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Isokinetic muscle imbalance and knee-joint injuries. A prospective blind study.
Abstract
One hundred and seventy-two randomly selected high-school football players underwent pre-season isokinetic muscle-testing to determine if there was any relationship between an imbalance in thigh-muscle function and the occurrence of knee injuries. Strength, power, power-endurance, and time to maximum tension were measured for the quadriceps and hamstring muscle groups for both lower extremities of each athlete. The resulting values were utilized to see if a difference of 10 per cent or more between the right and left extremities or between the mean and actual hamstring-to-quadriceps ratio of the individual extremity would result in more knee injuries. No such relationship was found.
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Dominant-to-non-dominant strength imbalances are normal to some extent.
“Some authors [27, 28] have pointed out that dominant to non-dominant strength imbalances are normal to some extent.”
From Comparison of muscle activation imbalance following core stability or general exercises in nonspecific low back pain: a quasi-randomized controlled trial (2020) · cites this paper as [27]
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BackgroundA Prospective Study of Ankle Injury Risk Factors
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Strength, Flexibility and Athletic Injuries1
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EMG Power Spectra of Intercollegiate Athletes and Anterior Cruciate Ligament Injury Risk in Females
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Injury Prevention and Future Research
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“…of studies reported not significant fluctuating (dominant vs. non-dominant) isokinetic asymmetries (Agre & Baxter, 1987; Bartlett et al., 1989; Grace et al., 1984; Mikesky et al., 1995; Orchard et al., 1997), while others reported significant lateral dominance based asymmetries, even though…”
BackgroundQuadriceps Insufficiency Following Repair of the Anterior Cruciate Ligament
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“We suggest that some of the discrepancy in the literature can be explained by the fact that typically, with some notable exceptions (4,7), reports are often characterized by relatively small sample size or diverse study populations, with the accompanying risk of making flawed generalizations.”
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“Besides the importance of muscular strength balance as a risk factor for knee and lower limb injuries [5,6], muscle contralateral deficit (i.”
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“A normal ratio between hamstring and quadriceps (also known as the flexion:extension ratio) has been reported to range from 50% to 80% in adults, depending on angular velocities and contraction modes (concentric, eccentric, isometric).(1,4,10,13) Holcomb et al(18) stated that for athletes with conventional ratios <0.”
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Calmels, P., & Minaire, P. (1995) · Disability and Rehabilitation · doi:10.3109/09638289509166646 · Cited by 50
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Avaliação isocinética no joelho do atleta
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Characteristics of the isokinetic performance of patients with injured cruciate ligaments
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Comparison of Three Methods of Assessing Strength Imbalances at the Knee
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Asymmetry of lower extremity force and muscle activation during knee extension and functional tasks
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BackgroundKnee Joint Strength Ratios and Effects of Hip Position in Rugby Players
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“However, evidence to support the relationship between muscular imbalances and lower limb musculoskeletal injury is inconsistent (1,4,9,13,24).”
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“These observations do not necessarily have any bearing on the incidence of knee injury.(16) The idea is widely held that women, who tend to be more supple than men, have increased ligamentous laxity, but this is not supported in the literature.”
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“However, using similar methods, Grace et al. (1984) showed that a difference of 10% or more in right and left extremity strength did not result in a higher incidence of knee injuries.”
MethodIsokinetic Testing in Young Nonathletic Able-Bodied Subjects
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Comparison of Muscle Strength Imbalance in Powerlifters and Jumpers
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“It has been postulated that the weaker or more imbalanced an extremity muscle group is, the more prone it is to injury (8,18), although others have questioned whether there is a link between muscle imbalance and injury (4).”
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“The muscular torque of the quadriceps and hamstrings, as well as their torque ratio (H/Q), is usually evaluated by the isokinetic test.(6) The H/Q ratio is used both clinically and in the laboratory as an indicator of the strength balance between the knee joint muscles.”
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Postsurgical knee rehabilitation
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Isokinetic Hamstrings/Quadriceps Ratios: Normal Values and Reproducibility in Sport Students
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Avaliação isocinética no joelho do atleta
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“In fact, previous research has reported strength asymmetries up to and exceeding 10% to be common among noninjured football and soccer athletes.(8,11) Even elite sprinters, who presumably use their lower limbs equally when sprinting, have shown more than 15% asymmetry in lower limb muscle volume.”
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“Isokinetic testing can be used to evaluate quadriceps and hamstrings muscle strength, providing a determination of the magnitude of torque generated, and subsequently, the hamstrings to quadriceps (H:Q) strength ratio [5, 6].”
MethodHattori, K., Sano, H., Komatsuda, T., et al. (2010) · Journal of Orthopaedic Science · doi:10.1007/s00776-010-1474-0 · Cited by 19
Fang, K., Lin, X., Liu, X., et al. (2020) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-020-03450-8 · Cited by 18
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Metadata
- Authors
- Grace, T. G., Sweetser, E. R., Nelson, M. A., Ydens, L. R., & Skipper, B. J.
- Venue
- The Journal of Bone & Joint Surgery
- Published
- 1984-06
- Volume
- 66
- Issue
- 5
- Pages
- 734-740
- ISSN
- 0021-9355 (ISSN-L)
- OpenAlex
- W2189545724
- Cited by
- 176
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 1 · 2020: 6 · 2019: 7 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 7 · 2014: 7 · 2013: 9 · 2012: 7
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Bone and Joint Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- knee injury, hamstring-to-quadriceps ratio, quadriceps strength, hamstring strength, power endurance, high school football players, knee injury risk factors
- MeSH terms
- Adolescent, Athletic Injuries, Biomechanical Phenomena, Football, Humans, Knee Injuries, Male, Muscles, Prospective Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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