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BMC Sports Science, Medicine and Rehabilitation
Published in: BMC Sports Science, Medicine and Rehabilitation 1/2024

Open Access 01-12-2024 | Fatigue | Research

The effectiveness of fatigue on repositioning sense of lower extremities: systematic review and meta-analysis

Authors: Parisa Sayyadi, Hooman Minoonejad, Foad Seidi, Rahman Shikhhoseini, Ramin Arghadeh

Published in: BMC Sports Science, Medicine and Rehabilitation | Issue 1/2024

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Abstract

Introduction

An injury can significantly harm both individual and team performance. One of the most important risk factors for sports-related injuries, especially non-collision injuries, is fatigue. It seems that poor proprioception may play an essential role to impose athletes to further injuries. This systematic review and meta-analysis aimed to examine the effectiveness of fatigue on the repositioning sense of the lower extremity joints.

Method

The electronic databases, including PubMed, Web of Science, Scopus, and Google Scholar were systematically searched from inception to 11January 2024. The obtained records were exported to the EndNote Software version 8. Then, two investigators examined the records independently to find eligible studies based on the inclusion/exclusion criteria. In the case of disagreements, a consequence method was utilized. The quality of the eligible studies was evaluated using the Downs and Black checklist. Comprehensive Meta-Analysis (CMA) software ver. 3 software was used for statistical analysis. Q-test and I2 were employed to examine the data homogeneity. In addition, considering the risk of bias, the Funnel Plot and trim-and-fill method were used.

Results

After reviewing the titles and abstracts of 3883 studies found in the selected databases, 43 articles were found to be eligible to include in meta-analyses. The results showed that fatigue led to a significant increase in the active absolute error of the knee (SDM = 0.524, 95% CI = 0.406–0.841), ankle in the horizontal plane (SDM = 0.541, 95% CI = 0.367–0.715), ankle in the sagittal plane (SDM = 0.443, 95% CI = 0.088–0.798), and hip (SDM = 0.988, 95% CI = 0.135–1.841). However, fatigue had no significant effects on the passive absolute error of the knee and ankle in horizontal plane and relative angular error of the knee.

