Effect of Multiple Angle Hamstring Isometric Exercises on Agility

EFFECT OF MULTIPLE ANGLE HAMSTRING ISOMETRIC… 1
1.0 ABSTRACT
Agility is the true indicator of an athlete’s soccer playing skills. This study used a
quantitative multiple time series true-experimental research design. The subjects had been selected
purposively and randomly assigned to a 6-week multiple angle-hamstring isometric exercise
(experimental group, EG) or usual training (control group, CG). Soccer – Specific Agility Tests
were used to measure agility performance such as T-test (TT), 4x5m (S4x5) and 9-3-6-3-9m with
180° (S180). Pearson and Spearmen rho- correlational statistics were used to determine the
relationship between ACL Injury prognosticators and agility while Mann-Whitney was used to test
the main hypothesis. Chi-square revealed a statistically significant improvement between person’s
agility and playing surface. Pearson correlation revealed a high positive significant correlation
between agility and age (r=0.736; p=0.016), muscle flexibility (r=0.664; p=0.040) and leg length
discrepancy (r=0.845; p=0.040). Mann-Whitney revealed a statistically significant improvement in
Agility of EG and CG starting from week 2 (p=0.02) until week 6 (p=0.01). Both EG and CG
showed equal improvement in agility.
KEYWORDS: ACL reconstruction, Multiple Angle Hamstring Isometric Exercises, Agility
OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

4.0 RESULTS
There were twenty male soccer players during the study, but only ten consented to
participate. Ten out of twenty were excluded from the study (eight had no previous ACL injury,
two had an ACL injury occurred in less than 7 months). All subjects were able to complete the
study.
The comparison between experimental group and control group characteristics at baseline
is shown in Table 1. There were 5 subjects for both experimental group and control group. Majority
of both experimental group and control group has leg length discrepancy and played on a natural
turf.
The mean age of Experimental Group (EG) was 21.40±1.14, (R) hip extension ROM of
18.60±2.19, (L) hip extension ROM of 19.00±2.27, (R) hip flexion ROM of 119.00±2.23, (L) hip
flexion ROM of 114.00±4.18, (R) hip abduction ROM of 37.00±4.22, (L) hip abduction ROM of
39.00±2.24, (R) hip adduction ROM of 17.00±4.47, (L) hip adduction ROM of 18.00±2.74, (R) hip
external rotation ROM of 43.00±2.74, (L) hip external rotation ROM of 39.00±2.24, (R) hip
internal rotation of 40.00±3.54, (L) hip external rotation ROM of 37.00±2.74, (R) knee flexion
ROM of 131.00±4.18, (L) knee flexion ROM of 131.00±4.18, (R) ankle dorsiflexion ROM of
14.00±5.48, (L) ankle dorsiflexion ROM of 16.00±4.18, (R) ankle plantarflexion ROM of
47.00±4.47, (L) ankle plantarflexion ROM of 48.00±2.74, (R) ankle eversion of 12.00±2.74, (L)
ankle eversion ROM of 12.00±2.74, (R) ankle inversion ROM of 31.00±4.18, (L) ankle inversion
ROM of 28.00±2.74, (R) true leg length of 91.62±3.75 and (L) true leg length of 90.38±2.18 ;
while the age of Control Group (CG) was 21.80±2.18, (R) hip extension ROM of 16.60±2.30, (L)
hip extension ROM of 16.60±2.30, (R) hip flexion ROM of 117.00±2.30, (L) hip flexion ROM of
114.00±4.18, (R) hip abduction ROM of 35.00±5.00, (L) hip abduction ROM of 37.00±2.74, (R)
hip adduction ROM of 17.00±4.47, (L) hip adduction ROM of 17.00±2.74, (R) hip external rotation
ROM of 40.00±5.00, (L) hip external rotation ROM of 44.00±2.24, (R) hip internal rotation ROM
of 43.00±2.74, (L) hip internal rotation ROM of 41.00±4.18, (R) knee flexion ROM of 130.00±3.54,
(L) knee flexion ROM of 130.00±5.00, (R) ankle dorsiflexion ROM of 15.00±3.54, (L) ankle
dorsiflexion ROM of 14.00±4.18m (R) ankle plantarflexion ROM of 47.00±4.47, (L) ankle
plantarflexion ROM of 47.00±2.74, (R) ankle eversion ROM of 13.00±2.74, (L) ankle eversion
ROM of 12.00±2.74, (R) ankle inversion ROM of 31.00±4.18, (L) ankle inversion ROM of
30.00±5.00, (R) true leg length of 89.56±2.16 , and (L) true leg length of 88.50±3.01.

