Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Sports Medicine - Open
Published in: Sports Medicine - Open 1/2020

Open Access 01-12-2020 | Fatigue | Systematic Review

The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review

Authors: Jessica Heil, Florian Loffing, Dirk Büsch

Published in: Sports Medicine - Open | Issue 1/2020

Login to get access

Abstract

Background

Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries.

Objective

The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review.

Methods

A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol.

Results

Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters.

Conclusions

Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.
Literature
1.
Impellizzeri FM, Marcora SM, Coutts AJ. Internal and external training load: 15 years on. Int J Sports Physiol Perform. 2019;14(2):270–3.PubMed
2.
Viru A, Viru M. Nature of training effects. In: WEG J, Kirkendall DT, editors. Exercise and sport science. Philadelphia: Lippincott Williams & Wilkens; 2000. p. 67–95.
3.
Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011;45(7):553–8.PubMed
4.
King D. Incidence of injuries in the 2006 New Zealand national junior rugby league competition. New Zeal J Sports Med. 2006;34(1):21–7.
5.
Gabbett TJ. Influence of training and match intensity on injuries in rugby league. J Sports Sci. 2004;22(5):409–17.PubMed
6.
7.
Bell DR, Pennuto AP, Trigsted SM. The effect of exertion and sex on vertical ground reaction force variables and landing mechanics. Am J Sports Med. 2016;30(6):1661–9.
8.
Barber-Westin SD, Noyes FR. Effect of fatigue protocols on lower limb neuromuscular function and implications for anterior cruciate ligament injury prevention training: a systematic review. Am J Sports Med. 2017;45(14):3388–96.PubMed
9.
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.PubMed
10.
Boden BP, Sheehan FT, Torg JS, Hewett TE. Non-contact ACL injuries: mechanisms and risk factors. J Am Acad Orthop Surg. 2010;18(9):520.PubMedPubMedCentral
11.
12.
Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations-update 2010. N Am J Sports Phys Ther. 2010;5(4):234–51.PubMedPubMedCentral
13.
Maloney SJ. The relationship between asymmetry and athletic performance: a critical review. J Strength Cond Res. 2019;33(9):2579–93.PubMed
14.
Hart NH, Nimphius S, Weber J, Spiteri T, Rantalainen T, Dobbin M, et al. Musculoskeletal asymmetry in football athletes: a product of limb function over time. Med Sci Sports Exerc. 2016;48(7):1379–87.PubMed
15.
Newton RU, Gerber A, Nimphius S, Shim JK, Doan BK, Robertson M, et al. Determination of functional strength imbalance of the lower extremities. J Strength Cond Res. 2006;20(4):971–7.PubMed
16.
17.
Parrington L, Ball K. Biomechanical considerations of laterality in sport. In: Loffing F, Hagemann N, Strauss B, MacMahon C, editors. Laterality in Sports: Theories and applications. San Diego: Academic Press; 2016. p. 279–308.
18.
Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38(10):1968–78.PubMedPubMedCentral
19.
Bishop C, Turner A, Read P. Effects of inter-limb asymmetries on physical and sports performance: a systematic review. J Sports Sci. 2018;36(10):1135–44.PubMed
20.
Girard O, Brocherie F, Morin J-B, Millet GP. Lower limb mechanical asymmetry during repeated treadmill sprints. Hum Mov Sci. 2017;52:203–14.PubMed
21.
Jordan MJ, Aagaard P, Herzog W. Asymmetry and thigh muscle coactivity in fatigued anterior cruciate ligament-reconstructed elite skiers. Med Sci Sports Exerc. 2017;49(1):11–20.PubMed
22.
23.
Smeets SA, Vanrenterghem J, Staes F, Verschueren S. Match play-induced changes in landing biomechanics with special focus on fatigability. Med Sci Sports Exerc. 2019;51:1884–94.PubMed
24.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010:336–41.
25.
