Int J Sports Med 2020; 41(11): 729-735 DOI: 10.1055/a-1171-2548
Training & Testing
Side Differences Regarding the Limb Symmetry Index in Healthy
Professional Athletes
Christophe Lambert
1
Faculty of Health, Department of Trauma and Orthopedic Surgery,
University Witten Herdecke, Witten, Germany
,
Thomas Pfeiffer
1
Faculty of Health, Department of Trauma and Orthopedic Surgery,
University Witten Herdecke, Witten, Germany
,
Maxime Lambert
1
Faculty of Health, Department of Trauma and Orthopedic Surgery,
University Witten Herdecke, Witten, Germany
,
Benedikt Brozat
1
Faculty of Health, Department of Trauma and Orthopedic Surgery,
University Witten Herdecke, Witten, Germany
,
Daniel Lachmann
2
Vice-rectorate for Teaching and Studies, Central Evaluation of Studies
and Teaching, University of Cologne, Koeln, Germany
,
Sven Shafizadeh
1
Faculty of Health, Department of Trauma and Orthopedic Surgery,
University Witten Herdecke, Witten, Germany
3
Department of Trauma Surgery and Sports Traumatology, Sana
Dreifaltigkeits-Krankenhaus Cologne, Cologne, Germany
,
Ralph Akoto
1
Faculty of Health, Department of Trauma and Orthopedic Surgery,
University Witten Herdecke, Witten, Germany
4
Asklepios Clinic St. Georg, Department of Trauma and Reconstructive
Surgery with Division of Knee and Shoulder Surgery, Sports Traumatology,
Hamburg, Germany
Side differences in the limb symmetry index during hop tests have been rarely
investigated in uninjured athletes. Unknown differences can result in false
interpretation of hop tests and affect return to sport decision. Hypothesis was
that un-injured athletes in Judo and Taekwondo have side differences in hop test
and that asymmetries can be predicted based on the athletes fighting display.
Differences, risk relationships were analyzed using the chi-squared test and the
odds ratio. A two-tailed p value of<0.05 was considered statistically
significant. 115 athletes from the national teams were included (mean age 18.4
years; range 13–27 years). 93, 97.4 and 98.3% did not have
symmetric hop distance for three hop tests. Up to a quarter did not reach a limb
symmetry index of>90. Moreover, 57.4% (n=66) reached
longer jumping distance with the standing leg. Ignoring such pre-existent side
differences in evaluation of hop tests and not knowing which limb was dominant
prior the injury, can lead to premature or delayed return to sports in the
rehabilitation process. Therefore, it might be helpful to refer to individual
jump lengths for each limb in case of injury by using hop tests in pre-season
screening in professional athletes in Judo and Taekwondo.
1
Ristolainen L,
Kujala U,
Heinonen A.
et al. Sport injuries as the main cause of sport career termination among Finnish
top-level athletes. Eur J Sport Sci 2012; 12: 274-282
2
Balendra G,
Turner M,
McCrory P.
et al. Career-ending injuries to professional jockeys in British horse racing
(1991–2005). Br J Sports Med 2008; 42: 22-24
3
Akoto R,
Lambert C,
Balke M.
et al. Epidemiology of injuries in judo: a cross-sectional survey of severe injuries
based on time loss and reduction in sporting level. Br J Sports Med 2018; 52: 1109-1115
4
Beis K,
Tsaklis P.,
Pieter W.
et al. Taekwondo competition injuries in Greek young and adult athletes. Eur J Sports Traumatol Rel Res 2001; 23: 130-136
5
Ardern C,
Feller J,
Webster K.
et al. Fifty-five per cent return to competitive sport following anterior cruciate
ligament reconstruction surgery: an updated systematic review and meta- analysis
including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48: 1543-1552
6
Hildebrandt C,
Muller L,
Zisch B.
et al. Functional assessments for decision-making regarding return to sports following
ACL reconstruction. Part I: development of a new test battery. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1273-1281
7
Jones P,
Bampouras T.
A comparison of isokinetic and functional methods of assessing bilateral
strength imbalance. J Strength Cond Res 2010; 24: 1553-1559
8
Jamshidi AOG,
Heydarian K.
et al. Isokinetic and functional parameters in patients following reconstruction of the
anterior cruciate ligament. Isokinet Exerc Sci 2005; 13: 267-272
9
Petschnig R,
Baron R,
Albrecht M.
et al. The relationship between isokinetic quadriceps strength test and hop tests for
distance and one-legged vertical jump test following anterior cruciate ligament
reconstruction. J Orthop Sports Phys Ther 1998; 28: 23-31
10
Gokeler A,
Welling W,
Benjaminse A.
