Elnagar, Youssif O (2012) Sex differences in the functional hamstring to quadriceps ratio and neuromuscular performance. PhD thesis, University of Gloucestershire.
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Increased relative risk of non-contact anterior cruciate ligament (ACL) injury has been attributed to numerous biomechanical, anatomical and neuromuscular factors. Females are at greater relative risk of non-contact ACL injury compared with males. Dynamic knee stability is an important component required to reduce relative risk of injury, especially to the knee joint. It is difficult to directly measure knee stability; however the eccentric ability of the hamstrings to co-contract to counter the torque produced by concentric quadriceps actions during knee extension is important in stabilising the knee (determined as the functional H/Q ratio [FH/Q]). One of the proposed reasons for a greater incidence of non-contact ACL injury in females is a reduced capacity for neuromuscular functioning to stabilise the knee joint effectively. Most injuries occur in the second half of an athletic event when fatigue is commonly present, therefore identifying fatigue as a potential risk factor for ACL injury and this may allow for the development of improved prevention strategies. The three experimental studies included within this thesis (chapter 4-6) have generated novel data on sex differences in the FH/Q ratio and neuromuscular performance prior to and following a downhill running fatigue task. One hundred and ten healthy males (n=55; mean ± SD 29 ± 5 yrs) and females (n=55; mean ± SD 27 ± 6 yrs) were recruited from the university population. Isokinetic torque of the hamstrings and quadriceps was determined at 60, 120 and 240˚·s–1with the hip flexed at 0°. Range of movement of the knee joint was 90° with 0° determined as full volitional extension. Concentric (CON) torque was determined first followed by eccentric (ECC) torque, with the slowest velocity tested first. Torque was gravity corrected and filtered to only include constant velocity periods. For functional relevance FH/Q ratio was determined at 15, 30, 45º (as these are the joint angles where injury is most likely to occur) and where peak torque (PT) was achieved (to compare with the extant literature) for each movement velocity. Surface electromyography was recorded from the semitendinosus (ST), semimembranosus (SM) and biceps femoris (BF) of the dominant limb using an 8-channel DelSys EMG telemetry system. The biodex square wave synchronization pulse was configured with the EMG software via a trigger system so that EMG and torque data were completely time aligned. Raw EMG data were collected at a sampling frequency of 1024 Hz and included a common mode rejection ratio of <80 dB and an amplifier gain of 1000. Raw EMG data was band pass filtered at 20 – 450 Hz. The electromechanical delay (EMD) was determined as the time delay between the onset of muscle activation (change in activation of +15 μV) and onset of torque production (9.6 N·m) according to the procedures described by Zhou et al (1995). The aim of the first study (chapter 4) was to explore sex differences in the FH/Q ratio whilst taking into account joint angle and movement velocity. A 2 (sex) x 3 (movement velocity) x 4 (joint angle) ANOVA was performed to determine interactions and main effects. FH/Q ratio ranged from 59 to 98% in females and 66 to 109% in males across joint angles and movement velocities. No significant differences between males and females in age but males were significantly taller and had greater body mass. Irrespective of sex the FH/Q ratio increased with joint angle and movement velocity to improve knee stability during high velocity movement and near full extension. However, the FH/Q ratio is significantly lower in females compared with males and importantly this sex difference increases as movement velocity increases. Females have a lower FH/Q ratio than males close to full knee extension and during high velocity movements, both of which are predisposing factors for increased injury risk. This reduced FH/Q ratio may impair dynamic knee stability in females during fast velocity movements and may predispose them to a greater relative risk of knee injury. The aim of the second study (chapter 5) was to examine sex differences in the EMD of the hamstring muscles during eccentric muscle actions at 60, 120 and 240˚·s–1. A 2 (sex) x 3 (muscle group) x 3 (movement velocity) ANOVA was performed to determine interactions and main effects. During eccentric hamstring muscle actions there were no differences in the EMD of the 3 muscles examined. Irrespective of sex, significant main effects for angular velocity was demonstrated, indicating an increase in the delay time with increasing angular velocity. This increased delay during fast velocity movements may account for the increased risk of injury during fast movements. No significant sex differences in EMD was found irrespective of movement velocity of muscle examined, suggesting that females do not have impaired neuromuscular performance of the hamstring compared with males during eccentric hamstring muscle actions in the rested state. The aim of the third study (chapter 6) was to examine the effects of a fatigue task on sex differences of the FH/Q ratio and EMD. The procedures used in study 1 and 2 were repeated pre and post a downhill running fatigue task to explore fatigue related effects on neuromuscular functioning. Each participant performed a 40 min intermittent downhill running protocol consisting of 5 × 8 min bouts on a -10% decline, with 2 min standing rest between each bout. Irrespective of sex, joint angle or angular velocity, the FH/Q ratio was lower and EMD of hamstrings muscle was longer post-fatigue compared to pre-fatigue. Significant interactions between sex and time (pre-post) for the FH/Q ratio and EMD of hamstring muscles were found. The interactions showed a significantly lower FH/Q ratio and significantly longer EMD post fatigue in females compared to males. These data suggest that functional stability of the knee is reduced when fatigue is present and the impact of fatigue is greater in females. The findings of this thesis indicate the importance of determining the FH/Q ratio using angle specific torque as well as taking into account movement velocity, rather than simply using PT values to monitor muscle function of the knee. The findings of the present thesis support the notion that fatigue compromises the stability of the knee by reducing the FH/Q ratio and lengthening EMD. These effects are greater in females compared to males and may predispose them to greater relative risk of injury. Therefore, movement velocity, joint angle and fatigue resistance all need to be considered when designing training programmes to reduce the relative risk of injury. The focus of such training should be aimed at eccentric conditioning of the hamstring muscles to improve both muscular and neuromuscular functioning to limit the fatigue related effects, especially in females.
|Item Type:||Thesis (PhD)|
|Additional Information:||Images redacted for anonymisation purposes page 106 and 143.|
|Uncontrolled Keywords:||Non-contact anterior cruciate ligament (ACL) injury, dynamic knee stability, effect of fatigue on risk, risk levels in male and female athletes|
|Subjects:||R Medicine > RC Internal medicine > RC1200 Sports Medicine|
|Divisions:||Schools and Research Institutes > School of Sport & Exercise|
|Depositing User:||Susan Turner|
|Date Deposited:||03 Mar 2015 12:50|
|Last Modified:||14 Feb 2017 11:35|