||The Effects of Knee Pain on Knee Biomechanics, Trunk Movement and Balance in Badminton Players
||Department of Physical Therapy
Background and purpose: Badminton is a sport that requires not only lower extremity movement but also upper extremity and trunk movements. Because of the high demands on the lower extremity, the knee pain is frequent in players. Many studies showed there are associations between core stability and knee injury. However, there was no study investigating and comparing the contribution of core neuromuscular control to dynamic knee joint stability between the athletes with knee pain and the uninjured athletes. Therefore, the purpose of this study was to investigate and compare the biomechanics of trunk and lower extremity, balance performance, and muscle activation patterns between knee injured and uninjured groups during diagonal lunge. Methods: 17 subjects with chronic knee pain (injured group) and 17 healthy subjects (control group) participated in this study. All subjects were asked to perform four different diagonal lunges. The motion, ground reaction force and electromyography data were all collected during tasks. Results: The injured group had less frontal and horizontal motions in the knee joint. The knee extensor activation level, CCI values and knee flexion moment were greater in the control group. Also, the hip-shoulder separation and trunk forward range were all larger in the control group. The velocity of COM was greater in the control group. Conclusions: The injured group had a conservative movement pattern to reduce the frontal and horizontal motion in the knee joint. The control group can have better balance control and weight shifting ability due to the great ability of knee extensor and trunk control. The training programs on neuromuscular control of core muscles and knee extensor strength were necessary for badminton players with knee pain. The knee pain players needed to increase the training on the backhand and backward lunges.
中文摘要(Chinese Abstract) I
英文摘要(English Abstract) II
表目錄(List of Tables) VII
圖目錄(List of Figures) X
Chapter 1. Introduction 1
1.1 Background 1
1.2 Research Purposes 3
1.3 Hypotheses 3
Chapter 2. Literature Review 5
2.1 Epidemiology of Badminton Injuries 5
2.2 Footwork in Badminton 6
2.3 Knee Pain in Badminton Players 7
2.4 Core Stability and Its Relationship to Knee Injury 9
Chapter 3. Methods 11
3.1 Subjects 11
3.2 Instrumentation 13
3.2.1 Marker Placement 13
3.2.2 Electromyography Arrangement 14
3.3 Experimental Procedures 15
3.3.1 Data Collection 15
3.3.2 Tasks 16
3.3.3 Core Stability Tests 18
3.4 Data Analysis 21
3.4.1 Kinematics and Kinetics of Knee Joint 22
3.4.2 Ground Reaction Force 23
3.4.3 Trunk Movement Parameters 23
3.4.4 Electromyography of Core Muscles and Lower Extremity Muscles 24
3.4.5 Balance Parameters 26
3.5 Statistic Analysis 27
Chapter 4. Results 28
4.1 The Numerical Pain Rating Scores and Duration 28
4.2 Core Muscle Tests 29
4.3 Forehand Forward Lunge 29
4.3.1 Kinematics and Kinetics of Knee Joint 29
4.3.2 Ground Reaction Force 33
4.3.3 Trunk Movement Parameters 33
4.3.4 Electromyography of Core Muscles and Lower Extremity Muscles 35
4.3.5 Balance Parameters 37
4.4 Backhand Forward Lunge 40
4.4.1 Kinematics and Kinetics of Knee Joint 40
4.4.2 Ground Reaction Force 42
4.4.3 Trunk Movement Parameters 43
4.4.4 Electromyography of Core Muscles and Lower Extremity Muscles 44
4.4.5 Balance Parameters 47
4.5 Forehand backward Lunge 50
4.5.1 Kinematics and Kinetics of Knee Joint 50
4.5.2 Ground Reaction Force 52
4.5.3 Trunk Movement Parameters 53
4.5.4 Electromyography of Core Muscles and Lower Extremity Muscles 54
4.5.5 Balance Parameters 57
4.6 Backhand backward Lunge 60
4.6.1 Kinematics and Kinetics of Knee Joint 60
4.6.2 Ground Reaction Force 62
4.6.3 Trunk Movement Parameters 62
4.6.4 Electromyography of Core Muscles and Lower Extremity Muscles 64
4.6.5 Balance Parameters 66
Chapter 5. Discussion & Conclusion 69
5.1 Kinematics and Kinetics of Knee Joint 70
5.2 Ground Reaction Force 72
5.3 Trunk Movement Parameters 73
5.4 Electromyography of Core Muscles and Lower Extremity Muscles 75
5.5 Balance Parameters 78
5.6 Limitation 81
5.7 Clinical Relevance 82
5.8 Conclusion 83
Alvarez-Nemegyei, J. (2007). "Risk factors for pes anserinus tendinitis/bursitis syndrome: a case control study." JCR: Journal of Clinical Rheumatology 13(2): 63-65.
