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The Influence of Movement Profile on the Female Athlete's THE INFLUENCE OF MOVEMENT PROFILE ON THE FEMALE ATHLETE’S BIOMECHANICAL RESILIENCE & TRAINING LOAD RESPONSE TO CONTROLLED EXERCISE EXPOSURE Barnett S. Frank A dissertation submitted to the faculty of The University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Interdisciplinary Human Movement Science Chapel Hill 2016 Approved by: Darin A. Padua Anthony C. Hackney Steven W. Marshall Claudio L. Battaglini J. Troy Blackburn ©2016 Barnett S. Frank ALL RIGHTS RESERVED ii ABSTRACT Barnett S. Frank: The Influence Of Movement Profile On The Female Athlete’s Biomechanical Resilience & Training Load Response To Controlled Exercise Exposure (Under the Direction of Darin A. Padua) Background: “Stiff” landing biomechanics and excessive frontal plane knee motion, such as limited trunk, hip, and knee flexion and medial knee displacement have been identified as risk factors or movement patterns associated with lower extremity musculoskeletal injury and elevated joint loads. Additionally, high training load exposure has similarly be linked to musculoskeletal injury in the physically active population. There is a significant volume of evidence supporting high training loads and high-load biomechanics to independently influence injury risk. However there is a lack evidence describing the influence of an individual’s baseline movement quality profile on their systemic and musculoskeletal tissue stress experienced secondary to high training load exposure. An individual’s global resilience to high training loads may be influenced by the mechanical demands of their inherent movement profile during physical activity and sport participation. Aim: Investigate the influence of an individual’s inherent baseline movement profile on their biomechanical, systemic stress, and musculoskeletal system stress response to an acute bout of high training load exposure. Methods: 43 physically active, healthy, college-aged females were enrolled in this study and were assigned to a poor high-load or excellent low-load movement profile group operationally defined by the Landing Error Scoring System (LESS). Jump-landing 3D iv biomechanics and blood samples were collected prior to and following a metabolically controlled acute high training load exercise protocol (HTL). Changes in biomechanics and circulating biomarkers of global systemic stress (cortisol), and musculoskeletal system tissue stress (sCOMP & CK-MM) were compared between poor and excellent movement profiles to better understand the influence of movement profile on the body’s response to the demands of HTL. Results: The poor group was observed to experience greater degradation of neuromuscular control strategies that effectively and efficiently dissipate mechanical stresses experienced during high-intensity exercise. Furthermore, we observed movement profile to influence systemic stress hormone levels (cortisol). A poor movement profile was associated with an elevated stress level in contrast to their excellent movement counter parts. Furthermore, it seems the excellent movement profile is linked to greater deployment of dynamic muscle tissue to efficiently dissipate the high mechanical stresses experienced during HTL activities, as the excellent movement profile was associated with greater circulation of CK-MM following acute HTL exposure. Conclusions: Movement quality profile influences the physically active, healthy, college-aged female’s biomechanical and global stress response to HTLs associated with sport participation. The excellent movement quality profile appears to be more biomechanically resilient to acute HTL exposure. Thus, promoting an excellent movement profile in individuals partaking in exercise activity with HTLs is encouraged the limit global stress levels, and promote safe neuromuscular control strategies limiting the mechanical load exposure to the system. iv TABLE OF CONTENTS LIST OF TABLES ........................................................................................................................ vii LIST OF FIGURES ..................................................................................................................... viii LIST OF ABBREVIATIONS & SYMBOLS ................................................................................ ix CHAPTER 1 ................................................................................................................................... 1 INTRODUCTION .......................................................................................................................1 OPERATIONAL DEFINITIONS ............................................................................................... 8 LIMITATIONS & ASSUMPTIONS ........................................................................................ 13 DELIMITATIONS ................................................................................................................... 14 INDEPENDENT VARIABLE ................................................................................................. 15 DEPENDENT VARIABLES ................................................................................................... 15 RESEARCH QUESTIONS ...................................................................................................... 16 HYPOTHESES ......................................................................................................................... 18 REFERENCES ......................................................................................................................... 20 CHAPTER 2 ............................................................................................................................... ..26 SECTION ONE: Epidemiology of Sport-Related Musculoskeletal Injury .............................. 27 Lower Extremity Musculoskeletal Injury in Sport & Physical Activity ............................... 27 Anterior Cruciate Ligament Injury is Responsible for High-Severity Knee Injury .............. 31 The Landscape of ACL Injury in Sport ................................................................................ 33 The Influence of Workload, Time-of-Season, Phase-of-Play, and Training & Competition Activity on Injury Incidence in Sport .............................................................. 40 vii SECTION TWO: Biomechanical Mechanisms and Risk Factors for Sport-Related Noncontact ACL Injury ..................................................................................... 47 Sagittal Plane Knee, Hip, and Trunk Biomechanics Associated with Noncontact ACL Injury .................................................................................................... 49 Frontal Plane Knee, Hip, and Trunk Biomechanics Associated with Noncontact ACL Injury ................................................................................................ 64 ACL Injury Biomechanics Summary and their Proposed Influence on Sport-Related Noncontact ACL Injury in a High-Risk Athlete Population ......................... 78 SECTION THREE: The Proposed Interaction Between Movement Profile and Total-Body Physiological Response to High-Intensity Exercise-Induced Fatigue ............ 88 Exercise-Induced Fatigue is an Interactive Process that Influences Muscle Function ......... 88 The Influence of Exercise-Induced Fatigue on Neuromuscular Function and Control of Human Movement ......................................................................... 92 Evidence of an Interaction Between Biomechanics and Exercise-Induced Physiological Demand on the Human Body .......................................... 101 Biomarker Assessment for Training Stress & Fatigue Monitoring in Athletes .................. 112 REFERENCES ....................................................................................................................... 134 CHAPTER 3 ............................................................................................................................... 163 RATIONALE .......................................................................................................................... 163 POPULATION ....................................................................................................................... 165 Subjects ............................................................................................................................... 165 Power Analysis ................................................................................................................... 169 Initial LESS Screening ........................................................................................................ 171 LESS Instrumentation & Setup ........................................................................................... 171 LESS Screening Procedure ................................................................................................. 172 TESTING SESSION ............................................................................................................... 173 DATA COLLECTION ........................................................................................................... 176 Instrumentation ................................................................................................................... 176 vii Procedures ........................................................................................................................... 182 DATA PROCESSING & REDUCTION ...............................................................................
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