Association between lower extremity muscle strength and acute ankle injury in youth team-sports athletes

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY-NC-ND 4.0 h ps://c ea i ecommons.o g/licenses/by-nc-nd/4.0/ Associa ion be ween lowe ex emi y muscle s eng h and acu e ankle inju y in you h eam-spo s a hle es © 2021 Else ie Accep ed e sion (Final d a ) Hie amo, J.; Pasanen, K.; Leppänen, M.; S e en, K.; Kannus, P.; Heinonen, A.; Ma ila, V.; Pa kka i, J. Hie amo, J., Pasanen, K., Leppänen, M., S e en, K., Kannus, P., Heinonen, A., Ma ila, V., & Pa kka i, J. (2021). Associa ion be ween lowe ex emi y muscle s eng h and acu e ankle inju y in you h eam-spo s a hle es. Physical The apy in Spo , 48, 188-195. h ps://doi.o g/10.1016/j.p sp.2021.01.007 2021 1 Hie amo, J., Pasanen, K., Leppänen, M., S e en, K., Kannus, P., Heinonen, A., Ma ila, V., & Pa kka i, J. 1 (2021). Associa ion be ween lowe ex emi y muscle s eng h and acu e ankle inju y in you h eam- 2 spo s a hle es. Physical The apy in Spo , 48, 188-195 3 4 ABSTRACT 5 Objec i es: To in es iga e lowe ex emi y muscle s eng h as isk ac o o an acu e ankle inju y 6 in you h a hle es. 7 Design: Coho s udy. 8 Se ing: Baske ball and loo ball clubs. 9 Pa icipan s: 188 you h (≤21) male and 174 emale a hle es. 10 Main ou come measu es: 1RM leg p ess, maximal concen ic isokine ic quad iceps and 11 hams ings as well as maximal isome ic hip abduc o s eng h we e measu ed and a hle es we e 12 ollowed o an acu e ankle inju y up o h ee yea s. Cox eg ession models we e used in s a is ical 13 analyses. 14 Resul s: In males, g ea e 1RM leg p ess and maximal quad iceps s eng h inc eased he isk o any 15 ype o acu e ankle inju y (Haza d a io [HR] o 1 SD inc ease, 1.63 [95% CI, 1.12‒2.39] and 1.43 16 [95% CI, 1.01‒2.01], espec i ely). In emales, g ea e 1RM leg p ess and di e ence be ween legs 17 in hip abduc ion s eng h inc eased he isk o acu e non-con ac ankle inju y (HR o 1 SD inc ease, 18 1.44 [95% CI, 1.03‒2.02] and 1.44 [95% CI, 1.03‒2.00], espec i ely). Howe e , ROC cu e 19 analyses showed AUC:s o 0.57-0.64 indica ing “ ail” o “poo ” combined sensi i i y and speci i y 20 o hese es s. 21 Conclusion: G ea e s eng h in bo h sexes along wi h asymme y in hip abduc o s eng h in 22 emales inc eased he isk o acu e ankle inju y. 23 2 24 Keywo ds: SPORT INJURY; INJURY RISK; YOUTH SPORT 25 1. INTRODUCTION 26 Incidence o ankle inju y is high in you h eam spo s (Bo owski, Ya d, Fields, & Coms ock, 2008; 27 Eme y, Ca olyn A., Meeuwisse, & Ha mann, 2005; Olsen, O-E, Myklebus , Engeb e sen, & Bah , 28 2006; Powell & Ba be -Foss, 2000). La e al ankle sp ain is obse ed mos equen ly (Sankey, 29 B ooks, Kemp, & Haddad, 2008; S a key, 2000; Woods, Hawkins, Hulse, & Hodson, 2003a). 30 Ankle sp ain can lead o a ma ked loss o p ac icing and playing ime (Cloke, Spence , Hodson, & 31 Deehan, 2009) and o en e ol e pe sis en pain, weakness and ch onic ins abili y possibly esul ing 32 in lowe spo ac i i y le els o e en change o spo s (Anandacooma asamy & Ba nsley, 2005). 33 Iden i ying isk ac o s ha a e modi iable and clinically easy o es a e essen ial 34 be o e planning inju y p e en ion p og ams (Bah & K osshaug, 2005). The ole o lowe ex emi y 35 (LE) muscle s eng h as a isk ac o o spo inju y is con o e sial. Lowe quad iceps and 36 hams ings s eng h o s eng h imbalances be ween hese muscles ha e shown o inc ease he isk 37 o an e io c ucia e ligamen inju y and hams ing s ain (C oisie , Gan eaume, Bine , Gen y, & 38 Fe e , 2008; Mye e al., 2009; Sode man, Al edson, Pie ila, & We ne , 2001) al hough con a y 39 esul s also exis (Bennell e al., 1998; Uho chak e al., 2003). In ou p e iously published s udy, 40 lowe hip abduc ion s eng h inc eased he isk o acu e knee inju y in you h male a hle es (Hie amo 41 e al., 2020). 