Testing limb symmetry and asymmetry after Anterior Cruciate Ligament injury: 4 considerations to increase its utility
Article
Jordan, M and Bishop, C. 2023. Testing limb symmetry and asymmetry after Anterior Cruciate Ligament injury: 4 considerations to increase its utility. Strength and Conditioning Journal. https://doi.org/0.1519/SSC.0000000000000821
| Type | Article |
|---|---|
| Title | Testing limb symmetry and asymmetry after Anterior Cruciate Ligament injury: 4 considerations to increase its utility |
| Authors | Jordan, M and Bishop, C. |
| Abstract | Anterior cruciate ligament (ACL) injury occurs frequently in sport and surgical reconstruction (ACLR) is often recommended to restore knee joint stability. To guide rehabilitation and determine return to sport readiness, practitioners have used a long-standing practice of calculating the limb symmetry index (LSI) in various functional, biomechanical, and strength tests to compare the injured limb to the non-injured contralateral limb. However, the evidence in support of the LSI calculation to quantify rehabilitation status and return to sport readiness is mixed. We synthesize scientific literature on the LSI calculation and discuss potential reasons for the mixed evidence and limitations. We present four considerations to improve the utility of the LSI calculation including: (1) the importance of establishing the right benchmark of recovery such as the pre-injury contralateral limb or a sport-specific non-injured control benchmark; (2) strategies to manage the high variation in movement asymmetry calculations and the importance of quantifying the intra-subject variability for the component parts of the LSI; (3) the evidence for assessing the movement strategy alongside performance when using the LSI; and (4) how a sport-specific envelope of function can be used to inform post-ACL injury testing that incorporates the LSI. |
| Keywords | asymmetry; return to sport; return to play; strength testing; hop testing; injury prevention |
| Sustainable Development Goals | 3 Good health and well-being |
| Middlesex University Theme | Health & Wellbeing |
| Publisher | Lippincott, Williams and Wilkins |
| Journal | Strength and Conditioning Journal |
| ISSN | 1524-1602 |
| Electronic | 1533-4295 |
| Publication dates | |
| Online | 28 Nov 2023 |
| Publication process dates | |
| Accepted | 11 Sep 2023 |
| Deposited | 14 Sep 2023 |
| Output status | Published |
| Copyright Statement | This is a non-final version of an article published in final form in: Jordan, Matthew J.; Bishop, Chris. Testing Limb Symmetry and Asymmetry After Anterior Cruciate Ligament Injury: 4 Considerations to Increase Its Utility. Strength and Conditioning Journal ():10.1519/SSC.0000000000000821, November 28, 2023. | DOI: 10.1519/SSC.0000000000000821 |
| Digital Object Identifier (DOI) | https://doi.org/0.1519/SSC.0000000000000821 |
| Language | English |
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Galati, D., Turner, A., Bishop, C. and Maloney, S. 2023. Contemporary practices of strength and conditioning coaches in high-level male ice hockey: a survey-based investigation. The Journal of Strength and Conditioning Research. 37 (11), pp. 2241-2250. https://doi.org/10.1519/JSC.0000000000004541Predicting weight category specific performance zones for Olympic, World and European weightlifting competitions
Chavda, S., Comfort, P., Lake, J., Bishop, C. and Turner, A. 2023. Predicting weight category specific performance zones for Olympic, World and European weightlifting competitions. The Journal of Strength and Conditioning Research. 36 (9), pp. 2657-2662. https://doi.org/10.1519/JSC.0000000000004511A systematic review of the different calculation methods for measuring jump height during the countermovement and drop jump tests
Xu, J., Turner, A., Comfort, P., Harry, J., McMahon, J., Chavda, S. and Bishop, C. 2023. A systematic review of the different calculation methods for measuring jump height during the countermovement and drop jump tests. Sports Medicine. 53 (5), pp. 1055-1072. https://doi.org/10.1007/s40279-023-01828-xMeasuring interlimb asymmetry for strength and power: a brief review of assessment methods, data analysis, current evidence, and practical recommendations
