Muscle Strength Differences of Hamstring and Quadriceps Ratio in Para-Footballers with Cerebral Palsy
Muscle Strength Differences in Para-Footballers
DOI:
https://doi.org/10.21134/eurjhm.2023.51.5Keywords:
Para-athletes, para-sport, Paralympic, spasticity, neurological impairmentsAbstract
The aims of this study were 1) to examine differences in knee flexor and knee extensor muscle strength between lower limbs and 2) to compare the hamstring to quadriceps (H/Q) muscle strength ratio and asymmetries, considering more and less affected legs in para-footballers with cerebral palsy (CP) and unilateral spasticity impairment profile. This cross-sectional design study included nine male para-footballers with CP who participated in this study. Participants performed an isometric knee extension and flexion for 5 seconds, and the force was registered with a load cell. The maximum peak force for the hamstring and quadriceps was registered for the more and less affected leg. The difference between legs, between muscle groups, and the hamstring and quadriceps ratio (H/Q ratio) was calculated. The knee extension of the less affected leg showed significantly greater strength than the more affected leg (p = 0.014, d = 0.63), but there were no differences between knee flexors (p = 0.35, d = 0.13). The H/Q ratio was significantly lower in the less affected leg than in the more affected leg (p = 0.03, d = -0.75). The majority of participants (77%) showed asymmetry in lower limb strength levels by more than 10%. Para-footballers with CP showed asymmetries and strength deficits which could be related to a higher prevalence of injury risk factors. The characteristics of this population should be taken into account, and this type of test should be implemented in order to design appropriate training programs to counteract the neuromuscular consequences of CP and improve physical performance.
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Alarcón, A., Henríquez, M., & Peñailillo, L. (2021). Effects of lower limb eccentric strength training on functional measurements in football players with cerebral palsy. European Journal of Adapted Physical Activity, 14(1), 2–14. https://doi.org/10.5507/euj.2020.010
Antunes, D., Rossato, M., Kons, R. L., Sakugawa, R. L., & Fischer, G. (2017). Neuromuscular features in sprinters with cerebral palsy: case studies based on paralympic classification. Journal of Exercise Rehabilitation, 13(6), 716–721. https://doi.org/10.12965/jer.1735112.556
Bar-On, L., Molenaers, G., Aertbeliën, E., van Campenhout, A., Feys, H., Nuttin, B., & Desloovere, K. (2015). Spasticity and its contribution to hypertonia in cerebral palsy. BioMed Research International, 2015. https://doi.org/10.1155/2015/317047
Baroni, B. M., Ruas, C. V., Ribeiro-Alvares, J. B., & Pinto, R. S. (2020). Hamstring-to-Quadriceps Torque Ratios of Professional Male Soccer Players: A Systematic Review. Journal of Strength and Conditioning Research, 34(1), 281–293. https://doi.org/10.1519/JSC.0000000000002609
Beckman, E. M., Connick, M. J., & Tweedy, S. M. (2016). How much does lower body strength impact Paralympic running performance? European Journal of Sport Science, 16(6), 669–676. https://doi.org/10.1080/17461391.2015.1132775
Böhm, H., & Döderlein, L. (2012). Gait asymmetries in children with cerebral palsy: Do they deteriorate with running? Gait and Posture, 35(2), 322–327. https://doi.org/10.1016/j.gaitpost.2011.10.003
Cans, C. (2000). Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers. Developmental Medicine and Child Neurology, 42(12), 816–824. https://doi.org/10.1017/S0012162200001511
Croisier, J. L., Ganteaume, S., Binet, J., Genty, M., & Ferret, J. M. (2008). Strength imbalances and prevention of hamstring injury in professional soccer players: A prospective study. American Journal of Sports Medicine, 36(8), 1469–1475. https://doi.org/10.1177/0363546508316764
Dayanidhi, S., & Lieber, R. L. (2018). Muscle Changes at the Cellular-Fiber Level in Cerebral Palsy. In Cerebral Palsy (pp. 1–12). Springer International Publishing. https://doi.org/10.1007/978-3-319-50592-3_13-1
de Groot, S., Dallmeijer, A., Bessems, P., Lamberts, M., Woude, L., & Janssen, T. (2012). Comparison of muscle strength, sprint power and aerobic capacity in adults with and without cerebral palsy. Journal of Rehabilitation Medicine, 44(11), 932–938. https://doi.org/10.2340/16501977-1037
Dedinsky, R., Baker, L., Imbus, S., Bowman, M., & Murray, L. (2017). Exercises That Facilitate Optimal Hamstring and Quadriceps Co-Activation To Help Decrease Acl Injury Risk in Healthy Females: a Systematic Review of the Literature. International Journal of Sports Physical Therapy, 12(1), 3–15.
