Clinical Implications of Hand Position and Lower Limb Length Measurement Method on Y-Balance Test Scores and Interpretations

Context:  The Lower Quarter Y-Balance Test (LQ-YBT) was developed to provide an effective and efficient screen for injury risk in sports. Earlier protocol recommendations for the LQ-YBT involved the athlete placing the hands on the hips and the clinician normalizing scores to lower limb length measured from the anterior-superior iliac spine to the lateral malleolus. The updated LQ-YBT protocol recommends the athlete's hands be free moving and the clinician measure lower limb length to the medial malleolus. Objective:  To investigate the effect of hand position and lower limb length measurement method on LQ-YBT scores and their interpretation. Design:  Cross-sectional study. Setting:  National Sports Institute of Malaysia. Patients or Other Participants:  A total of 46 volunteers, consisting of 23 men (age = 25.7 ± 4.6 years, height = 1.70 ± 0.05 m, mass = 69.3 ± 9.2 kg) and 23 women (age = 23.5 ± 2.5 years, height = 1.59 ± 0.07 m, mass = 55.7 ± 10.6 kg). Intervention(s):  Participants performed the LQ-YBT with hands on hips and hands free to move on both lower limbs. Main Outcome Measure(s):  In a single-legged stance, participants reached with the contralateral limb in each of the anterior, posteromedial, and posterolateral directions 3 times. Maximal reach distances in each direction were normalized to lower limb length measured from the anterior-superior iliac spine to the lateral and medial malleoli. Composite scores (average of the 3 normalized reach distances) and anterior-reach differences (in raw units) were extracted and used to identify participants at risk for injury (ie, anterior-reach difference ≥4 cm or composite score ≤94%). Data were analyzed using paired t tests, Fisher exact tests, and magnitude-based inferences (effect size [ES], ±90% confidence limits [CLs]). Results:  Differences between hand positions in normalized anterior-reach distances were trivial (t91 = −2.075, P = .041; ES = 0.12, 90% CL = ±0.10). In contrast, reach distances were greater when the hands moved freely for the normalized posteromedial (t91 = −6.404, P < .001; ES = 0.42, 90% CL = ±0.11), posterolateral (t91 = −6.052, P < .001; ES = 0.58, 90% CL = ±0.16), and composite (t91 = −7.296, P < .001; ES = 0.47, 90% CL = ±0.11) scores. A similar proportion of the cohort was classified as at risk with the hands on the hips (35% [n = 16]) and the hands free to move (43% [n = 20]; P = .52). However, the participants classified as at risk with the hands on the hips were not all categorized as at risk with the hands free to move and vice versa. The lower limb length measurement method exerted trivial effects on LQ-YBT outcomes. Conclusions:  Hand position exerted nontrivial effects on LQ-YBT outcomes and interpretation, whereas the lower limb length measurement method had trivial effects

Clinical Implications of Landing Distance on Landing Error Scoring System Scores

Context: The Landing Error Scoring System (LESS) screens for the risk of non-contact anterior cruciate ligament injury. The LESS requires individuals to jump forward from a 30-cm box to a distance of 50% of their body height. However, different landing distances have been cited in the scientific literature. Objective: To examine whether landing distance influences LESS outcomes. Design: Cross-sectional study. Setting: Laboratory. Participants or Other Participants: Seventy young active individuals (34 males, 36 females). Intervention(s): Participants performed 33 30-cm jump landing tasks under 2 landing conditions in randomized order: (1) 50% of body height (d50%), (2) self-selected distance (dss). Main Outcome Measure(s): Mean LESS scores, proportions of individuals categorized at high (LESS: 5 errors) and low (LESS: <5 errors) injury risk, and landing distances were compared between conditions using generalized estimating equations. Consistency of risk categorization was examined using odds ratios (ORs) and McNemar tests. McNemar and Wilcoxon signed rank tests were used to compare the occurrence of specific LESS errors. Results: Participants landed closer to the box under the dss condition (difference = 23.28 [95% CI = 20.73, 25.81]%, P < .001). Group mean LESS scores (difference = 0.01 [95% CI = 0.59, 0.57] error, P = .969) and risk categorization (OR = 0.94 [95% CI = 0.47, 1.88], P = .859) were similar between conditions. However, individual-level risk categorization was inconsistent in 33% of participants, as was the occurrence of specific errors. Conclusions: Using dss during the LESS might lead to different LESS errors and risk categorizations at an individual level than using d50%. Given that individual LESS scores are of primary interest in clinical and sport settings and the injury-risk threshold has not been validated for dss, we recommend the use of the original LESS protocol. When only group mean LESS scores or proportions of at-risk individuals are of interest, using dss is feasible to facilitate the testing of large cohorts

The Influence of Asymptomatic Hypermobility on Unanticipated Cutting Biomechanics

