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Impact of a High Body Mass Index on Lower Extremity Injury in Marathon/Half-Marathon Participants

Tyler F. Vadeboncoeur, Scott M. Silvers, Walter C. Taylor, Shane A. Shapiro, Jennifer A. Roth, Nancy Diehl, Sherry M. Mahoney, and Michael M. Mohseni

Background:

To evaluate whether a high body mass index (BMI) predisposes marathon/half-marathon participants to lower extremity injuries.

Methods:

Consenting adult participants at the 2008 National Marathon to Fight Breast Cancer were enrolled in this observational study. The primary outcome measure was prevalence of self-reported lower extremity injury, during both training and race participation, with respect to BMI.

Results:

There were 194 subjects with complete data: 139 females (72%) and 55 males. Forty-six percent of females and 51% of males ran the full marathon (P = .63). Median BMI was 23.7 kg/m2 for females and 26.2 kg/m2 for males (P = .001). Eleven (24%) females in BMI tertile 1 (T1) suffered a training injury, while 9 (18%) from T2 and 4 (9%) from T3 suffered injuries (P = .072; OR 0.89; 95% CI 0.78 to 1.01). Twenty-six (19%) females suffered an injury during the race. Females in T1 were more likely to suffer a race-related injury (P = .038; OR 0.87; 95% CI 0.77 to 0.99). Females were 13% less likely to suffer a race-related injury with each 1-unit increase in BMI. Rates of injury did not differ by BMI tertile in males.

Conclusions:

A high BMI did not impart an increased risk of lower extremity injury during training or race participation.

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Reliability of Lower Extremity Girth Measurements and Right- and Left-Side Differences

Susan L. Whitney, Larry Mattocks, James J. Irrgang, Pamela A. Gentile, David Pezzullo, and Abdulazeem Kamkar

The purpose of this two-part study was to determine if lower extremity girth measurements are repeatable. Sixteen males and 14 females participated in the intra- and intertester reliability portion of this study. Girth was assessed at five different lower extremity sites by two physical therapists using a standard tape measure. Thirty measures (15 by each examiner) were collected on the subject's right leg, and a mean of the three measures was used in the analysis. The measurements were repeated 7 days later. It was found that by using a simple standardized procedure, girth measurements in the clinic can be highly repeatable in experienced clinicians. Part 2 of the study involved testing the right and left legs of 22 subjects to determine if girth of the right and left legs was similar. All subjects had their girth assessed at five sites on their right and left legs during one session. It was found that girth measures on the right and left lower extremities are comparable. In an acutely injured lower extremity, it might be assumed that the girth of both lower extremities is similar.

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Lower Extremity Joint Work During Acceleration, Deceleration, and Steady State Running

D.S. Blaise Williams III, Jonathan H. Cole, and Douglas W. Powell

Running during sports and for physical activity often requires changes in velocity through acceleration and deceleration. While it is clear that lower extremity biomechanics vary during these accelerations and decelerations, the work requirements of the individual joints are not well understood. The purpose of this investigation was to measure the sagittal plane mechanical work of the individual lower extremity joints during acceleration, deceleration, and steady-state running. Ten runners were compared during acceleration, deceleration, and steady-state running using three-dimensional kinematics and kinetics measures. Total positive and negative joint work, and relative joint contributions to total work were compared between conditions. Total positive work progressively increased from deceleration to acceleration. This was due to greater ankle joint work during acceleration. While there was no significant change in total negative work during deceleration, there was a greater relative contribution of the knee to total negative work with a subsequent lower relative ankle negative work. Each lower extremity joint exhibits distinct functional roles in acceleration compared with deceleration during level running. Deceleration is dominated by greater contributions of the knee to negative work while acceleration is associated with a greater ankle contribution to positive work.

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Effects of Abdominal Postures on Lower Extremity Energetics during Single-Leg Landings

Anthony S. Kulas, Thomas C. Windley, and Randy J. Schmitz

Context:

Functional implications of clinically relevant abdominal postures have been sparsely examined.

Objectives:

To evaluate the reliability of sustaining abdominal postures during single-leg landings and the effects of abdominal postures on lower extremity kinetics and energetics.

Design:

One-way ANOVA tested effects of leg-spring stiffness and lower extremity energetics across groups (control, abdominal hollowing [AH], and pelvic tilting [PT]).

Participants:

12 male (24.0 ± 3.4 years) and 12 female (21.9 ± 2.3 years) healthy, recreationally active subjects.

Main Outcome Measures:

Leg-spring stiffness and relative joint-energy absorption from control, AH, and PT groups.

Results:

AH and PT ICCs2,k and standard error of measurements (AH = 0.53 ± 0.4 cm, PT = 0.9° ± 0.8°) were moderate to high. Relative knee-energy-absorption effect sizes comparing the control and treatment groups revealed moderate treatment effects (AH = 0.66%, PT = 0.41%).

Conclusions:

Abdominal postures can be reliably performed during a single-leg-landing task. Energy-absorption effect sizes suggest a link between the trunk and lower extremity.