42 The e a e se e al s udies in es iga ing ankle do si lexion, plan a lexion, in e sion, 43 e e sion, do si lexion and plan a lexion s eng h as well as s eng h a ios be ween hese as isk 44 ac o s o ankle inju y (Beynnon, Rens om, Alosa, Baumhaue , & Vacek, 2001; Wang, Chen, 45 Shiang, Jan, & Lin, 2006; Willems, T. M. e al., 2005; Willems, Tine Ma ieke e al., 2005). 46 Howe e , based on kine ic chain heo ies, impai men s o p oximal co e and hip muscle unc ion 47 3 a e sugges ed o inc ease he likelihood o uncon olled join displacemen s dis ally and occu ence 48 o dis al LE inju y (Lee un, I eland, Willson, Ballan yne, & Da is, 2004; Willson, Doughe y, 49 I eland, & Da is, 2005). Lowe hip abduc ion s eng h has ound o associa e wi h ch onic ankle 50 sp ains (F iel, McLean, Mye s, & Cace es, 2006), bu in ano he s udy, no associa ion be ween hip 51 muscle s eng h and he isk o non-con ac la e al ankle sp ain was epo ed in high school a hle es 52 (McHugh, Tyle , Te o, Mullaney, & Nicholas, 2006). In addi ion, al e a ions in knee kinema ics in 53 jump landing ask ha e ound in subjec s wi h ch onic ankle ins abili y (G ibble & Robinson, 2009) 54 and neu omuscula aining including quad iceps and hams ings s eng hening exe cises ha e 55 shown o dec ease he isk o acu e ankle inju y in you h a hle es (Eme y, C. A. & Meeuwisse, 56 2010; Olsen, Odd-Egil, Myklebus , Engeb e sen, Holme, & Bah , 2005). The e o e, lowe 57 quad iceps and hams ings s eng h may also be conside ed as isk ac o s o acu e ankle inju y. 58 The pu pose o his s udy was hus o in es iga e selec ed LE muscle s eng h 59 a iables as po en ial isk ac o s o an acu e ankle inju y in you h male and emale eam-spo 60 a hle es. We hypo hesized ha lowe muscle s eng h inc eases he isk o hese inju ies. 61 62 63 64 65 66 67 68 69 4 70 2. METHODS 71 2.1. S udy design and pa icipan s 72 This s udy is pa o he P edic o s o Lowe Ex emi y Inju ies in Team Spo s (PROFITS) s udy 73 (Pasanen e al., 2015). The s udy was conduc ed in acco dance wi h he Decla a ion o Helsinki and 74 was app o ed by he E hics Commi ee o he Pi kanmaa Hospi al Dis ic , Tampe e, Finland (ETL- 75 code R10169). The pa icipan s signed a w i en in o med consen be o e en e ing he s udy 76 (including pa en al consen o pa icipan s unde he age o 18). 77 Junio -aged (≤21 y s) baske ball and loo ball a hle es we e ec ui ed om 9 78 baske ball and 9 loo ball eams om 6 spo s clubs om Tampe e ci y dis ic . All a hle es played 79 a he wo highes junio o adul league le els. Al oge he 214 male (102 baske ball and 112 80 loo ball) and 189 emale (107 baske ball and 82 loo ball) a hle es en e ed he s udy du ing he 81 p eseason (Ap il‒May) in 2011, 2012 o 2013. Each a hle e comple ed a baseline ques ionnai e 82 including ques ions abou age, sex, p e ious inju ies and playing le el. S anding heigh (cm) and 83 body mass (kg) we e eco ded and muscle s eng h es s pe o med. A e baseline es s, inju y 84 egis a ion con inued un il he end o Ap il 2014. Twen y- ou male and 11 emale a hle es we e 85 excluded due o ongoing inju y. A hle es we e conside ed as inju ed i hey epo inju ies a 86 baseline ques ionnai e o we e no able o ully pa icipa e in muscle s eng h es s. In addi ion, 2 87 male and 4 emale a hle es we e excluded, because hey we e no o icial membe s o he eams 88 leading o a o al o 188 (88%) male and 174 (92%) emale a hle es in he inal analysis (Fig. 1). 89 The demog aphic da a and ankle inju y his o y o a hle es a e p esen ed in (Table 1). 90 2.2. Muscle s eng h es s 91 5 The muscle s eng h es s we e pa o a baseline es ba e y used o in es iga e po en ial 92 ana omical, biomechanical and neu omuscula isk ac o s o inju ies. The comple e es p o ocol 93 wi h s anda dised wa m-up p ocedu es be o e each es is desc ibed elsewhe e (Pasanen e al., 94 2015). 