceps muscles in response to anterior tibial translation; the three other test groups relied more on their hamstring muscles for initial knee stabilization.
View
Plyometric Training in Female Athletes Decreased Impact Forces and Increased Hamstring Torques
Article
Full-text available
The purpose of this study was to test the effect of a jump-training program on landing mechanics and lower extremity strength in female athletes involved in jumping sports. These parameters were compared before and after training with those of male athletes. The program was designed to decrease landing forces by teaching neuromuscular control of the lower limb during landing and to increase vertical jump height. After training, peak landing forces from a volleyball block jump decreased 22%, and knee adduction and abduction moments (medially and laterally directed torques) decreased approximately 50%. Multiple regression analysis revealed that these moments were significant predictors of peak landing forces. Female athletes demonstrated lower landing forces than male athletes and lower adduction and abduction moments after training. External knee extension moments (hamstring muscle-dominant) of male athletes were threefold higher than those of female athletes. Hamstring-to-quadriceps muscle peak torque ratios increased 26% on the nondominant side and 13% on the dominant side, correcting side-to-side imbalances. Hamstring muscle power increased 44% with training on the dominant side and 21% on the nondominant. Peak torque ratios of male athletes were significantly greater than those of untrained female athletes, but similar to those of trained females. Mean vertical jump height increased approximately 10%. This training may have a significant effect on knee stabilization and prevention of serious knee injury among female athletes.
View
Risk Factors in Noncontact ACL Injuries: A Review of the Literature
Article
The incidence and risk factors involved with noncontact anterior cruciate ligament (ACL) injuries have been extensively researched over the last 5 to 10 years. Research has concentrated on the identification and clinical assessment of potential risk factors that may lead to an athlete sustaining an ACL injury. These proposed risk factors are commonly placed into two categories: extrinsic or intrinsic. Extrinsic factors have been referred to as those factors that are potentially controllable or changeable. Common extrinsic factors discussed include conditioning levels, body movement and positioning, muscular strength and neuromuscular coordination, and shoe wear/shoe-surface interface. Intrinsic factors have been described as factors that are more gender-specific and less likely to be adapted. Common intrinsic factors include joint laxity, limb alignment, intercondylar notch size and shape, ligament size and strength, hormonal levels, and foot abnormalities. This article reviews the relevant literature in these areas in order to provide an overall understanding of the current research and to better assist the clinician in the prevention of ACL injuries.
View
View
Aggressive Quadriceps Loading Can Induce Noncontact Anterior Cruciate Ligament Injury
Article
Background The force responsible for noncontact anterior cruciate ligament (ACL) injuries remains controversial. The patella tendon to tibial shaft angle causes an anterior tibial shear force with quadriceps activation. Hypothesis An aggressive quadriceps contraction can injure the ACL. Methods The authors characterized noncontact ACL injury and kinematics with aggressive quadriceps loading. Thirteen freshfrozen knees were potted in a jig held in 20 ° of flexion while a 4500 N quadriceps contraction was simulated. Knee kinematics were recorded. A KT-1000 arthrometer and a simulated active quadriceps test assessed anterior displacement. Statistics were performed using paired t tests and 1-way analysis of variance. Results Kinematics revealed the following mean values: anterior displacement, 19.5 mm; valgus, 2.3 °; and internal rotation, 5.5 °. Mean KT-1000 and active quadriceps test differences were 4.0 mm and 2.7 mm, respectively (statistically significant P = .002 and P = .002). Six knees showed gross ACL injury at the femoral insertion. Based on ACL injury, KT-1000 differences were statistically significant (P = .029). Conclusions Aggressive quadriceps loading, with the knee in slight flexion, produces significant anterior tibial translation and ACL injury. This suggests that the quadriceps is the intrinsic force in noncontact ACL injuries, producing a model for further investigation.
