SPORTS BIOMECHANICS

2020, VOL. 19, NO. 5, 587–600

https://doi.org/10.1080/14763141.2018.1503322

ARTICLE

The biomechanical effect of warm-up stretching strategies

on landing mechanics in female volleyball athletes
Jason M. Avedesiana, Lawrence W. Judgeb, Henry Wanga and D. Clark Dickin a

College of Health, Biomechanics Laboratory, Ball State University, Muncie, IN, USA;
bSchool of Kinesiology, Ball State University, Muncie, IN, USA

ABSTRACT ARTICLE HISTORY

Female volleyball athletes incorporate dynamic and static stretching Received 13 March 2018
into a warm-up, with evidence generally supporting dynamic stretch- Accepted 17 July 2018
ing to improve performance. However, the effects of these stretching KEYWORDS
practices on injury risk during subsequent volleyball manoeuvres Kinematics; anterior cruciate
have yet to be fully elucidated in the warm-up literature. Three- ligament; injury prevention
dimensional kinematic data associated with non-contact, lower
extremity injury were recorded on 12 female collegiate club volley-
ball athletes during unilateral landing tasks on the dominant and
non-dominant limb. Participants performed landings as part of a
volleyball-simulated manoeuvre prior to and post-dynamic (DWU)
and combined dynamic-static (CDS) warm-ups. A significant reduc-
tion in non-dominant hip adduction angle was found at 15 min post
CDS warm-up (p = 0.016; d = 0.38), however, no other warm-up
differences were detected. The non-dominant limb demonstrated
greater knee abduction (p = 0.006; d = 0.69) and internal rotation
angle (p = 0.004; d = 0.88), suggesting that this limb demonstrates
more risky landing patterns that are potentially due to altered trunk
positioning upon landing. The results show that the majority of
selected landing kinematics are unaffected by additional static
stretching to a dynamic warm-up and that the non-dominant limb
may be at a higher injury risk in female volleyball athletes.

Introduction
The sport of volleyball places unique biomechanical demands on athletes, including the
completion of repetitive jump-landing manoeuvres during training or competition. It
has been observed that female volleyball athletes perform up to 73 jump-landings over
the course of a two game period (Tillman, Hass, Brunt, & Bennett, 2004), and the
frequency of this movement places cumulative stress on lower extremity joints and
musculature (Bere, Kruczynski, Veintimilla, Hamu, & Bahr, 2015). When performing a
landing task, female athletes often demonstrate landing mechanics that increase the
injury risk to the anterior cruciate ligament (ACL) and other lower extremity structures
(Pappas, Hagins, Sheikhzadeh, Nordin, & Rose, 2007). It is estimated that females
involved in landing sports are two-to-eight times more likely to sustain an ACL injury
compared to males (Boden, Griffin, & Garrett, 2000). Females tend to land in a more

CONTACT D. Clark Dickin dcdickin@bsu.edu

© 2018 Informa UK Limited, trading as Taylor & Francis Group
588 J. M. AVEDESIAN ET AL.

