Marc F. Norcross

Trunk and Hip Biomechanics Influence Anterior Cruciate Loading Mechanisms in Physically Active Participants

Background: Excessive trunk motion and deficits in neuromuscular control (NMC) of the lumbopelvic hip complex are risk factors for anterior cruciate ligament (ACL) injury. However, the relationship between trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads during a sidestep cutting task has not been examined. Purpose: To determine if there is an association between multiplanar trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads with ACL injury during a sidestep cutting task. Study Design: Descriptive laboratory study. Methods: The hip and knee biomechanics and trunk motion of 30 participants (15 male, 15 female) were analyzed during a sidestep cutting task using an optoelectric camera system interfaced to a force plate. Trunk and lower extremity biomechanics were calculated from the kinematic and ground-reaction force data during the first 50% of the stance time during the cutting task. Pearson product moment correlation coefficients were calculated between trunk and lower extremity biomechanics. Multiple linear regression analyses were carried out to determine the amount of variance in triplanar knee loading explained by trunk motion and hip moments. Results: A greater internal knee varus moment (mean, 0.11 ± 0.12 N·m/kg*m) was associated with less transverse-plane trunk rotation away from the stance limb (mean, 20.25° ± 4.42°; r = −0.46, P = .011) and a greater internal hip adduction moment (mean, 0.33 ± 0.25 N·m/kg*m; r = 0.83, P < .05). A greater internal knee external rotation moment (mean, 0.11 ± 0.08 N·m/kg*m) was associated with a greater forward trunk flexion (mean, 7.62° ± 5.28°; r = 0.42, P = .020) and a greater hip internal rotation moment (mean, 0.15 ± 0.16 N·m/kg*m; r = 0.59, P = .001). Trunk rotation and hip adduction moment explained 81% (P < .05) of the variance in knee varus moment. Trunk flexion and hip internal rotation moment explained 48% (P < .05) of the variance in knee external rotation moment. Conclusion: Limited trunk rotation displacement toward the new direction of travel and hip adduction moment are associated with an increased internal knee varus moment, while a combined increase in trunk flexion displacement and hip internal rotation moment is associated with a higher internal knee external rotation moment. Clinical Relevance: Prevention interventions for ACL injury should encourage trunk rotation toward the new direction of travel and limit excessive trunk flexion while adjusting frontal- and transverse-plane hip NMC.

The influence of hip strength on gluteal activity and lower extremity kinematics

The effects of hip muscle strength and activation on anterior cruciate ligament injury biomechanics, particularly knee valgus loading, have been reported in isolation and with equivocal results. However, the combination of these factors influences joint biomechanics. This investigation evaluated the influence of hip strength on gluteal activation and knee valgus motion. Maximal isometric hip abduction (ABD) and external rotation (ER) contractions were used to define High and Low strength groups. Knee kinematics and gluteus maximus (GMax) and medius (GMed) EMG amplitudes obtained during landing were compared between High and Low strength groups after controlling for the potential confounding influence of sex. Knee valgus motion did not differ between the High and Low hip ABD and ER strength groups. However, the Low ABD and ER strength groups displayed greater GMed and GMax EMG amplitudes, respectively, compared to the High strength groups. These findings suggest that weaker individuals compensate for a lack of force production via heightened neural drive. As such, hip muscle strength influences knee valgus motion indirectly by determining neural drive requirements.

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading.

CONTEXT Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks. OBJECTIVE To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg). INTERVENTION(S) Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests. MAIN OUTCOME MEASURE(S) Hamstrings stiffness was normalized to body mass (N/m·kg(-1)). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height. RESULTS Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729-2.224, P < .05). CONCLUSIONS Greater hamstrings stiffness was associated with landing biomechanics consistent with less ACL loading and injury risk. Musculotendinous stiffness is a modifiable characteristic; thus exercises that enhance hamstrings stiffness may be important additions to ACL injury-prevention programs.

Lower Extremity Energy Absorption and Biomechanics During Landing, Part I: Sagittal-Plane Energy Absorption Analyses

CONTEXT Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. OBJECTIVE To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. INTERVENTION(S) We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. MAIN OUTCOME MEASURE(S) Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to compare male and female representation in the high and low groups. RESULTS The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P < .05) and low (P < .05) groups and greater anterior tibial shear force than the low group (P < .05). No other group differences were noted. Women were not represented more than men in the high group (χ(2) = 1.20, P = .27). CONCLUSIONS Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential.

The effects of oral contraceptive use on muscle stiffness across the menstrual cycle.

ObjectiveTo determine the effect of oral contraceptives (OC) on hamstring neuromechanics and lower extremity stiffness across the menstrual cycle (MC). DesignCausal comparative. SettingResearch laboratory. ParticipantsThirty, healthy, normally menstruating female volunteers who were using OC (OC group, n = 15) or not (non-OC group, n = 15). Assessment of Risk FactorsStiffness and hamstring neuromechanics were assessed at 2 points of the MC corresponding to low (menses) and high (ovulation) hormone concentrations. Menses testing took place 3 to 5 days after the onset of menses (or pills 3-5 for the OC group). Ovulation test session occurred 2 to 4 days after ovulation identified using a commercial ovulation kit (or pills 15-17 in the OC group). Main Outcome MeasuresLower extremity stiffness and hamstring neuromechanics [stiffness, electromechanical delay, rate of force production (RFP), time to 50% peak force (T50%)] and blood plasma concentrations of estradiol-&bgr;-17, free testosterone, and progesterone. ResultsEstradiol-&bgr;-17, free testosterone, and progesterone increased at ovulation in the non-OC group and remained constant in the OC group. No changes were observed across the MC or between the groups in other variables (P > 0.05). ConclusionsAlthough previous literature suggests a prophylactic effect of OC use with respect to musculoskeletal injury risk, our results indicate that OC use does not affect muscle properties in manners thought to reduce ACL injury risk.

Spinal and Supraspinal Motor Control Predictors of Rate of Torque Development

During explosive movements and potentially injurious situations, the ability to rapidly generate torque is critical. Previous research has suggested that different phases of rate of torque development (RTD) are differentiately controlled. However, the extent to which supraspinal and spinal mechanisms predict RTD at different time intervals is unknown. RTD of the plantarflexors across various phases of contraction (i.e., 0–25, 0–50, 0–100, 0–150, 0–200, and 0–250 ms) was measured in 37 participants. The following predictor variables were also measured: (a) gain of the resting soleus H‐reflex recruitment curve; (b) gain of the resting homonymous post‐activation depression recruitment curve; (c) gain of the GABAergic presynaptic inhibition recruitment curve; (d) the level of postsynaptic recurrent inhibition at rest; (e) level of supraspinal drive assessed by measuring V waves; and (f) the gain of the resting soleus M wave. Stepwise regression analyses were used to determine which variables significantly predicted allometrically scaled RTD. The analyses indicated that supraspinal drive was the dominant predictor of RTD across all phases. Additionally, recurrent inhibition predicted RTD in all of the time intervals except 0–150 ms. These results demonstrate the importance of supraspinal drive and recurrent inhibition to RTD.

Lower Extremity Energy Absorption and Biomechanics During Landing, Part II: Frontal-Plane Energy Analyses and Interplanar Relationships

CONTEXT Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence frontal-plane biomechanics. We do not know whether frontal-plane INI EA is related to high-risk frontal-plane biomechanics. OBJECTIVE To compare biomechanics among INI EA groups, determine if women are represented more in the high group, and evaluate interplanar INI EA relationships. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Participants included 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active volunteers. INTERVENTION(S) We assessed landing biomechanics with an electromagnetic motion-capture system and force plate. MAIN OUTCOME MEASURE(S) We calculated frontal- and sagittal-plane total, hip, knee, and ankle INI EA. Total frontal-plane INI EA was used to create high, moderate, and low tertiles. Frontal-plane knee and hip kinematics, peak vertical and posterior ground reaction forces, and peak internal knee-varus moment (pKVM) were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to evaluate male and female allocation to INI EA groups. We used simple, bivariate Pearson product moment correlations to assess interplanar INI EA relationships. RESULTS The high-INI EA group exhibited greater knee valgus at ground contact, hip adduction at pKVM, and peak hip adduction than the low-INI EA group (P < .05) and greater peak knee valgus, pKVM, and knee valgus at pKVM than the moderate- (P < .05) and low- (P < .05) INI EA groups. Women were more likely than men to be in the high-INI EA group (χ(2) = 4.909, P = .03). Sagittal-plane knee and frontal-plane hip INI EA (r = 0.301, P = .006) and sagittal-plane and frontal-plane ankle INI EA were associated (r = 0.224, P = .04). No other interplanar INI EA relationships were found (P > .05). CONCLUSIONS Greater frontal-plane INI EA was associated with less favorable frontal-plane biomechanics that likely result in greater ACL loading. Women were more likely than men to use greater frontal-plane INI EA. The magnitudes of sagittal- and frontal-plane INI EA were largely independent.

