Document Title: BarberWestin-AJSM-Dec05.shtml
Article Title: Assessment of Lower Limb Neuromuscular Control in Prepubescent Athletes
Authors: Sue D. Barber-Westin, BSc, Marc Galloway, MD, Frank R. Noyes, MD, George Corbett, MD and Catherine Walsh, MSc.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2005
Volume 33, pages 1853-1860
Keywords: Kinematics, kinetics, biomechanics, children, adolescents, epidemiology, knee-injury predisposing factors, jump-landing technique, neuromuscular training, screening tests, isokinetic, limb symmetry, balance.

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Comments: This ground-breaking, penetratingly insightful study is the first to look at biomechanical knee-injury-predisposing factors in children (defined as young people who have not yet reached puberty). Barber-Westin notes that a large proportion of the prepubescent athletes studied exhibited a markedly inwards-angled (valgus, hence simulating knockkneedness) knee alignment during the drop-jump screening test. Also noted were off-balance, asymmetrical landings during the hop tests. Given that these inwards-angled and off-balance landings appear to be correlated with knee-ligament injuries in older athletes, Barber-Westin concludes that neuromuscular training may constitute an appropriate intervention measure. Such training may be big dividends later on, not only in terms of avoided knee injuries, but also in terms of improved athletic performance (e.g. higher jump height, greater endurance). Note that the use of a single consumer-grade video camera makes the assessments done in this study easy for trainers to do in the field, since no special equipment is required. (Other excellent articles on these topics are Noyes-AJSM-Feb05.shtml, Chappell-AJSM-Mar02.shtml, Ahmad-AJSM-Mar06.shtml, Mandelbaum-AJSM-Jul05.shtml, Chappell-AJSM-Feb07.shtml, and BarberWestin-AJSM-Mar06.shtml.)

ABSTRACT

Background: Although neuromuscular indices have been extensively studied in adolescents and adults, limited data exist for prepubescent children.

Hypothesis: No differences exist between prepubescent boys and girls in lower limb strength, symmetry on single-legged hop testing, and limb alignment during drop-jump testing.

Study Design: Cross-sectional study (prevalence); Level of evidence, 1.

Methods: The authors tested 27 female and 25 male athletes who were aged 9 to 10 years and matched for both body mass index and years of organized sports participation. In a drop-jump screening test, the distance between the right and left hips, knees, and ankles was measured as an indicator of lower limb axial alignment in the coronal plane. The distance between the knees and ankles was normalized by the hip separation distance. Quadriceps and hamstrings strengths were measured isokinetically at 180 deg/s. Lower limb symmetry was determined from 2 single-legged hop function tests.

Results: Boys demonstrated greater mean absolute and normalized knee and ankle separation distances on the drop-jump test. Even so, 76% of boys had a normalized knee separation distance of 60% or less of the hip separation distance, as did 93% of girls, indicating a distinctly valgus alignment. There were no differences between the sexes in quadriceps and hamstrings peak torques, hamstrings/quadriceps ratio, time to peak torque, total work, or lower limb symmetry values.

Conclusions: A high percentage of the prepubescent athletes studied had a distinctly valgus lower limb alignment during the drop-jump test and a lack of lower limb symmetry during the hop tests. These same indices have been hypothesized to increase the risk for knee ligament injuries in older athletes. Neuromuscular training may be needed to address these issues in children.

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