erect trunk position with less hip and knee flexion (Weinhandl, Joshi, & O’Connor,
2010) and increased knee valgus (i.e., greater hip adduction and knee abduction) angles
(Pappas et al., 2007; Quatman & Hewett, 2009), with these factors being part of the
multi-planar landing pattern that heightens the risk of lower extremity injury in female
competitors (Quatman & Hewett, 2009). Landing type may also influence injury, as
unilateral (single-leg) landings are further associated with high risk biomechanical
patterns (Quatman & Hewett, 2009; Weinhandl et al., 2010) compared to bilateral
(double-leg) counterparts. In women’s volleyball, nearly half (35% left limb, 10% right
limb) of all offensive landings occur in a unilateral position (Tillman, Hass et al., 2004),
therefore this sporting population may be at an increased risk for sustaining a non-
contact lower extremity injury. An estimated 26–60% of all knee injuries in women’s
volleyball are a sprain or tear of the ACL (Agel, Palmieri-Smith, Dick, Wojtys, &
Marshall, 2007; Majewski, Susanne, & Klaus, 2006), with these injuries predominantly
occurring during the completion of a jump-landing manoeuvre (Agel et al., 2007).
To minimise the injury risk from sport demands, female volleyball athletes practice a
variety of warm-ups strategies prior to training or competition (Judge, Bodey, Bellar,
Bottone, & Wanless, 2010). Specifically, an athlete may choose to perform dynamic
activity, static stretching, or a combination of the two (Judge et al., 2010). While
dynamic warm-ups (DWUs) have been demonstrated to improve volleyball-related
attributes such as jump height when compared to static stretching (Kruse, Barr,
Gilders, Kushnick, & Rana, 2013; Saez Saez De Villarreal, González-Badillo, &
Izquierdo, 2007), researchers continue to debate the efficacy of incorporating static
stretching into a warm-up for injury prevention purposes (Hadala & Barrios, 2009;
Zakaria, Kiningham, & Sen, 2015). The majority of female volleyball athletes perform
dynamic activity and static stretching prior to an athletic event (Judge et al., 2010) in a
combined dynamic-static (CDS) type of warm-up. While no research to date has been
conducted on injury risk after a CDS warm-up in volleyball athletes, Zakaria et al.
(2015) reported no differences in lower extremity injuries in male soccer athletes when
a CDS warm-up was compared to a DWU. A popular warm-up that has demonstrated
significant reductions in injury risk is the FIFA 11+ protocol, with researchers indicat-
ing a 30–70% reduction in athlete injury rates following this particular warm-up
(Barengo et al., 2014). The FIFA 11+ consists mainly of running and jumping move-
ments and excludes static stretching. While the aforementioned studies provide context
into the effects of different warm-up protocols on injury risk, there is a necessity to
analyse the biomechanics of sporting movements following warm-up to further estab-
lish practices that reduce athletic injuries (Barengo et al., 2014).
The current warm-up literature lacks sufficient evidence to make a definitive con-
clusion as to which warm-up type enhances movement mechanics; however, recent
evidence suggests that a DWU improves biomechanical performance indicators such as
hip and knee angular velocity (Amiri-Khorasani & Ferdinands, 2014) and deepest knee
flexion of the kicking limb during a soccer instep manoeuvre (Amiri-Khorasani,
Mohammadkazemi, Sarafrazi, Riyahi-Malayeri, & Sotoodeh, 2012). Additionally, female
volleyball athletes have displayed acute improvements in vertical jumping kinetics,
including peak force production and the rate of force development, after performing
a DWU compared to static stretching and control conditions (Kruse, Barr, Gilders,
Kushnick, & Rana, 2015). As it relates to jump-landings, a recent investigation of
 SPORTS BIOMECHANICS 589

landing mechanics in preadolescent female soccer players using the FIFA 11+ warm-up
revealed a reduction in peak knee valgus and ankle eversion moments during a bilateral
jump-landing task following an eight week intervention (Thompson et al., 2017).
However, no significant differences were reported during unilateral jump-landings
over this same time period (Thompson et al., 2017). Additional analysis into the effects
of warm-up on landing biomechanics have concluded that dynamic-based warm-ups
reduce peak ground reaction forces (GRFs; DiStefano et al., 2016) and improve knee
separation values (Grandstrand, Pfeiffer, Sabick, DeBeliso, & Shea, 2006). Following a
DWU, movement biomechanics that decrease injury risk (i.e., reduced knee valgus)
may be due to physiological mechanisms such as increased tissue temperature (Fletcher
& Monte-Colombo, 2010) and muscular activity (Amiri-Khorasani, Abu Osman, &
Yusof, 2010) during sporting manoeuvres. Generally, static stretching in a warm-up
impairs muscle electromyography activity (Amiri-Khorasani et al., 2010) that may lead
to reductions in quantifiable movement mechanics such as kicking kinematics (Amiri-
Khorasani & Ferdinands, 2014) or jumping kinetics (Kruse et al., 2015).
Even without support from the current literature, female volleyball athletes often
include static stretching exercises in combination with dynamic activity (CDS warm-
up) prior to an athletic event (Judge et al., 2010). However, it is unknown whether static
stretching influences biomechanical factors associated with injury risk during landing
manoeuvres. This particular sporting population may be at a heightened injury risk to the
ACL and surrounding structures (i.e., medial collateral ligament, menisci) due to altered
landing mechanics (Tillman, Criss, Brunt, & Hass, 2004) and the frequent performance of
landings during training and competition (Agel et al., 2007). The biomechanical manner
in which female volleyball athletes jump is affected by the type of stretching strategy
performed in a warm-up (Kruse et al., 2015), however, it is unknown whether stretching
affects kinematic patterns during the landing phase of these manoeuvres. There is a need
to examine biomechanical patterns following warm-ups to develop procedures that
mitigate injury in high-risk athletic populations (Barengo et al., 2014). Therefore, the
aim of the present investigation was to examine the effects of additional static stretching
to a dynamic warm-up on dominant and non-dominant unilateral landing kinematics in
female volleyball athletes. It was hypothesised that a dynamic warm-up with additional
static stretching (CDS) would demonstrate differences in unilateral landing kinematics
compared to the performance of solely dynamic activity (DWU). Specifically, after
completion of the CDS warm-up, athletes would demonstrate kinematic patterns that
increase injury risk (i.e., decreased hip and knee flexion angles along with increased knee
valgus angle) during a landing manoeuvre. A secondary hypothesis was that no differ-
ences would be observed between dominant and non-dominant landing kinematics.