Conclusion

Fatigue can diminish the active joint position sense of the lower extremities and thus may increase the risk of injury by reducing proprioception. Therefore, future research could be conducted to investigate the potential impact of integrated fatigue-mitigating exercises into athletes’ training programs, with the aim of reducing the incidence of sports-related injuries.
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Literature
1.
2.
Ribeiro F, Mota J, Oliveira J. Effect of exercise-induced fatigue on position sense of the knee in the elderly. Eur J Appl Physiol. 2007;99(4):379–85.PubMedCrossRef
3.
Ribeiro F, Santos F, Gonçalves P, Oliveira J. Effects of volleyball match-induced fatigue on knee joint position sense. Eur J Sport Sci. 2008;8(6):397–402.CrossRef
4.
Madhavan S, Shields RK. Influence of age on dynamic position sense: evidence using a sequential movement task. Exp Brain Res. 2005;164(1):18–28.PubMedCrossRef
5.
Han J, Anson J, Waddington G, Adams R, Liu Y. The role of ankle proprioception for balance control in relation to sports performance and injury. Biomed Res Int. 2015;
6.
Parkkari J, Kujala UM, Kannus P. Is it possible to prevent sports injuries? Sports Med. 2001;31(14):985–95.PubMedCrossRef
7.
Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev. 2012;4(1)
8.
Altomare D, Fusco G, Bertolino E, Ranieri R, Sconza C, Lipina M, et al. Evidence-based treatment choices for acute lateral ankle sprain: a comprehensive systematic review. Eur Rev Med Pharmacol Sci. 2022;26(6):1876–84.PubMed
9.
McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103–11.PubMedCrossRef
10.
Garrick JG. The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med. 1977;5(6):241–2.PubMedCrossRef
11.
Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot ank int. 1998;19(10):653–60.CrossRef
12.
McHugh MP, Tyler TF, Mirabella MR, Mullaney MJ, Nicholas SJ. The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. Am J Sports Med. 2007;35(8):1289–94.PubMedCrossRef
13.
Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: part 1, mechanisms and risk factors. Am J Sports Med. 2006;34(2):299–311.PubMedCrossRef
14.
Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. 1999;34(2):86.PubMedPubMedCentral
15.
Mir SM, Talebian S, Naseri N, Hadian M-R. Assessment of knee proprioception in the anterior cruciate ligament injury risk position in healthy subjects: a cross-sectional study. J Phys Ther Sci. 2014;26(10):1515–8.PubMedPubMedCentralCrossRef
16.
Barrack RL, Skinner HB, Buckley SL. Proprioception in the anterior cruciate deficient knee. Am J Sports Med. 1989;17(1):1–6.PubMedCrossRef
17.
Karagiannopoulos C, Watson J, Kahan S, Lawler D. The effect of muscle fatigue on wrist joint position sense in healthy adults. J Hand Ther. 2020;33(3):329–38.PubMedCrossRef
18.
Hunter SK, Duchateau J, Enoka RM. Muscle fatigue and the mechanisms of task failure. Exerc Sport Sci Rev. 2004;32(2):44–9.PubMedCrossRef
19.
Jones CM, Griffiths PC, Mellalieu SD. Training load and fatigue marker associations with injury and illness: a systematic review of longitudinal studies. Sports Med. 2017;47:943–74.PubMedCrossRef
20.
Hiemstra LA, Lo IK, Fowler PJ. Effect of fatigue on knee proprioception: implications for dynamic stabilization. J Orthop Sports Phys Ther. 2001;31(10):598–605.PubMedCrossRef
21.
Aune TK, Ingvaldsen R, Ettema G. Effect of physical fatigue on motor control at different skill levels. Percept Mot Skills. 2008;106(2):371–86.PubMedCrossRef
22.
Bayramoglu M, Toprak R, Sozay S. Effects of osteoarthritis and fatigue on proprioception of the knee joint. Arch Phys Med Rehab. 2007;88(3):346–50.CrossRef
23.
Barbieri FA, Beretta SS, Pereira VA, Simieli L, Orcioli-Silva D, dos Santos PCR, et al. Recovery of gait after quadriceps muscle fatigue. Gait post. 2016;43:270–4.CrossRef
24.
Gutierrez GM, Jackson ND, Dorr KA, Margiotta SE, Kaminski TW. Effect of fatigue on neuromuscular function at the ankle. J Sport Rehab. 2007;16(4):295–306.
25.
