Gender differences in lower extremity kinematics, kinetics and energy absorption during landing
Introduction
Numerous studies have found females to possess a higher rate of non-contact anterior cruciate ligament (ACL) injury compared to males during athletic competition (Arendt and Dick, 1995; Ferretti et al., 1992). An emerging theory for this gender disparity proposes that females perform high demand athletic maneuvers differently than males and in a manner that predisposes them to higher knee joint stress (Colby et al., 2000; Cowling and Steele, 2001; Huston et al., 2001; Kirkendall and Garrett, 2000; Wojtys et al., 2002). Kirkendall and Garrett (2000) reported ACL injuries occurring in basketball and soccer were most often (64 of 72 injuries, 88%) non-contact in nature and a result of a deceleration type of movement (landing from a jump was reported in 30 of the 72 injuries, 41%). Similarly, others have reported that landing from a jump is one of the primary non-contact mechanisms for ACL injury in female basketball and volleyball players (Ferretti et al., 1992; Kirkendall and Garrett, 2000; Gerberich et al., 1987; Gray et al., 1985; Noyes et al., 1983). In light of these observations, controlled laboratory experiments have investigated the performance of females during cutting and landing tasks (Colby et al., 2000; Cowling and Steele, 2001; Huston et al., 2001; Malinzak et al., 2001; McLean et al., 1999). Consensus of these reports indicate that the female knee is in a more extended position at ground contact, and thus predispose the ACL to greater loads; and that the neuromuscular function, particularly of the hamstring musculature, is inadequate in females compared to males (Colby et al., 2000; Rozzi et al., 1999).
Although it is generally accepted that external and internal forces can be mediated by manipulating the lower extremity joint kinematics during landing, no consensus has been reached regarding gender differences in the primary energy absorption strategy. However, the alteration of joint positions and angular velocities at ground contact and throughout the landing motion can influence the magnitudes and temporal relationships of the peak joint moment and power profiles and thus, mediate stresses placed on internal knee structures (Zhang et al., 2000). Landing performance differences between male and female athletes, therefore, require investigations beyond the kinematic level of analysis to understand the underlying neuromuscular performance criteria by which genders select an energy absorption strategy during landing.
Currently, few studies have included both genders during landing (Huston et al., 2001; McNitt-Gray et al., 1994), and none have investigated gender differences during landing at the level of kinetic and energetic detail. Gender differences in the muscular landing strategy may explain the disparity in ACL injury rates if one gender’s landing strategy requires a geometry that is more likely to result in ACL injury. The purpose of this study was to determine whether gender differences exist in the kinematic (hip, knee and ankle joint angles and joint angular velocities), kinetic (hip, knee and ankle joint moments) and energetic (hip, knee and ankle joint powers and work) profiles during landing from a drop-jump.
Section snippets
Methods
Twelve male (age, 28.3 (SD, 3.9 years); height, 1.8 (SD, 0.06 m); mass, 81.8 (SD, 9.1 kg)) and 9 female (age, 26.4 (SD, 4.5 years); height, 1.7 (SD, 0.06 m); mass, 60.1 (SD, 5.6 kg)) recreational athletes participated in this study. All athletes were currently involved in competitive intramural court sports consisting of volleyball and basketball, sponsored by the local public recreation district. Each subject had participated in these sports at least three times per week and had been active in
Results
Landing style and kinematics. All subjects performed forefoot rear-foot landings and group mean landing phase times were not different between groups (male group, 0.191 (SD, 0.046 s); female group, 0.209 (SD, 0.034 s); P>0.05). In addition, both groups demonstrated similar maximum knee flexion angles (males, −93.0 (SD, 10.8°); females −98.4 (SD, 10.6°)) (P>0.05). Group means and standard deviations for the impact phase kinematics are located in Table 1 and graphically presented in Fig. 1. The
Discussion
During landing, the lower extremity joints function to reduce and control the downward momentum acquired during the flight phase through joint flexion. A maximum knee flexion angle greater than and less than 90° has traditionally defined the landing technique as soft or stiff, respectively (Devita and Skelly, 1992). According to this criterion, both groups in the present study demonstrated the soft landing technique with the lower extremities in slight flexion at initial ground contact followed
Summary
This study provides an increased understanding for the commonly observed gender difference in knee contact position noted throughout the literature. It was noted that the preferred shock absorption strategy for the females required the ankle and knee to be in a more extended position to fully utilize the capacity of the ankle plantar-flexor muscles. Under certain landing conditions, this shock absorption strategy was proposed to provide a greater potential risk for non-contact ACL injury for
Acknowledgements
This study was funded in part by a grant from the NFL Charities and the Steadman-Hawkins Sports Medicine Foundation. The authors thank Kevin Shelburne, Ph.D., Forrest Pecha, M.S., A.T.C., and Mary “Molli” Pflum, M.S. for their assistance with this project.
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