The Levene’s Homogeneity revealed a p-value of p>0.05 indicating that both Experimental
Group (EG) and Control Group (CG) are characteristically homogenous at baseline except for
playing surface (p=0.011).

Table 1. Comparison between Experimental Group (EG) and Control Group’s (CG) Characteristics at baseline.
EG CG
VARIABLES p-value
(n=5) (n=5)
Age (Mean±SD, yrs) 21.40±1.14 21.80±2.17 0.105
Height 212.4±2.81 212.4±3.04 0.390
BMI 23.01±1.00 22.57±1.80 0.845
ROM (Mean±SD, degrees)
(R) hip extension 18.60±2.19 16.60±2.30 0.012
(L) hip extension 19.00±2.24 16.60±2.30 0.020
(R) hip flexion 119.00±2.24 117.00±2.74 0.025
(L) hip flexion 114.00±4.18 114.00±4.18 0.045
(R) hip abduction 39.00±2.24 35.00±5.00 0.044
(L) hip abduction 39.00±2.24 37.00±2.74 0.022
(R) hip adduction 17.00±4.47 17.00±4.47 0.034
(L) hip adduction 18.00±2.74 17.00±2.74 0.010
(R) hip external rotation 43.00±2.74 40.00±5.00 0.014
(L) hip external rotation 39.00±2.24 44.00±2.24 0.031
(R) hip internal rotation 40.00±3.54 43.00±2.74 0.048
(L) hip internal rotation 37.00±2.74 41.00±4.18 0.044
(R) knee flexion 131.00±4.18 130.00±3.54 0.046
(L) knee flexion 131.00±4.18 130.00±5.00 0.028
(R) ankle dorsiflexion 14.00±5.48 15.00±3.54 0.037
(L) ankle dorsiflexion 16.00±4.18 14.00±4.18 0.041
(R) ankle plantarflexion 47.00±4.47 47.00±4.47 0.030
(L) ankle plantarflexion 48.00±2.74 47.00±2.74 0.049
(R) ankle eversion 12.00±2.74 13.00±2.74 0.038
(L) ankle eversion 12.00±2.74 12.00±2.74 0.012
(R) ankle inversion 31.00±4.18 31.00±4.18 0.018
(L) ankle inversion 28.00±2.74 30.00±5.00 0.019
Muscle Strength
(R) hip extension Normal Normal 0.079
(L) hip extension Normal Normal 0.982
(R) hip flexion Normal Normal 0.586
(L) hip flexion Normal Normal 0.774
(R) hip abduction Normal Normal 0.958
(L) hip abduction Normal Normal 0.472
(R) hip adduction Normal Normal 0.945
(L) hip adduction Normal Normal 0.946
(R) hip external rotation Normal Normal 0.853