Denadai, B. S., de Oliveira, F. B. D., Camarda, S. R. de A., Ribeiro, L., & Greco, C. C. (2016). Hamstrings-to-quadriceps strength and size ratios of male professional soccer players with muscle imbalance. Clinical Physiology and Functional Imaging, 36(2), 159–164. https://doi.org/10.1111/cpf.12209
Dietz, V., & Sinkjaer, T. (2007). Spastic movement disorder: impaired reflex function and altered muscle mechanics. Lancet Neurology, 6(8), 725–733. https://doi.org/10.1016/S1474-4422(07)70193-X
dos Santos Andrade, M., Fleury, A. M., & Carlos da Silva, A. (2005). Isokinetic muscular strength of paralympic athletes with cerebral palsy (CP) from the Brazilian soccer team. Revista Brasileira de Medicina Do Esporte, 11(5), 263e–266e. https://doi.org/10.1590/S1517-86922005000500007
Ekstrand, J., Hägglund, M., & Waldén, M. (2011). Epidemiology of muscle injuries in professional football (soccer). The American journal of sports medicine, 39(6), 1226-1232. https://doi.org/https://doi.org/10.1016/j.jevs.2018.11.008
Flansbjer, U. B., & Lexell, J. (2010). Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio. Journal of Rehabilitation Medicine, 42(6), 588–592. https://doi.org/10.2340/16501977-0561
Fleeton, J. R. M., Sanders, R. H., & Fornusek, C. (2020). Strength Training to Improve Performance in Athletes With Cerebral Palsy: A Systematic Review of Current Evidence. Journal of Strength and Conditioning Research, 34(6), 1774–1789. https://doi.org/10.1519/JSC.0000000000003232
Fleeton, J. R. M., Sanders, R. H., & Fornusek, C. (2022). Impact of maximal strength training on countermovement jump phase characteristics in athletes with cerebral palsy. Journal of Sports Sciences, 1–10. https://doi.org/10.1080/02640414.2022.2137303
Fousekis, K., Tsepis, E., & Vagenas, G. (2010). Lower limb strength in professional soccer players: Profile, asymmetry, and training age. Journal of Sports Science and Medicine, 9(3), 364–373.
Graham, H. K., Rosenbaum, P., Paneth, N., Dan, B., Lin, J.-P., Damiano, Di. L., Becher, J. G., Gaebler-Spira, D., Colver, A., Reddihough, D. S., Crompton, K. E., & Lieber, R. L. (2016). Cerebral palsy. Nature Reviews Disease Primers, 2, 15082. https://doi.org/10.1038/nrdp.2015.82
Hart, N. H., Nimphius, S., Weber, J., Spiteri, T., Rantalainen, T., Dobbin, M., & Newton, R. U. (2016). Musculoskeletal Asymmetry in Football Athletes: A Product of Limb Function over Time. Medicine and Science in Sports and Exercise, 48(7), 1379–1387. https://doi.org/10.1249/MSS.0000000000000897
Henríquez, M., Kokaly, M., Herrera, F., & Reina, R. (2020). The relationship among repeated sprint and change of direction abilities in football players with cerebral palsy. Kinesiology, 52(2), 208–216. https://doi.org/10.26582/k.52.2.6
Hussain, A. W., Onambele, G. L., Williams, A. G., & Morse, C. I. (2014). Muscle size, activation, and coactivation in adults with cerebral palsy. Muscle & Nerve, 49(1), 76–83. https://doi.org/10.1002/mus.23866
Ishøi, L., Krommes, K., Nielsen, M. F., Thornton, K. B., Hölmich, P., Aagaard, P., Penalver, J. J. J., & Thorborg, K. (2021). Hamstring and Quadriceps Muscle Strength in Youth to Senior Elite Soccer: A Cross-Sectional Study Including 125 Players. International Journal of Sports Physiology and Performance, 16(10), 1538–1544. https://doi.org/10.1123/ijspp.2020-0713
Kaeding, C. C., & Borchers, J. (2014). Hamstring and quadriceps injuries. In New york: Springer (Issue 2). https://doi.org/10.1097/01.bco.0000192894.27510.f4
Kloyiam, S., Breen, S., Jakeman, P., Conway, J., & Hutzler, Y. (2011). Soccer-specific endurance and running economy in soccer players with cerebral palsy. Adapted Physical Activity Quarterly: APAQ, 28(4), 354–367.