Methods
Participants
Twelve female club volleyball athletes (age: 19.8 ± 1.2 years; height: 1.72 ± 0.06 m; mass:
70.9 ± 5.4 kg; volleyball playing experience: 9.8 ± 2.6 years), free from previous ankle or
knee injuries and any physiological or neurological conditions that would limit landing
technique, participated in this study. The athletes in this study trained three times per
590 J. M. AVEDESIAN ET AL.

week and competed in nationally sanctioned collegiate club volleyball tournaments. A

power analysis was conducted on knee valgus angle to confirm appropriate sample size
(alpha = 0.05; power = 0.80; Pappas et al., 2007). Participants were instructed to refrain
from strenuous physical activity at least 24 h prior to each testing session. Each
participant gave their informed consent prior to study initiation via a Ball State
University approved form in accordance with the Institutional Review Board and
Declaration of Helsinki.

Data collection
Participants visited the laboratory for two experimental sessions on non-consecutive
days to complete both warm-ups protocols. To minimise learning effects, a counter-
balanced, within-participant study design was implemented, in which the order of
warm-up completion (DWU and CDS) was randomised for each participant. Upon
arrival, participants were provided standardised compression clothing and athletic
footwear (Nike WMNS T-Lite VII Leather, Beaverton, OR, USA). Anthropometric
measurements were taken for each participant, including height, mass, leg length,
knee width, ankle width and inter-anterior superior iliac spine distance. These measures
were used for subsequent biomechanical calculations in the data processing software.
Joint width at the approximated joint centre was measured with an anthropometer
(Lafayette Instrument Company, Lafayette IN, USA) and leg length was measured with
a tape measure from the lateral malleolus to the anterior-superior iliac spine. Height
and mass were measured using a digital scale (Health-o-meter, McCook, IL, USA).
Prior to data collection, participants were instructed to complete three minutes of
self-paced, low-to-moderate intensity aerobic activity on a treadmill (velocity ≥ 3.5
mph). This period of aerobic exercise was implemented in accordance with recom-
mended pre-activity practices for active individuals (Fradkin, Zazryn, & Smoliga, 2010).
Participants then completed a vertical jump height assessment using a Vertec Jump
system (Sports Imports, Columbus, OH, USA). The Vertec Jump system was placed to
the right of each participant, corresponding to the hand that would be used to perform
an offensive volleyball manoeuvre (all participants reported the right arm as their
preferred hitting limb). Participants performed three maximum counter-movement
jumps (CMJs) and were encouraged to displace the highest Vertec vane possible with
the right hand. The best CMJ height was recorded during each testing session. To
control for effort, participants had to displace at least 80% of their maximum CMJ
height with the right hand during the pre- and post-warm-up jump-landing trials.
After completion of the jump height testing, participants performed landing trials (pre-
warm-up landings) on the dominant and non-dominant limb in a randomised order.
Limb dominance was defined as the preferred limb to kick a ball (Dickin, Johann,
Wang, & Popp, 2015). Five successful landing trails were recorded for each limb. These
procedures were repeated for the participants’ second test session.
Following the pre-warm-up landing trials, participants completed the DWU or CDS
warm-up protocol. The stretching exercises in the present investigation were used pre-
viously to examine jumping performance in female volleyball athletes (Kruse et al., 2015).
The CDS warm-up consisted of dynamic activity with additional static stretching, as it is
common for this sporting population to include both modalities in a pre-activity practice
 SPORTS BIOMECHANICS 591