Bishop C, Read P, Lake J, Chavda S, Turner A. Interlimb asymmetries: understanding how to calculate differences from bilateral and unilateral tests. Strength Cond J. 2018;40(4):1–6.
26.
Cohen J. Statistical power analysis for the behavioral sciences. New York: Routledge Academic; 1988.
27.
Cumming G. Cohen’s d needs to be readily interpretable: Comment on Shieh (2013). Behav Res Ther. 2013;45(4):968–71.
28.
Black GM, Gabbett TJ, Cole MH, Naughton G. Monitoring workload in throwing-dominant sports: a systematic review. Sports Med. 2016;46(10):1503–16.PubMed
29.
Brughelli M, Cronin J, Levin G, Chaouachi A. Understanding change of direction ability in sport. Sports Med. 2008;38(12):1045–63.PubMed
30.
31.
Hanley B, Tucker CB. Gait variability and symmetry remain consistent during high-intensity 10,000 m treadmill running. J Biomech. 2018;79:129–34.PubMed
32.
Hodges SJ, Patrick RJ, Reiser RF. Effects of fatigue on bilateral ground reaction force asymmetries during the squat exercise. J Strength Cond Res. 2011;25(11):3107–17.PubMed
33.
Mattes K, Wolff S. Asymmetry of the leg stretcher force high-performance female and male juniors in sweep rowing. Int J Perform Anal Sport. 2019;19(5):737–48.
34.
Tucker CB, Hanley B. Gait variability and symmetry in world-class senior and junior race walkers. J Sports Sci. 2017;35(17):1739–44.PubMed
35.
Radzak KN, Putnam AM, Tamura K, Hetzler RK, Stickley CD. Asymmetry between lower limbs during rested and fatigued state running gait in healthy individuals. Gait Posture. 2017;51:268–74.PubMed
36.
Webster KE, Austin DC, Feller JA, Clark RA, McClelland JA. Symmetry of squatting and the effect of fatigue following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3208–13.PubMed
37.
Delextrat A, Baker J, Cohen DD, Clarke ND. Effect of a simulated soccer match on the functional hamstrings-to-quadriceps ratio in amateur female players. Scand J Med Sci Sports. 2013;23(4):478–86.PubMed
38.
39.
Borg G. Borg’s perceived exertion and pain scales. Human kinetics; 1998.
40.
Zifchock RA, Davis I, Higginson J, Royer T. The symmetry angle: a novel, robust method of quantifying asymmetry. Gait Posture. 2008;27(4):622–7.PubMed
41.
Bourne MN, Webster KE, Hewett TE. Is fatigue a risk factor for anterior cruciate ligament rupture? Sports Med. 2019;49(11):1629–35.PubMed
42.
43.
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(4):565–86.PubMedPubMedCentral
44.
King E, Richter C, Franklyn-Miller A, Daniels K, Wadey R, Moran R, et al. Whole-body biomechanical differences between limbs exist 9 months after ACL reconstruction across jump/landing tasks. Scand J Med Sci Sports. 2018;28(12):2567–78.PubMed
45.
Dick R, Putukian M, Agel J, Evans TA, Marshall SW. Descriptive epidemiology of collegiate women's soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2002–2003. J Athl Train. 2007;42(2):278–85.PubMedPubMedCentral
46.
Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13-year review. Am J Sports Med. 2005;33(4):524–31.PubMed
47.
Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.PubMed
48.
Loffing F, Sölter F, Hagemann N. Left preference for sport tasks does not necessarily indicate left-handedness: sport-specific lateral preferences, relationship with handedness and implications for laterality research in behavioural sciences. PLoS One. 2014;9(8). https://​doi.​org/​10.​1371/​journal.​pone.​0105800.
49.
Brown N, Donelon T, Smith LC, Jones PA. An investigation into the effect of limb preference on knee mechanics and braking strategy during a 180° change of direction task: An exploratory study. J Sports Sci. 2016;34:s57.
50.
Greska E, Cortes N, Ringleb S, Onate J, Van Lunen B. Biomechanical differences related to leg dominance were not found during a cutting task. Scand J Med Sci Sports. 2017;27(11):1328–36.PubMed
51.
