Inclusion of a skeletal model partly improves the reliability of lower limb joint angles derived from a markerless depth camera.

A single depth camera provides a fast and easy approach to performing biomechanical assessments in a clinical setting; however, there are currently no established methods to reliably determine joint angles from these devices. The primary aim of this study was to compare joint angles as well as the between-day reliability of direct kinematics to model-constrained inverse kinematics recorded using a single markerless depth camera during a range of clinical and athletic movement assessments.A secondary aim was to determine the minimum number of trials required to maximize reliability. Eighteen healthy participants attended two testing sessions one week apart. Tasks included treadmill walking, treadmill running, single-leg squats, single-leg countermovement jumps, bilateral countermovement jumps, and drop vertical jumps. Keypoint data were processed using direct kinematics as well as in OpenSim using a full-body musculoskeletal model and inverse kinematics. Kinematic methods were compared using statistical parametric mapping and between-day reliability was calculated using intraclass correlation coefficients, mean absolute error, and minimal detectable change. Keypoint-derived inverse kinematics resulted in significantly smaller hip flexion (range = -9 to -2°), hip abduction (range = -3 to -2°), knee flexion (range = -5° to -2°), and greater dorsiflexion angles (range = 6-15°) than direct kinematics. Both markerless kinematic methods had high between-day reliability (inverse kinematics ICC 95 %CI = 0.83-0.90; direct kinematics ICC 95 %CI = 0.80-0.93). For certain tasks and joints, keypoint-derived inverse kinematics resulted in greater reliability (up to 0.47 ICC) and smaller minimal detectable changes (up to 13°) than direct kinematics. Performing 2-4 trials was sufficient to maximize reliability for most tasks. A single markerless depth camera can reliably measure lower limb joint angles, and skeletal model-constrained inverse kinematics improves lower limb joint angle reliability for certain tasks and joints.

Concurrent validity and test-retest reliability of VALD ForceDecks' strength, balance, and movement assessment tests.

OBJECTIVES: To evaluate the concurrent validity and test-retest reliability of common movement, strength, and balance tests using portable uniaxial dual force plates. DESIGN: Repeated measures cross-sectional study. METHODS: Sixteen healthy individuals participated in two testing sessions, where they performed 12 different movement, strength, and balance tests. Vertical ground reaction force and centre of pressure data were collected using the VALD ForceDecks simultaneously with ground-embedded laboratory force plates. Concurrent validity was assessed using root mean square error for raw time-series data and Bland-Altman plots for discrete metrics. Test-retest reliability was assessed using intraclass correlation coefficients and minimal detectable changes. RESULTS: ForceDecks recorded vertical ground reaction forces and center of pressure with high accuracy compared to laboratory force plates. The mean bias between systems was negligible (<2 N or 0.1 mm), with small limits of agreement (<5 N or 1 mm). Overall, 530/674 (79%) showed good or excellent validity (<10% difference) and 611/773 (79%) had good or excellent reliability (intraclass correlation coefficient >0.75). ForceDecks reliability was similar to laboratory force plates (<0.07 intraclass correlation coefficient median difference for all metrics). CONCLUSIONS: Portable uniaxial force plates record highly accurate vertical ground reaction forces and center of pressure during a range of movement, strength, and balance tests. The VALD ForcDecks are a valid and reliable alternative to laboratory force plates when strict standardized testing and data analysis procedures are followed. Users should be aware of the validity and reliability characteristics of the tests and metrics they choose.

Biceps femoris long head muscle and aponeurosis geometry in males with and without a history of hamstring strain injury.

OBJECTIVES: Hamstring strain injuries (HSIs) commonly affect the proximal biceps femoris long head (BFlh) musculotendinous junction. Biomechanical modeling suggests narrow proximal BFlh aponeuroses and large muscle-to-aponeurosis width ratios increase localized tissue strains and presumably risk of HSI. This study aimed to determine if BFlh muscle and proximal aponeurosis geometry differed between limbs with and without a history of HSI. METHODS: Twenty-six recreationally active males with (n = 13) and without (n = 13) a history of unilateral HSI in the last 24 months underwent magnetic resonance imaging of both thighs. BFlh muscle and proximal aponeurosis cross-sectional areas, length, volume, and interface area between muscle and aponeurosis were extracted. Previously injured limbs were compared to uninjured contralateral and control limbs for discrete variables and ratios, and along the relative length of tissues using statistical parametric mapping. RESULTS: Previously injured limbs displayed significantly smaller muscle-to-aponeurosis volume ratios (p = 0.029, Wilcoxon effect size (ES) = 0.43) and larger proximal BFlh aponeurosis volumes (p = 0.019, ES = 0.46) than control limbs with no history of HSI. No significant differences were found between previously injured and uninjured contralateral limbs for any outcome measure (p = 0.216-1.000, ES = 0.01-0.36). CONCLUSIONS: Aponeurosis geometry differed between limbs with and without a history of HSI. The significantly larger BFlh proximal aponeuroses and smaller muscle-to-aponeurosis volume ratios in previously injured limbs could alter the strain experienced in muscle adjacent to the musculotendinous junction during active lengthening. Future research is required to determine if geometric differences influence the risk of re-injury and whether they can be altered via targeted training.

