Sex-related differences in joint-angle-specific functional hamstring-to-quadriceps strength ratios

  • Said El-Ashker
  • Brian P. Carson
  • Francisco Ayala
  • Mark De Ste Croix
Knee

Abstract

Purpose

To examine and compare sex-related differences in the functioning of the hamstrings and quadriceps muscles and the isokinetic hamstrings eccentric-to-quadriceps concentric functional ratio (H/Q FUNC).

Methods

Fifty male and 46 female young adults completed this study. Each participant carried out an isokinetic assessment to determine isokinetic concentric and eccentric torques during knee extension and flexion actions at 3 different angular velocities (60, 180 and 300°/s) adopting a lying position. The H/Q FUNC was calculated using peak torque (PT) values and 3 different joint-angle-specific torque values (15°, 30° and 45° of knee extension). A repeated measures analysis of variance was used to compare the results, and post hoc analyses using Friedman correction were employed.

Results

There were statistically significant effects of angular velocity, joint angle and sex on the H/Q FUNC (p < 0.01). Thus, the H/Q FUNC ratio in both males and females decreases closer to full knee extension and with increasing movement velocity. The H/Q FUNC was also significantly lower in females compared to males, irrespective of moment velocity and joint angle.

Conclusions

The findings of the current study reinforce the need to examine the H/Q FUNC ratio closer to full knee extension (where knee injury is most likely to occur) rather than using PT values which may not be as informative, as well as to focus preventive and rehabilitation training programmes on reducing quadriceps dominance by enhancing eccentric hamstring strength (especially in females who are at higher risk of injury).

Level of evidence

III.

Keywords

Isokinetic Injury prevention Strength Torque Anterior cruciate ligament 

Notes

Compliance with Ethical Standards

Funding disclosure

No financial assistance was awarded for this project.

