Local and General Fatigue: Effects on Knee Proprioception in Soccer Players

Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 683 Carrasco, L.; Espinar, J.; Carbonell, F.J.; Martínez-Díaz, I.C. (2021) Local and General Fatigue: Effects on Knee Proprioception in Soccer Players. Revista Internacional de Medicina y Ciencias de la Actividad Física y el Deporte vol. 21 (84) pp. 683-698. Http://cdeporte.rediris.es/revista/revista84/artfatiga1280.htm DOI: https://doi.org/10.15366/rimcafd2021.84.004 ORIGINAL LOCAL AND GENERAL FATIGUE: EFFECTS ON KNEE PROPRIOCEPTION IN SOCCER PLAYERS FATIGA LOCAL Y GENERAL: EFECTOS SOBRE LA PROPIOCEPCIÓN DE RODILLA EN FUTBOLISTAS Carrasco, L.1; Espinar, J.2; Carbonell, F.J.3; Martínez-Díaz, I.C.4 1 Associate Professor at the Department of Physical Education and Sports, University of Seville (Spain) lcarra[email protected] 2 Bachelor’s degree in Sports Sciences. Sevilla Football Club, S.A.D.- Department of Fitness Performance (Spain) [email protected] 3 Bachelor’s degree in Sports Sciences. Department of Physical Education and Sports. University of Seville (Spain) [email protected] 4 Assistant Professor at the Department of Physical Education and Sports, University of Seville (Spain) [email protected] Spanish-English translator: Luis Carrasco, l[email protected] Código UNESCO / UNESCO code: 241118 Fisiología del Movimiento / Physiology of movement Clasificación Consejo de Europa / Council of Europe classification: 14: Fisioterapia y rehabilitación / Physiotherapy and rehabilitation. Recibido 29 de julio de 2019 Received July 29, 2019 Aceptado 1 de mayo de 2020 Accepted May 1, 2020 Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 684 ABSTRACT The aim of this study was to contrast the effects of two different types of fatigue, local and general, on knee proprioception. Twenty two male amateur soccer players were evaluated on isokinetic dynamometer before and after exerciseinduced both local and general fatigue. This evaluation consisted of an active knee repositioning test, in which mean absolute and relative deviations regarding target angle (30º knee flexion) were assessed. The proprioceptive capacity of the subjects was affected by induction of both types of fatigue only when mean abolute error was estimated; however, no statistical differences were found between them. In conclusion, and regardless of their type, fatigue induced to these players seems to influence the proprioception of the knees although this effect is dependent on the type of angular error that is considered. KEYWORDS: proprioception, joint repositioning test, fatigue, knee, soccer. Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 685 RESUMEN El objetivo del presente estudio fue contrastar los efectos de dos tipos de fatiga, local y general, sobre la propiocepción de la rodilla. 22 jugadores semiprofesionales de fútbol, fueron evaluados en un dinamómetro isocinético antes y después de realizar esfuerzos que indujeron fatiga muscular local así como fatiga general. Dicha evaluación se basó en la prueba de reposicionamiento angular activo de la rodilla, registrando las desviaciones absolutas y relativas respecto al ángulo diana (30º de flexión). La inducción de ambos tipos de fatiga consiguió alterar de forma significativa la capacidad propioceptiva de los sujetos tras valorar únicamente el error absoluto, si bien no se observaron diferencias significativas en su contraste. En conclusión, e independientemente de su tipología, la fatiga inducida a estos futbolistas parece influir sobre la propiocepción de sus rodillas, aunque este efecto está condicionado por el tipo de error angular que se considere. PALABRAS CLAVE: propiocepción, test de reposicionamiento, fatiga, rodilla, fútbol. Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 686 1 INTRODUCTION Soccer is characterized by being a contact sport that involves constant highintensity efforts, skilful actions with the ball, explosive movements and disputes with the opponent, among other actions. The combination of these and other external factors provokes that players are constantly and inevitably exposed to high injury risk (Adalid, 2014). The appearance of injuries is an aspect that increasingly worries both soccer players themselves and sports clubs due to many different factors; playing downtime (each player loses an average of 35 training sessions and 4-8 soccer matches a year due to injuries), loss of physical fitness due to inactivity, economic losses (reaching an average of 144,000 euros per player and 3,587,000 euros per team in one season) or possible fears when facing future situations similar to those that caused the injury (Ortega, Argemi, Batista, García, and Liota, 2006). For this reason, an increasing number of studies are focused on injury prevention and rehabilitation strategies to minimize the influence of all these