Anderson, K. and D. G. Behm (2005). "Trunk muscle activity increases with unstable squat movements." Canadian journal of applied physiology = Revue canadienne de physiologie appliquee 30(1): 33-45.
Bergfeld, J. (1979). "Symposium: functional rehabilitation of isolated medial collateral ligament sprains. First-, second-, and third-degree sprains." The American journal of sports medicine 7(3): 207-209.
Bisseling, R. W., A. L. Hof, et al. (2007). "Relationship between landing strategy and patellar tendinopathy in volleyball." British Journal of Sports Medicine 41(7): e8.
Boesen, A. P., M. I. Boesen, et al. (2010). "Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players." Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA.
Borghuis, A. J., K. A. P. M. Lemmink, et al. (2011). "Core Muscle Response Times and Postural Reactions in Soccer Players and Nonplayers." Medicine & Science in Sports & Exercise 43(1): 108-114.
Cabello Manrique, D. and J. J. Gonzalez-Badillo (2003). "Analysis of the characteristics of competitive badminton." British Journal of Sports Medicine 37(1): 62-66.
Chard, M. D. and S. M. Lachmann (1987). "Racquet sports--patterns of injury presenting to a sports injury clinic." British Journal of Sports Medicine 21(4): 150-153.
Chester, R., T. O. Smith, et al. (2008). "The relative timing of VMO and VL in the aetiology of anterior knee pain: a systematic review and meta-analysis." BMC musculoskeletal disorders 9: 64.
Cowan, S. M., K. L. Bennell, et al. (2001). "Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome." Archives of physical medicine and rehabilitation 82(2): 183-189.
Cram, J. R., G. S. Kasman, et al., Eds. (1998). introduction to surface electromyography Maryland, Aspen Publishers, Inc.
Cronin, J., P. J. McNair, et al. (2003). "Lunge performance and its determinants." Journal of Sports Sciences 21(1): 49-57.
da Fonseca, S. T., D. V. Vaz, et al. (2006). "Muscular co-contraction during walking and landing from a jump: comparison between genders and influence of activity level." Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology 16(3): 273-280.
Devlin, L. (2000). "Recurrent posterior thigh symptoms detrimental to performance in rugby union: predisposing factors." Sports Medicine 29(4): 273-287.
Earl, J. E. and A. Z. Hoch (2011). "A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome." The American journal of sports medicine 39(1): 154-163.
Eriksen, J., M. K. Jensen, et al. (2003). "Epidemiology of chronic non-malignant pain in Denmark." Pain 106(3): 221-228.
Ershad, N., S. Kahrizi, et al. (2009). "Evaluation of trunk muscle activity in chronic low back pain patients and healthy individuals during holding loads." Journal of back and musculoskeletal rehabilitation 22(3): 165-172.
Escamilla, R. F., N. Zheng, et al. (2008). "Patellofemoral joint force and stress between a short- and long-step forward lunge." The Journal of orthopaedic and sports physical therapy 38(11): 681-690.
Escamilla, R. F., N. Zheng, et al. (2010). "Cruciate ligament forces between short-step and long-step forward lunge." Medicine and Science in Sports and Exercise 42(10): 1932-1942.
Escamilla, R. F., N. Zheng, et al. (2010). "Cruciate ligament tensile forces during the forward and side lunge." Clinical Biomechanics 25(3): 213-221.
Fahlstrom, M., U. Bjornstig, et al. (1998). "Acute Achilles tendon rupture in badminton players." American Journal of Sports Medicine 26(3): 467-470.
Fahlstrom, M., U. Bjornstig, et al. (1998). "Acute badminton injuries." Scandinavian Journal of Medicine & Science in Sports 8(3): 145-148.
