(1) Background: A parsimonious test battery is deemed necessary to efficiently assess the functional performance of athletes avoiding redundant measurements. This study investigates the interrelationships between elements of an experimental field-based test battery during pre-season assessment (PA), with the purpose of enhancing comprehension of the underlying structure of the assessed variables and suggesting guidelines for the tests incorporated in a PA. (2) Methods: Sixty-two professional football athletes performed a PA, including isometric muscle strength, triple hop and core stability tests, the LESS, and evaluation of landing performance through kinetic and electromyographic data. (3) Results: For the dominant lower limb, the factor analysis resulted in six factors, explaining 79.04% of the variance including core stability, ground reaction forces, dynamic balance, hamstrings strength, quadriceps–hamstring EMG ratio, and quadriceps performance. For the non-dominant lower limb, factor analysis resulted in five factors, explaining 76.60% of the variance including core stability, dynamic balance, ground reaction force, quadriceps–hamstring EMG ratio, and quadriceps–abductors strength. The LESS was loaded with various factors. (4) Conclusions: Given the need for efficient field-based assessments that can be repeated throughout the season without sacrificing data quality, we suggest incorporating the LESS, the prone bridge test, and force-plate-based landing performance evaluation as key elements of the PA.

(1) Background: There is a need for a parsimonious test battery to efficiently assess the functional performance of athletes without redundant measurements. This study investigates the interrelationships between elements of an experimental field-based test battery during pre-season assessment (PA), with the purpose of enhancing comprehension of the underlying structure of the assessed variables and suggesting guidelines for the tests incorporated in a PA; (2) Methods: Sixty-two professional athletes performed a PA included strength, hop and core stability tests and evaluation of landing performance through kinetic and electromyographic data; (3) Results: For the dominant lower limb, the factor analysis resulted in 6 factors, explaining 79,04 % of the variance including core stability, Ground Reaction Forces, Dynamic balance, Hamstrings Strength, Quadriceps-Hamstring EMG ratio and Quadriceps performance. For the non-dominant lower limb, factor analysis resulted in 5 factors, explaining 76,60 % of the variance including Core stability, Dynamic balance, Ground Reaction Force, Quadriceps-Hamstring EMG ratio and Quadriceps - Abductors Strength. LESS was loaded with various factors. (4) Conclusions: Given the need for efficient field-based assessments that can be repeated throughout the season without sacrificing data quality, we suggest incorporating LESS, the prone bridge test, and force plate-based landing performance evaluation as key elements of the PA.

Background: There is no consensus on the optimal testing procedure to determine return-to-sport (RTS) readiness after anterior cruciate ligament (ACL) reconstruction. Current approaches use limb symmetry across a range of tests, but this does not consider a patient’s level of athleticism or benchmarks relative to his or her noninjured counterparts. Purpose: To examine the utility of the Total Score of Athleticism (TSA), a composite scale including strength, power, and reactive strength assessments, to aid RTS decision-making. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 95 professional soccer players (60 who underwent ACL reconstruction [mean age, 25.1 ± 12.6 years] and 35 who were uninjured [mean age, 23.8 ± 2.8 years]) completed a battery of tests including isokinetic knee extension and flexion torque, bilateral and unilateral countermovement jump height, relative peak power, and reactive strength index–modified. The TSA score (derived from Z scores) was calculated, and we (1) examined differences between the ACL-reconstructed and uninjured groups at the time of RTS, (2) assessed the predictive ability of the TSA to identify the player’s status (ACL reconstruction vs uninjured control), and (3) included a case series to discuss the characteristics of players who sustained a subsequent injury within 4 months after RTS. Results: A large difference between the ACL-reconstructed and uninjured groups in the TSA score ( d = 0.84; P < .0001) was evident. For every additional increase of 1 unit in the TSA score, the odds of belonging to the ACL-reconstructed group decreased by 74% (95% CI, 0.19-0.56). By visual inspection, the frequency of reinjured players was higher in the low (4/7) TSA tertile compared with the medium (2/7) and high (1/7) TSA tertiles. Conclusion: Preliminary evidence indicates that the TSA may be a useful RTS readiness tool, as the composite score derived from strength and power measures was different in soccer players at the time of RTS after ACL reconstruction compared with healthy matched controls. There was also a higher frequency of low TSA scores in players who sustained a second injury after RTS. Therefore, it is recommended to routinely administer RTS tests encompassing strength, power, and reactive strength qualities each season across the largest possible number of players (ideally teammates).

