Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review

Kellis, Eleftherios; Sahinis, Chrysostomos; Baltzopoulos, Vasilios

doi:10.1016/j.jshs.2022.01.002

Cited by 38 publications

(38 citation statements)

References 74 publications

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“…Implementing exercises specifically targeting the hamstring musculature (e.g., Romanian deadlift, Nordic hamstring curl) may improve H/Q ratios and reduce future hamstring and/or knee injury risk. Lastly, it is important to note that previous studies more commonly use dynamic isokinetic muscle actions (e.g., 30-300°•s −1 ) to examine conventional and functional H/Q ratios and the ability of H/Q ratios to predict lower extremity injuries specifically across fire academies requires future study (45).…”

Section: Muscle Strength and Vertical Jump Performancementioning

confidence: 99%

The Time Course of Health, Fitness, and Occupational Performance Changes in Recruits across a Fire Academy

Wohlgemuth

Gerstner

Giuliani-Dewig

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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PurposeThe purpose of this study was to examine the time course of health, fitness, and occupational performance changes in firefighter recruits across a fire academy.MethodsNineteen recruits (24.9 ± 4.3 yr; 26.7 ± 3.1 kg·m−2) had their body composition, balance, vertical jump (VJ) performance, cardiorespiratory fitness (CRF), upper and lower body strength, hamstrings-to-quadriceps (H/Q) ratio, lower back endurance, and weighted stair climb (SC) performance assessed at the beginning (week 1 [W1]), midpoint (week 15 [W15]), and end (week 30 [W30]) of a fire academy.ResultsThe fire academy improved body composition, balance, CRF, leg extension strength, and SC performance from W1 to W15 (P ≤ 0.042) which then plateaued at W30 (P ≥ 0.314). Leg flexion strength and the H/Q ratio decreased from W1 to W15 (P ≤ 0.035) and plateaued at W30 (P ≥ 0.947). Upper body strength was similar at W1 and W15 (P ≥ 0.999), but decreased at W30 (P ≤ 0.033). However, no significant changes occurred across the academy for VJ performance or lower back endurance (P ≥ 0.090).ConclusionsThese findings highlight the positive effect of the academy on body composition, CRF, balance, SC performance, and leg extension strength. However, the decreases in upper body and leg flexion strength, the H/Q ratio, and lack of changes in VJ performance and low back endurance may highlight key areas of need to maximize injury prevention and performance enhancement efforts in the academy. Further, the varied time course of changes may help fire departments identify opportunities to modify exercise programming across their academies.

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Section: Muscle Strength and Vertical Jump Performancementioning

confidence: 99%

The Time Course of Health, Fitness, and Occupational Performance Changes in Recruits across a Fire Academy

Wohlgemuth

Gerstner

Giuliani-Dewig

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Hamstrings act as posterior stabilizers of the knee and weakness in this muscle group can lead to greater anterolateral translation and increased risk of ACL graft rupture or contralateral injury 60 . An H/Q ratio lower than 0.50 indicates weak hamstrings that should be strengthened (acceptable H/Q close to 0.60) before progressing to sports functional testing 61 . Athletes with weak quadriceps hop slower and for shorter distances, which leads to not passing hop test criteria 62 .…”

Section: Evidence For Isokinetic Strength Testing During Rehabilitationmentioning

confidence: 99%

“…60 An H/Q ratio lower than 0.50 indicates weak hamstrings that should be strengthened (acceptable H/Q close to 0.60) before progressing to sports functional testing. 61 Athletes with weak quadriceps hop slower and for shorter distances, which leads to not passing hop test criteria. 62 As mentioned previously, an LSI ≥85-90% is considered acceptable 33,34 and we use this criterion to determine when the athlete is ready for functional testing.…”

