The Effects of Neuromuscular and Mental Fatigue on Knee Kinematics and Anterior Cruciate Ligament Injury Risk in Male Soccer Players

Document Type : Original research papers

Authors

1 MSc, Department of Health and Sports Rehabilitation, Faculty of Sports Science & Health, Shahid Beheshti University, Tehran, Iran.

2 Associate professor, Department of Health and Sports Rehabilitation, Faculty of Sports Science & Health, Shahid Beheshti University, Tehran, Iran

3 Associate professor, Department of Health and Sports Rehabilitation, Faculty of Sports Science & Health, Shahid Beheshti University, Tehran, Iran.

4 Department of Sport Sciences, Shahrekord University, Shahrekord, Iran

Abstract

Background: The majority of anterior cruciate ligament (ACL) injuries are non-contact, occurring most frequently during landing or changing directions in sports activities. Various factors, such as biomechanical and neuromuscular variables, have been implicated in these injuries. Recent research highlights that both physical and mental fatigue might influence the risk factors for ACL injuries by altering movement patterns during high-risk maneuvers. This study aimed to investigate the effects of neuromuscular and mental fatigue on knee kinematics and potential risk factors for ACL injuries in male soccer players during landing and crossover-cutting maneuvers.
Methods: Thirty professional male soccer players were randomly divided into three groups: physical fatigue (n=10), mental fatigue (n=10), and control (n=10). Experimental groups performed landing and crossover-cutting maneuvers during pre- and post-fatigue states, with kinematic data collected using a seven-camera system and Cortex software. The control group underwent identical maneuvers without fatigue protocols to ensure comparability of conditions across groups. The control group underwent the same tests without implementing fatigue protocols. Statistical analysis was conducted using repeated measures ANOVA to evaluate differences across groups and conditions.
Results: Physical fatigue caused a significant decrease in knee flexion at initial contact (P = 0.002), while mental fatigue showed no significant effects on kinematics. Group-by-time interaction effects were observed for knee flexion (P = 0.05), with pairwise comparisons revealing significant differences only in the physical fatigue group.
Conclusion: Neuromuscular fatigue alters knee kinematics, increasing ACL injury risk. Coaches should prioritize training programs that enhance fatigue resistance and proper movement mechanics.

Keywords

Main Subjects

References

  1. Rishiraj N, Taunton JE, Lloyd-Smith R, Woollard R, Regan W, Clement D. The potential role of prophylactic/functional knee bracing in preventing knee ligament injury. Sports Med. 2009;39(11):937-60.

https://doi.org/10.2165/11317790-000000000-00000

  1. Qu X, Jiang J, Hu X. Effects of subsensory noise and fatigue on knee landing and cross-over cutting biomechanics in male athletes. Journal of Applied Biomechanics. 2018;34(3):205-10.

https://doi.org/10.1123/jab.2017-0180

  1. Zadro JR, Pappas E. Time for a different approach to anterior cruciate ligament injuries: educate and create realistic expectations. Sports Med. 2019;49(3):357-63.

https://doi.org/10.1007/s40279-018-0995-0

  1. Jamison ST, Pan X, Chaudhari AM. Knee moments during run-to-cut maneuvers are associated with lateral trunk positioning. Journal of biomechanics. 2012;45(11):1881-5.

https://doi.org/10.1016/j.jbiomech.2012.05.031

  1. Boden BP, Dean GS, Feagin JA, Garrett WE. Mechanisms of anterior cruciate ligament injury. SLACK Incorporated Thorofare, NJ; 2000. p. 573-8.

https://doi.org/10.3928/0147-7447-20000601-15

  1. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee surgery, sports traumatology, arthroscopy. 2009;17(7):705-29.

https://doi.org/10.1007/s00167-009-0823-z

  1. Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2000;8(3):141-50.

https://doi.org/10.5435/00124635-200005000-00001

  1. Stacoff A, Steger J, Stuessi E, Reinschmidt C. Lateral stability in sideward cutting movements. Med Sci Sports Exerc. 1996;28(3):350-8.