Hamstring and knee injuries are associated with isometric hip and trunk muscle strength in elite Australian Rules and Rugby League players.

OBJECTIVES: This study investigated relationships between isometric trunk and hip extensor strength, lumbar muscle morphology, and the risk of hamstring and knee ligament injuries in Australian Football League and National Rugby League players. DESIGN: Prospective cohort study. METHODS: Trunk and hip extensor strength, multifidus and quadratus lumborum cross-sectional area were measured during the 2020 pre-season. Logistic regressions and decision trees were employed to explore associations between maximum strength, strength endurance, multifidus and quadratus lumborum cross-sectional area, age, previous injuries, and hamstring and knee ligament injury risk. RESULTS: Greater strength endurance [odds ratio = 0.42 (0.23-0.74), p = 0.004] and maximum strength [odds ratio = 0.55 (0.31-0.94), p = 0.039] reduced hamstring injury risk. Increased risk of knee ligament injuries was associated with larger multifidus [odds ratio = 1.66 (1.14-2.45), p = 0.008] and higher multifidus to quadratus lumborum ratio (odds ratio = 1.57 (1.13-2.23), p = 0.008]. Decision tree models indicated that low strength endurance (< 99 Nm) characterised hamstring strains, while high (≥ 1.33) multifidus to quadratus lumborum ratio mitigated risk. Knee ligament injuries were associated with larger (≥ 8.49 cm2) multifidus, greater (≥ 1.25) multifidus to quadratus lumborum ratio, and lower maximum strength (< 9.24 N/kg). CONCLUSIONS: Players with lower trunk and hip extensor maximum strength and strength endurance had increased risk of hamstring injuries, while knee ligament injury risk was elevated with larger multifidus cross-sectional area, higher multifidus to quadratus lumborum ratio, and lower maximum trunk and hip extensor strength.

Vertical Jump Testing after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

INTRODUCTION: Recently, there has been a call for vertical jump testing via force-plate analysis to be included in the assessment of individuals after anterior cruciate ligament reconstruction (ACLR) and as part of return-to-play criteria. However, a synthesis of current literature is needed to help guide clinicians on what tests to perform, which force-plate metrics to assess, and how these may change over the time course of rehabilitation. METHODS: Four online databases were searched from inception to July 2022. The Downs and Black checklist was used to assess study quality. Multilevel meta-analyses and meta-regressions were undertaken in conjunction with a best evidence synthesis. RESULTS: Forty-two articles were included, capturing 2375 participants with a history of ACLR. Reconstructed limbs displayed 1) lower peak eccentric forces, concentric forces, landing forces, and lower eccentric and concentric impulses (standardized means difference [SMD] = -1.84 to -0.46) than uninjured contralateral limbs during bilateral countermovement jumps (CMJ) and drop vertical jumps (DVJ); 2) lower jump heights and reactive strength indices (RSI), and longer contact times than uninjured contralateral limbs during unilateral CMJ and DVJ (SMD = -0.86 to 0.26); and 3) lower jump heights, RSI, and longer contact times during bilateral and unilateral CMJ, and unilateral DVJ, than uninjured controls (SMD = -1.19 to 1.08). Meta-regression revealed that time postsurgery was a significant moderator ( P < 0.05) for 1) bilateral CMJ height, peak concentric force, and peak landing force; 2) between-limb differences in unilateral CMJ height; and 3) differences in unilateral DVJ height, RSI, and contact time between reconstructed limbs and healthy controls with no history of injury. CONCLUSIONS: Individuals with a history of ACLR display chronic deficits in vertical jumping performance during a range of bilateral and unilateral tasks, which may have implications for return-to-play criteria and the design of interventions targeted at restoring long-term deficits in explosive lower limb strength after ACLR.

