Skip to main content
PMC home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2005 Jun;39(6):347–350. doi: 10.1136/bjsm.2005.018572

A review of electromyographic activation levels, timing differences, and increased anterior cruciate ligament injury incidence in female athletes

T Hewett 1, B Zazulak 1, G Myer 1, K Ford 1
PMCID: PMC1725222  PMID: 15911605

Full Text

The Full Text of this article is available as a PDF (87.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beard D. J., Kyberd P. J., Fergusson C. M., Dodd C. A. Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery? J Bone Joint Surg Br. 1993 Mar;75(2):311–315. doi: 10.1302/0301-620X.75B2.8444956. [DOI] [PubMed] [Google Scholar]
  2. Besier T. F., Lloyd D. G., Ackland T. R., Cochrane J. L. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc. 2001 Jul;33(7):1176–1181. doi: 10.1097/00005768-200107000-00015. [DOI] [PubMed] [Google Scholar]
  3. Besier T. F., Lloyd D. G., Cochrane J. L., Ackland T. R. External loading of the knee joint during running and cutting maneuvers. Med Sci Sports Exerc. 2001 Jul;33(7):1168–1175. doi: 10.1097/00005768-200107000-00014. [DOI] [PubMed] [Google Scholar]
  4. Besier Thor F., Lloyd David G., Ackland Timothy R. Muscle activation strategies at the knee during running and cutting maneuvers. Med Sci Sports Exerc. 2003 Jan;35(1):119–127. doi: 10.1097/00005768-200301000-00019. [DOI] [PubMed] [Google Scholar]
  5. Beynnon B. D., Fleming B. C. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech. 1998 Jun;31(6):519–525. doi: 10.1016/s0021-9290(98)00044-x. [DOI] [PubMed] [Google Scholar]
  6. Chappell Jonathan D., Yu Bing, Kirkendall Donald T., Garrett William E. A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. Am J Sports Med. 2002 Mar-Apr;30(2):261–267. doi: 10.1177/03635465020300021901. [DOI] [PubMed] [Google Scholar]
  7. Chimera Nicole J., Swanik Kathleen A., Swanik C. Buz, Straub Stephen J. Effects of Plyometric Training on Muscle-Activation Strategies and Performance in Female Athletes. J Athl Train. 2004 Mar;39(1):24–31. [PMC free article] [PubMed] [Google Scholar]
  8. Cowling E. J., Steele J. R. Is lower limb muscle synchrony during landing affected by gender? Implications for variations in ACL injury rates. J Electromyogr Kinesiol. 2001 Aug;11(4):263–268. doi: 10.1016/s1050-6411(00)00056-0. [DOI] [PubMed] [Google Scholar]
  9. Delp S. L., Hess W. E., Hungerford D. S., Jones L. C. Variation of rotation moment arms with hip flexion. J Biomech. 1999 May;32(5):493–501. doi: 10.1016/s0021-9290(99)00032-9. [DOI] [PubMed] [Google Scholar]
  10. Demont R. G., Lephart S. M., Giraldo J. L., Swanik C. B., Fu F. H. Muscle preactivity of anterior cruciate ligament-deficient and -reconstructed females during functional activities. J Athl Train. 1999 Apr;34(2):115–120. [PMC free article] [PubMed] [Google Scholar]
  11. Dietz V., Noth J., Schmidtbleicher D. Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls. J Physiol. 1981 Feb;311:113–125. doi: 10.1113/jphysiol.1981.sp013576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dunn T. G., Gillig S. E., Ponsor S. E., Weil N., Utz S. W. The learning process in biofeedback: is it feed-forward or feedback? Biofeedback Self Regul. 1986 Jun;11(2):143–156. doi: 10.1007/BF00999982. [DOI] [PubMed] [Google Scholar]
  13. Dyhre-Poulsen P., Simonsen E. B., Voigt M. Dynamic control of muscle stiffness and H reflex modulation during hopping and jumping in man. J Physiol. 1991 Jun;437:287–304. doi: 10.1113/jphysiol.1991.sp018596. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ford Kevin R., Myer Gregory D., Hewett Timothy E. Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc. 2003 Oct;35(10):1745–1750. doi: 10.1249/01.MSS.0000089346.85744.D9. [DOI] [PubMed] [Google Scholar]
  15. Greenwood R., Hopkins A. Landing from an unexpected fall and a voluntary step. Brain. 1976 Jun;99(2):375–386. doi: 10.1093/brain/99.2.375. [DOI] [PubMed] [Google Scholar]