(Judge et al., 2010). The DWU consisted of 14 whole-body dynamic exercises (light
jog across a 10 m platform, leg cross-overs, high knee-pull, high lunge-pull, high knees-
to-chest, quadriceps pull, hip cradle, lunge with twist, reverse kick, high kicks/reach,
spiderman, skip-hop, back pedal and high kicks), each performed for approximately 30 s
(total DWU warm-up duration = 7 min). To complete the CDS warm-up, participants
performed the same dynamic activity followed by seven static stretches to the major lower
extremity muscle groups. These static exercises included: pretzel, supine knee flex, hip
flexor lunge, hurdler’s stretch, quadriceps pull, calf stretch and soleus stretch. Participants
held the static stretch to the point of mild discomfort for 30 s on each limb (Kruse et al.,
2015), for a total CDS warm-up duration of 14 min. The order of exercise completion for
the CDS warm-up was implemented in a manner to investigate whether additional static
stretching following dynamic activity influenced landing kinematics in female
volleyball players.
The landing task consisted of participants starting approximately 1 m behind the
Vertec Jump system, which was placed to the right of the landing platform so that
participants could perform a simulated offensive volleyball manoeuvre with their pre-
ferred hitting arm (Kruse et al., 2015). Participants initiated the manoeuvre with a one-
step approach that was followed by a bilateral CMJ (displacing at least 80% of their
maximum CMJ height on the Vertec vanes) and a unilateral landing on the dominant
or non-dominant limb. The arms swung backwards during the approach, followed by
an upward motion in concurrence with the CMJ. Specifically, participants were
instructed to land with full foot contact on the landing platforms, avoiding contralateral
limb ground contact until the landing limb began its ascent. Three practice trials on
each limb were allowed prior to data collection, and five successful trials were recorded
at each time point. A 30 s rest was given between each trial to control for potential
fatiguing effects (Dickin et al., 2015). If the participant did not displace at least 80% of
their maximum CMJ height or failed to land with a full foot on the landing platforms,
the trial was discarded. Landing trials were completed at the pre-warm-up period, along
with at 1 min post- and 15 min post-warm-up to assess acute changes in landing
kinematics across time. Participants completed 1 min post-warm-up landings until five
successful trials on each limb were collected. Therefore, participants had approximately
five minutes of rest between the 1 min post- and 15 min post-warm-up trials.
Kinematic data were collected at 200 Hz using a 12-camera Vicon motion-analysis
system (VICON Inc., Denver CO, USA) with retro-reflective markers placed on the
following anatomical landmarks via a modified Plug-In-Gait Model (Vicon Motion
System Ltd., Oxford, UK): jugular notch, xiphoid process, medial and lateral femoral
condyles, medial and lateral malleoli, posterior calcaneus, base of the second metatarsal,
and the base of the fifth metatarsal. Bilateral markers were placed on the acromion
process, posterior superior iliac spine, anterior superior iliac spine, iliac crest and four-
marker clusters on the lateral aspect of the thigh and shank (Dickin et al., 2015).

Data processing/analysis
Data were processed in Visual 3D (Version 6, C-Motion, Inc., Germantown, MD, USA)
to quantify lower extremity landing kinematics. The independent variables in this study
were warm-up, limb and time. The dependent variables of interest were hip and knee
592 J. M. AVEDESIAN ET AL.

flexion angle at initial ground contact, along with maximum values of the following
variables during the landing phase (defined as initial limb contact until peak knee
flexion): hip and knee flexion, hip adduction and internal rotation, and knee abduction
and external/internal rotation. All variables were reported in degrees. These variables
were analysed due to their associated injury risk in female athletes performing landing
manoeuvres (Quatman & Hewett, 2009; Swartz, Decoster, Russell, & Croce, 2005).
Marker trajectory data were smoothed with a fourth-order Butterworth low pass- filter
at 8 Hz (Brown, Wang, Dickin, & Weiss, 2014). Kinematic data were analysed as the
average of five landing trials at each of the three time points for the dominant and non-
dominant limbs. Prior research on landing performance has deemed an average of at
least four trials to be sufficient for landing performance stability (ICC > 0.75; James,
Herman, Dufek, & Bates, 2007).

