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ORIGINAL ARTICLE
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Acute effect of eccentric knee exercises on dynamic balance among athletes and non-athletes


 Department of Sports Sciences and Medicine, Guru Nanak Dev University, Amritsar, Punjab, India

Date of Submission16-Mar-2021
Date of Decision31-May-2021
Date of Acceptance31-May-2021

Correspondence Address:
Amrinder Singh,
Assistant Professor, MYAS-GNDU Department of Sports Sciences and Medicine, Guru Nanak Dev University, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_202_21

  Abstract 


Purpose: Eccentric exercises may cause fatigue. Fatigue in lower body causes decline in dynamic balance which may cause injury. The purpose of the study was to examine the changes in dynamic balance before and after an acute bout of eccentric exercise using Y-balance test (lower quarter) among athletes and nonathletes and to find injury risk by change in balance. Materials and Methods: This study investigated 39 subjects which were divided into two groups: Group 1 (n = 19) athletes (mean age, 21.89 ± 2.62 years; height, 2.96 ± 0.25 m; mass, 66.52 ± 10.05 kg) and Group 2 (n = 20) nonathletes (mean age, 23.95 ± 1.73; height, 2.77 ± 0.30 m; mass, 60.12 ± 8.25 kg). Before and after acute bout of eccentric exercise, all subjects underwent an assessment for dynamic balance using Y-balance test-lower quarter. Results: After an acute bout of eccentric knee exercises, dynamic balance was not reduced significantly (P > 0.05) in Group 1 (athletes) as well as in Group 2 (nonathletes). Conclusion: In the current study by performing eccentric knee exercises, dynamic balance was not reduced in both the groups. Therefore, these eccentric knee exercises can be done by both the groups without risk of getting injured.

Keywords: Athlete, dynamic balance, eccentric knee exercises, nonathlete, Y-balance test-lower quarter



How to cite this URL:
Singh A, Tandel B, Shenoy S, Sandhu JS. Acute effect of eccentric knee exercises on dynamic balance among athletes and non-athletes. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=336318




  Introduction Top


In several daily activities such as walking, running, jumping, jogging, or controlling the movement of the trunk, muscles around knee joint play a crucial role.[1],[2] During gait cycle, hamstring is generally recognized for knee flexion, but it also exerts strong force at hip extension, stabilizes the knee, and helps in generation of movements.[3],[4],[5] Hamstring muscle strains were among the common injuries in high-speed running sports such as taekwondo,[6] soccer,[7] cricket, rugby,[8] and hockey.[9] During fast movements such as sprinting, accelerating, change of direction, kicking or landing; biceps femoris and rectus femoris were thought to be at great risk due to biarticular design of hamstring and quadriceps.[8],[10],[11]

Muscles are capable of achieving higher absolute forces when contracting eccentrically as compared with concentrically.[12],[13],[14] As increases in muscular strength are thought to be proportional to the magnitude of force developed,[15] it has been postulated that resistance training including eccentric contractions could stimulate greater adaptations compared with focusing only on concentric training.[16],[17] According to previous literature, abundance of lower extremity screening tools has been reported, most of which incorporate some level of functional or sports-specific criteria.[18],[19]

A derivative of star excursion balance test is Y-balance test for the lower quarter which is one such test with good to excellent intra- and inter-rater reliability that has been used to predict injuries in high school athletes.[20],[21] It also shows a reliable measure of an athlete's functional abilities.[22],[23] As Y balance test- lower quarter (YBT-LQ) is a functional outcome measure, it can be utilized in clinic and it may serve as a good evaluative tool in determining return to sports. Several studies also indicated that poor balance is associated with increased risk of lower-limb injury.[24],[25],[26] Plisky et al., 2006, was the first to report a cohort study of female high school basketball players, which states that an anterior (AT) reach asymmetry of more than 4 cm in the lower extremities and a composite reach distance <94.0% of limb length were both predictive of lower-limb injury.[21]