Evaluation of the Lateral Step-Down Test as a Clinical Assessment of Hip Musculature Strength

Gluteal musculature weakness is associated with lower extremity injury and greater frontal plane knee motion. A method for functionally evaluating hip abduction and external rotation strength by observing knee motion would be beneficial for clinicians. This study evaluated the association between hip abductor and external rotation strength and knee motion. Peak isometric and eccentric hip abduction and external rotation strength were assessed in 47 healthy participants before analysis of knee kinematics during a lateral step-down test. The relationships between each strength measure and frontal plane knee kinematics were evaluated using bivariate Pearson correlation coefficients. Frontal plane knee displacement was not associated with hip musculature strength. Frontal plane knee angle at peak knee flexion was not associated with exter nal rotation or eccentric abduction strength. Isometric abduction strength was negatively correlated with peak knee flexion. Hip musculature strength is not indicative of the magnitude of frontal plane knee motion during the lateral step-down test, and this test is not recommended for clinical assessment of hip muscle strength.

Relationships between explosive and maximal triple extensor muscle performance and vertical jump height.

Abstract Chang, E, Norcross, MF, Johnson, ST, Kitagawa, T, and Hoffman, M. Relationships between explosive and maximal triple extensor muscle performance and vertical jump height. J Strength Cond Res 29(2): 545–551, 2015—The purpose of this study was to examine the relationships between maximum vertical jump height and (a) rate of torque development (RTD) calculated during 2 time intervals, 0–50 milliseconds (RTD50) and 0–200 milliseconds (RTD200) after torque onset and (b) peak torque (PT) for each of the triple extensor muscle groups. Thirty recreationally active individuals performed maximal isometric voluntary contractions (MVIC) of the hip, knee and ankle extensors, and a countermovement vertical jump. Rate of torque development was calculated from 0 to 50 (RTD50) and 0 to 200 (RTD200) milliseconds after the onset of joint torque. Peak torque was identified and defined as the maximum torque value during each MVIC trial. Greater vertical jump height was associated with greater knee and ankle extension RTD50, RTD200, and PT (p ⩽ 0.05). However, hip extension RTD50, RTD200, and PT were not significantly related to maximal vertical jump height (p > 0.05). The results indicate that 47.6 and 32.5% of the variability in vertical jump height was explained by knee and ankle extensor RTD50, respectively. Knee and ankle extensor RTD50 also seemed to be more closely related to vertical jump performance than RTD200 (knee extensor: 28.1% and ankle extensor: 28.1%) and PT (knee extensor: 31.4% and ankle extensor: 13.7%). Overall, these results suggest that training specifically targeted to improve knee and ankle extension RTD, especially during the early phases of muscle contraction, may be effective for increasing maximal vertical jump performance.

The effects of isometric and isotonic training on hamstring stiffness and anterior cruciate ligament loading mechanisms

Greater hamstring musculotendinous stiffness is associated with lesser ACL loading mechanisms. Stiffness is enhanced via training, but previous investigations evaluated tendon rather than musculotendinous stiffness, and none involved the hamstrings. We evaluated the effects of isometric and isotonic training on hamstring stiffness and ACL loading mechanisms. Thirty-six healthy volunteers were randomly assigned to isometric, isotonic, and control groups. Isometric and isotonic groups completed 6 weeks of training designed to enhance hamstring stiffness. Stiffness, anterior tibial translation, and landing biomechanics were measured prior to and following the interventions. Hamstring stiffness increased significantly with isometric training (15.7%; p=0.006), but not in the isotonic (13.5%; p=0.089) or control (0.4%; p=0.942) groups. ACL loading mechanisms changed in manners consistent with lesser loading, but these changes were not statistically significant. These findings suggest that isometric training may be an important addition to ACL injury prevention programs. The lack of significant changes in ACL loading mechanisms and effects of isotonic training were likely due to the small sample sizes per group and limited intervention duration. Future research using larger sample sizes and longer interventions is necessary to determine the effects of enhancing hamstring stiffness on ACL loading and injury risk.