Wilson EL, Madigan ML. Effects of fatigue and gender on peroneal reflexes elicited by sudden ankle inversion. J Electromyogr Kinesiol. 2007;17(2):160–6.PubMedCrossRef
26.
Hoch MC, McKeon PO. Peroneal reaction time after ankle sprain: a systematic review and meta-analysis. Med Sci Sports Exerc. 2014;46(3)
27.
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 Surg Sports Traumatol Arthrosc. 2009;17(7):705–29.PubMedCrossRef
28.
Howatson G. The impact of damaging exercise on electromechanical delay in biceps brachii. J Electromyogr Kinesiol. 2010;20(3):477–81.PubMedCrossRef
29.
Jahjah A, Seidenspinner D, Schüttler K, Klasan A, Heyse TJ, Malcherczyk D, et al. The effect of ankle tape on joint position sense after local muscle fatigue: a randomized controlled trial. BMC Musculosk Disord. 2018;19(1):1–8.CrossRef
30.
McLean SG, Borotikar B, Lucey SM. Lower limb muscle pre-motor time measures during a choice reaction task associate with knee abduction loads during dynamic single leg landings. Clin Biomech. 2010;25(6):563–9.CrossRef
31.
Ju Y-Y, Wang C-W, Cheng H-YK. Effects of active fatiguing movement versus passive repetitive movement on knee proprioception. Clin Biomech. 2010;25(7):708–12.CrossRef
32.
33.
HISHAM M, ALAA S. Effect of peroneal muscles fatigue on repositioning error in athletic females. Med J Cairo Univer. 2019;87(June):2165–2168.
34.
Dieling S, van der Esch M, Janssen TW. Knee joint proprioception in ballet dancers and non-dancers. J Dance Med Sci. 2014;18(4):143–8.PubMedCrossRef
35.
Miura K, Ishibashi Y, Tsuda E, Okamura Y, Otsuka H, Toh S. The effect of local and general fatigue on knee proprioception. Arthrosc J Arthrosc Relat Surg. 2004;20(4):414–8.CrossRef
36.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health. 1998;52(6):377–84.CrossRef
37.
Takasaki H, Lim ECW, Soon B. The effect of shoulder muscle fatigue on active repositioning acuity and scapulothoracic resting alignment: a systematic review with meta-analysis. Phys Ther Sport. 2016;20:61–78.PubMedCrossRef
38.
Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):207–14.PubMedCrossRef
39.
Fyhr C, Gustavsson L, Wassinger C, Sole G. The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Man Ther. 2015;20(1):28–37.PubMedCrossRef
40.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
41.
42.
Ribeiro F, Venâncio J, Quintas P, Oliveira J. The effect of fatigue on knee position sense is not dependent upon the muscle group fatigued. Muscle Nerve. 2011;44(2):217–20.PubMedCrossRef
43.
Ghanbari A, Ghaffarinejad F, Mohammadi F. Effects of acute fatigue of the tibialis anterior due to a weight-bearing muscle activity on the ankle joint position sense in healthy subjects. J Rehab Sci Res. 2014;1(3):67–71.
44.
Choi J-D, Yi C-H. Effects of graded exercise-induced fatigue on the knee joint position perception. Phys Therapy Korea. 2003;10(4):61–8.
45.
Gear WS. Effect of different levels of localized muscle fatigue on knee position sense. J sports sci med. 2011;10(4):725.PubMedPubMedCentral
46.
Négyesi J, Zhang LY, Jin RN, Hortobágyi T, Nagatomi R. A below-knee compression garment reduces fatigue-induced strength loss but not knee joint position sense errors. Eur J Appl Physiol. 2021;121(1):219–29.PubMedCrossRef
47.
Steib S, Hentschke C, Welsch G, Pfeifer K, Zech A. Effects of fatiguing treadmill running on sensorimotor control in athletes with and without functional ankle instability. Clin Biomech. 2013;28(7):790–5.CrossRef
48.
Freshteh E, Torkan A. Effect of knee cooling after local fatigue on proprioception in trained women. J Rehabil Med. 2018;7(2):114–22.
49.
Fatemeh N, Reza M, Vahid Z. Effect of functional fatigue on position sense of ankle joint in female futsal players. J Res Sport Rehab. 2018;6(11):33–42.
50.
Marks R. Effect of exercise-induced fatigue on position sense of the knee. Austral J Physiother. 1994;40(3):175–81.CrossRef
51.
Marks R, Quinney HA. Effect of fatiguing maximal isokinetic quadriceps contractions on ability to estimate knee-position. Percept Mot Skills. 1993;77(3_suppl):1195–202.PubMedCrossRef
52.
Draz AH, Atya AM, Aboeleneen AM, Elgendy MH. Influence of Acute Back Muscle Fatigue on Repositioning Accuracy of the Knee Joint In healthy subjects.
