A qualitative screening tool to identify athletes with ‘high-risk’ movement mechanics during cutting: The cutting movement assessment score (CMAS)

Objective To assess the validity of the cutting movement assessment score (CMAS) to estimate the magnitude of peak knee abduction moments (KAM) against three-dimensional (3D) motion analysis, while comparing whole-body kinetics and kinematics between subjects of low (bottom 33%) and high CMASs (top 33%). Design Cross-sectional study. Setting Laboratory. Participants Forty-one participants (soccer, rugby, netball, and cricket). Main outcome measures Association between peak KAM and CMAS during a 90° cut. Comparison of 3D whole-body kinetics and kinematics between subjects with low (bottom 33%) and high CMASs (top 33%). Results A very large significant relationship (ρ = 0.796, p < 0.001) between CMAS and peak KAM was observed. Subjects with higher CMASs displayed higher-risk cutting postures, including greater peak knee abduction angles, internal foot progression angles, and lateral foot plant distances (p ≤ 0.032, effect size = 0.83–1.64). Additionally, greater cutting multiplanar knee joint loads (knee flexion, internal rotation, and abduction moments) were demonstrated by subjects with higher CMASs compared to lower (p ≤ 0.047, effect size = 0.77–2.24). Conclusion The CMAS is a valid qualitative screening tool for evaluating cutting movement quality and is therefore a potential method to identify athletes who generate high KAMs and “high-risk” side-step cutting mechanics

A preliminary investigation into a qualitative assessment tool to identify athletes with high knee abduction moments during cutting : Cutting Movement Assessment Score (CMAS)

Given the limited accessibility of 3D motion analysis for injury screening of athletes, there is a need to develop a field-based screening tool to identify athletes with ‘at-risk’ cutting mechanics. The aim of this preliminary study was to assess the validity of a qualitative assessment tool for cutting (CMAS) to estimate the magnitude of peak knee abduction moments (KAM) against ‘Gold Standard’ 3D motion analysis. The presented CMAS was able to rank cutting trials based on the magnitude of KAM. Thus, is a potential method to identify athletes who generate high KAM during cutting

The cutting movement assessment score (CMAS) qualitative screening tool: application to mitigate anterior cruciate ligament injury risk during cutting

Side-step cutting is an action associated with non-contact anterior cruciate ligament (ACL) injury with a plethora of negative economical, health, and psychological implications. Although ACL injury risk factors are multifactorial, biomechanical and neuromuscular deficits which contribute to “high-risk” and aberrant movement patterns are linked to ACL injury risk due to increasing knee joint loads and potential ACL loading. Importantly, biomechanical and neuromuscular deficits are modifiable; thus, being able to profile and classify athletes as potentially “high-risk” of injury is a crucial process in ACL injury mitigation. The Cutting Movement Assessment Score (CMAS) is a recently validated field-based qualitative screening tool to identify athletes that display high-risk postures associated with increased non-contact ACL injury risk during side-step cutting. This article provides practitioners with a comprehensive and detailed overview regarding the rationale and implementation of the CMAS. Additionally, this review provides guidance on CMAS methodological procedures, CMAS operational definitions, and training recommendations to assist in the development of more effective non-contact ACL injury risk mitigation programmes

Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting : a systematic review and technical framework

Background: Cutting actions are associated with non-contact ACL injuries in multidirectional sports due to the propensity to generate large multiplanar knee joint loads (KJLs) that have the capacity to increase ACL loading and strain. Numerous studies have investigated the biomechanical determinants of KJLs in cutting tasks. The aim of this systematic review was to comprehensively review the literature regarding biomechanical determinants of KJLs during cutting, in order to develop a cutting technical framework alongside training recommendations for practitioners regarding KJL mitigation. Methods: Databases (SPORTDiscus, Web of Science and PubMed) were systematically searched using a combination of the following terms: “Biomechanical determinants”, or “Knee abduction moment”, or “Technical determinants”, or “Knee loading”, or “Knee loads”, or “Mechanical determinants”, or “ACL strain”, or “Knee adduction moment”, or “Anterior tibial shear”, or “Knee internal rotation moment”, or “Knee valgus moment” AND “Change of direction”, or “Cutting manoeuvre”, or “Run and cut”, or “Run-and-cut”, or “Sidestepping”, or “Side-stepping”, or “Shuttle run”. Inclusion criteria were as follows: studies examining a cutting task < 110° with a preceding approach run that examined biomechanical determinants of KJLs using three-dimensional motion analysis. Results: The search returned 6404 possibly eligible articles, and 6 identified through other sources. Following duplicate removal, 4421 titles and abstracts were screened, leaving 246 full texts to be screened for inclusion. Twenty-three full texts were deemed eligible for inclusion and identified numerous determinants of KJLs; 11 trunk, 11 hip, 7 knee, 3 multiplanar KJLs, 5 foot/ankle and 7 identifying ground reaction forces (GRFs) as determinants of KJLs. Conclusion: Using the framework developed from the results, cutting KJLs can be mitigated through the following: reducing lateral foot-plant distances, thus lowering hip abduction and orientating the foot closer to neutral with a mid-foot or forefoot placement strategy; minimising knee valgus and hip internal rotation angles and motion at initial contact (IC) and weight acceptance (WA); avoiding and limiting lateral trunk flexion and attempt to maintain an upright trunk position or trunk lean into the intended direction; and finally, reducing GRF magnitude during WA, potentially by attenuation through increased knee flexion and emphasising a greater proportion of braking during the penultimate foot contact (PFC)