Injury Prevention Programmes Fail to Change Most Lower Limb Kinematics and Kinetics in Female Team Field and Court Sports: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: One mechanism by which exercise interventions may be effective in reducing anterior cruciate ligament (ACL) injury risk is through changes in lower limb biomechanics. Understanding how training programmes affect lower-limb kinematics and kinetics may help refine injury prevention programmes. OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the effect of injury prevention programmes on kinematics and kinetics during tasks related to ACL injury in female team field and court sports. DATA SOURCES: Five databases were searched in October 2022. ELIGIBILITY CRITERIA: Randomised controlled trials assessing the effect of injury prevention programmes compared with usual training/no training on lower limb kinematics and kinetics in female team field and court sports were eligible for review. RESULTS: Sixteen studies were included. A total of 976 female athletes were included. Most of the studies included interventions with multiple components (12/16). Commonly used components were plyometrics (12/16), strength (8/16), and balance/stability (7/16). Thirteen studies had routine training or sham interventions as the control group and three studies had no training. Very low certainty evidence suggests that injury prevention programmes increase knee flexion angles (mean difference = 3.1° [95% confidence interval 0.8-5.5]); however, very low to low certainty evidence suggests no effect on hip flexion angles/moments, knee flexion moments, hip adduction angles/moments, knee adduction angles/moments, hip internal rotation angles/moments, ankle dorsiflexion angles, and ground reaction forces, compared with usual training/no training. CONCLUSION: Injury prevention programmes may be effective in increasing knee flexion angles during dynamic landing and cutting tasks but may have no effect on other lower limb biomechanical variables. As such, the benefits of injury prevention programmes may be mediated by factors other than altered biomechanics and/or may happen through other biomechanical measures not included in this review.

Match Running Performance in Australian Football Is Related to Muscle Fiber Typology.

PURPOSE: To examine the association between muscle fiber typology and match running performance in professional Australian football (AF) athletes. METHODS: An observational time-motion analysis was performed on 23 professional AF athletes during 224 games throughout the 2020 competitive season. Athletes were categorized by position as hybrid, small, or tall. Athlete running performance was measured using Global Navigation Satellite System devices. Mean total match running performance and maximal mean intensity values were calculated for moving mean durations between 1 and 10 minutes for speed (in meters per minute), high-speed-running distance (HSR, >4.17 m·s-1), and acceleration (in meters per second squared), while intercept and slopes were calculated using power law. Carnosine content was quantified by proton magnetic resonance spectroscopy in the gastrocnemius and soleus and expressed as a carnosine aggregate z score (CAZ score) to estimate muscle fiber typology. Mixed linear models were used to determine the association between CAZ score and running performance. RESULTS: The mean (range) CAZ score was -0.60 (-1.89 to 1.25), indicating that most athletes possessed a greater estimated proportion of type I muscle fibers. A greater estimated proportion of type I fibers (ie, lower CAZ score) was associated with a larger accumulation of HSR (>4.17 m·s-1) and an increased ability to maintain HSR as the peak period duration increased. CONCLUSION: AF athletes with a greater estimated proportion of type I muscle fibers were associated with a greater capacity to accumulate distance running at high speeds, as well as a greater capacity to maintain higher output of HSR running during peak periods as duration increases.

Hamstring strain injury prevention: current beliefs and practices of practitioners working in Major League Baseball.

CONTEXT: Hamstring strain injuries (HSIs) are the most frequently sustained injury in Major League Baseball (MLB). However, the beliefs and practices of MLB practitioners regarding HSI risk factors and prevention strategies in baseball athletes, have not been documented. OBJECTIVE: To document the current beliefs and practices of MLB practitioners in relation to HSI prevention. DESIGN: cross-sectional study. SETTING: Major League Baseball via an online survey. PARTICIPANTS: Athletic trainers, physical therapists and strength and conditioning coaches employed in MLB during the 2021 season. DATA COLLECTION AND ANALYSIS: An online survey was conducted with participants completing the survey once. Questions pertained to risk factor identification, the use and perceived effectiveness of preventative strategies, and barriers to implementation. Descriptive statistics were calculated for each question. RESULTS: 91 responses were received featuring respondents from 28 of 30 MLB organizations. The perceived most important intrinsic risk factor for first-time HSI was tolerance to high-speed running and previous HSI for recurrent injury. The perceived most important extrinsic risk factor for both first-time and recurrent HSI was internal communication between staff.The perceived most effective prevention strategies were managing overall workload, exposure to high-speed running, and periodization. The most used prevention strategies were core/lumbopelvic strengthening, resistance training and workload management.Approximately half (53%) of respondents reported barriers to effective implementation of HSI prevention strategies, including player and coach buy-in, compliance, training time constraints, and in-season scheduling/reduced recovery time. CONCLUSIONS: This was the first survey to investigate MLB practitioner beliefs and practices regarding HSI prevention. Responses from practitioners regarding their beliefs about risk factors and appropriate prevention strategies were varied, and discrepancies existed between the perceived most effective strategies and those most frequently employed.

