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Patellar Tendinopathy Alters the Distribution of Lower Extremity Net Joint Moments during Hopping

Richard B. Souza, Shruti Arya, Christine D. Pollard, George Salem, and Kornelia Kulig

The purpose of the current investigation was to test the hypothesis that subjects with patellar tendinopathy would demonstrate altered sagittal plane joint moment contributions during hopping tasks. Fourteen subjects (7 patellar tendinopathy, 7 controls) participated. Sagittal net joint moments of the lower extremity, total support moment, and joint contributions to the total support moment were calculated while subjects hopped continuously at a self-selected frequency and at 1.67 Hz. Significant differences were observed for contributions to the total support moment (p = .022). When averaged across hopping frequencies, subjects with patellar tendinopathy demonstrated greater hip contribution (p = .030) and lesser knee contribution (p = .006) compared with the control subjects. Shifting the workload away from the knee and toward the hip may result in a detrimental increase in hip demand and potentially harmful long-term effects on the articular cartilage of the hip.

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Sex Differences and Discriminative Value of Lower Extremity Alignments and Kinematics during Two Functional Tasks

Jennifer M. Medina McKeon, Craig R. Denegar, and Jay Hertel

The purpose of this study was to formulate a predictive equation to discriminate males from females using static and dynamic lower extremity (LE) alignments. Twenty-four healthy adults volunteered to participate. Three-dimensional motion analysis was used to assess the kinematics of the right hip and knee during two functional tasks. Six measures of static LE alignment were also performed. Statistical comparisons were made between males and females for all variables. Static and dynamic variables that were significantly different by sex were entered into separate discriminant analyses for each task. The resulting equations were each able to correctly predict 87% of the subjects by sex. Fifty-eight percent and 55% of the variance was explained by sex for the vertical jump and plant & jump, respectively. The frontal plane hip angle was the best predictor of sex for both tasks. While there were statistically significant differences between the sexes for static measures of LE alignment, kinematic measures were better at discriminating between sexes.

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A Multicenter Study of the Test–Retest Reliability of the Lower Extremity Functional Test

Michael A. Tabor, George J. Davies, Thomas W. Kernozek, Rodney J. Negrete, and Vincent Hudson

Context:

Many clinicians use functional-performance tests to determine an athlete’s readiness to resume activity; however, research demonstrating reliability of these tests is limited.

Objective:

To introduce the Lower Extremity Functional Test (LEFT) and establish it as a reliable assessment tool.

Design:

Week 1: Subjects participated in a training session. Week 2: Initial maximal-effort time measurements were recorded. Week 3: Retest time measurements were recorded.

Setting:

The University of Wisconsin–La Crosse (UW-L) and the University of Central Florida (UCF).

Subjects:

27 subjects from UW-L and 30 from UCF.

Main Outcome Measures:

Time measurements were analyzed using intraclass correlation coefficients (ICCs).

Results:

ICC values of .95 and .97 were established at UW-L and UCF, respectively.

Conclusions:

The LEFT is a reliable assessment tool.

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Lower Extremity Biomechanics Differ in Prepubescent and Postpubescent Female Athletes during Stride Jump Landings

Chris J. Hass, Elizabeth A. Schick, John W. Chow, Mark D. Tillman, Denis Brunt, and James H. Cauraugh

Epidemiological evidence suggests the incidence of injury in female athletes is greater after the onset of puberty and that landing from a jump is a common mechanism of knee injury. This investigation compared lower extremity joint kinematics and joint resultant forces and moments during three types of stride jump (stride jump followed by a static landing; a ballistic vertical jump; and a ballistic lateral jump) between pre- and postpubescent recreational athletes to provide some insight into the increased incidence of injury. Sixteen recreationally active postpubescent women (ages 18–25 years) and 16 recreationally active prepubescent girls (ages 8–11 years) participated in this study. High speed 3D videography and force plate data were used to record each jumper’s performance of the stride jumps, and an inverse dynamic procedure was used to estimate lower extremity joint resultant forces and moments and power. These dependent variables were submitted to a 2 × 3 (Maturation Level × Landing Sequence) MANOVA with repeated measures on the last factor. The findings indicated that postpubescents landed with the knee more extended (4.4°) and had greater extension moments (approximately 30% greater hip and knee extension moments) and powers (40% greater knee power). Further, the post-pubescent athletes had greater knee anterior/posterior forces as well as medio-lateral resultant forces. The differences found between the two groups suggest there may be anatomical and physiological changes with puberty that lead to differences in strength or neuromuscular control which influence the dynamic restraint system in these recreational athletes. A combination of these factors likely plays a role in the increased risk of injury in postpubescent females.

