EFFECT OF MULTIPLE ANGLE HAMSTRING ISOMETRIC EXERCISES ON… 1

1.0 ABSTRACT

KEYWORDS: ACL injury, Multiple Angle Hamstring Isometric Exercises, Agility

2.0 INTRODUCTION
Soccer is the most popular sport worldwide (Sadigurky, Braid, De Lira &
Machado, 2017; Dai, Mao, Garret & Yu, 2014; Walde’n, Hagglund, Werner & Ekstrand,
2010). The Fédération Internationale de Football Association (FIFA) reported 270
million soccer players are registered worldwide (Sadigurky et al., 2017). Asia has been
estimated to have the largest number of soccer players (85 million), about 33% of the
world soccer players’ community (Dai et al., 2014). However, in a survey of fifteen cities
in Asia, soccer’s popularity ranges for 16.4% having Metro Manila and Taipei with
relatively lower rates (Global Habit, 2016).
Soccer is a contact sport which requires physical aptitude and the ability to play at
high levels of intensity. This carries a significant risk of injuries for both professional and
amateur players (Sadigurky et al., 2017). Smith, Chounthirath and Xiang (2016) reported
66.4% of mechanism of injury was soccer-related injuries. Most of the soccer-related
injuries commonly involve the lower extremity (Silvers-Granelli, Brizzini, Arundale,
Mandelbaum & Snyder-Mackler, 2017). Sadigurk et al. (2017) reported that 60-90% of
injuries occur in the lower limbs, especially the ankle, knee and thigh. One of the most
common injured in the knee is the anterior cruciate ligament (Kiapour & Murray, 2014).
ACL injury accounts for about 50% or more of all knee injuries (Joseph, Collins, Henke,
Yard, Field & Comstock, 2013). Dai et al., (2014) reported that ACL injury incidence
rates range from 0.15% to 3.67% per person per year and 0.07-1.07 per 1000 sports
exposures across various age and competition levels.

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2.1 Literature Review

Intro paragraph on dse definition epidemiology of the dse- SINO NAKA-ASSIGN SA DSE?
2.1.1 Risk Factors of (DV) among Soccer players with ACL injury

(2.1.1.1 age, 2.1.1.2 gender, ….. – JOURNAL ATA TO NG BAWAT CVs NATIN- PEREZ)

2.1.2 Effect of Multiple Angle Hamstring Isometric Exercises on Agility

2.2 Purpose Statement

The objective of the study is to evaluate the effect of Multiple Angle Hamstring Isometric
Exercises on agility among soccer players with anterior cruciate ligament injury. The purpose of
this study is to determine the effect of Multiple Angle Hamstring Isometric Exercises on agility
among soccer players with anterior cruciate ligament injury. These are the following who will
benefit from this study:

1. Soccer athletes
This study will benefit soccer athletes who are wishing to improve their agility to increase their
performance while preventing risk of ACL injury using isometric exercises on hamstring.

2. Soccer trainers and coaches

This study will benefit trainers, so they can provide a better training program for their athletes.
Not only that they can improve the agility of their athletes but also for preventing injuries.

3. Physical Therapists
This study will help the Physical Therapists, so they can prescribe better exercise programs on
developing the skills and performance of soccer athletes. Also, they can experiment on how
Multiple Angle Hamstring Isometric Exercises is different with typical rehab training.

4. Future researchers
The study will also be beneficial for the future researchers of this specific topic, so they can
experiment and replicate this study to help soccer athletes on performing better while reducing

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the risk of being injured.

2.3 Problem Statement

2.3.0 What are the characteristics of the subjects in terms of:

2.3.1.1 Age
2.3.1.2 Sex
2.3.1.3 Body Mass Index
2.3.1.4 Height
2.3.1.5 Weight
2.3.1.6 Activity level
2.3.1.7 Knee level of pain
2.3.1.8 Knee level of function
2.3.1.9 Limb dominance
2.3.2.0 Limb girth
2.3.2.1 ACL severity
2.3.2.2 Knee joint geometry
2.3.2.3 Knee joint laxity
2.3.2.4 Lower extremity alignment

2.3.1 What is the subjects level of agility?

2.3.2 What is the relationship between ACL injury prognosticating factors and agility?

2.3.3 What is the effect of Multiple Angle Hamstring Isometric Exercises on agility?

2.4 Hypothesis

Ho1: Prognosticating factors has no significant effect on agility

Ho2: Multiple Angle Hamstring Isometric Exercises has no effect on agility.

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2.5 Theoretical Framework

2.6 Simulacrum

Age
Sex
BMI
Height
Weight
Activity level Multiple Angle
Ha1 (+) Ha2 (-)
Hamstring
Knee Level of pain
Agility Isometric
Knee Level of function Exercises
Limb dominance
Limb girth
ACL severity
Knee joint geometry
Knee joint laxity
Lower extremity alignment

Figure 1: Research Simulacrum

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3.0 RESEARCH METHOD

3.1 Design
This study will use a quantitative, multiple time series true-experimental research design.
This study design was based on the Law of Diminishing Returns which states that there is a
biological ceiling to exercise included improvements in function. As this ceiling is approached,
quarter effort is needed to achieve minimal gain (Mold, Hamm, & McCarthy, 2009).