Gluteal Muscle Forces during Hip-Focused Injury Prevention and Rehabilitation Exercises.

PURPOSE: This study aimed to compare and rank gluteal muscle forces in eight hip-focused exercises performed with and without external resistance and describe the underlying fiber lengths, velocities, and muscle activations. METHODS: Motion capture, ground reaction forces, and electromyography (EMG) were used as input to an EMG-informed neuromusculoskeletal model to estimate gluteus maximus, medius, and minimus muscle forces. Participants were 14 female footballers (18-32 yr old) with at least 3 months of lower limb strength training experience. Each participant performed eight hip-focused exercises (single-leg squat, split squat, single-leg Romanian deadlift [RDL], single-leg hip thrust, banded side step, hip hike, side plank, and side-lying leg raise) with and without 12 repetition maximum (RM) resistance. For each muscle, exercises were ranked by peak muscle force, and k-means clustering separated exercises into four tiers. RESULTS: The tier 1 exercises for gluteus maximus were loaded split squat (95% confidence interval [CI] = 495-688 N), loaded single-leg RDL (95% CI = 500-655 N), and loaded single-leg hip thrust (95% CI = 505-640 N). The tier 1 exercises for gluteus medius were body weight side plank (95% CI = 338-483 N), loaded single-leg squat (95% CI = 278-422 N), and loaded single-leg RDL (95% CI = 283-405 N). The tier 1 exercises for gluteus minimus were loaded single-leg RDL (95% CI = 267-389 N) and body weight side plank (95% CI = 272-382 N). Peak gluteal muscle forces increased by 28-150 N when exercises were performed with 12RM external resistance compared with body weight only. Peak muscle force coincided with maximum fiber length for most exercises. CONCLUSIONS: Gluteal muscle forces were exercise specific, and peak muscle forces increased by varying amounts when adding a 12RM external resistance. These findings may inform exercise selection by facilitating the targeting of individual gluteal muscles and optimization of mechanical loads to match performance, injury prevention, or rehabilitation training goals.

The Relevance of Muscle Fiber Type to Physical Characteristics and Performance in Team-Sport Athletes.

PURPOSE: The aim of this systematic review was to (1) determine the muscle fiber-type composition (or muscle fiber typology [MFT]) of team-sport athletes and (2) examine associations between MFT and the physical characteristics and performance tasks in team-sport athletes. METHODS: Searches were conducted across numerous databases-PubMed, SPORTDiscus, MEDLINE, and Google Scholar-using consistent search terms. Studies were included if they examined the MFT of team-sport athletes. Included studies underwent critical appraisal using the McMasters University critical appraisal tool for quantitative research. RESULTS: A total of 10 studies were included in the present review, wherein the MFT of athletes was measured from 5 different team sports (soccer, rugby union, rugby league, handball, and volleyball). There was large variability in the MFT of team-sport athletes both within (up to 27.5%) and between sports (24.0% relative difference). Male football players with a higher proportion of type II fibers had faster 10- and 30-m sprint times, achieved a greater total distance sprinting (distance at >6.67 m·s-1), and a greater peak 1-minute sprint distance. CONCLUSIONS: MFT varies considerably between athletes both within and between different team sports. The results from some studies suggest that variation in MFT is associated with high-intensity running performance in a football match, as well as 10- and 30-m sprint times. Further experimental studies should focus on how determination of the MFT of team-sport athletes could be utilized to influence talent identification, team selection, and the individualization of training.

Study protocol for double-blind, randomised placebo-controlled trial evaluating semitendinosus function and morbidity following tendon harvesting for anterior cruciate ligament reconstruction augmented by platelet-rich plasma.

INTRODUCTION: Anterior cruciate ligament (ACL) rupture is debilitating, often requiring surgical reconstruction. An ACL reconstruction (ACLR) using a tendon autograft harvested from the semitendinosus results in substantial injury to the donor muscle. Following ACLR, patients rarely return to their preinjury level of physical activity, are at elevated risk of secondary lower limb injuries and early onset knee osteoarthritis. To date, no randomised controlled trial has evaluated the efficacy of platelet-rich plasma (PRP) in aiding knee function and semitendinosus morphology of following ALCR. METHODS AND ANALYSIS: This is a multicentre double-blind randomised placebo-controlled trial. Fifty-four ACLR patients aged 18-50 years will be randomised to receive either a single application of PRP (ACLR+) or placebo saline (ACLR) into the semitendinosus harvest zone at the time of surgery. All patients will undergo normal postoperative rehabilitation recommended by the attending orthopaedic surgeon or physiotherapist. The primary outcome measure is between-limb difference (ACLR compared with intact contralateral) in isometric knee flexor strength at 60o knee flexion, collected 10-12 months postsurgery. This primary outcome measure will be statistically compared between groups (ACLR+ and standard ACLR). Secondary outcome measures include bilateral assessments of hamstring muscle morphology via MRI, biomechanical and electromyographic parameters during an anticipated 45° running side-step cut and multidirectional hopping task and patient-reported outcomes questionaries. Additionally, patient-reported outcomes questionaries will be collected before (baseline) as well as immediately after surgery, and at 2-6 weeks, 3-4 months, 10-12 months and 22-24 months postsurgery 10-12 months following surgery. ETHICS AND DISSEMINATION: Ethics approval has been granted by Griffith University Human Research Ethics Committee, Greenslopes Research and Ethics Committee, and Royal Brisbane & Women's Hospital Human Research Ethics Committee. Results will be submitted for publication in a peer-reviewed medical journal. TRIAL REGISTRATION NUMBER: ACTRN12618000762257p.

Effect of an Isometric or Eccentric Hip Extension Exercise Intervention on Hamstring Strength, Architecture, and Morphology.

PURPOSE: This study aimed to investigate hamstring architectural, strength, and morphological adaptations after an eccentric or isometric hip extension exercise intervention. METHODS: Twenty-four recreationally active males performed either an eccentric ( n = 12) or an isometric hip extension ( n = 12) exercise intervention, twice per week for 6 wk, followed by a 4-wk detraining period. Biceps femoris long head (BFlh) architecture was assessed pre-intervention, mid-intervention, post-intervention, and post-detraining via two-dimensional ultrasound. Strength was assessed pre-intervention, post-intervention, and post-detraining during an isokinetic knee flexion, an isometric hip extension, a Nordic hamstring exercise, and a single-leg hamstring bridge repetition to fatigue test. Hamstring muscle morphology was assessed via magnetic resonance imaging before strength testing sessions. RESULTS: The eccentric hip extension exercise intervention significantly lengthened BFlh fascicles (+19.7%, P < 0.001, d = 1.57), increased eccentric knee flexion torque (ECC 60°·s -1 , +12%, P < 0.005, d = 0.66; ECC 180°·s -1 , +8.3%, P < 0.05, d = 0.41), and increased BFlh (+13.3%, P < 0.001, d = 1.96) and semimembranosus (SM) muscle volume (+12.5%, P < 0.001, d = 2.25). After 4 wk of detraining, BFlh fascicles were significantly shortened in the eccentric group (-14.8%, P < 0.005, d = -1.25), whereas eccentric knee flexion torque and BFlh and SM volumes were unchanged. The isometric hip extension exercise intervention significantly increased isometric knee flexion torque (+10.4%, P < 0.05, d = 0.54), isometric hip extension force (+12.4%, P < 0.05, d = 0.41), and semitendinosus volume (+15%, P = 0.054, d = 1.57). All other outcome measures saw no significant changes. After 4 wk of detraining, no significant changes to any variables were observed in the isometric group. CONCLUSIONS: The eccentric but not isometric hip extension exercise intervention significantly increased BFlh fascicle length. Both exercise interventions demonstrated contraction mode-specific increases in strength. However, the eccentric hip extension exercise intervention resulted in preferential hypertrophy of BFlh and SM, and the isometric hip extension exercise intervention led to selective hypertrophy of semitendinosus.

Validity and between-unit agreement of commercially-available linear position transducer and inertial sensor devices during loaded countermovement jumps.