factors that affect soccer performance. In any case, and considering the anatomical regions most frequently affected, the ankle joint shows the highest incidence of injury (20.4% of all seasonal injuries), followed by knee and thigh injuries (17.7% and 14.5%, respectively). Despite this, some authors insist that most of these injuries are located in the knee joint (Llana, Pérez, and Lledó, 2010) these being the most serious injuries, so the disabling period may be greater (Peterson, Junge, Chomiak, Graf- Baumann, and Dvorak, 2000). Regarding their etiology, knee injuries are associated with both intrinsic risk factors (previous injuries, inadequate rehabilitation, conditional and technical capacities, genetics, morphology, performance level and psychological factors) and extrinsic risk factors (weather, soccer field surface, sports equipment, etc.). In addition, alterations or deficits in the sensorimotor system, postural control, muscle activation, anticipation mechanisms and, in general, alterations in proprioceptive ability are other factors of consideration (Fort and Romero, 2013). Proprioception is the part of the somatosensory system responsible for obtaining sensitive information and sending it to the central nervous system (CNS) in order to control the state of different body segments concerning others (Biedert, 2000). Thus, it is not surprising that proprioceptive training is increasingly included in soccer injury prevention and rehabilitation programs. However, one of the factors that can directly affect the proprioceptive ability of soccer players and, therefore, to increase the risk of injury is fatigue. A number of joint and muscle injuries occur near the end of the match, especially in the lower limbs (Augustsson et al., 2006; Bazneshin, Amiri, Jamshidi, and Vasaghi- Gharamaleki, 2015). In this regard, previous studies have shown controversial results, since some of them have found an alteration of proprioception due to fatigue (Vuillerme and Boisgontier, 2008; Bayramoglu, Toprak, and Sozay, 2007), and others have not found this effect (Gurney, Milani and Pedersen, 2000; South and George, 2007; Miura et al., 2004). The study of different populations (with different training level), the analysis of different joints (mainly Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 687 knee and ankle), the induction of different forms of fatigue and the use of different evaluation tests of proprioceptive ability could explain the lack of concordance between studies (Bazneshin et al., 2015). In this case, the fatigue experienced by soccer players during training sessions and competition is both general, affecting different organ systems, and local, affecting mainly the muscles of lower limbs. On the other hand, different tests can be used in the proprioceptive evaluation, among which stanf out the passive movement detection threshold test, the sense of muscle tension test and the active joint position sense assessment (Torres, Vasques, Duarte and Cabri, 2010). These tests evaluate different areas of proprioception, since they are based on joint positioning or the sense of muscle contraction, and can also be performed passively or actively. Taking into account the above considerations, it seems logical that the results found in previous studies are certainly contradictory, not allowing valid conclusions to be drawn. This is the case for the study conducted by Bazneshin et al. (2015) who analyzed the effect of local muscle fatigue (quadriceps) on knee proprioception in healthy young people using the joint-repositioning test (targeted knee angle: 45º). These authors reported significant deviations from the targeted angle (increases in absolute and constant error) after administering the fatigue protocol. In this line, Torres et al. (2010) observed how the ability to reproduce two angular positions in the knee (30º and 70º) was diminished for 48 h after applying a local muscle fatigue protocol (multiple eccentric activations of quadriceps until exhaustion). In another study with similar design, Ribeiro, Mota and Oliveira (2007), reported an impairment of knee proprioception of older adults after an effort that induced local muscle fatigue, which resulted in a significant increase in absolute angular error in the joint repositioning test. More recently, Allison, Sell, Benjaminse and Lephart (2016), did not observe any significant effect of local muscular fatigue on the knee proprioceptive capacity of healthy subjects when the sense of muscle tension associated with this joint was evaluated. For their part, Miura et al. (2004) compared the effects of general and local muscle fatigue on knee proprioception in a group of healthy subjects. The induction of local fatigue, using successive knee flexion and extension movements under maximum isokinetic activation, did not produce significant alterations