Liporaci, R. F., Saad, M., Grossi, D. B., & Riberto, M. (2019). Clinical Features and isokinetic Parameters in Assessing Injury Risk in elite Football Players. International Journal of Sports Medicine, 40(14), 903–908. https://doi.org/10.1055/a-1014-2911
Maly, T., Zahalka, F., & Mala, L. (2014). Muscular strength and strength asymmetries in elite and sub-elite professional soccer players. Sport Science, 7(1), 27–34.
Moreno-Perez, V., Barbado-Murillo, D., Juan-Recio, C., Quesada-de-la-Gala, C. M., & Vera-Garcia, F. J. (2013). Aplicación de la dinamometría isocinética para establecer perfiles de riesgo de lesión isquiosural en futbolistas profesionales. [The use of isokinetic dynamometry to establish risk profiles of hamstring injury in professional football players]. RICYDE. Revista Internacional de Ciencias Del Deporte, 10(34), 333–341. https://doi.org/10.5232/ricyde2013.03403
Neil, S. E., Myring, A., Peeters, M. J., Pirie, I., Jacobs, R., Hunt, M. A., Garland, S. J., & Campbell, K. L. (2013). Reliability and validity of the Performance Recorder 1 for measuring isometric knee flexor and extensor strength. Physiotherapy Theory and Practice, 29(8), 639–647. https://doi.org/10.3109/09593985.2013.779337
Peek, K., Gatherer, D., Bennett, K. J., Fransen, J., & Watsford, M. (2018). Muscle strength characteristics of the hamstrings and quadriceps in players from a high-level youth football (soccer) Academy. Research in Sports Medicine, 26(3), 276–288.
Pellicer-Chenoll, M., Pardo, A., & Aranda, R. (2017). Comparison of conventional hamstring/quadriceps ratio between genders in level-matched soccer players. Revista Andaluza de Medicina Del Deporte, 10(1), 14–18.
Pellicer-Chenoll, M., Serra-Añó, P., Cabeza-Ruiz, R., Pardo, A., Aranda, R., & González, L. M. (2017). Comparación del ratio de fuerza convencional isquiotibial/cuádriceps entre jugadores de fútbol de niveles similares de ambos sexos. Revista Andaluza de Medicina Del Deporte, 10(1), 14–18. https://doi.org/10.1016/j.ramd.2015.05.002
Pietraszewska, J., Struzik, A., Burdukiewicz, A., Stachon, A., & Pietraszewski, B. (2020). Relationships between body build and knee joint flexor and extensor torque of polish first-division soccer players. Applied Sciences (Switzerland), 10(3), 1–11. https://doi.org/10.3390/app10030783
Ramos, S., Corso, M., Brown, A., Simão, R., & Dias, I. (2022). Asymmetries of Isokinetic Strength and Flexibility in Young Soccer Players: a Systematic Review. Human Movement, 23(4), 21–33. https://doi.org/10.5114/hm.2022.108317
Reina, R., Barbado, D., Soto-Valero, C., Sarabia, J. M., & Roldán, A. (2020). Evaluation of the bilateral function in para-athletes with spastic hemiplegia: A model-based clustering approach. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2020.01.003
Reina, R., Elvira, J., Valverde, M., Roldán, A., & Yanci, J. (2019). Kinematic and Kinetic Analyses of the Vertical Jump with and without Header as Performed by Para-Footballers with Cerebral Palsy. Sports, 7(9), 209. https://doi.org/10.3390/sports7090209
Reina, R., Iturricastillo, A., Castillo, D., Roldan, A., Toledo, C., & Yanci, J. (2021). Is impaired coordination related to match physical load in footballers with cerebral palsy of different sport classes? Journal of Sports Sciences, 1–10. https://doi.org/10.1080/02640414.2021.1880740
Reina, R., Iturricastillo, A., Sabido, R., Campayo-Piernas, M., & Yanci, J. (2018). Vertical and Horizontal Jump Capacity in International Cerebral Palsy Football Players. International Journal of Sports Physiology and Performance, 13(5), 597–603. https://doi.org/10.1123/ijspp.2017-0321
Reina, R., Sarabia, J. M., Caballero, C., & Yanci, J. (2017). How does the ball influence the performance of change of direction and sprint tests in para-footballers with brain impairments? Implications for evidence-based classification in CP-Football. PLOS ONE, 12(11), e0187237. https://doi.org/10.1371/journal.pone.0187237