(L) hip external rotation Normal Normal 0.635

(R) hip internal rotation Normal Normal 0.712
(L) hip internal rotation Normal Normal 0.753
(R) knee flexion Normal Normal 0.854
(L) knee flexion Normal Normal 0.745
(R) knee extension Normal Normal 0.923
(L) knee extension Normal Normal 0.756
(R) ankle dorsiflexion Normal Normal 0.945
(L) ankle dorsiflexion Normal Normal 0.754
(R) ankle plantarflexion Normal Normal 0.986
(L) ankle plantarflexion Normal Normal 0.654
(R) ankle eversion Normal Normal 0.986
(L) ankle eversion Normal Normal 0.235
(R) ankle inversion Normal Normal 0.654
(L) ankle inversion Normal Normal 0.754
Playing Surface 0.011
Natural turf 5 5
Artificial turf
Grass
Lower Extremity Alignment
Leg Length Discrepancy 0.046
Right 91.62±3.75 89.56±2.16
Left 90.38±2.18 88.50±3.01
Navicular Drop Test
Left 12.38±2.18 15.90±2.00
Right 14.09±3.90 14.99±1.45
Q-Angle
Right 2.14±0.13 4.90±0.89
Left 5.37±0.48 5.71±0.12
Knee Joint Laxity 0.589
Lachman Test (no. of positive)
Right 3 3
Left 2 2
Anterior Drawer Test (no. of positive)
Right 3 3
Left 2 2
Foot Posture Index
(R) Foot Posture Index 0.984
Normal 3 3

Supinated 0 0
Highly supinated 0 0
Pronated 2 2
Highly pronated 0 0
(L) Foot Posture Index
Normal 3 3
Supinated 0 0
Highly Supinated 0 0
Pronated 2 2
Highly Pronated 0 0
Playing Position 0.321
Defender 3 3
Midfielder 2 2
Attacker 1 1
Shoe Type 0.432
Round Studded Cleats
Turf Shoes 5 5
Bladed Studded Cleats
Soft Ground
Temperature Neutral Neutral 0.290
Balance (Mean ± SD, SEBT average
reach distance in cm)
(R) Anterior 89.23±1.42 88.37±1.42 0.294
(R) Anterolateral 92.86±4.29 89.31±4.29 0.834
(R) Anteromedial 72.09±3.09 93.10±3.09 0.918
(R) Lateral 90.85±4.89 80.97±4.89 0.472
(R) Medial 78.09±2.48 94.27±2.48 0.381
(R) Posterior 94.08±4.92 86.47±4.92 0.961
(R) Posterolateral 87.97±5.14 78.73±5.14 0.123
(R) Posteromedial 78.57±5.38 83.84±5.38 0.412
(L) Anterior 83.84±5.20 78.57±5.20 0.512
(L) Anterolateral 78.73±5.14 87.97±5.14 0.532
(L) Anteromedial 86.47±5.15 94.08±5.15 0.641
(L) Lateral 94.27±2.79 78.09±2.79 0.512
(L) Medial 80.97±3.35 90.85±3.35 0.564
(L) Posterior 93.10±5.14 72.09±5.14 0.632
(L) Posterolateral 89.31±5.80 92.86±5.80 0.245
(L) Posteromedial 88.37±3.52 89.23±3.52 0.523
*SD = Standard Deviation, EG = Experimental Group, CG = Control Group, Yrs = Years, ROM = Range of Motion, (R) = Right, (L)
= Left

The correlation between Anterior Cruciate Ligament (ACL) injury prognosticating factors
ang agility is shown in Table 2.1. Chi-Square correlation revealed a statistically significant high
positive correlation between agility and playing surface (p=.049). Pearson correlation revealed a
statistically significant high positive correlation between agility and age (r=.735, p=.016), (R) hip
extension ROM (r=.668, p=.040), (L) hip extension ROM (r=.780, p=.022), (R) hip flexion ROM
(r=.612, p=.013), (L) hip flexion ROM (r=.789, p=.026), (R) hip abduction ROM (r=.737, p=.039),
(L) hip abduction ROM (r=.759, p=.045), (R) hip adduction ROM (r=.645, p=.018), (L) hip
adduction ROM (r=.602, p=.015), (R) hip external rotation ROM (r=.716, p=.027), (L) hip external
rotation ROM (r=.643, p=.021), (R) hip internal rotation ROM (r=.680, p=.020), (L) hip internal
rotation ROM (r=.655, p=.019), (R) knee flexion ROM (r=.624, p=.014), (L) knee flexion ROM
(r=.676, p=.033), (R) ankle dorsiflexion ROM (r=.701, p=.048), (L) ankle dorsiflexion ROM
(r=.722, p=.031), (R) ankle plantarflexion ROM (r=.650, p=.037), (L) ankle plantarflexion ROM
(r=.650, p=.034), (R) ankle eversion ROM (r=.799, p=.028), (L) ankle eversion ROM (r=.611,
p=.017), (R) ankle inversion ROM (r=.613, p=.023), (L) ankle inversion ROM (r=.690, p=.041)
and leg length discrepancy (r=.845, p=.040). All other factors showed statistically insignificant
correlation.