Several studies state that balance was significantly decreased due to fatigue in participants during post single-leg balance testing.[27] Fatigue can be defined as a decline in tension capacity or force output after repeated muscle contractions. Muscle fatigue typically occurs after high-intensity exercise or even eccentric exercises can cause fatigue. This may result in negative effects on an individual's overall performance.[28],[29] There are several studies showing effect of fatigue on dynamic balance and effect of other exercises on balance, but there is a lack of studies on effect of eccentric exercises on dynamic balance. Previously, the eccentric knee exercise combination used in athletes has shown to be effective after knee muscle strain, but its effect on dynamic balance was not known in both athletes and nonathletes.[11] We hypothesized that dynamic balance will be maintained after an acute bout of eccentric knee exercises among both athletes and nonathletes. The aim of the current study was to compare the effect of eccentric knee exercises on dynamic balance among athletes and nonathletes and see the risk of injury through change in balance.


  Materials and Methods Top


The study was approved by the Institutional Ethics Committee of Guru Nanak Dev University (GNDU), Amritsar, Punjab, India, confirmed with letter number 36/HG on March 2, 2020. Subjects were informed about the purpose of the study by patient information sheet, and they agreed to sign the consent form before being enrolled. This study included 19 females and 20 males aged between 18 and 26 years with no recent history of injury to lower limb. Healthy athletes and non-athletes performing regular physical activity, having some previous experience with strength training, little or no experience with eccentric training were included in this study. Moreover, subjects with any neural, muscular, skeletal, or connective tissue injuries recently in quadriceps and hamstring muscle group were excluded. Subjects were selected from GNDU Campus as per the inclusion and exclusion criteria. They were allotted into two groups: Group A (athletes with national medals of GNDU campus) and Group B (students of GNDU campus were taken as nonathletes). Test was done in strength analysis laboratory at MYAS-GNDU Department of Sports Sciences and Medicine which includes pre exercise assessment of dynamic balance by Y-balance followed by a bout of eccentric knee exercises performed after 5 mins of warm-up on cycle ergometer which includes 2 sets × 8 reps Nordic hamstring exercise and 5 sets ×6 reps of Reverse Nordic Hamstrings and Lunges.[11] Post exercise YBT-LQ was done immediately. Test was done in the morning without any prior physical exertion.

Y-balance test-lower quarter protocol

Dynamic balance was tested using YBT-LQ. In YBT-LQ, the subjects were asked to stand on a single leg with the most distal aspect of the toes just behind the starting line on the intersection point of Y drawn on floor. While maintaining single-leg stance, ask the patient to reach the unsupported limb in anterior direction and return to center, reach to posteromedial and return to center, then reach to posterlateral and return to center without keeping the unsupported foot on the floor while reaching all directions. The farthest reach for each direction was used for analysis. The YBT-LQ examines maximum lower extremity reach of the free leg in the AT, PM, and PL directions while the subject maintains a unilateral stance with the opposite leg centered on a platform. This process is repeated after the subject switches to the contralateral leg. According to standardized protocol, a trial was considered invalid if the subject (1) failed to maintain unilateral stance, (2) touched down on the reaching foot, (3) failed to return to the starting position, such as removing the hands from the hips, or (4) pushed or kicked the indicator to increase distance. Three trials were repeated for each direction, in which the examiner recorded the maximum reach score. Differences in the maximum reach distance in centimeters for each limb were compared to examine right and left asymmetry for each AT, PM, and PL direction. The normalized composite score (CS) was calculated by summing the maximum reach in each of the three directions, then dividing by three times the leg length for that side. Leg length was measured from the inferior tip of the AT superior iliac spine to the distal end of the medial malleolus.[30]



Statistical analysis

The statistical evaluation of the data was performed using the SPSS software 21 version (IBM, CHICAGO, IL, USA). If significance value was >0.05, then parametric test was applied to compare the data. The results were presented as mean ± standard deviation. For comparison of anthropometric and Y-balance test-lower quarter, paired and unpaired t-test was used after verification of the equality of variance errors (Shapiro–Wilk test). Effect size was presented as “Cohen's d” value, which was calculated as: difference of means of Y-balance CSs between athletes and nonathletes/pooled standard deviation value shown in [Table 1].
Table 1: Statistical measures of composite score between athletes and nonathletes

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  Results Top


Anthropometric data are presented in [Table 2] of athletes and nonathletes.
Table 2: Anthropometric data of height, weight, and body mass index of athletes and nonathletes

