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Correlation Between Quadriceps, Hamstring, Tibialis Anterior, And Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1. Original Research Correlation between Quadriceps, Hamstring, Tibialis Anterior, and Gastrocnemius Muscle Activation, with Knee Flexion Angle in Basketball Athlete while Performing Double-Leg Landing Task Ditaruni Asrina Utami1 1 Departement of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Corresponding Author: Ditaruni Asrina Utami, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Mayjend Prof. Dr. Moestopo Str. No. 47, Surabaya, Jawa Timur, 60131, Indonesia Phone: +62 85730539291 Email: [email protected] ABSTRACT Background: Anterior cruciate ligament (ACL) injury cause great disability for athlete. Recent focus of ACL injury management is on prevention by identifying the risk factors. Most of basketball injury mechanism is non-contact, related to landing process with small knee flexion angle. Muscle activation and its ratio, which control movement pattern in sagittal plane, are said to play a role in dynamic movement such as landing. Aims: The purpose of this study is to analyze the correlation between muscles activation and their activation ratio of quadriceps, hamstring, tibialis anterior and gastrocnemius with knee flexion angle of basketball athlete while performing double-leg landing task. Material and methods: This study was an observational analytic, cross sectional study. Study subjects was basketball athletes age 16 – 25 years in Surabaya. Measurements of knee flexion angle done with digital measurements of reflective marker, and muscle activation was measured with sEMG while performing double-leg landing task. Result: There was no significant correlation between maximum knee flexion angle and muscle activation of quadriceps (p=0,562), hamstring (p=0,918), tibialis anterior (p=0,394) and gastrocnemius (p=0,419). There was also no significant correlation between maximum knee flexion angle and the muscle activation ratio of quadriceps-hamstring (p=0,347), quadriceps-tibialis (p=0,139), quadriceps-gastrocnemius (p=0,626), hamstring-tibialis anterior (p=0,365), hamstring-gastrocnemius (p=0,867), and tibialis anterior- gastrocnemius (p=0,109). Conclusions: There was no correlation between muscle activation and muscle activation ratio of quadriceps, hamstring, tibialis anterior and gastrocnemius with maximum knee flexion angle in basketball athlete while performing double-leg landing task. Keywords: ACL, quadriceps, hamstring, tibialis anterior, gastrocnemius, knee flexion angle, landing task 7 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1. Introduction landing, so the body position is relatively upright (small knee, hip and trunk flexion Injury of anterior cruciate ligament angle), this pattern thought to be the risk factors (ACL) can cause great disability, especially for for ACL injury.9 athletes. ACL injury require time and cost for Muscle activation controlling sagittal recovery, but restoration to the pre injury plane movement play a role in the amount of activity level is not always achievable. ACL knee and hip flexion angle during dynamic injury can happen with other injury of knee movement such as landing task. Eccentric 1-3 ligament or meniscus. ACL injury can lead to quadriceps muscle contraction will increase knee osteoarthritis, joint effusion, disturbance internal knee-extension moment when landing, in pattern of movement, muscle weakness, this will facilitate more erect posture and decrease in functional performance and loss of smaller knee flexion angle. While concentric 1 time in sport participation. contraction of hamstring and gastrocnemius The highest incidence of non-contact will increase internal knee-flexion moment and 4 injury in basketball athlete is knee injury ACL cause greater knee flexion angle when landing.9 injury rate among recreational basketball Gastrocnemius muscle is an antagonist of the athlete is 0.08 in male and 0.29 in female, with ACL which will cause increase of anterior the ratio of 3.63 between male and female. In shear force of the tibia, but this statement is still professional basketball athlete the incidence is debatable.3 Sousa showed correlation between lower, 0.20 for male and 0.21 for female.5 ACL gastrocnemius and tibialis anterior muscle in 6 injury accounts for 40% of all sports injury. ballet dancer while doing sauté.10 Walsh et al, Incidence of ACL injury is highest in the age of reporting knee flexion angle was influenced by 7 15 – 24 years. There is 55 cases of athlete with co-activation ratio of quadriceps and hamstring ACL injury having treated at Sport Clinic Dr. muscle.9 Soetomo General Hospital from January 2012 – The purpose of this