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Relationship of Knee Motions With Static Leg Alignments and Hip Motions in Frontal and Transverse Planes During Double-Leg Landing in Healthy Athletes

Shogo Uota, Anh-Dung Nguyen, Naoko Aminaka, and Yohei Shimokochi

Context:

Excessive knee valgus and tibial external rotation relative to the femur during weight bearing motions, such as jump-landing, reportedly increases the risk of developing chronic knee pain, such as patellofemoral pain. Excessive deviations from normal ranges of several static lower extremity alignment measures and dynamic hip motions may also increase the risks for patellofemoral pain.

Objective:

To determine the relationship between lower extremity alignments and hip motions to frontal and transverse plane knee motions during double-leg landings.

Design:

Correlational study.

Setting:

Laboratory.

Patients or Other Participants:

69 healthy, competitive athletes (27 men, 42 women; height, 166.5 ± 9.5 cm; weight, 61.3 ± 9.9 kg; age, 20.7 ± 1.0 y) participated in this study.

Interventions:

Prone and supine hip version, quadriceps angle, and tibiofemoral angle were measured. Frontal and transverse knee and hip angles at peak knee extensor moment during landing were calculated.

Main Outcome Measures:

2 separate stepwise multiple regression analyses were conducted to predict frontal and transverse plane knee motions using 4 static lower extremity alignment measures and hip motions.

Results:

Greater hip adduction and prone hip anteversion, and lesser hip internal rotation and supine hip anteversion, were related to greater knee valgus motions (R 2 = .475, P < .01). Greater hip adduction was related to greater knee external rotation (R 2 = .205, P < .01).

Conclusions:

Some targeted static lower extremity alignments and hip motions are associated with frontal and transverse knee motions. However, stronger relationships of hip motions with knee motions than static lower extremity alignments provided evidence that improving hip movements may help improve patellofemoral pain in those with lower extremity malalignments.

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Women’s College Volleyball Players Exhibit Asymmetries During Double-Leg Jump Landing Tasks

Jeffrey B. Taylor, Anh-Dung Nguyen, Audrey E. Westbrook, Abigail Trzeciak, and Kevin R. Ford

Context: Women’s volleyball requires frequent and repetitive jumping that when performed with altered biomechanics, including kinematic or kinetic asymmetry, may place the athlete at high risk for injury. This study identified and analyzed lower-extremity biomechanical asymmetries in college women’s volleyball players during standard and sport-specific double-leg landing tasks. Design: Cross-sectional laboratory study. Methods: Eighteen female college volleyball players were analyzed using standard 3D motion capture techniques during a drop vertical jump and an unanticipated lateral reactive jump task. Repeated-measures multivariate analysis of variance identified asymmetries in kinematic and kinetic variables of each task. Results: Average symmetry indices ranged from 9.3% to 31.3% during the drop vertical jump and 11.9% to 25.6% during the reactive jump task. During the drop vertical jump, the dominant limb exhibited lower knee abduction moments (P = .03), ankle dorsiflexion moments (P = .02), ankle eversion moments (P = .003) and vertical ground reaction forces (P = .03), and greater ankle inversion moments (P = .001). Both kinematic (λ = 0.27, P = .03) and kinetic (λ = 0.12, P = .008) asymmetries were identified during the reactive jump task. The dominant limb exhibited greater peak knee flexion (P = .003) and ankle dorsiflexion (P = .02) angles, and greater ankle dorsiflexion (P = .005) and inversion (P = .03) moments than the nondominant limb. Conclusions: These asymmetries observed during double-leg landing tasks may predispose volleyball athletes to unilaterally higher ground reaction or muscle forces and ultimately a greater risk of injury during landing.