Background Jump testing performance and limb symmetry measures are important metrics for clinicians to monitor during rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction, however they require hardware and software which is not commonly available in clinical practice. Video-based solutions may present a feasible alternative, but their veracity in classifying patients using limb-symmetry of 90% has not been established, nor have the clinimetric values for the performance measures been reported in this population. Purpose To describe the diagnostic accuracy (pass/fail using 90% LSI) and clinimetrics of an iPad-based app (“MyJump”) compared to reference force plate analyses for limb symmetry, jump/hop height, contact time, flight time, and reactive strength index Study design Prospective cohort, diagnostic accuracy Methods Fifty-one consecutive patients recovering from ACL reconstruction undertaking routine independent clinical evaluation of their hop and jump performance were concurrently and independently examined using force plates and the MyJump app. Diagnostic accuracy of MyJump was compared to reference force plate analyses using a criterion of 90% limb symmetry. Results Diagnostic accuracy of the MyJump app was very good: positive predictive value for jump height was 0.83 and 1.0 for reactive strength index, and negative predictive value was 0.95 and 1.0 for the same metrics, respectively. Of the 131 classifications made using the MyJump app, there were five false positives and three false negatives – all of these were in classification of jump height with no misclassifications of RSI. Irrespective of jump type, the MyJump app displayed excellent reliability (ICC>0.95) for both height and reactive strength index. Minimum detectable changes were approximately 1cm for height, 0.1 for reactive strength index, 0.02s for contact time, and 0.3s for flight time. Conclusion Where force plates are unavailable, the MyJump app is a valid and reliable substitute for criteria assessment of jump/hop height and reactive strength index in those recovering from ACL surgery using a 90% limb symmetry threshold. The minimum detectable changes vary by metric but are likely sufficiently accurate to detect clinical changes. Level Of Evidence Level 3

BACKGROUND:Strength and power is often reduced on the involved versus contralateral limb and healthy controls after anterior cruciate ligament (ACL) reconstruction, but no study has compared with preinjury values at the time of return to sport (RTS). HYPOTHESIS:Divergent recovery patterns in strength and power characteristics will be present at RTS relative to preinjury baseline data and healthy matched controls. STUDY DESIGN:Cohort study. LEVEL OF EVIDENCE:Level 3. METHODS:Isokinetic strength tests, bilateral and single-leg countermovement jumps (CMJ; SLCMJ) were measured before ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow-up testing before RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group preinjury. Values recorded at RTS of the ACL group were compared with preinjury. We also compared the uninjured and ACL groups at baseline and RTS. RESULTS:Compared with preinjury, ACL normalized quadriceps peak torque of the involved limb (difference = -7%), SLCMJ height (difference = -12.08%), and Reactive Strength Index modified (RSImod) (difference = -5.04%) were reduced after ACL reconstruction. No significant reductions in CMJ height, RSImod, and relative peak power were indicated at RTS in the ACL group when compared with preinjury values, but deficits were present relative to controls. The uninvolved limb improved quadriceps (difference = 9.34%) and hamstring strength (difference = 7.36%) from preinjury to RTS. No significant differences from baseline were shown in SLCMJ height, power, and reactive strength of the uninvolved limb after ACL reconstruction. CONCLUSION:Strength and power in professional soccer players at RTS after ACL reconstruction were often reduced compared with preinjury values and matched healthy controls. CLINICAL RELEVANCE:Deficits were more apparent in the SLCMJ, suggesting that dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.