95 2.2.1. Maximal one- epe i ion leg p ess s eng h 96 A sea ed leg p ess machine (Technogym®, Gambe ola, I aly) was used o measu e a combined 97 maximal ex ension s eng h o LE muscles. The dis ance be ween ee was 20 cm and end o shoes 98 we e 10 cm abo e om he lowes end o he oo pla e. The back o he sea was se on 30° angle 99 ela i e o he loo . A e ical ba was placed a he poin whe e he knees eached he a ge knee 100 angle o 80° (Fig. 2). The a ge knee angle was measu ed wi h a goniome e (HiRes, Baseline® 101 E alua ion Ins umen s, Whi e Plains, NY, USA). A s anda dized wa m-up p o ocol consis ed h ee 102 se s wi h g adually inc easing weigh s (Pasanen e al., 2015). The one- epe i ion maximum (1RM) 103 leg p ess es p o ocol s a ed wi h 80‒150 kg. App op ia e s a ing weigh s o each a hle e we e 104 decided indi idually by asking abou a hle e’s expe ience o weigh aining in sea ed leg p ess 105 machine. A he s a ing poin a hle e’s legs we e ex ended and he weigh s we e hen lowe ed un il 106 he knees o m he co ec angle and hen e u ned a he s a ing posi ion as ha d as possible. A e 107 each success ul ial, he weigh s we e inc eased by maximum 30 kg a e he i s ials and by 108 minimum 10 kg a e he las ials o he nex a emp . Reco e y pe iod be ween he a emp s was 109 2 minu es (Ve dijk, an Loon, Meije , & Sa elbe g, Hans H C M., 2009) and he es ends when 110 1RM was eached. Body mass no malized alue was used in he analysis. Simila es has been 111 p o ed o be eliable ool o measu ing muscle s eng h (Le inge e al., 2009). 112 2.2.2. Maximal isokine ic quad iceps and hams ings s eng h 113 Maximal concen ic isokine ic quad iceps and hams ings s eng h was measu ed a i s s udy yea 114 (2011) in non-comme cial dynamome e (name hidden). A he second s udy yea (2012) he 115 6 dynamome e was eplaced by Biodex Mul i-Join Sys em P o dynamome e (Biodex Sys em 4, 116 Biodex Medical Sys ems, Inc., Shi ley, NY, USA). The es p ocedu e was he same ei he o he 117 dynamome e s used. The es ange o mo ion was 90° h ough 15° o knee lexion wi h an angula 118 eloci y o 60°/s (Fig. 2). A s anda dized es p o ocol (Pasanen e al., 2015) wi h g adually 119 inc easing in ensi y we e pe o med and he inal es includes h ee epe i ions wi h maximum 120 s eng h. The maximal s eng h was epo ed as peak o que (N‧m) eco ded and body mass 121 no malized alue was used in he analysis. The s eng h di e ence be ween legs as well as 122 hams ings- o-quad iceps (HQ) s eng h a io we e calcula ed. Isokine ic s eng h es ing has been 123 es ablished as eliable ool o assessing muscle s eng h (B osky JA J , Ni z, Malone, Cabo n, & 124 Rayens, 1999). 125 To e alua e he ep oducibili y o measu emen s be ween he used wo dynamome e s, 126 wel e 14‒15 yea s old male socce a hle es (24 legs) we e es ed wi h bo h dynamome e s by 127 di e en es e s who collec ed he da a. In aclass co ela ion coe icien (ICC) alue (3,k) was 0.81 128 (95% CI, 0.43‒0.93) o isokine ic quad iceps and 0.79 (95% CI, 0.47‒0.91) o isokine ic 129 hams ing s eng h measu emen indica ing good es - e es eliabili y o he es s. 130 2.2.3. Maximal hip abduc o s eng h 131 Maximal isome ic hip abduc o s eng h (kg) was es ed wi h a hand-held dynamome e (Hyd aulic 132 Push-Pull Dynamome e , Baseline® E alua ion Ins umen s, Whi e Plains, NY, USA). The es was 133 pe omed wi h he a hle e lying legs ex ended in a supine posi ion on bench. The pel is and he 134 con ala e al high we e ixed wi h a bel and he a hle e hold his o he a ms ac oss he ches du ing 135 he es . The dynamome e was posi ioned app oxima ely 2 cm p oximal he la e al ankle malleolus 136 wi h he leg in neu al posi ion and he oo in sligh do si lexion (Fig. 2). The dynamome e was 137 