the effect of jump distance on biomechanical risk factors for acl injury during landing and their

257 Pages·2015·4.27 MB·English

THE EFFECT OF JUMP DISTANCE ON BIOMECHANICAL RISK FACTORS FOR
ACL INJURY DURING LANDING AND THEIR RELATIONSHIP WITH
SENSORIMOTOR CHARACTERISTICS AT THE KNEE

by
Nicholas Robert Heebner
B.S. Kinesiology, The Pennsylvania State University, 2009
M.S. Sports Medicine, University of Pittsburgh, 2012

Submitted to the Graduate Faculty of
Health and Rehabilitation Science in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy

University of Pittsburgh
2015
UNIVERSITY OF PITTSBURGH
SCHOOL OF HEALTH AND REHABILITATION SCIENCE

This dissertation was presented

by

Nicholas Robert Heebner

It was defended on
November 2, 2015
and approved by
Scott M. Lephart, PhD, Dean, College of Health Sciences, University of Kentucky
John P. Abt, PhD, ATC, Associate Professor, Athletic Training, University of Kentucky
Mita Lovalekar, MBBS, PhD, MPH, Assistant Professor, Sports Medicine and Nutrition
David Stone, MD, Assistant Professor, School of Medicine
Dissertation Advisor/Committee Chair: Timothy C. Sell, PhD, PT, Associate Professor,
Sports Medicine and Nutrition

ii
Copyright © by Nicholas Robert Heebner
2015
iii
THE EFFECT OF JUMP DISTANCE ON BIOMECHANICAL RISK FACTORS FOR
ACL INJURY DURING LANDING AND THEIR RELATIONSHIP WITH
SENSORIMOTOR CHARACTERISTICS AT THE KNEE