View
A comparison of knee joint motion patterns between men and women in selected athletic tasks
Article
Background: Women have higher non-contact anterior cruciate ligament injury rate than men do in sport activities. Non-contact anterior cruciate ligament injuries frequently occur in sports requiring cutting tasks. Alternated motor control strategies have identified as a potential risk factor for the non-contact anterior cruciate ligament injuries. The purpose of this study was to compare the patterns of knee kinematics and electromyographic activities in running, side-cutting, and cross-cutting between men and women recreational athletes. Methods: Three-dimensional kinematic data of the knee and electromyographic data of selected muscles across the knee joint were collected for 11 men and 9 women recreational athletes in running, side-cutting, and cross-cutting. Regression analyses with dummy variables for comparison of knee motion patterns between men and women. Results: Women tend to have less knee flexion angles, more knee valgus angles, greater quadriceps activation, and lower hamstring activation in comparison to men during the stance phase of each of the three athletic tasks. Literatures suggest these alternated knee motion patterns of women tend to increase the load on the anterior cruciate ligament. Conclusion: Women on average may have certain motor control strategies that may alter their knee motion patterns. Women's altered knee motion patterns may tend to increase the load on the anterior cruciate ligament in the selected athletic tasks, which may contribute to the increased anterior cruciate ligament injury rate among women. Relevance: Non-contact anterior cruciate ligament injuries frequently occur in sports. Altered motor control strategies and lower extremity motion patterns are likely to play an important role in non-contact anterior cruciate ligament injuries. Non-contact anterior cruciate ligament injuries may be prevented by correcting altered motor control strategies and associated lower extremity motion patterns through certain training programs.
View
Combined knee loading states that generate high anterior cruciate ligament forces
Article
  • Nov 1995
Injuries to the anterior cruciate ligament frequently occur under combined mechanisms of knee loading. This in vitro study was designed to measure levels of ligament force under dual combinations of individual loading states and to determine which combinations generated high force. Resultant force was recorded as the knee was extended passively from 90 degrees of flexion to 5 degrees of hyperextension under constant tibial loadings. The individual loading states were 100 N of anterior tibial force, 10 Nm of varus and valgus moment, and 10 Nm of internal and external tibial torque. Straight anterior tibial force was the most direct loading mechanisms; the mean ligament force was approximately equal to applied anterior tibial force near 30 degrees of flexion and to 150% of applied tibial force at full extension. The addition of internal tibial torque to a knee loaded by anterior tibial force produced dramatic increases of force at full extension and hyperextension. This loading combination produced the highest ligament forces recorded in the study and is the most dangerous in terms of potential injury to the ligament. In direct contrast, the addition of external tibial torque to a knee loaded by anterior tibial force decreased the force dramatically for flexed positions of the knee; at close to 90 degrees of flexion, the anterior cruciate ligament became completely unloaded. The addition of varus moment to a knee loaded by anterior tibial force increased the force in extension and hyperextension, whereas the addition of valgus moment increased the force at flexed positions. These states of combined loading also could present an increased risk for injury. Internal tibial torque is an important loading mechanism of the anterior cruciate ligament for an extended knee. The overall risk of injury to the ligament from varus or valgus moment applied in combination with internal tibial torque is similar to the risk from internal tibial torque alone. External tibial torque was a relatively unimportant mechanism for generating anterior cruciate ligament force.
View
Epidemiology of Anterior Cruciate Ligament Injuries in Soccer
Article
We did a retrospective study of all anterior cruciate ligament injuries (972) verified by arthroscopic evaluation at hospitals in the Hordaland region of Norway from 1982 to 1991. Our final study group comprised 176 patients who had participated in organized soccer and answered a questionnaire. The overall incidence rate was 0.063 injuries per 1000 game hours. Men incurred 75.6% (133) of the injuries. Women had an incidence rate of 0.10 injuries per 1000 game hours, significantly higher than that for men (0.057). The incidence rate was higher (0.41) for men in the top three divisions. Most of the injuries (124) occurred during games. Contact injuries from tackling was the injury mechanism in 46.0% of the cases. Players on the offensive team incurred 122 (69.3%) of the injuries. Reconstructive surgery was performed on 131 (74.4%) of the injured players and was found necessary for return to a high level of play. Half of the players (87) returned to soccer; men at high levels of play had the highest return rate (88.9%), and men over age 34 had the poorest return rate (22.9%). Nearly one-third of the injured athletes gave up soccer because of poor knee function or fear of new injury.
View