Does lower-limb asymmetry increase injury risk in sport? A systematic review

Helme, Mark; Tee, Jason; Emmonds, Stacey; Low, Chris

doi:10.1016/j.ptsp.2021.03.001

Cited by 62 publications

(66 citation statements)

References 51 publications

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“…Considering the differing specialized functions of the two brain hemispheres (Serrien et al, 2006;Takeuchi et al, 2012), along with documented microstructural disruption within the connecting white matter tracts following SRC Fjell et al, 2011;Womack et al, 2017;Yin et al, 2019), asymmetrical bradykinesia could be an indirect indicator of a subtle impairment of brain function. The majority of studies included in a recent systematic review of literature provided some amount of evidence that lower extremity asymmetry contributes to injury risk, which could be due to a constraint on an athlete's repertoire of movement options (Helme et al, 2021). Previous research that has utilized a Simple WBRA testing protocol has documented greater movement direction performance asymmetries among elite athletes who self-reported a history of SRC compared to those who denied ever having sustained such an injury (Wilkerson et al, 2018(Wilkerson et al, , 2020(Wilkerson et al, , 2021a.…”

Section: Potential For Improved Risk Screening and Individualized Interventionsmentioning

confidence: 99%

A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes

Wilkerson

Nabhan

Perry

2021

Front. Sports Act. Living

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Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.

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Section: Potential For Improved Risk Screening and Individualized Interventionsmentioning

confidence: 99%

A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes

Wilkerson

Nabhan

Perry

2021

Front. Sports Act. Living

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“…Another commonly reported measure from horizontal hop testing is inter-limb asymmetry data [7,11,12,22]. Such information is often used to try to determine whether such limb differences are associated with reductions in athletic performance [22][23][24] or with an increased risk of injury [23,25]. However, similarly to Kotsifaki et al [9], recent empirical investigations have suggested that the asymmetry value from hop testing may overestimate an injured athlete's rehabilitation status [7,26].…”

Section: Introductionmentioning

confidence: 99%

An Assessment of the Hopping Strategy and Inter-Limb Asymmetry during the Triple Hop Test: A Test–Retest Pilot Study

et al. 2021

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The aims of the present study are to: (1) determine within- and between-session reliability of multiple metrics obtained during the triple hop test; and (2) determine any systematic bias in both the test and inter-limb asymmetry scores for these metrics. Thirteen male young American football athletes performed three trials of a triple hop test on each leg on two separate occasions. In addition to the total distance hopped, manual detection of touch down and toe-off were calculated via video analysis, enabling flight time (for each hop), ground contact time (GCT), reactive strength index (RSI), and leg stiffness (between hops) to be calculated. Results showed all coefficient of variation (CV) values were ≤ 10.67% and intraclass correlation coefficients (ICC) ranged from moderate to excellent (0.53–0.95) in both test sessions. Intrarater reliability showed excellent reliability for all metrics (CV ≤ 3.60%, ICC ≥ 0.97). No systematic bias was evident between test sessions for raw test scores (g = −0.34 to 0.32) or the magnitude of asymmetry (g = −0.19 to 0.43). However, ‘real’ changes in asymmetry (i.e., greater than the CV in session 1) were evident on an individual level for all metrics. For the direction of asymmetry, kappa coefficients revealed poor-to-fair levels of agreement between test sessions for all metrics (K = −0.10 to 0.39), with the exception of the first hop (K = 0.69). These data show that, given the inherent limitations of distance jumped in the triple hop test, practitioners can confidently gather a range of reliable data when computed manually, provided sufficient test familiarization is conducted. In addition, although the magnitude of asymmetry appears to show only small changes between test sessions, limb dominance does appear to fluctuate between test sessions, highlighting the value of also monitoring the direction of the imbalance.

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“…Many athletes develop a difference in function or performance between their limbs, i.e., inter-limb asymmetries ( Bishop et al, 2017 ). It might occur differences in strength, physical capacity, or balance ( Bishop et al, 2018b ; Dos’Santos et al, 2021 ; Helme et al, 2021 ). Such differences appear in different sports and might be a consequence of the sporting activity ( Parrington and Ball, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…They might lead to unequal force absorption or a loss of frontal plane stability which are essential to bear the impacting forces in situations with high unilateral loading and a higher risk for non-contact injuries, such as landing, cutting, or stopping ( Paterno et al, 2010 ). Several studies investigated the relationship between certain side differences and occurring injuries ( Helme et al, 2021 ). For example, asymmetries in movement competencies measured with a functional movement screen (FMS) ( Chalmers et al, 2017 ; Attwood et al, 2019 ), Y-Balance Test (YBT) ( Kiesel et al, 2014 ; Gonell et al, 2015 ), or Star Excursion Balance Test (SEBT) ( Plisky et al, 2006 ) showed an association with non-contact injuries.…”

Section: Introductionmentioning

confidence: 99%

Load-Induced Changes of Inter-Limb Asymmetries in Dynamic Postural Control in Healthy Subjects

Heil

2022

Front. Hum. Neurosci.

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Inter-limb asymmetries are associated with a higher potential risk for non-contact injuries. Differences in function or performance between the limbs might lead to imbalances and promote instability, increasing the potential risk for injuries. Consequently, an investigation of inter-limb asymmetries should be included in injury risk assessment. Furthermore, since non-contact injuries mainly occur under loaded conditions, an investigation of load-induced changes of inter-limb asymmetries can provide additional information on the athlete’s potential injury risk. Therefore, the current study aimed to investigate the influence of physical load on inter-limb asymmetries in dynamic postural control, which is essential in situations with a high risk for non-contact injuries such as landing, cutting, or stopping. In total, dynamic postural control of 128 active and healthy subjects (64 males and 64 females, age: 23.64 ± 2.44, height: 176.54 ± 8.96 cm, weight: 68.85 ± 10.98 kg) was examined. Dynamic postural control was tested with the Y-Balance Test (YBT) before and after a loading protocol on a bicycle ergometer or a treadmill. The results showed no significant increase of the inter-limb asymmetries in anterior direction [F(1, 126) = 4.44, p = 0.04, η2p = 0.03]. Moreover, there is high variation between the subjects regarding the magnitude and the direction of the asymmetries and the changes due to load. Therefore, a more individual analysis considering the magnitude and the direction of the asymmetries is required. Thereby, considering different modifying factors, e.g., sex, injury history, and baseline level of asymmetries, can be helpful. Moreover, an analysis of the changes during load might provide further insights, reveal possible differences, and help detect the reasons and mechanisms underlying inter-limb asymmetries and asymmetrical loading.

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Does lower-limb asymmetry increase injury risk in sport? A systematic review

Cited by 62 publications

References 51 publications

A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes

A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes

An Assessment of the Hopping Strategy and Inter-Limb Asymmetry during the Triple Hop Test: A Test–Retest Pilot Study

Load-Induced Changes of Inter-Limb Asymmetries in Dynamic Postural Control in Healthy Subjects

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