  16. Heidt R. S., Jr, Sweeterman L. M., Carlonas R. L., Traub J. A., Tekulve F. X. Avoidance of soccer injuries with preseason conditioning. Am J Sports Med. 2000 Sep-Oct;28(5):659–662. doi: 10.1177/03635465000280050601. [DOI] [PubMed] [Google Scholar]
  17. Hewett T. E., Lindenfeld T. N., Riccobene J. V., Noyes F. R. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. 1999 Nov-Dec;27(6):699–706. doi: 10.1177/03635465990270060301. [DOI] [PubMed] [Google Scholar]
  18. Hewett T. E., Stroupe A. L., Nance T. A., Noyes F. R. Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. Am J Sports Med. 1996 Nov-Dec;24(6):765–773. doi: 10.1177/036354659602400611. [DOI] [PubMed] [Google Scholar]
  19. Hewett Timothy E., Myer Gregory D., Ford Kevin R. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg Am. 2004 Aug;86-A(8):1601–1608. doi: 10.2106/00004623-200408000-00001. [DOI] [PubMed] [Google Scholar]
  20. Imran A., O'Connor J. J. Theoretical estimates of cruciate ligament forces: effects of tibial surface geometry and ligament orientations. Proc Inst Mech Eng H. 1997;211(6):425–439. doi: 10.1243/0954411981534556. [DOI] [PubMed] [Google Scholar]
  21. Kim A. W., Rosen A. M., Brander V. A., Buchanan T. S. Selective muscle activation following electrical stimulation of the collateral ligaments of the human knee joint. Arch Phys Med Rehabil. 1995 Aug;76(8):750–757. doi: 10.1016/s0003-9993(95)80530-3. [DOI] [PubMed] [Google Scholar]
  22. Lephart Scott M., Ferris Cheryl M., Riemann Bryan L., Myers Joseph B., Fu Freddie H. Gender differences in strength and lower extremity kinematics during landing. Clin Orthop Relat Res. 2002 Aug;(401):162–169. doi: 10.1097/00003086-200208000-00019. [DOI] [PubMed] [Google Scholar]
  23. Li G., Rudy T. W., Sakane M., Kanamori A., Ma C. B., Woo S. L. The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL. J Biomech. 1999 Apr;32(4):395–400. doi: 10.1016/s0021-9290(98)00181-x. [DOI] [PubMed] [Google Scholar]
  24. Lloyd D. G., Buchanan T. S. A model of load sharing between muscles and soft tissues at the human knee during static tasks. J Biomech Eng. 1996 Aug;118(3):367–376. doi: 10.1115/1.2796019. [DOI] [PubMed] [Google Scholar]
  25. Lloyd D. G. Rationale for training programs to reduce anterior cruciate ligament injuries in Australian football. J Orthop Sports Phys Ther. 2001 Nov;31(11):645–661. doi: 10.2519/jospt.2001.31.11.645. [DOI] [PubMed] [Google Scholar]
  26. Malinzak R. A., Colby S. M., Kirkendall D. T., Yu B., Garrett W. E. A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech (Bristol, Avon) 2001 Jun;16(5):438–445. doi: 10.1016/s0268-0033(01)00019-5. [DOI] [PubMed] [Google Scholar]
  27. Markolf K. L., Burchfield D. M., Shapiro M. M., Shepard M. F., Finerman G. A., Slauterbeck J. L. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. 1995 Nov;13(6):930–935. doi: 10.1002/jor.1100130618. [DOI] [PubMed] [Google Scholar]
  28. Markolf K. L., Graff-Radford A., Amstutz H. C. In vivo knee stability. A quantitative assessment using an instrumented clinical testing apparatus. J Bone Joint Surg Am. 1978 Jul;60(5):664–674. [PubMed] [Google Scholar]
  29. McLean Scott G., Huang Xuemei, Su Anne, Van Den Bogert Antonie J. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clin Biomech (Bristol, Avon) 2004 Oct;19(8):828–838. doi: 10.1016/j.clinbiomech.2004.06.006. [DOI] [PubMed] [Google Scholar]
  30. Myer Gregory D., Ford Kevin R., Hewett Timothy E. Methodological approaches and rationale for training to prevent anterior cruciate ligament injuries in female athletes. Scand J Med Sci Sports. 2004 Oct;14(5):275–285. doi: 10.1111/j.1600-0838.2004.00410.x. [DOI] [PubMed] [Google Scholar]
  31. Myer Gregory D., Ford Kevin R., Palumbo Joseph P., Hewett Timothy E. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. J Strength Cond Res. 2005 Feb;19(1):51–60. doi: 10.1519/13643.1. [DOI] [PubMed] [Google Scholar]