applied in a ixed posi ion and he a hle e hold muscle con ac ion agains he dynamome e o 138 app oxima ely wo seconds (make- es ). A e one es ial he a hle e pe o med wo maximal 139 7 con ac ions wi h a 10 second es be ween he a emp s (Johnson, Mille, Ma inez, C ombie, & 140 Roge s, 2004). The highes esul was eco ded and body mass no malized alue was used in he 141 analysis. The s eng h di e ence be ween legs was also calcula ed. Simila p ocedu e has been 142 showed o be eliable o assessing hip abduc o s eng h (Tho bo g, Pe e sen, Magnusson, & 143 Holmich, 2010). 144 2.3. Inju y and exposu e egis a ion 145 Du ing a ollow-up pe iod (May 2011‒Ap il 2014), all acu e ankle inju ies we e egis e ed by wo 146 s udy physicians. They con ac ed he eams once a week o check possible new inju ies and a e 147 each inju y epo ed, he inju ed a hle e was in e iewed by elephone using he s uc u ed 148 ques ionnai e (Pasanen e al., 2015). Inju y de ini ion was modi ied om de ini ion by Fulle and 149 colleagues (Fulle e al., 2006). An inju y was eco ded i he a hle e was unable o ully pa icipa e 150 in ma ches o aining du ing he nex 24 hou s. Only inju ies which occu ed in a eams’ scheduled 151 aining sessions o ma ches we e included in his s udy. The inju ies we e classi ied as con ac (ie. 152 di ec con ac o s ike o he in ol ed ankle) o non-con ac (ie. no di ec con ac o he in ol ed 153 ankle). 154 Du ing he ollow-up, he coach o each eam eco ded a hle es’ pa icipa ion in 155 ainings and ma ches. A hle e a endance in a aining session (yes/no), du a ion o a aining 156 session (h) and a endance in each pe iod o a ma ch (yes/no) we e eco ded indi idually on a eam 157 dia y. The dia ies we e e u ned a e each ollow-up mon h and he indi idual mon hly exposu e 158 ime (h) we e egis e ed o all a hle es. I an acu e ankle inju y occu ed, he exposu e hou s o ha 159 mon h we e es ima ed by di iding he days om he beginning o he mon h o he inju y da e by all 160 days o he mon h and hen by mul iplying he esul by he a hle e’s egis e ed exposu e hou s o 161 ha mon h. 162 2.4. S a is ical analysis 163 8 Desc ip i e da a a e p esen ed as he mean ± s anda d de ia ion (SD) o he median and 164 in e qua ile ange (IQR) depending on he no mali y o dis ibu ion o a iables. An independen - 165 samples es was used o compa e g oup di e ences o no mally dis ibu ed a iables and he 166 Mann-Whi ney U es o non-no mally dis ibu ed a iables. Depending on he dis ibu ion o he 167 a iables, Pea son’s and Spea man’s co ela ion coe icien s we e used o e alua e linea co ela ion 168 be ween wo a iables. Inju y incidences we e calcula ed as he numbe o inju ies pe 1000 playe - 169 hou s and epo ed wi h 95% CIs: ([Incidence a e – 1.96 * S anda d e o o incidence a e] * 170 1000 hou s) o ([Incidence a e + 1.96 * S anda d e o o incidence a e] * 1000 hou s). Recu en 171 inju ies we e included in incidence calcula ions. 172 Conside ing he s udy p ocedu e, Cox eg ession models we e chosen o analyse 173 s eng h a iables using he a hle e o he leg as a uni o analysis. The uni o analysis was de ined 174 acco ding o he s eng h a iable ep esen ing ei he he cha ac e is ic o he a hle e o o he leg 175 (Bah & Holme, 2003b). The ou comes we e a new acu e (con ac o non-con ac ) ankle inju y and 176 a new acu e non-con ac ankle inju y. Exposu e ime (h) om he s a o he ollow-up un il he 177 i s inju y o he end o he ollow-up we e included in he models. Spo s club was included in all 178 models as andom e ec and he leg in he models using i as he uni o analysis. Unadjus ed and 179 adjus ed models wi h p ede ined adjus emen ac o s we e made sepa a ely o male and emale 180 a hle es. The adjus emen ac o s ha migh mos ly in luence o he isk o ankle inju y we e 181 selec ed in he ollowing o de : p e ious acu e ankle inju y, age, heigh , spo and playing a adul 182 le el. These adjus emen ac o s we e included in he models acco ding o he numbe o inju ies in 183 each model, using es ima ion o 10 inju ies needed pe included a iable (Peduzzi, Conca o, 184 Feins ein, & Hol o d, 1995). In he models using he a hle e as he uni o analysis, p e ious inju ies 185 o ipsila e al o con ala e al side we e included, and in he models using he leg as a uni o 186 analysis, only inju ies o ipsila e al side we e included. 