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- Does Performance with the Overhead Deep Squat Predict Lower Extremity Kinematics During a High-Velocity Pivot Task in Adolescent Female Soccer Players?Collaboration between Embry-Riddle Aeronautical University and Orlando Health Orthopedics
Background and Purpose
Anterior cruciate ligament (ACL) tears have become more frequent for female athletes. The National Federation of State High School Associations reports that approximately 1 in 50 female athletes will sustain a serious knee injury each year.3 The National Collegiate Athletic Association (NCAA) reported an average knee injury incidence of 1 in 10 female athletes per year between 1988 and 2004. In the sport of soccer, it should be noted that female players are 3 to 6 times more likely to sustain an ACL injury than male players.1 There are modifiable factors that can be manipulated to reduce the risk of ACL injury. Many recent papers have proven that programs focusing on increased lumbo-pelvic awareness and jump training have led to reduced ACL injury rates in female athletes. One of the problems with this assessment is that it is done in a very controlled environment with the athlete prepared for the movement. This may have the effect of biasing the test and reducing its sensitivity. Nonetheless, while these functional tests remain useful at intermediate points in the rehabilitation to determine progression to the next phase, they do not identify potential non-copers when it comes to readiness to return to sport. This is because they do not take into account the kinematics of the knee when the athlete has to plant her foot and pivot in a reactive manner. This movement is of interest because it is known to create the highest ground reaction forces to the knee, more than landing from a height and side-step cutting.
The literature has demonstrated that females at risk of ACL tears tend to perform a pivoting task with a more erect trunk posture, and smaller knee flexion angle.4 When the knee is loaded eccentrically during a pivot task at this angle, the quadriceps are able to produce a large anterior force on the knee that is relatively unopposed by the hamstrings. The hamstrings are important during dynamic pivoting movements because, if active, they can increase joint compression and thus reduce anterior translation on the knee that could lead to rupture. However, at small flexion angles, it is much more difficult for the hamstrings to generate sufficient torque to balance the force created by the quadriceps. The result is a dynamic imbalance about the knee that may expose the ligamentous structures to injury. It appears that one key to solving this problem is to create sufficient dynamic balance and kinesthetic awareness so that a female athlete is able to naturally produce more knee flexion during a high-speed pivot maneuver. Proper kinematics with this task require sufficient local and global core stability, excellent gluteus medius and maximus activation, and the ability to create stiffness in the hamstrings during eccentric knee flexion. One popular method of testing these variables is the overhead deep squat because it can reveal deficiencies in any of the mentioned variables.
Purpose
To our knowledge, the relationship between performance on the overhead deep squat test and pivot task has not been investigated. Based on our literature review, it does appear that having increased strength and activation with posterior chain musculature may in fact produce more favorable kinematics during a pivot task. Given that the overhead deep squat test also highlights these features, we would like to see if it is predictive of improved performance during a high-velocity pivot task with female soccer players. Therefore, the purpose of this study is to determine if athletes who perform better on an overhead deep squat maneuver will also demonstrate significantly improved kinematics during a high-velocity pivot task. This is part of a field of research directed at minimizing ACL injuries for female soccer players.
Funding:
2020-2021 Ignite Grant
Marker Placements
Passive reflective markers are placed on each subject to define segments and track position (coordinates). These placements are mimicked in OpenSim.
Marker Placement
Musculoskeletal Model - DSKL
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