Bishop, C., de Keijzer, K., Turner, A. and Beato, M. 2023. Measuring interlimb asymmetry for strength and power: a brief review of assessment methods, data analysis, current evidence, and practical recommendations. The Journal of Strength and Conditioning Research. 37 (3), pp. 745-750. https://doi.org/10.1519/JSC.0000000000004384A survey into the use of priming techniques implemented by athletes and coaches to improve athletic performance
Collins, J., Bishop, C., Hills, F., Spiegelhalter, A., Cohen, R. and Turner, A. 2023. A survey into the use of priming techniques implemented by athletes and coaches to improve athletic performance. The Journal of Strength and Conditioning Research. 37 (1), pp. 107-113. https://doi.org/10.1519/jsc.0000000000004220Inter-limb asymmetries in swimming and their impact on performance: evidence from a scoping review
Knihs, D., Bishop, C., Zimmerman, H. and Dal Pupo, J. 2023. Inter-limb asymmetries in swimming and their impact on performance: evidence from a scoping review. Strength and Conditioning Journal. 45 (6), pp. 642-662. https://doi.org/10.1519/SSC.0000000000000769Monitoring performance in golf: more than just clubhead speed
Brennan, A., Ehlert, A., Wells, J., Broadie, M., Coughlan, D., Turner, A. and Bishop, C. 2023. Monitoring performance in golf: more than just clubhead speed. Strength and Conditioning Journal. 45 (6), pp. 631-641. https://doi.org/10.1519/SSC.0000000000000764Optimal velocity loss threshold for inducing post activation potentiation in track and field athletes
Yuan, Z., Liao, K., Zhang, Y., Han, M., Bishop, C., Chen, Z., Zhang, X., Zhang, G. and Li, Y. 2023. Optimal velocity loss threshold for inducing post activation potentiation in track and field athletes. Biology of Sport. 40 (2), pp. 603-609. https://doi.org/10.5114/biolsport.2023.119284Seasonal variation of physical performance, bilateral deficit and inter-limb asymmetry in elite academy soccer players: which metrics are sensitive to change?
Bishop, C., Abbott, W., Brashill, C., Loturco, I., Beato, M. and Turner, A. 2023. Seasonal variation of physical performance, bilateral deficit and inter-limb asymmetry in elite academy soccer players: which metrics are sensitive to change? The Journal of Strength and Conditioning Research. 37 (2), pp. 358-365.Why sports should embrace bilateral asymmetry: A narrative review
Afonso, J., Pena, J., Sa, M., Virgile, A., Garcia-de-Alcaraz, A. and Bishop, C. 2022. Why sports should embrace bilateral asymmetry: A narrative review. Symmetry. 14 (10). https://doi.org/10.3390/sym14101993The effects of a 6-week unilateral strength and ballistic jump training program on the force-velocity profiles of sprinting
Bettariga, F., Maestroni, L., Martorelli, L., Turner, A. and Bishop, C. 2023. The effects of a 6-week unilateral strength and ballistic jump training program on the force-velocity profiles of sprinting. The Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000004424Post-activation performance enhancement in sprinters: effects of hard versus sand surfaces
Pereira, L., Boullosa, D., Moura, T., Mercer, V., Fernandes, V., Bishop, C. and Loturco, I. 2022. Post-activation performance enhancement in sprinters: effects of hard versus sand surfaces. Journal of Human Kinetics. 82 (1), pp. 173-180. https://doi.org/10.2478/hukin-2022-0062Associations between differing magnitudes of inter-limb asymmetry and linear and change of direction speed performance in male youth soccer players
Işın, A., Akdağ, E., Özdoğan, E. and Bishop, C. 2022. Associations between differing magnitudes of inter-limb asymmetry and linear and change of direction speed performance in male youth soccer players. Biomedical Human Kinetics. 14 (1), pp. 67-74. https://doi.org/10.2478/bhk-2022-0009The effects of training interventions on inter-limbs asymmetries: a systematic review with meta-analysis
Bettariga, F., Turner, A., Maloney, S., Maestroni, L., Jarvis, P. and Bishop, C. 2022. The effects of training interventions on inter-limbs asymmetries: a systematic review with meta-analysis. Strength and Conditioning Journal. 44 (5), pp. 69-86. https://doi.org/10.1519/ssc.0000000000000701Bilateral deficit in the countermovement jump and its associations with judo-specific performance
