isokinetic return to play conference 2016 london interseason variability of isokinetic strength in...
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Nicol van DykRehabilitation Department9 April 2016
INTER-SEASON VARIABILITY IN
ISOKINETIC STRENGTH ELITE FOOTBALL
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Contributing Authors– Rod Whiteley– Cristiano Eirale– Bhavesh Kumar– Bruce Hamilton– Hans Tol– Aziz Farooq– Roald Bahr– Erik Witvrouw
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Introduction
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Odds Ratio p-value 95% CI
Q Con 60 0.99 0.06 0.99 - 1.00
H Con 60 0.99 0.17 0.99 - 1.00
Q Con 300 0.99 0.97 0.99 - 1.00
H Con 300 0.99 0.20 0.99 - 1.00
H Ecc 60 0.99 0.12 0.99 - 1.00
Q Con 60 BW 0.71 0.03* 0.52 - 0.97
H Con 60 BW 0.75 0.29 0.43 -1.29
Q Con 300BW 1.10 0.87 0.56 - 1.89
H Con 300 BW 0.75 0.29 0.43 - 1.29
H Ecc 60 BW 0.73 0.04* 0.54 - 0.99
Q Con 60/ H Con 60 0.76 0.32 0.44 - 1.32
H Con 60/ H Ecc 60 1.08 0.90 0.34 - 3.40
Q Con 300/ H Con 300 1.46 0.26 0.76 - 2.79
Q Con 300/ H Ecc 60 1.46 0.35 0.66 - 3.25
Q Con 60 BW 0.71 0.03* 0.52 - 0.97
H Ecc 60 BW 0.73 0.04* 0.54 - 0.99
Q Con 60 BW Effect Size
0.17 6.9 Nm
H Ecc 60 BW Effect Size
0.18 7.1 Nm
4 seasons
614 players
190 injuries
1931Isokinetic
Tests performed are WEAK risk factors
HAMSTRING STRAIN INJURIES
have a small association with
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Odds Ratio p-value 95% CI
Q Con 60 0.99 0.06 0.99 - 1.00
H Con 60 0.99 0.17 0.99 - 1.00
Q Con 300 0.99 0.97 0.99 - 1.00
H Con 300 0.99 0.20 0.99 - 1.00
H Ecc 60 0.99 0.12 0.99 - 1.00
Q Con 60 BW 0.71 0.03* 0.52 - 0.97
H Con 60 BW 0.75 0.29 0.43 -1.29
Q Con 300BW 1.10 0.87 0.56 - 1.89
H Con 300 BW 0.75 0.29 0.43 - 1.29
H Ecc 60 BW 0.73 0.04* 0.54 - 0.99
Q Con 60/ H Con 60 0.76 0.32 0.44 - 1.32
H Con 60/ H Ecc 60 1.08 0.90 0.34 - 3.40
Q Con 300/ H Con 300 1.46 0.26 0.76 - 2.79
Q Con 300/ H Ecc 60 1.46 0.35 0.66 - 3.25
Q Con 60 BW 0.71 0.03* 0.52 - 0.97
H Ecc 60 BW 0.73 0.04* 0.54 - 0.99
Q Con 60 BW Effect Size
0.17 6.9 Nm
H Ecc 60 BW Effect Size
0.18 7.1 Nm
4 seasons
614 players
190 injuries
1931Isokinetic
Tests performed
Quadriceps Concentric strength
Hamstrings Eccentric strength
are WEAK risk factors HAMSTRING STRAIN INJURIES
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Aim
How stable is the strength variable
we are testing?
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All Teams in Qatar Stars
League (n=14 teams)
2010-2014
No isokinetic tests performed
(n=52 subjects)
Isokinetic Tests during Periodic Health Evaluation
(n=614 subjects) mean follow up of 2.24 years
Q Con 60°/s(n= 556)
H Con 60°/s(n= 555)
Q Con 300°/s(n= 556)
H Con 300°/s(n=556)
H Ecc 60°/s(n=562)
Materials & Methods
Over 1 season
240 players
Over 2 seasons
86 players
Over 3 seasons
18 players
Consecutive Isokinetic Strength Tests
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Statistical Analyses
Systematic Error• Mean difference• Paired sample
t-tests
Random Error• Intraclass
Correlation Coeficient (ICC)
• Measurement Error
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Statistical Analyses
Systematic Error• Mean difference• Paired sample
t-tests
Random Error• Intraclass
Correlation Coeficient (ICC)
• Measurement Error
Measurement Error
Standard Deviation (Season 1 – Season 2)
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Quadriceps Concentric @60°/s
Hamstrings Eccentric @60°/s
Quadriceps Concentric strength
Measurement error
24.5 Nm (10.5%)
Mean (SD)
234.1 Nm (37.0)
ICC (95% CI)
0.82 (0.78,0.85)
Minimal detectable change (MDC)
67.9 Nm
Results
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Measurement error26.6 Nm (14.6%)
Hamstrings Eccentric strength
Results
Mean (SD)
181.7 Nm (37.0)
Min detectable change (MDC)
73.7 Nm
ICC (95% CI)
0.68 (0.61,0.73)
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Results
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• 1st study to investigate stability/variability
• Large sample group over multiple seasons
• Different measures of variability tested
• No measure of exposure– Intervention/injury
Strengths and Limitations
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Clinical Take Home Message
Substantial Isokinetic Inter-season Variability
• When testing strength…
Be careful interpreting isokinetic strength
NO
YES
MAYBE
• ?
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Thank you