in joint repositioning capacity after measuring the absolute angular error; however, subjects showed an increase in such error after running for 5 minutes on a treadmill (general fatigue). Anyway, the investigations carried out with active populations or athletes are smaller in number. Thus, to our knowledge, there are only two studies focused on soccer or soccer players. Carrasco, Nadal and Rodríguez (2005), evaluated a group of semi-professional soccer players after submitting them to a local muscle fatigue protocol finding no effect on knee repositioning performance. Finally, Salgado, Ribeiro, and Oliveira (2015) studied the effects of general muscle fatigue (soccer match) on knee proprioception. After the effort, the semiprofessional soccer players evaluated showed a significant reduction in their knee repositioning accuracy. Considering, on the one hand, that the knee joint and the associted muscles are the most requested anatomical structures in soccer practice, being also those Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 688 that have the greatest injury incidence, and on the other hand, the controversy existing in the results that have been obtained in previous studies, the objective of the present study was to clarify whether fatigue, either general or local, alters the knee proprioceptive capacity of soccer players. 2 MATERIAL AND METHODS 2.1 PARTICIPANTS A total of 22 male semi-professional soccer players voluntarily participated in the study. The characteristics of these subjects are summarized in Table 1. They had no injuries at the time of being evaluated and did not show any illness or injury or surgical history that could compromise their participation in the study. Subjects with a history of lower limb injury in the past 6 months were excluded. Participants were informed of the need to avoid physical exercise 48 h before testing sessions. In any case, they signed the consent form after they were fully informed about the characteristics and the aims of the study, whose protocol, adjusted to the provisions of the Declaration of Helsinki of 1964 and later, was examined and approved by the Ethics Committee of the University of Seville. Table 1. General characteristics of the subjects mean (sd) Age (years) 24 (2,7) Height (cm) 179 (5,4) Body mass (kg) 77,1 (12,7) Body mass index (kg/m2) 23,8 (3,7) Experience (years) 15,8 (2,2) Volumen de entrenamiento al año (h) 261,9 (74,3) 2.2 PROCEDURES A randomized crossover study design was used. Participants underwent two different fatigue protocols (local and general), and the knee joint proprioceptive capacity was assessed both before and after the application of each protocol. Proprioception evaluation consisted of the active knee repositioning test using the Biodex System 4 Pro isokinetic dynamometer (Biodex Medical Systems, Shirley, NY, USA), which was calibrated before each session according to the manufacturer's instructions. Taking into account the most frequent injury mechanics, a knee extension movement throughout a joint range of 90º (beginning with the subject in sitting position with the knee flexed 90º and ending with the knee fully extended -0º-) was chosen, while the target angle was established at 30º of flexion. In order to adjust the segments of each subject with the dynamometer input shaft, the lateral femoral condyle of the evaluated leg was made to coincide in height with the rotation axis of the dynamometer, placing the knee attachment clamp 3 cm above the tibial malleolus of the evaluated leg. In addition, the visual information of the subjects was limited with a mask placed over the eyes and the intervention of other body segments or muscle groups was eliminated using the device's restraints and keeping the arms crossed on the chest (Figure 1). Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 689 Before fatigue protocols were performed, and with the subject sitting on the dynamometer, the examiner moved the subject's dominant leg until reaching the target angle (30º of flexion), at which time the device was locked to allow the subject maintain the position for 5 s. Once the initial position was recovered, the subject extended his knee again, stopping the movement in the position that, according to his estimation, coincided with the targeted angle. At this moment, the examiner blocked the device again recording the resulting deviation. This process was repeated as many times as necessary until the subject accumulated three consecutive repetitions in which the average of the absolute error was less than 1º. Based on the proposed research design, and for the purpose of avoiding any effect related to the order of participation and/or the application of fatigue protocol (local or general), the allocation of each tests to be performed by each subject was established using the Randomization program (www.randomization.com). In any case, and regardless of the fatigue protocol assigned to each subject, the first visit to the laboratory served to collect different personal data and other information related to their sports practice. In addition, the participants were subjected to an analysis of their body composition by means of bioelectrical impedance (TANITA BIOLÓGICA BC-418 MA; Easy Software 8.0.0.980). The assessment of proprioceptive capacity after fatigue induction was applied just after completing both protocols. With the subject seated on the dynamometer, in the same position as in the pre-fatigue situation, and according to the initial position described above (90º knee flexion), the subject was asked to extend his knee to the target angle. Once the subject considered that he had reached the position, he stopped the action and the dynamometer was blocked to record the angle positioned, repeating this process twice more. The difference between the target angle and the angle positioned by the fatigued subject was considered as the absolute error (without taking into account the direction of the error). On the other hand, relative error, another of the study outcomes, reported the direction of such error (positive if the target angle was exceeded and negative if it was not reached). Likewise, the variable error, defined as the standard deviation of the mean of the relative errors (intrasubject), was assessed. Since these variables were recorded in triplicate, the average value was used in each case. 2.2.1 LOCAL MUSCLE FATIGUE PROTOCOL The local fatigue protocol consisted of three phases. The first of them consisted of pedalling for 5 minutes on a cycle ergometer (Ergoselect 200) against a resistance of 70 W. Then, with the subject placed on the isokinetic dynamometer as indicated above, the peak torque of the quadriceps of the dominant leg under concentric activation at a speed of 240º / s (knee extension movement; second phase). For this, each subject was asked to perform five maximum repetitions, being the peak torque the maximum value reached in all of them (N / m). After 10 minutes of rest, and once the target knee angle was stabilized, local muscular fatigue (third phase) was induced in the subject's Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 690 dominant leg. To do this, and from the starting position on the isokinetic dynamometer, the subjects performed successive extension and flexion movements with their dominant leg (240º / s) until the value of the quadriceps torque was less than 50 percent peak value. 2.2.2 GENERAL FATIGUE PROTOCOL This protocol was performed on a motorized treadmill (H/P COSMOS, 170-190 / 65 / Pulsar). Once the angular repositioning of the knee was stabilized, the subjects performed a continuous running on the treadmill (10 minutes at 10 km / h, 5 minutes at 15 km / h, 5 minutes at 12 km / h, 5 minutes at 15 km / h, 5 minutes at 12 km / h, and so on until exhaustion the subject), constantly monitoring their heart rate with a Polar RCX5 heart rate monitor and recording their subjective perception of effort through the Borg scale (6-20). Figure 1. Frontal view of the starting position on the isokinetic dynamometer. A summary of the procedures is shown in Figure 2. Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 691 Figure 2. Summary of study procedures. 2.3 STATISTICAL ANALYSIS The SPSS V.24 (IBM ®) program was used for statistical analysis. All data are expressed as mean ± standard deviation. The Kolmogorov-Smirnov test was performed on all the variables, verifying that they fit a normal type distribution. Under this premise, one-sample T-test was conducted to check the global effect of both types of fatigue on the joint repositioning accuracy with respect to the target angle (absolute error). On the other hand, two independent samples T- test was carried out to compare the effects of the two types of fatigue (absolute, relative and variable errors); moreover, a repeated measures analysis was performed considering the types of fatigue (local and general) as the main factor and using the relative error obtained in the three post-fatigue evaluations as outcomes. In any case, a 95% confidence interval was established assuming significant differences with values of p ≤ 0.05. Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354 698 Llana, S., Pérez, P., Lledó, E. (2010). La epidemiología en el fútbol: una revisión sistemática. Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte, 10, 22-40. 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Effects of fatigue on indices of balance. Journal of Sport Rehabilitation, 13, 312–22. doi: 10.1123/jsr.13.4.312 Número de citas totales / Total references: 25 (100%) Número de citas propias de la revista / Journal's own references: 1 (4%) Rev.int.med.cienc.act.fís.deporte - vol. 21 - número 84 - ISSN: 1577-0354