Statistical analysis
Statistical analyses were performed using SPSS software (Version 24.0 for Windows,
IMB, Inc., Chicago, IL, USA), with descriptive statistics (mean ± SD) being reported for
all kinematic variables. To determine statistical significance, separate 2 × 2 × 3 (warm-
up by limb by time) ANOVAs were performed with repeated measures on the last
factor, with follow-up pairwise comparisons where appropriate to determine the loca-
tion of specific differences. Normality was assessed with the Kolmogorov-Smirnov and
Shapiro-Wilk statistics. Greenhouse-Geisser corrections were applied to data that vio-
lated sphericity. An alpha level of 0.05 was set for all tests and Cohen’s d effect sizes
(0.2 = small, 0.6 = moderate, 1.2 = large) were reported for all variables of interest
(Hopkins, Marshall, Batterham, & Hanin, 2009).

Results
Descriptive values of each kinematic variable from the within-participant analyses are
displayed in Table 1. The ANOVA for hip flexion angle at initial ground contact and
maximum hip internal rotation angle did not reveal any significant main or interaction
effects. Shown in Figure 2, a higher-order interaction (warm-up × limb × time) was
observed for maximum hip adduction angle [F(2,22) = 6.432; p = 0.006]. Specifically,
non-dominant hip adduction angle significantly decreased from pre-CDS warm-up
(8.3° ± 4.8) to 15 min post-CDS warm-up (6.5° ± 4.7), confirmed with a simple
follow-up pairwise contrast (p = 0.016; d = 0.38). No differences in maximum hip
adduction angle were detected in the dominant limb or DWU condition.
A main effect of time was detected for maximum knee abduction, knee external rotation,
and knee internal rotation angles. Specifically, the knee demonstrated less abduction angle
during pre-warm-up landings compared to 1 min post-warm-up [F(1,11) = 11.508;
p = 0.006; d = 0.21] and 15 min post-warm-up [F(1,11) = 41.873; p < 0.001; d = 0.29].
Examination of transverse knee kinematics revealed significantly less internal rotation
angle during pre-warm-up trials versus one minute post-warm-up [F(1,11) = 52.873;
p < 0.001; d = 0.27] and 15 min post-warm-up trials [F(1,11) = 11.572; p = 0.006;
d = 0.22]. Maximum knee external rotation angle was significantly greater during pre-
warm-up landings compared to 1 min post-warm-up [F(1,11) = 17.386; p = 0.002; d = 0.27]
 SPORTS BIOMECHANICS 593

