Biomechanical Phenomena
Conditions
Keywords
patellar tendinopathy, volleyball, basketball, landing, biomechanics, EMG, muscle activation, kinetics, kinematics
Brief summary
Patellar tendinopathy (PT) is an overuse injury associated with loading activities, and popular among basketball and volleyball players. Although altered biomechanical characteristics during landing has been suggested as one of the risk factors for the development of PT, previous evidence failed to show the link between the sagittal plane biomechanics of the hip and knee joint and PT; and little was known about the frontal and horizontal plane biomechanics in athletes with PT. While other factors such as motor control or muscle activation also have not been explored fully. The purpose of this study is to compare hip motor control and biomechanical characteristics of the hip and knee joint during landing in athletes with and without symptomatic PT.
Detailed description
Background: Patellar tendinopathy is an overuse injury associated with loading activities, and it is thought to be caused by repetitive force applied to the patellar tendon. Patellar tendinopathy is popular among basketball and volleyball players, particularly in men. Although altered biomechanical characteristics during landing has been suggested as one of the risk factors for the development of patellar tendinopathy, previous evidence failed to show the link between the sagittal plane biomechanics of the hip and knee joint and patellar tendinopathy; and little was known about the frontal and horizontal plane biomechanics in athletes with patellar tendinopathy. Among those factors contributing to the biomechanical characteristics, hip and quadriceps strength were shown linked with the presence of patellar tendinopathy, while other factors such as motor control or muscle activation have not been explored fully. The purpose of this study is to compare hip motor control and biomechanical characteristics of the hip and knee joint during landing in athletes with and without symptomatic patellar tendinopathy. The investigators hypothesize that the athletes with symptomatic patellar tendinopathy have poorer motor control and different landing biomechanics as compared with asymptomatic athletes. Method: the investigators plan to recruit seventeen symptomatic patellar tendinopathy athletes for the experimental group, using demographic data (sex, age, height, weight, exercise type) of experimental group to match seventeen non-symptomatic athletes as control group. The assessment included hip motor control in various directions, and measurement of kinetics, kinematics and muscle activation during the step-down task, drop vertical jump and countermovement jump using the computer-aided video motion analysis system (Vicon) and the surface EMG (Noraxon). The group difference will be tested using t-test for the motor control ability and biomechanical characteristics. The significant level was set at 0.05.
Interventions
None listed
Sponsors
National Yang Ming Chiao Tung University
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
* at the age of 18 to 40 years old * volleyball and basketball players have more than 2 years training experience * over 90 minutes of training time per week symptomatic group: * having patellar tendon pain during loading task last for 3 months * VISA-P questionnaire score ≦80 asymptomatic group: * without any lower extremity pain(NRS3/10) in past 3 months * VISA-P questionnaire score \>80
Exclusion criteria
* Underwent sports physical therapy for knee pain in the past three months. * Currently have any other chronic or acute lower limb injuries with a pain score \>3/10. * Self-reported pregnancy. * Had surgery, fractures, or received steroid injections for the patellar tendon in the lower limbs. * with a history of rheumatoid arthritis, systematic and neurological diseases
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximal Knee Flexion Angle | The landing phase of the countermovement jump in the experiment | In the countermovement jump test, the force received by the force plate changes from 0 to a positive value during the landing phase. Measure the maximal knee flexion angle during this phase. |
| Knee Joint Flexion Angle | the contralateral foot is at its lowest point in step-down test in the experiment | Perform the step-down test on a 15 cm high table to measure the knee flexion angle of the foot on the table when the side foot is at the lowest point. |
| Motor Control Ability | during the experiment, up to 4 hours | Having 4 motor control tests: Hip Flexion Control: Maintain an upright posture in a single-leg small knee bend. The knee aligns with the 2nd toe in the sagittal plane and \>5 cm beyond the toes. Internal/External Rotation Control:Perform a single-leg small knee bend while rotating the pelvis and upper body toward the opposite/same side. Rotate 35°/30° without excessive L/E compensation. Hip Adduction Control:Maintain a single-leg stance with symmetrical shoulders and pelvis. Pelvic lateral displacement \<10 cm, left-right displacement difference \<2 cm. Scoring Criteria: Avoid uncontrolled movements, perform isolated movements correctly, achieve adequate ROM, maintain normal breathing, control movements in eccentric/concentric phases, execute smoothly, stay relaxed and aware, ensure fluid transitions, avoid compensations, complete without feedback/support, and show no fatigue. Total score range: 0-52, converted to a percentage for comparison(0-100%). |