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Lower Extremity Muscular Strength and Leukocyte Telomere Length: Implications of Muscular Strength in Attenuating Age-Related Chronic Disease

Paul D. Loprinzi and Jeremy P. Loenneke

Objective:

Leukocyte telomere length (LTL) shortening is characteristic of aging and is associated with morbidity and mortality, independent of age. Research demonstrates that lower extremity muscular strength is associated with mobility, morbidity and mortality; however, no study, to our knowledge, had examined the association between lower extremity muscular strength and LTL, which was the purpose of this brief study.

Methods:

Data from the 1999–2002 NHANES was used (N = 2410; 50–85 years). Peak isokinetic knee extensor strength (IKES) was objectively measured with LTL assessed from a blood sample.

Results:

After adjustments, for every 50 N increase in IKES, participants had a 9% reduced odds (P = .04) of being in the 1st (vs. 4th) LTL quartile.

Discussion:

Lower extremity muscular strength is associated with LTL, suggesting a possible mechanism through which lower extremity muscular strength may be associated with morbidity and mortality.

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Consistent Immediate Effects of Foot Orthoses on Comfort and Lower Extremity Kinematics, Kinetics, and Muscle Activity

Anne Mündermann, Benno M. Nigg, R. Neil Humble, and Darren J. Stefanyshyn

In order to accommodate patients to new foot orthoses over time, two steps are required: The first is to obtain a baseline reading of the immediate effects across several weeks to ensure consistency. The second step is to look at changes with progressively longer wear periods similar to what occurs in general practice. This study addressed the first step. The purpose of this study was to determine whether the baseline reading of the immediate effects of foot orthoses on comfort and lower extremity kinematics, kinetics, and muscle activity is consistent between days. Participants were 21 recreational runners who volunteered for the study. Three orthotic conditions (posting, custom-molding, posting and custom-molding) were compared to a control (flat) insert. Lower extremity kinematic, kinetic, and EMG data were collected for 108 trials per participant and condition in 9 sessions for each person for running at 4 m/s. Comfort for all orthotic conditions was assessed in each session using a visual analog scale. Statistically significant session effects were detected using repeated-measures ANOVA (α = .05). Three of the 93 variables had a significant session effect. A significant interaction between orthotic condition and session was observed for 6 of the 93 variables. The results of this study showed that the effects of foot orthoses on comfort, lower extremity kinematics, kinetics, and muscle activity are consistent across a 3-week period when the wear time for each condition is restricted. Thus, foot orthoses lead to immediate changes in comfort, kinematics, kinetics, and muscle activity with limited use. These immediate effects of foot orthoses on comfort, kinematics, kinetics, and muscle activity are consistent between days.

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Lower Extremity Strength and Coordination Are Independent Contributors to Maximum Vertical Jump Height

Masao Tomioka, Tammy M. Owings, and Mark D. Grabiner

We previously reported that lower extremity muscular strength of older adults did not predict success of a balance recovery task. We propose that lower extremity coordination may limit performance independently of lower extremity strength. The present study was conducted to determine the extent to which knee extension strength and hip–knee coordination independently contribute to maximum vertical jump height. Maximum vertical jump height and isometric and isokinetic knee extension strength and power were determined in 13 young adults. Hip–knee coordination during the vertical jump was quantified using relative phase angles. Stepwise nonlinear multiple regression determined the variable set that best modeled the relationship between the dependent variable, maximum vertical jump height, and the independent variables of strength, power, and coordination. The quadratic terms of the normalized knee extension strength at 60 deg·s–1, and the average relative phase during the propulsion phase of the vertical jump, collectively accounted for more than 80% of the shared variance (p = .001). The standardized regression coefficients of the two terms, .59 and .52, respectively (p = .004 and .008), indicated the independence and significance of the contributions of knee extension strength and hip–knee coordination to maximum vertical jump height. Despite the pitfalls of extrapolating these results to older adults performing a balance recovery task, the results are interpreted as supporting the contention that while muscle strength confers a number of functional benefits, the ability to avoid falling as a result of a trip is not necessarily ensured. Increased muscle strength per se can occur in the absence of improved kinematic coordination.

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College and Professional Women’s Basketball Players’ Lower Extremity Injuries: A Survey of Career Incidence

Abby I. Gordon, Lindsay J. DiStefano, Craig R. Denegar, Rosemary B. Ragle, and Jeremy R. Norman

Context:

Lower extremity injuries in women’s basketball players are generally presented as seasonal team incidence. Available data were reported by team athletic trainers to overseeing bodies yielding estimates of injury rates as a percentage of all injuries sustained. By summarizing career incidence of women’s basketball players’ injuries, a new perspective indicating potential risk of injury can be considered.

Objectives:

To summarize the career incidence of lower extremity injuries in intercollegiate and professional women’s basketball players, examine the effect of anterior cruciate ligament (ACL) injury on professional basketball players’ career longevity, and explore the relationship between ankle sprains and knee injuries in this population.

Design:

Survey.

