Effect of Gluteus Maximus Muscle Strengthening on the Intensity of Quadriceps Muscle Contraction: A Non-Contact ACL Injury Risk Factor

Document Type : Original article

Authors

1 PhD Candidate in Corrective Exercises, Sports Injuries and Corrective Exercises Department, Sports Sciences faculty, University of Isfahan, Isfahan, Iran

2 Professor in Sports Injuries and Corrective Exercises Department, Sports Sciences faculty, University of Isfahan, Isfahan, Iran

3 Assistant Professor in Sports Biomechanics Department, Sports Sciences faculty, University of Isfahan, Isfahan, Iran

4 Associate Professor in Heart Failure Research Center, Cardiovascular Research Institute and Epidemiology and Biostatistics Department, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background and Aims: An increased Quadriceps to Hamstrings muscle strength ratio, which leads to development of anterior shear forces on the Tibia, is known as a risk factor for Anterior Cruciate Ligament (ACL) injury. The purpose of the present study was to investigate the effect of Gluteus Maximus Muscle (GM) strengthening exercises on the intensity of Quadriceps Muscle (QFM) contraction at landing.
Materials and Methods: A total of 25 healthy volunteer females, aged 18-30 years, were assigned into two groups of control (n = 13) and experimental (n = 12) in a randomized control trial. Maximum isometric strength was measured using hand-held dynamometer and the intensity of contraction on the moment of landing to the maximum intensity of voluntary isometric contraction (%MVIC) for GM, QFM, and Hams were measured using surface EMG, respectively. After eight weeks (3 sessions per week) of resistance training on the experimental group, measurements were repeated. Two-factor mixed model ANOVA was used as a significance test and paired samples T-test as the post hoc.
Results: There was a 4.55% non-significant increase in the mean GM strengths in the experimental group. In term of the intensity of contraction, there were a 16.36% increase, a 8.26% decrease, and a 9.21% increase all of which were significant in the experimental group (P≤0.05), and a 2.93% increase, a 4.73% decrease, and a 4.3% increase, all non-significant, in control group, for GM, QFM and HAMS, respectively.
Conclusion: These results suggest that GM strengthening exercises along with HAMS could be effective in decreasing the intensity of QFM contraction, preventing anterior translation of Tibia, and decreasing ACL injury, as a consequence.

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Main Subjects

References

  1. Engebretsen L, Bahr R. Why is injury prevention in sports important. Sports injury prevention (pp. 1Á6). Hoboken, NJ: Wiley-Blackwell. 2009 Jan 23.##
  2. Rosa BB, Asperti AM, Helito CP, Demange MK, Fernandes TL, Hernandez AJ. Epidemiology of sports injuries on collegiate athletes at a single center. Acta ortopedica brasileira. 2014 Dec; 22(6):321-4. ##
  3. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. The 2012 ABJS Nicolas Andry Award: The sequence of prevention: a systematic approach to prevent anterior cruciate ligament injury. Clinical Orthopaedics and Related Research®. 2012 Oct 1; 470(10):2930-40. ##
  4. Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, DeMaio M, Dick RW, Engebretsen L, Garrett WE, Hannafin JA, Hewett TE. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. The American journal of sports medicine. 2006 Sep; 34(9):1512-32. ##
  5. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. British journal of sports medicine. 2008 Jun 1; 42(6):394-412. ##
  6. Beynnon BD, Sturnick DR, Argentieri EC, Slauterbeck JR, Tourville TW, Shultz SJ, Vacek PM. A sex-stratified multivariate risk factor model for anterior cruciate ligament injury. Journal of athletic training. 2015 Oct; 50(10):1094-6. ##
  7. Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2000 May 1; 8(3):141-50. ##
  8. Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS. ACL research retreat VII: An update on anterior cruciate ligament injury risk factor identification, screening, and prevention: March 19–21, 2015; Greensboro, NC. Journal of athletic training. 2015 Oct; 50(10):1076-93. ##
  9. Shultz SJ. ACL injury risk in the physically active: why are females more susceptible?. Kinesiology Review. 2015 Feb 1; 4(1):52-62. ##

10. Santello M. Review of motor control mechanisms underlying impact absorption from falls. Gait & posture. 2005 Jan 1; 21(1):85-94. ##