Nicholas R. Heebner, PhD
University of Pittsburgh, 2015

There has been an abundance of research investigating risk factors for anterior cruciate ligament
(ACL) injury and demonstrating the importance of biomechanical characteristics, particularly in
females. However, there have been many different landing tasks used with varying demands.
Previous research has demonstrated that different landing tasks significantly alter demand and
biomechanical characteristics. However it is unknown how changes in landing demand using the
same task may alter landing biomechanics related to ACL injury. Therefore, the purpose of this
study was to examine the effects of jump distance during a double-leg stop-jump on
biomechanical risk factors of ACL injury and muscle activation and examine the contribution of
sensorimotor characteristics on these biomechanical characteristics.
Fifty-three recreationally active healthy females were recruited to participate in this
study. Each participant underwent a single test session that included demographic and
anthropometric assessment, dominant knee threshold to detect passive motion, landing
biomechanics and muscle activation measurement, and dominant knee time to peak torque and
peak torque testing. Biomechanical and muscle activation parameters relative to ACL injury
were compared between jump distances using repeated measures ANOVA. Multiple linear
regression was used to assess the relationship between the biomechanical characteristics and
sensorimotor characteristics (threshold to detect passive motion, time to peak torque, and peak
torque).
iv
The results of this study demonstrated that increases in jump distance significantly
increased landing demand and significantly impacted risk factors for ACL injury and muscle
activation strategies. These findings illustrated that studies utilizing tasks with different demands
cannot directly compare results or make inference to injury risk based previous findings. This
study suggested that a jump distance of 40% to 60% body height is used during a double-leg
stop-jump task to assess landing biomechanics related to ACL injury. Additionally, sensorimotor
characteristics had significant relationships with knee flexion angle at initial contact, peak knee
flexion, and peak knee abduction moment. Further research is needed to identify sensorimotor
characteristics that contribute to frontal plane knee motion during landing.
v
TABLE OF CONTENTS
PREFACE ................................................................................................................................. XVI
1.0 INTRODUCTION ........................................................................................................ 1
1.1 ANTERIOR CRUCIATE LIGAMENT INJURY ............................................ 3
1.1.1 Epidemiology of Anterior Cruciate Ligament Injuries ............................. 3
1.1.2 Mechanisms for Non-Contact Anterior Cruciate Ligament Injury ......... 4
1.2 SENSORIMOTOR SYSTEM ............................................................................. 5
1.2.1 Proprioception ............................................................................................... 5
1.2.2 Neuromuscular Control................................................................................ 6
1.2.3 Sensorimotor System and Non-Contact Anterior Cruciate Ligament
Injury ......................................................................................................................... 7
1.3 EVALUATING RISK OF ANTERIOR CRUCIATE LIGAMENT INJURY8
1.3.1 Modifiable Characteristics Predictive of Anterior Cruciate Ligament
Injury ......................................................................................................................... 8
1.3.2 Modifiable Risk Factors for Anterior Cruciate Ligament Injuries ......... 9
1.4 CURRENT ANTERIOR CRUCIATE LIGAMENT INJURY
PREVENTION ................................................................................................................... 10
1.5 EVALUATION OF LANDING BIOMECHANICS FOR ACL INJURY.... 11
1.6 DEFINITION OF THE PROBLEM ................................................................ 12
vi
1.7 PURPOSE ........................................................................................................... 12
1.8 SPECIFIC AIMS AND HYPOTHESES ......................................................... 13
1.9 STUDY SIGNIFICANCE ................................................................................. 14
2.0 LITERATURE REVIEW .......................................................................................... 16
2.1 EPIDEMIOLOGY OF ACL INJURIES ......................................................... 16
2.2 CONSEQUENCES OF ACL INJURY ............................................................ 18
2.3 MECHANISMS OF NON-CONTACT ACL INJURIES .............................. 20
2.3.1 Mechanisms of ACL Strain ........................................................................ 20
2.3.2 Knee Kinematics of Non-Contact ACL Injury ........................................ 21
2.3.3 Summary ...................................................................................................... 23
2.4 SENSORIMOTOR SYSTEM AND NON-CONTACT ACL INJURY ........ 24
2.4.1 Sensorimotor System Defined .................................................................... 24
2.4.2 Joint Stability .............................................................................................. 24
2.4.3 Proprioception ............................................................................................. 26
2.4.4 Neuromuscular Control.............................................................................. 28
2.4.4.1 Neuromuscular control in ACL deficient patients ........................... 28
2.4.4.2 Neuromuscular control differences between males and females .... 30
2.4.4.3 Neuromuscular control and landing characteristics ........................ 31
2.4.5 Summary ...................................................................................................... 32
2.5 RISK FACTORS FOR NON-CONTACT ACL INJURY ............................. 32
2.5.1 Predictors of Non-Contact ACL Injury .................................................... 33
2.5.2 Other Potential Risk for Non-Contact ACL Injury................................. 36
2.5.3 Summary ...................................................................................................... 38
vii
2.6 INTERVENTION STRATEGIES AND LANDING BIOMECHANICS ..... 39
2.7 METHODOLOGICAL CONSIDERATIONS ................................................ 41