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The Effects of Gluteal Strength and Activation on the Relationship Between Femoral Alignment and Functional Valgus Collapse During a Single-Leg Landing

Jennifer A. Hogg, Terry Ackerman, Anh-Dung Nguyen, Scott E. Ross, Randy J. Schmitz, Jos Vanrenterghem, and Sandra J. Shultz

Context: A bias toward femoral internal rotation is a potential precursor to functional valgus collapse. The gluteal muscles may play a critical role in mitigating these effects. Objective: Determine the extent to which gluteal strength and activation mediate associations between femoral alignment measures and functional valgus collapse. Design: Cross-sectional. Setting: Research laboratory. Patients or Other Participants: Forty-five females (age = 20.1 [1.7] y; height = 165.2 [7.6] cm; weight = 68.6 [13.1] kg) and 45 males (age = 20.8 [2.0] y; height = 177.5 [8.7] cm; weight = 82.7 [16.5] kg), healthy for 6 months prior. Intervention(s): Femoral alignment was measured prone. Hip-extension and abduction strength were obtained using a handheld dynamometer. Three-dimensional biomechanics and surface electromyography were obtained during single-leg forward landings. Main Outcome Measures: Forward stepwise multiple linear regressions determined the influence of femoral alignment on functional valgus collapse and the mediating effects of gluteus maximus and medius strength and activation. Results: In females, less hip abduction strength predicted greater peak hip adduction angle (R 2 change = .10; P = .02), and greater hip-extensor activation predicted greater peak knee internal rotation angle (R 2 change = .14; P = .01). In males, lesser hip abduction strength predicted smaller peak knee abduction moment (R 2 change = .11; P = .03), and the combination of lesser hip abduction peak torque and lesser gluteus medius activation predicted greater hip internal rotation angle (R 2 change = .15; P = .04). No meaningful mediation effects were observed (υadj < .01). Conclusions: In females, after accounting for femoral alignment, less gluteal strength and higher muscle activation were marginally associated with valgus movement. In males, less gluteal strength was associated with a more varus posture. Gluteal strength did not mediate femoral alignment. Future research should determine the capability of females to use their strength efficiently.

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Longitudinal Changes in Hip Strength and Range of Motion in Female Youth Soccer Players: Implications for ACL Injury, A Pilot Study

Anh-Dung Nguyen, Emma F. Zuk, Andrea L. Baellow, Kate R. Pfile, Lindsay J. DiStefano, and Michelle C. Boling

Context:

Risk of anterior cruciate ligament (ACL) injuries in young female athletes increases with age, appearing to peak during maturation. Changes in hip muscle strength and range of motion (ROM) during this time may contribute to altered dynamic movement patterns that are known to increase risk of ACL injuries. Understanding the longitudinal changes in hip strength and ROM is needed to develop appropriate interventions to reduce the risk of ACL injuries.

Objective:

To examine the longitudinal changes in hip strength and ROM in female youth soccer players.

Design:

Longitudinal descriptive study.

Setting:

Field setting.

Participants:

14 female youth soccer athletes (14.1 ± 1.1 y, 165.8 ± 5.3 cm, 57.5 ± 9.9 kg) volunteered as part of a multiyear risk factor screening project.

Main Outcome Measures:

Clinical measures of hip strength and ROM were collected annually over 3 consecutive years. Passive hip internal rotation (IR), external rotation (ER), abduction (ABD), and adduction (ADD) ROM were measured with a digital inclinometer. Isometric hip ABD and extension (EXT) strength were evaluated using a hand-held dynamometer. Separate repeated-measures ANOVAs compared hip strength and ROM values across 3 consecutive years (P < .05).

Results:

As youth female soccer players increased in age, there were no changes in normalized hip ABD (P = .830) or EXT strength (P = .062) across 3 consecutive years. Longitudinal changes in hip ROM were observed with increases in hip IR (P = .001) and ABD (P < .001), while hip ADD (P = .009) and ER (P < .001) decreased.

Conclusions:

Anatomical changes at the hip occur as youth female soccer players increase in age. While there are no changes in hip strength, there is an increase in hip IR and ABD ROM with a concomitant decrease in hip ER and ADD ROM. The resulting asymmetries in hip ROM may decrease the activation and force producing capabilities of the hip muscles during dynamic activities, contributing to altered lower extremity mechanics known to increase the risk of ACL injuries.