Differences in biomechanical determinants of ACL injury risk in Change of Direction tasks between males and females: A systematic review and meta-analysis

Background Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading. Objective The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks. Methods Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021–June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18–40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis. Results This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098–0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299–1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134–0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: −0.454, 95% CI 0.151–0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status. Conclusion No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females

Pregnancy in the female athlete - Part 1: antenatal

As female participation in sport and exercise continues to increase, there is a strong likelihood that a strength and conditioning (S&C) coach will work with a pregnant athlete. High profile athletes such as Serena Williams and Dame Jessica Ennis-Hill have shown recently that it is not uncommon for female athletes to become mothers during their careers, rather than after they have retired. However, historically pregnancy was perceived as time spent away from sport and being active was wrongly associated with a high, unreasonable risk to the unborn foetus. The challenge for the S&C coach working with pregnant athletes is navigating the wide range of global recommendations that are often aimed at active or inactive individuals, but not at elite athletes. It is fundamental that any coach working with pregnant athletes is knowledgeable about the physiological and anatomical changes that occur throughout the trimesters, the nutritional demands of pregnancy, and its effect on weight management in order to appropriately facilitate athlete and foetal health during the antenatal period. Therefore, the aim of this initial review is to summarise current literature and provide key insights that promote best practice for practitioners working with pregnant athletes. The use of ‘women’ throughout this paper will refer to the general population and ‘sportswomen’ to the athletic population. ‘Antenatal’ refers to a pregnant woman before childbirth and the term ‘postnatal’ means after childbirth, something which will be covered in part 2 of this review series

Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting: A systematic review and technical framework

Background: Cutting actions are associated with non-contact ACL injuries in multidirectional sports due to the propensity to generate large multiplanar knee joint loads (KJLs) that have the capacity to increase ACL loading and strain. Numerous studies have investigated the biomechanical determinants of KJLs in cutting tasks. The aim of this systematic review was to comprehensively review the literature regarding biomechanical determinants of KJLs during cutting, in order to develop a cutting technical framework alongside training recommendations for practitioners regarding KJL mitigation. Methods: Databases (SPORTDiscus, Web of Science and PubMed) were systematically searched using a combination of the following terms: “Biomechanical determinants”, or “Knee abduction moment”, or “Technical”, or “Knee loading”, or “Knee loads”, or “Mechanical determinants”, or “ACL strain”, or “Knee adduction moment”, or “Anterior tibial shear”, or “Knee internal rotation moment”, or “Knee valgus moment” AND “Change of direction”, or “Cutting manoeuvre”, or “Run and cut”, or “Run-and-cut”, or “Sidestepping”, or “Side-stepping”, or “Shuttle run”. Inclusion criteria were as follows: studies examining a cutting task < 110° with a preceding approach run that examined biomechanical determinants of KJLs using three-dimensional motion analysis. Results: The search returned 6404 possibly eligible articles, and 6 identified through other sources. Following duplicate removal, 4421 titles and abstracts were screened, leaving 246 full texts to be screened for inclusion. Twenty-three full texts were deemed eligible for inclusion and identified numerous determinants of KJLs; 11 trunk, 11 hip, 7 knee, 3 multiplanar KJLs, 5 foot/ankle and 7 identifying ground reaction forces (GRFs) as determinants of KJLs. Conclusion: Using the framework developed from the results, cutting KJLs can be mitigated through the following: reducing lateral foot-plant distances, thus lowering hip abduction and orientating the foot closer to neutral with a midfoot or forefoot placement strategy; minimising knee valgus and hip internal rotation angles and motion at initial contact (IC) and weight acceptance (WA); avoiding and limiting lateral trunk flexion and attempt to maintain an upright trunk position or trunk lean into the intended direction; and finally, reducing GRF magnitude during WA, potentially by attenuation through increased knee flexion and emphasising a greater proportion of braking during the penultimate foot contact (PFC)