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Joshua T. Weinhandl, Mukta Joshi and Kristian M. O’Connor

The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Among these injuries, those occurring to the ACL are commonly observed during landing maneuvers. The purpose of this study was to determine gender differences in landing strategies during unilateral and bilateral landings. Sixteen male and 17 female recreational athletes were recruited to perform unilateral and bilateral landings from a raised platform, scaled to match their individual jumping abilities. Three-dimensional kinematics and kinetics of the dominant leg were calculated during the landing phase and reported as initial ground contact angle, ranges of motion (ROM) and peak moments. Lower extremity energy absorption was also calculated for the duration of the landing phase. Results showed that gender differences were only observed in sagittal plane hip and knee ROM, potentially due to the use of a relative drop height versus the commonly used absolute drop height. Unilateral landings were characterized by significant differences in hip and knee kinematics that have been linked to increased injury risk and would best be classified as “stiff” landings. The ankle musculature was used more for impact absorption during unilateral landing, which required increased joint extension at touchdown and may increase injury risk during an unbalanced landing. In addition, there was only an 11% increase in total energy absorption during unilateral landings, suggesting that there was a substantial amount of passive energy transfer during unilateral landings.

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Emma Sconce, Paul Jones, Ellena Turner, Paul Comfort and Philip Graham-Smith

Context:

Hamstring injury-risk assessment has primarily been investigated using isokinetic dynamometry. However, practical issues such as cost and availability limit the widespread application of isokinetics for injury-risk assessment; thus, field-based alternatives for assessing eccentric hamstring strength are needed.

Objective:

The aim of this study was to investigate the validity of the angle achieved during Nordic hamstring lowers (break-point angle) as a field-based test for eccentric hamstring strength.

Design:

Exploratory study.

Setting:

Laboratory.

Participants:

Sixteen male (n = 7) and female (n = 9) soccer players (mean ± SD age 24 ± 6 y, height 1.77 ± 0.12 m, and body mass 68.5 ± 16.5 kg) acted as subjects for the study.

Main Outcome Measures:

The authors explored relationships between the Nordic break-point angle (the point at which the subject can no longer resist the increasing gravitational moment during a Nordic hamstring lower) measured from video and isokinetic peak torque and angle of peak torque of right- and left-knee flexors.

Results:

The results revealed a meaningful relationship between eccentric knee-flexor peak torque (average of right and left limbs) and the Nordic break-point angle (r = −.808, r 2 = 65%, P < .00001). However, there was a weak relationship observed (r = .480, r 2 = 23%, P = .06) between break-point angle and the angle of peak torque (average of right and left limbs).

Conclusions:

The results suggest that the break-point angle achieved during Nordic hamstring lowers could be used as a field-based assessment of eccentric hamstring strength.

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Heidi R. Thornton, Jace A. Delaney, Grant M. Duthie and Ben J. Dascombe

Purpose:

To investigate the ability of various internal and external training-load (TL) monitoring measures to predict injury incidence among positional groups in professional rugby league athletes.

Methods:

TL and injury data were collected across 3 seasons (2013–2015) from 25 players competing in National Rugby League competition. Daily TL data were included in the analysis, including session rating of perceived exertion (sRPE-TL), total distance (TD), high-speed-running distance (>5 m/s), and high-metabolic-power distance (HPD; >20 W/kg). Rolling sums were calculated, nontraining days were removed, and athletes’ corresponding injury status was marked as “available” or “unavailable.” Linear (generalized estimating equations) and nonlinear (random forest; RF) statistical methods were adopted.

Results:

Injury risk factors varied according to positional group. For adjustables, the TL variables associated most highly with injury were 7-d TD and 7-d HPD, whereas for hit-up forwards they were sRPE-TL ratio and 14-d TD. For outside backs, 21- and 28-d sRPE-TL were identified, and for wide-running forwards, sRPE-TL ratio. The individual RF models showed that the importance of the TL variables in injury incidence varied between athletes.

Conclusions:

Differences in risk factors were recognized between positional groups and individual athletes, likely due to varied physiological capacities and physical demands. Furthermore, these results suggest that robust machine-learning techniques can appropriately monitor injury risk in professional team-sport athletes.

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Adriana M. Duquette and David M. Andrews

Considerable variability in tibial acceleration slope (AS) values, and different interpretations of injury risk based on these values, have been reported. Acceleration slope variability may be due in part to variations in the quantification methods used. Therefore, the purpose of this study was to quantify differences in tibial AS values determined using end points at various percentage ranges between impact and peak tibial acceleration, as a function of either amplitude or time. Tibial accelerations were recorded from 20 participants (21.8 ± 2.9 years, 1.7 m ± 0.1 m, 75.1 kg ± 17.0 kg) during 24 unshod heel impacts using a human pendulum apparatus. Nine ranges were tested from 5–95% (widest range) to 45–55% (narrowest range) at 5% increments. ASAmplitude values increased consistently from the widest to narrowest ranges, whereas the ASTime values remained essentially the same. The magnitudes of ASAmplitude values were significantly higher and more sensitive to changes in percentage range than ASTime values derived from the same impact data. This study shows that tibial AS magnitudes are highly dependent on the method used to calculate them. Researchers are encouraged to carefully consider the method they use to calculate AS so that equivalent comparisons and assessments of injury risk across studies can be made.