Fahlstrom, M., R. Lorentzon, et al. (2002). "Painful conditions in the Achilles tendon region in elite badminton players." American Journal of Sports Medicine 30(1): 51-54.
Falconer, K. and D. A. Winter (1985). "Quantitative assessment of co-contraction at the ankle joint in walking." Electromyogr Clin Neurophysiol 25(2-3): 135-149.
Farrokhi, S., C. D. Pollard, et al. (2008). "Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise." The Journal of orthopaedic and sports physical therapy 38(7): 403-409.
Giannotti, B. F., T. Rudy, et al. (2006). "The non-surgical management of isolated medial collateral ligament injuries of the knee." Sports medicine and arthroscopy review 14(2): 74-77.
Graven-Nielsen, T., H. Lund, et al. (2002). "Inhibition of maximal voluntary contraction force by experimental muscle pain: a centrally mediated mechanism." Muscle & nerve 26(5): 708-712.
Griffith, C. J., R. F. LaPrade, et al. (2009). "Medial knee injury: Part 1, static function of the individual components of the main medial knee structures." The American journal of sports medicine 37(9): 1762-1770.
Hahn, M. E. and L. S. Chou (2004). "Age-related reduction in sagittal plane center of mass motion during obstacle crossing." Journal of Biomechanics 37(6): 837-844.
Henriksen, M., T. Alkjaer, et al. (2009). "Experimental muscle pain during a forward lunge--the effects on knee joint dynamics and electromyographic activity." British Journal of Sports Medicine 43(7): 503-507.
Hensley, L. D. and D. C. Paup (1979). "A survey of badminton injuries." British Journal of Sports Medicine 13(4): 156-160.
Hibbs, A. E., K. G. Thompson, et al. (2010). "Peak and average rectified EMG measures: Which method of data reduction should be used for assessing core training exercises?" Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.
Hodges, P. W. and C. A. Richardson (1997). "Contraction of the abdominal muscles associated with movement of the lower limb." Physical Therapy 77(2): 132-142; discussion 142-134.
Hoy, K., B. E. Lindblad, et al. (1994). "Badminton injuries--a prospective epidemiological and socioeconomic study." British Journal of Sports Medicine 28(4): 276-279.
Hughston, J. C., J. R. Andrews, et al. (1976). "Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments." Journal of Bone & Joint Surgery - American Volume 58(2): 159-172.
Iida, Y., H. Kanehisa, et al. (2011). "Activity modulations of trunk and lower limb muscles during impact-absorbing landing." Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.
Indelicato, P. A. (1995). "Isolated Medial Collateral Ligament Injuries in the Knee." The Journal of the American Academy of Orthopaedic Surgeons 3(1): 9-14.
Ireland, M. L., J. D. Willson, et al. (2003). "Hip strength in females with and without patellofemoral pain." J Orthop Sports Phys Ther 33(11): 671-676.
Irish, S. E., A. J. Millward, et al. (2010). "The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis." Journal of strength and conditioning research / National Strength & Conditioning Association 24(5): 1256-1262.
Jonhagen, S., K. Halvorsen, et al. (2009). "Muscle activation and length changes during two lunge exercises: implications for rehabilitation." Scandinavian Journal of Medicine & Science in Sports 19(4): 561-568.
Jorgensen, U. and S. Winge (1987). "Epidemiology of badminton injuries." International Journal of Sports Medicine 8(6): 379-382.
Jorgensen, U. and S. Winge (1990). "Injuries in badminton." Sports Medicine 10(1): 59-64.
Kellis, E., F. Arabatzi, et al. (2003). "Muscle co-activation around the knee in drop jumping using the co-contraction index." Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology 13(3): 229-238.
Kim, M. H., C. H. Yi, et al. (2011). "EMG and kinematics analysis of the trunk and lower extremity during the sit-to-stand task while wearing shoes with different heel heights in healthy young women." Human movement science.
Kimura, Y., Y. Ishibashi, et al. (2011). "Increased knee valgus alignment and moment during single-leg landing after overhead stroke as a potential risk factor of anterior cruciate ligament injury in badminton." British Journal of Sports Medicine.
Kimura, Y., Y. Ishibashi, et al. (2010). "Mechanisms for anterior cruciate ligament injuries in badminton." British Journal of Sports Medicine 44(15): 1124-1127.