11. McLean SG, Huang X, Su A, Van Den Bogert AJ. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clinical biomechanics. 2004 Oct 1; 19(8):828-38. ##

12. Baffa A, Felicio L, Saad M, Nogueira-Barbosa M, Santos A, Bevilaqua-Grossi D. Quantitative MRI of vastus medialis, vastus lateralis and gluteus medius muscle workload after squat exercise: comparison between squatting with hip adduction and hip abduction. Journal of human kinetics. 2012 Jun 1; 33:5-14.##

13. Khayambashi K, Ghoddosi N, Straub RK, Powers CM. Hip muscle strength predicts noncontact anterior cruciate ligament injury in male and female athletes: a prospective study. The American journal of sports medicine. 2016 Feb; 44(2):355-61. ##

14. Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. Journal of Orthopaedic Research. 1995 Nov; 13(6):930-5. ##

15. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee surgery, sports traumatology, and arthroscopy. 2009 Aug 1; 17(8):859-79. ##

16. Neumann DA. Kinesiology of the musculoskeletal system: Mosby. St. Louis. 2002. ##

17. Van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries. Sports medicine. 1992 Aug 1; 14(2):82-99. ##

18. Waldén M, Atroshi I, Magnusson H, Wagner P, Hägglund M. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. Bmj. 2012 May 3; 344:e3042. ##

19. DeMorat G, Weinhold P, Blackburn T, Chudik S, Garrett W. Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. The American journal of sports medicine. 2004 Mar; 32(2):477-83. ##

20. Holcomb WR, Rubley MD, Lee HJ, Guadagnoli MA. Effect of hamstring-emphasized resistance training on hamstring: quadriceps strength ratios. Journal of Strength and Conditioning Research. 2007 Feb 1; 21(1):41. ##

21. Kong PW, Burns SF. Bilateral difference in hamstrings to quadriceps ratio in healthy males and females. Physical Therapy in Sport. 2010 Feb 1; 11(1):12-7. ##

22. Harbo T, Brincks J, Andersen H. Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. European journal of applied physiology. 2012 Jan 1; 112(1):267-75. ##

23. Danneskiold‐Samsøe B, Bartels EM, Bülow PM, Lund H, Stockmarr A, Holm CC, Wätjen I, Appleyard M, Bliddal H. Isokinetic and isometric muscle strength in a healthy population with special reference to age and gender. Acta physiologica. 2009 Oct; 197:1-68. ##

24. Daneshjoo A, Mokhtar AH, Rahnama N, Yusof A. The effects of injury preventive warm-up programs on knee strength ratio in young male professional soccer players. PloS one. 2012 Dec 3; 7(12):e50979. ##

25. Hewett TE, Stroupe AL, Nance TA, and Noyes FR. Plyometric training in female athletes: decreased impact forces and increased hamstring torques. The American journal of sports medicine. 1996 Nov; 24(6):765-73. ##

26. Huston LJ, Wojtys EM. Neuromuscular performance characteristics in elite female athletes. The American journal of sports medicine. 1996 Jul; 24(4):427-36. ##

27. Chappell JD, Yu B, Kirkendall DT, Garrett WE. A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. The American journal of sports medicine. 2002 Mar; 30(2):261-7. ##

28. Uhorchak JM, Scoville CR, Williams GN, Arciero RA, Pierre PS, Taylor DC. Risk factors associated with noncontact injury of the anterior cruciate ligament. The American journal of sports medicine. 2003 Nov; 31(6):831-42. ##

29. Smith HC, Johnson RJ, Shultz SJ, Tourville T, Holterman LA, Slauterbeck J, Vacek PM, Beynnon BD. A prospective evaluation of the Landing Error Scoring System (LESS) as a screening tool for anterior cruciate ligament injury risk. The American journal of sports medicine. 2012 Mar; 40(3):521-6. ##

30. McCall A, Carling C, Nedelec M, Davison M, Le Gall F, Berthoin S, Dupont G. Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues. Br J Sports Med. 2014 Sep 1; 48(18):1352-7. ##

31. Walsh M, Boling MC, McGrath M, Blackburn JT, Padua DA. Lower extremity muscle activation and knee flexion during a jump-landing task. Journal of athletic training. 2012 Jul; 47(4):406-13. ##