| Hip Flexion Angles | In the experiment, the maximum knee flexion during the landing phase of the countermovement jump | Measure the hip joint angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump |
| Hip Abduction Angle | In the experiment, the maximum knee flexion during the landing phase of the countermovement jump | Measure the hip abduction angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Muscle Activity of Biceps Femoris | Immediately during the experiment | Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the GRF recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data and kinematics data is synchronized with EMG data to determine the activation of the biceps femoris muscle during maximal knee flexion in the landing phase. The signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals. |
| Maximum Muscle Activity of Biceps Femoris | Immediately during the experiment | Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the ground reaction force recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data is synchronized with EMG data to determine the peak activation of the biceps femoris muscle during the landing phase. The biceps femoris contraction signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals. |
Countries
Taiwan
Participant flow
Recruitment details
Participants were recruited from Taipei and New Taipei City via social media between February 2023 and June 2023. The first participant was enrolled on February 13, 2023 and the last participant was enrolled in June 2023
Participants by arm
| Arm | Count |
|---|---|
| Symptomatic Group Individuals with patellar tendon pain last for 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score ≦80 | 17 |
| Asymptomatic Group Individuals without any lower extremity pain(NRS\>3/10) in past 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score \>80 | 17 |
| Total | 34 |
Baseline characteristics
| Characteristic | Symptomatic Group | Total | Asymptomatic Group |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 17 Participants | 34 Participants | 17 Participants |
| Ankle DF ROM in weight bearing Left side | 39.90 degrees STANDARD_DEVIATION 4.64 | 39.40 degrees STANDARD_DEVIATION 4.36 | 38.90 degrees STANDARD_DEVIATION 4.28 |
| Ankle DF ROM in weight bearing Right side | 36.61 degrees STANDARD_DEVIATION 6.82 | 36.92 degrees STANDARD_DEVIATION 5.73 | 37.24 degrees STANDARD_DEVIATION 4.8 |
| BMI | 22.73 kg/m^2 STANDARD_DEVIATION 2.29 | 22.68 kg/m^2 STANDARD_DEVIATION 1.89 | 22.64 kg/m^2 STANDARD_DEVIATION 1.55 |
| Body weight | 68.59 kg STANDARD_DEVIATION 8.89 | 68.64 kg STANDARD_DEVIATION 8.46 | 68.69 kg STANDARD_DEVIATION 8.56 |
| Dominal leg left | 1 Participants | 2 Participants | 1 Participants |
| Dominal leg right | 16 Participants | 32 Participants | 16 Participants |
| Height | 174.07 cm STANDARD_DEVIATION 7.71 | 174.05 cm STANDARD_DEVIATION 7.822 | 174.03 cm STANDARD_DEVIATION 8.4 |
| Height of spike jump | 72.29 cm STANDARD_DEVIATION 12.19 | 72.25 cm STANDARD_DEVIATION 11.93 | 72.21 cm STANDARD_DEVIATION 11.66 |
| Hip extensor power Left side | 46.71 percentage of body weight STANDARD_DEVIATION 11.64 | 45.12 percentage of body weight STANDARD_DEVIATION 10.49 | 43.53 percentage of body weight STANDARD_DEVIATION 9.64 |
| Hip extensor power Right side | 44.93 percentage of body weight STANDARD_DEVIATION 10.73 | 44.16 percentage of body weight STANDARD_DEVIATION 10.61 | 43.39 percentage of body weight STANDARD_DEVIATION 11.08 |
| Jumping height | 63.84 cm STANDARD_DEVIATION 10.79 | 64.15 cm STANDARD_DEVIATION 10.38 | 64.46 cm STANDARD_DEVIATION 9.94 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 17 Participants | 34 Participants | 17 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 15 Participants | 30 Participants | 15 Participants |
| Sex: Female, Male Male | 2 Participants | 4 Participants | 2 Participants |
| Specializing in basketball | 4 Participants | 8 Participants | 4 Participants |
| Specializing in volley ball | 13 Participants | 26 Participants | 13 Participants |
| Training time per week | 442.94 min/wk STANDARD_DEVIATION 228.85 | 434.71 min/wk STANDARD_DEVIATION 259.48 | 425.29 min/wk STANDARD_DEVIATION 301.91 |
| VISA-PCh | 64.12 units on a scale STANDARD_DEVIATION 10.16 | 78.59 units on a scale STANDARD_DEVIATION 16.68 | 93.06 units on a scale STANDARD_DEVIATION 5.98 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 17 | 0 / 17 |
| other Total, other adverse events | 0 / 17 | 0 / 17 |
| serious Total, serious adverse events | 0 / 17 | 0 / 17 |
Outcome results
Primary
Hip Abduction Angle
Measure the hip abduction angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump
Time frame: In the experiment, the maximum knee flexion during the landing phase of the countermovement jump
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Hip Abduction Angle | 13.97 degrees | Standard Deviation 6.5 |
| Asymptomatic Group | Hip Abduction Angle | 10.68 degrees | Standard Deviation 3.76 |
p-value: 0.082t-test, 2 sided
Primary
Hip Flexion Angles
Measure the hip joint angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump
Time frame: In the experiment, the maximum knee flexion during the landing phase of the countermovement jump
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Hip Flexion Angles | 86.59 degrees | Standard Deviation 15.51 |
| Asymptomatic Group | Hip Flexion Angles | 73.65 degrees | Standard Deviation 20.05 |
p-value: 0.047t-test, 2 sided
Primary
Knee Joint Flexion Angle
Perform the step-down test on a 15 cm high table to measure the knee flexion angle of the foot on the table when the side foot is at the lowest point.