et al. A critical analysis of limb symmetry indices of hop tests in athletes after
anterior cruciate ligament reconstruction: a case control study. Orthop Traumatol Surg Res 2017; 103: 947-951
12
Grindem H,
Logerstedt D,
Eitzen I.
et al. Single-legged hop tests as predictors of self-reported knee function in
nonoperatively treated individuals with anterior cruciate ligament injury. Am J Sports Med 2011; 39: 2347-2354
13
Rambaud A,
Semay B,
Samozino P.
et al. Criteria for return to sport after anterior cruciate ligament reconstruction
with lower reinjury risk (CR'STAL study): protocol for a prospective
observational study in France. BMJ Open 2017; 7: e015087
17
Sousa P,
Krych A,
Cates R.
et al. Return to sport: does excellent 6-month strength and function following ACL
reconstruction predict midterm outcomes?. Knee Surg Sports Traumatol Arthrosc 2017; 25: 1356-1363
18
Reid A,
Stratford P,
Alcock G.
et al. Hop testing provides a reliable and valid outcome measure during rehabilitation
after anterior cruciate ligament reconstruction. Phys Ther 2007; 87: 337-349
19
Gokeler A,
Welling W,
Zaffagnini S.
et al. Development of a test battery to enhance safe return to sports after anterior
cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25: 192-199
20
Reid A,
Birmingham T,
Stratford P.
et al. Hop testing provides a reliable and valid outcome measure during rehabilitation
after anterior cruciate ligament reconstruction. Phys Ther 2007; 87: 337-349
21
Mortaza N,
Ebrahimi I,
Jamshidi AA.
et al. The effects of a prophylactic knee brace and two neoprene knee sleeves on the
performance of healthy athletes: a crossover randomized controlled trial. PLoS One 2012; 7: e50110
22
Noyes F,
Barber S,
Mangine R.
et al. Abnormal lower limb symmetry determined by function hop tests after anterior
cruciate ligament rupture. Am J Sports Med 1991; 19: 513-518
25
Kyritsis P,
Bahr R,
Landreau P.
et al. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria
before return to sport is associated with a four times greater risk of
rupture. Br J Sports Med 2016; 50: 946-951
26
Fitzgerald G,
Axe M,
Snyder-Mackler L.
et al. A decision-making scheme for returning patients to high-level activity with
nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2000; 8: 76-82
27
Barber S,
Noyes F,
Mangine R.
et al. Quantitative assessment of functional limitations in normal and anterior
cruciate ligament-deficient knees. Clin Orthop Relat Res 1990; 255: 204-214
29
Anderson L,
Triplett-McBride T,
Foster C.
et al. Impact of training patterns on incidence of illness and injury during a
women’s collegiate basketball season. J Strength Cond Res 2003; 17: 734-738
31
Krajnc Z,
Vogrin M,
Recnik G.
et al. Increased risk of knee injuries and osteoarthritis in the non-dominant leg of
former professional football players. Wien Klin Wochenschr 2010; 122 (Suppl. 02) 40-43
32
Hewett T,
Myer G,
Ford K.
et al. Biomechanical measures of neuromuscular control and valgus loading of the knee
predict anterior cruciate ligament injury risk in female athletes: a prospective
study. Am J Sports Med 2005; 33: 492-501
33
Munro A,
Herrington L,
Comfort P.
et al. Comparison of landing knee valgus angle between female basketball and football
athletes: possible implications for anterior cruciate ligament and
patellofemoral joint injury rates. Phys Ther Sport 2012; 13: 259-264
34
Cook G,
Burton L,
Hoogenboom B.
et al. Pre-participation screening: the use of fundamental movements as an assessment
of function – part 1. N Am J Sports Phys Ther 2006; 1: 62-72
37
Brumitt J,
Heiderscheit B,
Manske R.
et al. Lower extremity functional tests and risk of injury in Division III collegiate
athletes. Int J Sports Phys Ther 2013; 8: 216-227
39
Echemendia R,
Meeuwisse W,
McCrory P.
et al. The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and
rationale. Br J Sports Med 2017; 51: 848-850
41
Faude O,
Junge A,
Kindermann W.
et al. Injuries in female soccer players: a prospective study in the German national
league. Am J Sports Med 2005; 33: 1694-1700
43
Takahashi S,
Okuwaki T.
Epidemiological survey of anterior cruciate ligament injury in Japanese junior
high school and high school athletes: cross-sectional study. Res Sports Med 2017; 25: 266-276
44
Della Villa S,
Boldrini L,
Ricci M.
et al. Clinical outcomes and return-to-sports participation of 50 soccer players after
anterior cruciate ligament reconstruction through a sport-specific
rehabilitation protocol. Sports Health 2012; 4: 17-24