References

  1. 1.
    Aagaard P, Simonsen EB, Andersen JL, Magnusson SP, Bojsen-Moller F, Dyhre-Poulsen P (2000) Antagonist muscle coactivation during isokinetic knee extension. Scand J Med Sci Sports 10:58–67CrossRefPubMedGoogle Scholar
  2. 2.
    Aagaard P, Simonsen EB, Magnusson SP, Larsson B, Dyhre-Poulsen P (1998) A new concept for isokinetic hamstring: quadriceps muscle strength ratio. Am J Sports Med 26:231–237PubMedGoogle Scholar
  3. 3.
    Aagaard P, Simonsen EB, Trolle M, Bangsboo J, Klausen K (1995) Isokinetic hamstring/quadriceps ratio: influence from joint angular velocity, gravity correction and mode of contraction. Acta Physiol Scand 154:421–427CrossRefPubMedGoogle Scholar
  4. 4.
    Agel J, Arendt EA, Bershadsky B (2005) Anterior cruciate ligament injury in National Collegiate Athletic Association basketball and soccer a 13-year review. Am J Sports Med 33:524–531CrossRefPubMedGoogle Scholar
  5. 5.
    Bell DR, Myrick MP, Blackburn JT, Shultz SJ, Guskiewicz KM, Padua DA (2009) The effect of menstrual-cycle phase on hamstring extensibility and muscle stiffness. J Sport Rehabil 18:553–563CrossRefPubMedGoogle Scholar
  6. 6.
    Bennell K, Wajswelner H, Lew P, Schall-Riaucour A, Leslie S, Plant D, Cirone J (1998) Isokinetic strength testing does not predict hamstring injury in Australian Rules footballers. Br J Sports Med 32(4):309–314CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bojsen-Moller J, Larsson B, Magnusson SP, Aagaard P (2007) Yacht type and crew-specific differences in anthropometric, aerobic capacity, and muscle strength parameters among international Olympic class sailors. J Sports Sci 25:1117–1128CrossRefPubMedGoogle Scholar
  8. 8.
    Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 195:1381–1395Google Scholar
  9. 9.
    Calmels PM, Nellen M, Van Der Borne I, Jourdin P, Minaire P (1997) Concentric and eccentric isokinetic assessment of flexor-extensor torque ratios at the hip, knee, and ankle in a sample population of healthy subjects. Arch Phys Med Rehabil 78:1224–1230CrossRefPubMedGoogle Scholar
  10. 10.
    Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM (2002) Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med 30(2):199–203PubMedGoogle Scholar
  11. 11.
    Dauty M, Potiron-Josse M, Rochcongar P (2003) Identification of previous hamstring muscle injury by isokinetic concentric and eccentric torque measurement in elite soccer player. Isokinet Exerc Sci 11(3):139–144Google Scholar
  12. 12.
    De Ste Croix MBA, Deighan MA, Armstrong N (2007) Functional eccentric-concentric ratio of knee extensors and flexors in pre-pubertal children, teenagers and adults. Int J Sports Med 28:768–772CrossRefPubMedGoogle Scholar
  13. 13.
    De Ste Croix MBA, Deighan MA (2011) Dynamic knee stability during childhood. In Paediatric biomechanics and motor control: theory and application Eds (M. De Ste Croix and T. Korff), Routledge, UKGoogle Scholar
  14. 14.
    Deighan MA, Serpell BG, Bitcon MJ, De Ste Croix MBA (2012) Knee joint strength ratios and effects of hip position in Rugby players. J Strength Cond Res 26(7):1959–1966CrossRefPubMedGoogle Scholar
  15. 15.
    Dervisevic E, Hadzic V, Karpljuk D, Radjo I (2006) The influence of different ranges of motion testing on the isokinetic strength of the quadriceps and hamstring. Isokinet Exerc Sci 14:269–278Google Scholar
  16. 16.
    Drouin JM, Valovich TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex System 3 Pro Isokinetic Dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91:22–29CrossRefPubMedGoogle Scholar
  17. 17.
    Eiling E, Bryant AL, Petersen W, Murphy A, Hohmann E (2007) Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity. Knee Surg Sports Traumatol Arthrosc 15:126–132CrossRefPubMedGoogle Scholar
  18. 18.
    Evangelidis PE, Pain MTG, Folland J (2015) Angle-specific hamstring-to-quadriceps ratio: a comparison of football players and recreationally active males. J Sports Sci 33:309–319CrossRefPubMedGoogle Scholar
  19. 19.
    Forbes H, Bullers A, Lovell A, McNaughton LR, Polman RC, Siegler JC (2009) Relative torque profiles of elite male youth footballers: effects of age and pubertal development. Int J Sports Med 30(8):592–597CrossRefPubMedGoogle Scholar
  20. 20.
    Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, DeMaio M, Yu B (2006) Understanding and preventing noncontact anterior cruciate ligament injuries a review of the hunt valley ii meeting, January 2005. Am J Sports Med 34(9):1512–1532CrossRefPubMedGoogle Scholar
  21. 21.
    Hasler EM, Denoth J, Stacoff A, Herzog W (1994) Influence of hip and knee joint angles on excitation of knee extensor muscles. Electromyogr Clin Neurophysiol 34:355–361PubMedGoogle Scholar
  22. 22.
    Hass C, Schick E, Tillman M, Chow J, Brunt D, Cauraugh J (2005) Knee biomechanics during landings: comparison of pre and post-pubescent females. Med Sci Sports Exerc 37:100–107CrossRefPubMedGoogle Scholar
  23. 23.
    Hewett TE, Myer GD, Ford KR (2006) Anterior cruciate ligament injuries in female athletes part 1, mechanisms and risk factors. Am J Sports Med 34(2):299–311CrossRefPubMedGoogle Scholar
  24. 24.