https://doi.org/10.1097/00005768-199603000-00010

  1. Benjaminse A, Webster KE, Kimp A, Meijer M, Gokeler A. Revised approach to the role of fatigue in anterior cruciate ligament injury prevention: a systematic review with meta-analyses. Sports Med. 2019;49:565-86.

https://doi.org/10.1007/s40279-019-01052-6

  1. Madigan ML, Pidcoe PE. Changes in landing biomechanics during a fatiguing landing activity. Journal of electromyography and Kinesiology. 2003;13(5):491-8.

https://doi.org/10.1016/s1050-6411(03)00037-3

  1. García-Luna MA, Cortell-Tormo JM, García-Jaén M, Ortega-Navarro M, Tortosa-Martínez J. Acute effects of ACL injury-prevention warm-up and soccer-specific fatigue protocol on dynamic knee valgus in youth male soccer players. International Journal of Environmental Research and Public Health. 2020;17(15):5608.

https://doi.org/10.3390/ijerph17155608

  1. ZareeI M, Rahnama N, Rajabi R. The influence of a positional role of soccer players in iranian premier league on the sport injuries rates. HARAKAT. 2009;-(39).

https://sid.ir/paper/30329/en

  1. Bagherian S, Rahnama N, Wikstrom EA, Clark MA, Rostami F. Characterizing lower extremity movement scores before and after fatigue in collegiate athletes with chronic ankle instability. Int J Athl Ther Train. 2018;23(1):27-32.

https://doi.org/10.1123/ijatt.2017-0029

  1. McLean SG, Felin RE, Suedekum N, Calabrese G, Passerallo A, Joy S. Impact of fatigue on gender-based high-risk landing strategies. Med Sci Sports Exerc. 2007;39(3):502-14.

https://doi.org/10.1249/mss.0b013e3180d47f0

  1. Kellis E, Kouvelioti V. Agonist versus antagonist muscle fatigue effects on thigh muscle activity and vertical ground reaction during drop landing. Journal of Electromyography and Kinesiology. 2009;19(1):55-64.

https://doi.org/10.1016/j.jelekin.2007.08.002

  1. Van Cutsem J, Marcora S, De Pauw K, Bailey S, Meeusen R, Roelands B. The effects of mental fatigue on physical performance: a systematic review. Sports Med. 2017;47(8):1569-88.

https://doi.org/10.1007/s40279-016-0672-0

  1. Thompson CJ, Noon M, Towlson C, Perry J, Coutts AJ, Harper LD, et al. Understanding the presence of mental fatigue in English academy soccer players. J Sports Sci. 2020;38(13):1524-30.

https://doi.org/

  1. Swanik CB, Covassin T, Stearne DJ, Schatz P. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35(6):943-8.

https://doi.org/10.1080/02640414.2020.1746597

  1. Xing X, Zhong B, Luo H, Rose T, Li J, Antwi-Afari MF. Effects of physical fatigue on the induction of mental fatigue of construction workers: A pilot study based on a neurophysiological approach. Automation in Construction. 2020;120:103381.

https://doi.org/10.1016/j.autcon.2020.103381

  1. Kobayashi H, Kanamura T, Koshida S, Miyashita K, Okado T, Shimizu T, et al. Mechanisms of the anterior cruciate ligament injury in sports activities: a twenty-year clinical research of 1,700 athletes. Journal of sports science & medicine. 2010;9(4):669.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3761820/

  1. Orishimo KF, Kremenic IJ. Effect of fatigue on single-leg hop landing biomechanics. Journal of applied biomechanics. 2006;22(4):245-54.

https://doi.org/10.1123/jab.22.4.245

  1. Lessi GC, dos Santos AF, Batista LF, de Oliveira GC, Serrao FV. Effects of fatigue on lower limb, pelvis and trunk kinematics and muscle activation: gender differences. Journal of Electromyography and Kinesiology. 2017;32:9-14.