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With regard to the Y-balance test-lower quadrant, CSs of athletes on left side (t = 0.283, P = 0.781) and on right side (t = −1.168, P = 0.258) and CSs of nonathletes on left side (t = 1.633, P = 0.119) and on right side (t = 1.570, P = 0.133) are shown in [Table 3]. We found no significant difference (P > 0.05) between athletes and nonathletes after an acute bout of eccentric knee exercises shown in [Table 4].
Table 3: Composite score within the groups

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Table 4: Composite score data between the groups

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  Discussion Top


To the best of our knowledge, this is a novel study to investigate the immediate effect of eccentric knee exercises on dynamic balance using YBT-LQ among athletes and nonathletes. The aim of the current study was to evaluate the acute effect of eccentric knee exercises on dynamic balance among athletes and nonathletes.

The main outcome of the study summarizes that there was no significant decrease in CS after an acute bout of exercise within the group. Furthermore, there was no significant difference in CS seen between both athletes and nonathletes on left side. However, on right side, there was a significant difference (P < 0.05) seen between athletes and nonathletes after an acute bout of eccentric knee exercises.

In athletes, there were a slight decrease in left CS and a slight increase in right CS. In nonathletes, there was a slight decrease in CS on both sides. This may be due to the difference in strength in nonathletes compared to athletes as trained athletes possess enhanced muscle strength that may be inherent or develop as a result of long-term athletic training which might have countered the fatigue in athletic population.[31] Cooper et al., 2020, state that there was no significant difference seen between pre and post measurements in all balance variables which was similar to the results of our study.[29] However, Simoneau et al., 2006,[32] studied the effects of moderate fatigue on dynamic balance control and attentional demands in which they found that moderate fatigue leads to decrease in performance on the balance control task. For strength and conditioning professionals or any recreational athlete, large amount of lower body power generation is required for their performance which may cause acute muscular fatigue and may hamper balance due to fatigue. Therefore, to minimize the effect of fatigue for lower extremity power performance, optimal exercise protocol has to be set.

The findings of previous studies have shown elevated injury risk with poor performance on dynamic balance tests.[23],[33],[34] Plisky et al., 2006,[21] reported a cohort study of female high school basketball players, which states that an AT reach asymmetry of more than 4 cm in the lower extremities and a composite reach distance <94.0% of limb length were both predictive of lower-limb injury. Subsequent studies using the YBT-LQ to identify athletes at risk for injury reported conflicting results.[28],[34],[35],[36],[37] While some studies had demonstrated that a reach asymmetry of more than 4 cm was associated with an increased risk of injury,[35],[36] contrary to this other studies did not.[28],[34]

Muscle fatigue occurs after prolonged bouts of physical activity or high-intensity exercise which may affect an individual's performance. Muscle fatigue would hinder an individual's ability to maintain their balance.[28] As balance declines, the ability to control one's body position also decreases. Hence, balance is a crucial component in injury prevention, movement economy, and executing sports skills. The results of the current study state that as eccentric knee exercises did not cause immediate decrement in dynamic balance, it reduces chances of muscle injury which is in line with previous studies.[32],[38],[39]

This study has several limitations. As mentioned in previous studies, YBT-LQ has weaker sensitivity to predict the prevalence of injury, further other strength testing measures can be taken along with YBT-LQ. The sample size of the study was small in both the groups, so it can be increased in both the groups. Furthermore, athletes and nonathletes had a mean average age difference of 2.05 years.


  Conclusion Top


The findings of the current study state that even after differences in muscle strength among athletes and nonathletes, dynamic balance did not hamper immediately after the same set of eccentric knee exercises. Thus, eccentric knee exercises can be done by both the groups without causing immediate injury. Further studies are required to see the long-term effect of these exercises on nonathletic adults and can take data at a similar baseline.

Acknowledgments

We are thankful to all the subjects who participated in this study.

Financial support and sponsorship

The study was conducted at MYAS-GNDU Department of Sports Sciences and Medicine, Guru Nanak Dev University, Amritsar, Punjab, India. This center is funded by the Ministry of Youth Affairs and Sports, Government of India.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

 
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