53.
Mohammadi F, Roozdar A. Effects of fatigue due to contraction of evertor muscles on the ankle joint position sense in male soccer players. Am J Sports Med. 2010;38(4):824–8.PubMedCrossRef
54.
Lin YH, Li CW, Tsai LY, Liing R-J. The effects of muscle fatigue and proprioceptive deficits on the passive joint senses of ankle inversion and eversion. Isokinet Exerc Sci. 2008;16(2):101–5.CrossRef
55.
Bersotti FM, Tb DM, Rafael Skau J, Mochizuki L, Uf E. Fatigue of knee extensor muscles does not alter knee joint position sense. J Mechan Med Biol. 2022;22(02):2250012.CrossRef
56.
Romero-Franco N, Jiménez-Reyes P. Effects of warm-up and fatigue on knee joint position sense and jump performance. J Mot Behav. 2017;49(2):117–22.PubMedCrossRef
57.
Salgado E, Ribeiro F, Oliveira J. Joint-position sense is altered by football pre-participation warm-up exercise and match induced fatigue. Knee. 2015;22(3):243–8.PubMedCrossRef
58.
Ghahremani S, Ghahremani N, Abbasi A. The effect of erector spinae muscle fatigue on the sensation of trunk, hip, and knee position among the male karate athletes. J Res Rehab Sci. 2017;13(5):239–46.
59.
Changela PK, Selvamani K. A study to evaluate the effect of fatigue on knee joint proprioception and balance in healthy individuals. Sports Med J/Med Sport. 2012;8(2)
60.
Tomar A, Jagga V. Effect of fatigue on kinesthetic acuity of healthy ankle. J Exerc Sci Physiother. 2014;10(2):82–6.CrossRef
61.
62.
63.
Forestier N, Bonnetblanc F. Compensation of lateralized fatigue due to referent static positional signals in an ankle-matching task: a feedforward mechanism. Neurosci Lett. 2006;397(1–2):115–9.PubMedCrossRef
64.
Seo B-D, Kim H-J, Ju J-Y. Effect of muscle fatigue on the proprioception by the taekwondo training type. J Korean Soc Phys Med. 2020;15(3):1–9.CrossRef
65.
Hong W-H, Lo S-F, Wu H-C, Chiu M-C. Effects of compression garment on muscular efficacy, proprioception, and recovery after exercise-induced muscle fatigue onset for people who exercise regularly. PLoS One. 2022;17(2):e0264569.PubMedPubMedCentralCrossRef
66.
Sharma P, Rizvi MR, Ahmad I. Effect of central fatigue on dynamic balance and knee joint proprioception in recreational athletes: an experimental study. J Clin Diagn Res. 2023;17(2):YC14–YC7.
67.
Huston JL, Sandrey MA, Lively MW, Kotsko K. The effects of calf-muscle fatigue on sagittal-plane joint-position sense in the ankle. J Sport Rehabil. 2005;14(2):168–84.CrossRef
68.
Sandrey MA, Kent TE. The effects of eversion fatigue on frontal plane joint position sense in the ankle. J Sport Rehabil. 2008;17(3):257–68.PubMedCrossRef
69.
Ju Y-Y, Liu Y-C, Cheng H-YK, Chang Y-J. Rapid repetitive passive movement improves knee proprioception. Clin Biomech. 2011;26(2):188–93.CrossRef
70.
Niederseer D, Mörtl H, Liebensteiner M, Egger A, Thaler C, Plöderl M, et al. General fatigue and joint position sense in male elite handball players. Deutsche Zeitschrift fur Sportmedizin. 2014;65(6):149–53.
71.
Mohammadi Bazneshin M, Amiri A, Jamshidi AA, Vasaghi-Gharamaleki B. Quadriceps muscle fatigue and knee joint position sense in healthy men. Phys Treat Spec Phys Ther J. 2015;5(2):109–14.
72.
Ahn IK, Kim YL, Bae Y-H, Lee SM. Immediate effects of kinesiology taping of quadriceps on motor performance after muscle fatigued induction. Evid Based Complement Alternat Med. 2015;2015
73.
Skinner H, Wyatt M, Hodgdon J, Conard D, Barrack R. Effect of fatigue on joint position sense of the knee. J Orthop Res. 1986;4(1):112–8.PubMedCrossRef
74.
Arvin M, Hoozemans MJ, Burger BJ, Rispens SM, Verschueren SM, van Dieen JH, et al. Effects of hip abductor muscle fatigue on gait control and hip position sense in healthy older adults. Gait post. 2015;42(4):545–9.CrossRef
75.
Hussien H, Mohamed A, Yamany A. Evertor muscle fatigue decreases the passive inversion joint position sense in female volleyball players. Physiother Quart. 2021;29(1):28–32.CrossRef
76.
South M, George KP. The effect of peroneal muscle fatigue on ankle joint position sense. Phys Ther sport. 2007;8(2):82–7.CrossRef