https://doi.org/10.1016/j.jelekin.2016.11.001

  1. Quammen D, Cortes N, Van Lunen BL, Lucci S, Ringleb SI, Onate J. Two different fatigue protocols and lower extremity motion patterns during a stop-jump task. J Athl Train. 2012;47(1):32-41.

https://doi.org/10.4085/1062-6050-47.1.32

  1. Loch F, Hof zum Berge A, Ferrauti A, Meyer T, Pfeiffer M, Kellmann M. Acute effects of mental recovery strategies after a mentally fatiguing task. Frontiers in Psychology. 2020;11:558856.

https://doi.org/10.3389/fpsyg.2020.558856

  1. Smith MR, Marcora SM, Coutts AJ. Mental fatigue impairs intermittent running performance. Med Sci Sports Exerc. 2015;47(8):1682-90.

https://doi.org/10.1249/MSS.0000000000000592

  1. Kadaba MP, Ramakrishnan H, Wootten M. Measurement of lower extremity kinematics during level walking. Journal of orthopaedic research. 1990;8(3):383-92.

https://doi.org/

  1. Orekhov G, Robinson AM, Hazelwood SJ, Klisch SM. Knee joint biomechanics in transtibial amputees in gait, cycling, and elliptical training. PLoS One. 2019;14(12):e0226060.

https://doi.org/10.1002/jor.1100080310

  1. Lucci S, Cortes N, Van Lunen B, Ringleb S, Onate J. Knee and hip sagittal and transverse plane changes after two fatigue protocols. J Sci Med Sport. 2011;14(5):453-9.

https://doi.org/10.1016/j.jsams.2011.05.001

  1. Santamaria LJ, Webster KE. The effect of fatigue on lower-limb biomechanics during single-limb landings: a systematic review. J Orthop Sports Phys Ther. 2010;40(8):464-73.

https://doi.org/10.2519/jospt.2010.3295

  1. Lepers R, Hausswirth C, Maffiuletti N, Brisswalter J, Van Hoecke J. Evidence of neuromuscular fatigue after prolonged cycling exercise. Med Sci Sports Exerc. 2000;32(11):1880-6.

https://doi.org/10.1097/00005768-200011000-00010

  1. Benjaminse A, Habu A, Sell TC, Abt JP, Fu FH, Myers JB, et al. Fatigue alters lower extremity kinematics during a single-leg stop-jump task. Knee Surgery, Sports Traumatology, Arthroscopy. 2008;16(4):400-7.

https://doi.org/10.1007/s00167-007-0432-7

  1. Thomas AC, McLean SG, Palmieri-Smith RM. Quadriceps and hamstrings fatigue alters hip and knee mechanics. Journal of applied biomechanics. 2010;26(2):159-70.

https://doi.org/10.1123/jab.26.2.159

  1. Becker S, Simon S, Dindorf C, Dully J, Bartaguiz E, Schmitz L, et al. Fatigue as a key factor for testing knee stability with single leg drop landing for injury prevention and return to play tests. Frontiers in sports and active living. 2023;5:1243732.

https://doi.org/10.3389/fspor.2023.1243732

  1. Mejane J, Faubert J, Romeas T, Labbe DR. The combined impact of a perceptual–cognitive task and neuromuscular fatigue on knee biomechanics during landing. The Knee. 2019;26(1):52-60.

https://doi.org/10.1016/j.knee.2018.10.017

  1. Borotikar BS, Newcomer R, Koppes R, McLean SG. Combined effects of fatigue and decision making on female lower limb landing postures: central and peripheral contributions to ACL injury risk. Clinical biomechanics. 2008;23(1):81-92.

https://doi.org/10.1016/j.clinbiomech.2007.08.008

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History

  • Receive Date: 13 December 2023
  • Revise Date: 01 May 2025
  • Accept Date: 01 May 2025

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