32. Kim D, Hong J. Hamstring to quadriceps strength ratio and noncontact leg injuries: A prospective study during one season. Isokinetics and Exercise Science. 2011 Jan 1; 19(1):1-6. ##

33. Bahr R, Engebretsen L, editors. Handbook of sports medicine and science, sports injury prevention. John Wiley & Sons; 2011 Aug 24. ##

34. Myers CA, Torry MR, Shelburne KB, Giphart JE, LaPrade RF, Woo SL, Steadman JR. In vivo tibiofemoral kinematics during 4 functional tasks of increasing demand using biplane fluoroscopy. The American journal of sports medicine. 2012 Jan; 40(1):170-8. ##

35. Schmitz RJ, Kim H, Shultz SJ. Effect of axial load on anterior tibial translation when transitioning from non-weight bearing to weight bearing. Clinical Biomechanics. 2010 Jan 1; 25(1):77-82. ##

36. Oatis CA. Kinesiology: the mechanics and pathomechanics of human movement. Lippincott Williams & Wilkins; 2009. ##

37. Markolf KL, Wascher DC, Finerman GA. Direct in vitro measurement of forces in the cruciate ligaments. Part II: The effect of section of the posterolateral structures. The Journal of bone and joint surgery. American volume. 1993 Mar; 75(3):387-94. ##

38. Thomas JR, Nelson JK, Silverman SJ. Research methods in physical activity. Human kinetics; 2015 Jul 17.

39. Ratamess NA. ACSM's foundations of strength training and conditioning. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011. ##

40. Powers CM, Ghoddosi N, Straub RK, Khayambashi K. Hip strength as a predictor of ankle sprains in male soccer players: a prospective study. Journal of athletic training. 2017 Nov; 52(11):1048-55. ##

41. Kendall FP, McCreary EK, Provance PG. Muscles: testing and function with posture and pain. Lippincott Williams & Wilkins; 2005. ##

42. Thorborg K, Bandholm T, Hölmich P. Hip-and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 Mar 1; 21(3):550-5. ##

43. Kelln BM, McKeon PO, Gontkof LM, Hertel J. Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. Journal of sport rehabilitation. 2008 May 1; 17(2):160-70. ##

44. Hermens HJ, Freriks B, Merletti R, Stegeman D, Blok J, Rau G, Disselhorst-Klug C, Hägg G. European recommendations for surface electromyography. Roessingh research and development. 1999; 8(2):13-54. ##

45. Iida Y, Kanehisa H, Inaba Y, Nakazawa K. Activity modulations of trunk and lower limb muscles during impact-absorbing landing. Journal of Electromyography and Kinesiology. 2011 Aug 1; 21(4):602-9. ##

46. Konrad P. The ABC of EMG: A practical introduction to kinesiological electromyography. Version. 2005 Apr; 1:29-33. ##

47. Jeansonne JJ, Montz J, Rodriguez J. EXAMINING THE EFFECT OF AN IN SEASON PLYOMETRIC TRAINING PROGRAM ON PEAK IMPACT JUMPING FORCES IN FEMALES. Journal of Biomechanics. 2007 Jan 1; 40(2):S739. ##

48. Kwon YJ, Lee HO. How different knee flexion angles influence the hip extensor in the prone position. Journal of physical therapy science. 2013; 25(10):1295-7. ##

49. Jeon IC, Hwang UJ, Jung SH, Kwon OY. Comparison of gluteus maximus and hamstring electromyographic activity and lumbopelvic motion during three different prone hip extension exercises in healthy volunteers. Physical Therapy in Sport. 2016 Nov 1; 22:35-40. ##

50. Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, Powers CM. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. Journal of orthopaedic & sports physical therapy. 2012 Jan; 42(1):22-9. ##

51. Malinzak RA, Colby SM, Kirkendall DT, Yu B, Garrett WE. A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clinical biomechanics. 2001 Jun 1; 16(5):438-45. ##

52. Paterno MV, Ford KR, Myer GD, Heyl R, Hewett TE. Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clinical Journal of Sport Medicine. 2007 Jul 1; 17(4):258-62. ##

The Scientific Journal of Rehabilitation Medicine
Volume 9, Issue 3
November 2020
Pages 112-122

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History

  • Receive Date: 02 December 2019
  • Revise Date: 04 December 2019
  • Accept Date: 14 December 2019
  • First Publish Date: 22 September 2020

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