Background: Generalized joint hypermobility is an important risk factor for knee injuries, including to the anterior cruciate ligament (ACL). Examining movement patterns specific to hypermobile individuals during sport-specific movements could facilitate development of targeted recommendations and injury prevention programs for this population. Hypothesis: Asymptomatic hypermobile participants will present kinematics measures suggestive of a greater risk of noncontact knee or ACL injuries. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Forty-two (15 asymptomatic hypermobile and 27 nonhypermobile) individuals performed unanticipated side-step cutting on their dominant and nondominant legs. Ankle, knee, hip, pelvis, and trunk angles in all planes of motion were collected during the first 100 ms after initial contact using a 3-dimensional infrared system. Precontact foot-ground angles were also extracted. Data from hypermobile and nonhypermobile groups were compared using multiple regression models with sex as a confounder. When nonsignificant, the confounder was removed from the model. Effect sizes (Hedge g) were calculated in the presence of significant between-group differences. Results: Hypermobile individuals presented with lower minimum knee valgus angles with a mean difference of 3.5° (P = 0.03, Hedge g = 0.69) and greater peak knee external rotation angles with a mean difference of −4.5° (P = 0.04, Hedge g = 0.70) during dominant leg cutting, and lower peak ankle plantarflexion angles with a mean difference of 4.5° (P = 0.03, Hedge g = 0.73) during nondominant leg cutting compared with nonhypermobile individuals. Conclusions: Based on current scientific evidence, however, the identified differences are not crucial biomechanical injury risk factors that could predispose asymptomatic hypermobile individuals to noncontact knee or ACL injuries. Clinical Relevance: Further research is needed to highlight differences between hypermobility groups. Knowledge of the differences between these groups may change the physical activity recommendations, prevention of injury, and rehabilitation approaches

Testing the efficacy of a motor analogy designed to promote safe landing by older adults who fall accidentally: a study protocol for a randomised control study

Introduction: Falling is associated with adverse effects on the health of older people. The majority of research into falls among older people has focused on prevention, with less attention to ‘how to fall safely’. Previous research suggests that motor analogies can be used to promote safe landing by young adults; however, the efficacy of this technique for older people remains unknown. This study aims to determine whether a motor analogy is useful for promoting safe falling in the older adult population. Methods and analysis: The study adopts a randomised, controlled, single-blinded study design. People 65 years and older will be randomly allocated to a control condition or a motor analogy condition. They will receive a nudge in a forward, backward or sideways direction (randomised order), which will initiate a fall. The nudge will occur at variable (randomised) time points, so participants will not be aware of when they will fall. Participants in the motor analogy condition will be instructed to ‘land like a feather’, whereas participants in the control condition will be instructed to ‘land safely’. The primary outcome parameters are maximum impact force (normalised by mass) applied to different body segments during impact and fracture risk ratio of wrists and hips. A two-way multivariate analysis of variance will be conducted to examine differences between the motor analogy and control conditions as a function of the different variables. Ethics and dissemination: The University of Waikato Human Research Ethics Committee (Health 2021#45) has granted ethical approval. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12621001189819. Registered on 6 September 2021

ISBS 2018 AUCKLAND CONFERENCE AUT MILLENNIUM TEACHERS DAY

Dr Sarah Kate Millar is coordinating the New Zealand Biomechanics Teachers Day. Teachers will have the opportunity to work side-by-side with leading biomechanics instructors/researcher from across the world. There will be a focus on creating hands-on experiential learning opportunities to achieve science and physical education outcomes. Sarah-Kate Millar is a senior lecturer at AUT (AUT) in the area of sports coaching and in particular skill acquisition. Dr. Kim Hébert-Losier is a Senior Lecturer in Applied Biomechanics and Injury Prevention at the University of Waikato. Dr Laura-Anne M Furlong is a Lecturer in Biomechanics, currently based in the School of Sport, Exercise and Health Sciences at Loughborough University, and the National Centre for Sports and Exercise Medicine. Dr Philip Fink is Senior Lecturer in motor control and biomechanics at the School of Sport, Exercise and Nutrition at Massey University. Dr Duane Knudson is a Professor in the Department of Health & Human Performance at Texas State University. Suzie Belcher is currently working with Netball New Zealand as part of their national Injury prevention team, NetballSmart

Performance in the 1.2 km shuttle run test reflects fitness capacities in rugby players