Thomas C, Dos’Santos T, Kyriakidou I, Cuthbert M, Fields C, Jones PA. An investigation into the effect of limb preference on knee mechanics and braking strategy during pivoting in female soccer players: An exploratory study. The 8th Annual Strength and Conditioning Student Conference. London: Middlesex University; 2017.
52.
Dos’Santos T, Bishop C, Thomas C, Comfort P, Jones PA. The effect of limb dominance on change of direction biomechanics: a systematic review of its importance for injury risk. Phys Ther Sport. 2019;37:179–89.PubMed
53.
Sadeghi H, Allard P, Prince F, Labelle H. Symmetry and limb dominance in able-bodied gait: a review. Gait Posture. 2000;12(1):34–45.PubMed
54.
Brown AM, Zifchock RA, Hillstrom HJ. The effects of limb dominance and fatigue on running biomechanics. Gait Posture. 2014;39(3):915–9.PubMed
55.
Sanchez-Sanchez J, Bishop D, Garcia-Unanue J, Ubago-Guisado E, Hernando E, Lopez-Fernandez J, et al. Effect of a Repeated Sprint Ability test on the muscle contractile properties in elite futsal players. Sci Rep. 2018;8(17284):1–8.
56.
Corben JS, Cerrone SA, Soviero JE, Kwiecien SY, Nicholas SJ, McHugh MP. Performance Demands in Softball Pitching: A Comprehensive Muscle Fatigue Study. Am J Sports Med. 2015;43(8):2035–41.PubMed
57.
58.
Morouço PG, Marinho DA, Fernandes RJ, Marques MC. Quantification of upper limb kinetic asymmetries in front crawl swimming. Hum Mov Sci. 2015;40:185–92.PubMed
59.
60.
Simon AM, Ferris DP. Lower limb force production and bilateral force asymmetries are based on sense of effort. Exp Brain Res. 2008;187(1):129–38.PubMed
61.
Dai B, Mao D, Garrett WE, Yu B. Anterior cruciate ligament injuries in soccer: Loading mechanisms, risk factors, and prevention programs. J Sport Health Sci. 2014;3(4):299–306.
62.
Gardiner JC, Weiss JA, Rosenberg TD. Strain in the human medial collateral ligament during valgus loading of the knee. Clin Orthop Relat Res. 2001;391:266–74.
63.
Hewett TE, Myer GD, Ford KR. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg. 2004;86(8):1601–8.PubMed
64.
Bini R, Hume P. Relationship between pedal force asymmetry and performance in cycling. J Sport Med Phys Fit. 2015;55:892–8.
65.
Bishop C, Read P, Chavda S, Turner A. Asymmetries of the lower limb: The calculation conundrum in strength training and conditioning. Strength Cond J. 2016;38(6):27–32.
66.
Kobayashi Y, Kubo J, Matsubayashi T, Matsuo A, Kobayashi K, Ishii N. Relationship between bilateral differences in single-leg jumps and asymmetry in isokinetic knee strength. J Appl Biomech. 2013;29(1):61–7.PubMed
67.
68.
Exell TA, Irwin G, Gittoes MJR, Kerwin DG. Implications of intra-limb variability on asymmetry analyses. J Sports Sci. 2012;30(4):403–9.PubMed
Metadata
Title
The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review
Authors
Jessica Heil
Florian Loffing
Dirk Büsch
Publication date
01-12-2020
Publisher
Springer International Publishing
Keyword
Fatigue
Published in
Sports Medicine - Open / Issue 1/2020
Print ISSN: 2199-1170
Electronic ISSN: 2198-9761
DOI
https://doi.org/10.1186/s40798-020-00270-x

Other articles of this Issue 1/2020

Sports Medicine - Open 1/2020 Go to the issue

Original Research Article

Nordic walking training in elderly, a randomized clinical trial. Part II: Biomechanical and metabolic adaptations

Correction

Correction to: Biological determinants of physical activity across the life course: a “Determinants of Diet and Physical Activity” (DEDIPAC) umbrella systematic literature review

Systematic Review

Physical Activity Behavior from a Transdisciplinary Biopsychosocial Perspective: a Scoping Review

Systematic Review

The Influence, Barriers to and Facilitators of Anterior Cruciate Ligament Rehabilitation Adherence and Participation: a Scoping Review

Systematic Review

Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review

Systematic Review

Effect of Non-Steroidal Anti-Inflammatory Drugs on Sport Performance Indices in Healthy People: a Meta-Analysis of Randomized Controlled Trials