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Young female handball players represent a high-risk population for anterior cruciate ligament (ACL) injuries. While the external knee abduction moment (KAM) is known to be a risk factor, it is unclear how cutting technique affects KAMs in sport-specific cutting maneuvers. Further, the effect of added game specificity (e.g., catching a ball or faking defenders) on KAMs and cutting technique remains unknown. Therefore, this study aimed: (i) to test if athletes grouped into different clusters of peak KAMs produced during three sport-specific fake-and-cut tasks of different complexities differ in cutting technique, and (ii) to test whether technique variables change with task complexity. Fifty-one female handball players (67.0 ± 7.7 kg, 1.70 ± 0.06 m, 19.2 ± 3.4 years) were recruited. Athletes performed at least five successful handball-specific sidestep cuts of three different complexities ranging from simple pre-planned fake-and-cut maneuvers to catching a ball and performing an unanticipated fake-and-cut maneuver with dynamic defenders. A k-means cluster algorithm with squared Euclidean distance metric was applied to the KAMs of all three tasks. The optimal cluster number of koptimal = 2 was calculated using the average silhouette width. Statistical differences in technique variables between the two clusters and the tasks were analyzed using repeated-measures ANOVAs (task complexity) with nested groupings (clusters). KAMs differed by 64.5%, on average, between clusters. When pooling all tasks, athletes with high KAMs showed 3.4° more knee valgus, 16.9% higher downward and 8.4% higher resultant velocity at initial ground contact, and 20.5% higher vertical ground reaction forces at peak KAM. Unlike most other variables, knee valgus angle was not affected by task complexity, likely due to it being part of inherent movement strategies and partly determined by anatomy. Since the high KAM cluster showed higher vertical center of mass excursions and knee valgus angles in all tasks, it is likely that this is part of an automated motor program developed over the players' careers. Based on these results, reducing knee valgus and downward velocity bears the potential to mitigate knee joint loading and therefore ACL injury risk.
Biomechanical Risk Factors of Injury-Related Single-Leg Movements in Male Elite Youth Soccer Players
(2022)
Altered movement patterns during single-leg movements in soccer increase the risk of lower-extremity non-contact injuries. The identification of biomechanical parameters associated with lower-extremity injuries can enrich knowledge of injury risks and facilitate injury prevention. Fifty-six elite youth soccer players performed a single-leg drop landing task and an unanticipated side-step cutting task. Three-dimensional ankle, knee and hip kinematic and kinetic data were obtained, and non-contact lower-extremity injuries were documented throughout the season. Risk profiling was assessed using a multivariate approach utilising a decision tree model (classification and regression tree method). The decision tree model indicated peak knee frontal plane angle, peak vertical ground reaction force, ankle frontal plane moment and knee transverse plane angle at initial contact (in this hierarchical order) for the single-leg landing task as important biomechanical parameters to discriminate between injured and non-injured players. Hip sagittal plane angle at initial contact, peak ankle transverse plane angle and hip sagittal plane moment (in this hierarchical order) were indicated as risk factors for the unanticipated cutting task. Ankle, knee and hip kinematics, as well as ankle and hip kinetics, during single-leg high-risk movements can provide a good indication of injury risk in elite youth soccer players.
Running footwear is continuously being modified and improved; however, running-related overuse injury rates remain high. Nevertheless, novel manufacturing processes enable the production of individualized running shoes that can fit the individual needs of runners, with the potential to reduce injury risk. For this reason, it is essential to investigate functional groups of runners, a collective of runners who respond similarly to a footwear intervention. Therefore, the objective of this study was to develop a framework to identify functional groups based on their individual footwear response regarding injury-specific running-related risk factors for Achilles tendinopathy, Tibial stress fractures, Medial tibial stress syndrome, and Patellofemoral pain syndrome. In this work, we quantified the footwear response patterns of 73 female and male participants when running in three different footwear conditions using unsupervised learning (k-means clustering). For each functional group, we identified the footwear conditions minimizing the injury-specific risk factors. We described differences in the functional groups regarding their running style, anthropometric, footwear perception, and demographics. The results implied that most functional groups showed a tendency for a single footwear condition to reduce most biomechanical risk factors for a specific overuse injury. Functional groups often differed in their hip and pelvis kinematics as well as their subjective rating of the footwear conditions. The footwear intervention only partially affected biomechanical risk factors attributed to more proximal joints. Due to its adaptive nature, the framework could be applied to other footwear interventions or performance-related biomechanical variables.