Kons, R., Ache-Dias, J., Gheller, R., Bishop, C. and Detanico, D. 2023. Bilateral deficit in the countermovement jump and its associations with judo-specific performance. Research in Sports Medicine. 31 (5), pp. 638-649. https://doi.org/10.1080/15438627.2021.2024542Does size matter? Effects of small vs. large pitch small-sided game training on speed and endurance in collegiate soccer players
Faga, J., Bishop, C. and Maloney, S. 2022. Does size matter? Effects of small vs. large pitch small-sided game training on speed and endurance in collegiate soccer players. International Journal of Sports Science & Coaching. 18 (6), pp. 2033-2043. https://doi.org/10.1177/17479541221126955Validity and reliability of strategy metrics to assess countermovement jump performance using the newly developed My Jump Lab smartphone application
Bishop, C., Jarvis, P., Turner, A. and Balsalobre-Fernández, C. 2022. Validity and reliability of strategy metrics to assess countermovement jump performance using the newly developed My Jump Lab smartphone application. Journal of Human Kinetics. 83, pp. 185-195. https://doi.org/10.2478/hukin-2022-0098Assessing eccentric hamstring strength using the Nordbord: between-session reliability and inter-limb asymmetries in professional soccer players
Bishop, C., Manuel, J., Drury, B., Beato, M. and Turner, A. 2022. Assessing eccentric hamstring strength using the Nordbord: between-session reliability and inter-limb asymmetries in professional soccer players. The Journal of Strength and Conditioning Research. 36 (9), pp. 2552-2557. https://doi.org/10.1519/JSC.0000000000004303Momentum-based load prescriptions: applications to jump squat training
Harry, J., Krzyszkowski, J., Harris, K., Chowning, L., Mackey, E., Bishop, C. and Barker, L. 2022. Momentum-based load prescriptions: applications to jump squat training. The Journal of Strength and Conditioning Research. 36 (9), pp. 2657-2662. https://doi.org/10.1519/JSC.0000000000004294Strength and conditioning for golf athletes: biomechanics, injury risk, physical requirements, and recommendations for testing and training
Bishop, C., Ehlert, A., Wells, J., Brearley, S., Brennan, A. and Coughlan, D. 2022. Strength and conditioning for golf athletes: biomechanics, injury risk, physical requirements, and recommendations for testing and training. Professional Strength and Conditioning. (64), pp. 7-18.Effects of direction-specific training interventions on physical performance and inter-limb asymmetries
Gonzalo-Skok, O., Sánchez-Sabaté, J., Tous-Fajardo, J., Mendez-Villanueva, A., Bishop, C. and Piedrafita, E. 2022. Effects of direction-specific training interventions on physical performance and inter-limb asymmetries. International Journal of Environmental Research and Public Health. 19 (3), pp. 1-13. https://doi.org/10.3390/ijerph19031029Reverse engineering in strength and conditioning: applications to agility training
Turner, A., Read, P., Maestroni, L., Chavda, S., Yao, X., Papadopoulos, K., Virgile, A., Spiegelhalter, A. and Bishop, C. 2022. Reverse engineering in strength and conditioning: applications to agility training. Strength and Conditioning Journal. 44 (4), pp. 85-94. https://doi.org/10.1519/SSC.0000000000000681Effects of unilateral vs. bilateral resistance training interventions on measures of strength, jump, linear and change of direction speed: a systematic review and meta-analysis
Liao, K., Nassis, G., Bishop, C., Yang, W., Bian, C. and Li, Y. 2022. Effects of unilateral vs. bilateral resistance training interventions on measures of strength, jump, linear and change of direction speed: a systematic review and meta-analysis. Biology of Sport. 39 (3), pp. 485-497. https://doi.org/10.5114/biolsport.2022.107024“Small steps, or giant leaps?” Comparing game demands of U23, U18, and U16 English academy soccer and their associations with speed and endurance
Smalley, B., Bishop, C. and Maloney, S. 2022. “Small steps, or giant leaps?” Comparing game demands of U23, U18, and U16 English academy soccer and their associations with speed and endurance. International Journal of Sports Science & Coaching. 17 (1), pp. 134-142. https://doi.org/10.1177/17479541211018771Effects of a resistance training intervention on the strength-deficit of elite young soccer players