This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction. A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity. A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42

Single leg drop jump (SLDJ) assessment is commonly used during the later stages of rehabilitation to identify residual deficits in reactive strength but the effects of physical capacity on kinetic and kinematic variables in male soccer players following ACL reconstruction remain unknown. Isokinetic knee extension strength, kinematics from an inertial measurement unit 3D system and SLDJ performance variables and mechanics derived from a force plate were measured in 64 professional soccer players (24.7 ± 3.4 years) prior to return to sport (RTS). SLDJ between-limb differences was measured (part 1) and players were divided into tertiles based on isokinetic knee extension strength (weak, moderate and strong) and reactive strength index (RSI) (low, medium and high) (part 2). Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance (d = 0.92-1.05), kinetic (d = 0.62-0.71) and kinematic variables (d = 0.56) were evident. Stronger athletes jumped higher (p = 0.002; d = 0.85), produced greater concentric (p = 0.001; d = 0.85) and eccentric power (p = 0.002; d = 0.84). Similar findings were present for RSI, but the effects were larger (d = 1.52-3.84). Weaker players, and in particular those who had lower RSI, displayed landing mechanics indicative of a 'stiff' knee movement strategy. SLDJ performance, kinetic and kinematic differences were identified between-limbs in soccer players at the end of their rehabilitation following ACL reconstruction. Players with lower knee extension strength and RSI displayed reduced performance and kinetic strategies associated with increased injury risk.

OBJECTIVE:Vertical jump tests are more sensitive in revealing asymmetries in performance metrics at the time of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) than horizontal hop tests. However, it remains unclear which vertical tests (bilateral or unilateral) and which metrics (kinetics or performance) are most effective in informing the rehabilitation status and readiness for return to sport. We aimed to investigate the status of athletes during vertical jump testing at return to sport after ACLR. METHODS:A dual force platform system was used to evaluate jumping performance of 126 recreational and professional athletes at the time of return to sport after ACLR, as well as 532 healthy control participants. Performance and kinetic metrics were collected during four jump tests: double-leg countermovement jump, single-leg countermovement jump, double-leg 30 cm drop jump and single-leg 15 cm drop jump. Between-limb and between-group differences were explored using mixed models analyses. RESULTS:At the time of return to sport after ACLR, athletes still presented significant differences favouring the uninvolved side, particularly in the symmetry of the concentric impulse (p<0.001) in all jumps compared with the control group. Peak landing force asymmetry was greater in the ACLR group than the controls during the countermovement (p<0.001, MD=-11.6; 95% CI -15.4 to -7.9) and the double-leg drop jump (p=0.023, MD=-8.9; 95% CI -14.9 to -2.8). The eccentric impulse asymmetry was significantly greater (p=0.018, MD=-3.8; 95% CI -5.8 to -1.7) in the ACLR group during the single-leg drop jump only. Jump height was significantly lower (p<0001) in the ACLR group compared with controls in all tests except the double-leg drop jump. CONCLUSION:At the time of return to sport after ACLR, despite passing the traditional discharge criteria, athletes remained asymmetrical during all vertical jump tests, in the concentric (push-off) phase, during landing from bilateral jumps and for most performance metrics. Clinicians should aim to restore not only symmetry in ground reaction forces but also absolute performance metrics such as jump height, reactive strength index and contact times, to potentially reduce injury risk and improve overall athletic performance.

Background: Current return-to-sport (RTS) criteria after anterior cruciate ligament (ACL) reconstruction (ACLR) include demonstrating symmetry in functional and strength tests. It remains unknown if at the time that athletes are cleared to RTS, they exhibit between-limb symmetry in ACL and tibiofemoral contact forces or if these forces are comparable with those in uninjured athletes. Purposes: To (1) examine ACL and tibiofemoral contact forces in athletes who underwent ACLR and were cleared to RTS and (2) compare the involved leg to the healthy contralateral leg and healthy controls during functional tasks. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 26 male athletes who underwent ACLR were tested at the time of RTS during tasks that included single-leg vertical, horizontal, and side jumps; cutting maneuvers; and high-intensity running. We used an electromyography-constrained musculoskeletal modeling workflow to estimate ACL and tibiofemoral contact forces and compared the results with those of 23 healthy male participants. Results: The ACLR group presented no differences in peak tibiofemoral contact forces in the involved limb compared with the control group. However, there were significant between-limb differences mainly due to higher contact forces in the uninvolved (healthy) limb of the ACLR group compared with the control group. In the ACLR group, ACL forces were significantly higher in the uninvolved limb compared with the involved limb during cutting and running. Lateral contact forces were lower in the involved compared with the uninvolved limb, with large effect sizes during cutting ( d = 1.14; P < .001) and running ( d = 1.10; P < .001). Conclusion: Current discharge criteria for clearance to RTS after ACLR did not ensure the restoration of symmetric loading in our cohort of male athletes. ACL force asymmetry was observed during cutting and running, in addition to knee loading asymmetries on several tasks tested.