Table 2.1 Correlation between Anterior Cruciate Ligament Injury Prognosticating Factors and Agility.
VARIABLES Correlation coefficient p-value
Age (Mean±SD, yrs) 0.735 0.016
Height 0.234 0.058
BMI 0.532 0.067
(R) hip extension 0.668 0.040
(L) hip extension 0.780 0.022
(R) hip flexion 0.612 0.013
(L) hip flexion 0.789 0.026
(R) hip abduction 0.737 0.039
(L) hip abduction 0.759 0.045
(R) hip adduction 0.645 0.018
(L) hip adduction 0.602 0.015
(R) hip external rotation 0.716 0.027
(L) hip external rotation 0.643 0.021
(R) hip internal rotation 0.680 0.020
(L) hip internal rotation 0.655 0.019
(R) knee flexion 0.624 0.014
(L) knee flexion 0.676 0.033
(R) ankle dorsiflexion 0.701 0.048
(L) ankle dorsiflexion 0.722 0.031
(R) ankle plantarflexion 0.650 0.037
(L) ankle plantarflexion 0.650 0.034
(R) ankle eversion 0.799 0.028
(L) ankle eversion 0.611 0.017
(R) ankle inversion 0.613 0.023
(L) ankle inversion 0.690 0.041
Muscle Strength


(R) knee extension 0.456 0.695
(L) knee extension 0.700 0.878
Leg Length Discrepancy 0.845 0.040
Navicular Drop Test
Left .092 0.059
Right 0.532 0.064
Q-Angle
Right 0.077 0.089
Left 0.090 0.054
Knee Joint Laxity
Lachman Test
Right 0.234
Left 0.765
Anterior Drawer Test
Right 0.134
Left 0.345
Foot Posture Index
(L) Foot Posture Index 0.564
Shoe Type 0.731
Temperature 0.560
(R) Anterior 0.326 0.643

(R) Anterolateral 0.160 0.724

(R) Anteromedial 0.242 0.642
(R) Lateral 0.634 0.521
(R) Medial 0.235 0.234
(R) Posterior 0.134 0.336
(R) Posterolateral 0.222 0.157
(R) Posteromedial 0.745 0.356
(L) Anterior 0.367 0.754
(L) Anterolateral 0.734 0.257
(L) Anteromedial 0.745 0.374
(L) Lateral 0.634 0.367
(L) Medial 0.856 0.822
(L) Posterior 0.683 0.684
(L) Posterolateral 0.795 0.799
(L) Posteromedial 0.128 0.702
Leg Dominance 0.050
= Left