187 15 Rega dless o signi ican associa ions be ween he muscle s eng h and ankle inju y in 325 ou s udy, subs an ial o e lap be ween he es esul s in inju ed and uninju ed a hle es exis ed 326 leading “ ail” o “poo ” combined sensi i i y and speci i y o he s eng h es s meaning ha he 327 es s can co ec ly classi y <70% o inju ed and uninju ed a hle es. The e o e, in clinical p ac ice, 328 he muscle s eng h es s as measu ed in he p esen s udy canno be ecommended alone as inju y 329 sc eening ools o acu e ankle inju y in you h a hle es. 330 S udy s eng hs and limi a ions 331 This s udy had se e al s eng hs. Fi s , all he da a was collec ed p ospec i ely. Second, he 332 accu acy o ankle inju y da a collec ion was good, because s udy physicians con ac ed coaches once 333 a week. Thi d, indi idually collec ed exposu e da a enabled he use o Cox eg ession in s a is ical 334 analyses (Bah & Holme, 2003). Finally, he s eng h isk ac o s we e measu ed wi h s anda d and 335 simple p ocedu es easy o use in clinical p ac ice. 336 One main limi a ion o he s udy was ha we measu ed only muscle s eng h, bu 337 ankle inju y is likely a esul o he complex in e ac ion be ween many in e nal (a hle e- ela ed) and 338 ex e nal (en i onmen al) isk ac o s (Bah & K osshaug, 2005; Meeuwisse, 1994). Howe e , we 339 ook in o analyses se e al o he po en ial isk ac o s as adjus emen ac o s. Ano he main 340 limi a ion was, ha s eng h measu emen s we e no epea ed and hus he s eng h alues migh 341 ha e been changed du ing he 3-yea ollow-up. In addi ion, we did no ake he in luence o le e 342 a m (limb leng h) in o accoun o 1RM leg p ess and hip abduc ion s eng h measu emen s 343 (Bakken e al., 2018; McHugh e al., 2006). Finally, because he s udy coho comp ised o you h 344 loo ball and baske ball a hle es, he indings may no be applicable o adul a hle es o a hle es 345 om o he you h spo s. 346 347 348 16 349 5. CONCLUSION 350 Ou 3-yea p ospec i e s udy showed ha g ea e 1RM leg p ess and maximal quad iceps s eng h 351 inc eased he isk o any ype o acu e ankle inju y in you h male a hle es while g ea e 1RM leg 352 p ess s eng h and g ea e di e ence be ween legs in maximal hip abduc ion s eng h inc eased he 353 isk o acu e non-con ac ankle inju y in you h emale a hle es. Howe e , acco ding o he ROC 354 cu e analysis, hese s eng h a iables as measu ed in he p esen s udy canno be used alone as 355 sc eening ools o acu e ankle inju y in you h eam-spo a hle es. 356 357 358 359 360 361 362 363 364 365 366 367 368 17 369 Re e ences 370 Anandacooma asamy, A., & Ba nsley, L. (2005). Long e m ou comes o in e sion ankle inju ies. 371 B i ish Jou nal o Spo s Medicine, 39(3), e14. 372 Bah , R., & Holme, I. (2003a). Risk ac o s o spo s inju ies--a me hodological app oach. B i ish 373 Jou nal o Spo s Medicine, 37(5), 384-392. 374 Bah , R., & K osshaug, T. (2005). Unde s anding inju y mechanisms: A key componen o 375 p e en ing inju ies in spo . B i ish Jou nal o Spo s Medicine, 39(6), 324-329. 376 Bakken, A., Ta ge , S., Be e, T., Ei ale, C., Fa ooq, A., Mosle , A. B., e al. (2018). Muscle 377 s eng h is a poo sc eening es o p edic ing lowe ex emi y inju ies in p o essional male 378 socce playe s: A 2-yea p ospec i e coho s udy. Ame ican Jou nal o Spo s Medicine, 379 46(6), 1481-1491. 