Table 1. Descriptive statistics (mean, SD) for limb kinematics in each warm-up condition at pre
warm-up, 1 min post warm-up, and 15 min post warm-up. All kinematics are reported in degrees.
Dominant limb Non-dominant limb
DWU Pre 1 min post 15 min post Pre 1 min post 15 min post
Hip IC flexion 27.8 (5.9) 27.2 (7.3) 27.0 (7.1) 27.4 (5.9) 26.9 (6.5) 27.3 (6.4)
Peak hip ADDa 10.8 (3.6) 11.0 (2.9) 10.0 (4.1) 7.4 (4.4) 7.6 (3.9) 7.6 (3.2)
Peak hip IR 2.3 (6.9) 1.4 (6.8) 1.6 (7.3) 3.7 (5.7) 3.8 (6.8) 4.2 (7.1)
Knee IC flexion 9.8 (4.1) 10.3 (4.5) 10.3 (4.4) 10.1 (3.2) 10.3 (2.5) 10.4 (2.8)
Peak knee ABDb,c −5.1 (3.5) −5.4 (3.7) −5.8 (4.0) −6.7 (4.3) −7.3 (4.5) −7.3 (4.3)
Peak knee ERb,c −3.1 (5.2) −1.7 (5.1) −1.3 (4.7) 2.6 (4.9) 4.3 (4.2) 4.6 (4.2)
Peak knee IRb,c 10.1 (5.0) 11.7 (4.4) 11.0 (4.1) 15.4 (7.3) 17.4 (7.4) 16.7 (7.6)
CDS
Hip IC flexion 30.2 (7.3) 29.9 (7.6) 30.5 (7.3) 30.0 (6.6) 29.5 (7.2) 29.3 (7.4)
Peak hip ADDa 8.8 (3.4) 9.7 (4.0) 9.0 (3.9) 8.3 (4.8) 7.9 (3.9) 6.5 (4.7)
Peak hip IR 2.2 (2.5) 0.8 (2.5) 0.7 (3.2) 4.1 (6.4) 3.9 (6.7) 3.3 (6.2)
Knee IC flexion 9.2 (5.0) 8.7 (4.8) 8.9 (4.9) 11.5 (3.7) 11.6 (4.1) 11.1 (4.2)
Peak knee ABDb,c −5.0 (2.9) −5.6 (2.7) −6.1 (2.9) −7.7 (2.9) −9.1 (2.8) −9.3 (3.2)
Peak knee ERb,c −2.8 (5.0) −2.2 (4.8) −1.9 (5.1) 0.8 (5.2) 3.1 (5.6) 2.6 (4.9)
Peak knee IRb,c 9.1 (5.1) 10.8 (5.5) 11.0 (4.3) 13.9 (6.7) 15.7 (6.2) 15.2 (6.2)
a
Indicates significant interaction effect of warm-up by limb by time
b
Indicates significant main effect of limb
c
Indicates significant main effect of time
DWU = Dynamic Warm-Up
CDS = Combined Dynamic-Static Warm-Up
ABD = abduction
ADD = adduction
ER = external rotation
IR = internal rotation
IC = initial contact

and 15 min post warm-up [F(1,11) = 26.211; p < 0.001; d = 0.31]. No significant differences
were reported between the one minute post- and 15 min post-warm-up trials for the
kinematic variables of interest.
A main effect of limb was detected for maximum knee abduction, knee external
rotation, and knee internal rotation angles. Maximum non-dominant knee abduction
angle [F(1,11) = 11.330; p = 0.006; d = 0.69] and internal rotation angle [F(1,11) = 12.660;
p = 0.004; d = 0.88] during landing were significantly greater than the dominant limb.
The dominant limb demonstrated significantly greater external rotation compared to the
non-dominant limb [F(1,11) = 14.059; p = 0.003; d = 1.07].

Discussion and implications

The goal of this study was to determine the effects of additional static stretching to a
dynamic warm-up on unilateral landing kinematics in female volleyball athletes.
Previous research has suggested that static stretching impairs neuromuscular and
biomechanical performance (Amiri-Khorasani & Ferdinands, 2014; Amiri-Khorasani
et al., 2010). Therefore, it was hypothesised that following the CDS warm-up, female
volleyball athletes would perform unilateral landings with higher injury risk kinematic
patterns (i.e., decreased hip and knee flexion angles; increased hip adduction and knee
abduction angles) compared to the DWU. An additional hypothesis was that no
differences would be detected between the dominant and non-dominant limb. The
majority of selected kinematic variables in this investigation did not demonstrate warm-
up differences, suggesting that these variables are unaffected by additional static
594 J. M. AVEDESIAN ET AL.