2.7.1 Threshold to Detect Passive Motion .......................................................... 41
2.7.2 Knee Isokinetic Strength ............................................................................ 43
2.7.3 Hamstring and Quadriceps Surface Electromyography ......................... 44
2.7.4 Two-Leg Stop-Jump Biomechanics ........................................................... 46
3.0 METHODOLOGY ..................................................................................................... 48
3.1 DEPENDENT AND INDEPENDENT VARIABLES .................................... 48
3.1.1 Specific Aim 1: Effect of Jump Distance ................................................... 48
3.1.2 Specific Aim 2: Effect of Jump Distance on the Relationship Between
Sensorimotor System and Biomechanical Risk Factors for ACL Injury ............. 49
3.2 SUBJECT RECRUITMENT ............................................................................ 50
3.3 SUBJECT CHARACTERISTICS ................................................................... 50
3.3.1 Inclusion Criteria ........................................................................................ 51
3.3.2 Exclusion Criteria ....................................................................................... 51
3.3.3 Sample Size Calculation ............................................................................. 52
3.4 INSTRUMENTATION ..................................................................................... 53
3.4.1 Three-Dimensional Motion Analysis System ........................................... 53
3.4.2 Force Platform System ............................................................................... 54
3.4.3 Surface Electromyography System ........................................................... 55
3.4.4 Isokinetic Dynamometer ............................................................................ 55
3.4.5 Vertical Jump Target ................................................................................. 56
3.5 TESTING PROCEDURES ............................................................................... 56
viii
3.5.1 Threshold to Detect Passive Motion and Direction ................................. 58
3.5.2 Dynamic Warm-up ..................................................................................... 60
3.5.3 Maximum Vertical Jump Height ............................................................... 60
3.5.4 Biomechanical Assessment of Landing Characteristics .......................... 61
3.5.4.1 Subject Preparation ............................................................................ 61
3.5.4.2 Stop-Jump Task .................................................................................. 64
3.5.5 Knee Flexion and Extension Isokinetic Strength and Time to Peak
Torque ....................................................................................................................... 66
3.6 DATA REDUCTION......................................................................................... 67
3.6.1 Threshold to Detect Passive Motion and Direction ................................. 67
3.6.2 Landing Kinematics, Kinetics, and Muscle Activation ........................... 68
3.6.3 Knee Flexion and Extension Strength and Time to Peak Torque .......... 69
3.7 STATISTICAL ANALYSIS ............................................................................. 70
4.0 RESULTS ................................................................................................................... 71
4.1 SUBJECTS ......................................................................................................... 71
4.2 WITHIN SUBJECT DIFFERENCES IN LANDING BIOMECHANICS
AND MUSCLE ACITIVTY BETWEEN JUMP DISTANCES ..................................... 72
4.2.1 Potential Outliers ........................................................................................ 73
4.2.2 Normality Test Results ............................................................................... 74
4.2.3 Repeated Measures Between Jump Distances .......................................... 76
4.3 RELATIONSHIP BETWEEN SENSORIMOTOR CHARACTERISTICS
AND BIOMECHANICAL RISK FACTORS FOR ACL INJURY ............................... 87
4.3.1 Univariate Analysis ..................................................................................... 87
ix
4.3.2 Bivariate Analysis ....................................................................................... 91
4.3.3 Multiple Linear Regression Models .......................................................... 94
4.3.3.1 Peak Vertical Ground Reaction Force .............................................. 94
4.3.3.2 Peak Anterior-Posterior Ground Reaction Force ............................ 96
4.3.3.3 Knee Flexion at Initial Contact .......................................................... 97
4.3.3.4 Knee Abduction at Initial Contact .................................................. 100
4.3.3.5 Peak Knee Flexion ............................................................................. 100
4.3.3.6 Peak Knee Abduction ....................................................................... 102
4.3.3.7 Peak Knee Abduction Moment ........................................................ 102
4.3.3.8 Peak Proximal Anterior Tibial Shear Force ................................... 106
5.0 DISCUSSION ........................................................................................................... 109
5.1 SUBJECT CHARACTERISTICS ................................................................. 110
5.2 LANDING BIOMECHANICS DURING LANDING .................................. 111
5.2.1 Peak Vertical and Anterior-Posterior Ground Reaction Forces .......... 111
5.2.2 Knee Flexion at Initial Contact ................................................................ 112
5.2.3 Knee Abduction at Initial Contact .......................................................... 112
5.2.4 Peak Knee Flexion..................................................................................... 113
5.2.5 Peak Knee Abduction ............................................................................... 114
5.2.6 Peak Knee Abduction Moment ................................................................ 115
5.2.7 Peak Proximal Anterior Tibial Shear Force .......................................... 116
5.3 MUSCLE ACTIVATION DURING LANDING .......................................... 116
5.3.1 Quadriceps Activation .............................................................................. 116
5.3.2 Hamstrings Activation .............................................................................. 117
x