380 Bandholm, T., Tho bo g, K., Ande sson, E., La sen, T., To dahl, M., Bencke, J., e al. (2011). 381 Inc eased ex e nal hip- o a ion s eng h ela es o educed dynamic knee con ol in emales: 382 Pa adox o adap a ion?. Scandina ian Jou nal o Medicine & Science in Spo s, 21(6), 215. 383 Bennell, K., Wajswelne , H., Lew, P., Schall-Riaucou , A., Leslie, S., Plan , D., e al. (1998). 384 Isokine ic s eng h es ing does no p edic hams ing inju y in aus alian ules oo balle s. 385 B i ish Jou nal o Spo s Medicine, 32(4), 309-314. 386 Beynnon, B. D., Rens om, P. A., Alosa, D. M., Baumhaue , J. F., & Vacek, P. M. (2001). Ankle 387 ligamen inju y isk ac o s: A p ospec i e s udy o college a hle es. Jou nal o O hopaedic 388 Resea ch, 19(2), 213-220. 389 18 Bo owski, L. A., Ya d, E. E., Fields, S. K., & Coms ock, R. D. (2008). The epidemiology o US 390 high school baske ball inju ies, 2005-2007. Ame ican Jou nal o Spo s Medicine, 36(12), 391 2328-2335. 392 B osky JA J , Ni z, A. J., Malone, T. R., Cabo n, D. N., & Rayens, M. K. (1999). In a a e 393 eliabili y o selec ed clinical ou come measu es ollowing an e io c ucia e ligamen 394 econs uc ion. Jou nal o O hopaedic & Spo s Physical The apy, 29(1), 39-48. 395 Cloke, D. J., Spence , S., Hodson, A., & Deehan, D. (2009). The epidemiology o ankle inju ies 396 occu ing in english oo ball associa ion academies. B i ish Jou nal o Spo s Medicine, 43(14), 397 1119-1125. 398 Coppack, R. J., E he ing on, J., & Wills, A. K. (2011). The e ec s o exe cise o he p e en ion o 399 o e use an e io knee pain: A andomized con olled ial. Ame ican Jou nal o Spo s 400 Medicine, 39(5), 940-948. 401 C oisie , J., Gan eaume, S., Bine , J., Gen y, M., & Fe e , J. (2008). S eng h imbalances and 402 p e en ion o hams ing inju y in p o essional socce playe s: A p ospec i e s udy. Ame ican 403 Jou nal o Spo s Medicine, 36(8), 1469-1475. 404 C ons om, A., C eaby, M. W., Nae, J., & Agebe g, E. (2016). Modi iable ac o s associa ed wi h 405 knee abduc ion du ing weigh -bea ing ac i i ies: A sys ema ic e iew and me a-analysis. 406 Spo s Medicine, 46(11), 1647-1662. 407 De Ridde , R., Wi ouw, E., Dolphens, M., Roosen, P., & Van Ginckel, A. (2017). Hip s eng h as 408 an in insic isk ac o o la e al ankle sp ains in you h socce playe s: A 3-season p ospec i e 409 s udy. Ame ican Jou nal o Spo s Medicine, 45(2), 410-416. 410 19 Eme y, C. A., & Meeuwisse, W. H. (2010). The e ec i eness o a neu omuscula p e en ion 411 s a egy o educe inju ies in you h socce : A clus e - andomised con olled ial. B i ish 412 Jou nal o Spo s Medicine, 44(8), 555-562. 413 Eme y, C. A., Meeuwisse, W. H., & Ha mann, S. E. (2005). E alua ion o isk ac o s o inju y in 414 adolescen socce : Implemen a ion and alida ion o an inju y su eillance sys em. Ame ican 415 Jou nal o Spo s Medicine, 33(12), 1882-1891. 416 Fousekis, K., Tsepis, E., & Vagenas, G. (2012). In insic isk ac o s o noncon ac ankle sp ains in 417 socce : A p ospec i e s udy on 100 p o essional playe s. Ame ican Jou nal o Spo s Medicine, 418 40(8), 1842-1850. 419 F eckle on, G., & Pizza i, T. (2013). Risk ac o s o hams ing muscle s ain inju y in spo : A 420 sys ema ic e iew and me a-analysis. B i ish Jou nal o Spo s Medicine, 47(6), 351-358. 421 F iel, K., McLean, N., Mye s, C., & Cace es, M. (2006). Ipsila e al hip abduc o weakness a e 422 in e sion ankle sp ain. Jou nal o A hle ic T aining, 41(1), 74-78. 423 Fulle , C. W., Eks and, J., Junge, A., Ande sen, T. E., Bah , R., D o ak, J., e al. (2006). 424 Consensus s a emen on inju y de ini ions and da a collec ion p ocedu es in s udies o oo ball 425 (socce ) inju ies. Clinical Jou nal o Spo Medicine, 16(2), 97-106. 