The correlation between Anterior Cruciate Ligament (ACL) injury prognosticating factors
ang agility is shown in Table 2.2. Chi-Square correlation revealed a statistically significant high
negative correlation between agility and playing surface (p=.049). Pearson correlation revealed a
statistically significant high negative correlation between agility and age (r=-.735, p=.016), (R) hip
extension ROM (r=-.668, p=.040), (L) hip extension ROM (r=-.780, p=.022), (R) hip flexion ROM
(r=-.612, p=.013), (L) hip flexion ROM (r=-.789, p=.026), (R) hip abduction ROM (r=-.737,
p=.039), (L) hip abduction ROM (r=-.759, p=.045), (R) hip adduction ROM (r=-.645, p=.018), (L)
hip adduction ROM (r=-.602, p=.015), (R) hip external rotation ROM (r=-.716, p=.027), (L) hip
external rotation ROM (r=-.643, p=.021), (R) hip internal rotation ROM (r=-.680, p=.020), (L) hip
internal rotation ROM (r=-.655, p=.019), (R) knee flexion ROM (r=-.624, p=.014), (L) knee flexion
ROM (r=-.676, p=.033), (R) ankle dorsiflexion ROM (r=-.701, p=.048), (L) ankle dorsiflexion
ROM (r=-.722, p=.031), (R) ankle plantarflexion ROM (r=-.650, p=.037), (L) ankle plantarflexion
ROM (r=-.650, p=.034), (R) ankle eversion ROM (r=-.799, p=.028), (L) ankle eversion ROM
(r=-.611, p=.017), (R) ankle inversion ROM (r=-.613, p=.023), (L) ankle inversion ROM (r=-.690,
p=.041) and leg length discrepancy (r=-.845, p=.040). All other factors showed statistically
insignificant correlation

Table 2.2 Correlation between Anterior Cruciate Ligament Injury Prognosticating Factors and Agility.
VARIABLES Correlation coefficient p-value
Age (Mean±SD, yrs) -0.735 0.016
Height 0.234 0.058
BMI 0.532 0.067
(R) hip extension -0.668 0.040
(L) hip extension -0.780 0.022
(R) hip flexion -0.612 0.013
(L) hip flexion -0.789 0.026
(R) hip abduction -0.737 0.039
(L) hip abduction -0.759 0.045
(R) hip adduction -0.645 0.018
(L) hip adduction -0.602 0.015
(R) hip external rotation -0.716 0.027
(L) hip external rotation -0.643 0.021
(R) hip internal rotation -0.680 0.020
(L) hip internal rotation -0.655 0.019
(R) knee flexion -0.624 0.014
(L) knee flexion -0.676 0.033
(R) ankle dorsiflexion -0.701 0.048
(L) ankle dorsiflexion -0.722 0.031
(R) ankle plantarflexion -0.650 0.037
(L) ankle plantarflexion -0.650 0.034
(R) ankle eversion -0.799 0.028
(L) ankle eversion -0.611 0.017
(R) ankle inversion -0.613 0.023
(L) ankle inversion -0.690 0.041
Muscle Strength


(R) knee extension 0.456 0.695
(L) knee extension 0.700 0.878
Leg Length Discrepancy -0.845 0.040
Navicular Drop Test
Left .092 0.059
Right 0.532 0.064
Q-Angle
Right 0.077 0.089
Left 0.090 0.054
Knee Joint Laxity
Lachman Test
Right 0.234
Left 0.765
Anterior Drawer Test
Right 0.134
Left 0.345
Foot Posture Index
(L) Foot Posture Index 0.564
Shoe Type 0.731
Temperature 0.560
(R) Anterior 0.326 0.643

(R) Anterolateral 0.160 0.724

(R) Anteromedial 0.242 0.642
(R) Lateral 0.634 0.521
(R) Medial 0.235 0.234
(R) Posterior 0.134 0.336
(R) Posterolateral 0.222 0.157
(R) Posteromedial 0.745 0.356
(L) Anterior 0.367 0.754
(L) Anterolateral 0.734 0.257
(L) Anteromedial 0.745 0.374
(L) Lateral 0.634 0.367
(L) Medial 0.856 0.822
(L) Posterior 0.683 0.684
(L) Posterolateral 0.795 0.799
(L) Posteromedial 0.128 0.702
Leg Dominance 0.050
= Left

The Effects of Multiple-Angle Hamstring Isometric Exercises on Agility is shown in Table

2. The Mann-Whitney revealed between group comparisons revealed a statistically significant
effect on the Agility among the Experimental Group (EG) and Control Group (CG) at week 2
(p=0.040), week 4 (p=0.025) and week 6 (p=0.011). It was also revealed that there was statistically
insignificant effect in the within-group of EG and CG (p =0.068).
Table 3.1 Effects of Multiple-Angle Hamstrings Isometric Exercises on Agility

