Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

Abstract

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ± 188 vs. 152 ± 106); VM (363 ± 192 vs. 140 ± 96); BF (229 ± 60 vs. 150 ± 63); MH (231 ± 88 vs. 203 ± 89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols.

Screening Tests for Assessing Athletes at Risk of ACL Injury or Reinjury—A Scoping Review

“…Indeed, poor neuromuscular control may lead to inefficient movement strategies by increasing ACL loading. Accordingly, previous studies have used alternative drop jump testing protocols to analyse muscle activation of the knee stabilizers to identify a potential risk of dynamic valgus due to inadequate neuromuscular timing [ 78 , 79 ]. Reviewing jump tests other than those related to dynamic knee valgus, we found that all but one test fit into one of two categories: the first category assessed the asymmetry between legs in single-leg jumps, focusing on metrics such as jump height or width [ 18 , 39 , 60 ].…”

Chronic Endothelial Dysfunction after COVID-19 Infection Shown by Transcranial Color-Coded Doppler: A Cross-Sectional Study

“…After the COVID-19 infection, difficulties sometimes can occur in the healthiest population, such as athletes. De Sire et al [ 38 ] examined the neuromuscular function of female volleyball players after recovering from COVID-19 and concluded that they may experience an increased risk of injury as a consequence of weak quadriceps varus/valgus stabilization during ACL stressful movements. Authors conclude that COVID-19 influenced the athletes’ body composition with weight loss, sarcopenia, and possible malnutrition.…”

Effects of Kinesio Taping and Rigid Taping on Gluteus Medius Muscle Activation in Healthy Individuals: A Randomized Controlled Study

“…Due to contradictory reports produced by different researchers, further research is needed in this regard. However, taping can be considered as part of comprehensive rehabilitation plans for pathological conditions and injury prevention [ 64 , 65 , 66 ].…”