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Effects of Gender and Foot-Landing Techniques on Lower Extremity Kinematics during Drop-Jump Landings

Nelson Cortes, James Onate, João Abrantes, Linda Gagen, Elizabeth Dowling, and Bonnie Van Lunen

The purpose of this study was to assess kinematic lower extremity motion patterns (hip flexion, knee flexion, knee valgus, and ankle dorsiflexion) during various foot-landing techniques (self-preferred, forefoot, and rear foot) between genders. 3-D kinematics were collected on 50 (25 male and 25 female) college-age recreational athletes selected from a sample of convenience. Separate repeated-measures ANOVAs were used to analyze each variable at three time instants (initial contact, peak vertical ground reaction force, and maximum knee flexion angle). There were no significant differences found between genders at the three instants for each variable. At initial contact, the forefoot technique (35.79° ± 11.78°) resulted in significantly (p = .001) less hip flexion than did the self-preferred (41.25° ± 12.89°) and rear foot (43.15° ± 11.77°) techniques. At peak vertical ground reaction force, the rear foot technique (26.77° ± 9.49°) presented significantly lower (p = .001) knee flexion angles as compared with forefoot (58.77° ± 20.00°) and self-preferred (54.21° ± 23.78°) techniques. A significant difference for knee valgus angles (p = .001) was also found between landing techniques at peak vertical ground reaction force. The self-preferred (4.12° ± 7.51°) and forefoot (4.97° ± 7.90°) techniques presented greater knee varus angles as compared with the rear foot technique (0.08° ± 6.52°). The rear foot technique created more ankle dorsiflexion and less knee flexion than did the other techniques. The lack of gender differences can mean that lower extremity injuries (e.g., ACL tears) may not be related solely to gender but may instead be associated with the landing technique used and, consequently, the way each individual absorbs jump-landing energy.

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Lower-Extremity Kinetic Response to Activity Program Dosing in Older Adults

George J. Salem, Man-Ying Wang, Stanley P. Azen, Jean T. Young, and Gail A. Greendale

The purpose of this investigation was to determine the effects of two doses of a weighted vest on acute lower-extremity gait kinetics in older adults. Peak ankle, knee, and hip net joint moments were quantified in 56 men and women volunteers (73.8 ± 6.9 years old) enrolled in a 6-month physical activity study. At the initial study visit, participants underwent 6 walking trials (3 with vest, 3 without vest) at their normal pace. During the vest-wearing trials, participants wore a vest loaded with either 0% of body weight (BW) (n = 19), 3% of BW (n = 16), or 5% of BW (n = 21). With acute application of the vests, maximum peak plantarflexion moments increased by 5.7% in the 5% BW group compared to the 0% BW group, p < 0.01. Compared to the 0% vest-weight group, knee extension moments increased by 13.8% when 5% BW was applied, p < 0.01; a marginally significant treatment effect was evident in the 3% BW group, p = 0.04. Despite these acute alterations, knee strength and physical performance did not improve when subjects wore the vests 2 hours a day, 4 days a week for 27 weeks, without additional exercise prescription. These findings suggest that: (a) the acute changes in vest-mediated lower-extremity kinetics are not systemic but joint specific and load dependent, and (b) weighted vest prescription should be greater than 5% BW without prescribed exercise, or should include prescribed exercises, to invoke long-term strength and physical performance gains in older adults.

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Influence of External Ankle Support on Lower Extremity Joint Mechanics During Drop Landings

Mitchell L. Cordova, Yosuke Takahashi, Gregory M. Kress, Jody B. Brucker, and Alfred E. Finch

Objective:

To investigate the effects of external ankle support (EAS) on lower extremity joint mechanics and vertical ground-reaction forces (VGRF) during drop landings.

Design:

A 1 × 3 repeated-measures, crossover design.

Setting:

Biomechanics research laboratory.

Patients:

13 male recreationally active basketball players (age 22.3 ± 2.2 y, height 177.5 ± 7.5 cm, mass 72.2 ± 11.4 kg) free from lower extremity pathology for the 12 mo before the study.

Interventions:

Subjects performed a 1-legged drop landing from a standardized height under 3 different ankle-support conditions.

Main Outcome Measures:

Hip, knee, and ankle angular displacement along with specific temporal (TGRFz1, TGRFz2; s) and spatial (GRFz1, GRFz2; body-weight units [BW]) characteristics of the VGRF vector were measured during a drop landing.

Results:

The tape condition (1.08 ± 0.09 BW) demonstrated less GRFz1 than the control (1.28 ± 0.16 BW) and semirigid conditions (1.28 ± 0.21 BW; P < .0001), and GRFz2 was unaffected. For TGRFz1, no-support displayed slower time (0.017 ± 0.004 s) than the semirigid (0.014 ± 0.001 s) and tape conditions (0.014 ± 0.002 s; P < .05). For TGRFz2, no-support displayed slower time (0.054 ±.006 s) than the semirigid (0.050 ± 0.006 s) and tape conditions (0.045 ± 0.004 s; P < .05). Semirigid bracing was slower than the tape condition, as well (P < .05). Ankle-joint displacement was less in the tape (34.6° ± 7.7°) and semirigid (36.8° ± 9.3°) conditions than in no-support (45.7° ± 7.3°; P < .05). Knee-joint displacement was larger in the no-support (45.1° ± 9.0°) than in the semirigid (42.6° ± 6.8°; P < .05) condition. Tape support (43.8° ± 8.7°) did not differ from the semirigid condition (P > .05). Hip angular displacement was not affected by EAS (F 2,24 = 1.47, P = .25).