To assess the validity and between-unit agreement of velocity monitoring devices during incrementally-loaded countermovement jumps (CMJ), 16 males (24.0 ± 3.5 yr) completed 12 CMJs on a force plate (FP). Performance variables were collected through two linear position transducers (GymAware [GA]) and four accelerometer-based devices (two PUSH units, two Bar Sensei units). Pearson correlations (r) and coefficients of variation (CV) demonstrated strong to very-strong relationships (r = 0.60-0.88) and poor agreement (CV = 11.7-25.3%) between FP and GA, and moderate to very-strong relationships (r = 0.31-0.81) and poor agreement (CV = 10.1-24.2%) between FP and PUSH. Between-unit comparisons demonstrated moderate to very-strong relationships (r = 0.50-0.88) with poor agreement (CV = 10.8-26.6%) for GA, and very weak to very-strong relationships (r = 0.01-0.87) with moderate to poor agreement (CV = 9.1-24.1%) for PUSH. Bar Sensei units were excluded from analyses. Loaded CMJ data collected with either device displayed poor agreement with a FP. Velocity monitoring devices demonstrate poor validity across all loads; however, GA demonstrated strong between-unit agreement. A FP should be utilised to accurately assess CMJ performance at all times.

Nordic strength and history of hamstring injury in Australian Football League players.

OBJECTIVES: Compare hamstring strength between Australian Football League (AFL) players with and without a prior hamstring injury and determine the effect of the number of previous hamstring injuries, time since the last injury, and injury severity, on hamstring strength. DESIGN: Cross-sectional, retrospective. SETTING: AFL clubs. PARTICIPANTS: 124 AFL players. MAIN OUTCOME MEASURES: Bilateral hamstring strength was assessed on a Nordbord (Vald Performance) during the Nordic Hamstring Exercise. Self-reported questionnaires were used to record previous hamstring injuries. Players were categorized into No Injury or Hamstring Injury groups. Previously injured players were subgrouped based on number of prior hamstring injuries (single or multiple), time since the last hamstring injury (≤1 or > 1-year ago), and hamstring injury severity (≤3 or > 3 matches missed). RESULTS: 19 hamstring injuries were reported. Hamstring strength was not different between players with and without a history of hamstring injury when assessed in absolute (N) or relative (i.e., N.kg-1) terms. No differences in strength were detected between hamstring injury subgroups when assessed in absolute or relative terms. CONCLUSIONS: AFL players that experienced a previous hamstring injury did not exhibit deficits in hamstring strength relative to their uninjured limb or players without a previous hamstring injury.

Mechanical, Material and Morphological Adaptations of Healthy Lower Limb Tendons to Mechanical Loading: A Systematic Review and Meta-Analysis.

BACKGROUND: Exposure to increased mechanical loading during physical training can lead to increased tendon stiffness. However, the loading regimen that maximises tendon adaptation and the extent to which adaptation is driven by changes in tendon material properties or tendon geometry is not fully understood. OBJECTIVE: To determine (1) the effect of mechanical loading on tendon stiffness, modulus and cross-sectional area (CSA); (2) whether adaptations in stiffness are driven primarily by changes in CSA or modulus; (3) the effect of training type and associated loading parameters (relative intensity; localised strain, load duration, load volume and contraction mode) on stiffness, modulus or CSA; and (4) whether the magnitude of adaptation in tendon properties differs between age groups. METHODS: Five databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE) were searched for studies detailing load-induced adaptations in tendon morphological, material or mechanical properties. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated and data were pooled using a random effects model to estimate variance. Meta regression was used to examine the moderating effects of changes in tendon CSA and modulus on tendon stiffness. RESULTS: Sixty-one articles met the inclusion criteria. The total number of participants in the included studies was 763. The Achilles tendon (33 studies) and the patella tendon (24 studies) were the most commonly studied regions. Resistance training was the main type of intervention (49 studies). Mechanical loading produced moderate increases in stiffness (standardised mean difference (SMD) 0.74; 95% confidence interval (CI) 0.62-0.86), large increases in modulus (SMD 0.82; 95% CI 0.58-1.07), and small increases in CSA (SMD 0.22; 95% CI 0.12-0.33). Meta-regression revealed that the main moderator of increased stiffness was modulus. Resistance training interventions induced greater increases in modulus than other training types (SMD 0.90; 95% CI 0.65-1.15) and higher strain resistance training protocols induced greater increases in modulus (SMD 0.82; 95% CI 0.44-1.20; p = 0.009) and stiffness (SMD 1.04; 95% CI 0.65-1.43; p = 0.007) than low-strain protocols. The magnitude of stiffness and modulus differences were greater in adult participants. CONCLUSIONS: Mechanical loading leads to positive adaptation in lower limb tendon stiffness, modulus and CSA. Studies to date indicate that the main mechanism of increased tendon stiffness due to physical training is increased tendon modulus, and that resistance training performed at high compared to low localised tendon strains is associated with the greatest positive tendon adaptation. PROSPERO registration no.: CRD42019141299.