The relationships between performance in the 1.2 km shuttle test (Bronco) with the Multistage Shuttle Run Test (MSRT) and Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) in rugby players were investigated. Additionally, differences in Bronco, MSRT, and Yo-Yo IR1 scores between backs (B) and forwards (F), and rugby codes were assessed. Data from professional players (23 rugby sevens and 133 rugby union) were analysed. All rugby sevens players performed the Bronco and MSRT, whereas rugby union players completed the Bronco and Yo-Yo IR1. The relationship between the Bronco and MSRT or Yo-Yo IR1 was quantified using Pearson’s r, whereas differences between playing positions and codes were quantified using Hedges’ g effect sizes (ES). Large correlations were observed between Bronco and MSRT (r = -0.57 and 0.53). Very large correlations were observed between Bronco and Yo-Yo IR1 (r = -0.74 and 0.71). Similar Bronco (B: 289 ± 10 s; F: 291 ± 10 s) and MSRT (B: 2470 ± 162 m; F: 2446 ± 236 m) scores were found in rugby sevens backs and forwards, while moderately better Bronco (B: 294 ± 15 s; F: 311 ± 21 s) and Yo-Yo IR1 (B: 1985 ± 367 m; F: 1627 ± 375 m) scores characterised rugby union backs (ES = -0.90 and 0.96). Small to moderately better Bronco scores were observed in rugby sevens compared to rugby union players (ES = -0.36 to -0.99). These results support the utility of the Bronco as a fitness test in rugby. The low shared variance observed between the Bronco and the two other tests, however, indicates the scores derived from these tests (e.g., speed) are not interchangeable

Reactive Strength as a Metric for Informing Return-to-Sport Decisions: A Case-Control Study

Objective: Current return-to-sport decisions are primarily based on elapsed time since surgery or injury and strength measures. Given data that show rates of successful return to competitive sport at around 55%, there is strong rationale for adopting tools that will better inform return-to-sport decisions. The authors’ objective was to assess reactive strength as a metric for informing return-to-sport decisions. Design: Case-control design. Methods: Fifteen elite athletes from national sports teams (23 [6.0] y) in the final phase of their return-to-sport protocol following a unilateral knee injury and 16 age-matched control athletes (22 [4.6] y) performed a unilateral isometric strength test and 24-cm drop jump test. Pairwise comparisons were used to determine differences between legs within groups and differences in interleg asymmetry between groups. Results: Strength measures did not distinguish the control from the rehabilitation group; however, clear differences in the degree of asymmetry were apparent between the control and rehabilitation groups for contact time (Cohen d = 0.56; −0.14 to 1.27; 8.2%; P = .113), flight time (d = 1.10; 0.44 to 1.76; 16.0%; P = .002), and reactive strength index (d = 1.27; 0.50 to 2.04; 22.4%; P = .002). Conclusion: Reactive strength data provide insight into functional deficits that persist into the final phase of a return-to-sport protocol. The authors’ findings support the use of dynamic assessment tools to inform return-to-sport decisions to limit potential for injury