Participants:

246 elite-level women’s basketball players.

Outcome Measures:

Career incidence of lower extremity injury, professional career length, relationship between history of ankle sprain and ACL injury frequency calculations, and chi-square statistics. Results: Seventy-four of 85 (87.06%) professional Women’s National Basketball Association (WNBA) and 172/179 (96.09%) available collegiate Big East Conference (BEC) women’s basketball players completed the survey. Ankle sprains were the most frequently reported injury with 170/246 (69.11%) participants indicating at least one during their career. Patellar tendinopathy (28.46%), meniscal injury (22.76%), and ACL tear (21.54%) were also common. Professional career length in participants with an ACL reconstruction averaged 6.11 ± 3.20 seasons, more than the 5.70 ± 4.17 seasons reported by those without an ACL injury. Professional participants who did not report an ankle sprain were more likely to report an ACL tear (χ2 = 10.96; p = .000932).

Conclusion:

Summarizing career incidence provides a new perspective of women’s basketball players’ injuries. Ankle sprains and knee injuries were commonly reported, both more frequently than by traditional research methods. These data may assist in developing injury prevention and rehabilitation strategies for injured athletes.

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Reliability of Using a Handheld Tablet and Application to Measure Lower-Extremity Alignment Angles

Deborah L. King and Barbara C. Belyea

Context: Landing kinematics have been identified as a risk factor for knee injury. Detecting atypical kinematics in clinical settings is important for identifying individuals at risk for these injuries. Objective: To determine the reliability of a handheld tablet and application (app) for measuring lower-extremity kinematics during drop vertical-jump landings. Design: Measurement reliability. Setting: Laboratory. Participants: 23 healthy young adults with no lower-extremity injuries and no contraindications for jumping and landing. Intervention: Subjects performed 6 drop vertical jumps that were captured with an iPad2 and analyzed with a KinesioCapture app by 2 novice and 2 experienced raters. Three trials each were captured in the frontal and sagittal planes. Main Outcome Measures: Frontal-plane projection angles, knee flexion, and hip flexion at initial contact and maximum knee flexion were measured. ICC and SEM were calculated to determine intertrial and interrater reliability. One-way ANOVAs were used to examine differences between the measured angles of the raters. Results: Average intertrial reliability ranged from .71 to .98 for novice raters and .77 to .99 for experienced raters. SEMs were 2.3-4.3° for novice raters and 1.6-3.9° for experienced raters. Interrater ICC2,1 was .39-.98 for the novice raters and .69-.93 for the experienced raters. SEMs were smallest with the experienced raters, all less than 1.5°. Conclusion: A handheld tablet and app is promising for evaluating landing kinematics and identifying individuals at risk for knee injury in a clinical setting. Intertrial reliability is good to excellent when using average trial measures. Interrater reliability is fair to excellent depending on experience level. Multiple trials should be assessed by a single rater when assessing lower-extremity mechanics with a handheld tablet and app, and results may vary with experience level or training.

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Effects of Exercise on Lower Extremity Muscle Function After Anterior Cruciate Ligament Reconstruction

Christopher Kuenze, Jay Hertel, and Joseph M. Hart

Purpose:

Persistent quadriceps weakness due to arthrogenic muscle inhibition (AMI) has been reported after anterior cruciate ligament (ACL) reconstruction. Fatiguing exercise has been shown to alter lower extremity muscle function and gait mechanics, which may be related to injury risk. The effects of exercise on lower extremity function in the presence of AMI are not currently understood. The purpose of this study was to compare the effect of 30 min of exercise on quadriceps muscle function and soleus motoneuron-pool excitability in ACL-reconstructed participants and healthy controls.

Methods:

Twenty-six (13 women, 13 men) healthy and 26 (13 women, 13 men) ACL-reconstructed recreationally active volunteers were recruited for a case-control laboratory study. All participants completed 30 min of continuous exercise including alternating cycles of inclined-treadmill walking and bouts of squats and step-ups. Knee-extension torque, quadriceps central activation ratio (CAR), soleus H:M ratio, and soleus V:M ratio were measured before and after 30 min of exercise.

Results:

There was a significant group × time interaction for knee-extension torque (P = .002), quadriceps CAR (P = .03), and soleus V:M ratio (P = .03). The effect of exercise was smaller for the ACL-R group than for matched controls for knee-extension torque (ACL-R: %Δ = −4.2 [−8.7, 0.3]; healthy: %Δ = −14.2 [−18.2, −10.2]), quadriceps CAR (ACL-R: %Δ = −5.1 [−8.0, −2.1]; healthy: %Δ = −10.0 [−13.3, −6.7]), and soleus V:M ratio (ACL-R: %Δ = 37.6 [2.1, 73.0]; healthy: %Δ = −24.9 [−38.6, −11.3]).

Conclusion:

Declines in quadriceps and soleus volitional muscle function were of lower magnitude in ACL-R subjects than in healthy matched controls. This response suggests an adaptation experienced by patients with quadriceps AMI that may act to maintain lower extremity function during prolonged exercise.