Agility (Mean ± SD, TTA score in secs)
EG CG
Weeks (n=5) (n=5) p-value
0 11.66±2.42 12.19±0.91 0.175
2 9.73±1.87 10.41±0.42 0.040
4 7.91±0.59 8.53±0.49 0.025
6 6.98±0.89 6.98±0.88 0.011
Mean Difference 5.37 ± 1.01 4.16 ± 0.62
p-value 0.068 0.068
*SD=Standard Deviation, EG=Experimental Group, CG=Control Group, TTA= T-Test of Agility, Secs= Seconds
*Interpretation: The greater the time, the less agile.
5.0 DISCUSSION
The demographic characteristics of the study’s subjects are consistent with the
epidemiology of anterior cruciate ligament injury in terms of height, weight, BMI, muscle strength,
balance, leg dominance, knee joint laxity, foot posture, playing position, shoe type and temperature
(Beynnon, Connolly & Murphy, 2003; Barber-Westin et al., 2009; Cimino, Setter, & Volk, 2010;
Serpel et al., 2012; Alentorn-Geli et al., 2013) except for age, playing surface, muscle flexibility
and leg length discrepancy. In this study, the subjects are younger. Epidemiological studies in
Norwegian and Swedish soccer leagues showed that ACL injury rates peaked in female athletes in
their late teens and early twenties. For male athletes, with the exception of one, most studies showed
the peak occurred in their mid to late 20s (Serpell, Scarvell, Ball, & Smith, n.d.). In this study, the
subject has no leg length discrepancy. According to Daneshmandi, Azhdari, Saki, & Saeed
Daneshmandi (2011), they hypothesized that limbs shorter than the contralateral side may be more
associated with ACL injury risk because the shorter limb would tend to pronate, and thus rotate,

more than longer limbs. In this study, the subject has normal range of motion. One literature shows
that individuals at high risk have a smaller knee flexion angle during athletic tasks than individuals
at low risk. Recent biomechanical studies demonstrated that female recreational athletes exhibited
small knee flexion angles in running, jumping and cutting tasks (Papoutsidakis, 2011). In this study,
the subject plays on a natural turf. Injury to the anterior cruciate ligament (ACL) is frequently cited
as a significant risk to athletes on artificial turf because of the changes in shoe-surface interaction.
Increased frictional force between the athlete’s footwear and the field, coupled with increased force
necessary to ‘‘release’’ from the surface, may contribute to noncontactand contact-related ACL
injury. There is an observed trend in football toward increased risk of ACL injury on modern
artificial turf (synthetic fibers with rubberized infill), and this risk seems to increase with higher
levels of competition (Balazs et al., 2015).
The demographic characteristics of the study’s subject are consistent with the profile of
soccer players in terms of height, weight, BMI, muscle strength, balance, leg dominance, knee joint
laxity, foot posture, playing position, shoe type and temperature (Beynnon, Connolly & Murphy,
2003; Barber-Westin et al., 2009; Cimino, Setter, & Volk, 2010; Serpel et al., 2012; Alentorn-Geli
et al., 2013) except for age, playing surface, muscle flexibility and leg length discrepancy. In this
study the subjects are younger. Increased injury incidence has been reported with increased age
among soccer players, Australian football players, recreational athletes, and military recruits.
Ostenberg and Roos studied 123 female soccer players (age range 14–39 years), and found a
significantly increased risk of overall injury in athletes older than 25 years in comparison with
younger athletes (Murphy, 2003). In this study majority of the subjects play on a natural turf. More
injuries may be incurred on artificial turf than on other surfaces because of its stiffness and the
increased frictional force at the shoe/surface interface (Murphy, 2003). In this study, the subject
has no leg length discrepancy. Playing soccer during the prepubescent growth period could be a
triggering or aggravating factor for LLDs (Guer, Blanchard, Harnagea, Lopez, & Behr, 2017). In
this study the subject has normal range of motion. There is some evidence that ROM is an injury
risk factor for all injuries as a group, ankle injury, and lower extremity injury. Soderman et al found
knee hyperextension greater than 10° to be a risk factor for lower extremity injury in female soccer
players; however, ankle dorsiflexion ROM and hamstring flexibility were not risk factors. Side to