Load Centralization Does Not Affect the Kinetic and Kinematic Output of Countermovement Jumps.

ABSTRACT: Tredrea, MSJ, Middleton, KJ, Bourne, MN, Carey, DL, Scanlan, AT, and Dascombe, BJ. Load centralization does not affect the kinetic and kinematic output of countermovement jumps. J Strength Cond Res 36(4): 1084-1089, 2022-This study aimed to compare the kinetics, kinematics, and performance of countermovement jumps (CMJs) when completed with 2 different loading conditions (centralized or peripheral) across increasing loads. Seventeen subjects (12 men and 5 women) randomly completed 2 series of CMJs with increasing loads separated by a 30-minute rest period between conditions. Subjects were loaded with either a weighted vest (centralized) or straight barbell (peripheral). A randomized, counterbalanced crossover design was used with incremental loads of 10, 20, 30, 40, and 50% of body mass added to the vest or barbell. Measures of peak force, acceleration, velocity, and power were calculated across each subphase of the CMJs. No significant differences were observed in kinetic or kinematic variables between loading conditions. Within each condition there were significant reductions (p < 0.05) in peak concentric velocity and acceleration, as well as significant increases (p < 0.05) in peak force when the external load increased. Furthermore, braking and propulsive phase duration significantly increased (p < 0.05) and jump height significantly decreased (p < 0.05) as the external load increased. Countermovement jump performance was similar in both central and peripheral loading, whereas increasing load significantly affected jump height, force, velocity, and acceleration variables irrespective of load position. The training stimulus from an external load placed centrally or peripherally is similar regardless of where it is positioned; however, from a practical perspective, a weighted vest may provide a more mobile and safer alternative than a barbell.

Strength and Biomechanical Risk Factors for Noncontact ACL Injury in Elite Female Footballers: A Prospective Study.

PURPOSE: This study aimed to determine if a preseason field-based test battery was prospectively associated with noncontact anterior cruciate ligament (ACL) injury in elite female footballers. METHODS: In total, 322 elite senior and junior female Australian Rules Football and soccer players had their isometric hip adductor and abductor strength, eccentric knee flexor strength, countermovement jump (CMJ) kinetics, and single-leg hop kinematics assessed during the 2019 preseason. Demographic and injury history details were also collected. Footballers were subsequently followed for 18 months for ACL injury. RESULTS: Fifteen noncontact ACL injuries occurred during the follow-up period. Prior ACL injury (odds ratio [OR], 9.68; 95% confidence interval (95% CI), 2.67-31.46), a lower isometric hip adductor to abductor strength ratio (OR, 1.98; 95% CI, 1.09-3.61), greater CMJ peak take-off force (OR, 1.74; 95% CI, 1.09-3.61), and greater single-leg triple vertical hop average dynamic knee valgus (OR, 1.97; 95% CI, 1.06-3.63) and ipsilateral trunk flexion (OR, 1.60; 95% CI, 1.01-2.55) were independently associated with an increased risk of subsequent ACL injury. A multivariable prediction model consisting of CMJ peak take-off force, dynamic knee valgus, and ACL injury history that was internally validated classified ACL injured from uninjured footballers with 78% total accuracy. Between-leg asymmetry in lower limb strength and CMJ kinetics were not associated with subsequent ACL injury risk. CONCLUSIONS: Preseason field-based measures of lower limb muscle strength and biomechanics were associated with future noncontact ACL injury in elite female footballers. These risk factors can be used to guide ACL injury screening practices and inform the design of targeted injury prevention training in elite female footballers.

Screening Hamstring Injury Risk Factors Multiple Times in a Season Does Not Improve the Identification of Future Injury Risk.