Loturco, I., Pereira, L., Bishop, C., Zanetti, V., Freitas, T. and Pareja-Blanco, J. 2022. Effects of a resistance training intervention on the strength-deficit of elite young soccer players. Biology of Sport. 39 (3), pp. 615-619. https://doi.org/10.5114/biolsport.2022.106157Magnitude or direction? Seasonal variation of interlimb asymmetry in elite academy soccer players
Bishop, C., Read, P., Chavda, S., Jarvis, P., Brazier, J., Bromley, T. and Turner, A. 2022. Magnitude or direction? Seasonal variation of interlimb asymmetry in elite academy soccer players. The Journal of Strength and Conditioning Research. 36 (4), pp. 1031-1037. https://doi.org/10.1519/JSC.0000000000003565The association between Interlimb asymmetry and athletic performance tasks: a season long study in elite academy soccer players
Bishop, C., Read, P., Bromley, T., Brazier, J., Jarvis, P., Chavda, S. and Turner, A. 2022. The association between Interlimb asymmetry and athletic performance tasks: a season long study in elite academy soccer players. The Journal of Strength and Conditioning Research. 36 (3), pp. 787-795. https://doi.org/10.1519/JSC.0000000000003526
Effects of three different combined training interventions on jump, change of direction, power performance, and inter-limb asymmetry in male youth soccer players
Moreno-Azze, A., Arjol-Serrano, J., Falcón-Miguel, D., Bishop, C. and Gonzalo-Skok, O. 2021. Effects of three different combined training interventions on jump, change of direction, power performance, and inter-limb asymmetry in male youth soccer players. Sports. 9 (12), pp. 1-14. https://doi.org/10.3390/sports9120158No relationship between lean mass and functional asymmetry in high-level female tennis players
Chapelle, L., Bishop, C., Clarys, P. and D’Hondt, E. 2021. No relationship between lean mass and functional asymmetry in high-level female tennis players. International Journal of Environmental Research and Public Health. 18 (22). https://doi.org/10.3390/ijerph182211928A comparison of vertical and horizontal reactive strength index variants and association with change of direction performance
Šarabon, N., Kozinc, Ž. and Bishop, C. 2021. A comparison of vertical and horizontal reactive strength index variants and association with change of direction performance. The Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000004193Reactive strength index and its associations with measures of physical and sports performance: A systematic review with meta-analysis
Jarvis, P., Turner, A., Read, P. and Bishop, C. 2021. Reactive strength index and its associations with measures of physical and sports performance: A systematic review with meta-analysis. Sports Medicine. 52 (2), pp. 301-330. https://doi.org/10.1007/s40279-021-01566-yStrength and conditioning in schools: a strategy to optimise health, fitness and physical activity in youths
Till, K., Bruce, A., Green, T., Morris, S., Boret, S. and Bishop, C. 2021. Strength and conditioning in schools: a strategy to optimise health, fitness and physical activity in youths. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2021-104509Effects of strength training on jump performance and bilateral deficit in Premier League academy soccer players
Bishop, C., Abbott, W., Brashill, C., Read, P., Loturco, I., Beato, M. and Turner, A. 2021. Effects of strength training on jump performance and bilateral deficit in Premier League academy soccer players. Professional Strength and Conditioning. (62), pp. 7-14.Intra- and inter-limb strength asymmetry in soccer: a comparison of professional and under-18 players
Bishop, C., Coratella, G. and Beato, M. 2021. Intra- and inter-limb strength asymmetry in soccer: a comparison of professional and under-18 players. Sports. 9 (9). https://doi.org/10.3390/sports9090129Seasonal variation of inter-limb jumping asymmetries in youth team-sport athletes
Fort-Vanmeerhaeghe, A., Bishop, C., Buscà, B., Vicens-Bordas, J. and Arboix-Alió, J. 2021. Seasonal variation of inter-limb jumping asymmetries in youth team-sport athletes. Journal of Sports Sciences. 39 (24), pp. 2850-2858. https://doi.org/10.1080/02640414.2021.1968123Assessing the magnitude and direction of asymmetry in unilateral jump and change of direction speed tasks in youth female team-sport athletes
Arboix-Alió, J., Bishop, C., Benet, A., Buscà, B., Aguilera-Castells, J. and Fort-Vanmeerhaeghe, A. 2021. Assessing the magnitude and direction of asymmetry in unilateral jump and change of direction speed tasks in youth female team-sport athletes. Journal of Human Kinetics. 79 (1), pp. 15-27. https://doi.org/10.2478/hukin-2021-0061A framework to guide practitioners when selecting metrics during the countermovement and drop jump tests
Bishop, C., Turner, A., Jordan, M., Harry, J., Loturco, I., Lake, J. and Comfort, P. 2022. A framework to guide practitioners when selecting metrics during the countermovement and drop jump tests. Strength and Conditioning Journal. 44 (4), pp. 95-105. https://doi.org/10.1519/SSC.0000000000000677Comparison of three eccentric overload training strategies on power output and interlimb asymmetry in youth soccer players
Moreno-Azze, A., Arjol-Serrano, J.L., Falcón-Miguel, D., Bishop, C. and Gonzalo-Skok, O. 2021. Comparison of three eccentric overload training strategies on power output and interlimb asymmetry in youth soccer players. International Journal of Environmental Research and Public Health. 18 (16). https://doi.org/10.3390/ijerph18168270Percentage-based change of direction deficit: a new approach to standardize time- and velocity-derived calculations
Freitas, T., Pereira, L., Alcaraz, P., Azevedo, P., Bishop, C. and Loturco, I. 2021. Percentage-based change of direction deficit: a new approach to standardize time- and velocity-derived calculations. The Journal of Strength and Conditioning Research. https://doi.org/10.1519/jsc.0000000000004118Inter-limb jump asymmetries and their association with sport-specific performance in young male and female swimmers
Phukan, M., Thapa, R., Kumar, G., Bishop, C., Chaabene, H. and Ramirez-Campillo, R. 2021. Inter-limb jump asymmetries and their association with sport-specific performance in young male and female swimmers. International Journal of Environmental Research and Public Health. 18 (14). https://doi.org/10.3390/ijerph18147324Post-activation potentiation: is there an optimal training volume and intensity to induce improvements in vertical jump ability in highly-trained subjects?
Kobal, R., Pereira, L., Kitamura, K., Paulo, A., Ramos, H., Carmo, E., Roschel, H., Tricoli, V., Bishop, C. and Loturco, I. 2019. Post-activation potentiation: is there an optimal training volume and intensity to induce improvements in vertical jump ability in highly-trained subjects? Journal of Human Kinetics. 66 (1), pp. 195-203. https://doi.org/10.2478/hukin-2018-0071Variations in the physical performance of Olympic boxers over a four-day national qualifying tournament
Loturco, I., McGuigan, M., Freitas, T., Bishop, C., Alcaraz, P., Romano, F., Alves, M., Reis, V., Pereira, L. and Franchini, E. 2021. Variations in the physical performance of Olympic boxers over a four-day national qualifying tournament. Sports. 9 (5). https://doi.org/10.3390/sports9050062International vs. National female tennis players: a comparison of upper and lower extremity functional asymmetries
Chapelle, L., Bishop, C., Clarys, P. and D'Hondt, E. 2021. International vs. National female tennis players: a comparison of upper and lower extremity functional asymmetries. Journal of Sports Medicine and Physical Fitness. https://doi.org/10.23736/S0022-4707.21.12482-XAssociations between inter-limb asymmetries in jump and change of direction speed tests and physical performance in adolescent female soccer players
Pardos-Mainer, E., Bishop, C., Gonzalo-Skok, O., Nobari, H., Pérez-Gómez, J. and Lozano, D. 2021. Associations between inter-limb asymmetries in jump and change of direction speed tests and physical performance in adolescent female soccer players. International Journal of Environmental Research and Public Health. 18 (7). https://doi.org/10.3390/ijerph18073474Optimal training sequences to develop lower body force, velocity, power, and jump height: a systematic review with meta-analysis
Marshall, J., Bishop, C., Turner, A. and Haff, G. 2021. Optimal training sequences to develop lower body force, velocity, power, and jump height: a systematic review with meta-analysis. Sports Medicine. 51 (6), pp. 1245-1271. https://doi.org/10.1007/s40279-021-01430-zStrength and conditioning practices and perspectives of volleyball coaches and players
Weldon, A., Mak, J., Wong, S., Duncan, M., Clarke, N. and Bishop, C. 2021. Strength and conditioning practices and perspectives of volleyball coaches and players. Sports. 9 (2), pp. 1-17. https://doi.org/10.3390/sports9020028Effects of training on sand or hard surfaces on sprint and jump performance of team-sport players: a systematic review with meta-analysis
Pereira, L., Freitas, T., Marín-Cascales, E., Bishop, C., McGuigan, M. and Loturco, I. 2021. Effects of training on sand or hard surfaces on sprint and jump performance of team-sport players: a systematic review with meta-analysis. Strength and Conditioning Journal. 43 (3), pp. 56-66. https://doi.org/10.1519/SSC.0000000000000634Unilateral vs. bilateral hamstring strength assessments: comparing reliability and inter-limb asymmetries in female soccer players
Cuthbert, M., Comfort, P., Ripley, N., McMahon, J., Evans, M. and Bishop, C. 2021. Unilateral vs. bilateral hamstring strength assessments: comparing reliability and inter-limb asymmetries in female soccer players. Journal of Sports Sciences. 39 (13), pp. 1481-1488. https://doi.org/10.1080/02640414.2021.1880180Enhancing high-intensity actions during a basketball game after a strength training program with random recovery times between sets
Arede, J., Leite, N., Tous-Fajardo, J., Bishop, C. and Gonzalo-Skok, O. 2022. Enhancing high-intensity actions during a basketball game after a strength training program with random recovery times between sets. The Journal of Strength and Conditioning Research. 36 (7), pp. 1989-1997. https://doi.org/10.1519/JSC.0000000000004002Effects of flywheel training on strength-related variables in female populations. A systematic review
Raya-González, J., de Keijzer, K., Bishop, C. and Beato, M. 2022. Effects of flywheel training on strength-related variables in female populations. A systematic review. Research in Sports Medicine. 30 (4), pp. 353-370. https://doi.org/10.1080/15438627.2020.1870977Video-based biomechanical analysis of an unexpected Achilles tendon rupture in an Olympic sprinter
Loturco, I., De la Fuente, C., Bishop, C., Nichioka, H., Lessio, D., Moreno, C., Pereira, L. and Carpes, F. 2021. Video-based biomechanical analysis of an unexpected Achilles tendon rupture in an Olympic sprinter. Journal of Biomechanics. 117, pp. 1-6. https://doi.org/10.1016/j.jbiomech.2021.110246Implementing strength training strategies for injury prevention in soccer: scientific rationale and methodological recommendations
Beato, M., Maroto, S., Turner, A. and Bishop, C. 2021. Implementing strength training strategies for injury prevention in soccer: scientific rationale and methodological recommendations. International Journal of Sports Physiology and Performance. 16 (3), pp. 456-461. https://doi.org/10.1123/ijspp.2020-0862Developing powerful athletes part 2: practical applications
Turner, A., Comfort, P., McMahon, J., Bishop, C., Chavda, S., Read, P., Mundy, P. and Lake, J. 2021. Developing powerful athletes part 2: practical applications. Strength and Conditioning Journal. 43 (1), pp. 23-31. https://doi.org/10.1519/SSC.0000000000000544Unilateral isometric squat: test reliability, interlimb asymmetries, and relationships with limb dominance
Bishop, C., Read, P., Lake, J., Loturco, I., Dawes, J., Madruga, M., Romero-Rodrigues, D., Chavda, S. and Turner, A. 2021. Unilateral isometric squat: test reliability, interlimb asymmetries, and relationships with limb dominance. The Journal of Strength and Conditioning Research. 35, pp. S144-S151. https://doi.org/10.1519/JSC.0000000000003079Levels of agreement for the direction of inter-limb asymmetry during four simple change-of-direction tests in young male handball players: a pilot study
Kozinc, Ž., Bishop, C., Pleša, J. and Šarabon, N. 2021. Levels of agreement for the direction of inter-limb asymmetry during four simple change-of-direction tests in young male handball players: a pilot study. Symmetry. 13 (10). https://doi.org/10.3390/sym13101940