BACKGROUND:After anterior cruciate ligament reconstruction (ACLR), a battery of strength and hop tests is frequently used to determine the readiness of an athlete to successfully return to sports. However, the anterior cruciate ligament reinjury rate remains alarmingly high.PURPOSE:To evaluate the lower limb function of athletes after ACLR at the time when they had been cleared to return to sports (RTS). We aimed to evaluate if passing discharge criteria ensures restoration of normal lower limb biomechanics in terms of kinematics, kinetics, work, and percentage work contribution during a triple hop for distance.STUDY DESIGN:Controlled laboratory study.METHODS:Integrated 3-dimensional motion analysis was performed in 24 male athletes after ACLR when cleared to RTS and 23 healthy male controls during the triple-hop test. The criteria for RTS were (1) clearance by the surgeon and the physical therapist, (2) completion of a sports-specific on-field rehabilitation program, and (3) limb symmetry index >90% after quadriceps strength and hop battery tests. Lower limb and trunk kinematics, as well as knee joint moments and work, were calculated. Between-limb differences (within athletes after ACLR) and between-group differences (between ACLR and control groups) were evaluated using mixed linear models.RESULTS:Although achieving 97% limb symmetry in distance hopped and displaying almost 80% symmetry for knee work absorption in the second rebound and third landing, the ACLR cohorts demonstrated only 51% and 66% limb symmetry for knee work generation in the first and second rebound phases, respectively. During both work generation phases of the triple hop, the relative contribution of the involved knee was significantly smaller, with a prominent compensation from the hip joint (P < .001, for all phases) as compared with the uninvolved limb and the controls. In addition, patients deployed a whole body compensatory strategy to account for the between-limb differences in knee function, mainly at the hip, pelvis, and trunk.CONCLUSION:Symmetry in the triple hop for distance masked important deficits in the knee joint work. These differences were more prominent during work generation (concentric-propulsive) than work absorption (eccentric-landing).CLINICAL RELEVANCE:Symmetry in hop distance during the triple hop test masked significant asymmetries in knee function after ACLR and might not be the appropriate outcome to use as a discharge criterion. Differences between limbs in athletes after ACLR were more prominent during the power generation than the absorption phase.

Objective: To report how wearable sensors have been used to identify between-limb deficits during functional tasks following ACL reconstruction and critically examine the methods used. Methods: We performed a scoping review of studies including participants with ACL reconstruction as the primary surgical procedure, who were assessed using wearable sensors during functional movement tasks (e.g., balance, walking or running, jumping and landing) at all postsurgical time frames. Results: Eleven studies met the inclusion criteria. The majority examined jumping-landing tasks and reported kinematic and kinetic differences between limbs (involved vs. unninvolved) and groups (injured vs. controls). Excellent reliability and moderate-strong agreement with laboratory protocols was indicated, with IMU sensors providing an accurate estimation of kinetics, but the number of studies and range of tasks used were limited. Methodological differences were present including, sensor placement, sampling rate, time post-surgery and type of assessment which appear to affect the outcome. Conclusions: Wearable sensors consistently identified between-limb and group deficits following ACL reconstruction. Preliminary evidence suggests these technologies could be used to monitor knee function during rehabilitation, but further research is needed including, validation against criterion measures. Practitioners should also consider how the methods used can affect the accuracy of the outcome. (c) 2022 Published by Elsevier Ltd.