side differences in ankle dorsiflexion ROM and hamstring flexibility were found to be risk factors
for overuse leg injury (Murphy, 2003).
The result of this study indicated that soccer players has significant effect in terms of
playing surface on agility. This was supported by the study of Choi, Sum, & Leung (2015), their
results indicated that subjects showed significantly better overall agility performance (P < 0.05) in
sprinting (Natural Turf: 6.40 ± 0.26 seconds, Agility: 6.24 ± 0.26 seconds) and turning (Natural
Turf: 6.40 ± 0.44 seconds, Artifical Turf: 5.96 ± 0.38 seconds) on Artificial Turf than Natural Turf.
By comparing the trials with and without ball, the present study has shown that the agility
performance test is affected by ground surface and the situation ball carrying effect. The results
show that players’ 40-meter sprinting performance was not affected by carrying balls which means
that the ground surface effect is larger than the ball carrying effect while the turning movement in
“L” test is affected by both effects.
The result of this study indicated that soccer players has significant effect in terms of age
on agility. Agility time decreases with increasing age up to early maturity. Such a decrease in agility
time can be divided into three phases. There is a rather steep decrease in agility time from 7 to 10
years of age (27.1 %) and from 10 to 14 years of age (26.5 %). Afterwards, there is a slow decrease
during puberty, from age 14 to 18 (16.5 %). The ability to reproduce sprint running performance in
subsequent efforts (e.g. repeated-sprint ability) appears to deteriorate as children age (Ratel, Duche,
& Williams, 2006).
The result of this study indicated that soccer players has significant effects in terms of
muscle flexibility on agility. Boden et al (2000) reported that the hamstrings muscles were
significantly more lax in ACL-injured athletes. Pilot work suggests that increased hamstrings
flexibility could be partially responsible for the decreased dynamic control of the knee in female
athletes. It appears that developmental differences in flexibility, especially hamstrings flexibility,
might contribute to the post pubertal gender gap in knee injury rate; however, further research in
this is needed. Lax hamstrings may lead to a delay in hamstrings muscle activation that results in
an absence of co-contraction between the quadriceps and hamstrings muscle groups for a period of
time early in foot strike (Hewett, Myer, & Ford, 2006).

The result of this study indicated that soccer players has significant effects in terms of leg length
discrepancy on agility. In one study they did not identify a significant difference between either leg
length in subjects with and without ACL reconstruction. They included these variables in their
study because they had not been extensively examined in previous studies of lower extremity
structural alignment and ACL injury risk (Daneshmandi, Azhdari, Saki, & Saeed Daneshmandi,
2011).
This study hypothesized that Multiple-Angle Hamstrings Isometric Exercise has no

significant effect on agility among male soccer players with post anterior cruciate ligament injury.
This hypothesis was rejected due to the significant improvements found on the agility between EG
and CG. The main finding showed that both experimental and control groups improved their agility.
However, the experimental group showed a more significant improvement in a short period of time
compared to that of the control group.
The result of the study is consistent with the findings of Folland (2005), who found that
training isometrically at four angles produced significantly greater gains in isometric strength
across a range of angles (assessed with two dynamometers), but similar gains in isokinetic (dynamic)
strength in comparison to dynamic training. The greater isometric strength gains could be due to a
residual angle specificity effect or, perhaps more likely, the greater absolute torque involved with
isometric training. This was further supported by the study of Dogu, Sirzai, Yilmaz, Polat, & Kuran
(2013), this study showed that isometric and isotonic hand exercises decrease pain and disease
activity and improve hand functions, dexterity and quality of life as well as mildly increasing
muscle strength in patients diagnosed as RA. In the study of van Ark et al., (2016), it is the first
study to show a decrease in patellar tendon pain without a modification of training and competition
load and the first study to investigate isometric exercises in a clinical setting. Both isometric and
isotonic exercise programs are easy-to-use exercises that can reduce pain from patellar
tendinopathy for athlete’s in-season (van Ark et al., 2016). In the study of Coleman (1969), the
results of the multiple linear regression analysis indicated that unilateral isometric and isotonic
contractions of equal load, duration, and range of movement were similarly effective in the
development of muscular strength of the contralateral limb (Coleman, 1969).