426 G ibble, P. A., & Robinson, R. H. (2009). Al e a ions in knee kinema ics and dynamic s abili y 427 associa ed wi h ch onic ankle ins abili y. Jou nal o A hle ic T aining, 44(4), 350-355. 428 G ibble, P. A., Te ada, M., Bea d, M. Q., Kosik, K. B., Lepley, A. S., McCann, R. S., e al. (2016). 429 P edic ion o la e al ankle sp ains in oo ball playe s based on clinical es s and body mass 430 index. Ame ican Jou nal o Spo s Medicine, 44(2), 460-467. 431 20 Hawkins, D., & Me heny, J. (2001). O e use inju ies in you h spo s: Biomechanical 432 conside a ions. Medicine & Science in Spo s & Exe cise, 33(10), 1701-1707. 433 Hie amo, J., Pa kka i, J., Leppänen, M., S e en, K., Kannus, P., Vasanka i, T., e al. (2020). 434 Associa ion be ween lowe ex emi y muscula s eng h and acu e knee inju ies in young eam- 435 spo a hle es. T ansla ional Spo s Medicine, n/a doi:10.1002/ sm2.172 436 Johnson, M. E., Mille, M., Ma inez, K. M., C ombie, G., & Roge s, M. W. (2004). Age- ela ed 437 changes in hip abduc o and adduc o join o ques. A chi es o Physical Medicine & 438 Rehabili a ion, 85(4), 593-597. 439 Laue sen, J. B., Ande sen, T. E., & Ande sen, L. B. (2018). S eng h aining as supe io , dose- 440 dependen and sa e p e en ion o acu e and o e use spo s inju ies: A sys ema ic e iew, 441 quali a i e analysis and me a-analysis. B i ish Jou nal o Spo s Medicine, 52(24), 1557-1563. 442 Lee un, D. T., I eland, M. L., Willson, J. D., Ballan yne, B. T., & Da is, I. M. (2004). Co e s abili y 443 measu es as isk ac o s o lowe ex emi y inju y in a hle es. Medicine & Science in Spo s & 444 Exe cise, 36(6), 926-934. 445 Le inge , I., Goodman, C., Ha e, D. L., Je ums, G., Toia, D., & Selig, S. (2009). The eliabili y o 446 he 1RM s eng h es o un ained middle-aged indi iduals. Jou nal o Science & Medicine in 447 Spo , 12(2), 310-316. 448 McHugh, M. P., Tyle , T. F., Te o, D. T., Mullaney, M. J., & Nicholas, S. J. (2006). Risk ac o s 449 o noncon ac ankle sp ains in high school a hle es: The ole o hip s eng h and balance 450 abili y. Ame ican Jou nal o Spo s Medicine, 34(3), 464-470. 451 Meeuwisse, W. H. (1994). Assessing causa ion in spo inju y: A mul i ac o ial model. Clinical 452 Jou nal o Spo Medicine, 4, 166-170. 453 21 Mye , G. D., Fo d, K. R., Ba be Foss, K. D., Liu, C., Nick, T. G., & Hewe , T. E. (2009). The 454 ela ionship o hams ings and quad iceps s eng h o an e io c ucia e ligamen inju y in 455 emale a hle es. Clinical Jou nal o Spo Medicine, 19(1), 3-8. 456 Nils ad, A., Ande sen, T. E., Bah , R., Holme, I., & S e en, K. (2014). Risk ac o s o lowe 457 ex emi y inju ies in eli e emale socce playe s. Ame ican Jou nal o Spo s Medicine, 42(4), 458 940-948. 459 Olsen, O., Myklebus , G., Engeb e sen, L., Holme, I., & Bah , R. (2005). Exe cises o p e en lowe 460 limb inju ies in you h spo s: Clus e andomised con olled ial. Bmj, 330(7489), 449. 461 Olsen, O., Myklebus , G., Engeb e sen, L., & Bah , R. (2006). Inju y pa e n in you h eam 462 handball: A compa ison o wo p ospec i e egis a ion me hods. Scandina ian Jou nal o 463 Medicine & Science in Spo s, 16(6), 426-432. 464 Pasanen, K., Rossi, M. T., Pa kka i, J., Heinonen, A., S e en, K., Myklebus , G., e al. (2015). 465 P edic o s o lowe ex emi y inju ies in eam spo s (PROFITS-s udy): A s udy p o ocol. BMJ 466 Open Spo & Exe cise Medicine, 1(1), e000076. 467 Peduzzi, P., Conca o, J., Feins ein, A. R., & Hol o d, T. R. (1995). Impo ance o e en s pe 468 independen a iable in p opo ional haza ds eg ession analysis. II. accu acy and p ecision o 469 eg ession es ima es. Jou nal o Clinical Epidemiology, 48(12), 1503-1510. 470 Powell, J. W., & Ba be -Foss, K. D. (2000). Sex- ela ed inju y pa e ns among selec ed high school 471 spo s. Ame ican Jou nal o Spo s Medicine, 28(3), 385-391. 