Abstract Nascimento, N, Sideris, V, and Read, PJ. Biomechanical analysis of the tuck jump assessment. J Strength Cond Res 36(10): 2946–2949, 2022—The tuck jump assessment (TJA) examines plyometric technique flaws associated with the increased risk of anterior cruciate ligament injury. Biomechanical data to investigate the mechanics used during the TJA are limited and assessing each jump individually across the entire test period is time inefficient. This study examined performance characteristics and movement mechanics in 16 professional soccer players during a standardized TJA protocol (10 jumps) to determine if sensitive periods exist within the test period (first 5 vs. last 5). Jump height, average power (PW) reactive strength index (RSI), frontal plane projection angle (FPPA), knee angular velocity (AV), and peak knee flexion angle (PKA) were analyzed using an optoelectrical and inertial measurement unit device. Jump height and PW increased in the past 5 jumps displaying a medium effect size (d = > 0.5). A trend was observed of increased AV, FPPA, and PKA during the past 5 jumps; however, no meaningful differences were observed between respective jump phases, and effect sizes were small (d ≤ 0.2). This study indicates that performance metrics increase during the past 5 jumps of a standardized TJA 10-jump protocol; thus, analyzing the entire test period may not be required, providing a time-efficient approach. Caution should be applied if using this protocol as an injury risk screening tool or to identify fatigue related alterations in male professional soccer players as no obvious movement abnormalities were apparent and minimal differences were present between jump phases in a range of kinematic variables across the recorded test duration.

Abstract Read, PJ, Pedley, JS, Eirug, I, Sideris, V, and Oliver, JL. Impaired stretch-shortening cycle function persists despite improvements in reactive strength followingafter anterior cruciate ligament reconstruction. J Strength Cond Res 36(5): 1238–1244, 2022—Reactive strength index (RSI) during a single-leg drop jump (SLDJ) has been indicated to determine return-to-sport readiness after anterior cruciate ligament (ACL) reconstruction, but only cross-sectional studies are available. Ground reaction force data and characterization of stretch-shortening cycle (SSC) function also remain sparse. Single-leg drop jump performance, ground reaction force, and SSC function were examined in soccer players with ACL reconstruction (n = 26) and matched controls (n = 25). Injured players were tested at 2 time points (32 and 42 weeks postsurgery). Stretch-shortening cycle function was classified as good (no impact peak and spring like), moderate (impact peak but still spring like or no impact peak and not spring like), or poor (impact peak and not spring like). The involved limb displayed lower-jump height, poorer RSI, less spring-like behavior, earlier peak landing force, and a greater ratio of landing peak to take-off peak force compared with the uninvolved limb and controls at the initial assessment (p < 0.001). Proportionally, more involved limbs were categorized as poor or moderate at the initial assessment (69.2%) and follow-up (50%) in comparison with the control limbs (14%). The reactive strength index was the only variable to change significantly between the initial assessment and follow-up on the involved limb (p < 0.05). No changes in the proportion of ACL reconstructed individuals categorized as poor or moderate SSC function at the follow-up assessment were observed. Residual deficits are present in SLDJ performance, SSC function, and ground reaction force characteristics after ACL reconstruction. The reactive strength index should not be the sole metric, as observed increases did not correspond with changes in SSC function.

Objectives Vertical jump performance (height) is a more representative metric for knee function than horizontal hop performance (distance) in healthy individuals. It is not known what the biomechanical status of athletes after anterior cruciate ligament (ACL) reconstruction (ACLR) is at the time they are cleared to return to sport (RTS) or whether vertical performance metrics better evaluate knee function. Methods Standard marker-based motion capture and electromyography (EMG) were collected from 26 male athletes cleared to RTS after ACLR and 22 control healthy subjects during single leg vertical jumps (SLJ) and single leg drop jumps (SLDJ). Performance outcomes, jump height and the Reactive Strength Index, were calculated. Sagittal plane kinematics, joint moments and joint work were obtained using inverse dynamics and lower limb muscle forces were computed using an EMG-constrained musculoskeletal model. Muscle contribution was calculated as a percentage of the impulse of all muscle forces in the model. Between-limb and between-group differences were explored using mixed models analyses. Results Jump performance, assessed by jump height and Reactive Strength Index, was significantly lower in the involved than the uninvolved limb and controls, with large effect sizes. For the ACLR group, jump height limb symmetry index was 83% and 77% during the SLJ and SLDJ, respectively. Work generation was significantly less in the involved knee compared to uninvolved limb and controls during the SLJ (p<0.001; d=1.19; p=0.003, d=0.91, respectively) and during the SLDJ (p<0.001; d=1.54; p=0.002, d=1.05, respectively). Hamstrings muscle contribution was greater in the involved compared to the uninvolved limb and controls, whereas soleus contribution was lower in the involved limb compared to controls. Conclusions During vertical jumps, male athletes after ACLR at RTS still exhibit knee biomechanical deficits, despite symmetry in horizontal functional performance and strength tests. Vertical performance metrics like jump height and RSI can better identify interlimb asymmetries than the more commonly used hop distance and should be included in the testing battery for the RTS.