Risberg, M. A., Steffen, K., Nilstad, A., Myklebust, G., Kristianslund, E., Moltubakk, M. M., & Krosshaug, T. (2018). Normative Quadriceps and Hamstring Muscle Strength Values for Female, Healthy, Elite Handball and Football Players. Journal of Strength and Conditioning Research, 32(8), 2314–2323. https://doi.org/10.1519/JSC.0000000000002579
Rodby‐Bousquet, E., Czuba, T., Hägglund, G., & Westbom, L. (2013). Postural asymmetries in young adults with cerebral palsy. Developmental Medicine & Child Neurology, 55(11), 1009–1015. https://doi.org/10.1111/dmcn.12199
Roldan, A., Henríquez, M., Iturricastillo, A., Castillo, D., Yanci, J., & Reina, R. (2022). To What Degree Does Limb Spasticity Affect Motor Performance in Para-Footballers With Cerebral Palsy? Frontiers in Physiology, 12(January), 1–11. https://doi.org/10.3389/fphys.2021.807853
Ruas, C. V., Pinto, R. S., Haff, G. G., Lima, C. D., Pinto, M. D., & Brown, L. E. (2019). Alternative Methods of Determining Hamstrings-to-Quadriceps Ratios: a Comprehensive Review. Sports Medicine - Open, 5(1). https://doi.org/10.1186/s40798-019-0185-0
Runciman, P., Tucker, R., Ferreira, S., Albertus-Kajee, Y., & Derman, W. (2016). Effects of Induced Volitional Fatigue on Sprint and Jump Performance in Paralympic Athletes with Cerebral Palsy. American Journal of Physical Medicine & Rehabilitation, 95(4), 277–290. https://doi.org/10.1097/PHM.0000000000000372
Śliwowski, R., Grygorowicz, M., Hojszyk, R., & Jadczak, Ł. (2017). The isokinetic strength profile of elite soccer players according to playing position. PLoS ONE, 12(7). https://doi.org/10.1371/journal.pone.0182177
Timmins, R. G., Bourne, M. N., Shield, A. J., Williams, M. D., Lorenzen, C., & Opar, D. A. (2016). Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. British journal of sports medicine, 50(24), 1524-1535.
Tisha, A. L., Armstrong, A. A., Wagoner Johnson, A., & López-Ortiz, C. (2019). Skeletal Muscle Adaptations and Passive Muscle Stiffness in Cerebral Palsy: A Literature Review and Conceptual Model. Journal of Applied Biomechanics, 35(1), 68–79. https://doi.org/10.1123/jab.2018-0049
Stackhouse, S. K., Binder-Macleod, S. A., & Lee, S. C. (2005). Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle & nerve, 31(5), 594–601. https://doi.org/10.1002/mus.20302
Uehara, M., Takahashi, J., Ikegami, S., Tokida, R., Nishimura, H., Sakai, N., Kuraishi, S., Horiuchi, H., & Kato, H. (2020). Values for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. Journal of Orthopaedic Science, 1–10. https://doi.org/10.1016/j.jos.2020.08.010
van Melick, N., van der Weegen, W., & van der Horst, N. (2022). Quadriceps and Hamstrings Strength Reference Values for Athletes with and without Anterior Cruciate Ligament Reconstruction Who Play Popular Pivoting Sports, including Soccer, Basketball, and Handball: A Scoping Review. Journal of Orthopaedic and Sports Physical Therapy, 52(3), 142-155. https://doi.org/10.2519/jospt.2022.10693
Webborn, N., Cushman, D., Blauwet, C. A., Emery, C., Derman, W., Schwellnus, M., Stomphorst, J., Van de Vliet, P., & Willick, S. E. (2016). The Epidemiology of Injuries in Football at the London 2012 Paralympic Games. PM and R, 8(6), 545–552. https://doi.org/10.1016/j.pmrj.2015.09.025
Worrell, T. W., Karst, G., Adamczyk, D., Moore, R., Stanley, C., Steimel, B., & Steimel, S. (2001). Influence of Joint Position on Electromyographic and Torque Generation During Maximal Voluntary Isometric Contractions of the Hamstrings and Gluteus Maximus Muscles. Journal of Orthopaedic & Sports Physical Therapy, 31(12), 730–740. https://doi.org/10.2519/jospt.2001.31.12.730
Yanci, J., Castillo, D., Iturricastillo, A., Urbán, T., & Reina, R. (2018). External match loads of footballers with cerebral palsy: A comparison among sport classes. International Journal of Sports Physiology and Performance, 13(5), 590–596. https://doi.org/10.1123/ijspp.2017-0042
Zabka, F. F., Valente, H. G., & Pacheco, A. M. (2011). Isokinetic evaluation of knee extensor and flexor muscles in professional soccer players. Revista Brasileira de Medicina Do Esporte, 17(3), 189–192. https://doi.org/10.1590/S1517-86922011000300008
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