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Ina Janssen, Jeremy M. Sheppard, Andrew A. Dingley, Dale W. Chapman and Wayne Spratford

Countermovement jumps loaded with a weighted vest are often used for the training of lower body power to improve jump performance. However, it is currently unknown how this added load affects the lower extremity kinematics and kinetics, in particular whether this results in an increased injury risk. Therefore, the purpose of this investigation was to determine how lower extremity kinematics and kinetics during landing are affected by loaded jumps as demonstrated in a volleyball block jump landing. Ten elite male volleyball players performed block jump landings in an unloaded and loaded (9.89 kg) condition. Kinematic and kinetic landing data from the three highest jumps were collected and assessed. Paired samples t test was used to establish whether load condition had a significant effect on lower extremity kinematics and kinetics. Hip flexion was significantly greater in the unloaded condition compared with the loaded condition (p = .004). There was no significant difference in any other kinematic or kinetic variables measures between the unloaded and loaded conditions. These results suggest that landing from loaded volleyball block jumps does not increase injury risk compared with unloaded jumps in elite male volleyball players.

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Alasdair R. Dempsey, Bruce C. Elliott, Bridget J. Munro, Julie R. Steele and David G. Lloyd

Anterior cruciate ligament (ACL) injuries are costly. Sidestep technique training reduces knee moments that load the ACL. This study examined whether landing technique training alters knee moments. Nineteen team sport athletes completed the study. Motion analysis and ground reaction forces were recorded before and after 6 weeks of technique modification. An inverse dynamic model was used to calculate three-dimensional knee loading. Pre- and postintervention scores were compared using paired t tests. Maximal knee flexion angle during landing was increased following training. There was no change in valgus or flexion moments, but an increase in peak internal rotation moment. This increase in internal rotation moment may increase the risk of ACL injury. However, the increased angle at which the peak internal rotation moment occurred at follow up may mitigate any increase in injury risk by reducing load transmission.

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Evangelos Pappas, Karl F. Orishimo, Ian Kremenic, Marijeanne Liederbach and Marshall Hagins

Retrospective studies have suggested that dancers performing on inclined (“raked”) stages have increased injury risk. One study suggests that biomechanical differences exist between flat and inclined surfaces during bilateral landings; however, no studies have examined whether such differences exist during unilateral landings. In addition, little is known regarding potential gender differences in landing mechanics of dancers. Professional dancers (N = 41; 14 male, 27 female) performed unilateral drop jumps from a 30 cm platform onto flat and inclined surfaces while extremity joint angles and moments were identified and analyzed. There were significant joint angle and moment effects due to the inclined flooring. Women had significantly decreased peak ankle dorsiflexion and hip adduction moment compared with men. Findings of the current study suggest that unilateral landings on inclined stages create measurable changes in lower extremity biomechanical variables. These findings provide a preliminary biomechanical rationale for differences in injury rates found in observational studies of raked stages.

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Monna Arvinen-Barrow, Kelsey DeGrave, Stephen Pack and Brian Hemmings

The purpose of this study was to document the lived experiences of professional cricketers who had encountered a career-ending non-musculoskeletal injury. Three male cricketers each with over nine years of playing experience in professional cricket representing England and Wales participated in retrospective in-depth semi-structured interviews. The Interpretative Phenomenological Analysis revealed that at the time of the injury, the participants were at the “final stretch” of their professional sporting careers and that despite a range of unpleasant reactions to injury, all participants experienced a healthy career transition out of sport. To best prepare athletes for a life outside of sport, ensuring athletes have sufficient plans in motion early on in their careers can reduce external and internal stressors, which if not addressed, can increase sport injury risk and have a negative effect on athletes’ reactions post-injury.

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Irene S. McClay, John R. Robinson, Thomas P. Andriacchi, Edward C Frederick, Ted Gross, Philip Martin, Gordon Valiant, Keith R. Williams and Peter R. Cavanagh

Basketball is a sport that involves multiple impacts with the ground through a variety of moves such as running Jumping, and cutting. Repetitive impacts have been associated with stress-related injuries in other sports such as running. The purpose of this investigation was to gain an understanding of the typical stresses the body experiences during common basketball moves. To this end, the ground reaction forces from 24 players from five professional basketball teams were studied. In addition, a game analysis was performed to determine the frequency of selected moves. These data indicated that certain common movements, such as jump landings and shuffling, resulted in absolute and relative forces much greater than many of those reported previously in studies of other sports. These movements were also identified in a companion paper as being associated with large angular excursions and velocities. Findings are discussed with respect to injury risks, and suggestions for future study are made.

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Elizabeth C. J. Pike and Joseph A. Maguire

This paper provides a development from previous conceptual frameworks related to the risk/pain/injury nexus in sporting subcultures (Hughes & Coakley, 1991; Maguire & Roberts, 1998; Nixon, 1992; Young, 1991). To do this, we have developed a model of factors contributing to injury risk in sport. In outlining our framework we seek to trace the enabling and coercive social forces that combine to act upon athletes and consequently promote participation to the extent of risking injury. This paper is grounded in a two-year study of female rowers in the United Kingdom. Several dimensions of sporting activities are mapped out, including the physical and structural settings, or “stage” upon which the sport takes place; preparation and participation in the sport itself; and the athletes’ attitudes toward, and actions on, receiving an injury. The themes identified in the model are used to “make sense” of the substantive insights drawn from the rowers’ stories.