Background Hop tests are part of the discharge criteria to determine return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Usually, only the distance hopped is measured, but little is known regarding biomechanical performance during these tests. Objective Describe biomechanical parameters of ACLR patients during single and triple hop for distance at the time of RTS. Design Cross-sectional study. Setting Laboratory, level I sport athletes. Patients (or Participants) 28 males: 14 primary ACLR patients (24±6 years) who were cleared to RTS, 14 healthy recreational athletes (30±5). Interventions (or Assessment of Risk Factors) Biomechanical differences between limbs and groups. Main Outcome Measurements Knee power absorption and generation during the propulsion and landing phases of single and triple hops. Results Despite similar hop distance, ACLR patients had significantly lower between-limb knee power generation (d=1.12, p=0.001), and absorption (d=1.00, p=0.002) during single hop and less power compared to controls in both phases (d=0.78, p=0.05). During triple hop, ACLR patients displayed less knee power generation in the first (d=1.11, p=0.001) and second hop (d=1.14, p=0.001) and less power absorption in the final landing (d=0.73, p=0.017) in comparison to the uninvolved leg. Similarly, ACLR patients had less knee power generation in the first (d=1.69, p=0.000) and second hop (d=1.21, p=0.004) and less absorption in the final landing (d=1.09, p=0.008) compared to the control group. Conclusions ACLR patients underload their injured knee despite meeting hop distance targets to be cleared to RTS. This pattern has not been documented previously and could explain the high risk of reinjury to the knee and other structures in the kinetic chain after RTS.

BackgroundWe evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls).MethodsWe captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively.ResultsSignificant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion.ConclusionSymmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.

Background: Progressive loading of the lower limb muscles during running on a positive pressure or reduced gravity (Alter-G (TM)) treadmill is suggested as a rehabilitation strategy after muscle and tendon injury but the influence of running up or downhill and at higher speeds is not known, nor are the interaction effects of speed, inclination, and indicated bodyweight. Research question: What are the lower limb EMG activation levels and cadence when running up and downhill in normal and reduced gravity? Methods: 10 recreationally active male athletes ran on a positive-pressure Alter-G (TM) treadmill at: 3 indicated bodyweights (60 %, 80 %, and 100 %); 5 speeds (12, 15, 18, 21, and 24 km/h); for incline, decline, and flat conditions (-15 %, -10 %, -5%, 0%, 5%, 10 %, and 15 %); while monitoring the surface EMG of 11 leg muscles as well as cadence (strides per minute). Results and significance: Linear mixed models showed significant effect of running speed, inclination, and indicated bodyweight, with interaction effects observed. Increasing running speed was associated with the largest change in activity, with smaller effects for increasing bodyweight and inclination. Downhill running was associated with reduced activity in all muscle groups, and more tightly clustered activity patterns independent of speed. Substantial variation in sEMG activity occurred in the flat and uphill conditions. Subject responses were quite variable for sEMG, less so for cadence. For the conditions examined, increasing running speed induced the largest changes in EMG of all muscles examined with smaller changes seen for manipulations of inclination and bodyweight.