stretching to a DWU. However, the CDS warm-up demonstrated a significant reduction

in peak hip adduction angle, which did not support the first hypothesis. A secondary
observation from this analysis was that select landing kinematics (i.e., knee abduction
and external/internal rotation angles) significantly differed between the dominant and
non-dominant limb.
Female volleyball athletes are 3.6 times more likely to land on the left limb, versus
the right, when completing an offensive jump-landing manoeuvre (Tillman, Hass et al.,
2004). When performing a left limb landing, participants in the present investigation
displayed a reduction in peak hip adduction angle at 15 min post-CDS warm-up.
Increased hip adduction during landings has been reported to be part of a multi-planar,
non-contact ACL injury mechanism in females (Quatman & Hewett, 2009; Taylor,
Ford, Nguyen, & Shultz, 2016); therefore, it may be advantageous to land with less hip
adduction to reduce the risk of knee injury. However, no differences were reported
during right limb landings following the completion of the CDS warm-up; presently it
is unclear why similar reductions were not found. Given that participants had approxi-
mately five minutes of rest between 1 min post- and 15 min post-warm-up trials, static
stretching may be included with dynamic exercise as long as a sufficient rest period is
given prior to sport-related activity.
Although decreased hip adduction angle was found after the CDS warm-up, peak
knee abduction and external rotation angles increased from pre-warm-up to 1 min
post- and 15 min post-warm-up (both CDS and DWU). Greater knee abduction and
external rotation is associated with increased ACL injury risk in female athletes
(Quatman & Hewett, 2009) and these landing patterns found shortly after warm-up
completion may in part be attributed to the lack of jump-landing exercises in the warm-
up protocols. It is speculated that the warm-ups in the present investigation may not
adequately meet the jump-landing demands that female volleyball athletes are exposed
to following warm-up completion. Prior study on the effects of chronic exposure to
jump-landing exercises within a warm-up has shown improved landing mechanics in
female athletes (Grandstrand et al., 2006), therefore, it may be beneficial to incorporate
similar practices for volleyball athletes to reduce injury risk.
A secondary finding from this analysis revealed significantly greater knee abduction
and internal rotation in the non-dominant limb, which did not support the second
hypothesis. Increased knee valgus, in combination with knee internal rotation, appears
to place the greatest load on the ACL and lead to injury (Shimokochi & Shultz, 2008). A
female volleyball athlete may be at a higher risk for knee injury in the non-dominant
limb due to altered trunk mechanics when completing this particular landing man-
oeuvre. Shown in Figure 1a, participants needed to laterally bend the trunk in order to
complete the non-dominant jump-landing, displacing the centre of mass over the
landing limb. As the trunk shifts towards the non-dominant limb, the external landing
force moves lateral to the knee joint centre, increasing the amount of knee abduction
and strain on the ACL (Powers, 2010). This is in contrast to a dominant limb landing,
in which the centre of mass visually shifted away from the landing limb (Figure 1b),
thus reducing the amount of knee abduction. Further analysis of sagittal plane
mechanics revealed that participants landed on the dominant and non-dominant
limbs with 8–12 degrees of initial contact knee flexion, approximately 10 degrees less
knee flexion compared to female athletes who sustained an ACL injury in live
 SPORTS BIOMECHANICS 595

Figure 1a. Non-dominant limb landing in a single participant. Similar to Powers, 2010, it is
speculated that lateral trunk displacement towards to landing limb influences knee injury risk by
displacing the knee into a valgus position upon completion of a unilateral landing.

competition (Koga et al., 2010). Overall findings in the non-dominant knee demon-
strated that female volleyball athletes landed with increased frontal and transverse plane
motion, along with small flexion angles at initial ground interaction, landing patterns
associated with a non-contact knee injury (Quatman & Hewett, 2009). Non-contact
ACL injuries are likely multi-planar in nature (Quatman & Hewett, 2009), and athletes
in the present study demonstrated non-dominant limb landing mechanics in all three
planes of motion that subject the knee to high risk loading patterns.
A discussion on limb dominance in the sport of volleyball is warranted given the
findings from the present investigation. All participants were right limb dominant, yet
female volleyball athletes in competition perform a greater number of unilateral land-
ings on their left limb (Tillman, Hass et al., 2004), which has been reported to be the
non-dominant limb in this population (Sinsurin, Srisangboriboon, & Vachalathiti,
2017). This pattern was also supported anecdotally by athletes. Participants indicated
that completing an offensive jump-landing manoeuvre requires an athlete to initiate the
596 J. M. AVEDESIAN ET AL.