ISBS 2018 AUCKLAND CONFERENCE SPRINZ-HPSNZ-AUT MILLENNIUM APPLIED PROGRAMME

An interactive afternoon of sessions delivered by High Performance Sport New Zealand (HPSNZ) and AUT SPRINZ Biomechanists, Performance Analysts and other biomechanics relevant sport facing practitioners. The 11 sessions are at AUT Millennium (AUTM), which is a satellite site of AUT University and the Auckland training hub for many HPSNZ supported sports such as athletics, sailing, and swimming. These sports and others (cycling, rowing, snow sports etc.) will be represented in the line-up. The applied sessions involve practical demonstrations of aspects of analysis and/or tools used to deliver in the field to directly positively impact athletes performances on the world stage. Following these engaging sessions there will be tasting of New Zealand wine, allowing for further discussion and networking. Sir Graeme Avery will be acknowledged for his contribution to sport science. Mike Stanley is AUT Millennium Chief Executive & NZ Olympic Committee President will explain the partners in the facility. AUT Millennium is a charitable trust established to help New Zealanders live longer and healthier lives, and to enjoy and excel in sport through the provision of world-class facilities, services, research and education. Founded in 2002 as Millennium Institute of Sport and Health (MISH) by Sir Stephen Tindall and Sir Graeme Avery as a premium health and fitness facility for both athletes and the public alike. Partnered with AUT University in 2009, forming AUT Millennium, to expand research and education in the sporting sector. Professor Barry Wilson is an Adjunct Professor with SPRINZ at Auckland University of Technology and will be outlining the research and student opportunities. Martin Dowson is the General Manager Athlete Performance Support at High Performance Sport New Zealand and has overall responsibility for the programme. Simon Briscoe, AUT Millennium Applied Session Coordinator, is the head of the Performance and Technique Analysis discipline within HPSNZ. Simon is coordinating the applied sessions along with technical support from Dr Allan Carman, Research Fellow, AUT SPRINZ. Jodi Cossor and Matt Ingram will provide a demonstration of a multidisciplinary approach driven by biomechanical analysis for Paralympic swimmers. Justin Evans and Sarah-Kate Millar will provide a practical session assessing the athletes rowing stroke to assist the coach on technical changes. This session will demonstrate various rowing traits and how the biomechanist and coach can work together to optimise boat speed. Mike Schofield and Kim Hébert-Losier will provide a session looking at shotput and the evidence based approach to coaching. Dr Craig Harrison and Professor John Cronin will provide examples from the AUTM Athlete Development programme. Kim Simperingham and Jamie Douglas who work with high performance rugby athletes will outline sprinting mechanics in practice. Dr Bruce Hamilton, Fiona Mather, Justin Ralph and Rone Thompson will demonstrate the approach of HPSNZ and Cycling NZ performance health teams in the use of some specific tools for prevention of injury and optimisation of performance. Kelly Sheerin, Denny Wells and Associate Professor Thor Besier will provide examples of using IMU and motion capture methods for running and basketball biomechanics research, education and service. Dr Rodrigo Bini and Associate Professor Andrew Kilding will show how linking of biomechanics and physiology improves injury prevention and performance enhancement. Robert Tang, Andre de Jong and Farhan Tinwala discuss select projects developed by Goldmine, HPSNZ’s in-house engineering team, and how these innovations have enabled unprecedented levels of biomechanics feedback. Cameron Ross and Paul McAlpine demonstrate the technology being used at the Snow Sports NZ training centre in Cadrona to enhance load monitoring of athletes. This application allows greater insight into training performances and biomechanical loads than has been previously possible in the training environment. AUT Millennium tour guides are coordinated by Josh McGeown and include Enora Le Flao, Dustin Oranchuk, Erika Ikeda, Jono Neville, Aaron Uthoff, Andrew Pichardo, Farhan Tinwala, Shelley Diewald, Renata Bastos Gottgtroy, Jessica Yeoman, Casey Watkins, Eric Harbour, Anja Zoellner, Alyssa Joy Spence, Victor Lopez Jr, and Albert Chang

Training during the COVID-19 lockdown : knowledge, beliefs, and practices of 12,526 athletes from 142 countries and six continents

OBJECTIVE Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March–June 2020). RESULTS Overall, 85% of athletes wanted to “maintain training,” and 79% disagreed with the statement that it is “okay to not train during lockdown,” with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered “coaching by correspondence (remote coaching)” to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], most (83%) training for “general fitness and health maintenance” during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification. CONCLUSIONS COVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to “maintain” training and the greatest opposition to “not training” during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered “coaching by correspondence” as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes’ physical capacities and were also likely detrimental to athletes’ mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness).A specific funding was provided by the National Sports Institute of Malaysia for this study.The National Sports Institute of Malaysia.https://www.springer.com/journal/40279am2023Sports Medicin

COVID-19 lockdown : a global study investigating athletes’ sport classification and sex on training practices

PURPOSE : To investigate differences in athletes’ knowledge, beliefs, and training practices during COVID-19 lockdowns with reference to sport classification and sex. This work extends an initial descriptive evaluation focusing on athlete classification. METHODS : Athletes (12,526; 66% male; 142 countries) completed an online survey (May–July 2020) assessing knowledge, beliefs, and practices toward training. Sports were classified as team sports (45%), endurance (20%), power/technical (10%), combat (9%), aquatic (6%), recreational (4%), racquet (3%), precision (2%), parasports (1%), and others (1%). Further analysis by sex was performed. RESULTS : During lockdown, athletes practiced body-weight-based exercises routinely (67% females and 64% males), ranging from 50% (precision) to 78% (parasports). More sport-specific technical skills were performed in combat, parasports, and precision (∼50%) than other sports (∼35%). Most athletes (range: 50% [parasports] to 75% [endurance]) performed cardiorespiratory training (trivial sex differences). Compared to prelockdown, perceived training intensity was reduced by 29% to 41%, depending on sport (largest decline: ∼38% in team sports, unaffected by sex). Some athletes (range: 7%–49%) maintained their training intensity for strength, endurance, speed, plyometric, change-of-direction, and technical training. Athletes who previously trained ≥5 sessions per week reduced their volume (range: 18%–28%) during lockdown. The proportion of athletes (81%) training ≥60 min/session reduced by 31% to 43% during lockdown. Males and females had comparable moderate levels of training knowledge (56% vs 58%) and beliefs/attitudes (54% vs 56%). CONCLUSIONS : Changes in athletes’ training practices were sport-specific, with few or no sex differences. Team-based sports were generally more susceptible to changes than individual sports. Policy makers should provide athletes with specific training arrangements and educational resources to facilitate remote and/or home-based training during lockdown-type events.https://journals.humankinetics.com/view/journals/ijspp/ijspp-overview.xmlhj2023Sports Medicin