    Hewett TE, Myer GD, Zazulak BT (2008) Hamstrings to quadriceps peak torque ratios diverge between sexes with increasing isokinetic angular velocity. J Sci Med Sports 11:452–458CrossRefGoogle Scholar
  25. 25.
    Hootman JM, Dick R, Agel J (2007) Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 42:311–319PubMedPubMedCentralGoogle Scholar
  26. 26.
    Hughes G, Watkins J (2006) A risk-factor model for anterior cruciate ligament injury. Sports Med 36:411–428CrossRefPubMedGoogle Scholar
  27. 27.
    Impellizzeri FM, Bizzini M, Rampinini E, Cereda F, Maffiulet NA (2008) Reliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer. Clin Physiol Funct Imaging 28(2):113–119CrossRefPubMedGoogle Scholar
  28. 28.
    Kannus P, Jarvinnen M (1990) Knee flexor and extensor strength ratios in follow up of acute knee distortion injuries. Arch Phys Med Rehabil 71:38–41PubMedGoogle Scholar
  29. 29.
    Kellis E, Katis A (2007) Quantification of functional knee flexor to extensor moment ratio using isokinetics and electromyography. J Athl Train 42:477–486PubMedPubMedCentralGoogle Scholar
  30. 30.
    Kim D, Hong J (2011) Hamstring to quadriceps strength ratio and noncontact leg injuries: a prospective study during one season. Isokinet Exerc Sci 19(1):1–6Google Scholar
  31. 31.
    Liu H, Garrett WE, Moorman CT, Yu B (2012) Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: a review of the literature. J Sport Health Sci 1(2):92–101CrossRefGoogle Scholar
  32. 32.
    Myer GD, Ford KR, Foss KDB, Liu C, Nick TG, Hewett TE (2009) The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin J Sport Med 19:3–8CrossRefPubMedGoogle Scholar
  33. 33.
    Myer GD, Ford KR, Palumbo OP, Hewett TE (2005) Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. J Strength Cond Res 19:51–60PubMedGoogle Scholar
  34. 34.
    Podraza JT, White SC (2010) Effect of knee flexion angle on ground reaction forces, knee moments and muscle co-contraction during an impact-like deceleration landing: implications for the non-contact mechanism of ACL injury. Knee 17:291–295CrossRefPubMedGoogle Scholar
  35. 35.
    Portney L, Watkins M (2009) Foundations of clinical research: applications to practice. Prentice Hall Upper Saddle River, NJGoogle Scholar
  36. 36.
    Proske U, Morgan DL, Brockett CL, Percival P (2004) Identifying athletes at risk of hamstring strains and how to protect them. Clin Exp Pharmacol Physiol 31(8):546–550CrossRefPubMedGoogle Scholar
  37. 37.
    Rosa BB, Asperti AM, Helito CP, Demange MK, Fernandes TL, Hernandez AJ (2014) Epidemiology of sports injuries on collegiate athletes at a single center. Acta Ortop Bras 22:321–324CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Sapega AA (1990) Current concepts review: muscle performance evaluation in orthopaedic practice. Am J Bone Joint Surg 72:1562–1574CrossRefPubMedGoogle Scholar
  39. 39.
    Senter C, Hame SL (2006) Biomechanical analysis of tibial torque and knee flexion angle. Sports Med 36(8):635–641CrossRefPubMedGoogle Scholar
  40. 40.
    Shimokochi Y, Shultz SJ (2008) Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train 43:396–408CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Sole G, Hamrén J, Milosavljevic S, Nicholson H, Sullivan SJ (2007) Test-retest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil 88(5):626–631CrossRefPubMedGoogle Scholar
  42. 42.
    Sun Y, Wei S, Liu Y, Zhong Y, Fu W, Li L (2015) How joint torques affect hamstring injury risk in sprinting swing–stance transition. Med Sci Sports Exer 47:373–380CrossRefGoogle Scholar
  43. 43.
    Williams KR (2000) The dynamics of running. Biomech Sport 161Google Scholar
  44. 44.
    Yamamoto T (1993) Relationship between hamstring strains and leg muscle strength. A follow-up study of collegiate track and field athletes. J Sports Med Phys Fitness 33(2):194–199PubMedGoogle Scholar
  45. 45.
    Yeung SS, Suen AM, Yeung EW (2009) A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. Br J Sports Med 43(8):589–594CrossRefPubMedGoogle Scholar
  46. 46.
    Yoon TS, Park DS, Kang SW, Chun SI, Shin JS (1991) Isometric and isokinetic torque curves at the knee joint. Yonsei Med J 32:33–43CrossRefPubMedGoogle Scholar
  47. 47.
    Yu B, Queen RM, Abbey AN, Liu Y, Moorman CT, Garrett WE (2008) Hamstring muscle kinematics and activation during overground sprinting. J Biomech 41:3121–3126CrossRefPubMedGoogle Scholar
  48. 48.
    Zvijac JE, Toriscelli TA, Merrick S, Kiebzak GM (2013) Isokinetic concentric quadriceps and hamstring strength variables from the NFL scouting combine are not predictive of hamstring injury in first-year professional football players. Am J Sports Med 41:1511–1518CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Said El-Ashker
    • 1
  • Brian P. Carson
    • 2
  • Francisco Ayala
    • 3
    • 4
  • Mark De Ste Croix
    • 5
  1. 1.Faculty of Physical EducationMansoura UniversityMansouraEgypt
  2. 2.Physical Education and Sport SciencesUniversity of LimerickLimerickIreland
  3. 3.Sports Research CentreMiguel Hernández University of ElcheElcheSpain
  4. 4.ISEN University Formation, Centre Affiliate to the University of MurciaMurciaSpain
  5. 5.Faculty of Sport, Health and Social Care, School of Physical EducationUniversity of GloucestershireGloucesterUK

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