However, the result of the study is in contrast with the findings of Latorre Román, Villar
Macias, & García Pinillos (2018), they examine the effects of a 10 week contrast training
programme (isometric + plyometric) on jumping, sprinting abilities and agility performance in
prepubertal basketball players. Significant differences were found in posttest between EG and CG
in sprint and T-test: EG showed better results than CG. The CT programme led to increases in
vertical jump, sprint and agility levels, so that the authors suggest that prepubertal children exhibit
high muscular strength trainability. This was further supported by the study of Rio et al., (2017),
Isometric muscle contractions resulted in significantly greater immediate analgesia than isotonic
muscle contractions in a 4-week trial while athletes were playing and training. There are potential
benefits to the increased immediate pain relief demonstrated by isometric exercise. Both protocols
appear efficacious for in-season athletes to reduce pain, however, isometric contractions
demonstrated significantly greater immediate analgesia throughout the 4-week trial.
Greater analgesia may increase the ability to load or perform. In the study of Anwer & Alghadir
(2014) it shows that 5-week of isometric quadriceps exercise program for patients with knee OA
showed beneficial effects on quadriceps muscle strength, pain, and functional disability. In the
study of Unver & Alarab (2018), there was no difference between the use isotonic and isometric in
decrease pain intensity, but there were significant differences in improvement functional disability
where isometric exercises allow a greater improvement in functional disability than isotonic in low
back pain.
6.0 CONCLUSION
In this study, soccer players with decrease range of motion towards knee flexion, higher
leg length discrepancy and plays on artificial grass tend to have lower agility. Both usual training
and multiple angle hamstring isometric exercises have equal improvement to agility of soccer
players with anterior cruciate ligament reconstruction.
7.0 RECOMMENDATION
On the basis of the study’s findings, it is recommended that soccer players who age >25
years old undergo agility training or reassign to other position that does not require agility. Soccer
players with limited range of motion undergo stretching exercises or joint mobilization exercises

to increase their range of motion and improve their agility training. Soccer players with higher leg
length discrepancy, should add shoe inserts to correct their leg length discrepancy. Soccer players
should undergo agility under all playing surface starting from natural turf to grass field to artificial
turf. It is recommended that soccer players who had acute or recent injury should undergo multiple
angle hamstrings isometric exercise for strengthening and agility improvement and soccer players
who has injury occurred for more than 7 months should undergo usual training. It is also
recommended that soccer players should undergo multiple angle hamstrings isometric exercise to
improve their agility during their off season tournament and undergo usual training during their on
season tournament.

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Effect of Multiple Angle Hamstring Isometric Exercises on Agility

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EFFECT OF MULTIPLE ANGLE HAMSTRING ISOMETRIC… 1

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

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

(L) hip external rotation Normal Normal 0.635

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

(R) hip internal rotation 0.426 0.456

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

(R) Anterolateral 0.160 0.724

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

(R) hip internal rotation 0.426 0.456

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

(R) Anterolateral 0.160 0.724

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

The Effects of Multiple-Angle Hamstring Isometric Exercises on Agility is shown in Table

Table 3.1 Effects of Multiple-Angle Hamstrings Isometric Exercises on Agility

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

This study hypothesized that Multiple-Angle Hamstrings Isometric Exercise has no

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

in young football players. Journal of Sports Sciences, 33(12), 1293–1297. Retrieved on

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

OUR LADY OF FATIMA UNIVERSITY COLLEGE OF PHYSICAL THERAPY

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