Time frame: the contralateral foot is at its lowest point in step-down test in the experiment
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Knee Joint Flexion Angle | 60.79 degrees | Standard Deviation 5.57 |
| Asymptomatic Group | Knee Joint Flexion Angle | 65.18 degrees | Standard Deviation 5.05 |
p-value: 0.022t-test, 2 sided
Primary
Maximal Knee Flexion Angle
In the countermovement jump test, the force received by the force plate changes from 0 to a positive value during the landing phase. Measure the maximal knee flexion angle during this phase.
Time frame: The landing phase of the countermovement jump in the experiment
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Maximal Knee Flexion Angle | 97.87 degrees | Standard Deviation 15.17 |
| Asymptomatic Group | Maximal Knee Flexion Angle | 83.70 degrees | Standard Deviation 14.21 |
p-value: 0.009t-test, 2 sided
Primary
Motor Control Ability
Having 4 motor control tests: Hip Flexion Control: Maintain an upright posture in a single-leg small knee bend. The knee aligns with the 2nd toe in the sagittal plane and \>5 cm beyond the toes. Internal/External Rotation Control:Perform a single-leg small knee bend while rotating the pelvis and upper body toward the opposite/same side. Rotate 35°/30° without excessive L/E compensation. Hip Adduction Control:Maintain a single-leg stance with symmetrical shoulders and pelvis. Pelvic lateral displacement \<10 cm, left-right displacement difference \<2 cm. Scoring Criteria: Avoid uncontrolled movements, perform isolated movements correctly, achieve adequate ROM, maintain normal breathing, control movements in eccentric/concentric phases, execute smoothly, stay relaxed and aware, ensure fluid transitions, avoid compensations, complete without feedback/support, and show no fatigue. Total score range: 0-52, converted to a percentage for comparison(0-100%).
Time frame: during the experiment, up to 4 hours
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Motor Control Ability | 78 score on a scale | Standard Deviation 11 |
| Asymptomatic Group | Motor Control Ability | 86 score on a scale | Standard Deviation 8 |
p-value: 0.016t-test, 2 sided
Secondary
Maximum Muscle Activity of Biceps Femoris
Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the ground reaction force recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data is synchronized with EMG data to determine the peak activation of the biceps femoris muscle during the landing phase. The biceps femoris contraction signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals.
Time frame: Immediately during the experiment
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Maximum Muscle Activity of Biceps Femoris | 16.03 percentage of MVC | Standard Deviation 7.5 |
| Asymptomatic Group | Maximum Muscle Activity of Biceps Femoris | 21.44 percentage of MVC | Standard Deviation 6.02 |
p-value: 0.029t-test, 2 sided
Secondary
Muscle Activity of Biceps Femoris
Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the GRF recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data and kinematics data is synchronized with EMG data to determine the activation of the biceps femoris muscle during maximal knee flexion in the landing phase. The signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals.
Time frame: Immediately during the experiment
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Symptomatic Group | Muscle Activity of Biceps Femoris | 4.93 percentage of MVC | Standard Deviation 1.89 |
| Asymptomatic Group | Muscle Activity of Biceps Femoris | 7.40 percentage of MVC | Standard Deviation 2.91 |
p-value: 0.007t-test, 2 sided