Conclusions:

EAS reduces ankle- and knee-joint displacement, which appear to influence the spatial and temporal characteristics of GRFz1 during drop landings.

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Lower-Extremity Isokinetic Strength Profiling in Professional Rugby League and Rugby Union

Scott R. Brown, Matt Brughelli, Peter C. Griffiths, and John B. Cronin

Purpose:

While several studies have documented isokinetic knee strength in junior and senior rugby league players, investigations of isokinetic knee and hip strength in professional rugby union players are limited. The purpose of this study was to provide lower-extremity strength profiles and compare isokinetic knee and hip strength of professional rugby league and rugby union players.

Participants:

32 professional rugby league and 25 professional rugby union players.

Methods:

Cross-sectional analysis. Isokinetic dynamometry was used to evaluate peak torque and strength ratios of the dominant and nondominant legs during seated knee-extension/flexion and supine hip-extension/flexion actions at 60°/s.

Results:

Forwards from both codes were taller and heavier and had a higher body-mass index than the backs of each code. Rugby union forwards produced significantly (P < .05) greater peak torque during knee flexion in the dominant and nondominant legs (ES = 1.81 and 2.02) compared with rugby league forwards. Rugby league backs produced significantly greater hip-extension peak torque in the dominant and nondominant legs (ES = 0.83 and 0.77) compared with rugby union backs. There were no significant differences in hamstring-to-quadriceps ratios between code, position, or leg. Rugby union forwards and backs produced significantly greater knee-flexion-to-hip-extension ratios in the dominant and nondominant legs (ES = 1.49–2.26) than rugby union players.

Conclusions:

It seems that the joint torque profiles of players from rugby league and union codes differ, which may be attributed to the different demands of each code.

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Gender Differences in Lower Extremity Coupling Variability during an Unanticipated Cutting Maneuver

Christine D. Pollard, Bryan C. Heiderscheit, Richard E.A. van Emmerik, and Joseph Hamill

The purpose of this study was to determine if gender differences exist in the variability of various lower extremity (LE) segment and joint couplings during an unanticipated cutting maneuver. 3-D kinematics were collected on 24 college soccer players (12 M, 12 F) while each performed the cutting maneuver. The following intralimb couplings were studied: thigh rotation (rot)/leg rot; thigh abduction-adduction/leg abd-add; hip abd-add/knee rot; hip rot/knee abd-add; knee flexion-extension/knee rot; knee flx-ext/hip rot. A vector-coding technique applied to angle-angle plots was used to quantify the coordination of each coupling. The average between-trial standard deviation of the coordination pattern during the initial 40% of stance was used to indicate the coordination variability. One-tailed t-tests were used to determine differences between genders in coordination variability for each coupling. Women had decreased variability in four couplings: 32% less thigh rot/leg rot variability; 40% less thigh abd-add/leg abd-add variability; 46% less knee flx-ext/knee rot variability; and 44% less knee flx-ext/hip rot variability. These gender differences in LE coordination variability may be associated with the increased incidence of ACL injury in women. If women exhibit less flexible coordination patterns during competition, they may be less able to adapt to the environmental perturbations experienced during sports. These perturbations applied to a less flexible system may result in ligament injury.

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Predicting in Vivo Soft Tissue Masses of the Lower Extremity Using Segment Anthropometric Measures and DXA

Jeffrey D. Holmes, David M. Andrews, Jennifer L. Durkin, and James J. Dowling

The purpose of this study was to derive and validate regression equations for the prediction of fat mass (FM), lean mass (LM), wobbling mass (WM), and bone mineral content (BMC) of the thigh, leg, and leg + foot segments of living people from easily measured segmental anthropometric measures. The segment masses of 68 university-age participants (26 M, 42 F) were obtained from full-body dual photon x-ray absorptiometry (DXA) scans, and were used as the criterion values against which predicted masses were compared. Comprehensive anthropometric measures (6 lengths, 6 circumferences, 8 breadths, 4 skinfolds) were taken bilaterally for the thigh and leg for each person. Stepwise multiple linear regression was used to derive a prediction equation for each mass type and segment. Prediction equations exhibited high adjusted R 2 values in general (0.673 to 0.925), with higher correlations evident for the LM and WM equations than for FM and BMC. Predicted (equations) and measured (DXA) segment LM and WM were also found to be highly correlated (R 2 = 0.85 to 0.96), and FM and BMC to a lesser extent (R 2 = 0.49 to 0.78). Relative errors between predicted and measured masses ranged between 0.7% and –11.3% for all those in the validation sample (n = 16). These results on university-age men and women are encouraging and suggest that in vivo estimates of the soft tissue masses of the lower extremity can be made fairly accurately from simple segmental anthropometric measures.