study is to analyze May 2014. correlation between muscle activation around Recently, the management of ACL knee joint, namely quadriceps (Q), hamstring injury focused on injury prevention, by (H), tibialis anterior (TA) and gastrocnemius identifying risk factors and mechanism of (G) at basketball athlete when performing 2 injury. According to the mechanism, 72% of double-leg landing task. This study also analyze ACL injury happened through non-contact the correlation between ratio of quadriceps- mechanism, when athlete perform landing hamstring (Ratio Q-H), quadriceps-tibialis 2,8 movement with 2 feet. Movement pattern that anterior (Ratio Q-TA), quadriceps- can cause non-contact injury in basketball gastrocnemius (Ratio Q-G), hamstring-tibialis athlete mostly happened during deceleration anterior (Ratio H-TA), hamstring- movement such as landing with knee in small gastrocnemius (Ratio H-G), and tibialis 2,8 knee flexion angle. Krosshaug movement anterior-gastrocnemius (Ratio TA-G) with knee analysis study of 39 ACL injury video showed flexion angle at basketball athlete when most of the athlete have injury when they performing double-leg landing task. landed with 2 feet.8 Movement analysis showed decrease in sagittal plane movement when 8 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1. Material and Methods and recorded with digital video camera placed 3 meter from platform to measure knee flexion Study Subjects angle and muscle activation. Study population was male basketball Subject performed double-leg landing athletes, trained on basketball club in Surabaya task from top of wooden box 30 cm high, 50 meeting the inclusion criteria. Inclusion cm behind the platform. Both feet was opened criterias: (1) basketball athlete from basketball as wide as the shoulder, upper extremity raised club in Surabaya age 16 – 26 years, (2) agree to paralel to the floor in front of the body, eyes participate in the study, follow the examination staring forward. Subject jumped as natural as and sign the informed consent. Exclusion possible to the force plate in the platform with criterias: (1) has lower extremity injury or two feet. The dominant leg land on force plate surgery at lower extremity in the past 6 months, and the non-dominant legs land outside force (2) subject with other musculoskeletal disorder plate. Each subject did 2 jumps and the data which can endanger or limit subject to perform from 2 jumps included in data measurement. double-leg landing task. Reflective markers placed at dominant legs (greater trochanter, lateral epicondyle of Sample Size femur, lateral malleolus) to measure knee flexion angle. Knee flexion angle measured at This study used each jump as a sample maximum knee flexion after subject landed. unit. Each subject performed 2 test procedure, Measurements done using software (Protractor, taken as 2 sample unit. Minimal sample unit Korea). needed is 15. Study Design This is an observational analytic study, with a cross sectional design. Study conducted from January until March 2015. The study conducted at Gait Analysis Laboratorium, Physical Medicine and Rehabilitation Department, Dr. Soetomo General Hospital, Surabaya. Figure 1. Measurement of knee flexion angle Test Procedure Muscle activation measured by surface electromyography (sEMG) recorded through Study subject who signed the informed surface electrodes on muscle belly of the consent underwent physical examination for dominant leg. Measurement of quadriceps body weight, body height and joint laxity. muscle done at vastus medial oblique muscle Subject conducted test session for double leg belly, 4cm superior and 3 cm medial from landing task wearing spandex shorts and shirt superomedial border of patella. Hamstring and also athletic shoes they frequently used. muscle electrode placed at the middle between The test was done at gait analysis laboratorium 9 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1. ischial tuberosity and head of fibula. The Statistical analysis gastrocnemius electrode placed on the lateral head of gastrocnemius. The tibialis anterior The statistical analysis performed with muscle electrode placed on 4 finger below tibial SPSS 17 with level of signification p < 0,05 tuberosity and 1 finger lateral to tibial crest. using double regression analysis or pearson Maximum muscle activation was taken. correlation analysis. Ratio of quadriceps-hamstring, Ethical Clearance quadriceps-tibialis anterior, quadriceps- gastrocnemius, hamstring-tibialis anterior, This study is approved by Ethical hamstring-gastrocnemius, and tibialis anterior- Comitee for Basic and Clinical Science Dr. gastrocnemius was measured from maximum Soetomo General Hospital
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