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Perturbation-enhanced neuromuscular training alters muscle activity in female athletes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Female athletes involved in jumping and cutting sports injure their anterior cruciate ligaments (ACL) 4–6 times more frequently than their male counterparts in comparable sports. Neuromuscular factors, including quadriceps dominance, has been incriminated as contributing to the higher rates of injury in women. Currently, the most effective form of intervention developed to reduce female ACL injury rates has been neuromuscular training. The purpose of this study was to (1) identify gender based muscle activity patterns during disturbed walking that may contribute to ACL injury, and (2) determine if a novel training program could positively influence patterns among healthy female athletes utilizing a disturbed gait paradigm. Twenty healthy athletes (female=10, male=10) were tested. All subjects participated in five trials during which a platform translated horizontally in a lateral direction at heel contact before and after completing ten sessions of a perturbation training program. Electromyographic (EMG) data from the vastus lateralis, medial and lateral hamstrings, and medial gastrocnemius were collected. Trials were analyzed for the muscle onset, termination of activity, peak amplitude, time to peak amplitude, and integrated EMG activity. Muscle cocontraction, the simultaneous activation of antagonistic muscles (lateral hamstrings-vastus lateralis, and medial gastrocnemius-vastus lateralis), was calculated as indicators of active knee stiffness in preparation for heel strike, during weight acceptance and midstance. Prior to training, women had significantly higher peak quadriceps activity and higher integrated quadriceps activity during midstance than men. Both medial and lateral hamstring integrals during midstance increased from pre to posttraining. Onset times to peak activities for hamstrings and quadriceps were similar before training except for medial hamstring time to peak which occurred after heel strike in most women. Time to peak medial hamstring activity moved from after to just before heel strike after training. Women had higher medial gastrocnemius-vastus lateralis cocontraction indices in the preparatory and weight acceptance phases of gait than men after training. Prior to training, the athletic women in our sample demonstrated characteristic quadriceps dominance and decreased active knee stiffness when compared to male athletes. Modulation of activity and timing of ACL agonist musculature (hamstrings and gastrocnemius) from before to after training resulted in normal quadriceps-hamstring balance and increased active stiffness. These alterations in ACL agonist muscle activation patterns may reduce the risk of biomechanical strain injury among a high risk population.

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References

  1. Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 23:694–701

    CAS  PubMed  Google Scholar 

  2. Beard DJ, Dodd CA, Trundle HR, Simpson AH (1994) Proprioception enhancement for anterior cruciate ligament deficiency. A prospective randomised trial of two physiotherapy regimes. J Bone Joint Surg Br 76:654–659

    CAS  PubMed  Google Scholar 

  3. Caraffa A, Cerulli G, Projetti M, Aisa G, Rizzo A (1996) Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc 4:19–21

    Article  CAS  PubMed  Google Scholar 

  4. Cowling EJ, Steele JR (2001) Is lower limb muscle synchrony during landing affected by gender? Implications for variations in ACL injury rates. J Electromyogr Kinesiol 11:263–268

    Article  CAS  PubMed  Google Scholar 

  5. Cox JS, Lenz HW (1984) Women midshipmen in sports. Am J Sports Med 12:241–243

    CAS  PubMed  Google Scholar 

  6. DeHaven KE, Lintner DM (1986) Athletic injuries: comparison by age, sport, and gender. Am J Sports Med 14:218–224

    CAS  PubMed  Google Scholar 

  7. Fagenbaum R, Darling WG (2003) Jump landing strategies in male and female college athletes and the implications of such strategies for anterior cruciate ligament injury. Am J Sports Med 31:233–240

    PubMed  Google Scholar 

  8. Ferber R, McClay Davis I, Williams DS III (2003) Gender differences in lower extremity mechanics during running. Clin Biomech (Bristol, Avon) 18:350–357

    Google Scholar 

  9. Ferber R, Osternig LR, Woollacott MH, Wasielewski NJ, Lee JH (2002) Reactive balance adjustments to unexpected perturbations during human walking. Gait Posture 16:238–248

    Article  PubMed  Google Scholar 

  10. Fitzgerald GK, Axe MJ, Snyder-Mackler L (2000) The efficacy of perturbation training in nonoperative anterior cruciate ligament rehabilitation programs for physical active individuals. Phys Ther 80:128–140

    CAS  PubMed  Google Scholar 

  11. Fitzgerald GK, Axe MJ, Snyder-Mackler L (2000) Proposed practice guidelines for nonoperative anterior cruciate ligament rehabilitation of physically active individuals. J Orthop Sports Phys Ther 30:194–203

    CAS  PubMed  Google Scholar 

  12. Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TN, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150

    CAS  PubMed  Google Scholar 

  13. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR (1999) The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med 27:699–706

    CAS  PubMed  Google Scholar 

  14. Hewett TE, Stroupe AL, Nance TA, Noyes FR (1996) Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. Am J Sports Med 24:765–773

    CAS  PubMed  Google Scholar 

  15. Huston LJ, Wojtys EM (1996) Neuromuscular performance characteristics in elite female athletes. Am J Sports Med 24:427–436

    CAS  PubMed  Google Scholar 

  16. Johansson H, Sjolander P, Sojka PIW (1987) Fusimotor reflexes to antagonistic muscles simultaneously assessed by multi-afferent recordings from muscle spindle afferents. Brain Res 435:337–342