77.
Gandevia S. Neural control in human muscle fatigue: changes in muscle afferents, moto neurones and moto cortical drive. Acta Physiol Scand. 1998;162(3):275–83.PubMedCrossRef
78.
Swinkels A, Dolan P. Regional assessment of joint position sense in the spine. Spine. 1998;23(5):590–7.PubMedCrossRef
79.
80.
Ribeiro F, Oliveira J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. Eur Rev Aging Phys Act. 2007;4(2):71–6.MathSciNetCrossRef
81.
Theofilidis G, Bogdanis GC, Koutedakis Y, Karatzaferi C. Monitoring exercise-induced muscle fatigue and adaptations: making sense of popular or emerging indices and biomarkers. Sports. 2018;6(4):153.PubMedPubMedCentralCrossRef
82.
Bourne MN, Webster KE, Hewett TE. Is fatigue a risk factor for anterior cruciate ligament rupture? Sports Med. 2019;49(11):1629–35.PubMedCrossRef
83.
Gandevia S, Enoka R, McComas A, Stuart D, Thomas C. Neurobiology of muscle fatigue: advances and issues. Fatigue: Neural and muscular mechanisms; 1995. p. 515–25.
84.
Taylor JL, Amann M, Duchateau J, Meeusen R, Rice CL. Neural contributions to muscle fatigue: from the brain to the muscle and back again. Med Sci Sports Exerc. 2016;48(11):2294.PubMedPubMedCentralCrossRef
85.
Hagbarth K, Nordin M, Bongiovanni L. After-effects on stiffness and stretch reflexes of human finger flexor muscles attributed to muscle thixotropy. J Physiol. 1995;482(1):215–23.PubMedPubMedCentralCrossRef
86.
Ribot-Ciscar E, Tardy-Gervet M, Vedel J, Roll J. Post-contraction changes in human muscle spindle resting discharge and stretch sensitivity. Exp Brain Res. 1991;86(3):673–8.PubMedCrossRef
87.
Proske U, Morgan DL, Gregory JE. Thixotropy in skeletal muscle and in muscle spindles: a review. Prog Neurobiol. 1993;41(6):705–21.PubMedCrossRef
88.
Foley TE, Fleshner M. Neuroplasticity of dopamine circuits after exercise: implications for central fatigue. Neuro Molecular Med. 2008;10:67–80.CrossRef
89.
Hill D. Tension due to interaction between the sliding filaments in resting striated muscle. The effect of stimulation. J Physiol. 1968;199(3):637–84.PubMedPubMedCentralCrossRef
90.
91.
Hodges PW, Cholewicki J, Van Dieën JH. Spinal control: the rehabilitation of back pain: state of the art and science 2013:163.
92.
Stillman BC, McMeeken JM. The role of weightbearing in the clinical assessment of knee joint position sense. Austral J Physiother. 2001;47(4):247–53.CrossRef
93.
Smith TO, Davies L, Hing CB. A systematic review to determine the reliability of knee joint position sense assessment measures. Knee. 2013;20(3):162–9.PubMedCrossRef
94.
Emery CA, Pasanen K. Current trends in sport injury prevention. Best Pract Res Clin Rheumatol. 2019;33(1):3–15.PubMedCrossRef
95.
Fort-Vanmeerhaeghe A, Romero-Rodriguez D, Lloyd RS, Kushner A, Myer GD. Integrative neuromuscular training in youth athletes. Part II: Strategies to prevent injuries and improve performance. Strength Condition J. 2016;38(4):9–27.CrossRef
96.
Elliot DL, Goldberg L, Kuehl KS. Young women’s anterior cruciate ligament injuries. Sports Med. 2010;40(5):367–76.PubMedCrossRef
97.
Mclean S, Samorezov J. Fatigue-induced ACL injury risk stems from a degradation in central control. Med Sci Sports Exerc. 2009;41(8):1662.CrossRef
98.
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. Clin Biomech. 2008;23(1):81–92.CrossRef
99.
Papadelis C, Kourtidou-Papadeli C, Bamidis P, Albani M. Effects of imagery training on cognitive performance and use of physiological measures as an assessment tool of mental effort. Brain Cogn. 2007;64(1):74–85.PubMedCrossRef
Metadata
Title
The effectiveness of fatigue on repositioning sense of lower extremities: systematic review and meta-analysis
Authors
Parisa Sayyadi
Hooman Minoonejad
Foad Seidi
Rahman Shikhhoseini
Ramin Arghadeh
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Fatigue
Published in
BMC Sports Science, Medicine and Rehabilitation / Issue 1/2024
Electronic ISSN: 2052-1847
DOI
https://doi.org/10.1186/s13102-024-00820-w

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