Kroner, K., S. A. Schmidt, et al. (1990). "Badminton injuries." British Journal of Sports Medicine 24(3): 169-172.
Kuntze, G., N. Mansfield, et al. (2010). "A biomechanical analysis of common lunge tasks in badminton." Journal of Sports Sciences 28(2): 183-191.
Leetun, D. T., M. L. Ireland, et al. (2004). "Core stability measures as risk factors for lower extremity injury in athletes." Medicine & Science in Sports & Exercise 36(6): 926-934.
Leigh, S., M. T. Gross, et al. (2008). "The relationship between discus throwing performance and combinations of selected technical parameters." Sports Biomechanics 7(2): 173-193.
Markolf, K. L., D. M. Burchfield, et al. (1995). "Combined knee loading states that generate high anterior cruciate ligament forces." Journal of Orthopaedic Research 13(6): 930-935.
Markolf, K. L., J. L. Slauterbeck, et al. (1996). "Effects of combined knee loadings on posterior cruciate ligament force generation." Journal of Orthopaedic Research 14(4): 633-638.
McGill, S. M., A. Childs, et al. (1999). "Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database." Archives of physical medicine and rehabilitation 80(8): 941-944.
Mills, R. (1977). "Injuries in badminton." British Journal of Sports Medicine 11(1): 51-53.
Neptune, R. R., I. C. Wright, et al. (1999). "Muscle coordination and function during cutting movements." Medicine & Science in Sports & Exercise 31(2): 294-302.
Oh, J. S., H. S. Cynn, et al. (2007). "Effects of performing an abdominal drawing-in maneuver during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt." The Journal of orthopaedic and sports physical therapy 37(6): 320-324.
Ooi, C. H., A. Tan, et al. (2009). "Physiological characteristics of elite and sub-elite badminton players." Journal of Sports Sciences 27(14): 1591-1599.
Rennie, W. J. and A. Saifuddin (2005). "Pes anserine bursitis: incidence in symptomatic knees and clinical presentation." Skeletal radiology 34(7): 395-398.
Senter, C. and S. L. Hame (2006). "Biomechanical analysis of tibial torque and knee flexion angle: implications for understanding knee injury." Sports Medicine 36(8): 635-641.
Shariff, A. H., J. George, et al. (2009). "Musculoskeletal injuries among Malaysian badminton players." Singapore Medical Journal 50(11): 1095-1097.
Silfies, S. P., R. Mehta, et al. (2009). "Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain." Archives of physical medicine and rehabilitation 90(7): 1159-1169.
Solomonow, M., R. Baratta, et al. (1987). "The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability." The American journal of sports medicine 15(3): 207-213.
Sommer, H. M. (1988). "Patellar chondropathy and apicitis, and muscle imbalances of the lower extremities in competitive sports." Sports Med 5(6): 386-394.
Thijs, Y., D. Van Tiggelen, et al. (2007). "Relationship between hip strength and frontal plane posture of the knee during a forward lunge." British Journal of Sports Medicine 41(11): 723-727; discussion 727.
Wijdicks, C. A., C. J. Griffith, et al. (2009). "Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament."
Willson, J. D. (2006). "Core strength and lower extremity alignment during single leg squats." Medicine and Science in Sports and Exercise 38(5): 945.
Willson, J. D., C. P. Dougherty, et al. (2005). "Core stability and its relationship to lower extremity function and injury." Journal of the American Academy of Orthopaedic Surgeons 13(5): 316-325.
Wilson, D. J., K. Gibson, et al. (2008). "Kinematics and kinetics of 2 styles of partial forward lunge." Journal of sport rehabilitation 17(4): 387-398.
Winter, D. A. (2005). Biomechanics and motor control of human movement. Hoboken, N.J., John Wiley & Sons, Inc.
Wymenga, A. B., J. J. Kats, et al. (2006). "Surgical anatomy of the medial collateral ligament and the posteromedial capsule of the knee." Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 14(3): 229-234.
Yung, P. S.-H., R. H.-K. Chan, et al. (2007). "Epidemiology of injuries in Hong Kong elite badminton athletes." Research in Sports Medicine 15(2): 133-146.
Zazulak, B. T., T. E. Hewett, et al. (2007). "The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study." The American journal of sports medicine 35(3): 368-373.