BACKGROUND:Single-leg vertical and horizontal hop tests are commonly used to assess performance of healthy athletes and as a measure of progress during rehabilitation from knee injury. It is unclear if they measure similar aspects of leg function, as the relative joint contributions of the hip, knee, and ankle joints during propulsion and landing are unknown.HYPOTHESIS:The proportion of work done by the hip, knee, and ankle will not be the same for these 2 jump types and will vary for propulsive and landing phases.STUDY DESIGN:Cross-sectional cohort study.LEVEL OF EVIDENCE:Level 3.METHODS:Twenty physically active participants completed instrumented single-leg hop analysis in both vertical and horizontal directions. Joint peak power, work generated or absorbed, and percentage contribution of each joint during propulsive and landing phases were compared between tasks using paired t tests.RESULTS:Vertical hop was performed with roughly similar contributions of the hip, knee, and ankle for both propulsion (31%, 34%, 35%, respectively) and landing (29%, 34%, 37%, respectively). Horizontal hop distance was mostly (87%) determined by the hip and ankle (44% and 43%), but landing was mostly (65%) performed by the knee with lesser contribution from the hip and ankle (24% and 11%). Propulsive phase showed a proximal-to-distal temporal sequence for both hop types, but landing was more complex.CONCLUSION:Performance during vertical and horizontal hops (jump height and jump distance, respectively) measures different aspects of hip, knee, and ankle function during the propulsive and landing phases.CLINICAL RELEVANCE:Assessment of knee joint function during rehabilitation should not be done using a horizontal hop. The knee contributes about a third to vertical hop height, but only about an eighth to horizontal hop distance. Practitioners carrying out performance testing using either vertical or horizontal hops should be mindful of the relative contributions for meaningful training inferences to be derived.

Background Hop tests are part of the discharge criteria to determine return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Usually, only the distance hopped is measured, but little is known regarding biomechanical performance during these tests. Objective Describe biomechanical parameters of ACLR patients during single and triple hop for distance at the time of RTS. Design Cross-sectional study. Setting Laboratory, level I sport athletes. Patients (or Participants) 28 males: 14 primary ACLR patients (24±6 years) who were cleared to RTS, 14 healthy recreational athletes (30±5). Interventions (or assessment of risk factors) Biomechanical differences between limbs and groups. Main outcome measurements Knee power absorption and generation during the propulsion and landing phases of single and triple hops. Results Despite similar hop distance, ACLR patients had significantly lower between-limb knee power generation (d=1.12, p=0.001), and absorption (d=1.00, p=0.002) during single hop and less power compared to controls in both phases (d=0.78, p=0.05). During triple hop, ACLR patients displayed less knee power generation in the first (d=1.11, p=0.001) and second hop (d=1.14, p=0.001) and less power absorption in the final landing (d=0.73, p=0.017) in comparison to the uninvolved leg. Similarly, ACLR patients had less knee power generation in the first (d=1.69, p=0.000) and second hop (d=1.21, p=0.004) and less absorption in the final landing (d=1.09, p=0.008) compared to the control group. Conclusions ACLR patients underload their injured knee despite meeting hop distance targets to be cleared to RTS. This pattern has not been documented previously and could explain the high risk of reinjury to the knee and other structures in the kinetic chain after RTS.

Aim: To compare repositioning error, habitual and self-perceived optimal sitting posture, between patients with low back pain presenting with a directional preference into extension and asymptomatic individuals. Method: Fifteen patients with low back pain were matched with 15 asymptomatic individuals. Lumbo-pelvic repositioning error, pain, functional disability, and depression were evaluated. Participants reproduced two target positions (neutral and lordotic sitting postures) after slump sitting. Results: No significant differences (all p > .05) were detected between patients with low back pain and asymptomatic individuals in error direction, magnitude and variability. Furthermore, no differences were found in habitual or self-perceived optimal posture between the patients and control groups. Conclusions: We found no evidence of deficits in proprioception in patients with mild low back pain and directional preference into extension. While the lack of clear deficits in repositioning error is consistent with many previous studies, there are also data suggesting deficits in repositioning error among patients with low back pain. Variations in methodology, the population of patients studied, and especially their level of pain, could explain this variation. The lack of consistent deficits in repositioning error suggests other factors, across the biopsychosocial spectrum, may be more relevant in the development, and persistence, of low back pain.