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Background The role of lower extremity (LE) muscle strength for predicting traumatic knee injury in youth athletes is largely unknown. Aims The aim was to investigate the influence of LE muscle strength on traumatic knee injury in youth female and male athletes. Methods 225 athletes (40% females) from sport senior high schools in Sweden were included in this case-control study. The athletes recorded any traumatic knee injury that had occurred during their high-school period in a web-based injury form. A one repetition maximum (1RM) barbell squat test was used to measure LE muscle strength. The 1RM was dichotomised to analyse weak' versus strong' athletes according to the median (weak median vs strong median). Results 63 traumatic knee injuries, including 18 ACL injuries, were registered. The majority of injured female athletes were in the weak group compared with the strong group (p=0.0001). The odds of sustaining a traumatic knee injury and an ACL injury was 9.5 times higher and 7 times higher, respectively, in the weak median group compared with the strong median group in females (p ≤0.011). A relative 1RM squat ≤1.05 kg (105% of bodyweight) was established as the best cut-off value to distinguish high versus low risk of injury in female athletes. No strength-injury relationships were observed for the male athletes (p ≥0.348). Conclusions Weaker LE muscle strength predicted traumatic knee injury in youth female athletes, but not in males. This suggests that LE muscle strength should be included in injury screening in youth female athletes.
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