PURPOSE: To determine if eccentric knee flexor strength and biceps femoris long head (BFlh) fascicle length were associated with prospective hamstring strain injury (HSI) in professional Australian Football players, and if more frequent assessments of these variables altered the association with injury risk. METHODS: Across two competitive seasons, 311 Australian Football players (455 player seasons) had their eccentric knee flexor strength during the Nordic hamstring exercise and BFlh architecture assessed at the start and end of preseason and in the middle of the competitive season. Player age and injury history were also collected in preseason. Prospective HSIs were recorded by team medical staff. RESULTS: Seventy-four player seasons (16%) sustained an index HSI. Shorter BFlh fascicles (<10.42 cm) increased HSI risk when assessed at multiple time points only (relative risk [RR], 1.9; 95% confidence interval [CI], 1.2-3.0). Neither absolute (N) nor relative (N·kg-1) eccentric knee flexor strength was associated with HSI risk, regardless of measurement frequency (RR range, 1.0-1.1); however, between-limb imbalance (>9%), when measured at multiple time points, was (RR, 1.8; 95% CI, 1.1-3.1). Prior HSI had the strongest univariable association with prospective HSI (RR, 2.9; 95% CI, 1.9-4.3). Multivariable logistic regression models identified a combination of prior HSI, BFlh architectural variables and between-limb imbalance in eccentric knee flexor strength as optimal input variables; however, their predictive performance did not improve with increased measurement frequency (area under the curve, 0.681-0.726). CONCLUSIONS: More frequent measures of eccentric knee flexor strength and BFlh architecture across a season did not improve the ability to identify which players would sustain an HSI.

Anterior Cruciate Ligament Reconstruction Increases the Risk of Hamstring Strain Injury Across Football Codes in Australia.

OBJECTIVE: The aim of this study was to determine the impacts of anterior cruciate ligament reconstruction (ACLR) and recent (< 12 months) hamstring strain injury (HSI) on (1) future HSI risk, and (2) eccentric knee flexor strength and between-limb imbalance during the Nordic hamstring exercise. A secondary goal was to examine whether eccentric knee flexor strength was a risk factor for future HSI in athletes with prior ACLR and/or HSI. METHODS: In this prospective cohort study, 531 male athletes had preseason eccentric knee flexor strength tests. Injury history was also collected. The main outcome was HSI occurrence in the subsequent competitive season. RESULTS: Overall, 74 athletes suffered at least one prospective HSI. Compared with control athletes, those with a lifetime history of ACLR and no recent HSI had 2.2 (95% confidence interval [CI] 1.1-4.4; p = 0.029) times greater odds of subsequent HSI while those with at least one HSI in the previous 12 months and no history of ACLR had 3.1 (95% CI 1.8-5.4; p < 0.001) times greater odds for subsequent HSI. Only athletes with a combined history of ACLR and recent HSI had weaker injured limbs (p = 0.001) and larger between-limb imbalances (p < 0.001) than uninjured players. An exploratory decision tree analysis suggested eccentric strength may protect against HSI after ACLR. CONCLUSION: ACLR and recent HSI were similarly predictive of future HSI. Lower levels of eccentric knee flexor strength and larger between-limb imbalances were found in athletes with combined histories of ACLR and recent HSI. These findings may have implications for injury rehabilitation.

Predicting Noncontact Lower Limb Injury Using Lumbar Morphology in Professional Australian Football and Rugby League Players.

INTRODUCTION: Noncontact lower limb injuries are common within the Australian Football League (AFL) and National Rugby League (NRL). Smaller (<8.5 cm2) lumbar multifidus at the fifth vertebra (LM L5) and larger (>8.2 cm2) quadratus lumborum (QL) cross-sectional area (CSA) have been associated with increased noncontact lower limb injury risk in AFL players. These associations have not been explored in an NRL cohort. This study will attempt to replicate previous research findings by confirming that muscle morphology is associated with noncontact lower limb injury. METHODS: AFL (n = 87) and NRL (n = 151) players underwent LM L2-L5 and QL CSA ultrasound measures during preseason. Each club's medical staff reported all noncontact lower limb injuries sustained in the subsequent regular season. LM and QL CSA, age, body mass index, and noncontact lower limb injuries were analyzed using multivariable logistic regression. RESULTS: Seventy-two players sustained a noncontact lower limb injury in the 2020 regular season (AFL = 21, NRL = 51). The multivariable logistic regression (odds ratio (OR) = 1.36; 95% confidence interval (CI), 1.02-1.85; P = 0.038) identified AFL players with larger QL CSA at increased risk of sustaining a noncontact lower limb injury during the regular season, but no relationship was found for LM CSA and noncontact lower limb injuries in the AFL (OR = 1.01; 95% CI, 0.36-2.78; P = 0.591) or NRL (OR = 0.63; 95% CI, 0.29-1.33; P = 0.149). CONCLUSIONS: AFL players who sustained regular season noncontact lower limb injuries had larger QL CSA in preseason tests. No significant associations between either LM L5 CSA or LM L5 to QL ratio and regular season noncontact lower limb injuries were found.