Figure 1b. Dominant limb landing in the same participant. In contrast to the non-dominant limb
landing, the landing external force is medial to the knee joint centre. This may be attributed to
lateral trunk displacement away from the landing limb.

movement with the dominant limb, perform a bilateral jump, and land more frequently
on the non-dominant limb, with the current literature in agreement with this technique
(Tillman, Hass et al., 2004). A recent investigation into limb dominance and landing
mechanics in female volleyball athletes concluded the dominant limb (right leg, defined
as the limb that jumped furthest in a single-hop test) was at a greater injury risk
(Sinsurin et al., 2017). Differences from the present study may be due to the previous
study’s jump-landing task, consisting of participants starting on a 30-cm box and
landing on a force plate from multiple directions (Sinsurin et al., 2017). Participants
in the current investigation displayed higher risk non-dominant limb kinematic pat-
terns, however, it is acknowledged that this may not define the preferred landing limb
in female volleyball athletes. Jump-landing training may improve bilateral landing
mechanics in female athletes (Grandstrand et al., 2006); however, it is unknown as to
whether this training can improve unilateral landing mechanics in volleyball athletes. It
is recommended that future research continue to delineate the association between limb
 SPORTS BIOMECHANICS 597

16

14

Peak Hip ADD Angle (deg)

12
*
10

8 Pre
1 Min Post
6
15 Min Post
4

0
DOM DWU DOM CDS NDOM DWU NDOM CDS
Condition

Figure 2. Peak hip adduction angle for each landing condition. Results are presented as mean ± SD.
*Significant three-way interaction (warm-up × limb × time, p = 0.006).

dominance and landing mechanics in female volleyball athletes to determine training

methods that offset any associated injury risks in the dominant or non-dominant limb.
Limitations must be considered when interpreting the study results. The warm-up
protocols in this investigation, adopted from warm-up practices implemented by
collegiate female volleyball athletes (Kruse et al., 2013), did not include any jump-
landing exercises. Since jump-landings are very common to the sport, it is necessary for
future research to examine the effects of a volleyball-specific warm-up on subsequent
landing biomechanics, as sport-specific warm-ups are believed to be the most beneficial
in reducing injury risk (Grooms, Palmer, Onate, Myer, & Grindstaff, 2013). Second,
athletes performed a one-step approach manoeuvre without additional movement
sequencing upon landing, even though in competitive situations a player will often
perform offensive attacks using a multi-step approach followed by lateral manoeuvres
immediately after landing. It would be pertinent for further investigation into the effects
of warm-up on jump-landing sequencing that incorporate additional directional move-
ment both prior to take-off and following landing. Medio-lateral trunk position in this
investigation, along with prior commentary (Powers, 2010), is speculated to influence
knee loading during jump-landing activity. Therefore, future study on female volleyball
athletes should include a complete upper body marker set to determine the association
between trunk mechanics and lower extremity injury risk during unilateral landing
manoeuvres. An additional limitation was the definition of limb dominance, as parti-
cipants were asked to define the dominant limb that would be used to kick a ball. Limb
dominance may be activity dependent and differences could exist between the study-
defined dominant limb and the volleyball athletes’ preferred landing limb. Finally, this
study consisted of collegiate club volleyball athletes; therefore, the results may not be
generalizable to athletes at higher competition levels. It is recommended that future
analysis of stretching strategies and landing mechanics include NCAA Division 1 or
professional competitors.
598 J. M. AVEDESIAN ET AL.

Conclusion
The majority of unilateral landing kinematic variables associated with a non-contact
ACL injury are unaffected by additional static stretching to dynamic activity. A reduc-
tion in non-dominant hip adduction at 15 min post CDS warm-up may signify
decreased injury risk once sufficient time is allowed after the completion of static
stretching. The non-dominant limb displayed increased knee valgus and rotational
angles compared to the dominant limb, potentially attributed to altered frontal plane
trunk position during the jump-landing task. The findings from this study highlight the
potential biomechanical effects of warm-up stretching strategies on landing manoeuvres
and provide further information regarding lower extremity injury risk during a uni-
lateral landing in female volleyball athletes.

Acknowledgements
The authors would like to thank Alex Stokes and Nathan Edwards for their assistance in data
collection.

Disclosure statement
No potential conflict of interest was reported by the authors.

ORCID
D. Clark Dickin http://orcid.org/0000-0002-3104-4167

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