3.2 Site and Sampling

This study will be conducted at a football field in Quezon City. This site was chosen because
of availability & accessibility of the subjects. A total of sixty will be recruited to participate in
this study. This sample size was based on the 3.67% incidence rate of ACL injury per 100,000
soccer players (Dai et al., 2014) at 95% confidence interval, plus 10% attrition rate using the EPI
Info formula (Dean et al., 2011).
The subjects will be selected purposively. To be included, he/she must be: (1) a soccer player
(2) Underwent ACL-Reconstruction (3) returned to training for about 4 to 6 months and with (4)
agility cut-off score of >12.5 for females and agility cut off score with >11.5 for males.
Those with (1) History of other lower extremity pathology and trauma (2) Previous surgery
of the lower extremity with (3) Inflammatory disorders or other rheumatic diseases, neurological
or psychiatric disorders (4) Other problems related to either knee (5) History of drug therapy
other than analgesics or physiotherapy treatment within the last 3 months, and (6) with agility cut
off score of <12.5 for females and agility cut off score with <11.5 for males will be excluded. The
Agility cut-off score of >12.5 for females and >11.5 for males (Hoffman, 2006) was based on the
Law of Initial Values which states that those who initially have low capacity will have greatest
functional improvement from a given program (Graham et al., 2010).

Those who will qualify based on inclusion and exclusion criteria and consent to participate in
the study will be assigned Experimental Group (EG) or Control Group (CG) systematically using
a list of random numbers generated by Excel: The upper half to EG and lower half CG.

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3.3 Research Instrument

A personal demographic sheet will be used to gather the demographic profile of the
respondent like Age, Sex, BMI, Height, Weight, and Activity level. These factors were noted to
affect the agility of the soccer players.

3.4 Intervention

3.4.0 Preparation Phase

The objective of the preparation phase is to formulate a sound and feasible thesis
proposal. A review of literature was conducted to serve as a background for the study. Legitimate
databases like PubMed were searched using the keywords Isometric Hamstring Exercise, Agility,
ACL, and soccer athletes. The thesis proposal was then drafted, presented before the panel and
revised based on the panel’s feedback. The identification of prospective subjects including the
sites of the study and the formulation of informed consent forms, letters, and questionnaires will
also be done during this phase.

3.4.1 Pilot Testing

The purpose of the pilot testing is to determine the conceptual equivalence of the Filipino
version of Knee Injury & Osteoarthritis Outcome (FV KOOS). The researchers will translate the
KOOS from English to Filipino. A linguist without prior knowledge of KOOS will translate the
KOOS back to English. Another linguist also without prior knowledge of KOOS will verify the
accuracy of translation (appendix____).
The purpose of the pilot testing is to determine the clarity and understandability of the FV
KOOS. Five sub-pilot test subjects meeting the study’s criteria will be asked to answer FV KOOS
individually. After the test, each will be asked to critique the questionnaire. FV KOOS will then
be revised based on the pilot test subject’s feedback.
The purpose of the pilot testing is to determine the reliability of the study’s assessor. Two
licensed Physical Therapists will be asked to administer T-agility test, and interview format of the
FV KOOS. To five pilot test subjects meeting the study’s criteria twice, randomly, independently.
The tests will be repeated after a week for a test pre-test for reliability. The Physical Therapist
with a reliability coefficient equal to or greater than .80 will be assigned as the study’s assessor.

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The purpose of the pilot testing is to determine the reliability of the study’s assessor. Two
licensed Physical Therapists will be asked to administer Lysholm scale, ROM, Visual Analog
Scale, Thigh Circumference Measurement and interview format of the Filipino version of KOOS.
To five pilot test subjects meeting the study’s criteria twice, randomly, independently. The tests
will be repeated after a week for a test pre-test for reliability.

3.4.2 Revision Phase

FV KOOS will be revised based on pilot test subjects feedback. The PT with reliability
coefficient of ≥.80 will be assigned as the study’s assessors.

3.4.3 Pre-testing Phase

The objective of the pre-testing is to identify prospective subjects. A letter address to the
dean of the college asking permission to conduct the study will be sent personally by the
researchers. After a week, the request will be followed up. Upon approval, all subjects will be
briefed about the purpose of the study. Those who will consent to participate will be asked to sign
an informed consent form. Those who will be pre-qualified based on the criteria and consent to
participate will be asked to perform the agility test. Those who will score >11.50 (Males); >12.50
(Females) (Hoffman, 2006) will be assigned systematically to experimental group or control
group using a list of random numbers generated by Microsoft Excel: the upper half to
experimental group and lower half to control group.

3.4.4 Implementation Phase

3.4.5 Post-testing Phase

The purpose of the post-testing is to evaluate the effect of Multiple Angle Hamstring
Isometric Exercises on agility. All subjects will be asked to perform the agility test every week of
intervention.

3.5 Data Analysis

All data gather from the study will be tabulated and send to a statistician for analysis.

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3.6 Ethical Consideration

OPERATIONAL DEFINITION OF TERMS

References:

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