    CAS  PubMed  Google Scholar 

  17. Kendall FP, McCreary EK, Provance PG (1993) Muscle testing and function. Williams and Wilkins, Philadelphia, PA

    Google Scholar 

  18. Lindenfeld TN, Schmitt DJ, Hendy MP, Mangine RE, Noyes FR (1994) Incidence of injury in indoor soccer. Am J Sports Med 22:364–371

    CAS  PubMed  Google Scholar 

  19. Malinzak RA, Colby SM, Kirkendall DT, Yu B, Garrett WE (2001) A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech (Bristol, Avon) 16:438–445

    Google Scholar 

  20. Mandelbaum BR, Silvers HJ, Watanabe D, Knarr J, Thomas S, Griffin LY, Kirkendall DT, Garrett WE (2003) Effectiveness of a neuromuscular and proprioceptive training program in preventing the incidence of ACL injuries in female athletes: year two. AOSSM Specialty Day Abstract

    Google Scholar 

  21. McClay Davis I, Ireland ML (2001) ACL research retreat: the gender bias. April 6–7, 2001. Meeting report and abstracts. Clin Biomech (Bristol, Avon) 16:937–959

  22. McLean SG, Neal RJ, Myers PT, Walters MR (1999) Knee joint kinematics during the sidestep cutting maneuver: potential for injury in women. Med Sci Sports Exerc 31:959–968

    Article  CAS  PubMed  Google Scholar 

  23. More RC, Karras BT, Neiman R, Fritschy D, Woo SL, Daniel DM (1993) Hamstrings–an anterior cruciate ligament protagonist. An in vitro study. Am J Sports Med 21:231–237

    CAS  PubMed  Google Scholar 

  24. Myklebust G, Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13:71–78

    Article  PubMed  Google Scholar 

  25. Pope DF, Cole KJ, Brand RA (1990) Physiologic loading of the anterior cruciate ligament does not activate quadriceps or hamstrings in the anesthetized cat. Am J Sports Med 18:595–599

    CAS  PubMed  Google Scholar 

  26. Rudolph KS, Axe MJ, Buchanan TS, Scholz JP, Snyder-Mackler L (2001) Dynamic stability in the anterior cruciate ligament deficient knee. Knee Surg Sports Traumatol Arthrosc 9:62–71

    Article  CAS  PubMed  Google Scholar 

  27. Schultz SJ, Perrin DH, Adams JM, Granata KP (2001) Neuromuscular response characteristics in men and women after knee perturbation in a single-leg, weight bearing stance. J Athl Train 36:37–43

    PubMed  Google Scholar 

  28. Tang PF, Woollacott MH, Chong RK (1998) Control of reactive balance adjustments in perturbed human walking: roles of proximal and distal postural muscle activity. Exp Brain Res 119:141–152

    Article  CAS  PubMed  Google Scholar 

  29. Williams GN, Chmielewski T, Rudolph K, Buchanan TS, Snyder-Mackler L (2001) Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther 31:546–566

    CAS  PubMed  Google Scholar 

  30. Winter DA, Eng P (1995) Kinetics: our window into the goals and strategies of the central nervous system. Behav Brain Res 67:111–120

    CAS  PubMed  Google Scholar 

  31. Wojtys EM, Ashton-Miller JA, Huston LJ (2002) A gender-related difference in the contribution of the knee musculature to sagittal-plane shear stiffness in subjects with similar knee laxity. J Bone Joint Surg Am 84-A:10–16

    PubMed  Google Scholar 

  32. Wojtys EM, Huston LJ, Schock HJ, Boylan JP, Ashton-Miller JA (2003) Gender differences in muscular protection of the knee in torsion in size-matched athletes. J Bone Joint Surg Am 85-A:782–789

    PubMed  Google Scholar 

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Acknowledgements

This research was supported by the National Institutes of Health (grant no. R01HD037985-03) and the Foundation for Physical Therapy. The authors would like to acknowledge Joel Desautels, M.P.T., AT.C., and David McGuigan for their assistance during data collections. The experiment conducted and described in this manuscript complies with current laws in the United States.

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Author notes

  1. Terese L. Chmielewski

    Present address: Department of Physical Therapy, University of Florida, Gainesville, FL, USA

Authors and Affiliations

  1. Department of Physical Therapy, University of Delaware, Newark, DE, 19716, USA

    Wendy J. Hurd, Terese L. Chmielewski & Lynn Snyder-Mackler

  2. Program in Biomechanics and Movement Sciences, University of Delaware, Newark, DE, 19716, USA

    Wendy J. Hurd, Terese L. Chmielewski & Lynn Snyder-Mackler

  3. Center for Biomedical Engineering Research, University of Delaware, 301 McKinly Lab, Newark, DE, 19716, USA

    Lynn Snyder-Mackler

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  1. Wendy J. Hurd
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  2. Terese L. Chmielewski
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  3. Lynn Snyder-Mackler
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Correspondence to Lynn Snyder-Mackler.

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Hurd, W.J., Chmielewski, T.L. & Snyder-Mackler, L. Perturbation-enhanced neuromuscular training alters muscle activity in female athletes. Knee Surg Sports Traumatol Arthrosc 14, 60–69 (2006). https://doi.org/10.1007/s00167-005-0624-y

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  • DOI: https://doi.org/10.1007/s00167-005-0624-y

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