HAMSTRING QUADRICEPS RATIO IN PHYSICAL THERAPY Application For

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HAMSTRING QUADRICEPS RATIO IN PHYSICAL THERAPY Application For Injury Prevention and Rehabilitation

HAMSTRING QUADRICEPS RATIO IN PHYSICAL THERAPY Application For Injury Prevention and Rehabilitation

WHAT IS HS: Q • Strength comparison between hamstrings and quadriceps • Quadriceps dominance

WHAT IS HS: Q • Strength comparison between hamstrings and quadriceps • Quadriceps dominance increased strain on ACL increased injury risk • Conventional HS: Q > 0. 6 indicates decreased risk of HS/ACL injury. • Co-activation increases knee stability and decreases injury risk. 6

MALES VERSUS FEMALES • Males: as angular velocity increases, HS: Q increases (large difference

MALES VERSUS FEMALES • Males: as angular velocity increases, HS: Q increases (large difference between lowest HS: Q ratio and highest HS: Q ratio) • Females: HS: Q relatively constant despite increase in angular velocity • Gender differences not observed at slower angular velocities • High knee angular velocity, approaching those in sports showed significant gender differences in HS: Q • “females, unlike males, do not increase hamstrings to quadriceps torque ratios at velocities that approach those of functional activities” 9 • Both: HS: Q higher in dominant leg 13

HOW IS HS: Q MEASURED 1. Conventional Ratio 2. Functional Ratio 3. Rate of

HOW IS HS: Q MEASURED 1. Conventional Ratio 2. Functional Ratio 3. Rate of Force Development (RFD)

CONVENTIONAL VS FUNCTIONAL HS: Q • Conventional: Concentric hamstrings and concentric quadriceps 11 •

CONVENTIONAL VS FUNCTIONAL HS: Q • Conventional: Concentric hamstrings and concentric quadriceps 11 • Impractical: concentric activities do not occur simulteneously in opposing muscle groups • Goal: 0. 6 • Functional: Eccentric hamstrings and concentric quadriceps 11 • Practical: i. e. kicking a ball, jumping • Goal: 1. 0

RATE OF FORCE DEVELOPMENT • Maximum Volitional Contraction (MVC) vs. Rate of Force Development

RATE OF FORCE DEVELOPMENT • Maximum Volitional Contraction (MVC) vs. Rate of Force Development (RFD) • RFD is low during contraction initiation (50 ms) compared to MVC (reduced potential for knee joint stabilization during initial phase of contraction) • 500 ms to reach MVC ACL injuries occur 17 -50 ms after ground contact 14

HOW IS HS: Q CHANGED 1. Long-term: 1. Plyometrics and Dynamic Stabilization 2. Specific

HOW IS HS: Q CHANGED 1. Long-term: 1. Plyometrics and Dynamic Stabilization 2. Specific Strength Training 2. Short-term: 1. Fatigue 2. Static stretching

PLYOMETRICS AND DYNAMIC STABILIZATION • Jump training program- H: Q increased 26% on non-dominant

PLYOMETRICS AND DYNAMIC STABILIZATION • Jump training program- H: Q increased 26% on non-dominant side and 13% on dominant side 10 • Injury incidence per 1, 000 • 0. 43 untrained females • 0. 12 trained females • 0. 09 untrained males • Untrained females 3. 6 x more likely to have knee injury than trained females and 4. 8 x more likely than males. 8 • Risk decreased after a specific plyometric training program. 10

STRENGTH TRAINING • “Restoring a normal strength profile decreases the muscle injury incidence. ”

STRENGTH TRAINING • “Restoring a normal strength profile decreases the muscle injury incidence. ” 5 • OKC vs. CKC 6 • CKC promotes coactivation and helps prevent injury via compressive forces increasing knee stability • OKC encourage quadriceps dominance and increase stress on ACL. • Issue: many CKC exercises emphasize quads, increasing overall strength but further decreasing the HS: Q ratio. • General Principles: • Choose proper knee flexion angle during CKC • • 42 -72 degrees = ideal knee flexion angle for a hamstring activation 2 Adding resistance to CKC exercises does not increase ACL loading. Adding resistance to OKC exercises does increase ACL loading. 3

HOLCOMB ET AL. 1 1 • Hypothesis: A training program that emphasizes hamstring strengthening

HOLCOMB ET AL. 1 1 • Hypothesis: A training program that emphasizes hamstring strengthening can increase the conventional and functional HS: Q ratio in female soccer players. • Method: 6 weeks during preseason training, 2 days/wk general LE strengthening substituted with hamstring exercises • Single leg curls, straight leg deadlifts, good mornings, trunk hyperextensions, resisted sled walking, exercise ball leg curls • Results: functional ratio increased 12% (0. 96 1. 08) • Quads increased 9% con and 8% ecc; HS increased 17% con and 20% ecc. • Larger increase in ND leg • No significant change with conventional ratio (0. 82 0. 88)

EXERCISES WITH HIGH HS: Q 6 Exercise HS: Q OF COMMON PT EXERCISES 2

EXERCISES WITH HIGH HS: Q 6 Exercise HS: Q OF COMMON PT EXERCISES 2 H: Q Squat machine- scapular 1. 26 support Exercise H: Q Single-leg deadlift 0. 35 Modified SL squat 0. 81 Transverse hop 0. 27 Slide board 0. 739 Lateral hop 0. 26 Single leg squat- labile 0. 71 Lateral bandwalk 0. 27 Fitter 0. 706 Forward hop 0. 19 Stairmaster 0. 629 Single-leg squat 0. 18 Single leg squat- stable 0. 62 Transverse lunge 0. 13 Squat machine- I-L 0. 62 Lateral lunge 0. 11 Unilateral quarter squat 0. 615 Forward lunge 0. 10 Lateral step up 0. 611

SHORT-TERM EFFECTS • Fatigue • Functional HS: Q decreased after simulated soccer match •

SHORT-TERM EFFECTS • Fatigue • Functional HS: Q decreased after simulated soccer match • Greater risk of HS tears/ACL injury at the end of a match 7 • Static Stretching • Q, HS, Q+HS all decreased HS: Q ratios • “stretching may adversely affect the conventional and functional H: Q ratios” 4

CONCLUSION 1. ACL injury prevention 2. ACL reconstruction rehab • Early: protect graft •

CONCLUSION 1. ACL injury prevention 2. ACL reconstruction rehab • Early: protect graft • Late: prevent secondary injury

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