Section: Strength Evaluation As a Screening Tool For Functional Testsmentioning

confidence: 99%

Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery

Rivera-Brown

Frontera

Fontanez³

et al. 2022

PM&R

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The rupture and reconstruction of the anterior cruciate ligament (ACL) of the knee are associated with an increased risk of functional instability, a reduction in sports performance, and a higher risk of future additional injuries. Competitive athletes who participate in sports that require pivoting, cutting, and jumping are at particularly high risk for ACL rupture. The return to sport progression continuum after surgery includes sports-specific rehabilitation, evaluation of strength and function, gradual participation in exercise training with progressively challenging activities in the field of play, participation in sports at a lower level, and finally a return to preinjury-level sports competition. This narrative review evaluates the evidence that supports the use of quadriceps and hamstrings isokinetic strength testing and sports-specific functional skills assessments to evaluate progress with rehabilitation after ACL surgery. Strength evaluations, hop tests, agility tests, and the limb symmetry index are described, as well as the associations of quadriceps and hamstrings muscle strength and functional test results with successful return to sports and the risk of ACL graft rupture and contralateral knee injuries. Suggestions for future research directions are presented including the importance of presurgery testing, standardization of test batteries, and comparison of test results with normative data.

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“…Maximal knee flexor and knee extensor strength was obtained under specific concentric and eccentric isokinetic conditions. These were selected to allow for the computation of two commonly reported H:Q ratios: a conventional H:Q ratio, and a functional H:Q ratio, which have been used in previous research (6,15,21). These ratios are typically calculated using peak joint moment but, by analysing joint moment data throughout the full isokinetic ROM, we were able to compare the discrete calculations of H:Q ratio to a range of angle-specific strength ratios as independent variables, thus allowing us to establish the ability of discrete ratios to represent strength ratios throughout the full joint ROM.…”

Section: Methodsmentioning

confidence: 99%

“…Where conventional H:Q ratio is determined by measuring the peak joint moment of the hamstrings and quadriceps during concentric actions, the functional H:Q ratio is determined by measuring the peak moment of the quadriceps during concentric action and the hamstrings peak moment during eccentric action, as would be observed during running or kicking (1). Despite literature commonly reporting these values, there remains uncertainty regarding their relevance to human movement (21). The widely accepted "optimal" conventional H:Q ratio is 0.6 (i.e., the peak joint moment of the hamstrings is 60% of the quadriceps).…”

Section: Introductionmentioning

confidence: 99%

Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players

Lunn,

Nicholson,

Cooke

et al. 2023

Journal of Strength and Conditioning Research

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Lunn, DE, Nicholson, G, Cooke, M, Crespo, R, Robinson, T, Price, RJ, and Walker, J. Discrete hamstring: quadriceps strength ratios do not represent angle-specific ratios in Premier League soccer players. J Strength Cond Res XX(X): 000–000, 2023—This study compared angle-specific hamstring:quadriceps (H:Q) ratios with their discrete counterparts during strength testing in professional male soccer players. Twenty-seven professional English Premier League soccer players were recruited for this study (age: 22 ± 4 years; stature: 1.81 ± 0.08 m; body mass: 74.7 ± 6.5 kg). Isokinetic testing of the knee flexors and extensors was conducted concentrically at two angular velocities (60° and 240°·s−1) and eccentrically (for the knee flexors only) at 30°·s−1. Conventional H:Q ratio was calculated as the ratio between peak joint moment in the flexors and extensors at 60°·s−1. Functional H:Q ratio was calculated as the peak joint moment in the flexors during the eccentric condition and the extensors at 240°·s−1. Discrete conventional and functional H:Q ratios were 0.56 ± 0.06 and 1.28 ± 0.22, respectively. The residual differences between discrete values and angle-specific residual values were 13.60 ± 6.56% when normalized to the magnitude of the discrete value. For the functional ratios, the normalized residual was 21.72 ± 5.61%. Therefore, neither discrete ratio was representative of angle-specific ratios, although the conventional ratio had lower error overall. Therefore, practitioners should consider H:Q ratio throughout the full isokinetic range of motion, not just the discrete ratio calculated from peak joint moments, when designing and implementing training programs or monitoring injury risk, recovery from injury, and readiness to return to play.

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Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review

Cited by 38 publications

References 74 publications

The Time Course of Health, Fitness, and Occupational Performance Changes in Recruits across a Fire Academy

The Time Course of Health, Fitness, and Occupational Performance Changes in Recruits across a Fire Academy

Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery

Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players

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