  32. Myklebust Grethe, Engebretsen Lars, Braekken Ingeborg Hoff, Skjølberg Arnhild, Olsen Odd-Egil, Bahr Roald. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. 2003 Mar;13(2):71–78. doi: 10.1097/00042752-200303000-00002. [DOI] [PubMed] [Google Scholar]
  33. Nashner L. M. Fixed patterns of rapid postural responses among leg muscles during stance. Exp Brain Res. 1977 Oct 24;30(1):13–24. doi: 10.1007/BF00237855. [DOI] [PubMed] [Google Scholar]
  34. Neptune R. R., Wright I. C., van den Bogert A. J. Muscle coordination and function during cutting movements. Med Sci Sports Exerc. 1999 Feb;31(2):294–302. doi: 10.1097/00005768-199902000-00014. [DOI] [PubMed] [Google Scholar]
  35. Nyland J. A., Caborn D. N., Shapiro R., Johnson D. L. Fatigue after eccentric quadriceps femoris work produces earlier gastrocnemius and delayed quadriceps femoris activation during crossover cutting among normal athletic women. Knee Surg Sports Traumatol Arthrosc. 1997;5(3):162–167. doi: 10.1007/s001670050045. [DOI] [PubMed] [Google Scholar]
  36. Renström P., Arms S. W., Stanwyck T. S., Johnson R. J., Pope M. H. Strain within the anterior cruciate ligament during hamstring and quadriceps activity. Am J Sports Med. 1986 Jan-Feb;14(1):83–87. doi: 10.1177/036354658601400114. [DOI] [PubMed] [Google Scholar]
  37. Rozzi S. L., Lephart S. M., Gear W. S., Fu F. H. Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players. Am J Sports Med. 1999 May-Jun;27(3):312–319. doi: 10.1177/03635465990270030801. [DOI] [PubMed] [Google Scholar]
  38. Shultz S. J., Perrin D. H., Adams J. M., Arnold B. L., Gansneder B. M., Granata K. P. Assessment of neuromuscular response characteristics at the knee following a functional perturbation. J Electromyogr Kinesiol. 2000 Jun;10(3):159–170. doi: 10.1016/s1050-6411(00)00002-x. [DOI] [PubMed] [Google Scholar]
  39. Solomonow M., Krogsgaard M. Sensorimotor control of knee stability. A review. Scand J Med Sci Sports. 2001 Apr;11(2):64–80. doi: 10.1034/j.1600-0838.2001.011002064.x. [DOI] [PubMed] [Google Scholar]
  40. Söderman K., Werner S., Pietilä T., Engström B., Alfredson H. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc. 2000;8(6):356–363. doi: 10.1007/s001670000147. [DOI] [PubMed] [Google Scholar]
  41. Thompson H. W., McKinley P. A. Landing from a jump: the role of vision when landing from known and unknown heights. Neuroreport. 1995 Feb 15;6(3):581–584. [PubMed] [Google Scholar]
  42. Wedderkopp N., Kaltoft M., Lundgaard B., Rosendahl M., Froberg K. Prevention of injuries in young female players in European team handball. A prospective intervention study. Scand J Med Sci Sports. 1999 Feb;9(1):41–47. doi: 10.1111/j.1600-0838.1999.tb00205.x. [DOI] [PubMed] [Google Scholar]
  43. Wilk K. E., Voight M. L., Keirns M. A., Gambetta V., Andrews J. R., Dillman C. J. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993 May;17(5):225–239. doi: 10.2519/jospt.1993.17.5.225. [DOI] [PubMed] [Google Scholar]
  44. Winter E. M., Brookes F. B. Electromechanical response times and muscle elasticity in men and women. Eur J Appl Physiol Occup Physiol. 1991;63(2):124–128. doi: 10.1007/BF00235181. [DOI] [PubMed] [Google Scholar]
  45. Wojtys E. M., Huston L. J. Neuromuscular performance in normal and anterior cruciate ligament-deficient lower extremities. Am J Sports Med. 1994 Jan-Feb;22(1):89–104. doi: 10.1177/036354659402200116. [DOI] [PubMed] [Google Scholar]
  46. Wojtys E. M., Huston L. J., Taylor P. D., Bastian S. D. Neuromuscular adaptations in isokinetic, isotonic, and agility training programs. Am J Sports Med. 1996 Mar-Apr;24(2):187–192. doi: 10.1177/036354659602400212. [DOI] [PubMed] [Google Scholar]
  47. Wojtys Edward M., Ashton-Miller James A., Huston Laura J. A gender-related difference in the contribution of the knee musculature to sagittal-plane shear stiffness in subjects with similar knee laxity. J Bone Joint Surg Am. 2002 Jan;84-A(1):10–16. doi: 10.2106/00004623-200201000-00002. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES