PREVALENCE AND INFLUENCE OF LOWER LIMB JOINT HYPERMOBILITY ON NEUROMUSCULAR PERFORMANCE IN YOUNG FEMALE GREEK GYMNASTS

V. Athanasoglou¹, A. McCarthy^1,2, J. Simmonds^1,2

¹University College London, Great Ormond Street Institute of Child Health, London, United Kingdom, ²Central Health Physiotherapy, London, United Kingdom

Background: Although increased flexibility is a requirement in gymnastics, joint hypermobility and potentially associated ligament laxity and instability is an area of focus concerning injury risk factors in sports. Previous research has shown that poor neuromuscular control can lead to injury in a young sporting population. However, the influence of joint hypermobility on neuromuscular control in young gymnasts remains unclear.

Purpose: The aims of the research were:

1. To determine the prevalence of lower limb hypermobility (LLH) in female gymnasts aged 11-15 years
2. To explore the influence of lower limb hypermobility on neuromuscular performance in young female gymnasts

Methods: An observational case control study design was undertaken in two stages. In the first stage, young female gymnasts aged between 11-15 years with a minumum of two years training were recruited from two clubs in Greece. Gymnasts were excluded if they had injury in the past 6 months, if they had a joint disease, orthopaedic or neurological condition which might impact on movement. Demographic information was collected along with an assessment for lower limb joint hypermobility using the Lower Limb Assessment Scale. In the second stage, participants were allocated into two groups, a lower limb hypermobile (LLH) group and a non-lower limb hypermobile (NLLH) group. Neuromuscular performance was assessed in a random sample of each group using the Lower Extremity Grading Score (LEGS). The LEGS assessment includes three functional tests; the Y-balance Test (YBT) measuring dynamic balance, the Drop Vertical Jump Test (DVJT) for jump-landing mechanics and lower limb control, and the Triple Crossover Hop for Distance Test (TXHD) for lower limb strength and control. Comparisons of neuromuscular performance between gymnasts with and without lower limb joint hypermobility were performed using independent sample t-tests.

Results: The prevalence of lower limb hypermobility was 32% (n=39). Gymnasts with lower limb hypermobility had significantly lower mean neuromuscular performance scores compared to those without hypermobility (p=0.016, 95%CI 0.2 to 1.95). Further analysis into the subcomponents, revealed that there was no difference in dynamic balance and lower limb strength and control measured by the Y-balance and Triple-Crossover Hop for Distance test respectively. However, hypermobile gymnasts demonstrated significantly lower mean scores in the Drop Vertical Jump Test (p <0.001), suggesting that the hypermobile gymnasts demonstrated a poorer knee control during landing compared to those who were not hypermobile.

Conclusions: Lower limb hypermobility is relatively common in young Greek gymnasts. Gymnasts in this study with LLH demonstrated poorer overall lower limb neuromuscular control, particularly during jump landing than the non-hypermobile gymnasts. Screening for LLH and landing mechanics in gymnastics is recommended.

Implications: Physiotherapists and coaches may use this information to develop training programmes to improve landing neuromuscular control in gymnasts with lower limb hypermobility.

Funding acknowledgements: No funding

Keywords:
Joint hypermobility
Gymnastics
Neuromuscular performance

Topics:
Musculoskeletal: lower limb
Sport & sports injuries
Paediatrics

Did this work require ethics approval? Yes

Institution: University College London

Committee: UCL REC

Ethics number: REC number: 15055/001