472 Powe s, C. M., Ghoddosi, N., S aub, R. K., & Khayambashi, K. (2017). Hip s eng h as a p edic o 473 o ankle sp ains in male socce playe s: A p ospec i e s udy. Jou nal o A hle ic T aining, 474 52(11), 1048-1055. 475 22 Qua man-Ya es, C. C., Qua man, C. E., Mesza os, A. J., Pa e no, M. V., & Hewe , T. E. (2012). A 476 sys ema ic e iew o senso imo o unc ion du ing adolescence: A de elopmen al s age o 477 inc eased mo o awkwa dness? B i ish Jou nal o Spo s Medicine, 46(9), 649-655. 478 Ryman Augus sson, S., & Agebe g, E. (2017). Weake lowe ex emi y muscle s eng h p edic s 479 auma ic knee inju y in you h emale bu no male a hle es. BMJ Open Spo & Exe cise 480 Medicine, 3(1), e000222. 481 Sankey, R. A., B ooks, J. H. M., Kemp, S. P. T., & Haddad, F. S. (2008). The epidemiology o 482 ankle inju ies in p o essional ugby union playe s. Ame ican Jou nal o Spo s Medicine, 483 36(12), 2415-2424. 484 Sode man, K., Al edson, H., Pie ila, T., & We ne , S. (2001). Risk ac o s o leg inju ies in emale 485 socce playe s: A p ospec i e in es iga ion du ing one ou -doo season. Knee Su ge y, Spo s 486 T auma ology, A h oscopy, 9(5), 313-321. 487 S a key, C. (2000). Inju ies and illnesses in he na ional baske ball associa ion: A 10-yea 488 pe spec i e. Jou nal o A hle ic T aining, 35(2), 161-167. 489 Tho bo g, K., Pe e sen, J., Magnusson, S. P., & Holmich, P. (2010). Clinical assessmen o hip 490 s eng h using a hand-held dynamome e is eliable. Scandina ian Jou nal o Medicine & 491 Science in Spo s, 20(3), 493-501. 492 Uho chak, J. M., Sco ille, C. R., Williams, G. N., A cie o, R. A., S Pie e, P., & Taylo , D. C. 493 (2003). Risk ac o s associa ed wi h noncon ac inju y o he an e io c ucia e ligamen : A 494 p ospec i e ou -yea e alua ion o 859 wes poin cade s. Ame ican Jou nal o Spo s 495 Medicine, 31(6), 831-842. 496 23 Ve dijk, L. B., an Loon, L., Meije , K., & Sa elbe g, Hans H C M. (2009). One- epe i ion 497 maximum s eng h es ep esen s a alid means o assess leg s eng h in i o in humans. 498 Jou nal o Spo s Sciences, 27(1), 59-68. 499 Walden, M., A oshi, I., Magnusson, H., Wagne , P., & Hagglund, M. (2012). P e en ion o acu e 500 knee inju ies in adolescen emale oo ball playe s: Clus e andomised con olled ial. Bmj, 501 344, e3042. 502 Wang, H., Chen, C., Shiang, T., Jan, M., & Lin, K. (2006). Risk- ac o analysis o high school 503 baske ball-playe ankle inju ies: A p ospec i e con olled coho s udy e alua ing pos u al 504 sway, ankle s eng h, and lexibili y. A chi es o Physical Medicine & Rehabili a ion, 87(6), 505 821-825. 506 Willems, T. M., Wi ouw, E., Delbae e, K., Philippae s, R., De Bou deaudhuij, I., & De Cle cq, 507 D. (2005). In insic isk ac o s o in e sion ankle sp ains in emales--a p ospec i e s udy. 508 Scandina ian Jou nal o Medicine & Science in Spo s, 15(5), 336-345. 509 Willems, T. M., Wi ouw, E., Delbae e, K., Mahieu, N., De Bou deaudhuij, I., & De Cle cq, D. 510 (2005). In insic isk ac o s o in e sion ankle sp ains in male subjec s: A p ospec i e s udy. 511 Ame ican Jou nal o Spo s Medicine, 33(3), 415-423. 512 Willson, J. D., Doughe y, C. P., I eland, M. L., & Da is, I. M. (2005). Co e s abili y and i s 513 ela ionship o lowe ex emi y unc ion and inju y. Jou nal o he Ame ican Academy o 514 O hopaedic Su geons, 13(5), 316-325. 515 Woods, C., Hawkins, R., Hulse, M., & Hodson, A. (2003a). The oo ball associa ion medical 516 esea ch p og amme: An audi o inju ies in p o essional oo ball: An analysis o ankle sp ains. 517 B i ish Jou nal o Spo s Medicine, 37(3), 233-238. 518 24 Zoui a, S., Zoui a, A. B. M., Kebsi, W., Dupon , G., Ben Abde ahman, A., Ben Salah, F. Z., e al. 519 (2016). S eng h aining educes inju y a e in eli e young socce playe s du ing one season. 520 Jou nal o S eng h & Condi ioning Resea ch, 30(5). 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545